Careers

Ian Florance talks to Gesthimani (Manya) Merodoulaki about her views on the role and practice of counselling psychology

How did you come to be a psychologist?
I was born in Crete and educated there until I was 18. My family had told me stories about British allies in World War Two. ‘British’ and ‘excellent’ have long been two associated words so I wanted to come to England and learn English.

I won a scholarship when I was 15 and came to Cambridge University for a language summer school. It was wet and cold and I hated the place. Thenthe sun came out, we sat on the lawns playing guitars, and I knew I’d be back.

I decided to spend a year here when I was 18, polishing my English language skills before going back to Crete to teach children. Instead I started a modular degree in English literature at Richmond College, London.

I had achieved top grades for psychology at high school, so in the first semester I took an introduction to psychology, and subsequently changed to a social science degree. The modular course permitted choice, and I was taught by Ernesto Spinelli.?He introduced me to the existential/phenomenological approach, which became a very different way of experiencing life. Had I been Alexander, he would have been my Aristotle!

I consider my undergraduate years among the richest experiences in my life.

Did you take to psychology straight away?
I failed introduction to psychology the first time! I retook it and my final mark was a straight A. I wasn’t going to succumb to failure!

What were your aims at the time?
I’d always wanted to work with children. After my first degree, I took the Diploma in Psychology of Education and Human Rights at London University’s Institute of Education, followed by an MA in Psychology of Education. After that I started working in the NHS as an assistant occupational therapist in adult mental health day services in London.

Was this a good experience?
Mixed. I was desperate to work with disadvantaged people, to open up opportunities through their experience of an interaction based on respect. Some people may see this as naive but it’s a continuing motive for many practising psychologists. My counselling studies had already planted the seed of experiential learning and therapists’ ways of being alongside doing. The interpersonal relationship continues to be an important feature in my client work, training and personal life.

The first hospital I worked in was a converted Victorian workhouse in one of the poorest and most ethnically mixed areas in Britain. It was run down, psychiatry-ruled, and conveyed neglect and disrespect to clients and workers. I was very interested in mental health issues, but I thought I couldn’t stay in the NHS. Nineteen years later, I found I was wrong. There is something compelling about providing a service seemingly at no charge, having a sense of autonomy in practising, and being able to predict  a reasonable income at the end of the month.

That job gave me good knowledge of, skills in and respect for psychoanalytic and psychodynamic approaches. I also got involved in running groups on areas such as relaxation, anxiety management, work-finding skills, and general support. I learned a lot from how my co-therapists practised.

Alongside full-time NHS work, I taught counselling skills one or two evenings a week. At weekends, I worked with children with learning and emotional difficulties in a private school, and individually with an adolescent with learning difficulties who had experienced abuse. This was the early 1990s, when I was training as a counselling psychologist at Roehampton University. At the time, there was no Division, only a special interest group in counselling psychology. Getting chartered took a lot of ingenuity, time and mental space.

My first job as a chartered psychologist involved adult mental health roles in Teesside. I worked in a community mental health team attached to a GP surgery and had a specific role in reducing the central psychology service’s waiting list. In the late 1990s I moved to Derbyshire near my then partner. I worked in adult mental health services there.

You seem to have moved around a lot!
It made me realise something important: psychology services are configured differently in different places, often shaped by the leader’s implementation of the latest government ‘good idea’. One of the services I worked in was impressive, filled with clever, committed people delivering high-quality services; another was chaotic, and interfered with opportunities for professional growth. We seem to be a profession very influenced by individual people and particular schools of thought.

Movement also shaped a continuing theme in my thought. From the mid-1990s, evidence-based practice was being introduced and became a dominant ideology, repressing approaches that were deemed not proven. I’m all for evidence-based practice, but I’m concerned about the all-pervasiveness of quantitative research and what I perceive as poor critiques of its outcomes.

At that time, counselling psychologists plugged holes in services that did not attract clinical psychologists. I hope this is changing to a more accurate appraisal of the breadth and depth of skills and knowledge that counselling psychologists contribute, especially in therapeutic and team-work. When I left my early post, elements of it were regraded to consultant level – yet, as a newly qualified counselling psychologist, I had coped with all the demands of the job.

My goal to achieve a consultant grade took me to Lincolnshire. Then I moved to Rampton Hospital, in the role of Head of the Counselling Service for Staff, managing two other therapists. My manager was a non-psychologist and, again, there was a real difference in the way he guided and supported me. I enjoyed lots of leadership and management training. The organisation respected its staff and service users.

Can we return to your earlier comments about your strong reaction to imposed approaches?
I’m very concerned with power issues in social contexts, language and discourse, and particularly in therapeutic relationships. I believe that open debate is one of the best ways to advance science and civilisation. People can find creative ways to overcome oppression, and I would like to think that my approach to psychology facilitates such creativity and promotes tolerance of otherness. I’ve long had an interest in human rights and in equal opportunities, hence my focus. The person-centred approach seems the only one that pays more than lip service to power issues. And yet, that approach seems underused where it is much needed, such as in mental health services. It contrasts with ways of doing psychology which view individuals as requiring correction in their ways of thinking or their hormone levels.

Encountering feminist ideas in Richmond felt like someone flicking on  a light-switch. Later on, I coordinated and taught the Women and Psychology course in Roehampton. I have also been a member of the Society’s Standing Committee for the Promotion of Equal Opportunities for a few years. Growing up during the dictatorship in Greece has influenced me in these areas.

I’ve been exposed to a variety of approaches to therapy during my career. I have serious concerns about the predominance of cognitive behaviour therapy. CBT fits well the medical model which prevails in the NHS, and the NHS is a major funder of psychology services. It can seem that unless we speak and think in medical terms, the profession may become marginalised. We often react to such a threat by adopting the language and spirit of the dominant discourse. Returning to the idea of tolerance, I am concerned about portraying happiness as the correct way of being and feeling. People are much richer emotionally, and it may be our role to enable people and wider society to be more accepting of this richness.

I question compliance to the CBT model. Clinical governance includes a degree of mindful autonomy and I’m not certain we use that enough.

Psychologists are versatile scientist-practitioners. We need room for debate, for a wider variety of approaches, and a pinch of pragmatism. We need to continue questioning our findings and searching for more understanding and knowledge.

Are there other concerns you have about psychology as a profession?
How do we obtain our knowledge? There are significant limits to what we can learn from nomothetic approaches, studying large groups of people to draw conclusions about the total. Our world is hugely diverse, so idiographic approaches are equally, if not more, suitable for psychological inquiry, understanding and knowledge. Sometimes I think that we try to explain psychological phenomena before achieving sufficient understanding of what they are. That feels like the wrong way around.

Finally, different domains could learn more from each other. For instance, we could all benefit from knowing more about the work of developmental psychologists, as well as those working with adults across the lifespan. In adult mental health we often discover the late effects of a difficult childhood, and we could invest more in examining timelines and work on promoting lifelong healthy development.   

What are you up to at the moment?
I wanted to learn more about new ways of researching, of psychometric testing, about applying psychology to people in different circumstances and services. So, I started clinical psychology training in 2006, but the training remains incomplete. In the past year, I’ve been re-examining whether this path will deliver the outcomes I wish to reach while retaining what I value most about being a psychologist.

I am pleased to be working for a not-for-profit organisation now: I’m employed part-time by Relate Institute as their Clinical Supervision Programme Leader. In private practice, I provide clinical supervision (and contribute to the Division of Counselling Psychology as an assessor). I have been interested in clinical supervision since my earliest days of practice. I have read and written about it and provided it. Holding a training and education role also suits my constant thirst for learning.

What do you think about counselling psychology now?
I value its independence and integrity, though it is undervalued. We draw on a wide variety of approaches, use our experience of interaction within sessions to inform our work. While respecting evidence-based models, I believe that we retain a healthy doubting/inquiring approach to what constitutes evidence.

Having established its identity, counselling psychology now seems to me to have reached a crossroads: should it remain autonomous or pair up with another member network of the British Psychological Society? We need to consider carefully the costs and benefits of such options – and beyond questions of employability. Our philosophical roots make our field very distinct. We need to ensure we safeguard distinctive aspects of our professional identity. Counselling psychology is not a miniature or paraphrase of other specialities; it is an entity with its own identity.

 

 

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