Before I give an account of the sessions with CAMHS art therapist, Sally Mungall, I should take the opportunity to explain two very important concepts. Awareness of these concepts are fundamental to understanding what happened to me during ‘art therapy’ with Sally. I was truly ignorant of both at the time.

INFORMED CONSENT

Consent is usually defined as the permission given for something to happen or the agreement for something to start. Informed consent is a principle in medical ethics and medical law  requiring that a person must have sufficient information and understanding before making decisions about accepting the risks associated with their medical care or their participation in research or clinical studies.

There are many obvious legal and ethical advantages in obtaining informed consent from a patient or client. Not only does it empower the patient or client, improve the therapeutic relationship and the efficacy of the work but ‘reduces the risk of exploitation or harm of clients by informing clients of reasonable expectations in roles, responsibilities, and behaviour’s - (Barnett et al., 2007).

Sally Mungall belongs to two professional therapist organisations, the first being the British Association of Art Therapists ( BAAT ) and the second being the Health and Care Professions Council ( HCPC ), the latter actually being the statutory regulator of art therapists in the UK.

The BAAT website states the following.

 ’We work to promote art therapy and provide support to our members.  We have issued this Code of Ethics to provide our members with the fundamental principles, standards and guidelines for good practice. This is to support them in their work, as well as to inform and protect members of the public using their services.’

7. Informed consent

7.1 Members should obtain informed consent prior to the start of treatment which must be recorded in their clinical notes. Information should be given both verbally and in written form. If a client has difficulty understanding the language or procedures used, Members should arrange for appropriate support to be provided to the client, such as the assistance of a qualified interpreter or signer.

7.2 Information about treatment should include:• Clear description of the art therapy intervention• Potential benefits for client• Potential risks for client (e.g.: “Sometimes people find they feel a little worse at the start of therapy” or “Occasionally, children starting therapy may at first display some increase of disruptive behaviour or feelings.”• Possible alternatives to art therapy where NICE guidelines may suggest interventions specific to conditions (e.g. CBT for mild anxiety and depression).

Likewise, on its website the HCPC states,

 ’They should have the consent of their service users (or other appropriate authority) before they carry out any care, treatment or other services.

We define consent as when someone has all the information they need to make a decision about receiving care or services.’

It wasn’t until over a year later that I understood that consent should have been asked for. I did not understand the nature of the work of that was about to be delivered. Nor could I have anticipated that Sally Mungall was deliberately determined to go beyond the remit of ‘parent work’ and engage in unsanctioned and deeply invasive and damaging psychotherapy. Sally Mungall was going to indulge her own personal and professional ego and step beyond her competency and the responsibilities officially laid out by CAMHS. I was woefully ill prepared for the psychological distress that I would soon experience.

TRANSFERENCE, COUNTER-TRANSFERENCE AND IDEALISED TRANSFERENCE

‘Dysfunctional patterns, beliefs, and assumptions that affect a patient’s perception of other people often affect their perceptions and behaviours towards the therapist. This tendency has been traditionally called transference for its psychoanalytical roots and presents an important factor to monitor and process. In supervision, it is important to put the patient’s transference in the context of the conceptualization of the case. Countertransference occurs when the therapist responds complementary to the patient’s transference based on their own dysfunctional beliefs or assumptions. Transference and countertransference provide useful insights into the inner world of the patient, therapist, and supervisor.’ – from ‘Managing Transference and Countertransference in Cognitive Behavioral Supervision: Theoretical Framework and Clinical Application’  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9384966/

It wasn’t until almost a year after my sessions with Sally were concluded that I came across an article written by Dawn Devereux published in Therapy Today in September 2016. In later posts I will go into greater detail about Dawn’s article and her assessment of the potentially damaging side effect of Adverse Idealising Transference, AIT, in psychotherapy. For the time being I will quote the following extracts,

‘Clients who develop AIT tell us they wish they had been warned about the possibility before the therapy began. They often point out that a drug with the same adverse potential would only be prescribed with informed consent. Most feel that, if they had been informed of the risk beforehand, the experience would have been less confusing and traumatic.’

‘Informed consent has not been embraced by the counselling and psychotherapy profession. This is perhaps because there has been almost no discussion of the risk of harm from transference. There may also be a fear that clients will be discouraged from engaging in psychotherapy or made anxious by raising the issue. These are, however, all factors that other healthcare workers negotiate successfully. For example, it would be unethical for a surgeon to recommend an operation without first discussing the potential adverse effects.

In our experience, AIT interferes with clients’ capacity for rational thought, making them vulnerable to both dependency and exploitation. As such, AIT is a potentially serious side effect of psychotherapy. The absence of discussion in the professional literature about this type of harm is concerning because there is much a therapist can do to discourage an idealising transference from becoming adverse. If therapists don’t know about it, however, there is a clear risk that they may unwittingly encourage it. What we hear from people who have developed AIT is that therapists should have a greater awareness of what might encourage it, and that clients should be informed about the risk before they embark on psychotherapy.'

I never realised just how vulnerable I was as a single dad and beleaguered carer. I was much less aware of the concepts of transference and counter-transference and totally ignorant of the concept of idealised transference. I was wholly unprepared for what was about to happen to me over the next three months.