REMOVING JUDGEMENTS

My current role is as an emotion regulation pathway (ERP) lead practitioner within an NHS Mental Health Trust. We have an ERP team across the Trust, and we all sit in local community mental health teams.

I have been in this role for six months, with most of my experience as a qualified OT gained through working in acute mental health on inpatient wards, mainly female. I found working on the wards extremely fulfilling and enjoyed building up therapeutic relationships with my patients. One of my favourite interventions was finding ways to help long-term patients build up their identities which are often lost, forgotten about, or pushed to the side in a hospital environment where it can be difficult to express or remember what truly makes you, you.

As an inpatient OT, I had a unique and privileged position to spend time finding out what was important to patients and learning about who they were in their own words.

Many of my patients on the ward had a diagnosis of emotionally unstable personality disorder (EUPD), which some found a helpful diagnosis, others did not. I wanted to be a bigger advocate for my patients and help end the stigma this diagnosis and label can carry.

I read about a relatively new pathway in my area in emotion regulation and was struck by how proactive and positive it seemed about supporting people who might fit the diagnostic criteria for EUPD. I applied for a post and was delighted to be successful.

In ERP we have the opportunity to undertake specialist training in the models and approaches we use on the pathway. I am currently on two year-long training programmes to become an accredited practitioner in delivering evidencebased psychological therapies. The models and approaches we use have a big emphasis on validation, which is something that as health professionals we can actually be really bad at, especially when it comes to personality disorders, and we need to take responsibility for this and own our mistakes.

No Judgements

There is a compassionate and non-judgemental stance to the pathway, which is refreshing and very welcome to me. To work alongside other practitioners who have the same nonjudgemental stance feels so beneficial as we work to move away from the stigma around personality disorders.

While I am not practicing occupational therapy directly within my current role, I feel that my OT knowledge and experience is utilised every day. My values as an OT feel like they fit well in our work on the pathway, particularly justice, dignity and freedom.

One of the approaches we use has problem solving at its core, and of course as OTs, we excel in this area! We also aim to build self-agency to enable the person to have and feel in control, and to develop confidence in their lives. In ERP we get the chance to be creative.

Once a person is referred to ERP, we provide assessment to determine if the pathway is suitable. This typically happens over 6-8 sessions however can be longer if needed. When ERP treatment starts, this consists of weekly one-to-one sessions with a practitioner and also weekly group therapy sessions which are usually a couple of hours long. In the groups, we cover three modules of content which are: emotions, people skills, and impulsivity.

These modules cover a whole range of topics, including myths about relationships and ways to challenge these, our boundaries with others, assertiveness, the function of emotions and distress tolerance, to name a few.

Emotive Days

My days can change quickly, but generally start off with prepping for a group session and meetings. I cofacilitate two groups a week, so this takes up two mornings. I try to keep two days a week completely free for appointments so I can focus purely on the people on my caseload who are booked in, and I squeeze admin and any training into the gaps left!

We have a reduced caseload so we can work with people intensively, which means we can really get to know them well. We have a good amount of time in supervision in ERP, which is so beneficial and ensures we don’t feel isolated. This job role can have emotive days and we can carry a high-risk caseload, so the level of supervision is needed.

My favourite thing about my job is working intensively with the people on ERP, and when we get feedback from them saying that the pathway is making a difference to their lives. It is a real highlight when we ask for a person’s thoughts in a group session, and they tell us they have been practicing the skills from the modules in their everyday life. I also feel so pleased for people in group sessions when they offer help and support to others or receive it for themselves. There is a huge therapeutic benefit from sitting with others in a safe space knowing you are held by those around you.

I am proud of my OT background, and I want my role to show that OTs can bring their experience and knowledge to areas they might not have considered working in. The hardest thing about my role is knowing how much stigma and judgement there is in society about mental illnesses including EUPD, we still have a lot of work to do as a society to end this.

You can follow Beth on Twitter @Beth_Wardle86

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