BABCP CBT TODAYalt 31/1/13 16:26 Page 1 Volume 41 Number 1 ... · PDF fileVolume 41 Number 1 February 2013 Albert Ellis posthumously recognised ... Anxiety Disorders, ... A sense of

Volume 41 Number 1February 2013

From the LeadOrganisation for CBTin the UK and Ireland

The three Welsh Branches withinBABCP have launched an initiative inresponse to serious concerns aboutthe lack of CBT provision in Wales.

Wales misses out

In 2007, Lord Layard maderecommendations to the UKGovernment which led to theestablishment of new NHS outpatientservices to improve access topsychological therapies for commonmental health problems. Funding wasalso made available to train therequired number of CBT therapistsand these services have now beenrolled out across England only.

Within Wales, health provision isdevolved to the Welsh Governmentand equivalent services have notbeen automatically set up there aswell as other parts of the UK. On 2November 2010, the NationalAssembly for Wales passed theMental Health (Wales) Measure intoWelsh law. Although the provision ofpsychological therapies is included,there is still no promise of anyfinancial investment which is pivotalto training competent therapists andexpanding service provision.

Raising the profile of CBT in Wales

The Welsh Branches have highlightedthis inequality, including to the WelshGovernment, for some time, as well asestablished the National Wales Forumat the BABCP Annual Conference in2011. Following another successfulmeeting of the National Wales Forumat the Leeds conference last year, thethree Branches agreed to worktogether on an initiative to raise theprofile of CBT in Wales with a view tosecuring the kinds of improvedaccess enjoyed by England.

This initiative, called #CBT4Wales, waslaunched in Cardiff at the OCD-UKAnnual Conference in November. Thelaunch took the form of a jointpresentation by Keith Fearns, BABCPAccredited CBT therapist and NorthWest Wales Branch committeemember, and Deon Gorle, who hasbeen helped by CBT in the treatmentof his OCD.

Continued overleaf

With this issue:News and views from the BABCPIndependent Practitioners Special InterestGroup in this CBT Today supplement

(Pictured above, from left) Keith Fearnsand Deon Gorle with Neil Kitchiner fromSouth & West Wales Branch, MaggieFookes from North West Wales Branchand Graham Yeates also from South &West Wales Branch

BABCP_CBT_TODAYalt 31/1/13 16:26 Page 1

| February 20132

The initiative emphasises that CBT isan evidence-based, NICErecommended treatment of choicefor many common emotional andphysical health problems. CBT is alsobacked by a number of user groupsas their preferred treatment.

Another key message is to promoteBABCP Practitioner Accreditation asthe best guarantor for protecting thepublic and raising the qualitystandards of CBT within Wales. It isanticipated that the initiative willinclude the provision of high qualitytraining opportunities to improve thestandards and widen the range ofevidence-based psychologicaltherapies, including CBT, within Wales.

Media interest

Following the November launch, KeithFearns was invited to discuss theseissues on BBC Wales televisionprogramme The Wales Report withpresenter Huw Edwards and WelshAssembly Member Eluned Parrott.Since Keith’s appearance on The WalesReport, Eluned Parrott has been incontact with Keith and has pledged toraise this issue with her Assemblycolleagues.

Special feature

To coincide with the launch, CBTToday has commissioned a series ofarticles which powerfully depict thehuman cost behind the lack ofadequate CBT provision in Wales.These articles can be found onpages 11 to 14.

#CBT 4 WalesContinued

Managing Editor - Stephen Gregson

Associate Editor - Patricia Murphy

CBT Today is the official magazine of theBritish Association for Behavioural &Cognitive Psychotherapies, the leadorganisation for CBT in the UK and Ireland.The magazine is published four times ayear and mailed posted free to allmembers. Back issues can be downloadedfrom www.babcp.com/cbttoday.

Submission guidelines

Unsolicited articles should be emailed asWord attachments to [email protected],except for PWP-related articles which shouldbe send to [email protected] cannot be guaranteed.

An unsolicited article should beapproximately 500 words written inmagazine (not academic journal) style.Longer articles will be accepted by prioragreement only.

In the first instance, potential contributors areadvised to send a brief outline of theproposed article for a decision in principle.

The Editors reserve the right to edit anyarticle submitted, including where copyrightis owned by a third party.

Next deadline

9.00am on 15 April 2013 (for distributionweek commencing 13 May 2013)

Advertising

For enquiries about advertising in themagazine, please email [email protected].

© Copyright 2013 by the British Associationfor Behavioural & CognitivePsychotherapies unless otherwiseindicated. No part of this publication maybe reproduced, stored in a retrieval systemnor transmitted by electronic, mechanical,photocopying, recordings or otherwise,without the prior permission of thecopyright owner.

Volume 41 Number 1February 2013

Albert Ellis posthumously recognisedfor outstanding contributionThe American PsychologicalAssociation will this yearposthumously recognise Albert Elliswith its Award for LifetimeContribution to Psychology. This isthe Association’s highest award andwill be presented to Dr Ellis’ wife andcollaborator Dr Debbie Joffe Ellis(pictured below, with Albert Ellis) atits Annual Convention in Hawaii thisAugust. 2013 also marks thecentenary anniversary of Ellis’ birth.He died in 2007.

This award recognises thesignificance of Ellis’ work,particularly in creating RationalEmotive Behaviour Therapy (REBT)which laid down the intellectualfoundations for CBT and otherpopular approaches in therapy.

About her husband’s posthumousaward, Dr Joffe Ellis said: ‘If Al werehere, he would have been veryhappy to accept the award. Not forany self-aggrandising reasons, butbecause of the depth of his careabout people and his desire to helpas many as possible to suffer lessemotional misery, and to help themenjoy and relish the gifts of life asmuch as possible. He would haverealised that the honour wouldbring fresh attention to hiscontributions, which include hisvigorous and empowering approachof REBT. His hope would have beenthat, as a consequence of the award,

more people would want to learnREBT and apply it. He would havehoped that they would particularlynotice its emphasis onunconditional acceptance of oneself,others and life. And I share Al's wishthat the wisdom of REBT willcontinue to touch the minds andhearts of many, making their livesmore inspired, sweet and happy.’

Robin Thorburn

Dr Debbie Joffe Ellis will bepresenting REBT: The PioneeringCognitive Approach WhichRevolutionised Psychology andCounselling at the Eric Liddell Centre,15 Morningside Road, EdinburghEH10 4DP on Saturday 26 October2013 between 12.00-2.00pm and at11.00am-1.00pm on Friday 1November at the BritishPsychological Society, 30, TabernacleStreet, London EC2A 4UE. Visitwww.exclusivehypnotherapy.com forfurther information.


| February 2013 3

www.babcpconference.com

BABCP 41st AnnualWorkshops &ConferenceImperial College London16-19 July 2013

Registration is now open!

Confirmed topicsAnxiety Disorders, Acceptance and Commitment Therapy,Basic Processes, Behavioural Medicine, Children andAdolescents, Dissemination, Depression, Eating Disorders,Impulse Control, IAPT, Intellectual Disabilities, Long TermConditions, Low Intensity Therapies, Older Adults,Mindfulness, New Developments, Policy, Primary care, Self-esteem, Serious Mental Illness, Suicide Prevention,Therapeutic Techniques, Training, Schema-Focused Therapy

Confirmed keynoteand workshop speakers Eni Becker, David M. Clark, Michelle Craske, ChristopherFairburn, Melanie Fennell, Elaine Fox, Simon Gilbody, JohnGreen, Dougal Hare, Jennie Hudson, Sheri Johnson, IanMcPherson, Susan Michie, Rona Moss-Morris, Rory O’Connor,Martin Orrell, Lars Goran Öst, Tom Prout, Silvia Schneider,Imogen Sturgeon-Clegg, Mark Williams, Lucene Wisniewski,Marc van de Gaag, Jeff Young

For further details of topics and programme updates, please see the draftprogramme and visit www.babcpconference.com


| February 20134

Freud saw grief as the necessaryprocess of breaking attachment to alove object. Much of the thinkinglater in the 20th century was in theform of stages to complete in theprocess of adjusting to the loss. Thesestages can help people recognisetheir experience. If, however, they areseen as ‘normal’ and expected to berigidly followed, people can getunhelpful thoughts that their grief is‘wrong’ if it does not fit the model.

Bereavement by unexpectedtraumatic or violent incidents cancomplicate grief, while informationabout the deceased or the death maynot be so easily processed cognitivelywhen images or memories aretraumatic. A sense of losing controlor helplessness differentiates more‘normal’ grief from ‘complicated’ grief,with symptoms associated with PTSD.Complicated grief is not a formaliseddiagnosis, but experts suggest it is

distinguished by a sense of disbeliefregarding the death; anger andbitterness over the death; recurrentpangs of painful emotions, withintense yearning; and, intrusivethoughts and preoccupation withthoughts of the deceased. Avoidanceof situations and activities iscommon. Research shows shock,intrusive thoughts about thedeceased and resentment are mostpredictive of complicated grief. Theoverlap with PTSD in terms ofmechanism and symptom starts to increase.

Manualised complicated grieftreatment, mixing elements ofinterpersonal psychotherapy fordepression with elements of CBT forPTSD, has been shown to be effectivein RCTs. Meanwhile, recent data isencouraging: exposure and cognitiverestructuring was more effective thansupportive counselling in one study,

while one RCT has been moreeffective than interpersonalpsychotherapy in another.

Whilst there are clearly majordifferences to some other kinds oftrauma, it has been proposed that anapproach modelled on cognitivetherapy for PTSD might be helpful.After all, the cognitive model for PTSDhas been shown to be effective inseveral studies and tested specificallyin relation to conflict-related PTSD inNorthern Ireland.

The components of a cognitiveapproach to complicated grief will bepresented in my Belfast workshop.

For more information on otherworkshops, keynotes andsymposia taking place during theSpring Conference, please visitwww.babcpconference.com

Spring Conference preview

Cognitive approach tocomplex and traumatic grief

Michael Duffy, well-known for his work with Anke Ehlers and others in developing and disseminating effective PTSD treatment,is delivering a one-day workshop on 3 April at the BABCP Spring Conference, which this year takes place at Queen’s UniversityBelfast. Here Michael outlines the history of working with grief and where his novel approach fits in

Lancashire Care NHS FoundationTrust’s Early Intervention Service (EIS)is one of only two in the country tobe selected by the Department ofHealth as a demonstration site forpsychosis under the IAPT in SevereMental Illness (IAPT SMI) programme.

The wider IAPT SMI programme aimsto improve access to a range of NICE-recommended psychologicaltherapies for those with psychosis,bipolar disorder and personalitydisorders. The ultimate long-termambition of the programme is toensure that everyone with psychosis,bipolar or personality disorders whocould benefit from evidence-basedpsychological therapies has access tothese interventions.

The EIS specialises in working withindividuals aged 14 to 35 at risk of, or

currently experiencing, first episodepsychosis. The EIS delivers specialistinterventions through a modularprogramme, which will provide newopportunities for clients and theircarers, and promote optimismthrough to recovery.

Lancashire Care was also awardedfunding last year to transformchildren and adolescence mentalhealth access to psychosocialservices. As such Lancashire is one ofthe few sites nationally to offer IAPTacross its range of mental healthservices.

Care Services Minister Norman Lambsaid: ‘These sites will benefit thosewith the most severe mental illnessesand personality disorders, and willhelp policy makers, commissionersand providers better understand how

we can ensure people get the righthelp and support that is needed. Thesuccessful sites have been chosen fortheir experience in deliveringsuccessful support and treatment andI look forward to seeing the results ofthis initiative.’

Lancashire Care Chief ExecutiveHeather Tierney-Moore said, ‘This is afantastic example of one of the Trust’sservices working at national level tocontribute to the furtherdevelopment of improved outcomesfor service users and their families.’

Following the demonstration project,an evaluation will take place toidentify any improvements which canbe made nationally within mentalhealth service services for serviceusers who experience serious mentalhealth difficulties.

Lancashire hosts IAPT demonstration site for psychosis


| February 2013 5

Titanic Struggles for CBTQueen’s University BelfastThursday 4 - Friday 5 April


KeynotesOpening Pandora’s Box: Clinical Implications of theParadox of Unwanted Intrusions and IntentionalMental ControlDavid A Clark, University of New Brunswick, Canada

Challenges for CBT in Dealing withPersonality DisordersArnoud Arntz, Maastricht University, Netherlands

Innovations in the Treatment of Health AnxietyFreda McManus, Oxford Cognitive Therapy Centre, UK

WorkshopsComplex and Persistent Anxiety: AlternativeInterventions for Recurring Intrusive CognitionsDavid A Clark, University of New Brunswick, Canada

Schema Therapy for Personality DisordersArnoud Arntz, Maastricht University, Netherlands

Cognitive Behavioural Therapy for Low Self-esteemFreda McManus, Oxford Cognitive Therapy Centre, UK

A Cognitive Approach to Complex and Traumatic GriefMichael Duffy, Queens University Belfast, NI

Psychosis: Struggling to Break Free from the BiologicalDominanceAlison Brabban, Durham University, UK

Symposia have now been addedDeveloping CBT for Challenging ProblemsKate Gillespie

From the Inside Out: Supports for TherapistsPeter Armstrong, Newcastle University

Registration is now open!For further programme information and details on how toregister, please visit www.babcpconference.com


| February 20136

As usual, the pre-conferenceworkshops (held on Tuesday) will bedelivered by a wide range of worldclass speakers while the three days ofthe conference proper (Wednesday toFriday) will be a mix of presentationson the whole gamut of topicsguaranteed to appeal to the CBTpractitioner. This is the ideal place tolearn and participate, developingskills and updating your CPD.

This year’s themes include childhealth, long-term conditions, CBT inthe workplace, sex and sexuality, andsuicidality. All of these themes will bewell represented, with a lot morebesides. Whatever your area ofinterest or practice, there will beplenty for you. The ScientificCommittee has worked hard toensure that you will have a diverseselection of workshops, keynotes andsymposia which have practical as wellas theoretical implications. Thesubmissions have been coming inover recent months, and this processdoes not end until the finalsubmissions (open posters andpapers) arrive in early April. The finalprogramme will go online when thesubmissions are all in and the reviewprocess is finished. In the meantime,visit the conference website to get aflavour of what is to come.

There are keynotes and workshops bynational and international figures,including (in no particular order):

• Mark Williams (mindfulness andsuicidality)

• Michelle Craske (exposure therapyfor anxiety)

• Jeff Young (schema therapy)

• Jennie Hudson (anxiety in children)

• Melanie Fennell (self-esteem)

• Lars Goran Ost (one-sessiontreatment of specific phobias)

• Lucene Wisniewski (DBT for eatingdisorders)

• David M Clark (social anxiety,dissemination)

• Christopher Fairburn (training)

• Martin Orrell (dementia care)

• Mark van der Gaag (EMDR,psychosis)

• Simon Gilbody (depression)

A more complete list can be found onthe conference website.

The conference venue is located inLondon’s West End, with parks,museums and great shopping closeby. London is not as hilly as Leeds orExeter, but neither does it haveBrighton’s beach. You cannot have

everything! Accommodation hasbeen arranged close by, within easyreach of the venue and other parts ofcentral London. You can choosebetween rooms within a new studentresidence or rooms in a Grade 2-listedhall of residence adjacent to theRoyal Albert Hall.

Last but not least, the conference’ssocial programme. At the time ofwriting, details are not confirmed,apart from one hint: ‘boat disco’. TheScientific Committee hopes thatconference delegates will make fulluse of the opportunities to socialiseand network in the evenings, andLondon does have a lot ofopportunities! Keep checking theconference website for the latestnews and updates.

Remember that the conference iseven better value if you book before31 May 2013.

Looking forward to seeing you inLondon in July.


Annual Conference previewGlenn Waller, incoming Co-Chair of the ScientificCommittee, updates readers on what is in store at thisyear’s conference, which runs at ImperialCollege London from 16 to 19 July


| February 2013 7


Call for papersSubmit your research or clinical workas an OPEN PAPER or POSTER to the2013 BABCP Conference

We are delighted to receive submissions relating to clinicalresearch and clinical practice, including case reports. Workin progress is also welcomed.

BABCP Excellence Awards, judged by leaders in the field,are available for oral presentations, posters and casereports by trainees and new researchers. Winners willreceive free registration at the 2014 Annual Conference aspart of their prize.

Poster presenters will be offered the opportunity topublish their poster online.

Closing date - Tuesday 2 April 2013

For more information and to submit please visitwww.babcpconference.com

BABCP 41st AnnualWorkshops & ConferenceImperial College London16-19 July 2013


Leadership is a choice and not a role foreveryone, and great clinicians do notnecessarily make great leaders. Yet CBTpractitioners have valuable skills andqualities which can be applied toleadership.

Clinical leadership is at the heart ofrecent healthcare reforms and key toimproving the quality of care whichpatients receive. As clinicians we are onthe frontline and directly exposed to theproblems affecting patient care, so weare well equipped to judge the need,quality and safety of services. Cliniciansoften have ideas for improvement andinnovation so need to be at the centreof planning, decision-making anddelivery of services.

Much of the focus has been on doctorsand nurses taking on leadershippositions. Yet clinical leadership mustbe dispersed and shared acrossprofessions and at all levels. We all havea part to play and diversity inleadership supports the reduction ofhealth inequalities among patients.With the emergence of IAPT andchanges to mental health services, CBTtherapists have the opportunity to leadinnovative and novel ideas.

As CBT therapists we want to make apositive difference to individual lives.Leadership offers the opportunity tomake a positive difference throughimproved patient experience andimproved services, as well as to staffteams. Leadership is not a magic wandand does not necessarily mean holding aformal leadership role. Rather, it is aboutengaging and empowering others tocontinually improve healthcare on botha small and large scale.

Many of the skills used by CBTtherapists overlap with those requiredin leadership. Leaders need toappreciate the system and the contextin which they work in, just as CBTtherapists need to understand thecontext in which the individual facingthem and their problem exists.

Engagement, collaboration and theability to form and maintain effectiverelationships are skills which we usewith our clients everyday. They are alsocrucial to effective leadership.

Leaders help manage and lead change,helping teams to develop new ways ofworking which can present anxiety andresistance. Are these not the samechallenges we face in the therapy room?Leaders also enable people to managetimes when the plan does not work; withpatients we teach coping strategies tohelp when situations do not go to plan.

Leadership involves having a vision andworking towards a goal and this is whatwe help our clients to do also. The ‘plan-do-study-act’ quality improvement toolused by leaders relies on the sameprinciples as behavioural experimentsused in CBT: forming a prediction,planning an experiment, testing thisout and reflecting on the learning.Meanwhile, the use of data to drivedecision-making is becomingincreasingly important for leaders inhealthcare and, again, is mirrored in CBT

sessions where we might collect andmeasure data on the frequency ofchecking behaviours. Last but not least,CBT therapists are reflective,emotionally aware and passionateabout their jobs, highlighting furtherqualities which give us the potential tobe successful clinical leaders.

Medical training is putting a greateremphasis on leadership andmanagement, could this beincorporated into CBT training too? Iwould love to see more CBTpractitioners in leadership roles andhelping to lead the future of healthcare.

Rebecca works as a CBT therapist in aNHS IAPT service in London. She can beemailed at [email protected]. Theviews in this article are personal and donot necessarily represent those of theorganisations she is associated with.

Details of the NHS ClinicalLeadership Fellowship can be foundat: http://is.gd/NHSLeadership

Future leaderBABCP member and CBT therapist Rebecca Minton (pictured) was awarded a place on the NHSClinical Leadership Fellowship in competition with clinicians across all disciplines in the NHS. Runby the NHS Leadership Academy, an organisation which promotes the development of futureNHS leaders, this one-year programme involved a combination of academic study, experientiallearning and application of leadership skills through a service improvement project. Rebecca wasthe only CBT therapist on the programme, out of a cohort of 60. CBT Today invited her to reflecton why CBT therapists should be leading

| February 20138


| February 2013 9

ProfessorMalcolmAdamsProfessor Malcolm Adams, Co-Director of the ClinicalPsychology Programme at theUniversity of East Anglia, passedaway on 2 January 2013, aged62. Although Professor Adamswas not a BABCP member, hewas known to many in theAssociation. One of his legacieswill be the work he wascommissioned to undertake byBABCP on Standards ofProficiency. Professor Adams’family is inviting people to makedonations to Mencap orAmnesty International in his memory.

Leading BABCP members have been recognised in theQueen’s New Year’s Honours List for their services in thefield of behavioural and cognitive psychotherapies.

Professor David M Clark (pictured) hasbeen awarded a CBE for services to mentalhealth. His research has focused oncognitive approaches to the understandingand treatment of anxiety disorders, whichhas led to the development of new andeffective cognitive therapy programmes for

four different anxiety disorders: panic disorder,hypochondriasis, social phobia and PTSD.

Professor Clark has been involved with the IAPTprogramme since its inception and is currently the NationalClinical Advisor.

He currently holds the Professor of ExperimentalPsychology at the University of Oxford, where heestablished the Oxford Centre for Anxiety Disorders andTrauma. He is also a Visiting Professor at the Institute ofPsychiatry, King’s College London.

Professor Janet Treasure, Director of the Eating DisorderUnit at the Institute of Psychiatry, has been awarded an OBEfor services to people with eating disorders. ProfessorTreasure is a Consultant Psychiatrist who has specialised in

the treatment of eating disorders for more than 20 years.She is Chief Medical Adviser of the eating disorders charityB-eat, and is Director of South London and MaudsleyNHS Foundation Trust’s inpatient unit at the Bethlem Royal Hospital.

Steve Regel, Principal Psychotherapist at NottinghamshireHealthcare NHS Trust and co-Director with Stephen Josephof the Centre for Trauma, Resilience and Growth, has alsobeen awarded an OBE for services to victims of trauma.

BABCP President Professor Trudie Chalder said: ‘I know allthree members and am delighted that their efforts have beenrewarded appropriately. All three have dedicated theirworking lives to addressing the needs of people withspecific problems through CBT. On behalf of the Board, I wantto say how proud we all are of their achievements. I amsure I also speak for the whole Association too.’Knighthood for Leeds keynote speaker

Professor Simon Wessely, who gave a keynote at last year’sBABCP Annual Conference in Leeds, was awarded aknighthood for services to military healthcare andpsychological medicine. Sir Simon is currently Professor ofPsychological Medicine, Director of King’s College London’sCentre for Military Health Research and Vice Dean forAcademic Psychiatry at the Institute of Psychiatry.

Children, Adolescents and Families Special Interest GroupBritish Association for Behavioural & Cognitive Psychotherapies

www.babcp.com/cafsig

Workshops and Conference 2013

CBT for Children, Young People and FamiliesAddressing the challenges faced by users and practitioners in accessing and providing services

11-12 April 2013, University of BirminghamOnline registration is now open:www.formstack.com/forms/eyas-cafsig

Conference themes:• Improving access to CBT services for young people, and families• Training and supervision• CYP IAPT• CBT for specific populations such as young people with

developmental disorders and learning difficulties• Ways of communicating with young people using novel and old technologies• Clinical skills in both disorder specific and transdiagnostic approaches

Keynotes andPre-conference workshops by:• Bill Yule• Paul Stallard• Robert Friedberg• Sabine Wilhelm• Susan Bogels• David Trickey• Anne Stewart

For further information please visit www.babcp.com/cafsig

BABCP members recognised inNew Year’s Honours


Bromley’s IAPT service is a partnershipbetween Bromley Mind and astatutory provider. Bromley Mindprovides low intensity CBTinterventions to people experiencingmild to moderate anxiety disordersand depression, as well asemployment support and jobretention services to people accessingboth high and low intensityinterventions. The statutory provideroffers high intensity CBT interventionsand counselling for peopleexperiencing moderate to severeanxiety disorders, depression and PTSD.

We began developing and pilotingways of involving clients at Step 2, inline with recommendations in the2006 NHS Act that both service usersand members of the public beconsulted in the planning andprovision of services, as it is believedthat this produces better outcomes ofcare. When developing our model,which was initially limited to serviceusers in the low intensity CBT part ofthe service, we noted that ‘serviceuser’ implies a continuous relationshipwith a service. The time-limited natureof IAPT therapeutic interventionsmeans that service users typicallydevelop relationships with individualtherapists, rather than with the wholeservice. We were also aware of thepossibility of fostering a dependencyon the service by encouraging clientsto volunteer their time beyond givingfeedback about the experiencereceived, which runs counter to theIAPT focus on self-management ofsymptoms and recovery.

As we wanted service user feedback tobe a focus for real changes to servicedelivery, service users wereencouraged to position themselves as‘consultants’ to the service,volunteering their time in a short-termand task-specific manner. In return wewere able to gain advantage fromfeedback and use service users’ inputin specific ways, such as sitting oninterview panels and advisingpartnership forums.

In Bromley’s IAPT service we call ourservice user consultants ‘Associates’. Allservice users on the Associates

Programme are paid and involved at alllevels from strategic planning to focusgroups. There are a number of otheropportunities available to clients afterthey have been discharged from theservice, which include attending andfacilitating focus groups, training newAssociates, writing promotionalliterature, reviewing self-help materials,involvement in staff recruitment anddelivering PWP training.

In addition to providing therapy, IAPTservices can help people back intoemployment or to stay in work. Ourmodel reflects this by providing anopportunity for Associates to developtransferable skills which are valuablewhen seeking employment.Associates have a role description andperson specification and each one iscontracted to deliver consultancy tothe service. In turn, the service is ableto provide references for Associates,which can enhance their prospects ofreturning to work if currentlyunemployed.

Our Associates Programme has beenpopular with clients, to the extent thatthere are currently more Associates onthe database than opportunities. Thiscould result in opportunities forAssociates being created which arenot genuinely required. We must,therefore, manage Associates’expectations by emphasising thatopportunities for involvement aretime-limited and task-specific, whilenot encouraging Associates to offersupport over a long period of time.

Presently, white, middle-aged womenform the majority on our database,which is consistent with the currentdemographics of those accessing theservice. We expect to see an increasein service users from diversebackgrounds when it is open to self-referral, which we hope will besubsequently reflected in thedemographics of the AssociatesProgramme. Links are being made bythe service with community groups toencourage self-referral when thisoption becomes available.

As a result of feedback from Associatefocus groups, there have been anumber of changes to the service,

including self-help workshops forclients on waiting lists, clients beingseen in more appropriate locations,completing routine outcome measuresprior to (not during) appointments andproviding clearer information ontreatment options at the point of opt-in to the service. There have also beena number of positive outcomes forstaff including increased opportunitiesto reflect on practice, and enhancedmotivation and morale. Associateshave reported positive outcomes too,including being able to ‘give back’ tothe service, having a sense of value aspaid ‘experts by experience’ anddeveloping knowledge, skills andconfidence.

The Associates Programme isgradually being rolled out to theservice as a whole.

In our opinion, the optimum way toencourage meaningful service userinvolvement is to share best practiceby discussing our work withcolleagues in other IAPT services.Some of you may have heard ourpaper about the Associate Programmepresented at last year’s BABCP AnnualConference in Leeds. We also believethat service user involvement is a vitalpart of staff development within ourIAPT service and have includedAssociates in staff training. Wewelcome contact from other IAPTservices and are happy to providemore details of the AssociatesProgramme, as well as BABCPmembers interested in setting-up aforum or discussion group on serviceuser involvement. Please [email protected].

Sinead Brennan is a Senior PWP atBromley Mind and a Clinical Tutor atUniversity College London

Clare Coppock is a PWP at BromleyMind

Jocelyne Kenny is a Trainee ClinicalPsychologist at Royal Holloway,University of London

Frances Westerman is a Senior CBTPsychotherapist and Psychological

Transforming service userinvolvement in South LondonSinead Brennan, Clare Coppock, Jocelyne Kenny and Frances Westerman write about theirexperience of developing Bromley IAPT’s Associates Programme

| February 201310


| February 2013 11

The service user’s storyAs a CBT service user in North Wales,I (like so many) feel a real need tostand up, shout out loud and give mystory in order to try and raiseawareness about the lack of CBTtherapists and services within theNHS here in Wales.

I have suffered with OCD for over 30years. Due to the lack of knowledgefrom doctors and NHS therapists, aswell as the lack of NHS services, Ispent 23 years with an undiagnosedillness, which was no fun, believe me. Igot passed from pillar to post andwas given various kinds ofmedication, from beta blockers todiazepam to antidepressants. Nothingwas working, and for sure the tabletswere having absolutely no effectwhatsoever, except turn me into awalking zombie. I was referred to anNHS therapist for the usual six toeight sessions. To be brutally honest,they just hadn’t got a clue what OCDwas, and I’m certain they had no CBTtraining whatsoever.

About seven years ago, my OCD wasso bad I had not far off 500 separateand differing ‘OCD habits’. Thesewould occupy up to 95 per cent ofevery day and quite literally made lifeunbearable. On numerous occasions Ihad contemplated ending it all. Onceagain I was going back and forth tothe doctors, and once again beinghanded more and more medication.Things just became ‘too much’ and itwas having a very large and directimpact on my 19-year relationshipwith my wonderful wife. She wasalso at her wits’ end and felt sofrustrated herself that she couldn’thelp me. My eyes still fill up to thisday when I remember the pain I musthave put her through. On my last andfinal bid for help, I went back to thedoctors and, fortunately for me, I wasseen by a locum. He had heard ofOCD and CBT (I had never even heardof OCD or CBT until then). He wasable to refer me to my local mentalhealth team in Bangor, which is whereI met my CBT therapist Keith Fearns(who, might I add, has quite literallysaved my life). Not only did I nowfinally know what was wrong withme, but I wasn’t alone! There wereother people just like me with thesame problems. You cannot imaginewhat a relief it was to know that Iwasn’t on my own.

I continued to receive my weekly CBTsessions with Keith in my own home,which was hugely helpful becausethat was where the problem resided.This continued right up until the NHSdecided that they didn’t need a CBTservice in Bangor anymore and, as aresult, my therapist retired! So there Iwas, finally knowing what was wrongwith me and what treatment I

needed, yet having absolutely no NHSservices to help me and other sufferers.

I have continued to see Keithprivately on a weekly basis. It doescost, but what cost can you put onlife? Fortunately, my wife has a prettygood job so we are able to afford thesessions. God knows what I would doif she didn’t.

CBT has been a life saver for me. Ithasn’t just given me my life back, butit has given my wife her husband backand our little girl her daddy back (aproper daddy rather than one whospends 16 to18 hours a dayconsumed by OCD). Without myamazing therapist working tirelesslyto give me CBT for OCD, I am certainthat I wouldn’t be here today writingthis article. Thank you to everyonewho is working tirelessly to get CBTrecognised as a genuine treatment forOCD. Now let’s see what we can do toget it recognised in Wales as well.

Deon Gorle

The CBT therapist’s storyCurrently, Wales has 56 BABCPAccredited CBT therapists livingwithin its borders. It is likely that agood number of these live in Walesbut actually work in England, giventhat that pay structures and careeropportunities are much morefavourable across the border.

Whichever way you look at it, this isdisappointing reading for people inWales in need of CBT. Put anotherway, for a population of three million,there is one BABCP Accredited CBTtherapist for every 54,000 people in

Welsh vistasTo mark the launch of #CBT4Wales, CBT Today has commissioned a series of articleswhich tell some of the personal and professional stories inspiring this initiative

Continued overleaf


| February 201312

Wales. This compares unfavourablywith England (one for every 17,000people), Northern Ireland (one forevery 21,600 people) and Scotland(one for every 30,900 people).

On 2 November 2010, the NationalAssembly for Wales passed theMental Health (Wales) Measure intoWelsh law. This makes it a legalrequirement to provide assessmentfor people with mental healthproblems. This will mean a massiveshift of resources into the process ofassessment to the detriment oftherapeutic intervention. There isalready talk of a 24-page assessmentdocument, and of staff being movedaway from intervention intoassessment roles.

Last March, the Welsh Governmentlaunched its policy implementationguidance on psychological therapiesin Wales at a conference promisinglycalled ‘Improving Access toPsychological Therapies in Wales’. Atthe outset, this Welsh IAPT documentclaims that it intends to follow theNICE guidelines for the treatment ofmental health problems. The briefestof scans of the NICE guidelinesshould lead anyone to the conclusionthat the most frequentlyrecommended talking therapy is CBT.Yet the document proceeds topropose a ‘range of psychologicaltherapies’. It contains an appendixlisting the range of talking therapies

presently available in Wales. This ismysterious since most of thetherapies on their list do not appearin NICE recommendations.

A study carried out by Rebecca Juryand Louise Waddington at CardiffUniversity drew some starkcomparisons between Scotland andWales. Scotland ‘specifies thecharacteristics of patients who canexpect to receive high intensitytherapy, the number of sessions thatthey can expect, and crucially thelevel of training and competencerequired for their therapists’. Wales,however, has ‘not yet specified whichpatient groups or level of difficultiesshould access formal psychologicaltherapies, which psychologicaltherapies are considered to beevidence-based, the recommendednumber of sessions patients canexpect, or the qualifications of thepractitioner. No competence modelor minimum training criteria arespecified for CBT therapists.’

The Welsh Government has providedno funding for their IAPT initiativesuch as it is. There is only one CBTtraining centre in Wales, at CardiffUniversity. This is presentlyundergoing the BABCP Accreditationprocess. If it is successful, it willprovide only 16 places for studentsand will receive no funding from theWelsh Government.

Welsh Local Health Boards, then, are

left with real dilemmas. Do theybumble along with a range ofpsychological therapies or try toprovide some sort of service whichapproximates to what isrecommended by NICE? Many Boardswill be tempted to opt for quick andcheap in–house CBT training coursesfor existing staff, with the inevitableoutcome of poor continuingsupervision leading to interventionsspuriously purporting to be CBT.

The presentation that Deon and Idelivered at the OCD-UK conferencein November was entitled ‘ChwaraeTeg’ (Welsh for ‘Fair Play’). It is evidentthat the people of Wales are not beingtreated fairly when it comes to CBT.

Keith Fearns

The nurse’s storyI am committed and passionateabout training in CBT. I haveconducted a lot of research andattended conferences outside of mywork time and I have worked inhealthcare, including mental health,for over a decade.

Until this enormous shortfall in accessto psychological therapies isaddressed and improved in Wales, Ido not think mental health servicescan call themselves person-centred. Iwork on the frontline with peopleexperiencing acute mental ill-healthwho have to wait 18 months for

A video, in which Deon Gorle talksto his CBT therapist Keith Fearnsabout how CBT has helped himclaim back his life from OCD, is thefirst to appear on BABCPtv.

Using the popular video-sharingwebsite YouTube, BABCPtv has beenset up to help raise awareness ofCBT to a wider lay audience as partof the Association’s public outreachactivities.

The video, called CBT for OCD,wasmade in support of #CBT4Wales and shown during the initiative’slaunch at the OCD-UK conference in November.

The video offers powerful testimonyfrom someone whose life has beenpositively transformed by CBT, whichin turn has significantly improved thequality of life for their loved ones.

To watch the video, please go towww.babcp.com/tv.

It is hoped that more videos,particularly from members of thepublic talking about theirexperience of CBT, will be added tothe BABCPtv page on YouTube soon.If you would like to submit a videofor inclusion on BABCPtv, pleaseemail [email protected].

Deon’s story launches BABCPtv

Welsh vistas Continued

The comments expressed in videoson BABCPtv are those of thepresenters and do not necessarilyreflect the views of BABCP or any ofits Trustees.


| February 2013 13

psychological therapies. The sheerfrustration is what keeps me awake atnight! This does not reflect a servicewhich meets the needs of a person. Istruggle with this on a personal,professional, ethical and a caringhuman being level. The service willnot allow me to be the nurse I wantto be.

I have also lived with mental ill-healthfor almost 30 years and have justfunctioned enough to always work. Ihave friends and relationships but ithas been the biggest struggle of mylife to date. My mental ill-health haspermeated every aspect of my life likea dark fog seeping into everything Ithink and do. Apart from medicationand five out of the standard six freecounselling sessions through my GP, Ihave never received a psychologicalintervention. Incidentally, thetherapist cancelled the sixth one as itwas deemed I needed long-termtherapy so there was no point to afinal session - don't get me started onpeople being expected to fit theirstory into six 50-minute slots! Myoptions are to wait 18 months for CBTor pay to access it privately, as it is forso many others.

I feel utterly disheartened about theservice I work in not meeting theneeds of the people who use it,especially when I see the distress. Iknow that the help is out there, but itis not here in Wales! Lots of people,including myself, would love to trainas a CBT therapist but there arecurrently no BABCP Accreditedcourses in the whole of Wales. Don’tget me started on that one, either!

CBT is the gold standard treatmentfor so many mental illnesses asrecommended by the NICEguidelines. The fact that it is sodifficult to access is, in my opinion,neglect and must be addressed as amatter of urgency.

Name withheld

The charity’s storyDuring the recent OCD-UKconference, held in Cardiff, we heardmany harrowing tales from Welshservice users who were failing toaccess suitable CBT to help themovercome, and recover, from thedebilitating nature of their OCD.Many of these service users had towait months, even years for CBT. Even

then, they were offered treatmentwhich lacked a quality understandingof OCD. This can, perhaps, be bestechoed by the following story.

During the summer of 2011, OCD-UKwas approached by the anguishedmother of a young man in his 20sliving just outside of Newport. Toprotect anonymity, we shall call himSteve. Despite having been previouslydiagnosed with OCD prior to thesummer of 2011, Steve attended anappointment with an OT MentalHealth Worker following a relapse ofhis OCD. During his appointment,Steve reported that he was havingintrusive thoughts about harmcoming to his family in addition tothoughts that he may cause harm to

his family. At no point did he indicatethat he wanted, or intended, to causeharm.

Intrusive thoughts of harming a lovedone are a common symptom of OCD.Since OCD-UK was formed in 2004,we have never been informed abouta single case of an OCD suffereractually acting on their thoughts.

What happened next was a tale ofwoe and a catalogue of failures toassess the situation, and the risk,which Steve posed. The OT reportedSteve’s intrusive thoughts to othermembers of the service, includingSocial Services. A care meeting wasconvened to discuss risk, but Steve

Continued overleaf

BABCP Accreditation figurescorrect as of 31 December 2012

ScotlandPopulation: 5.25 million

BABCP AccreditedCBT therapists: 170

One BABCP Accredited CBTtherapist per 30,900 people

EnglandPopulation: 53 million

BABCP AccreditedCBT therapists: 3,079


Northern IrelandPopulation: 1.75 million



WalesPopulation: 3 million




| February 201314

was not in attendance. Neither was heassessed again prior to the Policebeing sent to his house. Steve wasremoved from his property, informedto stay away from his children andforced to spend that night sleepingon the back seat of his car. At nopoint did any of the various agencyworkers involved ask if thesethoughts could be related to his pre-diagnosed OCD. It then took the LocalHealth Board nearly two weeks toarrange an assessment to identify ifSteve was a risk to his family or not.

Thankfully, that second assessmentcleared Steve to return to his familyhome, and no long-term damage wasdone to Steve or his children. All ofthis could have been avoided byhaving some basic understanding ofhow OCD can manifest itself in somepatients. It should no longer beacceptable for a patient with OCD to be put through such a traumaticexperience, especially when thepatient already had a diagnosis of OCD!

That story, and others like it, happenbecause there is a severe lack ofawareness and education amongsthealth professionals about OCD. Eventoday, some people, including GPsand mental health professionals, stillthink OCD is just about hand-washing.

Wales could, and should, steal amarch on offering quality mentalhealth services in comparison to

other parts of the UK – if they wantedto? Whilst IAPT across England hasimproved access to services(arguably), we are still hearing dailytales from service users that theirIAPT health professional simply failsto understand OCD. Dare we suggestthat IAPT is focussed too much onquantity rather than quality? I amsure many BABCP members will notapplaud us for suggesting this. Froman OCD perspective, however, IAPT isgenerally failing those who sufferwith OCD. The time has come forhealth professionals to start listeningto charities working on the frontline.

This is where Welsh Health Boardscould take a lead in providing qualityservices. The formation of#CBT4Wales, launched by KeithFearns and Deon Gorle at our Cardiffconference, can only serve to improveaccess to CBT. But, we have to send awarning and issue a challenge:providing CBT across the whole ofWales is important, but it is pointlessif CBT therapists’ knowledge andunderstanding about conditions likeOCD is flawed and lacking in quality.You must focus on quality trainingand treatment, and make CBT inWales the envy of the rest of the UK.

Kylie Cloke and Ashley Fulwood,OCD-UK

Welsh vistas Continued

Get involvedIf you would like to see how youcan support #CBT4Wales, pleaseemail [email protected]. There isalso a dedicated page on theBABCP website atwww.babcp.com/wales.

For more information on OCD-UK,please visit www.ocduk.org


Henck van Bilsen is known to manyreaders as a highly-regarded CBTtherapist, trainer and supervisor. He isalso a self-confessed opera buff whorecently admitted that his recentattendance at a conference may havebeen best explained by its closeproximity to the world famous La Scalaopera house in Milan (pictured above).CBT Today invited Henck to talkabout his operatic passion and whatinsights this art form offers thoseworking in mental healthcare

Opera and me

I became interested in opera throughmy dad. When I was young, one of hisfavourite pastimes was listening toBeniamino Gigli (an Italian operasinger, the most famous tenor of hisgeneration). My mother hated operawith a vengeance and became quitehysterical every time she ‘caught’ myfather indulging his passion. Nowaged 86, he can only repeat mymother’s verdict, that opera is ‘awful,just some fat people screaming aboutnothing, I don’t understand why youlike it’. But I still remember theabsolute stillness, the sparkle in hiseyes and the occasional tear when heplayed some of Gigli’s tapes.

Badness and madness

Opera has so many things to offer formental health professionals, fromclear-cut examples of evil-doing (inOtello, Lucia di Lammermoor, Tosca,Turandot, Don Giovanni and Rigoletto,to name a few) to examples ofirrational thinking (L’Elisir d’Amore,Carmen and all the above). It showsstories focused on all of humanity’sweaknesses: greed (Lucia diLammermoor); jealousy (Otello);psychopathy (Don Giovanni) and love(La Bohème, L’Elisir d’Amore). This is byno means an exhaustive list of thetopics which operas deal with.

Opera is full of drama. Indeed, theaudience at the Metropolitan OperaHouse in New York got more than itbargained for with the actual deathmid-performance of one of itsgreatest stars. In March 1960, whileperforming Verdi’s La Forza del

Destino, the great baritone LeonardWarren completed his second actaria, O Gioia (Oh Joy, which begins‘morir, tremenda cosa’, meaning ‘todie, a momentous thing’), and pitchedforward dead. That evening, for one ofthe very few times in its history, theMet’s show did not go on.

La Bohème

Many operas contain lessons on lifeas well as helpful hints for practisingmental health clinicians. To illustratethis, I have chosen one of Puccini’sgrand operas, La Bohème. This is anopera in four acts with an Italianlibretto by Luigi Illica and GiuseppeGiacosa, based on Henri Murger’sFrench novel Scènes de la Vie deBohème. The world premiere ofPuccini’s La Bohème took place inTurin on 1 February 1896 at theTeatro Regio, conducted by theyoung Arturo Toscanini.

Bohemians were seen as peoplepractising an unconventional lifestyle,often in like-minded company, withfew permanent ties, involvingmusical, artistic or literary pursuits.This use of the word ‘bohemian’ firstappeared in the English language inthe 19th century to describe the non-traditional lifestyles of marginalisedand impoverished artists, writers,journalists, musicians and actors inmajor European cities. Five of themain characters in La Bohème areartists: Rodolfo is a poet, Marcello is apainter, Schaunard is a musician,Colline is a philosopher and Musettais a singer. The two remainingcharacters are non-bohemian: Mimi is

a seamstress and Benoît is a landlord.

The story is as follows: In 1830s Paris,four arty types shiver in theirapartment, owing rent. When one ofthem - the musician Schaunard -earns money, they are all set to go fora meal in a nearby restaurant.Rodolpho, the poet, stays behind tofinish his writing and is interrupted byMimi, a seamstress, from aneighbouring apartment. They areinstantly attracted to each other andcatch the others up at the restaurant,where Rodolpho's painter friendMarcello is re-acquainted with hisflirtatious ex-girlfriend Musetta, whodumps her current lover after gettinghim to pay everyone's bill. Sometimelater, Musetta and Alfredo are livingtogether, as are Mimi and Rodolpho,but he is aware that she hastuberculosis and is mean to herhoping she will leave him forsomeone who can take better care ofher. Eventually she does, whileMusetta also splits from Marcello. Thefour men resume living together in anapartment. They are visited byMusetta, who has sought out Mimi,now living with a wealthy count, butdying, and has brought her back todie in the presence of her true loveand friends. Musetta and Marcelloreunite as Rodolpho cries over thedead body of his Mimi.

Lessons from act one

I have selected a scene from the firstact of La Bohème to focus on lessonswe can learn as practising mentalhealth professionals from opera.

Wik

imed

ia C

om

mo

ns

- On

Dit

Wikim

edia C

om

mo

ns - o

2ma

Lessons we can learn from

opera

| February 2013 15

Continued overleaf


| February 201316

Rodolfo and Mimi are alone in theapartment, all the candles have beenblown out, it is dark, Mimi is about toleave, but before she does Rodolfotakes her hand and introduceshimself to her (in the form of a ratherbeautiful aria). They have beensearching for Mimi’s key to herapartment. Rodolfo has found thekey, but hidden it as he wants tospend more time with Mimi.

Even when it is completely dark you canfind happiness

Mimi and Rodolfo have beensearching in the dark and they stillfind ‘something’: happiness inmeeting. In forensic psychology andpsychiatry, there is a strong emphasison evidence-based interventions andformulation-driven treatmentprogrammes. This is all based onknowing exactly what one is doingand why it is being done. However, invery complex situations, it can pay offto apply nature’s best approach,which in the end always producesresults. You do not always need toknow where you are going in order toget somewhere. With complex andmulti-problem patients, it may be agood idea to carefully start‘somewhere’ with interventions,instead of waiting until all the factsare known, evaluated and weighted.In other words, even without a nicelypolished formulation (you are in thedark), tentative and careful steps canproduce satisfying results.

Keep an open mind, even if you havefound what you were looking for

Mimi and Rodolfo continue lookingfor the key, even after Rodolfo hasfound it. Sometimes the answer isreally blowing in the breeze andtherefore not important. It is thebreeze which counts, letting it dictatewhere you are heading even after youhave found the answer. This may leadto interesting and uplifting results. Inthe field of mental health, the effortsof a clinician or clinical team toooften come to grinding halt after adiagnosis has been identified or atreatment programme pathway hasbeen selected. How the patientresponds to the specific interventionsalmost becomes a sideshow (becausewe know, based on the evidence, how apatient ought to respond and patientsresponding differently are justdifficult…). Going with the patient’sidiosyncratic response to our

interventions has become a ‘not-done’ in this Zeitgeist of protocolisedand manualised interventions.Finding the protocol (‘the key’) andcontinually being open toadaptations are what we learn fromthis excerpt. Let’s face it, if Rodolfo,upon finding the key would havesaid, ‘Oh, found it, here it is, goodbye’,we would have missed out on a fine opera.

Not all irrational thinking is bad andneeds to become the focus of therapy

Rodolfo sings, ‘Where in spirit I am amillionaire’. Put another way, he isvery poor but feels as if he is amillionaire and it makes him happy. Inmental health, we frequently behavelike the ‘thought police’ and pursuerelentlessly any thought or ideawhich does not conform to our ownperspective of rationality and reality.Reality is simply an option. Ifsomeone chooses to believe in anoption of reality not shared by us andit does not cause problems, perhapswe should congratulate the patienton their creative problem-solvinginstead of challenging their ‘incorrectappraisal of reality’.

It is better to lead a life worth sufferingfor, than to avoid all suffering in life

‘Yet sometimes from my safe, all mygems are stolen by two thieves, a pairof lovely eyes!...Beautiful dreams I'dcherished, immediately vanishedwithout a trace’. When Rodolfo singsthese words, he is indicating that heknows that he is on a path which willbring suffering, but he accepts it as

part of life. Too often in the field ofpsychiatry and psychology, sufferingis mistaken for pathology. Yet,suffering is part of life and we shouldnot teach our patients to avoidsuffering but how to lead a life whichis so good, it is worth suffering for.

Finale

Opera is an experience which isdependent on all its individualcomponents working well together:conductor, orchestra, singers andmise-en-scène all need to be inharmony. In mental health practice, itis exactly the same. Conducting CBTdemands that the right questions areasked at the right moment; to startwith agenda-setting at the end of thesession is not really the done thing!The words need to be spoken withthe right emotional tone. Inresidential mental health settings,there are even more componentswhich need to work together in orderto create a meaningful treatmentprogramme. Just like in opera, manyof the critical factors may not beimmediately visible. In opera, theorchestra is often not visible, whilethe creative team (design, directionand choreography) are never foundon stage, but their contributions allhave an impact on the quality of theend product. The same goes formental health practice: the actualphysical surroundings are often takenas a given, while the firstgreeting may gounnoticed. Nevertheless,they are important factorsin the quality of our care.

Chester, Wirral & North East Wales BranchSpring Programme 2013

12 March 2013 Introduction to Narrative Exposure TherapyOne-day workshop by Katy Robjant10.00am to 4.00pm (registration from 9.30am)Venue: Chester Rugby ClubBooking for this event is via BABCP, please email [email protected] telephone 0161 705 4304

24 April 2013 Exposure Therapy for Anxiety DisordersEvening talk by Mike Davison6.30-8.30pmFree to BABCP members, £10 for non-members (no need to book)Venue: Chester Rugby Club

15 May 2013 Is CBT a Profession - Yes or No?*Evening talk by Ken Lewis6.30-8.30pmFree to BABCP members, £10 for non-members (no need to book)Venue: Chester Rugby Club* This event is followed by the Branch AGM

www.babcp.com

Continued


| February 2013 17

I have been a mental healthpractitioner since 1981 and in CBTpractice since 1987. Throughout mycareer, I have noted the difficultiescaused by clinicians or services whofail to recognise and cater for thespecific needs of people fromdifferent cultural backgrounds. Hugeefforts have been made in someareas to ensure greater equality inaccess to, and delivery of, qualityservices designed to effectivelysupport clinical needs. There hasbeen slow but steady growth in theawareness of trans-culturalpsychological issues, gender, sexualorientation and age, as well asimprovements in the understandingand support for specific areas ofdifficulty in patients’ lives.

However, there remain blind spots.

There is one ‘cultural issue’ whichtranscends ethnicity, age, gender andsexuality, and that is the matter of class.

I was born into a working class familyfrom a working class area of London.My generation of the extendedfamily has ‘done well for ourselves’educationally and professionally. Yet,since my time as a student RMN at aSouth London teaching hospitalthrough the many stages and diversegeographical locations of my mentalhealth career, I have been curious asto why, what remains essentially amiddle class profession seems tostruggle so hard to be able toidentify with, understand andsupport the needs of working classindividuals. This is particularly true for the ‘underclass’: the unwaged,welfare benefit-dependent section of our society.

How come a profession which

encourages an understanding of theworkings of the mind, the structure ofthinking, the development of beliefsystems and their impact onbehaviour and emotion, so often failsto recognise where the other personmight be coming from? Is it because,even now, most clinicians inhealthcare come from middle classbackgrounds with the experience andattitudes which this entails? Workingclass and upper class individuals donot appear to have the samedifficulty recognising and acceptingthe diversity in thinking which classconformity may generate.

To illustrate, let me describe how, earlyin my training when I was a second-year student nurse, I was allocated toa placement at a Cottage Day Hospital(CDH) within a large psychiatrichospital, with a catchment areacovering much of South West London.

It is the days of the weekly grandround, the whole team has met toreview patient treatmentprogrammes. I am the most juniormember there, but still expected tocontribute. We are discussing adepressed young man in his early 20swho has been attending the CDH forseveral weeks. He does not appear tobe making any progress and, despitebeing placed into several therapygroups, appears reluctant to engagewith therapeutic activities. The keyworker in this case is our dancetherapist, who has given us feedbackabout her concerns regarding hisfailure to engage. Possible solutionsand treatment options are discussedwith much concern expressed abouthis reluctance to engage and hisresistance to treatment. Thediscussion moves around the room

with each member of staff in turnexpressing opinions, giving feedbackabout interventions and makingsuggestions for further treatment.

I am asked for my opinion.‘Hasanyone thought that maybe thisbloke has just been placed in thewrong group?’ Silence. All eyes turn tome as the consultant asks why I feel Ican question the experience anddecisions of more senior staff. In for apenny, in for a pound, I replied,‘Hisfamily and friends all work in thebuilding industry. When he walkedout of the dance session, he said that,if they knew he had been asked toexpress himself as if he were a treebuffeted by strong winds, hell wouldfreeze over before they stoppedmaking jokes at his expense.’

This experience has been repeatedmany times over the years. It is sadthat many clinicians lack the ability tounderstand the real circumstances oftheir patients’ lives and the culturaldeterminants of their behaviour.

I went into independent practice in2007. The issues around engagementwith therapy, which I observed in theNHS, leading to mutualmisunderstanding, frustrations andmisperceptions, equally apply here.The proportion of working classpatients in my caseload is in facthigher than at any time during myNHS practice. This may explained bythe number of referrals from themotor insurance sector followingRTAs and personal injury claims.

My experience of talking to manyblue-collar workers, who possesspractical skills but few academic

Diversity matters

Class actThe 2010 Equalities Act 2010 makes economic and social differencesa diversity issue. Barbara Swinburne asks to what extent CBTpractitioners consider social class in their delivery of therapy

Continued overleaf


| February 201318

Therapies Manager at Bromley Mind

Roz proved to be an inspiring speakerand demonstrated an easy mastery ofher topic. She presented thetheoretical background and thetransdiagnostic aspect of the subject,focusing primarily on the assessmentand treatment of this relevant andsometimes overlooked issue.

We explored the most effective waysof assessing and formulating, keepingthe formulation simple, relevant andunderstandable and differentiatingwhich domains of the client’s worldwere affected and which remainedintact. We had the opportunity todiscuss the model of treatment,which Roz has been involved indeveloping, identifying problems inengaging this client group andexploring engagement approaches,treatment strategies, treatmentevaluation and blueprints for staying well.

We took time to reflect on thestructure and content of sessions,

identifying how treatment will differfrom standard CBT sessions as well astherapy blocks which we mightexpect to encounter in the course oftreatment. This was complementedwith DVD and case study examplesfrom Roz’s own clinical practice. Therewas plenty of time for discussion andquestions from a very engagedaudience and the day came too aclose too quickly.

If there is something innovative youhave done in your work area orpractice or a topic in which you havea specific interest or skill and you feelyou would like to share it with us atone of these evenings, then pleasecontact one of the Eastern CountiesBranch committee members for aninitial chat.

To find out about our future events,including a series of eveningworkshops, please visitwww.babcp.com/CPD.

Branch news is moving onlineNews, views and reviews from the thriving network of Branchesand Special Interest Groups is moving to ‘The Roots’ area ofBABCP’s online forum CBT Café. Share your experiences, presenterfeedback and upcoming events, while enjoying the benefit ofgetting the word out as soon as possible and engaginginteractively with current and potential new recruits. If youhaven’t registered already for CBT Café, go towww.babcp.com/cafe and register your details to make full useof the online forum. Make sure you create a user name which isthe same as that of your Branch or Special Interest Group. If youneed any assistance, please email [email protected].

qualifications, is that often self-esteem and confidence are investedin being good at what they do. Whenillness or injury takes that away,entering into a process of therapy isnot only alien to their usual copingstrategies, but further impactsnegatively on esteem and confidencecausing both stress and difficultieswith mood management.

Attendance at sessions may bedifficult for many reasons. Thesemight include financial problems,difficulties in travellingindependently, or a reluctance to askfor help to attend due to feeling aburden or not wanting to discloseweakness. These circumstances arenot exclusive to the working classpatient, but many middle classpatients have better access to money,knowledge or a social network,together with a greater understandingof the treatment on offer.

I do not have any definitive answers.But, I think it is time for our industryto look at the issue of classdiscrimination alongside other betterpublicised diversity and equalityissues. We need to present theprocess of therapeutic change in amanner that makes it acceptable toall of our patients.

Class actContinued

Branch news

Eastern Counties BranchThe Branch hosted Roz Shafran and her workshop on Clinical Perfectionism at theSuffolk Showground in Ipswich on 10 October

Roz Shafran (thirdfrom right) withBranch members


| February 2013 19


| February 201320

Couples Special Interest Grouppresents

An Introduction toCognitive-BehaviouralCouples Therapy (CCT)A one-day workshop by Carla Swan and John Williams

Thursday 21 March 2013 from 9.30am to 5.00pm (registration from 9.00am)

David Lloyd Conference Centre, David Lloyd Gym, Livingstone Drive, Newlands,Milton Keynes MK15 0DL (telephone 01908 207901)

The workshop is likely to be helpful for clinicians working in IAPT, NHSadult primary and secondary mental health care teams, CAMHSprofessionals working with parents, Relate therapists or therapistsworking in private practice who are interested in involving clients’partners in individual therapy cases. No experience of couples orfamily therapy is required although basic knowledge of CBT theoryand practice would be necessary to get the mostfrom the day.

Presenters Carla Swan is an accredited CBT therapist who hasworked with couples over many years primarily aspart of the Relate organisation, IAPT and in private practice.

John Williams is a Consultant Clinical Psychologist andSystemic Family Therapist and accredited CBT practitionerand supervisor. He has worked in adult, and child andfamily mental health services in private practice and theNHS for over 20 years, developing and delivering familyand couples therapy services.

FeesBABCP member - £75 Non member - £95 Students - £75

Tea and coffee is included and sandwiches are available in the David Lloyd dining area. Free parking is availableat the centre

For more information including how to registerplease visit www.babcp.com/cpd

Schema Focussed Therapy and theUse of CBT in the Treatment ofComplex TraumaHelen Kennerley, D PhilConsultant Clinical Psychologist

Tuesday 26 March 20139.00am to 5.00pm (registration from 8.30am)

Venue: Bristol Zoo, Clifton Pavilion,College Road, Bristol BS8 3HA

Cost: Before 5 February After 5 February

BABCP members: £60 £70

Non-members: £70 £80

Price includes two-course buffet lunch, refreshments andentrance to the zoo for the day of the conference.

For further information including how to register, pleasevisit www.babcp.com/cpd

West Branchpresents

www.babcp.com www.babcp.com


| February 2013 21


| February 201322


| February 2013 23


| February 201324


Documents

BABCP CBT TODAYalt 31/1/13 16:26 Page 1 Volume 41 Number 1 ... · PDF fileVolume 41 Number 1 February 2013 Albert Ellis posthumously recognised ... Anxiety Disorders, ... A sense of