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      Published by

      SAGE Publications Ltd, 1 Oliver’s Yard, 55 City Road, London EC1Y 1SP

      SAGE Publications, Inc, 2455 Teller Road, Thousand Oaks, California 91320

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      SAGE Publications Asia-Pacific Pte Ltd, 3 Church Street, #10-04 Samsung Hub, Singapore 049483

      in association with

      The Open University, Walton Hall, Milton Keynes MK7 6AA

      First published 2020

      Copyright © 2020 The Open University

      All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted or utilised in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher or a licence from the Copyright Licensing Agency Ltd. Details of such licences (for reprographic reproduction) may be obtained from the Copyright Licensing Agency Ltd, 5th Floor, Shackleton House, Hay’s Galleria, 4 Battle Bridge Lane, London SE1 2HX (website www.cla.co.uk).

      This publication forms part of the Open University module D241 Exploring mental health and counselling. Details of this and other Open University modules can be obtained from Student Recruitment, The Open University, PO Box 197, Milton Keynes MK7 6BJ, United Kingdom (tel. +44 (0)300 303 5303; email [email protected]).

      Alternatively, you may visit the Open University website at www.open.ac.uk where you can learn more about the wide range of modules and packs offered at all levels by The Open University.

      Edited and designed by The Open University.

      Typeset by The Open University.

      Paperback printed and bound in the United Kingdom by Bell and Bain Ltd.

      Hardback printed and bound in the United Kingdom by CPI.

      Paperback ISBN 978-1-5297-1227-8 Hardback ISBN 978-1-5297-1228-5 eBook ISBN 978-1-5297-3806-3

      1.1

      Introduction

      Naomi Moller

      Andreas Vossler

      David W. Jones

      David Kaposi

      Contents

      Introduction to understanding mental health and counselling

      The Earth and a birds-eye street view. Both are factually accurate but distance changes how things are seen and understood.

      Welcome to Understanding mental health and counselling. We hope you will enjoy reading this book and come to understand more about the key debates in mental health and counselling and the core approaches taken to working with mental health problems.

      This opening chapter introduces the core aims of Understanding mental health and counselling, the three themes that are interwoven through the chapters, and the structure of the book. There is also a section on the terms used to describe people with mental health difficulties.

      Core aims of this book

      Existing resources on the broad topic of mental health often explore how it is currently, and has historically been, understood and how this understanding has impacted the evolution of mental health care, policy and law. Many such resources largely ignore what this might mean in practice for how to work ethically and effectively with a person who is in mental distress. Equally, many books about counselling theory and practice engage seriously with building knowledge around the topics necessary for ethical and effective practice, yet they pay scant consideration to broader understandings of mental health and ill-health and how these have shaped the field of counselling and psychotherapy.

      The result of a failure to consider mental health and counselling holistically is, in the worst cases, that counselling theory is taught as if it were a cult, where criticality is discouraged and fervent support encouraged, while mental health is taught in a way that creates disdain for anyone trying to engage with a system so demonstrably flawed.

      This book aims to do something both ambitious and radical: to create a resource that allows readers to consider the field of mental health from the practical to the conceptual and from the individual to society. The hope is to offer a perspective that combines a strong commitment to criticality (asking: But how do you know that?) with an acknowledgement that therapeutic practice often involves a deliberate stance of ‘not-knowing’ (Bion, 1967) in order to foster deep and empathic listening to the client. The stance is that it is important to hold on to two opposing ways of understanding. On the one hand, mental health is an area that is shifting and highly complex, full of seriously troubling experiences and practices and plagued by a lack of knowledge and arguments about the ‘right’ kind of knowledge. On the other hand, it is an area in which decisions must be made and actions taken, often quickly.

      A word on terminology

      Before going any further, it is important to say something about the terminology used in this book to refer to people with mental health concerns. Words are important because they shape how people are perceived and understood, and how they experience themselves. There are lots of words – slang, medical and everyday words – that have been used to describe people with mental health problems.

      Pause for reflection

      Briefly consider a few words that are used to describe people experiencing mental health problems. Then consider how you might think or feel about a person who was described by each word.

      Language can perpetuate stigma and thus there is a commitment in this book to trying to use non-discriminatory language (alongside the recognition that there is debate about which terms are/are not discriminatory). For example, we avoid any language that suggests that a particular difficulty defines the person – such as ‘depressive’. We also discuss the considerable and important debate about the use of medical language for mental health difficulties. The Time to Change campaign, which was set up to reduce the discrimination faced by people with mental health problems, provides guidelines on appropriate and inappropriate terminology (e.g. Time to Change, 2020). In line with this, we will be using the following terms in this book:

      These terms all have slightly different meanings; for example, ‘client’ tends to mean someone who is having counselling, whereas

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