Saiqa Naz: CBT Therapist, Sheffield Specialist Psychotherapy Service, Co-author IAPT BAME Positive Practice Guide, & Chair, BABCP Equality and Culture Special Interest Group)
PPN North West Blog
It’s an unfamiliar place and time we live in now. Probably very few of us have a plan or script for how we cope with this situation and the potential future. I’m sure most of us have found it unsettling to stop doing the things we take for granted in our lives. These may be the chores that we’re not so keen on – grocery shopping, paying bills or the activities we enjoy – films, live entertainment, eating out, exercising, socialising. For the former, we still have to do them but find different ways of doing them and the same is true of the latter. Online platforms are available but acoustics and connectivity may be a challenge.
This week I've been to Bristol for the launch of PPN in the South West. This is the result of the hard work by Catherine Gallup, Ken Laidlaw and Phil Self who have secured funding to develop the South West Psychological Professions Network.
The national conversation is due to start for Psychological Professions into Action. Some of you may have already heard of this, some of you may already signed up and some of you may have been at the conference and heard more about it there.
What’s the purpose of classifying things? We do this every day – we use it to make sense of our world. At its most basic, it is about pattern recognition and realising that some things are similar and some are not. This can be distinguishing between adults and children, birds and bees, stones and trees. These are not necessarily contentious but classification systems can be more contentious – describing ethnic background, gender preferences, diagnosis in healthcare. These systems are designed with a purpose and sometimes an underlying framework. Whether we agree with these or not, it is important to understand the system and its functions.
Yorkshire and Humber Psychological Practitioners Network
Why I do more homework than my clients
If you've learned anything about therapy before, especially something structured like CBT, you will know about therapy 'homework' or between session work where you tasks are set to complete before you next meet up. Clients often have mixed feelings about doing this, sometimes it reminds them of school, for example. There's a lot of emphasis put on the idea of homework, so it's supposed to show how motivated people are and can affect the outcome (the more you put in, the more you get out). For the most part homework is set up with the therapist to be completed by the client, but sometimes there is also a bit of between session work done by the therapist too (usually completing surveys). However, that's not what I'm talking about when I say that I do homework for my clients.....
When I started looking at adapted interventions for the young people I work with in Early Intervention we started looking at ways to engage people using their own interests (this eventually became part of a project I run called heavy metal therapy but this isn't about that specifically). I started using music, lyrics and other media in the session that clients had selected to describe their feelings or experiences. What started happening was that people asked me to listen to stuff or watch things in between the sessions so that we could use the session time to reflect on it. Now obviously there are some pitfalls in this, not having infinite time being one of them, and the joys of playing very sweary metalcore in the office displeasing your colleagues. But, over time, I have been converted to this approach for a few reasons:
Yorkshire and Humber Psychological Practitioners Network
Whiteness in Psychology: Starting a Conversation
By Tansy Warrilow, Third Year Trainee Clinical Psychologist, University of Sheffield
How often do we talk about diversity on clinical training? A reasonable amount I would say. We acknowledge our differences from our clients, we tick boxes on placement confirming we have discussed diversity and we recognise that clinical psychology programmes are pretty much dominated by middle class white women. So we talk about it, but how often do we really face the harsh reality that ‘Whiteness’ remains a persistent entrenched problem in clinical psychology and little appears to be changing. It’s taken me until my third year of clinical training and my fourteenth year of being a part of the psychology world to start talking about the white privilege that exists and is maintained within clinical psychology. Are we simply blind to white privilege? Do we ignore it because it’s uncomfortable? Or do we allow it to continue because it is beneficial to the most of us?
There’s no denying it, psychology is Eurocentric. In the main, our psychological assessments are developed and normed on and by white people, our theories were developed and re-tested by white people, our therapies are based on the norms of a Eurocentric society, almost all lecturers are white, our trainees are mainly white and the majority of qualified psychologists are white.
Yet when we talk about ethnicity, diversity or racism we look to our black peers to take over. Surely it is not the role of the very people who are marginalised by clinical psychology to address it? Should it not be the responsibility of those who are afforded power and privilege due to their whiteness to challenge it?
So why has it taken me to my fourteenth year in the psychology world to start talking about this? Well because for many years I was simply blind to it. I didn’t notice my skin gave me an advantage (which in itself defines privilege). I never had to worry about my whiteness, so I never did. I was always the norm especially in psychology. It didn’t occur to me that if others were oppressed then perhaps I was an oppressor. When it started coming into my consciousness I resisted it, I was too awkward to acknowledge it, too ashamed to admit I was part of any wrong doing. I kept quiet when I heard stereotypes at work, I thoughtlessly ticked the boxes agreeing I was reflecting on diversity and felt quietly pleased I had done my bit to understand others. I excused any part I had in systematic racism and colluded with the status quo. And as I write this, it remains awkward. I still don’t have the words, I talk clumsily and constantly worry I am getting it wrong or being offensive. The difference is, now I believe it is better to be clumsy and awkward than to collude with the racism.
Professor Nimisha Patel (2004) states:
“To develop and to demonstrate competence in empowerment, clinical psychologists need to be able to operationalise a social and political analysis of culture and racialism oppression in their psychological thinking, as well as in their assessment, intervention, training and research skills”
There is much more to say on this topic. But as a start, I encourage everyone within clinical psychology to take a step back and ask themselves what they do to challenge the status quo.
Some starting suggestions for exploring white privilege include:
- Read the book “Why I’m not Longer Talking to White People About Race” by Reni Eddo-Lodge.
- Read the (3 page) article “White Privilege: Unpacking the Invisible Knapsack” Peggy McIntosh.
- Check out Patel and Keval (2018) “Fifty ways to leave …… your racism”.
- Review and reflect on social media echo chambers. How much content is mindlessly absorbed that only reflects our own privilege. Follow pages representing; disabled, trans, cultural, Asian, black, and platforms that actively support and promote people of colour.
- Take an implicit bias test to reveal your hidden biases www.implicit.harvard.edu
Tansy’s article was published in the Sheffield University Clinical Psychology Unit Newsletter this month. She has kindly agreed for it to be circulated to the Yorkshire and Humber PPN members to encourage us all to reflect carefully about the above thinking points described.
@YH_PPN www.nwppn.nhs.uk Dr Paul Boyden
The delayed NHS Long Term Plan was finally published this week. It’s encouraging that mental health is mentioned prominently in the plan. The focus is on both adult and children’s mental health as well as learning disabilities. Staff wellbeing is also mentioned.
It’s World Mental Health Day and there has been a lot of attention to this with programmes, news etc. on TV and radio, Twitter as well as blogs focusing on things such as early warning signs, the importance seeking help and reducing stigma. And this is another blog on World Mental Health Day…..
There are many publications, tweets, media reports and so on around celebrating the National Health Service’s 70th birthday on 5th July this year. There is less focus on social care although it is also the anniversary of the founding of the social care system. Health and social care are inextricably linked so it may feel as if we celebrate the birthday of one twin but not the other. The impact on colleagues who work in social care is likely to be negative. The celebration of the NHS at 70 may also feel negative to those who are working in difficult situations – poor environments, lack of support, insecure employment and reducing wages.
It’s been a year since the Manchester Arena bombing. This week also saw the start of the Grenfell Tower enquiry. There can be hardly anyone who has not been touched by these events in some way – whether directly or indirectly, professionally or personally. The testimonies of those who survived the events and those who lost loved ones has been all around over the past week. Some have been heart-breaking and some uplifting as people have expressed their own personal experiences. Some people have chosen not to talk publicly or to retreat from all the public memorials and that needs also to be respected.
The Mental Health Foundation have identified next week as Mental Health Awareness week with the theme of stress for 2018. There is a lot of information available on the website about stress, managing stress and how to support their campaign.
There are probably a million and one ways to say something. But how do we decide how to say something? How we speak to our family and friends is often different to how we speak to people at work. At work, we may speak differently to different audiences – our service users/patients, our colleagues, our managers. We also use jargon – this can be helpful in precise communication with someone who speaks the same jargon. In academic contexts, we can use less frequently used words and express ourselves in a different more complex way with longer and more complex sentences too. This may support the clear expression of complex ideas (or it may not).
A cognitive assessment can be used to gain an understanding of a person’s higher mental functions, and how these skills and abilities impact on their lives. The potential benefits of assessment include: obtaining a profile of cognitive deficits and strengths to assist formulation and treatment plans; clarifying cognitive profiles that exist alongside co-morbid mental health issues which may aid diagnosis (- e.g. differentiating between progressive and non-progressive conditions); assisting clients, families, carers and colleagues in understanding cognitive issues and the likely impact on the client’s everyday function; and, providing evidence to assist with decisions about Capacity issues.
The new Psychological Professions Network Alliance has completed its first piece of work. We have jointly written a report on how we can support the new Health Education England Workforce plan that was developed to support the Five Year Forward View for Mental Health implementation plan.
It’s hard to believe we’re nearly at the end of another year. I’m probably not the only person who thinks the year has gone very quickly. The Psychological Professions Network has had a busy year and gained more members and taken on projects on behalf of Health Education England (Core 24 and assistant practitioners to name but two). We organised a live-streamed panel debate on The Future Professional Representation of Clinical Psychology. This was watched by over 100 people live on the night and streamed by a further 1100 in the following week. We also contributed to the Digital IAPT summit in Manchester earlier this month with a presentation around the importance of wellbeing in our Psychological Wellbeing Practitioner workforce.
Last night (19th October), a panel discussion took place in Manchester with representatives from different organisations and viewpoints. The areas represented included:
The dreadful events in Manchester on Monday night will have had an impact on us all. Some of us may have been directly affected, some of us may have been indirectly affected, some may be professionally involved and some of us may become involved professionally over the months. It’s important to recognise the impact of something happening so close to home. Many of us will know what helps in situations like this and many of us may well be involved in providing advice and support.
In March it was the 10th Anniversary of the New Savoy Partnership Psychological Therapies Conference and an opportunity to reflect on the last 10 years. As someone who’s worked in and with the Step 2 workforce throughout that time it’s certainly interesting to look back at just how much the PWP role has developed, although I was a little sad to note that, according to the delegate list anyway, not one working PWP was in attendance – they were probably all back at the day job working hard to get their contacts in for the last quarter of 2016/2017!
Last week, I co-facilitated a Schwartz Round with students at the University of Liverpool. This was the sixth Round we have run with students at the university. I first heard about Schwartz Rounds at a conference I attended several years ago. The presenter's enthusiasm for Rounds sparked an interest in me. I was keen to know more but also curious to know whether the Rounds offered anything additional to the reflective spaces I was already familiar with in my work as a clinical psychologist. Did Schwartz Rounds offer anything different or better?
As many of you will know it’s Time to Talk day on Thursday this week. It’s part of the Time to Change campaign to end mental health discrimination. The point of the Time to Talk day is to increase conversations about mental health to reduce the isolation and negative feelings that people may experience when dealing with a mental health problem. For those of us working in clinical settings, this may be what you do every day – talk to people with mental health problems. That’s important and the role we have in doing this is a privilege as well as hard work – we should definitely keep doing this. How often are we able to do this in other settings? We often have those conversations that involve one person saying ‘How are you?’ and the other saying ‘Fine’ or ‘Hanging in there’. We may nod sympathetically but perhaps we don’t ask more and the conversation moves on. Perhaps it’s time to think about doing things differently – could we say something else that may be encourages a different conversation. There could be so many ways of doing this and I’m sure you all know of many different options. So instead of moving on, we could ask ‘What’s been happening?’ or ‘How’s your day/week going?’
Unless you have been completely shut off from civilisation, you will be aware that a crisis in football has erupted. Well that’s what the press are calling it, but I disagree, the crisis isn’t in football, but in how we deal with the mental health and wellbeing of male victims and survivors of sexual abuse.
It’s been a big week for mental health in the media this week starting with Theresa May’s speech at the Charity Commission which focused on children’s mental health. Jeremy Hunt was also on the radio commenting on children’s mental health and the need to reduce avoidable deaths.
Happy New Year from the PPN. The start of a new year can sometimes feel a bit arbitrary and there are different New Year dates in different cultures (as well as different Christmas dates). However, the change of the year number often does feel like a marker and a point to reset and refocus. It can also be a time of creating expectations for oneself that may not be easily achievable e.g. joining a gym and doing more exercise. While the goals are desirable, we don’t all find them easy to stick to and then we may use them as ways to criticise ourselves. As psychological professionals, I’m sure we are all aware of the potential impact of this pattern of behaviour. Perhaps we could also see this as an opportunity to try new things and review their fit for ourselves – so maybe not the gym but perhaps a regular walk is achievable?
There has been much written about eye contact and that maintaining it can need extra brain power. Also averting one's gaze can help one think. However, an interesting finding is that our eyes are in constant motion - microsaccades. The reason for this is that if our brains are presented with a static image then they no longer 'see' it and will not process what is in front of us. Therefore, even when we are staring at a fixed point - our eyes are constantly moving creating that sense of a changing landscape. This is in addition to the voluntary movements we make when we are reading, looking at pictures, TV or talking to someone.
There has been a lot of focus in the media recently about the abuse experienced by boys at football clubs and some of them have grown up to become professional footballers. Some of these professional footballers who are now retired have been on television and radio to say what happened to them. There are now reports of over 860 phone calls to an NSPCC hotline, 17 police forces are now investigating, police have said around 350 people have reported child sexual abuse at UK football clubs. The numbers are big and behind all these numbers are the traumatic experiences of boys who thought they were being giving the opportunity to follow their dream. Yet following that dream came at the price of living a nightmare: One said ‘From being 11 years of age, you didn’t discuss things like that because the dream would have burst’.
This time last week, Laura Golding and I were privileged to be in Santander, Spain presenting on the PPN. This was a journey that took a day to get there and a day to get back as there did not appear to be any winter flights directly to Santander from the North of England. We flew from Manchester to London, then from London to Madrid and then on to Santander. In total, three flights and two taxis and lots of walking around airports (steps targets met!). The only things missing transport-wise were trains and boats but there were plenty of boats to be seen in the harbour at Santander. It was strange being at work in Santander – it didn’t look like work (or anywhere I have worked) and it felt like it should have been a holiday but we were there with work colleagues and we did do some work too!
The PPN 4th annual conference took place today. It was a pleasure and a privilege to be able to open the event. Our key note speaker was Jacqui Dyer – Vice Chair of the Mental Health Task Force amongst her many other roles and achievements – both personal and professional.
World mental health day this week was focused on psychological first aid and supporting people in distress. There have been stories in the media, website links and other resources and information on this area which I am sure many of you will have seen.
Time seems to pass quickly and it seems surprisingly quick that the PPN is approaching the 3rd anniversary of the website launch. There has been research looking at the experience of time passing and relating it to age and experience (adults have more to remember than children) and to heart rate (slower heart rates may mean time is experienced more quickly). However, that’s for another day.
There’s a phrase which I’m sure many of you will have heard that describes the UK and USA as divided by a common language. It’s been attributed to both George Bernard Shaw and Oscar Wilde. Hearing the phrase again made me think about the day to day world of the NHS and how sometimes communication seems particularly difficult. As psychological professionals, we spend a lot of time communicating with our service users/patients/clients and endeavour to ensure there’s a shared understanding of the issues being discussed. Our colleagues in other professions/disciplines have similar aims in their clinical work too.
It's mental health awareness week this week. The theme of the week is relationships. There's been research showing the importance of social relationships for our health overall. People with fewer social relationships had more ill-health and died younger. Also, the importance of at least one close confiding relationship on better wellbeing has been well established.
In a recent survey of psychological professions conducted by the BPS and New Savoy Conference showed that most of the respondents agreed that they had good relationships outside work. However, they still reported high levels of stress and workload pressures. They also reported feelings of failure and depression.
I was recently at a meeting with colleagues from NHS England (North) and Health Education England (in the North West and North East) which was facilitated by Clare Baguley – PPN programme manager. The meeting looked at the overlaps and potential for shared work across these.
There’s probably a recommendation for each defined part of the population in the report from the Mental Health Taskforce as well as recommendations for government, NHS England, commissioners and bodies such as Health Education England, Public Health England. There’s also mention of the need to improve research and implement evidence-based pathways. Spending on mental health research is reported as less than 5.5% of all health research funding. NICE provides guidance on evidence-based approaches and much of their work focuses on the robustness of the research.
The Five Year Forward View for Mental Health: A report from the independent Mental Health Taskforce to the NHS in England
It’s been a while since I last posted. It’s been a really busy year for the network and really encouraging that it continues to go from strength to strength. We now have over 1500 members – thank you to all of you and please do encourage colleagues to join.
This week the North West PWP Professional Network welcomed Dr Saba Khan and Kate Thompson from the Tavistock Clinic to their master class at the University of Central Lancashire to explain what Couples Therapy for Depression (CTfD) is and how it is helpful, how to screen for suitability and to explore how elements of ‘Think Couple’ can be used to to enhance the role of the PWP.
There has been a lot about parity of esteem recently and it appears to be used in a variety of ways to basically say that mental and physical health should be viewed and treated equally within health care. However, I was recently asked by a very senior Health Education England director whether frontline staff and patients/service users actually knew what it meant. I confessed I didn’t know if they would and then reflected that perhaps they wouldn’t as it appears to have become a label for a range of thoughts – a bit like ‘Transforming Community Services’ if anyone remembers that.
I read an interesting article in the newspaper today about curiosity, the psychological concept of ‘Need For Cognition’ and its role in fostering creativity and innovation.
Its good to be back following pre-election ‘purdah’ and although we've been quiet on social media a lot has been happening.
Gita and I are signing off our blogs for the month of April as the PPN is subject to the 6 week pre-election 'purdah' conditions. During this time publicly funded bodies and their employees are not allowed to use social media or any communication that may influence the election.
Leadership has been on my mind this week. We’ve recruited to two multi-professional leadership programmes that are jointly funded by the CPWD. The first is a one day introduction to leadership for early career psychological professionals and the second for practitioners who are already in leadership roles to help them to develop skills in ‘transformational change’. The number of applications have been high showing that psychological professionals are keen to develop leadership both within day-to-day practice and at a strategic level. The number of applications has been particularly impressive for the introductory course and we’re really pleased to be able to offer two more dates in the autumn for those who didn’t make the spring dates.
PPN North West supports the most active and longest-lived IAPT network in England and it is a great example of the potential that comes from collaboration between practitioners, service managers, clinical leads, academics and commissioners.
The PPN has reached its first anniversary marked by our second annual conference.
When we were offered the chance by HENW to create a brand new psychological professions network it was an important signal of the growing awareness of the importance of psychological approaches across health care. In the North West we are well known for 'just getting on with it', so, not wanting to loose a unique opportunity, this is exactly what we've done!
I am looking forward to 2015 being a successful year for the Psychological Professions Network - North West. We launched in February 2014 and since then the PPN now has nearly 800 members. Networks have been set up with counsellors, cognitive behaviour therapists, psychological well-being practitioners and psychological services leads as well as other areas such as CPD. Just before Christmas, we also met with psychological colleagues in the North East of England to explore how we can support each other in promoting psychological approaches and workforce development with Health Education across the North
It’s coming to that time of year again when there is a big focus on Christmas and its associated customs. Whether you celebrate or you don’t, it’s practically impossible to ignore the general focus on the buying of gifts for others and planning a meal with others.
The Health Secretary needs a Psychologist appointment was the title of an article recently published in the Health Services Journal (HSJ). The HSJ for those who may not know is a professional journal aimed at managers and senior leads in health and socialcare. The article sets out reasons why a chief psychologist is needed. It describes the advisory role the individual would provide. These include (taken from the article):
There’s been a lot about mental health recently from our politicians of all persuasions. I think it’s really encouraging that these speeches and debates have started to happen. It may be just be talk at the moment and party conferences don’t mean definite change but regardless of your own personal views on politics and politicians, it’s still good to talk.
I was recently at a meeting where the topic of innovation and change came up and the discussion highlighted innovation and change champions as being key to this. However, colleagues were divided as to whether innovators and change champions were the same or different. Innovators were described as the people with new ideas who do things differently and could perhaps be described as mavericks. As an aside, I’m not sure when maverick started becoming a negative description with healthcare but it does seem to have these connotations that mavericks are difficult, dangerous and need to be reined in and managed properly.
The PPN Launch day took place on Wednesday 26th February 2014. It was wonderful to see so many new and familiar faces at the event. It was a pity we could not accommodate everyone who was interested in attending the event. However, we have uploaded the presentations and some photos already to the website and will also be making the morning presentations available to watch too. I’m still getting used to the whole filming thing.
It’s now less than a week to go to the launch event for the Psychological Professions Network. Clare and I and the rest of the committee have been overwhelmed by the interest shown in the event. We’ve had over 300 expressions of interest in the event and faced the job of trying to accommodate as many people as we could at the venue. This has meant we couldn’t give everyone a place and it’s been hard to make these decisions. What we’ve tried to do is allocate places based on being representative of profession, specialty, geography. We may not have got it completely right but we’ve done our best. For people who haven’t got a place or can’t attend, we will be putting all the presentations on the website. Also, we’d really like everyone to have the opportunity to contribute to the discussions we have planned for the day. Therefore, we will be making space on the website to enable people to contribute their thoughts and ideas too and also to see what’s been discussed on the day. Hopefully, we will have our Twitter experts to support this too (I still need to get the hang of this one).