What has this to do with counselling? Something about Engagement and Ownership, I think. When I was nursing it felt as though most of my patents were done unto. They were recipients of care. They had some say about what happened to them. But not a lot. They could choose to take their medication. Or not. They could keep appointments. Or not. Beyond this there was not too much choice. (Despite the rhetoric, I’m not sure how much has really changed in the last decade. A few new drugs have been patented. A few new “illnesses” have been invented to be the recipient of the new drugs. But fundamentally, little changes.) Contrast this with my phone. I have a choice. I can choose from a range of phones. A range of tariffs. A range of networks. I am getting two or three phone calls a day from Carphone Warehouse telling me I am eligible for an upgrade. I am engaged in the process of choice. My opinion matters – albeit briefly! When I make my choice, I shall know that I had a choice. (If anyone from Carphone warehouse is reading this, I am still open to offers!)

I was talking recently about something that I’d heard in a cafe. A woman was saying “I had Anorexia when I was younger.” My companion pointed out the problem with this sentence. It denied ownership. The speaker gave the impression of being the unfortunate recipient of an illness. Rather as we quite reasonably say “I’ve caught a cold from somewhere. Probably work. There’s a lot of it around at the moment.” Emotional difficulties do not get “caught”. We do not catch schizophrenia. Or depression. Or anxiety. We are them. They are part of who we are. How we have been brought up. The messages we heard as children. Our current circumstances. The whole of our personality is involved with our mental health problems. And the answer lies in the same place. T.S. Eliot asked “Where does one go from a world of insanity? Somewhere on the other side of despair.” But at least one can be reached in despair. We knows we are in need  when we are in despair. All our other attempts at defence have broken down. We have to engage with that part of ourselves. (This is the danger of the language of medicine. We are given antidepressants to remove the illness “depression”. Far better to have time to sit with a therapist and take ownership of the reasons for our depression. That way we are engaged in something creative.)

Unlike my new phone contract,  most people with emotional difficulties will not be phoned five times a day to remind them of what is on offer for them. (Although we could see the messages from one part of our psyche to another as a malevolent equivalent in many cases. Thus a psychoanalytic view of suicide which sees suicide as an answer to the conflict between different “selves”.  The link is to Freud’s paper Mourning and Melancholia where he writes about depression and suicide. www.english.upenn.edu/~cavitch/…/Freud_ MourningAndMelancholia .)

My wife has just looked over my shoulder, read this piece and observed “It’s more complicated than  you usually write. It’s good. But you have to think about it more.” I suppose that sums up the whole idea of user involvement. At a professional level, it is more than just inviting a couple of patients along to a committee meeting once a month. (The technical term  might be “tokenism”. At a personal  level, user involvement requires the “user” to engage with all their parts. Which is complicated. But interesting.