New Beginnings Therapy


The following strategy was developed whilst considering over 100 NHS staff cases  across different departments from one specific NHS Trust in London. The work was finalised with creating an overall pattern of working events and experiences that could not and are not attributed to an internal world of clients. The exercise comprises work experience that spans over 5 years and each individual case is discussed in at least one aspect of both VALIDATE and DATE exercises. The NHS staff's mental health and wellbeing are representative of a public care system that has accountability for the entire UK population at large. There is no real other form of health care in the UK because private care in the UK is provided by the NHS staff current or former employees. 

This work is going to be developed into a larger work  and publish individual cases presented as case studies as a starting point of reflection over what and how a health care public system function and to what degree such responsibilities are delegated and distributed across an entire country population- the lives of many becomes that of one*

Being yourself exercise is a very useful tool to apply in all instances involving an organisational transition or personal transition that feels at conflict or difficult. Being yourself exercise can be conceptualised as an updating and realigning long term goals – i.e. career prospects or managing change - by revalidating or assessing values with an application to new developments/ situations.

In order to illustrate such an exercise various difficulties in managing transitions or search for a new employment position are examined all involving self-introspective questions around values and standards.

All questions could be formulated around one acronym VALIDATE exemplified by questions on self-reported attitude to work and contrasted with STANDARDS in reference to the company/organisation/agency you are currently working for or seek employment with.

VALIDATE- for the purpose of this exercise, the term is used as a confirmation or endorsement for a desired change i.e. a specific work role, but it can be applied more generally to various other transitional roles and or life events.

V = Values – as common sense this may be, making time for a brief reflection on work-related personal values could be seen as a good starting point to address some anxieties around a new job or re/assessing your current position/role in your career; Values are different for everybody and they can change over time and that potential change can be identified and signposted also as a tool to reduce anxiety and or gain clarity during a period of organisational change or an active choice to change employment. The two most apparent value domains work related are work environment and education/training and or personal growth. For instance, some relevant questions that come up in such occurrences could be meanings attached to a specific work role, working as part of a team including a sense of belonging and type of skills aimed to for further development. Values are different from set goals and could be seen as a form of reasoning behind specific set goals. Questions around type of skills and personal qualities desired to affirm or re/affirm as part of a role with than corresponding set goals of seeking a specific training and or building stronger work relationships. A further example could be made in reference to domains that are not necessarily apparent at first analysis. For instance, values related to parenting and role modelling, type of relationships that are aimed to be developed and or considered at specific moments in life, what type of community would like to live in and contribute towards and questions around well-being and self-care - are all part of interrelated values domains with a clear relation to work choices and organisational changes involving re/creating and reflecting over specific set goals at different moments in time. Values related to parenting and role modelling involve decisions around flexible part time schedule and or location, career progression tasks etc. Contribution to community and values around civic duties and environmental views could give way to seeking specific roles within a community setting and or adjacent to a current work role i.e. volunteering and or pro bono work, engagement and investment in community programmes, promoting and or funding specific causes etc.

A = Assessing - this step would involve a self-assessment of personal values and recording personal ideal work value domains identified in previous step; What value domains are identified as being presently significant and observation of any, if any, changes in variation of value domains. For instance, if in a previous work role work domain value did not account for values attached to family and social life, or there is currently a need for an acute sense of reconsidering location, commute etc. There is also possible that changes are more subtle, such as opportunities for involvement in specific projects that would account for environmental held beliefs and or a need for re/training. At different stages in career development an identification of newly added values could be recognised such as desire to share knowledge and or develop a different branch to your existing role such as teaching, mentoring or perhaps acquiring specialist expert knowledge in your specific work field.

L = Listing – this stage is concerned with creating a priority list of all your ideal value domains work related;

I = Identifying - aspects of your current work that correspond to your ideal value domains, desired aspects that are not momentarily present and aspects that are in contrast and or at conflict. The three column table would involve a brief assessment of questions related to standards of your company/organisation/agency you are currently working for or seeking future employment with. This step is crucial for more than one reason as it could also potentially identify sources of stress or anxiety around your current role coupled with specific recognised value domains conflicts. For instance, a rotational change to working in a community setting and outreach support as part of your retraining can be experienced as a significant change from being based in an office and working part of a team for same role. This situation can be felt as highly stressful with an outreach position perceived as a considerable reduction on network support, sense of belonging within a team, availability of different training opportunities and self-growth etc. All such aspects are related to domain values of work environment, collegial relationships, opportunities for training, membership to a team and isolation. Positive aspects could be greater flexibility, efficacy, and development of your profession in specialised or specialist knowledge etc. However, if your domain values are at conflict with existing tasks and retraining job description specification, such a conflict can create high stress and several other difficulties that can vary in degrees of severity. Another example could involve a positive progression in your job role with proceeding to a hierarchical higher position and when assessing all new developments it is recognised that specific aspects in value domain are lost or in contrast. Identifying all such sources of conflict it is paramount to being able to progress to next step of delimiting and revising all potential changes that could be made.

D = Delimiting or Demarcating all potential conflictual changes by contrasting your current role and desired outcome - this step only refers to demarcating value domains and not set goals. For instance, working as a part of a team and not as an independent or seeking a career progression where you would attend to your value of wanting to share your experience and knowledge, hence actively seeking opportunities for mentoring, collaborations across various networks and extending current support network. A decision for career progression can be conceptualised as bringing in or offering an opportunity for such adjustments. Seemingly such choices could be made within an existing role that had become to be experienced as non-challenging. A change could be introduced in seeking a variety of challenges aligned to your adhered value domains.

A= Aligning If a specific situation arises such as a restructuring of your work role, change in management and or organisational loss, a rapid change in team composition, redeployment, variation of significant aspects of your work role such as retraining within your current role, or embarking on a career progression and self-growth, all such situations are potentially perceived or “felt” as negative (loss) or positive (opportunity); independently of such attached meanings of positive and negative valence, all such changes could involve heightened levels of anxiety and high level of stress. By focussing on specific value domains assessed in step two (Assessing), creating a list of all desired value domains (Listing), grouping all such identified domain values in three categories as currently existent, non-existent and at conflict or potential conflict (Identifying), followed by an exercise concerned with resolution of existing conflicts and evaluating all desired outcomes (Delimiting or Demarcating) it is going to offer you a clear picture as to why, where and how on your current situation with an opportunity for Aligning or reaffirming your domain values that are fundamentally essential to your current situation and changes involved. This task would require creating a list of domain values and sought changes offering a clear understanding on remaining options. Considering previous example, an application at this stage would involve a final decision on whether or not working in a community setting without an office based position it is your best option or perhaps team work and developing working relationships are primary values for consideration. Could be that an adjustment to existing role needs deep consideration in terms of accessible potentialities and opportunities for re/training? Equally this step is going to bring closer understandings to setting goals/tasks and revisiting existing goals (long term, medium term and short term), which is the next step.

T= Tasks – setting new goals aligned to your recognised primary work values and sought changes - this step is entirely reserved to designing an action plan where you are accounting for your previous steps introspections and evaluations. Taking previous example, it would suggest a reconsideration of your job role where developing work relationships and working as part of a team with face to face interactions are identified as essential to your job satisfaction and outreach community work identified as considerably lacking on such aspects, than the task would be to seek employment opportunities that are accounting for such changes or at minimum an examination of existent opportunities within current role i.e. work related networking and or accessing peer support.

E= Empowered/ Enabled This final step involves a revision of your previous steps and devised action plan with a reinforcement and recognition of meanings attached to value based system. A sense of enablement and empowerment gained through such an introspection could be identified and if not at minimum a clarification of your work related Expectations.

Taking another previous example, if a career progression is next step but anxieties around such a task are present, this exercise would have offered you a clear signposting to existing conflict and informing set tasks ahead. For instance, if departmental restructuring is at play where your work role is no longer available and there is availability for progression within a new role, potential considerations would had involved all stages of analysis and identification of where and why there is a conflict i.e. new role, albeit a clear career advancement would also involve less time in practice and or fewer opportunities for gaining specialist knowledge and developing projects based on main interests and passions.

Needless to say that work related values and value domains are very specific to individuals and this exercise can only bring clarification when all such values are reflected upon and an action plan is devised. Using the acronym VALIDATE makes such a process structured, evaluative, self-reflective and more importantly its practice can be reduced to simply devising action plans when conflicts within existing roles are already somehow acknowledged but a revision of changes need to take place within set times - by only conducting from stage D (Delimiting/Demarcating) to and including stage E (Enabled) so DATE as a new acronym and a set specific time for change.

Example of a case involved in V.A.L.I.D.A.T.E

Choices for Friday at 9am: where is the heart?

Friday at 9am, my weekly appointment, enters the consulting room and sits in her usual chair near the window. I welcome her and move from my desk to a chair, creating a symbolic therapeutic space – it is attentive; I am facing Friday at 9am, containing her safe confidential space rather than when seated at my desk with a computer and a notepad. Fridays at 9am are booked for the next six to seven weeks, an average of six as it were, sometimes it could be one extra week if interim weeks are rescheduled by agreement for training and / or other reasons. Session starts in usual terms with a patient recapping from her last week’s session and a brief update on how her situation is developing for her now. She is composed and it seems that she used her time in between sessions for reflection. Friday at 9am is a senior member of a large department within an NHS Trust, her name printed as author on most of the policies that the Trust has due for a review every three years. The client is not aware that I hold that knowledge about her – she was a referral from the Occupational Health Department and it is only by chance that I recognised her name from memory; upon appointment of my honorary contract I’ve read most of the Trust’s organisational policies.

During sessions, the client’s reflections tell a story of hurt and a need for healing; Friday at 9am is at crossroads with hard choices to make about her role within the Trust due to an inevitable department restructuring. Within the next couple of months the client will no longer have an offer of employment with a job description that matches her current role, most significantly without one specific aspect related to her clinical role. The client’s devotion to her job and to the Trust are indisputable and somehow difficult to measure, except upon consideration that the client started working for the NHS immediately after her medical training, three, almost four decades ago. The NHS Trust is what she calls family/home, with such strong ties to it that there is no mentioning of any other compelling identification with a different personal role.

The Third Choice

At the time of her sessions, the client's therapeutic focus is to decide on her next career move between two choices that are truly felt and perceived by my client as not being real, valid employment options. On first choice, the client tells me that if she opts for it, it would be experienced much like a demotion. On the second option, the client describes it as opening up a process similar to a conflict resolution for redundancy, with future possibilities for the client seeking employment in either the Private Health Sector or a different NHS Trust. I am listening to the client's narrative and she is unravelling a story of love and betrayal: her work is described as her partnership for life, with the recent proposed changes by the Trust’s Director making her feel as if she is no longer wanted, and the hurt is unbearable. Fridays at 9am dedicated her life to this partnership, surely there must be a recognition of that in some form, but instead of love she feels betrayal.

There was all but a mist, the client’s sense that there is little time and / or not many options for things to change, her account of happenings being urgent and alarming. Attuning and carefully listening to the client developing her story, she sounds beyond articulate, with an insistence and eloquence on a sense of running out of time. Such a feeling is at first expressed and then transferred into the room for a brief analysis and almost immediately questioned. To start with, a collaborative examination of the moment of the onset of difficulty was revisited by the client, precisely the moment when the client was informed of decisions and announcements about future structural departmental changes.

Due to the seniority of her role and her involvement in the department, Friday at 9am, like any other staff member, was consulted about her options and furthermore, she was asked to write up a proposal for such restructuring. When elaborating with me in the room as to what was asked of her, Friday at 9am had a revelation: there is a third choice. Friday at 9am realised that during the restructuring of her department there will be an opening for a senior role in the newly restructured department, and thus an opportunity for her to transition and progress into a work role but more importantly being able to continue her clinical work; the client’s identification with her job role, with her overall career in the NHS, all upheld her associations and values aligned to specific standards.

When the third option was identified, there was no longer a mist all around; choices were now well-defined with a regained determined sense of what is next; a vision and an action plan developing and contouring agreed focus for sessions.

Fridays at 9am left the room after her final session with a reminder that her devotion to her work role and the NHS Trust are unbroken: her sessions were about transitioning and rechecking held values against professional standards and validating her wish to continue clinical aspects of her work against a decision to hold a merely senior managerial position. The client also were able to recognise that she is in a position of negotiating her future employment and role within the NHS Trust with the Trust having to acknowledge such choices.

Fridays at 9am also answered questions around whether or not there is ever going to be a readiness to renounce clinical aspects of her work role - implicit adherence to her long standing professional associations. For Fridays at 9am it was strongly asserted that that would never be a real option: her Values were Standards and vice versa.

Where was the heart?

One could question, yes, but what is new about such a case? The NHS staff’s loyalty and attachment to their work role is well documented, and the NHS being a big united family is a highly recognised fact, if only by consulting the NHS Constitution and / or each individual NHS Trust own stated Values and Standards of their work with their staff and the public.

I am in agreement, Choices for Friday at 9am is about all such knowledge, universal and accessible, such facts are not to be disputed, and yet again, there were moments with Friday at 9am when I wondered who entered my consultancy room. There was a real beating heart with me in the room, but what was also evoked with certainty was that, at times, a couple-client was present in the room or at least one other client in the room besides Friday at 9am: The NHS Trust.

The NHS Trust was analysed through its organisational presence, pulsating in the room through its dynamic relationship with my client. In such moments, ‘Where was the heart?’ would have been merely the wrong question to ask. Friday at 9am, my client, was reminded that the NHS as an organisation is an ever changing evolving entity*, shifting and advancing, with Friday at 9am very much part of such shift. Friday at 9am’s progression and options were also progressions and options for the NHS Trust – whether that was also to be seen as a dynamic relationship between the two clients, that could have only been questioned if my client would have remained within a position of debating her employment with that specific Trust. It can be argued that my presence in the room certified such a dynamic, mediating it with clients recognising it; my honorary contract kept all allegiances at bay within a reliable and stable ethical framework. The BACP guidance for good practice and work counselling/psychotherapeutic services are my specialism and my guidance and I always recognised that psychotherapy services offered to the NHS staff through an honorary contract and workplace therapy meant that the NHS as an organisation was also my client. My work was consolidated by an existing structure of a psychotherapeutic/counselling service dedicated to the NHS staff with such structure further containing and safeguarding services provided in impartiality: no organisational politics involved, but a culture of help and guidance prevalent also through the very policies that had my client’s name printed on.

Friday at 9am was a point in time when a contractual negotiation was taking place with questions on adapting and adjusting to the demands imposed by external organisational factors such as departmental restructuring and internal dynamic factors of self-belief and or realigning in with long established values such as my client’s reconfirmation of the importance of her clinical practice.

Friday at 9am was a pause in time dedicated to and honouring an NHS staff member who needed to reaffirm her allegiance, and a reminder for an NHS Trust to check in, always check in with values and standards held high, but more importantly check in with rhythms created by its very own beating heart/s.

Friday at 9am represents one of many examples as to how the “Being Yourself Exercise”, V.A.L.I. D.A.T.E and D.A.T.E, were created – Friday at 9am being mentioned in aspects on values standing for I (Identifying) of the acronym

V.A. L.I.D.A.T.E. Identifying the conflict between values held and proposed standards to embark on, a crucial moment to the client’s focus on her employment options, renamed in this case example: “Choices for Friday at 9am”