Mental Health and Illness Questions and Answers for Counsellors and Therapists By DAWN FRESHWATER Bournemouth University with contributions from JENI BOYD and SABI REDWOOD Series Editor MICHAEL JACOBS Mental Health and Illness Questions and Answers for Counsellors and Therapists Mental Health and Illness Questions and Answers for Counsellors and Therapists By DAWN FRESHWATER Bournemouth University with contributions from JENI BOYD and SABI REDWOOD Series Editor MICHAEL JACOBS Copyright © 2006 Whurr Publishers Limited (a subsidiary of John Wiley & Sons Ltd) The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England Telephone (+44) 1243 779777 Email (for orders and customer service enquiries): [email protected] Visit our Home Page on www.wiley.com All Rights Reserved. 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Library of Congress Cataloging in Publication Data Freshwater, Dawn. Mental health and illness : questions and answers for counsellors and therapists / by Dawn Freshwater, with contributions from Jeni Boyd and Sabi Redwood. p. cm. ISBN-13: 978-1-86156-413-9 ISBN-10: 1-86156-413-9 1. Mental health—Miscellanea. 2. Mental illness—Miscellanea. 3. Psychotherapy. I. Title. [DNLM: 1. Mental Health. 2. Mental Disorders. 3. Psychological Theory. 4. Mental Health Services—trends. WM 105 F885m 2006] RA790. F73 2006 616.89'14—dc22 2005020001 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN-13 978-1-86156-413-9 ISBN-10 1-86156-413-9 Typeset in 10/12.5pt Baskerville by Integra Software Services Pvt. Ltd, Pondicherry, India Printed and bound in Great Britain by TJ International Ltd, Padstow, Cornwall, UK This book is printed on acid-free paper responsibly manufactured from sustainable forestry in which at least two trees are planted for each one used for paper production. Contents About the author ix Contributors xi Chapter 1 1 An introduction to mental health and mental illness Chapter 2 13 Understanding and assessing mental illness: The psychological aspects 2.1 Psychiatrists and psychologists categorise mental illness. Are 13 these categories helpful for counsellors? 2.2 Some clients believe that their mental illness is hereditary. Is 18 there any foundation for this belief? 2.3 A possible new client says at assessment that she is seeing a 20 psychiatrist. What are the implications for me as her counsellor? 2.4 If someone has a history of serious mental illness, are they 21 likely to relapse when in counselling? 2.5 Are there any contra-indications to counselling and psycho- 23 therapy where mental illness is concerned? 2.6 How do I recognise that the client has an underlying mental 24 illness that could be made worse by counselling or psychotherapy? 2.7 Are there any existing frameworks for assessing a client’s mental 25 health? 2.8 What is the difference between endogenous depression and 30 reactive depression? Does it make a difference as to whether counselling is effective? 2.9 Should I work with someone who has severe depression? 31 2.10 Is it true that psychotherapy doesn’t work with psychotic clients? 32 2.11 How effective are psychological therapies with clients who are 33 on medication for mental illness? vi CONTENTS Chapter 3 39 Psyche and soma: The relationship between mental health and physical symptoms 3.1 What is the relationship between physical illness and mental illness? 39 3.2 A number of my clients are referred for anxiety/panic related 44 physical symptoms. What is the relationship between stress, anxiety and the body? 3.3 Are there specific physical illnesses that impact on the client’s 45 mental health? 3.4 Is it true that certain biological and personality types are more 47 prone to mental and physical illness? 3.5 Is depression a common response to physical illness? 48 3.6 I am working with a woman who has recently had a mastectomy. 49 She claims that she still feels as if she has both breasts. Is this usual or is she developing hallucinations? 3.7 Is counselling suitable for clients who have both a terminal 50 illness and a mental illness? 3.8 A young male client has recently been referred to me for his self- 51 harming behaviour. Is counselling a suitable treatment? 3.9 Is it true that substance misuse can lead to mental illness? 53 Chapter 4 55 Socio-political influences: The social construction of mental illness 4.1 How is mental illness currently being conceptualised within the 55 social and political context? 4.2 Are there cultural differences in the way that mental illness is 57 assessed, treated and understood? 4.3 Is it true that African-Caribbean men are more likely to develop/ 60 be diagnosed with schizophrenia? 4.4 How can counsellors permit diversity and difference whilst 62 simultaneously maintaining the clients’ (and others’) safety? 4.5 Some feminist counsellors believe that women are more likely to 64 be diagnosed with mental illness than men are. Is there any evidence for this? 4.6 I work in a young offender’s unit as a counsellor. I have noticed 66 an increase in the amount of suicide attempts in this age group over the past two years. Are young people becoming susceptible to mental instability? CONTENTS vii 4.7 Is there any point in using counselling techniques with a client 67 who has Alzheimer’s disease? 4.8 Many of the clients that I work with as a volunteer attend a day 68 hospital and have learning disabilities. My supervisor is sceptical of the benefit of counselling to this client group. Should I continue to offer my support? Chapter 5 71 Mental health and spiritual distress 5.1 What is the interface between mental illness and spiritual distress? 71 5.2 My client, who has been referred to me by his GP, believes that 75 he has been visited by the Holy Spirit and has been given powers of healing. He is a lay preacher and had a strong Christian faith but has resigned from his job as an executive director to attend to his calling. How can I be sure that he is not mentally ill? 5.3 Why is it that psychotic clients tend towards spiritual themes 77 during periods of mental breakdown? 5.4 Some writers refer to the concept of a spiritual emergency when 79 a client has a mental breakdown. What do they mean? Chapter 6 81 Working collaboratively to improve care 6.1 There are a number of new roles being developed within the 81 NHS mental health services. How do they link with counselling and psychotherapy as emerging professions? National Service Framework for Mental Health 6.2 The (NSF) 83 emphasises the role of counselling and counsellors in the management of acute and chronically ill patients. How will this affect counsellors in private practice? 6.3 What are the existing mechanisms for referral to acute psychiatric 84 services? 6.4 I am currently working with a client who is also in regular 86 contact with her community psychiatric nurse (CPN). How can I maintain good collaborative relations with the CPN, whilst also ensuring my client’s confidentiality is not compromised? 6.5 As a voluntary counsellor in a health centre how should I prioritise 88 the counselling waiting list given that many of the clients are also awaiting a hospital appointment for an acute outpatient assessment?