Simon McCarthy-Jones talks to Human Givens

McCarthySimon McCarthy-Jones, author of Can’t You Hear Them?, talks to Human Givens about what is known – and what has been ignored – in explaining the experience of hearing voices. 

The experience of ‘hearing voices’, once associated with lofty prophetic communications, has fallen low. Today, the experience is typically portrayed as an unambiguous harbinger of madness caused by a broken brain, an unbalanced mind, biology gone wild. Yet an alternative account, forged predominantly by people who hear voices themselves, argues that hearing voices is an understandable response to traumatic life-events. There is an urgent need to overcome the tensions between these two ways of understanding ‘voice hearing’.

Read the interview here


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Why Neuroscience for Counsellors?

Rachal Zara Wilson is a counsellor, social worker and author of the new Neuroscience for CounsellorsWe caught up with her for a quick chat about the book and why she wanted to write about such a complex topic. 

1.  Who do you think would benefit from reading this book?

Definitely counsellors, but also any other therapists as well.  The book is designed so that it has sections where the neuroscience is explained, and separate sections for counsellors and other therapists with suggestions on how to use this knowledge for the benefit of their clients in the session room.

Families of people who are experiencing mental health dysfunction may also be interested in the knowledge contained in this book, and also in the implications for how they can support their loved ones.

2.  Why did you write this book? Wilson_Neuroscience-fo_978-1-84905-488-1_colourjpg-print

I’ve always been interested in neuroscience; the brain is so fascinating and amazing, and capable of so much more than we’ve always been led to believe.  And of course, as a counsellor working with people, how the brain works has always been top of my mind.  The final motivator was having a child who was experiencing problems with their mental health, and I guess I just hoped to find something that would help him and others in a similar situation during the course of my research.

3.  So what’s so exciting about what you learned?

Probably the most exciting thing would be the brain’s capacity to change itself, known as brain plasticity.  The brain isn’t static, it’s more like a dynamic organ that is constantly changing for better or worse.  And what we do plays a huge part in how it changes.  How much stress we’re under, what we eat, the quality of our sleep, whether we exercise and how much, our living environments, and the presence or absence of early trauma in our lives are some of the things that contribute to the way our brain functions, and to its capacity for change, or plasticity.  I guess the most exciting thing is that we have control over this plasticity to a large degree, and we can therefore improve the quality of our brain function, our health and our lives.

4. Why don’t we know this stuff already?

Because neuroscience is a field in its infancy.  There’s a lot of learning coming through, but much of it’s wrapped up in scientific jargon, making it inaccessible to those of us who are not scientists.  And because there’s lots of different levels of looking at the brain, (both micro and macro,) different neuroscience specialties do not always integrate their specialist knowledge.  I think the benefit of this book is that it integrates the neuroscience into an overall big picture, while also drawing on this resource to come up with practical ways for integrating it into therapy.  It hasn’t been done before because it’s new, because it’s complex, and because integrating neuroscience with counselling and other therapies requires a knowledge of both fields.  I believe that in the future, all practitioners providing talking therapies are going to need to understand what neuroscience offers our professions, or risk becoming irrelevant.

5.  Why put it in a book?

This knowledge is meant to be shared.  All counsellors and therapeutic practitioners want best outcomes for their clients, and the more knowledge we have that can help people make positive change in their lives, the better.

6.  Is it complicated?

The neuroscience is complex, but the book is designed so that people who just want to know what it means for their practice can just read those sections, while those who want to understand how it all works can read up on the explanations for how all the scientific evidence fits together.  The book is written in the plainest English possible, and there is a glossary and diagrams at the back to help you fit it all together.

You can find out more about the book, read reviews and order your copy here.

Browse our latest collection of new and bestselling titles in counselling and psychotherapy

Here are our new and bestselling titles in counselling and psychotherapy. For more information on any of the books inside, simply click the title or cover image to view the full book page.

Celebrating the launch of ‘Forensic Music Therapy’

Forensic Music TherapyJKP were delighted to attend the launch of Forensic Music Therapy: A Treatment for Men and Women in Secure Hospital Settings on Friday 25th January at the stunning Burgh House in Hampstead, London.

Hosted by the three editors of the book, Stella Compton Dickinson, Helen Odell-Miller and John Adlam, and attended by many of those who had authored individual chapters, the evening brought together not only music therapists, but many professional musicians, psychiatrists, psychotherapists and other mental health professionals. We were treated to an evening of beautiful music by the Henry Lowther Quartet followed by two solo oboe recitals. The editors, and Dr. Gill McGauley, Consultant Psychiatrist at Broadmoor Hospital, spoke about the ground-breaking work that the book sheds light on, and the proven effectiveness of music therapy with those in secure settings, especially in encouraging feelings of empathy. They also spoke about the rarity of being able to obtain informed consent for case studies involving high security offenders, another factor which makes this book unique.

Click below to see a video of Stella Compton Dickinson’s speech at the celebratory evening:



© 2013 JKP blog. All Rights Reserved.

A case study extract from ‘Forensic Music Therapy’ – Working with Conflict

Stella Compton Dickinson, editor

This is an edited extract from Forensic Music Therapy: A Treatment for Men and Women in Secure Hospital Settings edited by Stella Compton Dickinson, Helen Odell-Miller and John Adlam. This case study comes from Chapter 7, ‘Working with Conflict: A Summary of Developments in the Long-term Treatment of a Man Suffering with Paranoid Schizophrenia Who Committed Manslaughter’, by Stella Compton Dickinson and Manjit Gahir.


This chapter describes the process of long-term music therapy over seven years with a man who we shall call “Ewan.” Ewan has given informed consent for case material to be used in telling the story of his rehabilitation; his real name has not been used. Ewan suffered with paranoid schizophrenia and whilst actively psychotic with hallucinations and delusions, he killed a man.


Committed to hospital for an indefinite period after being convicted of the offence, Ewan spent ten years in high secure detention without undertaking therapy until he requested a referral to music therapy, “to learn to play the violin” as his grandfather had done. He engaged in music therapy as his main psychological treatment. The intervention and its impact were new to the clinical team who had to adjust to the fact that internal changes were starting to happen for a patient who they had known to be static for many years. Thus their own past experiences, their judgments of Ewan in the face of fear when he had erupted with violent outbursts, and their perceptions for his future were all challenged.

Music therapy

Ewan’s fundamentally chaotic presentation was marked by fixed perseveration, which is typical of schizophrenia. Notable in his early musical improvisations were repeated, stuck, desperate, and stabbing sounding attacks on the piano keys. This represented exactly his situation and offence: angry, locked in, stuck, as if he had nowhere to turn. The therapeutic work required orientation to the here and now, rather than unlocking too much past material at once. Nevertheless, Ewan recognized how he could receive rather than reject my non verbal musical support. This elicited a maternal transference. Towards the end of the second assessment session, Ewan rushed from the room, having exclaimed his recognition within our musical improvisation that “you are supporting me! I have not felt like that since I was with my mother.”

The significance of this was central to the therapy as Ewan had been unable to mourn the death of his biological mother. He returned explaining that this experience had “brought a tear to my eye.”

Starting the treatment process

Ewan had never experienced any previous psychological therapy at all, so the same weekly place and time was an entirely new experience for him, which he almost religiously observed. As the therapy progressed, he became more proactive in ensuring that regular physical health appointments were not timetabled to coincide, as nothing had to come between him and his music-making. Over time, as he became more trusting in the continuity of his life and less fearful of sudden abandonment, he gradually extended his range and felt safe to play the piano on his own rather than with me. Ewan began to take responsibility for his own actions rather than remaining over-identified with his own victim self-state.

The mother–child dyad and symbolic musical representations

In session 12, Ewan elucidated on his feelings of stupidity and how he played on these as a childhood strategy. He said he had taken to “acting stupid” whenever he felt threatened by his father. The mother–son relationship was enacted symbolically as a maternal transference developed. The merged relationship that developed between Ewan and his biological mother during childhood was cemented when both mother and son cowered from the violence and physical abuse of the father. This relationship was represented musically in session 2 in which initially Ewan played mournfully on the recorder, copying my choice of instrument, then merging with it and introducing a sensual, rocking rhythmic pulsation which indicated an as yet unconscious underlying erotic transference. The music then became violent and angry as Ewan repeatedly hit a small glockenspiel as if he was a frustrated child waiting for dinner. This had a direct correlation to verbal material in which Ewan described the intimacy and frustrations that he felt with his mother. After this the music became mournful and sad although it finished in a resolved, harmonious fashion.

The index offence: developing victim empathy

In reference to the man who he had killed, Ewan attempted to make an offering in musical terms by sitting at the piano to play a piece which he entitled “Requiem.” At the time this felt sincere but also very sad, as I perceived that Ewan felt very clumsy and inadequate in trying to address such a huge and tragic event. From this state, the first expressions of remorse at the magnitude of his violent act began to emerge. Perhaps the fluctuations between reflecting on his offence and reflecting on his childhood suggested how Ewan was trying to make links in understanding why he had committed his offence.


The individual music therapy was characterized largely by a positive transference. Ewan completed his mourning process in the following two years of group therapy where he discovered how to be part of a “family,” as well as how to feel included and valued by others. He remains in custodial care at a lower level of security. At his care program review as the therapy closed, he described his recovery process in music therapy as “akin to the raising of Lazarus.” This biblical reference to Christ’s greatest miracle probably says at least as much about Ewan’s internal morbid state of loss, including loss of hope prior to engagement in music therapy, as it does about his creativity and ability to express himself and to develop through music therapy in a way which, after ten years of stagnation, he may have felt was miraculous.

Copyright © Jessica Kingsley Publishers 2012


The Therapeutic Milieu Under Fire

By John Adlam, Anne Aiyegbusi, Pam Kleinot, Anna Motz and Christopher Scanlon, editors of the new volume, The Therapeutic Milieu Under Fire.

What therapy can be offered to people with forensic histories and how might it work? What can we learn about the minds of offenders from observing our own reactions to working with them? How do teams working with dangerous and disturbed people survive? How can organisations themselves become perverse and abusive, and how is it possible to prevent this through reflective practice and team development?

In The Therapeutic Milieu Under Fire, we explore these and other essential questions in forensic work in organisations and institutions. We work with highly complex, disturbed, dangerous and endangered people; trying to keep their thinking alive despite conscious and unconscious assaults on the therapeutic relationships and on the milieu itself.

This book is based on a series of seminars organised by practitioners that promoted psycho-social enquiry into the nature of forensic systems of care and the qualities of their relationship to the excluded outsider.

This book also reflects on this particular historical moment and it movingly describes the impact of the lethal attacks that have been carried out against organisations and institutions that were dedicated to providing care for some of our most vulnerable fellow citizens. It argues powerfully that it can be a false economy to ignore the wealth of accumulated practice-based evidence and to offer, by contrast, so-called evidence-based, technical-rational packages of treatment under the guise of improving access to psychological therapies.

This volume is in the form of a series of psycho-social and ‘groupish’ associations to the theme of the therapeutic milieu under fire. The approach is trans-disciplinary and it offers spaces for conversations between service-users, nurses, social therapists, project workers, housing support workers, probation officers, psychiatrists, social workers, group analysts, psychologists, psychotherapists, managers, civil servants, educators, researchers and the general public (among others) about the changing and complex relationship between troubled individuals and their troubling social, organisational and institutional context.

The contributors all work on the ‘frontline’ in one way or another, many working with marginalised and excluded outsiders at the edges of our exclusive society. This book explores the ways in which these outsiders are offended against and how, in turn, they offend against others, within systems designed both to care for and to contain them. What is the task of the professional caring for a mentally disordered offender? How can they offer security without custody, or care without collusion or detachment? When does ‘care’ become a perversion of ‘control’? Why is thought replaced with action and why might it be so hard for the milieu to replace action with thought? These are some of the central questions that were debated in our one-day seminars, and whose dynamics are explored in this text.

In presenting this range of papers, and the multiple complexities that these authors explore, we hope to enable the reader to come to a better understanding of the ways in which the therapeutic milieu comes under fire from without and within, so that we can think together about how to remain thoughtful and committed to the task while anticipating and responding to these inevitable attacks.

Thinking under fire is essential in this work, and so too is reconstructing our internal and external milieu. The systems-psychodynamic thinking of the International Association for Forensic Psychotherapy and the therapeutic community model combine in contemporary practice to give us a model of the conscious and unconscious processes that inform criminal acting out or the expression of personality disorder: a model that helps us to make sense both of the violence in the patients and the violence in the societal response.

Copyright © Jessica Kingsley Publishers 2012.

British Medical Association (BMA) Honours Three JKP Titles at 2011 Book Awards

We were so thrilled that three JKP titles were honoured at the prestigious
2011 BMA Medical Book Awards, which took place on Wednesday, 14th September
at BMA House in Tavistock Square, London.

JKP commissioning editor Steve Jones attended the awards ceremony and was joined by JKP authors Ilona Roth, Liz Hoggarth, Hilary Comfort and Tony White, whose books each received the distinction of “Highly Commended” and were nominated for first prize in their respective categories.

All nominated books were reviewed by a select group of doctors and educators. Here are some more details about the books, along with some comments from the judges:

A Practical Guide to Outcome Evaluation
Liz Hoggarth and Hilary Comfort
Highly Commended – Health and Social Care Category

‘This is an unusually successful book with one typically germane phrase in the introduction: “We hope that you will find some sections of this material that specifically answer the questions you are faced with in evaluating your work. Dip into the material for something you need or work through it systematically, Use it for reference, Make it work for you.”
It’s particularly relevant at an especially innovative time in health care.’

The Autism Spectrum in the 21st Century – Exploring Psychology, Biology and Practice
Ilona Roth with Chris Barson, Rosa Hoekstra and Greg Pasco and Terry Whatson
Highly Commended – Popular Medicine Category

‘This book is well-researched and provides clear, impartial and accurate knowledge of many facets of the autism spectrum. Its language is very accessible. The book was designed as a self-contained volume for a variety of readers, not necessarily with any scientific or specialist knowledge, either “as part of an education programme or for general interest and self-directed study” or as a module in the Open University. The book is written by Open University academic staff in association with a number of professional in the autism field and covers a wide range of topics, clearly showing the multidisciplinary nature of the field. To encourage active participation and adult learning, each chapter section has a summary of key points and at the end of each chapter is a list of learning outcomes and self-assessment question, and comments/suggested answers on these areas are nicely places at the end of the book. The important words and concepts are written in bold and this together with exercises, learning outcomes and questions, enhances the value of the book even for those pickling it up out of interest rather than as part of a study as it provides a useful summary and worked examples.’

Working with Suicidal Individuals – A Guide to Providing Understanding, Assessment and Support
Tony White
Highly Commended – Psychiatry Category

‘This is “must” reading for the different practitioners who work with person who do self harm. Provide an theoretical and practical introduction to the type of personality who do self harm or are suicidal … This book presents and comprehensive quantitative and qualitative suicidal risk assessment and describes valuable management strategies both in how to manage people with suicidal and pseudo-suicidal behaviour. It’s easy-to-read and understand provided with illustrations and case studies for better understanding. In my opinion this book fills the gap in the current literature addressing suicide and self-harm behaviour.’

It’s always a pleasure to attend the BMA Awards, partly as an opportunity to catch up with authors in the illustrious interior of BMA House, but also to hear about new outstanding medical books being published and to enjoy the buffet which never fails to impress (white chocolate, cherry and lavender tart was a particular hit this year)!

Another highlight of the night was the keynote address from President of the Royal College of Pathologists Dr Suzy Lishman, FRCPath who – as well as gamely posing for all of the award photographs – gave a compelling keynote laying out the case for public understanding of medical science in general and particularly the work of pathologists. Contrary to public opinion, not all pathologists are “CSI-style” forensics but form the backbone of health care, carrying out tests on blood samples, pregnancy tests and so on – over 70% of all diagnoses made in the NHS.

We’d like to offer our congratulations and thanks to all nominated authors who worked so hard to write the books – I know we’re already looking forward to next year’s BMA Awards!

Copyright © Jessica Kingsley Publishers 2011.

“Dancing at the crossroads and playing on the battlefields” – An Interview Stephen Levine and Ellen Levine, authors of Art in Action

In this interview, expressive arts pioneers Stephen K. Levine and Ellen G. Levine discuss their fascinating new JKP book, Art in Action: Expressive Arts Therapy and Social Change.

How did each of you come to the expressive arts field?

Steve: My primary field of education was in philosophy. I earned a PhD with a dissertation on Heidegger’s philosophy of art at the New School for Social Research in New York. I was particularly interested in the philosophy of art, since I had been a poet for many years. I was also becoming interested in theatrical performance, particularly in improvisational and physical theatre (clown, commedia dell’arte, bouffon, and neutral mask), and did intensive training in that. I wondered what it was about the arts that made them have such a powerful impact on people’s lives. At the same time, I had completed a five-year training in psychotherapy and discovered that creative and artistic approaches to human development were more effective than verbal reflection. Thus I was working in several fields, teaching philosophy and social thought as a Professor at York University in Toronto, practicing psychotherapy, and working in the creative arts. I felt a connection between these fields and began to look for some way to put them all together.

This search lead me to the Expressive Therapies program at Lesley University in Cambridge, Massachusetts. The program was housed in the Institute for the Arts and Human Development at Lesley; it was an innovative and creative program which not only integrated the arts in therapy but also was searching for a philosophical foundation for the field. After a year as a Post-Doctoral Fellow, working with Paolo Knill and Shaun McNiff—founders of the field—I decided to focus on this integrative approach to the creative and expressive arts therapies and to try to articulate the philosophical concepts and principles that underlay its practice.

Upon returning to Toronto, I founded ISIS Canada, a three-year training program in Expressive Arts Therapy, together with Ellen Levine in 1991. In 1996, I helped create the Doctoral Program in Expressive Arts: Therapy, Education, Consulting and Social Change, at the European Graduate School (EGS) in Switzerland. These programs continue to this day and have been the site of further reflection on the foundations of the field, as has the journal of EGS which I edit, POIESIS: A Journal of the Arts and Communication. I have also continued to write about the basic principles of the field in a series of books for JKP, including Poiesis: The Language of Psychology and the Speech of the Soul, Principles and Practice of Expressive Arts Therapy: Towards a Therapeutic Aesthetics (co-authored with Paolo Knill and Ellen Levine), and Trauma, Tragedy, Therapy: The Arts and Human Suffering.

In the course of the work, it became clear to me that the basic principles of expressive arts are not restricted to therapy but can be extended to education, consulting and social change. As Dean of the Doctoral Program at EGS, I encouraged students to develop research projects in these areas and to conduct practical as well as theoretical investigations. The current book, Art in Action: Expressive Arts Therapy and Social Change, is an extension of these efforts.

Ellen: I also studied philosophy originally and had a first career as a university teacher. My doctoral dissertation was entitled: Psychoanalysis and Symbolism: The Space Between Self and World.

I was always interested in the arts and was a painter almost all of my life. I also was involved in social movements and highly engaged in anti-war activism in the sixties and seventies. I had an abiding concern for those who were less privileged and marginalized and decided to pursue training as a therapist in order to be of help. Bringing together my impulse toward the arts and my social concern, I studied art therapy from a psychoanalytic perspective and this led me to another training in psychoanalytic child psychotherapy. I recognized that working with children and parents might be a way to interrupt long-standing and entrenched individual and familial patterns.

Steve’s involvement at Lesley University intrigued me. I attended some of his classes and met the teachers whom I recognized as innovators in this new and interesting field. I began to expand my thinking beyond a psychoanalytic perspective and was inspired, by these teacher/artists/therapists, to place art and art-making activity more at the center of the therapeutic relationship—not to see the artwork as simply a reflection of the individual life or psyche of the one who made it. I recognized the enlivening aspect of the art-making itself and the strengthening impact it could have on individuals, groups and communities. I also was inspired to expand my own range of artistic practice—becoming more serious about painting and moving on to study clown and learn to play the accordion. I have found that all of these practices have added a significant richness to my own life.

In 1995, I decided to write a book articulating the encounter between an arts-based therapeutic practice and the psychoanalytic project. This book, Tending the Fire: Studies in Art, Therapy and Creativity, has become a major text in the field of expressive arts therapy. In the book, I bring together a description of my own studio practice of painting with the ideas of psychoanalytic writers that I consider “crossover thinkers” (particularly D.W. Winnicott) and the practice of expressive arts therapy, citing many examples of my own clinical work in play therapy and intermodal expressive arts therapy.

My contribution to the field in my writing and in my teaching has been to ground the principles and theories in practice. In addition to Tending the Fire, I have co-edited (with Stephen Levine) Foundations of Expressive Arts Therapy, among other important works.

How did the new book, Art in Action, come about?

We knew that there were a number of practitioners who had begun to use the principles of expressive arts therapy in the field of social change. Ellen and I decided that it would be useful to bring their work together in one volume and also to invite some of the founders of the field to reflect on the way in which expressive arts can be of use on the societal as well as individual level. Thus, as well as contributions from practitioners in different parts of the world, we invited Shaun McNiff and Paolo Knill to contribute and also wrote new essays ourselves in which we tried to lay a foundation for the work.

The publication of the volume coincides with the inauguration of a new MA program in Expressive Arts in Conflict Transformation and Peacebuilding at the European Graduate School and will serve as one of the sources for understanding the principles that support the practice of expressive arts in areas of social turmoil and trauma.

What makes expressive arts therapy a powerful tool in resolving or mediating conflict?

The central concept of expressive arts is that of poiesis. The original Greek term referred to making or producing in all its forms, including art-making. I use the term to indicate that art-making is not foreign to ordinary human experience; rather it is one of the varieties of making or shaping in general. Human beings are not born into the world with instincts that are pre-adapted to a specific environment. Rather humans shape the world in which they live and, in so doing, also shape themselves. In this sense, we could say the the human being is the poietic animal. What is characteristic of the particular kind of shaping or poiesis involved in art-making, is that it is a mode of shaping for its own sake, rather than for a purpose extrinsic to itself. Moreover it is designed to show itself and not to disappear into its function. This characteristic of showing or appearing also means that the arts can show us the world we have made and the people we have shaped to live in it. Thus the work illuminates the world and can show aspects of it that are normally invisible. This capacity for disclosure can give us a new perspective on our experience and show new possibilities for change. The fact that poiesis takes place through the senses—it affects us on a bodily emotional level—means that art can touch people more deeply than rational reflection. When communities or social groups engage in art-making together, it binds their members at a deeper level than debate or discussion can do.

Quoting from the Foreword, how does expressive therapy “transform conflict, acknowledging its complexity while trusting mystery”?

To focus on conflict usually means that individuals and groups get stuck in polarizing positions and are unable to see alternatives. Art-making, within an expressive arts framework, ‘decenters’ from the usual perspective and opens up new possibilities. It also makes us aware of resources that we might have otherwise overlooked in our focus on our difficulties.

One example of this process took place at the European Graduate School when a group of fourteen Israelis and fourteen Palestinians came to study in the MA program in Expressive Arts Therapy. Although they were all counselors or social workers, they approached each other with the conflict-laden history of their communities embedded within them. Moreover, most of them had come to know the conflict directly: all the Palestinians had experienced the occupation and the ways in which their lives were rigidly circumscribed by others. Some of the Palestinian men had been in Israeli prisons, and several of them had been shot and still bore the scars of the conflict. On the Israeli side, the Israelis had experienced the terror of suicide bombings, and several had lost friends or family members in the fighting. As a result, the Palestinians and Israelis were almost unable to be in the same room with each other.

Their teachers, especially Ellen Levine, who recounts her experience in a chapter in Art in Action, worked with them through the expressive arts to enable them to decenter from the past and become sensitive to what was present in their encounters with each other. This meant using play and art-making as media for conflict-transformation, rather than attempting to engage directly in dialogue and discussion. The culmination of this process came by chance at a dance party that the students had after an evening session. The drumming of the Palestinian men was impossible to resist, and both groups engaged in making music and dancing together. In subsequent encounters, there was the sense of having shared something that was nurturing and essential. As a result, members of each group were able to see the others as embodied human beings, capable of playing in relationship. This experience increased trust and lead to further sharing and the ability to listen empathically to the stories of the other.

What guidance might you give those on the front lines of recent social movements looking for new and meaningful ways to resolve conflict and effect change?

The framework of the expressive arts tells us that those who come to us for help, whether they be individuals or social groups, are the ‘experts’ about their situation; we can only be their companions. This means that expressive arts change agents in the field of social change are not there to give advice or to try to change people’s behaviour. Rather the function of an expressive arts change agent is to accompany those who are involved in a situation and help them find the resources which they already have in order to achieve their goals. This might mean using the arts as effective means of community-building and also as ways to show what in their situation is usually not shown, either overlooked or prohibited. It is also possible to use an ‘art-analogue’ method to help in transforming conflict, i.e., to find ways to bring new perspectives to a situation; to develop an attitude of appreciative curiosity that will lead to surprises that can open up new horizons; to build community support and tolerance for differences; to find visions that can galvanize others into action.

People on the front lines of social change are the experts in their situations; what we can do is help them find playful and engaging ways of working together, opening up to surprises and touching on qualities, like joy and celebration, that are often overlooked in the heat of a conflictual situation. Emma Goldman famously said, “If I can’t dance, I don’t want to be part of your revolution.” If Art in Action has an impact, it will be to help us keep dancing at the crossroads and playing on the battlefields.

Copyright © Jessica Kingsley Publishers 2011.

Video: JKP author Tony White on Working with Suicidal Individuals

In this video, JKP author and psychologist Tony White talks about some key features of his new book, Working with Suicidal Individuals, including subjects rarely covered in the literature such as the “suicide secret” – pertaining to the shocking 25% of suicidal people who never tell anyone of their intentions to take their own life – and the qualitative type of risk assessment used identify those who have made the “suicide decision.”

Click here to watch the video:

Read an in-depth interview with Tony about Working with Suicidal Individuals.

Working with Suicidal Individuals – An Interview with JKP author Tony White

Tony White has been a registered psychologist in private practice for the past 29 years, and is a teacher and supervisor of Transactional Analysis psychotherapists. He has worked with suicidal individuals for many years, including spending three years working in a prison identifying and managing suicidal and self-harming inmates.

Here he answers some questions about his new book, Working with Suicidal Individuals: A Guide to Providing Understanding, Assessment and Support.

How did you come to work with suicidal individuals?

My counselling and therapy background is unusual in that both my parents were trainers and psychologists. I began my university and therapy training early and began running my first therapy groups with a co-therapist at age 22. I am now 53. It was a private practice setting and people kept coming so I kept running therapy groups even at that quite young age.

In private practice one takes whomever walks in through the consulting room door. Often you have no idea of what the problem is until the person sits down and starts talking. People presenting with suicidal thoughts and urges was not uncommon and this was my first introduction to the area of the suicidal individual. In this way over the years I have worked with a lot of depressed and many quite suicidal individuals.

However, I also had a personal interest in the area and began to specialise in working with the suicidal individual which culminated in 1991 when I wrote a book about the ‘no suicide contract’. At the personal level when I was about 17 and 18 years of age I made two suicide attempts. As an adult I have never made a suicide attempt and I am not a suicidal person. It is simply not an option for me. In my adult years there have been some very low times with the loss of loved ones and so forth. At these times I have never even thought of suicide let alone planned anything.

How could I make two attempts as a teenager and yet not be a suicidal person in my adult years? This is why the book includes a discussion of teenage suicide. The usual reason given for teenage suicide is that it is a time of extra stress, where these young people are neither adults nor children, their bodies are changing, and so forth. Whilst I agree with this explanation, it is simplistic and certainly an incomplete explanation of why adolescence is a high risk stage for suicide. Through my own experience and study of teenagers I suggest that there is a more comprehensive explanation in that teenagers think of suicide differently than mature adults.

In more recent years I worked in the prison system. My role was to co-ordinate the At Risk Management System. This was the organisational process set up to manage and identify suicidal and self harming inmates. How I came to do this was sort of by accident. A friend of mine worked in a prison and they needed someone for the co-ordinator’s job. He asked me if I wanted to do it, and feeling like I needed a new project I said yes. This meant I was working with suicidal and self harming men each and every day. My knowledge of the psyche of the suicidal person from age 18 to 70 increased at an exponential rate as a result of this. And that is how I ended up working with suicidal individuals.

Why did you decide to write the book?

Over the years I had accumulated extensive knowledge of the area. I had written many articles for journals and magazines, and had presented at many workshops and conferences. In essence the book was already written.

Also, over the years I had developed some new ideas and methods of understanding and working with the suicidal. The literature on the suicide to my mind has been quite stagnant for some time. There are few new, innovative ideas stated and most of it tends to be picture straightening. I decided to produce the book so as to include some of these new ideas which I have never seen in the literature before.

The book is written in a user-friendly style with theory that is readily understandable. It certainly is for anyone who works with or has to deal with suicidal people in the course of their work or day to day activities.

As it is easily understandable by the layman it would also give the family and loved ones of a suicidal person a framework by which to understand what is going on with their distressed friend or relative. At least half of the book provides this framework, while the other half discusses the treatment of and therapeutic management of the suicidal individual.

What is the most accurate way to assess suicide risk?

This book covers two different approaches to assessing suicide risk, the quantitative and qualitative approaches. In the literature one often sees the quantitative approach used which usually includes a list of features found in high risk groups. The unmarried, prisoners, the mentally ill, the depressed, substances users and so forth. These are covered in-depth in this book with a lot of new information added that I have accumulated over the last 20 years of working with the suicidal.

In the literature one rarely, if ever, sees the qualitative approach discussed, especially outside the transactional analysis literature. This approach identifies the definitive aspect of the suicidal individual, that of the ‘suicide decision’. If one can make such a determination then a significant step in assessing the suicide risk of the individual has been achieved. One knows that the individual has suicide in their mind as a viable means to solve a problem at some time in their life.

This adds an extra dimension to suicide risk assessment. The vast majority of suicide risk assessments look only for those people who are at imminent risk of a suicide attempt. Whilst this is obviously very important the qualitative approach to suicide risk assessment allows one to ascertain the person’s longer term suicide risk. If the suicide decision is identified then that person is a higher, longer term suicide risk. Once diagnosed then monitoring the person is possible such that the suicidal crisis can be avoided earlier, rather than waiting for the imminent suicide risk to arrive. Or treatment can be applied so as to reduce the power of the suicide decision in the personality of the individual, thus reducing the longer term suicide risk level.

Is it possible to ‘cure’ someone who is suicidal?

People display suicidal behaviour and make suicidal statements for a variety of reasons. There is a group of people who have made what is known as the suicide decision in childhood. From a psychological point of view this person could be considered the ‘truly’ suicidal person. Their psychological make up is structured such that suicide is a viable option for them to solve difficult problems at some point in their life. These people can be treated such that they can make a change to that early suicide decision and thus the likelihood of suicide being used as a problem solving technique in the future is greatly reduced.

As mentioned before the suicidal teenager has a different comprehension of what suicide is compared to the mature adult. Teenagers in this way are more managed through their difficult adolescence rather than cured of their suicidality.

Others may suicide because of command hallucinations. That is the person who is engaging in suicidal behaviour because they are experiencing hallucinations that command them to. In such instances if one ‘cures’ the psychotic hallucinations then the threat of suicide greatly reduces which is usually done with some regime of medication. There are other motives which can lead to suicidal actions and these are dealt with in a variety of ways.

How do you address the ‘no-suicide contract’ in the book?

The literature has an enormous amount written about this topic and it is indeed a very divisive one. There has been much heated debate about the usefulness, or lack of usefulness, with the no-suicide contract. This book provides an explanation of why there has been such debate. The main reason is because many writers on the topic do not understand the theory underlying the no-suicide contract. The no-suicide contract originated within the Transactional Analysis literature. Those who are not well informed about Transactional Analysis theory do not understand what the term no-suicide contract actually means.

This book explains the theory behind the no-suicide contract so that much of the heated debate can be avoided. For instance a no-suicide contract is no different from any other behavioural contract used in counselling. Any treatment contract is useful in certain circumstances and not in others with the no-suicide contract being the same. Those circumstances when the no-suicide contract is useful are articulated in this book. Then one is provided with a procedure to follow when the no-suicide contract is indicated and a procedure to follow when the no-suicide contract is contraindicated.

Video: Tony talks about some key features of the book.

Copyright © Jessica Kingsley Publishers 2010.