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イングランド内のNHSの診療活動の中でサイコロジカル・セラピィやカウンセリングを受けることができる。NICE(National Institute for Health and Care Excellence)のガイドラインでは、最も推奨されるサイコロジカル・セラピィは、Cognitive Bavioural Therapy (CBT)CBTの形式は、Improving Access to Psychological Therapies (IAPT)におけるStepped Careの中で、受診者の状況に応じてカウンセリングの段階が別れる。

Stepped care for people with common mental health disorders commissioning guide



Translated self help IAPT materials









Diversity workshopに参加して

先週、かつてトレイニー・カウンセラーとして研修していた機関で催された「Diversity Workshop」に参加した。

The aim of the workshop is to raise awareness about issues concerning equality, diversity and respect. The session will also celebrate differences, as well as common interests, illustrating that these can be relevant for us all in our daily lives and in our working environments.

The approach will be thought provoking and experiential in nature, providing an opportunity for participants to explore sensitive subject areas with each other in a safe environment.

Workshop Outcomes:
The session will:

Introduce commonly used and abused terms and concepts concerning prejudice, stereotyping and discrimination

Demonstrate how prejudice and discrimination happens and the impact it can have

Gain an understanding of the different types of psychological constructs that might have relevance or come into play with clients

Explore the impact of unconscious bias – and what we can do about it

Explore ways to embrace difference but also to examine our own values in relation to it

Develop the capacity to think critically about our own theoretical model, exploring tensions between theory and practice

Assess how different aspects of Western-based theory can or cannot be applied in a range of cultural contexts

Recognise the benefits of equality and diversity - and why they should be actively practiced in a workplace environment

Enable students to learn about tangible, positive actions that can be put into practice

 このようなワークショップでは必ずいるドミナントな二人の参加者のおかげで実際は予定の半分くらいで終わってしまった。ただ、ダイヴァーシティに関しては、日常で経験していることで充分だと感じていたが、このようなきちんとしたワークショップに参加したことで、情報をアップデイトできたのは良い経験だった。特に名前だけは知っていたが、自分で調べようと思うきっかけがなかった「Equality Act 2010」を知る良い機会になった。


Protected Characteristics

Throughout the guidance you will see reference to 'protected characteristics'. This page gives you mor
e information on each of the nine protected characteristics.


Where this is referred to, it refers to a person belonging to a particular age (e.g. 32 year olds) or range of ages (e.g. 18 - 30 year olds).


A person has a disability if s/he has a physical or mental impairment which has a substantial and long-term adverse effect on that person's ability to carry out normal day-to-day activities.

Gender reassignment

The process of transitioning from one gender to another.

Marriage and civil partnership

In England and Wales marriage is no longer restricted to a union between a man and a woman but now includes a marriage between a same-sex couple. [1] This will also be true in Scotland when the relevant legislation is brought into force. [2]

Same-sex couples can also have their relationships legally recognised as 'civil partnerships'. Civil partners must not be treated less favourably than married couples (except where permitted by the Equality Act).

Pregnancy and maternity

Pregnancy is the condition of being pregnant or expecting a baby. Maternity refers to the period after the birth, and is linked to maternity leave in the employment context. In the non-work context, protection against maternity discrimination is for 26 weeks after giving birth, and this includes treating a woman unfavourably because she is breastfeeding.


Refers to the protected characteristic of Race. It refers to a group of people defined by their race, colour, and nationality (including citizenship) ethnic or national origins.

Religion and belief

Religion has the meaning usually given to it but belief includes religious and philosophical beliefs including lack of belief (e.g. Atheism). Generally, a belief should affect your life choices or the way you live for it to be included in the definition.


A man or a woman.

Sexual orientation

Whether a person's sexual attraction is towards their own sex, the opposite sex or to both sexes.

[1] Section 1, Marriage (Same Sex Couples) Act 2013.

[2] Marriage and Civil Partnership (Scotland) Act 2014.



What percentage of the UK population think that speaking English is important for being "truly British"?





Stopping therapy: We have ways of making you talk

Walking away from therapy is a big step, but what if your analyst tries to stop you? Their methods of persuasion can be intense – and not always ethical, reports Rhodri Marsden


Having spent six months overcoming a period of depression in private therapy sessions, Gemma felt ready to stop. But when she raised the issue with her therapist, she met resistance.

"For two months, I told her that we need to cut down or stop altogether," she says, "and every time it would be diverted into a discussion about why I'm not willing to spend £60 a week on myself." The absurdity of the situation reminded Gemma of trying to cancel her contract with Sky. She says: "I contacted them eight times. They'd tell me that changing to BT would be a bad idea; every time, I ended up saying that I'd 'have a think'."

While the Murdoch empire kept her firmly in its clutches, Gemma's therapist was unintentionally piling on the anxiety. "She would say that I was 'abandoning' the sessions and I didn't understand why she was using that kind of language," she says. "It was awful."




The ethical framework issued by the British Association for Counselling & Psychotherapy is clear on this issue. One of the principles emphasises "the importance of developing a client's ability to be self-directing within therapy and all aspects of life", and "the value of voluntary participation" in therapy.

"Client autonomy is absolutely paramount," says consultant psychologist Carina Eriksen. "The therapy is meant to empower them, not disempower them. A good therapist will keep a conversation going about where the therapy is going – is it benefiting the client?"

Blunden agrees. "I give guidance on how long therapy might take, but I don't require commitment. They don't even have to sit there for the entire session if they don't want to! Any pressure on a client to continue would seem to me to be exploitation; by making a decision about future sessions, you're removing a client's autonomy."








[UK statistics]
Estimated over 100 000 adults were living with HIV at the end of 2011.

27% were unaware of their infection.

Over 6,000 new diagnoses in 2010.

One new infection every 80 minutes.

55,000 people were diagnosed late.

1/5 PLHIV(People living with HIV) over 50.


[HIV in 2012]
Long term chronic illness

More women infected (children infected and affected)

Optimism around treatment but uncertain future?

Vaccine and Cure ? - long way off?

Social implications of HIV still big issue (Criminalisation, DDA/ESA, Treatment, Employment,

Co-infection increasing

Mental health issues very common


[HIV & Children]
Vertical transmission (from mother to baby) is now very rare when proper medical procedures are followed (less than 1%).

Most often happens when a women has undiagnosed HIV infection, or if birth is abroad.

HIV treatment for children has dramatically improved.

Adherence to HIV medications big problem.

Generation of young people infected at birth reaching adolescence and entering sexual relationships.

[Travel and HIV]
Having HIV will impact on ability and opportunity to travel

Many countries do not allow you to emigrate if you are HIV positive

Many countries place restrictions on visitors who have HIV

There are no restrictions on EU nationals travelling within the EU

Before travelling outside EU it is worth checking with Embassy as things do change


 ワークショップが始まる前に、ウォーム・アップのための質問が配られました。その中で、「Who you MUST tell your HIV status?」と言うのがありました。


 ここまで読んでくださった皆さん、一つ気づかれたかと思いますが、AIDSという単語を使っていませんし、今後も使わないようにするつもりです。THTでも、できるだけAIDSを使わないようにしていくであろうとのこと。なぜなら、この単語を使うことで、HIVの認識をスティグマタイズする可能性を看過できないからの様です。やはり、言葉の持つ力は大きいです。些細なことに思われるからも知れないですが、HIVのカテゴリィをSTD(sexually transmitted disease) からSTI(Sexually transmitted infections)へ移行する流れもあります。これは、disease がもたらすであろう心理的な印象を、より現実的なinfection(感染症)の方に近づけようとのことだそうです。



A job interview in the North


After the disastrous interview at the joint recruitment scheme in November, I received an invitation to a job interview from Lancashire NHS Foundation Trust. The position was the Psychological Wellbeing Practitioner, Band 5.

Before the interview in the North, I am writing about the joint scheme. The scheme was organised by three NHS Trust (Camden, Barnet and London North West) in London and Middlesex University. The position was the P/T trainee Mental Health Worker. Although some of you know about the definitions and differences between Mental Health Worker and Mental Health Practitioner, I was not, and am still not sure about what is a role of MHW in mental health service.

Because I passed Literacy and Numeracy test, I attended both the group interview and individual interview. Before the interviews, I thoroughly read the person specification as well as the job description, but I had not been clear at what position I was trying to obtatin.

During the individual interview, as I was concerned, I was not comfortable about the questions being asked. Although there was the particular question I was not able to answer, I managed to answer the rest of the six questions. The interview last only for 20 minutes, but I was utterly exhausted. Not surprisingly, I was not offered the position. I now feel that the position was mismatching.

Between the two interviews, I talked to a woman of Camden and Islington NHS, who is a nurse and operation administrator. I told her about my background and interest (psychodynamic counselling and psychological therapies), and what I expected to improve my career in an NHS if I were offered this position.
Her answer was very interesting. Through the joint scheme, the candidates will have to attend the course of PG Dip in Mental Health Practice at Middlesex University and upon graduation, they will be awarded the title of a Graduate Mental Health Worker. Because Psychological Wellbeing Practitioner is a specialist position, you will have to take another course to be a PWP. By the time when you are qualified as the PWP, you would be overqualified, she told me. I just felt as if I were stuck in the biggest ever Catch-22.

The interview by the Lancs was taken place at their newest community centre which is very clean and modern. There were two interviewers, man and woman and both of them looked early 30s, in other words, much younger than I am.

Although the interview again last only for 20 minutes, the number of the questions were more than ten. All of the questions were much more comfortable to think and answer than the previous ones. I cannot remember all of them, nor what they were actually asked, but here are some of them.

Why did you think that PWP position would be suitable for you?

What do you understand about the role of PWP?

Could you please tell us how our service users contact you and when you can do an initial assessment?

When you find a referral inappropriate for PWP, what would you do? And what are the inappropriate referrals?

When a service user mention their suicidal thought during an initial assessment either over the phone, or in a counseling room, how will you manage the situation?

Working at a GP surgery as PWP, what is benefit or risk for GP, patients and PWP?

What might a PWP be rocognised at GP surgery?

When a patient has already uses anti-depressant, how would you work with the patient and what you might have to do in order to continue the psychological treatment day-to-day basis?

Please tell us your thought/ understanding about what current issues in IAPT programme are.

What is your strengthens working as a PWP?

Luckily enough, since I had read an interesting paper written both by the Royal College of Psychiatry and the Royal College of General Practitioners, I could answer the questions relating to GP surgeries. According to the paper, GPs are urged to improve their knowledge about common mental ill-health at GP surgeries.

The question which surprised me was about the medication. Neither did I know about the medicine, nor I was aware that the PWP courses would teach their candidates what drug would be used at GP surgeries and the PWP were expected to understand the drugs used in Primary Mental Health Service.

I received a phone call from the one of the interviewers following day and I was not successful. However, she provided me feedback which I think is really useful. The Dorset NHS has never given me their feedback.

According to her, I did well at the interview, but the person (man) offered the position has already worked as a PWP (seems to be band 4) and he knows how to work as the PWP at GP surgeries.

I asked her whether the fact that I am not qualified as PWP yet does matter or not and she said No. However, she told me that it seemed better for me to apply for a trainee PWP position through which I would be able to get clearer understandings of what PWPs do at GP surgeries. During the interview, what I felt about IAPT was that the scheme will be shifting from the current situation of focusing only on CBT, to a possible situation that other psychological therapies will be provided at GP surgeries since CBT does not work well for some patients.

I really need to talk to a person who can tell me which direction I should go.

Looking at NHS Jobs site frequently, I have found that there are more jobs relating to psychology/ CBT and hardly jobs of traditional psychological counselling.

Another thing is that some NHS trusts are unfair. For instance, Oxford NHS and Berkshire NHS seem that they always and already have the certain person for a position, but because they have to put an ad on the site, they do. Then, the position is expired just an hour after they put the ad.

There was an interesting article about psychotherapy and psychoanalysis in the Observer on 4th of December.

Therapy stole my boyfriend

Initially, I was laughing, but after reading the comments by the readers, there is still a big misunderstanding of psychological therapies even in the UK.




 応募したポジションは、P/T Psychological Wellbeing Practitioner。この、サイコロジカル・ウェルビーング・プラクティショナー、省略形PWPは、国を挙げての精神医療向上計画、Improving Access to Psychological Therapies (IAPT,に設けられているステイタスです。自殺者が全く減らない日本でこのような国を挙げての活動がないのが不思議でなりません。以下にあげるのは、仕事内容の一部です。

Duties include providing high volume, low intensity interventions, which will involve providing a range of cognitive behavioural therapy (CBT) based self management interventions to service users with mild to moderate anxiety and depression. You will receive weekly supervision and work as part of a team.

All staff deliver low intensity comprehensive telephone assessments, screening, treatment and signposting followed by rapid access to planned intervention / onward referral. You may also provide supervision for the PWP Trainees as required.




 ここで改めて考えたことは、外国人である僕が、このイギリス白人コミュニティで心理カウンセラーとして働けるか、という点。いわゆる巷の人種差別という点ではなく、サイコロジカル・サポートを必要としている、特に65歳以上の人たちにとって、非イギリス人から心理サポートを提供されることは、彼らにとって果たして「Psychological Wellbeing」になるのだろうか?、という疑問。僕個人としては、そのような状況で得られるであろう経験を期待します。が、サーヴィス・プロヴァイダーとしては、不必要な心の葛藤は避けられるものなら避けなければと考えなければでしょう。


 さらにこの友人からは、「インタヴューの最後に、絶対に君からquestion backするように。そうすることで、君がこのポジションに本当に興味を持っていることをアピールするから」。加えて、「たぶん問題ないと思うけど、一応、方言があるかどうか調べておいたほうが良いだろうね。英語は君の母国語ではないのだから」。

a job interview in Dorset


Although I should write to the people who have been supporting me to get through the frustrating process of job-hunting in NHS, I would like to share my experience of a job interview taken place in Dorset. I do not want to forget my experience.

As some of my classmates know, NHS Jobs ( is a good tool to find a job in NHS. As soon as I finished my written works last June, I started to check the website everyday.

Not many, but there are always some interesting vacancies of counselling/ mental health practitioner. The biggest problem to use this site, for me, is that I cannot tell when a position would be updated onto the site. It has been really frustrating.

However, with lots of valuable supports from my friends, I got an interview invitation from Dorset Healthcare Foundation Trust in September. The position I applied to was P/T Psychological Wellbeing Practitioner, Band 5.

This position is a part of IAPT, Improving Access to Psychological Therapies, and the part of the job description is:

Duties include providing high volume, low intensity interventions, which will involve providing a range of cognitive behavioural therapy (CBT) based self management interventions to service users with mild to moderate anxiety and depression. You will receive weekly supervision and work as part of a team.

All staff deliver low intensity comprehensive telephone assessments, screening, treatment and signposting followed by rapid access to planned intervention / onward referral. You may also provide supervision for the PWP Trainees as required.

Why Dorset? I am happy to relocate when I can get a job by which I will be able to sufficient experience as a counsellor more and more. Frankly speaking, when I got the invitation, I had no idea about the place. However, I thought that it could be an interesting experience for me and it was certainly the exciting adventure.

I got to the venue without any problem. After an administrator made the photocopies of my identification documents and qualifications, I was ushered to a meeting room. There were two interviewers, a woman and a man. I felt warmly welcomed by them.

As soon as I sat down, the lady told me that they wanted me to do a role-play before the interview. I had been informed they would ask me to do a role-play, but I did not expect it to happen immediately. Needless to say, however, I have enough experience not to show my surprise to them.

The tasks were 1) I receive a phone call from a possible service user and ask her why she phones and what she is experiencing in 3 minutes, then 2) I explain to the interviewers about the possible diagnosis, why I would conclude the diagnosis and what sort of psychological intervention would fit for her situation.

Because I was given some opportunities of doing role-plays for CBT during the workshop, I hope I did OK and I started enjoying the situation. I must tell you that another woman who played as a service user was a great actor. I was really convinced by her.

Then, they started to ask me some questions. The questions were not as same as I am writing.

What would you bring into the team and our service?

What would you do when you face a difficult situation but you have to make a decision?

What would you think when older people in the community need our service?

A question about a limited time-frame in counselling service

What do you do when you need to talk to GP about the condition of a service user over the phone?

When you receive a call from a person who later seems to do self-harming, how would you respond to that person?

If I start to work here, what is my future plan?

Although the interview last for just over 30 minutes, I felt as if I was in the room for an hour.

Following what a friend of mine had suggested to me, I spent for some hours to observe people, the quality of life there and what sort of people live there. At the end of the interview, I asked them about the range of the people who would use their service. According to them, a third of the population in the community is now over 65yo. In addition, I had checked whether the particular dialect would exist or not. Thanks to the internet, it was easy to do some research before I had attended the interview.

I have not heard about the result and I do not feel I could at this occasion. I would like to work in the community. However, from service user's point of view, I might not be suitable to meet the need of the community. My clear will to support the local community may not work for the people in the community who need to be provided psychological support without any uncertain feeling.

Many people have the frustrating experiences to get a job as I do. During my struggle, what I have mostly learned is how important to build up network with friends and people. My dear friends from BBK have immensely heled me to improve the quality of my application form. My flat mate suggests to me to focus on why I am asked the particular questions. Another friend of mine offered me to do a mock interview together. I have recently been talking with a friend of mine about how I can extend my network.

The goal of attending a job interview is to get a job. However, this interview has also provided me an interesting opportunity to know the reality, even a bit, of the mental health service in the UK and to understand what a candidate is expected to offer the community.


以下にリンクしてあるヴィデオは、NHSにおける医療情報を提供するサイト、NHS choicesが製作した、Cognitive Bahavioural Therapy(CBT)を紹介するもの。








 主題は、「Transgender Awareness」です。この勉強会、人気が高くてこれまでに2回、抽選にもれて3回目にしてやっとでした。関心がない人のほうが多いとは思います。僕も、THTに参加しなければ、自らこの勉強会に赴くなんてことはなかったと思います。でも、心にかかわる分野で活動している以上少なくとも「知る」ことは大切だと最近感じることが多かったのでとてもいい機会でした。参加してなんというか、イギリスってある意味すごい国なんだなと改めて感じることが多くありました。いつもはできる限り使わないようにしているのですが、今回は、訳を一つ一つ気にしているといつまでたっても終わらないので、カタカナがたくさん出てくることをあらかじめお知らせしておきます。


A life less ordinary:The extraordinary life and death of Sonia/ David Burgess






Where is your gender?


A person who is Transgender is someone who expresses themselves in a different gender to the gender they were assigned as birth. For, transsexual people, this is usually a permanent gender change. Cross-dressers and transvestites are people who adopt the manner and dress of the opposite gender for part of their lives. Some, but not all, transvestites opt for gender confirmation (reassignment) treatment later in their life.
The noun “Transgender” as an umbrella term is appropriate for the majority of people who identify in some way as “Trans” although “Gender Variant” is fast becoming a popular alternative.


Transwoman: someone born with a male body, but internally sense of gender is female

Transman: someone born with a female body, but internally sense of gender is male


The term “transsexual” is a medical term and has a recognized medical diagnosis and care pathway for treatment. Specialist Gender Identity Clinics (GIC) under the care of psychiatry has historically led the treatment of trans people. This has led to stigmatization and the mistaken assumption that trans people are mentally ill.

Being “Trans” is neither a lifestyle choice nor a mental disorder but a condition widely recognized to be largely innate and somatic.

What is vital in every case is for trans people to be given the freedom and respect to express their gender identity.

Fashion and dress codes for men and women change, and vary across the diverse cultures that form part of our society. Therefore, it is not unusual that a patient may appear with an uncertain gender, but not identify as trans.


 続いてワークショップで紹介されたことは、性転換手術をして、二人の精神科医からGender Recognition Certificate (GRC) を発行してもらえると、出生証明書 (Birth Certificate) の書き換えがみとめられるというもの。

The Gender Recognition Act 2004 (GRA) gives legal recognition to trans people who have or have had gender dysphoria, have had at least 2 years medical supervision in their confirmed gender, and intend to live in that gender for the rest of their lives. To get this legal recognition the trans person must apply to the Gender Recognition Panel (GRP) for a Gender Recognition Certificate (GRC). If the application is approved, the trans person will receive a GRC and a new birth certificate. At the point they become their confirmed gender for all legal purposes, and must be treated as such.


It is against the law to ask a trans person to show you his or her GRC; if verification of identity is required they may show you their birth certificate or other identity documentation such as a passport.
The law makes it a criminal offence, with a financial penalty, for an organization or the employee of an organization to knowingly reveal the status of a trans person with a GRC and disclose this “protected information”.

 つまり、トランスセクシャルであると判ったとしても、本人にCertificate を見せることを強要することは法律に違反し、罰金が科せられる。これは、一義的には、トランスセクシャルの人々の平等雇用を守るということですから、イギリスで事業を展開する企業、そして人事関係者は知らなくてはならないことでしょう。


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