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Counsellingの記事一覧

How to support a depressed partner while maintaining your own mental health

2017.07.19
*転載するガーディアンの記事は、著者の経験であって、それが全ての人の解決にはならないことがあると心に留めておいて欲しい。

How to support a depressed partner while maintaining your own mental health
https://www.theguardian.com/society/2017/jul/10/how-to-support-a-depressed-partner-while-maintaining-your-own-mental-health

Looking after someone with chronic depression can be hard, as Poorna Bell discovered when her husband became ill. The first rule, she says, is to look after yourself

There is no lightning-bolt moment when you realise you are losing your sense of self; just an absence. When you are caring for someone you love, your wants and needs are supplanted by theirs, because what you want, more than anything, is for them to be well. Looking after a partner with mental health problems – in my case, my husband Rob, who had chronic depression – is complicated.

Like many people, Rob and I were not raised in a society that acknowledged, let alone spoke about, depression. The silence and stigma shaped how he dealt with his illness: indeed, he struggled with the very idea of being ill. He told me fairly early on in our relationship that he had depression, but I had no idea what this entailed – the scale, the scope, the fact that a chronic illness like this can recur every year and linger for months.


I didn’t know what questions to ask. And Rob struggled to articulate how bad it was. He wanted to be “normal” so he expended a lot of energy trying to pretend he was OK when he wasn’t. In 2015, Rob took his life. The reasons are complex, but I believe it was a mix of depression and an addiction to the opiates he used to self-medicate.

Although I am painfully aware of how Rob’s battle ended, I am often asked about how I dealt with it when he was alive. Hindsight is always bittersweet, but I did learn a lot – especially about taking care of my own mental health. Here’s what I learned:


Look after yourself
Feeling that you have to handle everything is natural, but you have to look after yourself or you won’t be any use to your partner. “That pressure to keep it all going can feel too much,” says Dr Monica Cain, counselling psychologist at Nightingale hospital in London. She advises “taking that pressure seriously. It’s something that is very difficult to manage even at the best of times.”

Remember that depression isn’t just a mental illness
It used to drive me mad that Rob wouldn’t get out of bed. It took a while to realise that he “couldn’t” rather than “wouldn’t”. I was so sure he would feel better if he came out for a walk or met his friends, but depression is a physical illness, too. As Dr Cain says: “Physically, depression impacts energy levels. People sometimes feel very tired and want to stay in bed all the time.”


Don’t stop doing the things you love
When your partner can’t get out of bed or come to social engagements with you, there can be anger and frustration. Jayne Hardy, founder of the Blurt Foundation, which helps those affected by depression, says the “feelings of helplessness, hopelessness and unworthiness” depressed people may have mean they often “place loved ones on a pedestal”. She says their skewed perspective means they can “struggle to see what they have to offer you”.

On more than one occasion, Rob said to me: “I feel like I’m ruining your life.” I stopped doing the things I loved and, because I stayed at home with him, it made him feel guilty that I was missing out.


Take charge of admin and finance
People with depression find even mundane tasks, such as opening the post or going to the shops, impossible. Often, they keep their finances hidden, says Dr Cain. “It can feel quite shameful for them to say: ‘I’m finding it difficult to stay on top of it.’” This can be stressful for their partners. As Dr Antonis Kousoulis, a clinician and an assistant director at the Mental Health Foundation, says: “Being the main source of support for a partner with depression can add a lot of pressure.” But it is still better than not knowing what’s happening with your partner’s finances or admin. So, to maintain your own mental health and avoid unnecessary stress, it may be easier to have an agreement with your partner that, when they are ill, you will be in the admin driving seat. And when they feel able, they will sort it out.


Talk to your friends and family
You may fear that friends and family won’t understand. But trying to maintain appearances while supporting your partner is exhausting. “Opening up conversations to friends and families, and getting them involved usually makes a big difference in tackling the stigma and building a circle of support,” says Dr Kousoulis. Hardy adds: “All the advice we would give to someone who is unwell with depression also applies to loved ones who support us: make sure you are supported, reach out for help in understanding more about the illness, keep the channels of communication open; don’t be afraid to ask questions, and prioritise self-care.”


Don’t take it personally
There is the person you fell in love with, who makes you laugh until it hurts – and then there are the bad days, when you are dealing with a stranger who won’t let you in. “Depression can magnify or alter emotions,” says Dr Kousoulis. “A person can have emotional highs and lows in equal degrees, so it is important not to take changes personally.”

This can be easier said than done. I found my own coping mechanisms – therapy, exercise and lowering my expectations of what I needed and wanted from Rob when he was feeling bad. I knew that somewhere inside this person was my husband, so from time to time, I’d leave him postcards telling him how much I loved him. He didn’t react in an effusive way but I know it got through because he kept every one in a memory box.

Above all, hold on to your love. “You won’t always feel as though you are making any progress,” says Hardy. “You, too, may feel helpless at times. But your patience, kindness and understanding make such a difference.”


Chase The Rainbow, Poorna Bell’s memoir about life with her husband, is published by Simon & Schuster.

The Samaritans helpline is 116 123.

In the US, the National Suicide Prevention Hotline is 1-800-273-8255.

In Australia, the crisis support service Lifeline is on 13 11 14.


スポンサーサイト

イギリスの精神医療は危機状態:オブザーヴァ紙の意見

2017.07.02
The Observer view on a crisis in mental health
https://www.theguardian.com/commentisfree/2017/jul/01/observer-view-on-mental-health-crisis

Anxiety can be good for you. It is part of the “fight or flight” reflex triggered in the presence of danger. The amygdala, the brain’s alarm system, is responsible for generating negative emotions. To prevent them flooding the brain, this part of the iambic system must be quiet. Working hard on non-emotional mental tasks inhibits the amygdala which is why keeping busy is often said to be one source of happiness. Keeping busy is not what the anxious and depressed can do – and so a cycle of misery is locked into place.

In England, new figures released last week revealed that misery appears to be escalating at an alarming scale. Prescriptions for 64.7 million items of antidepressants – an all-time high – were dispensed in 2016, the most recent annual data from NHS Digital showed. This is a staggering 108.5% increase on the 31 million antidepressants dispensed 10 years earlier.

Is the scale of the rise a welcome sign of progress, more people coming forward for help? Or does it also flag up a rising tide of insecurity and distress, beginning in the very young, that requires a more profound change in society as a whole than individual GPs repeatedly reaching for the prescription pad?

Helen Stokes-Lampard, chair of the Royal College of GPs, said: “The rise could be indicative of better identification and diagnosis of mental health conditions across healthcare and reducing stigma … Nevertheless, no doctor wants their patient to be reliant on medication and where possible we will always explore alternative treatments, such as talking therapies.”

She also pointed out that talking therapies are in desperately short supply. She urged NHS England to meet its commitment to have 3,000 new mental health therapists based in GP surgeries. Kate Lovett, dean of the Royal College of Psychiatrists, said talking therapies have their place but “for people who have recurrent episodes of depression, longer use of antidepressants reduces incidence of relapse”. The theory that more people may be coming forward for help is positive news – but, for many, that is still not early enough. One study followed a large cohort of children through to adulthood and found that half of the adults who had a psychiatric disorder at 26 first had problems before the age of 15. While the young have never been better behaved, drinking and smoking less, their levels of anxiety and depression are rising and the chances of even the most chronic cases receiving adequate help are still shamefully slim.

In My Age of Anxiety: Fear, Hope, Dread and the Search for Peace of Mind, published three years ago, Scott Stossel explains how as a child he had separation anxiety then he developed phobias about flying, fainting, speaking in public, closed places, germs, vomiting and cheese. Antidepressants and therapy have not provided relief. “To grapple with understanding anxiety,” he writes, “is in some sense to grapple with and understand the human condition.”

The human condition today is ever more complex in an era of the internet, social media and the focus on status, appearance and material success. However, more is required as an antidote than early intervention, self-help and medication alone. As Richard Layard rightly argues in Happiness: Lessons from a New Science, a boost to serotonin and dopamine, both associated with mental wellbeing, is also provided by public policy that is judged on how it increases human happiness and reduces misery.

What might that mean in practice? A real living wage, a living rent related to local income levels, an end to the gig economy, affordable housing, investment in training and skills, an end to the freeze in benefits, proper pay for public sector workers and an increase in spending on the NHS. According to the Nuffield Trust last week, the NHS in England is currently receiving an annual increase of less than 1% compared with 4% over its history. Children born today, according to the Office for National Statistics, are likely to spend at least 20% of their lives in poorer health, a disgrace in a rich country such as this.

The World Health Organisation defines mental health as “a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her own community”. It is also a definition of the common good that is the kind of medicine we all need.


Adult Improving Access to Psychological Therapies programme
https://www.england.nhs.uk/mental-health/adults/iapt/

 7年前に発表されたマーモット・レヴュー。全部読むのは骨が折れるが、ソーシャル・モビリティ等の課題に興味がある人には今でも有益だと思う。

Fair society; healthy lives
http://www.parliament.uk/documents/fair-society-healthy-lives-full-report.pdf

イングランド内のNHSによる心理カウンセリング、心理セラピィの受診

2017.02.16
http://iamlisteningtoyou.net/

*イングランド内の医療情報は、大きな変更を以外は不定期に更新される。ここに挙げる情報は、2017年2月現在、一般生活の中で得られる情報である。

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
https://www.nice.org.uk/guidance/cg123/resources/stepped-care-for-people-with-common-mental-health-disorders-commissioning-guide-561922205893

 2009年に本格的に発効したIAPTは、現在ではGPからの紹介の他に、自己申告で受診できることもある。例えばロンドンのウェストミンスター区に居住している場合、このような情報がある。

http://www.westminstercommunityinfo.org/content/westminster-iapt-improving-access-psychological-therapies

 IAPTにおいて、カウンセラーとのFace-to-faceのカウンセリングは、現状では「ステップ3」からになる。ステップ2では、セルフースタディ形式になることが多い。

Translated self help IAPT materials
http://www.londonhp.nhs.uk/services/mental-health/improving-access-to-psychological-therapies-iapt/translated-self-help-iapt-materials/

 ステップ3のCBTを受診できるまでの待機期間は、居住域内のサーヴィスの繁忙さに大きく左右される。また、サイコダイナミック・サイコセラピィや専門性の高い心理セラピィは、更に待機期間が長くなることもあり得る。

 NHSで心理セラピィを希望するのであれば、まず居住域内でのIAPTサーヴィスに連絡することを勧める。

http://www.nhs.uk/Service-Search/Psychological%20therapies%20(IAPT)/LocationSearch/10008

イングランドでのメンタル・ヘルスのほんの一例

2017.02.05
心理カウンセラーのトレイニングは、カウンセリング専門機関で受けてきた。カウンセリングに関する深い経験を受けてこられたことは、自分自身が専門職として働くことの得難い基礎となっている。

 他方、NHS等の一般病院でのメンタル・ヘルスの現場に携わることは、とても条件が限られていて、是非、参加してみたかったのだが、簡単には機会が巡ってこなかった。
 
 勉強会で知り合った精神科医の紹介で、あるメンタル・ヘルス・ホスピタルで通院では対応できない程度の患者さんへのサポート・ティームで働く機会を得た。

 治療方針のミーティング等では、患者の意見を尊重しつつ、同時に、これまでの治療、新しい治療がどのような効果があるか、薬による効果・副作用について明瞭に説明することの大切さ、そして難しさを学んでいる。

 精神科医、オキュペイショナル・セラピスト、臨床心理学者、心理カウンセラー、看護師のチームによる患者の支援を決めるディスカッションは、メンタル・ヘルスの現場におけるティーム・ワークの存在の大切さがよく判る。

http://iamlisteningtoyou.net/

Diversity workshopに参加して

2014.10.22
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。

http://www.legislation.gov.uk/ukpga/2010/15/contents

 左にリンクされているPDFは100ペイジを超えるから関係のない人には勧めない。この中で、最も大切な情報は以下の9のカテゴリーが、イギリスでは法律でも守られている。

http://www.equalityhumanrights.com/private-and-public-sector-guidance/guidance-all/protected-characteristics

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.

Age

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).

Disability

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.

Race

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.

Sex

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.


 差別をなくす為にこのようなことが公になっていることは素晴らしいが、イギリス全土で確実に実践されているかといえば、まだ道のりは長いだろう。

 ワークショップの最後に、グループに分かれてクイズをした。設問の一つの回答が、個人的にはかなり衝撃だった。質問は、

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

37%
51%
73%
95%


 どのグループも51%か73%を選んだ。正答は、95%。ロンドンだけで暮らしているとそこまでとは感じない。最近では、中心地ですら英語が耳に入ってこないことの方が日常になっている。ロンドンが他の地域とは全く違う都市になっているのだろうが、個人的には訳もなく衝撃だった。この情報のソースを訊かなかったのが悔やまれる。

患者がカウンセリング・サイコセラピィを終了すること

2014.06.21
カウンセリングについては本当に久しぶり。ブログに書くと情報が誤解されることがまだまだ多く起きるので控えている。数日前に、インディペンデント紙に、面白い記事があったのでそれを紹介。

Stopping therapy: We have ways of making you talk
http://www.independent.co.uk/life-style/health-and-families/features/stopping-therapy-we-have-ways-of-making-you-talk-9541789.html

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

心理カウンセリングを受けるのを終わらせるのは大きなステップだが、もしカウンセラー(サイコアナリスト)があなたの決断を止めようとしたら?彼らが引き止めようとする際、それはとても緊張感があるし、常に理想的であるとは限らない。

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."

鬱を克服しようと6ヶ月受けてきたプライヴェイトの心理セラピィを、ジェンマはそろそろ終了しようと考え、それをセラピストに伝えた。常に、(終わらせようとしないと思われる)セラピストの抵抗にあった。

 そのやり取りはまるでケイブル・テレヴィの契約を解除するときの経験を思い出させる。違うのは、ジェンマのセラピストが、彼女の不安を増加させるような言葉を使ったこと。
 「セラピストは、私が彼女とのセッションを放棄すると表現した。私は彼女がなぜそのような言葉を使うのかが理解できなかったし、酷い気分だった」。

 記事の仲に書かれているように、クライアントが来なくなる、即収入源につながる不安というのは、何も心理カウンセラーに限ったことではない。しかし、クライアントの不安を自分たちの不安を隠す為にかき立てるのは、間違っている。以下の部分は、心理カウンセラーが常に守らなければならない業務上の基本について。

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."


 簡単に書くと、カウンセリングはクライアントの「自主性」を高めることであって、それを低めることではない。カウンセリングによって、クライアントがどの方向に進むのかをカウンセラーは常に考えるべきであると。

 日本だけでなく、イギリスでも根強く心理カウンセリングやサイコアナリシスへの「思い込み」が残っている。典型例だと、精神分析では必ず「カウチ」に横たわらなければならない、と。カウチに横たわれば鬱が軽減するなんてことは、あるのかもしれないけど、クライアントが使いたくなければその選択を尊重しなければならない。研修時代、個人カウンセリングを受けるのは必須だった。カウンセリングを受ける方もする方も人間だから合う、合わないがある。3人のカウンセラーを経験したが、常に「絶対にカウチには横たわらない」と伝えて全く問題なかった。精神分析にはカウチが必要と科学的、論理的に証明した論文があったら読んでみたい。

 もちろん、収入は大切だけど、クライアントの人生をカウンセリング/カウンセラーが縛り始めたら、それはもはやカウンセリングではない。クライアントがカウンセリングからどのような道を進めるかを考えられるようになることが主眼におかれるべきだと思う。

HIVアップデイト・トレイニングに参加して

2012.09.17
シルヴァー・ウィーク、世界中が内憂外患という印象を持ちます。

 11日に、ヴォランティアとして参加しているテレンス・ヒギンス・トラストhttp://www.tht.org.uk/)の本部で、ヴォランティア向けのHIVについての新しめの情報を話し合うワークショップがあったので参加してきました。皆さんの日常生活の中で、どれほどの頻度でHIVのことが話題になるか判りませんが、こんなことを気軽に読めるブログがあっても良いかなと思います。僕が参加した理由はいくつかあります。一つは、HIVポジティヴの人と直接会うコミュニティ・サポート・ヴォランティア活動をずっとしていないので、自分の知識をリフレッシュしておきたかった。それと、自分のカウンセリング活動や他の関わりの中で、60歳以上のグループの感染率を知りたかったというのも理由です。

 本来は一般に配布することを想定した資料ではないので、イギリスの現状の一部という程度で読んでください。

[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.


 数字としては、最後のHIVポジティヴの2割が50歳以上というのの詳細を知りたかったのですが、そこまでの数字は用意されていませんでした。この50歳以上の感染率は、ポジティヴになってから既に長期間経っているのか、それともつい最近になって感染が判ったのか。その辺りのことを知りたかったです。
 どうして興味を抱いたかというと、50歳、60歳以上の感染率が上昇しているのは、ネット・デイティング等でこの世代の性感染症への知識が低下しているのかどうかということ知りたいからです。

[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,
Travel)

Co-infection increasing

Mental health issues very common

 このセクションは、世界的に観た全般の情報です。HIVへの間違った印象が全く改善されない一方で、完全な治癒を実現する治療法が確立されるのではと煽る情報が後を絶たない。この根拠のない情報によって感染防止の方法を知ろうとする人、国が減っているのではないかという危惧を持っているようです。

[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.


 母子感染については、イギリスでのサポート活動の結果からです。強調されているのは、きちんとした医療サポートを受けていれば、母子感染の確率は1%にもみたないということ。言い換えれば、母子感染だけでなく、HIVに感染しない、感染させない知識を持っていれば、感染する確率は低くなるということ。
 ワークショップの中で講師が何度か強調したことは、HIV自体の感染率の弱さ。C型肝炎のヴァイルスは空気に触れても4週間弱サヴァイヴするのに対し、HIV派空気に触れるとすぐに死滅する。それほど弱いヴァイルスだから、限られている感染ルートとその防止策をしっかり知るのは本当に大切なこと。
 
[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


 個人的に驚いたのがこのセクション。今でもこんなにHIV感染者を拒絶する、言い換えればその存在を認めたくない国があるのかと。中でも最も驚いたのがカナダ。
 講師曰く、HIVポジティヴで就労ヴィザを持っている人は受け入れる。しかしながら、ポジティヴの移民希望者の受け入れは拒否だそうです。講師は続けて、カナダほどの先進国であれば、HIV感染者への医療費は巨額ではないはずだから、この措置は悲しいことだと言っていました。僕が考えたのは、治療を受ける目的ではなく、例えば家族で、また夫婦で移住したいとしても、家族の一員やパートナーがポジティヴだと離ればなれになるのか、それとも移住を断念しなければならないことになることもあるのではということです。

 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。
 もちろん、「義務」ではないです。しかしながら、例えば海外出張でドバイにとなったとき、HIVの確認を要求されます。本人が隠したくても、隠し通せない、そんなこともあり得るのではないか。

 この「隠す」、「隠さない」についてもやもやした気持ちを引きずったので、翌日、健康問題にも詳しい先輩セラピストの考えを訊いてみました。「例えば、がんの治療を回りに隠そうとする人もいるよね。それと同じだと思う。HIVだけが最も忌み嫌われる症状であるという認識を社会が変えなければと思う」、と。

 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。

 もう一つ、HIV感染の抑制・撲滅にかかわるチャリティや医療関係者の懸念は、国によって感染者が利用できる薬の「質」に大きな差があること。例えばイギリスではもはや使われなくなった、腎臓や肝臓への副作用が大きい薬が、アフリカ諸国では未だに使われている。なぜなら、薬価が最新の薬と比べて遥かに安いからだそうです。

 HIVを完全に治癒する薬や治療法は未だにありません。しかしながら、感染したら即死ぬという感染症ではありません。

A job interview in the North

2011.12.06
日本語で書く余力がないので、イギリス国内のメンタル・ヘルス・サーヴィスの現状の一端にご興味あれば、読んでみてください。

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
http://www.guardian.co.uk/lifeandstyle/2011/dec/04/relationships-health-and-wellbeing

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.

http://loveandhatelondon.blog102.fc2.com/blog-entry-1464.html

イギリスでの心理カウンセラー職獲得への、楽しく長い道のり

2011.10.02
信じられない好天も今日までらしいロンドン、そしてイギリス。寒くなるのは季節のめぐりですから仕方ないとしても、太陽が隠れない秋、そして冬であって欲しいです。

 6月上旬に、メンタル・ヘルス(「精神医療」だと予想以上に重く響くようなので)のコースワークを終えてすぐに、この機会を利用してNHS内のカウンセラー職に就けるかどうか試してみようと思い立ち、活動を始めました。プライヴェイトとはいえカウンセリング活動をしていても、イギリスで暮らしているのであれば、人々の日常に深くかかわっているNHS内でメンタル・ヘルスにかかわることができれば、今後の自分の仕事にとって興味深い経験になるだろうと思ったからです。
 これまでの経験、勉強、そして資格などからさくさく決まるかと思ったら大間違い。世の中は不況で、イギリス人ですらまともに職につけない人が全国に。そして予算削減で大揺れのNHSは、ポジション募集はかなりあるものの、プライオリティはNHS内で退職勧告の状況にある職員にということで、外国人がインタヴューにこぎつけられることなどないのではと疑心暗鬼に感じてしまうほど、書類を送り続けても何も起きない日々が続きました。
 それでも友人や、同じようにプライヴェイトのカウンセラーとして働いている研修仲間の知恵を借りて、応募書類の内容を加筆・訂正は続けていました。また、何度も応募書類を書いているうちに、自分のこれまでの経験や資格を別の面から見直しをし、心理カウンセラーとして活動していく上で、どのような分野に目を向けるべきなのかを考えるいい機会にもなりました。

 いくつ応募書類を送ったのか、どこに送ったのかを気にかけなくなった頃、イングランド南西部、ドーセットのNHS管内のメンタル・ヘルス・サーヴィスからジョブ・インタヴューの知らせが届きました。
 なぜドーセット?経験を積めるのであればロンドンを離れてもいいかなと。それに、ロンドン内は競争率が厳しく、また、自分の被害妄想かもしれないですが、若い世代のほうが有利なのではと感じることが多々あります。プライヴェイト・プラクティスも、いざとなったら重い腰を上げてスカイプでという選択肢がある時代。
 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, http://www.iapt.nhs.uk/)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.



 ちょっと早めに現地に赴いてしたことは、応募したメンタル・ヘルスがサーヴィスを提供するコミュニティを観察すること。ロンドンで僕が住んでいる地域は、ミドル・イースタン化が著しいところ。訪れた地域では、スカーフをかぶった女性を見かけることは一切なく、耳に入ってきた外国語といえば、東欧圏の言葉がほんの2回ほど。9割以上が、イギリス白人。まず考えたのは、この仕事を獲得したいけど、では非英国人の僕がこの地域で働くことは可能なのだろうか、ということ。
 インタヴューが行われる場所につき、通された小さな会議室でまず言われたのは、「インタヴューを始める前に、ロール・プレイをしてもらいます」、と。ロール・プレイがあることはメイルの中に記載されていましたが、まさかしょっぱなにあるとは思っていなかったので、ちょっと吃驚しました。が、そんな驚きを出すほど、初心者ではありません。

 要求されたのは、コミュニティ・メンタル・ヘルス・センターにかかってきた電話に答える。電話をかけてきたサーヴィス・ユーザーの話を聴く。その会話の内容を判断して、3分間のロール・プレイ終了後間髪いれずに、インタヴューアーに1)予想される症状は何か?2)なぜ、その症状だと判断したのか、その根拠は?3)電話をかけてきたサーヴィス・ユーザーにあう心理サポートの方法にはどんなものが考えられるか、そしてその理由を述べる、というものでした。

 ロール・プレイが最初という設定には驚いたものの、これまでに同様な状況を数えられないほど経験してきたこと。説明するときに、どの言葉がふさわしいかを判断するのにためらいがあったほかは、自分でも驚くほど冷静に対応でき、「受かるとは思えないけど、この経験を楽しまなければ」との気分がじわじわ身体を満たしてくるのがわかりました。

 そのあと通常のインタヴューになりました。質問の数は、確か7つだったはず。僕個人の資質を自分でどう判断するかというものと、仮にそのミュニティ・メンタル・ヘルス・センターで心理カウンセラーとして働くことになったとき、実際に起こるであろうことにどう対応できるかという質問に大別できると思います。
 それらの質問を通して、またインタヴューの最後に僕から尋ねたことへの回答から理解できたのは、そのセンターが心理カウンセリングを提供するサーヴィス・ユーザーに占める65歳以上の人口が増えつつあるということ。実際、そのコミュニティ周辺や、大きな鉄道駅の周辺を歩いていたときに、多くの人がウォーキング・スティックや車椅子を使っていました。
 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。

 一つ、ここでもか、と感じたことがありました。これまで、心理学の学位をとり、心理カウンセリングを勉強し、メンタル・ヘルスの講義を終え、常に言われるのは、「カウンセリングをやるのに心理学は必要なかったのに」やその逆のこと。今回、インタヴューの最後に質問はと尋ねられたので、インタヴューに招んでもらえたことの感謝を伝えてから、どうして僕を選んだのかを尋ねました。男性インタヴューアー曰く、「サーヴィスを向上させるには、いろいろな分野から人を選んだほうが良いという方針です。あなたは、どうやらメンタル・ヘルスにシフトしているようですね」。
 先方の言い訳なのかもしれないですが、心理学、心理カウンセリング、そしてメンタル・ヘルスをそれぞれ切り分けてしまうのは、的をはずしているように思えます。

 これまでのジョブ・ハンティング、そしてインタヴューの準備を通して学んだことは、ネットワークが如何に大切かということ。応募書類の質を向上させるために友人の助言を仰ぐ。ビジネス・コンサルタントをしている別の友人に、模擬インタヴューを設定してもらう。この友人からの助言は本当に役立ちました。「いいかい、インタヴューの場でネガティヴな返答をするんじゃない。君がイギリスでやってきたことは、多くの人が経験してきたことではない、ということを忘れないように。インタヴューには、何か一つ、いつもは着用しないアクセサリィをするといいよ。いつもとは違うものを身に着けると、それが君の気分をコンフォート・ゾーンから引き戻してくれるはずだよ」。で、いつもは使わないメガネをかけていったら、大当たり。いつもとは違う居心地の悪い装着感が、質問に答えるのを避けたいと感じる逃げの気分をインタヴューに引き戻してくれました。
 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」。
 
 ジョブ・ハンティングは日本、イギリス、そして世界中で多くの人が今、経験していること。僕の経験は、メンタル・ヘルスにかかわることに限定されている点を除けば、多くの人が日々経験していることとは大差ありません。一つ挙げるとすれば、心理カウンセラーのポジションは、イギリスのほうが断然日本よりは多いであろうことでしょう。

a job interview in Dorset

2011.10.02
これは、研修仲間やイギリスや他の国にいる友人たちに送ったもの。日本語で書いたものと大差ないけど、日本語に訳すの面倒だった質問を加えてある。


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 (
http://www.jobs.nhs.uk/index.html) 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.


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