CBT Today Vol 42 No 4 (Dec 2014)

Volume 42 Number 4 December 2014

Inside this issue: The women’s room Changing the game in wider society Pages 11-15

BABCP, CBT and public involvement This July, Professor Rob Newell (pictured below) began his two-year term of office as the BABCP President. CBT Today invited him to introduce himself and his vision for the Association I write to introduce myself as President of BABCP. Many BABCP Presidents have scarcely needed to introduce themselves to the membership, and I am humbly aware that I follow many well-known, influential and innovative people as President. By contrast, I am not a household name in CBT, so I will start by saying a little bit about myself.

Mainly though, I will talk about how I see one future direction of BABCP, and how I hope we will move in that direction as an organisation.

First off, and perhaps surprisingly, I have not been a therapist for a good many years. I was lucky enough to

From the Lead Organisation for CBT in the UK and Ireland

train with Isaac Marks back in the 1980s and, following a fairly brief time as a therapist, moved into roles that were primarily teaching and research.

I finally ceased to practise as a therapist in around 2000 and concentrated entirely on teaching and research, mainly centred around my chief area of research, which is visible difference and disfigurement.

For all that, I am very proud to have been a BABCP member for over 30 years, and a member of the Association’s Board of Trustees for the past three years. Of course, I am especially grateful to have benefitted from Trudie Chalder’s example and advice during my year as President Elect, at a time when BABCP has been going through a challenging period and has achieved its landmark 10,000 membership. Our growing membership itself challenges us to think about the place of CBT in the UK and Ireland, and what we might do to be worthy of that position and respond to the expectations of people who use CBT and the wider public when CBT remains a scarce resource.

I am very clear that CBT is much more than a therapy; much more than something for people who are defined as having problems. CBT is a way of looking at life and, in an ideal world I would take Continued overleaf

BABCP, CBT and public involvement Continued from page 1 the ‘T’ away and talk about Cognitive Behaviourism to describe that view of the world. I know CBT has transformed my life and, I imagine that of many BABCP members; those who use CBT services would echo that feeling. Yet, at the same time, I am acutely aware of how little impact this way of looking at life has on the world at large.

So here is the challenge: we have a growing membership, an increasingly recognised treatment approach, and yet, in my eyes, the cognitive behavioural approach is understood by a vanishingly small percentage of our population and is more or less invisible in the broad cultural life of our country.

“

Our job is to engage with people and the media to communicate the message that CBT is something for everyone

”

Volume 42 Number 4 December 2014 Managing Editor - Stephen Gregson Deputy Editor – Peter Elliott Associate Editor - Patricia Murphy CBT Today is the official magazine of the British Association for Behavioural & Cognitive Psychotherapies, the lead organisation for CBT in the UK and Ireland.

The magazine is published four times a year and mailed post free to all members.

Back issues can be downloaded from www.babcp.com/cbttoday.

2

| December 2014

Here are a couple of examples. On television hardly a week goes by without some soap hero having counselling for her anger problems or the consequences of his early childhood experiences. Similarly, television couples in difficulties will inevitably seek some form of guidance. Rarely is the intervention specified and, if it is shown at all, there is no discernible CBT content, but most likely an unfocussed discussion, perhaps with reference to people’s experiences with their parents.

Likewise, almost every area of literature, criticism, biography, or popular song seeks to ascribe motivations to people based on arcane belief systems or folklore explanations of behaviour. I am always, for example, amazed that the use of psychoanalysis to explain the behaviour of dramatic protagonists has not really changed since I studied literature as a schoolboy. Once again cognitive behavioural perspectives do not shape our collective life as a nation. Of course, I am only following BF Skinner’s introduction to Beyond Freedom and Dignity here. Fans will

recall that he deplored the prevalence of mentalist explanations for behaviour current in everyday life.

I do not think much has changed since Skinner wrote this in 1971.

Do not think that I am after evidencebased TV and a fairer profile for CBT in fiction - although these are interesting ideas! Rather, I am illustrating ways in which public views of what therapy is and how we come to act as we do are shaped.

Why should BABCP have a role in all this? I believe we should because we have a duty to point to a different way of looking at life: one that offers credible, testable explanations for our behaviour without seeking to pathologise our difficulties, and one in which CBT is freely available to all because it is not just offered by therapists. Instead, it is offered by everyone; your friends, your next door neighbour, because we all understand the basics as a normal part of our culture. Sounds far-fetched? I do not think so. I believe everyone has a basic understanding of CBT principles - that is why our parents often told us not to shy away from things that made us anxious. Everyone does informal CBT sometimes. Imagine if that was increased and refined.

Our job, then, is to engage with people and the media to communicate the message that CBT is something for everyone. This is very much part of the aims of the

Submission guidelines

Advertising

Unsolicited articles should be emailed as Word attachments to editorial@babcp.com.

Publication cannot be guaranteed.

An unsolicited article should be approximately 500 words written in magazine (not academic journal) style.

Longer articles will be accepted by prior agreement only.

For enquiries about advertising in the magazine, please email advertising@babcp.com.

In the first instance, potential contributors are advised to send a brief outline of the proposed article for a decision in principle.

The Editors reserve the right to edit any article submitted, including where copyright is owned by a third party.

Next deadline 9.00am on 26 January 2015 (for distribution week commencing 23 February 2015)

Disclaimer The views and opinions expressed in this issue of CBT Today are those of the individual contributors, and do not necessarily reflect the views of BABCP. © Copyright 2014 by the British Association for Behavioural & Cognitive Psychotherapies unless otherwise indicated. No part of this publication may be reproduced, stored in a retrieval system nor transmitted by electronic, mechanical, photocopying, recordings or otherwise, without the prior permission of the copyright owner.

Association, but will take effort from us. In developing our continuing strategy, I hope BABCP will seek new ways to be part of the structure of our society.

I hope we will expand our membership so that more members of health and other professions who are not therapists want to join us. We will also seek ways to provide meaningful membership to lay people who are interested in CBT, and we will have a user involvement strategy at the heart of our work. CBT has always been the most clientcentred of therapies, but that is often lost on professionals and lay people who have not directly experienced CBT. I believe CBT has a powerful and, above all, positive message we can promote through seeking more media opportunities.

This will not be completed overnight.

But I hope BABCP members will want to work with me and the Board to support these continuing initiatives towards making CBT part of our society as a whole for the future.

Advertisement 'Supervision in Southampton', by Supervisor with 20 years’ therapy experience plus Eating Disorder Specialism; £65 per hour or negotiate group fee. Phone or text Vicky Duddridge 07810 870788 or email vicky.duddridge@btinternet.com.

2015 EABCT congress in Jerusalem Statement from the Board At BABCP’s AGM the following motion was carried with the following numbers voting: BABCP regrets the decision of the European Association for Behavioural and Cognitive Therapies to hold the 2015 EABCT congress in Jerusalem. We believe that the choice of Jerusalem as the host city will do little or nothing to promote unity and inclusion but inevitably lead to division and exclusion. We recognise our members’ concerns that: 1) their attendance at a conference in Jerusalem may be used to promote and or legitimate Israel’s continued occupation of Palestinian land; 2) the choice of Jerusalem as the host city precludes the attendance of many people including Palestinian mental health professionals from the West Bank and Gaza, EABCT members who support the academic boycott of Israel and others who, by attending would face the disapprobation of their communities; 3) the Israel Cognitive & Behaviour Therapies Association (ICBTA) chose to disregard our members’ recommendation in 2012 that a less insensitive venue be found.

We urge those members of BABCP planning on attending or presenting at the conference to consider the statement made by the UK Palestine Mental Health Network in relation to this event.

In favour - 45 Against - 2 Abstentions - 10 Accordingly, this motion represents the agreed position of BABCP regarding this congress and, in keeping with this position, BABCP will not be sending a representative to the 2015 EABCT Congress in Jerusalem.

| December 2014

3

Collaborative solutions for children’s CBT This summer Steve Killick attended a course run by Ross Greene, the founder and Director of Lives in the Balance and the originator of the Collaborative Problem Solving approach (now called Collaborative and Proactive Solutions). Here Steve reflects on the experience I read Ross Greene’s book The Explosive Child a few years ago and found it sufficiently intriguing to go on a threeday course run by him at the University of York in June earlier this year. He has a very specific model for dealing with challenging behaviours across a range of diagnostic disorders.

His focus is not on the diagnosis but rather on the ‘lagging’ cognitive or emotional skills that might be underlying the behaviour.

The approach aims to help parents or staff in residential or educational settings understand the difficulties to which the behaviour is the response, and give them a method to help the child develop the skills to overcome the difficulty. Greene is very critical of behavioural approaches that focus on reward and punishment and seeks to find ways of developing cognitive flexibility in children and young people, especially those with extreme challenging behaviour.

There is some promising evidence described on his website that this approach can make a big difference, especially in institutionalised settings whether there can often be an overreliance on sanction- and rewardbased systems. His argument is that focusing on consequences is often counter-productive, while adult theories and attributions about the causes of the behaviour can get in the way of accurately recognising antecedents and intervening in a way that helps develop skills.

His model, which follows prescribed steps, involves a thorough assessment of antecedents and triggers to identify situations that the child finds difficult, rather than what the actual behaviour is. After identifying possible lagging skills in areas such as executive function, emotional regulation, social

4

| December 2014

skills and so on, the intervention then focuses on a very thorough and patient use of problem-solving conversations. Reflective listening and guiding is then used to help the child develop specific skills with an adult commitment to negotiation, empathy and creative thinking.

Greene describes his model as a family or team-based approach that fits within a CBT framework. Although he was highly critical of behavioural approaches on the course, I feel that what he was describing was the misapplication and abuse of behavioural approaches which I have certainly observed on a frequent basis.

What is more radical is his movement away from consequences to a focus on identifying difficulties in lagging skills or unsolved problems. There were some extended role-plays on the course with a focus on using reflective listening for extended times

to help really explore and develop the child’s point of view.

Many of the participants seemed taken aback by how hard it was to keep their own theories and explanations out of the conversation. I learnt many useful skills, but was also surprised that a model emphasising negotiation and flexibility actually followed a very structured process. My view is that it could be very useful for organisations that routinely work with challenging behaviour to develop skills in this, but I am not sure whether I would think it so applicable elsewhere without combining other approaches. Although this model is not so well known in the UK, I am sure that this will not be his last visit here.

Ross Greene’s website can be found at www.livesinthebalance.org

www.babcpconference.com

Annual Conference and Workshops 2015 University of Warwick 21 - 24 July 2015 The 2015 Annual Conference will take place at the University of Warwick, with full day workshops on Tuesday 21 July, and the conference itself running from Wednesday 22 to Friday 24 July.

Confirmed presenters at the 2015 Conference are: • Max Birchwood University of Birmingham • Rob DeRubeis University of Pennsylvania • Melanie Fennell University of Oxford • Mike Kyrios Swinburne University of Technology, Australia • Michelle Moulds University of New South Wales, Australia

• Ronan O’Carroll University of Stirling • Vikram Patel London School of Hygiene and Tropical Medicine • Alisa Russell University of Bath • Michael Scott Sheffield Hallam University • Sue Spence Griffith University, Australia

The scientific committee invite submissions of Pre-Conference Workshops, Symposia, Clinical Roundtables, Panel Discussions, Skills Classes, Open Papers and Posters.

Deadline for Workshops, Symposia and Skills Classes: 12 January 2015 Deadline for Open Papers and Posters: 27 February 2015 For more information please visit www.babcpconference.com

| December 2014

5

Why we proposed the motion David Raines and Mohammed Mukhaimar put forward the motion about the 2015 EABCT congress at this year’s BABCP Annual General Meeting in Birmingham. CBT Today invited them to explain their reasons behind the motion David Raines, who proposed the motion, writes: At the AGM in Birmingham a motion was passed that ‘BABCP regrets the decision of the European Association for Behaviour and Cognitive Therapies to hold the 2015 EABCT congress in Jerusalem’, saying that, ‘We believe that the choice of Jerusalem as the host city will do little or nothing to promote unity and inclusion but inevitably lead to division and exclusion’. There were 45 votes in favour, two against and 10 abstentions.

The background to this motion follows a meeting of the EABCT in Reykjavik in 2011 at which Austria announced that it had withdrawn its application to host the 2015 conference, leaving Israel as the only applicant.

Although our representative was unable to attend the meeting, I understand concerns were raised and reassurances given about engaging with the Palestinian community.

I doubt that many of the EABCT representatives knew that six weeks earlier the Israeli Parliament had passed the ‘Law for Prevention of Damage to the State of Israel through Boycott’. This makes it an offence for a person of ‘any nationality’ to call for economic, cultural or academic boycotts. Few will have understood that they had voted to hold the congress in a place where any of their members advocating a boycott of the conference could face punitive damages and withdrawal of funding for the institution they represent.

CBT Today, September 2013), I discussed the proposed conference with as many Palestinian mental health professionals as possible and the response was pretty unanimous.

Those people I met did not believe that the conference should be held in Jerusalem. They insisted that the choice was, by definition, a political act, and feared that it would be used to promote and or legitimate Israel’s continued occupation of Palestinian land. They argued that, while Palestinian citizens of Israel may be able to attend, Israel’s discriminatory system would mean that many Palestinian therapists from the West Bank and Gaza would be excluded from the proceedings. Even if they could attend they would be likely to face opprobrium from their community. They reminded me that the ‘law against boycott’ applied to me.

Sofi Marom, the President of the Israeli Association, had asked for my help in developing contacts in the Palestinian community and, in my emails, I repeatedly expressed my concerns about the choice of Jerusalem and urged them to change the venue. My concerns and suggestions were politely rebuffed.

At the BABCP Annual Conference in June 2012, I talked with as many Board members as possible about my concerns but was unsuccessful in my attempt to have the issue included in the AGM agenda under ‘Any Other Business’.

It is an admittedly small group of BABCP members who give their time helping Palestinian mental health workers to develop the services their people so desperately need. They come together with likeminded European colleagues whose professional organisations are affiliated to EABCT. Would they publicly support a boycott? Have they been gagged? If, like me, they would like to return to Israel/Palestine, they had better remember that any public support for a boycott may result in them being denied entry or facing court proceedings and punitive damages.

During my visit to Palestine in December 2012 (see my article,‘CBT training behind the wall’, published in

I proposed the motion not least because I felt that it was regrettable that EABCT should have decided to

6

| December 2014

hold their congress in a country that has passed laws prohibiting the members from publicly saying,‘This is not a good idea, please don’t come, our organisation is hosting the conference in a divided and occupied city where the people in most need will inevitably be excluded’.

I also called on BABCP to take the motion to the EABCT AGM and call for an amendment to the constitution to include a clause stating that EABCT will not hold their congress in any country that has passed laws prohibiting their members from calling for a boycott of the congress.

Our representative, Katy Grazebrook reported BABCP’s motion at EABCT’s General Meeting, and the full text of the motion will be circulated to the representatives of all EABCT’s member associations.

More details about the debate can be found on my postings on the CBT Café forum.

Mohammed Mukhaimar, who seconded the motion, writes: Consider the challenges of a psychological therapist in Palestine.

As therapists they are dedicated to building hope and psychological resilience among people who have been repeatedly traumatised by the Israeli military occupation since 1948.

Yet they themselves are being subjected to the same traumas from being delayed or humiliated at an Israeli checkpoint while trying to reach their clients or clinics, in some cases being arrested and in others facing torture. Many have experienced the personal loss of family members during an Israeli air strike or a ground invasion of their areas. Our colleague in Gaza, Yasser Abu Jame, a psychiatrist, has lost 26 of his family members, while Hassan Zeada, a psychologist, lost his mother and five members of his family in the current Israeli attack on Gaza. Hassan, in a recent statement to the New York Times, said,‘Scared parents cannot reassure scared children’. His words

give some indication of the grim challenge in managing others’ feelings of hopelessness, entrapment and severe vulnerability while facing the ongoing dangers imposed by the Israeli occupying forces.

Compared to their Israeli colleagues from established and supported mental health services, Palestinian therapists face the challenge of limited access to mental health training and ongoing supervision made worse by limited resources, restrictions on movement and siege.

And here comes the EABCT congress next year in Jerusalem to add more salt to the wound. The congress delegates are invited to view the conference as an inter-group relations event that might even make some contribution to ‘political negotiations, peace-making and conflict resolution’. This gives a highly distorted picture and completely ignores Israel’s signal failure to integrate those people for whom Palestine has been home for centuries, and its policies of military occupation and systematic dispossession of the Palestinians. CBT therapists who live within a few miles of the congress venue will find it almost impossible to attend because of the difficulty of obtaining travel permits and of getting through the Israeli checkpoints. Israeli therapists living in the illegal settlements in the

Occupied Territories will be free to come and go.

The motion we proposed at the AGM invited our BABCP colleagues to express regret at the EABCT decision to hold the congress in Jerusalem and gave voice to the concerns of many of our members that the people most in need of the training opportunities afforded by the congress would be excluded. Our goal is to increase training opportunities for Palestinian health workers and the motion was framed with the hope that more colleagues will help to develop mental health training in Palestine.

Over the last two decades many Western professionals have committed themselves to the development of Palestinian local mental health organisations. These include BABCP members such as Alan Kessedjian, whose invaluable work over six visits to Bethlehem has helped to establish CBT practice in the Palestinian community there.

As a Palestinian British CBT therapist (I was born and raised in Gaza), I have tried to help develop desperately needed services and support for colleagues struggling with the day to day reality of occupation. In 2012 we established Sumud Palestine, a small project that sponsors UK-based psychotherapists to deliver structured training programmes to local mental

health professionals in the West Bank and Gaza. Since Sumud was established, we have provided four CBT courses in partnership with the Palestinian counselling centre in Ramallah. The training has been delivered by BABCP colleagues including David Raines, Helen Macdonald, Harry O’Hayon and Lisa Williams and I would like to thank them for their invaluable help and support.

The healing of deep psychological wounds will be needed to achieve a sustainable peace, but I do not think we cannot afford to wait for a peace treaty to start training people to heal these wounds.

I hope you may consider how you could help.

To learn more about Sumud Palestine visit http://sumudpalestine.org.uk.

If you would like further information, please email Mohammed Mukhaimar at mkm1975@hotmail.co.uk.

You can also join the UK Palestine Mental Health Network by emailing ukpalmhn@gmail.com.

If you would like to respond to any of the issues raised in these articles, email editorial@babcp.com.

A selection of responses may be included in a future issue.

Accreditation Supervision update At the Accreditation & Registration Committee meeting held in February 2014, there was discussion relating to increasing the minimum monthly supervision.

It was decided to increase this to 1.5 hours for full-time clinical practice.

Discussion was broad-ranging and included views such as the evidence base supporting quality, rather than quantity, aspects of supervision.

The importance of BABCP taking responsibility as a standard setting body for ensuring that previously set ‘minimums’ cannot be misinterpreted by those not fully

supportive of Accredited practitioners, was considered.

The advisability of bringing our standard more into line with standards within psychotherapy more generally was also taken into account.

It was considered on balance, taking aspects of these factors into consideration, that an increase would be generally beneficial, and supportive of those who might need to lobby more locally for adequate support for their practice.

With this in mind all Accredited practitioners should make the change to 1.5 hours CBT supervision per

month, or 18 hours per annum, by December 2014 at the latest.

There are allowances made for those working less than full-time hours.

Please contact the accreditation team at accreditation@babcp.com if you have any queries about this change.

Accreditation Team

| December 2014

7

t n e m t i m m o C d n a e Acceptanc 5 1 0 2 n o i t i t e p m o c y a s s Therapy SIG e Essay questions

Essays are welcome from those at all stages of psychology or CBT training in the following categories: • Student • Assistant • Research Assistant • Trainee Psychologists • Trainee CBT Therapists In addition to offering prize money, the purpose of this competition is to provide applicants with experience of preparing papers for publication. The winning essay will receive £500 and publication with the online BABCP journal the Cognitive Behaviour Therapist (tCBT) will be supported and encouraged. Publication is subject to the journal’s normal review processes.

Choose one of the following: • Discuss how skills and knowledge from ACT could complement and enhance practice in another specific cognitive behavioural approach of your choice.

• To what extent is ACT an evidence-based therapy?

The essay should be 2,000 words in length, including footnotes but excluding references. It must neither be in print already nor submitted for publication elsewhere. The style should be formal, such as in a book chapter or professional magazine.

Judging criteria Essays will be judged on the following criteria: • Understanding and ability to write clearly about ACT relevant processes • Understanding and ability to write clearly about concepts and philosophy • Understanding of empirical evidence base of ACT • Accessibility and originality • Quality of writing in terms of grammar, style, spelling, economy of expression

How to submit The essay must be submitted by email as a single Word document attachment, together with references and a cover sheet, to Henry Whitfield at actessay@presentmind.org.

The cover sheet template can be downloaded as a Word document from www.babcp.com/actcomp Please do not include details of the author on the essay itself. Failure to incorporate the cover sheet will render disqualification.

The closing date for submissions is 31 March 2015 You should also pay attention to the tCBT ‘Instructions for Contributors’, which can be downloaded here: http://assets.cambridge.org/CBT/CBT_ifc.pdf

Spring Conference

CBT approaches to personality disorders in adolescents and adults 9 and 10 April 2015 King’s College London 8

| December 2014

www.babcp.co.uk

Picture by Finerain/SXC

The Acceptance and Commitment Therapy (ACT) SIG is pleased to announce the launch of its 2015 essay competition, the aim of which is to encourage interest in ACT.

Diversity matters

Increasing access for Birmingham’s communities Birmingham Healthy Minds is an NHS primary care psychological therapies service that has taken innovative steps to increase access to CBT for the city's diverse population. CBT Today invited Birmingham Healthy Minds’ Joanne Gill and Kully Ingram to explain

Birmingham Healthy Minds, the IAPT service for the city, has developed an innovative ‘walk-in’ service in order to increase access to psychological therapies, and CBT in particular.

Although we use a self-referral system in addition to GP referral, we realised that particular communities in the city were still not accessing the service.

Two communities and geographical areas in Birmingham were targeted where we knew that referrals to the service did not reflect the expected prevalence of common mental health problems in this population.The service was advertised in different languages on the local radio station and at bus stops near the walk-in centres.

We understood that possible reasons for this were shame and stigma, difficulties in travel, language barriers, fear of confidentiality issues with a GP, and lack of knowledge about the service, to name but a few. We decided that, instead of waiting for people to be referred to us or to refer themselves, we would need to go to them in their communities and in their languages.

The Amman Walk-In Service is run weekly at two health care centres in the middle of the target communities. We ensure that we have qualified practitioners that reflect the population we serve, and that our staff have a good understanding of faith and cultural issues as well as being able to speak the main languages of Punjabi, Urdu, Bengali and Hindi.

Realising that the whole referral process may in itself be a barrier to access, we removed that barrier and encouraged people to simply walk in off the street for a screening appointment, hopefully in their preferred language.

We called this initiative the Amman Walk-In Service (Amman meaning peace in Punjabi and faith in Islam).

This name was chosen in response to existing patients from diverse backgrounds telling us that, if our service had a name they could relate to and engage with, this may have helped them to seek our help earlier.

We also wanted people to identify with the benefits of CBT and achieve their main goal, which for many people was described as needing to find inner peace at distressing times.

People can simply walk in off the street and be triaged for the problems they are experiencing and the help they are seeking. They are seen in the order they arrive and will be seen the same day without an appointment. Following triage, they are either signposted to the appropriate community service for their needs or offered a range of treatments within Birmingham Healthy Minds. We have adapted many of our Step 2 interventions, such as the psycho-educational workshops, so that they are delivered in the appropriate languages. We also use faith and culture as a strength to help people make the changes they want in their lives.

Over 400 service users, aged between 16 and 88 years, from a range of diverse communities but

predominantly self-classified as Asian or Asian British, have walked in to our clinics and accessed the service in the first 12 months. Patient feedback has indicated that people using the walkin service felt their concerns had been taken seriously by staff while the service had helped them better understand and address their difficulties. GPs have also stated how pleased they are that patients can be seen face-to-face so quickly.

For more information on the Amman Walk-In Service, visit http://bit.do/Amman

| December 2014

9

Control Theory Special Interest Group relaunched The members of the newly relaunched Control Theory SIG take a unique and progressive approach to practising CBT. This approach can be hard to describe in a brief article, so we have provided some questions to which we might expect you to answer ‘yes’ if you are a good fit for our SIG.

Some questions about theory

Some questions about practice

Do you think that we need to better understand the way people engage in control and ‘self-regulation’ if we are to improve the science and practice of CBT?

Do you put your clients’ needs, purposes and intentions at the heart of your approach to therapy?

Are you interested in a transdiagnostic, or universal, approach to mental health and wellbeing?

Do you think that all effective psychological therapies might tap into the same process of change, and that we could harness this process more efficiently?

Can you imagine that there might be a quantitative, mechanistic theory that explains this process, along with such cherished concepts as purpose, free will, intentionality and values?

Are you particularly interested in helping clients to raise awareness of their ‘background’ experiences – such as focusing on their fleeting thoughts, affect change, mental imagery and metaphors?

Do you often end up noticing that your clients are in ‘two minds’ about their problems or that they begin to see their problems ‘from a new perspective’?

Are you the kind of therapist who believes your clients can find their own answers to their problems, just through your curious questions and your focus on the present moment?

If your answer to many of these questions is ‘yes’, then we think our SIG is likely to appeal to you.

The aims of the SIG are to:

Hertfordshire Partnership University NHS Trust (HPFT) IAPT services are expanding and we have exciting opportunities for Qualified CBT Therapists and Psychological Wellbeing Practitioners to join our services.

We are seeking to recruit Qualified Psychological Wellbeing Practitioners at Band 5 and High Intensity CBT Therapists at Band 7 to join our services in Hertfordshire and Essex.

Hertfordshire was one of the original eleven 2007/08 IAPT Pathfinder sites and has recently taken on two additional services in Mid and North East Essex. We have IAPT teams based in Stevenage, Welwyn Garden City, Ware, Hemel Hempstead, Watford, Borehamwood, Braintree and Colchester.

You will bring your knowledge and experience to work alongside our multi-disciplinary team including social workers and consultant psychiatrists. There are opportunities to develop areas of expertise by working as part of our special interest groups focussed on clinical areas such as trauma, older adults and individuals with long term conditions.

Supervision will be provided from BABCP registered psychologists and senior clinicians.

For all posts, the Trust operates a robust Continuing Professional Development system within a Performance Management framework, including an annual appraisal and CPD review.

For further information and details of how to apply please contact: Dr Jo Wood, 07880 794494 or Alison Smith 07796263149 Car driver and access to a car essential (unless you have a disability as defined by the Equality Act 2010 which prevents you from driving) We offer our staff a wide range of benefits including work life balance policies, childcare savings, a free Counselling Service, Occupational Health Services, excellent pension scheme and NHS shopping discounts.

To view the job specification or to apply for this role, please log on to www.jobs.nhs.uk and enter the reference number: Psychological Wellbeing Practitioner - Ref: 367-HPFT981 High Intensity CBT Therapists – Ref: 367-HPFT982

10

| December 2014

• Disseminate a control theory understanding of psychological function and dysfunction • Disseminate a control theory perspective on the science and practice of cognitive and behavioural therapies • Facilitate the development and evaluation of transdiagnostic psychological interventions based on control theory, such as Method of Levels We are holding a free two-day event at the University of Manchester on Thursday 9 and Friday 10 April 2015. The Thursday is a full-day workshop titled ‘A Transdiagnostic Approach to CBT Using Method of Levels Therapy’ led by Warren Mansell. Friday is a day of oral and poster presentations, which is open to everyone to submit, and includes clinical cases, clinical research studies and basic science research, as well as our Annual General Meeting where we plan to elect the new SIG committee. There will be plenty of opportunity for making connections and to engage in discussion to put control theory into the practice of CBT. If you would like to reserve a place on either or both days, or to join the Control Theory SIG, please email control-sig@babcp.com Further information on control theory approaches to CBT are discussed in greater detail at www.pctweb.org and www.methodoflevels.com.au

The women’s room

Changing the game in wider society Concluding our series of articles on women, feminism and mental health, are profiles of four female ‘game changers’ who have made a significant difference outside the CBT world

Changing times: Sue Baker Sue is the Director of Time to Change, England’s biggest ever programme to end mental health stigma and discrimination. Time to Change is a multi-million pound programme funded by the Department of Health and Comic Relief, which is delivered by leading mental health charities Mind and Rethink Mental Illness.

Here Sue writes about her work, inspirations and vision for the future It does feel that after many, many years of us all battling to get more attention on mental health we are being heard.

Mental health has been under the spotlight far more than I can remember over the last 20 years, and we are all waiting for parity of esteem to become a reality and for people to have timely access to appropriate treatment, services and support.

We recently published the latest survey of public attitudes (carried out in England since 1993) showing that we are starting to change the nation’s thinking about mental health; attitudes have improved significantly in England with the highest rate of positive change evidenced in 2013. An estimated two million people have improved their attitudes over the last two years.

We have also seen the media cover mental health in more responsible ways and feature more people with life experience, as well as the emergence and growth of a powerful and empowering movement of individuals and organisations wanting to work together to combat stigma and discrimination.

People are taking action against stigma and supporting each other to do so both online and offline in communities, workplaces, schools and universities, churches, and even in the House of Commons. Many people feel more empowered to use their experiences of mental health issues in order to drive change.

After many years of campaigning, I was reminded the other day that it is not my generation (as I near 50) who will drive the next stages of social change. We have said from the outset that ending mental health stigma and discrimination is the work of a generation. Having started to see change in recent years, the real test will be when we look back over a much longer chapter in our history to see if long-term and irreversible change has been secured; when having a mental health issue is seen as unremarkable.

So this is the work of the next generation and I think we have many reasons to be optimistic; I recently met some of the young people with experience of mental health problems from our youth panel who are leading the campaign and delivering antistigma activity in schools. It was a very,

Continued overleaf

| December 2014 11

very emotional day as well as a very humbling experience.

I am often left deeply moved by the many people I meet who have had to deal with prejudice and discrimination at the same time as learning to cope with a mental health problem. They have had such a huge battle on so many levels, but have shown enormous guts and determination, and built the strength to overcome the major hurdles that other people and systems have put in their way. I am often left in awe.

In my life so many women have inspired me, and some still do. These women include my Mum and Grandmother who were dedicated nurses, writers and wise souls like Maya Angelou, Mo Mowlam, and here I have to bring in Princess Diana (she showed a level of compassion not traditionally expressed by the Royal family at the time when she visited a ward with HIV/AIDS patients back in the 1990s).

Others I have a deep respect for include Clare Balding who stood up to prejudice and has enhanced her career, and as a teenager from the 80s I have got to also include French and Saunders, Julie Walters, Whoopi Goldberg, and Sandi Toksvig for making me laugh out loud and help me see the lighter side of life.

In a professional capacity in the mental health sector two women inspired me in my early days at Mind in the mid 1990s; Judi Clements (Mind CEO at the time) and Liz Sayce (Policy Director). We worked closely on many policy campaigns related to ‘care in the community’ and on the first survey of

“

stigma and discrimination that I wanted to do in order to highlight the human impact of stigma. I was inspired, or incensed, by a story I had heard about a woman who had had a brick thrown through her window simply because she had just returned home from a stay in the local psychiatric hospital. Horrific prejudice from her own neighbours.

More recently another woman has shown real leadership in a way I hugely admire both on a personal and professional level. Lisa Rodrigues is the recently retired CEO of the Sussex Partnership Trust. She decided to share her many experiences of depression in the Health Service Journal on World Mental Health Day 2013 – not something that many people in senior NHS positions (or at any level) have done which shows us how much stigma exists in many workplaces including the NHS. When things get tough for me mentally and emotionally a number of things help. Firstly I remember how very low and unhappy I was when I was very, very depressed and didn’t want to live on this planet anymore (I was having suicidal thoughts) and nothing can feel as bad as that. Secondly I have got the most dedicated, passionate and supportive people around me at work – I could not wish for a better team as well as the large movement of people and organisations who want this programme to work and are all adding their energy and getting behind the same goal (of ending stigma). I am also very fortunate to have the love and support of my partner (I do not like to

After many years of campaigning, I was reminded the other day that it is not my generation who will drive the next stages of social change. We have said from the outset that ending mental health stigma and discrimination is the work of a generation

12

| December 2014

”

say ‘wife’), family and friends, and finally I take care of myself – even when passion can squeeze so much more energy from you I have learnt, from my breakdown and many useful reminders from insightful people on twitter and practitioners, that I need to look after myself. I live in Whitstable, and in an effort to switch off at weekends more and go running by the sea, I look out for the early signs that I am pushing myself too hard and I am trying to learn to be more patient for change - but that is the one thing I may never learn!

My advice to young women is be inclusive and approachable and willing to continue to learn and adapt whatever you do with your life – but be true to yourself and your values. I am fortunate (or maybe I crafted my own ‘fate’) because I am doing the job that I have always wanted to do but it did not even exist when I started my career. It took me 20 years of working towards this (before I set up Time to Change in 2007) but the wait has been well worth it. If you have passion and drive and have the utmost belief that things need to change – never give up and do not let anyone tell you it cannot be done.

For more information on Time to Change and how you can help reduce mental health discrimination visit www.time-to-change.org.uk. You can also follow Sue on Twitter @suebakerTTC Muslims, mental health and misunderstandings: Nazmin Akthar-Sheikh (top left) and Dr Iram Sattar Nazmin and Iram are part of the Muslim Women’s Network UK (MWN-UK), a national charity sharing knowledge, experience, best practice and opinions among Muslim and other BME (Black and Minority Ethnic) women and those working with them in order to strengthen these women's ability to bring about effective changes in their lives and communities. Here they write about their work in changing attitudes to mental health, which is one of the current priority areas for MWN-UK Mental health matters are universally misunderstood. Stigma, denial and misinformation are prevalent throughout the wide cross-section of communities of varying faiths and ethnicities, which is why it is imperative that collective action is taken across the board to raise awareness and change the status quo.

The women’s room There are, however, particular hurdles and barriers faced by sufferers within the Muslim and BME communities, upon which our work is focused.

Take Ayesha, who gives birth to a daughter and suffers from post-natal depression. She feels emotional and unable to cope. Family members see her crying and do not understand why.

They become exasperated with her ‘moping around’ especially as it is embarrassing when guests arrive to see her and the newborn baby and she cannot make the effort to look her usual immaculate self. Her mother-inlaw is annoyed by her inability to carry out any housework and complains at how she had given birth four times herself and managed to do everything immediately on her own. Ayesha hears these comments from her mother-inlaw and others, and feels even worse.

The nurse who visits to check on Ayesha and her baby notices that she is distant, or on other occasions, overly affectionate towards her child as if to prove a point. She discusses this with her colleagues who come to the conclusion that Ayesha must be upset she gave birth to a girl instead of a boy because that is her cultural upbringing and they know of other examples where this had been the case.

professionals either missed her state or misunderstood due to stereotypical notions. In another case, a GP ruled out the possibility of PND within a patient because it was apparent that she was constantly surrounded by family members who were providing a helping hand – so not appreciating the internal nature of health matters. In turn, this highlights the need to raise awareness not only within Muslim and BME communities, but also within medical professions in order to ensure that signs are not missed when faced with Muslim and BME sufferers.

Please note, whilst this case study has focused on PND, we have found misunderstandings to be prevalent across the board from OCD, eating disorders to schizophrenia. In our case study, Ayesha found that the blame for her situation always ended up with her.

She was seen as lazy, a bad mother, and ultimately a bad Muslim.

A guest who visits one day suggests to Ayesha’s sister that perhaps she is suffering from post-natal depression (PND). The sister rebukes her saying that she suffered from PND and it only lasted a few days and, if that was the case, Ayesha should have recovered by now. Ayesha must just be a bad mother.

The fact that Islam teaches all trials and tribulations are a test from Allah SWT with emphasis on forgiveness rather than punishment were not considered, highlighting a lack of understanding of their own faith within the Muslim community. As we reiterated at our AGM in May 2014, which was dedicated to raising awareness of mental health issues:‘Would you tell someone with diabetes that their condition is due to a lack of imaan (faith)? No? The same applies to mental health.’

Ayesha becomes increasingly withdrawn and attempts to hide how she feels in order to stop the negativity being directed towards her. Someone suggests she may have been possessed by ‘Jinns’ (spirits), and the family take her to various healers in an attempt to ‘cure’ her. Ayesha’s situation continues to deteriorate and she shows signs of paranoia. The healers blame Ayesha’s lack of faith in her religion for her situation, claiming that if she had faith their methods would have worked.

Islam teaches us of the existence of the unseen or supernatural, and more specifically, of Jinns (spirits). Most Islamic scholars believe that Jinns are able to possess humans, although a small number disagree. What really needs to be understood by the Muslim community, however, is that even within our belief framework, Jinn possession is to be a very rare phenomenon and most importantly, a belief of spirit possession should not act as a barrier to seeking medical help.

This case study was compiled using the many examples that MWN-UK has come across, highlighting a range of issues that need to be addressed. Lack of understanding, or the existence of misunderstandings, have been key factors in this situation. Family and friends either did not know of PND or showed a lack of understanding as to what it consisted of. Meanwhile medical

It is an inherent part of the Islamic faith that where we suffer from an ailment, we are to seek medical treatment, for Prophet Muhammad (PBUH) has said: ‘There is no disease that Allah has created, except that He also has created its remedy’ (Bukhari, 7:582). It is also necessary to look towards all possible solutions as the remedy may not lie in just one path.

In turn, even where you think spirit possession may be the cause and you wish to seek the help of healers, there is no harm in also seeking medical and/or psychological opinion/treatment. There may however be great harm in only relying on spiritual healers for what is likely to be a medical or psychological matter. In one case study, for example, the use of spiritual healers actually exacerbated the paranoia that was being experienced by the bipolar sufferer and led to a worsening of the situation.

We are aware of the fears that practitioners may immediately prescribe medication thus causing biological harm, or being forcibly sectioned. However, such decisions are to be made after proper assessment taking all alternative measures into account. If you feel that your GP or other medical practitioner has been too hasty in doing so then there are complaint procedures as well as legal measures, which can be considered.

We must also warn of the existence of opportunistic healers who have physically and emotionally abused sufferers by taking advantage of their vulnerability and we urge everyone involved to be alert in this regard.

The key to success is an open and honest conversation. For this we need the medical profession to show a better understanding and be alert to the various dynamics that may be at play. In one case study, a Muslim woman suffering depression mentioned to her doctor that she feels she may have been possessed; the doctor flags up the possibilities of bipolar, schizophrenia and sectioning under the Mental Health Act, not appreciating the cultural normality of the comment being made.

Of course, in some situations, this will be a cause for concern, and this is why better awareness and training is needed so as to allow proper assessment on a case by case basis.

There have also been various instances of failures in approach and

Continued overleaf

| December 2014 13

“

It is an inherent part of the Islamic faith that where we suffer from an ailment, we are to seek medical treatment

Continued from page 13 understanding by police when dealing with sufferers. Racial stereotypes and prejudice towards Muslim and BME individuals has led to both physical and emotional mistreatment of sufferers highlighting further barriers to seeking help. In turn, better training and guidance from a faith and cultural perspective is required, together with a multi-agency approach in order to address the issues in an effective manner.

A matter which is a part of our overall health and well-being is now only seen to be a problem. It is relatively easy to say we are suffering from a cold, yet how many are able to say the same when just feeling down? Similarly, when someone has been suffering from flu for a long while we all know to take them to a doctor, yet leave alone the person that has been feeling depressed for perhaps much longer.

It is this understanding that needs to be instilled within the Muslim and BME communities, as well as generally, in order to allow diagnosis and treatment of mental health matters early on. And whilst we work on raising awareness, we need all other stakeholders to be aware of the hurdles and facilitate access to help.

For more information about MWN-UK, visit www.mwnuk.co.uk Private grief and public inspiration: Joanne Thompson

Millie's Trust was established

by Joanne and Dan Thompson following the sudden death of their nine-month-old daughter.The charity's main aim is to make First Aid training readily available for minimal costs and in as many places as possible. Here Joanne, who was recently named Inspirational Woman of the Year

by ITV's Lorraine Kelly show, talks to CBT Today Deputy Editor Peter Elliott about her experience in dealing with the loss of her daughter Millie Thompson died after a choking

14

| December 2014

”

incident at nursery in October 2012. The inquest held into her death recorded a verdict of misadventure, with the Coroner scathing in his assessment of the assistance provided in the early stages of the emergency.

Joanne instinctively wanted to do something to prevent the same thing happening to another child, and setting up Millie’s Trust was the outlet for her and husband Dan. Despite throwing herself into her work with the charity, Joanne found it difficult to cope with the trauma of losing her daughter:‘We went to a private counsellor who had been recommended to us. It was what was needed at the time. I was on a lot of medication to help me through things, and, although Dan was going through the same as me, he did not see Millie in the hospital the way I had.

‘It got to a stage where he could see that I was a lot farther behind him, in terms of dealing with our grief, and I could see it myself. Between us we said to ourselves that it was not a normal grief that I was suffering. So I went back to our GP, as there were regular occasions where I was wanting to end my life. I was looking through some diaries and, there was one night where I asked Dan to take away all the pills at the side of the bed. I did not like the fact that it was too easy. When it got to that stage, I knew it was not right. The doctor referred me to Stepping Hill hospital, which is where it happened with Millie. The psychology team came to visit me and, three to four weeks later, I got a letter saying that I was just suffering from normal grief.

“

‘At the time I thought that I must be, as they were the experts. But it was a couple of months later that I was on the road outside our offices; I got stuck in the middle of the road and froze. There was a bus coming the other way. I was so close to the bus, with cars beeping at me to move. I could not move. As soon as I got to the other side, I broke down.

‘My GP told me he was going to refer me again. I was referred to Wythenshawe hospital, to a psychologist there. They had my case notes from the doctor and, within 24 hours, they were ringing me to come in as an emergency case. I had a full assessment lasting about two-and-ahalf hours, which was a lot longer than all the sessions I had had previously.

After that session, she told me that she wanted me to return and start CBT sessions with her. I was back within a few days after receiving a letter to say that I had been diagnosed with severe PTSD, anxiety and depression.’

Joanne initially struggled to accept this diagnosis:‘I knew I needed help, but I did not want to see a psychologist.

There is still a stigma. I had thought, I cannot see a psychologist; Millie has died, and other babies and children die, so why do I need to see a psychologist, and not other people? I sat down and thought about it. I actually had to deal with more than Millie passing away, as most people do not see what I saw in hospital that day. That was what a lot of my problems were, with the flashbacks that I was getting, with nightmares of what I saw in the hospital.

‘After a few days of thinking about it, I

I knew I needed help, but I did not want to see a psychologist. There is still a stigma. I had thought, I cannot see a psychologist; Millie has died, and other babies and children die, so why do I need to see a psychologist, and not other people?

”

The women’s room went along to the first CBT session. I sat there and cried; in fact I cry in them now, but the first session was particularly hard. They are massively draining. When I come out, the rest of the day is a bit of a write-off, as there is that much emotion being brought to the fore.

‘I was scheduled in for a block of twelve sessions, which I think is the normal period. At the end of that block, I was told that I was not being discharged.

We continued through that next block of sessions and, some time in that period, my psychologist said she wanted to try EMDR. I did not have a clue what it was, but I was given some information, looked it up online, and was given the choice as to whether I wanted to try it. A lot of people do not want to try it, but at that point I was ready to try anything. I did not want to be dealing with this 10 years down the line for not having dealt with it sooner.

So I started EMDR, which I found bizarre at first.'

A long holiday at the start of 2014

interrupted the therapy but, on her return, Joanne was happy to acknowledge the benefits of the treatment she had received up to that point:‘We had a review before we went on holiday to New Zealand, and I said to my psychologist that I knew that the treatment had massively helped me, that I was a completely different person since I first saw her in June last year.'

Joanne Thompson with daughter Millie

On her return from holiday, Joanne’s progress was reviewed once more:‘I was worried that she was going to discharge me, but I have been booked in for at least another twelve sessions.

When I got home, I felt that, because I thought she was going to discharge me, I was on a downer for days. I thought to myself again that I do not want to be dealing with this in 10 years, so got used to the idea of continuing the therapy. Now I want to carry on doing it until they say that I am much better.’

For more information about Millie’s Trust, including how to donate to the charity, visit www.milliestrust.com

| December 2014 15

Showcasing Irish excellence in CBT practice This September the Irish Association for Behavioural & Cognitive Psychotherapies (IABCP) held a one-day event in Dublin on the subject of ‘CBT in Practice across Ireland’.

Here, outgoing IABCP Secretary Mairead Ryan reflects on the day's proceedings

Our event - the first of its kind hosted by IABCP - was very well attended, proving to be such a success that it is hoped it will become an annual occurrence.

Siobhan Lydon, a CBT therapist at St Patrick's Hospital in Dublin, presented on ‘Keeping Compassion in Mind’ with a soft-spoken gentleness that makes her the ideal candidate to do justice to the work of Professor Paul Gilbert. Compassion Focussed Therapy recognises that, above and beyond the chance circumstances of our birth and our genes, we all share a common humanity, as well as promoting the development of nonjudgemental, non-shaming formulations. Rather than trying to think our way out of shame, we need to feel our way out by accessing emotional memories of safety and self–soothing. Where these are absent, we need to facilitate their development and strengthen the capacity for self-compassion and self–kindness in each of us.

Charlotte Wilson, a lecturer in Clinical Psychology at Trinity College Dublin, spoke about ‘Ten Things We Have Learned about CBT from Working with Children and Families’, which included the effective use of the language of cartoons and puppetry, and applying flexibility to the length of sessions. Joint child/parent formulations which help to highlight

18 16

| December 2014

variations in interpretation of behaviours can lead to better clarity and understanding.

It is known that children have the basic knowledge and skills required to engage with CBT from at least seven years of age, although much less is known about their cognitiveemotional development and mood induction procedures that do not work very well in pre-school children.

Charlotte paid tribute to the work of Dr Gary O’Reilly from University College Dublin who, along with his team, has developed child-friendly interventions in the form of computer games and apps called ‘Pesky Gnats’ where children go ‘gnat catching’ accompanied by a David Attenborough-style voiceover.

Paddy Love and Julia O’Grady, Senior CBT therapists with the Belfast and South Eastern Health and Social Care Trusts, spoke about their experience of ‘Implementing Stress Control Classes throughout Northern Ireland’.

This consists of a series of six-session didactic CBT classes developed by Dr Jim White, provided without fee or the need for booking as a rolling programme in community venues. It is also provided to communities in the Republic of Ireland through the Health Service Executive.

Classes do not involve discussion of personal problems, and feedback is anonymous. Ages of those attending

class ranged from early teens to over-65s with a 30:70 ratio of men to women which is a noteworthy statistic. One participant commented:‘I have learnt more through stress control than attending other services for years’.

Social media is used to advertise classes, as are sporting groups. There is a constant review and evaluation by a Stress Control Regional Group and it is hoped that findings will be presented at an Irish symposium on Stress Control at the proposed BABCP Annual Conference in Belfast in 2016.

Andrea Nulty is a straight-talking CBT therapist who works with the National Forensic Mental Health Services. Her presentation on ‘Psychotherapeutic Practices in Forensic Mental Health Care’ provided us with a short history of the ‘What Works’ movement, which culminated in an upsurge of interest in the application of CBT-based interventions over the past decade.

Having been influenced by this movement and developed a working relationship with one of its pioneers Professor James McGuire, Andrea convinced her managers in Dublin to introduce a comprehensive threepart CBT pathway of programmes.

Influenced by economist Richard Layard and the English IAPT programme, the skill level of the practitioners were matched with the level and intensity of the

intervention. This resulted in a marked increase of patients’ accessibility to psychotherapy where the emphasis is always on recovery.

Debbie Van Tonder, a CBT therapist with St Patrick’s Mental Health Services who was recently awarded an MSc in CBT with first class honours, presented on ‘Evocative Imagery in the Treatment of Emotional Arousal in GAD’. Although well-documented in conditions such as Social Phobia and PTSD, the imagery aspect of cognition is unfortunately all too often forgotten in the treatment of other disorders such as OCD and GAD. There is no specific literature on imagery in GAD, although it is generally accepted that images allow a person to access emotions more effectively, are rich in detail, and provide information about future fears, catastrophic predictions, rule systems, core beliefs and fears. Images are disorder-specific and can be retrieved or evoked deliberately, while the processing of previously avoided affect by means of effective exposure can trigger an automatic cognitive shift.

Roy Cheetham is Senior CBT Therapist and CBT Professional Lead with the South Eastern Health and Social Care Trust. His presentation on ‘CBT for Bipolar Affective Disorder - A Working Model’ informed us that CBT is the dominant psychotherapeutic treatment for bipolar disorder available today. In 1967 Aaron Beck talked about the ‘negative cognitive triad' of depression and the 'positive cognitive triad' of mania. Roy dismissed this as one of the myths about bipolar disorder, the others being that therapy can be employed solely for the depressive phase (a unipolar approach) and that comorbid problems should be treated when the bipolar illness is stable.

Roy has been working for the past 12 years with a client caseload that includes 60 to 70 per cent with bipolar disorder. He uses an adaptation of a cognitive behavioural model of mood swings and bipolar illness and incorporates aspects of Relational Frame Theory, with a clear focus on longitudinal formulation, an

emphasis on the mechanisms and hypotheses that lead to overcompensation and avoidance in the maintenance of bipolar disorder, and a recognition that a control agenda and the role of self-criticism are key components within Bipolar Affective Disorder.

As I stand down from the IABCP Committee, I would like to pay tribute to all of the presenters who spoke so eloquently and respectfully about

their work, and to all the IACBP and BABCP National Committees Forum members with whom I have worked over the past years. I would also like to wish the new IABCP committee well in the further unfolding of their development plans and to acknowledge all members who work tirelessly in the promotion of mental wellbeing through the practice of CBT.

(Left to right) Paddy Love, Andrea Nulty, Charlotte Wilson, Debbie Van Tonder, Roy Cheetham, Siobhan Lydon and Julia O'Grady | December 2014 17

On course to a career in CBT Having just completed the CBT PG Dip at the University of Hertfordshire and recently starting work as a High Intensity therapist, Jerrie Richards reviews her experiences of the course and gives some advice to others considering training in this field Choosing the right course I found it difficult to decide when and where to do my CBT training.The NHS can sponsor individuals to complete a CBT PgDip, however these places are highly competitive and are few and far between, so I decided to fund the CBT training myself. This, at the time, felt like a big commitment as it required me to reduce my paid working hours and borrow a large sum of money, with no guarantee of full-time employment when I qualified.

The level of accreditation is an important factor to consider when choosing a CBT course, as not every course is accredited. A few colleagues of mine who were CBT trained had the additional stress of waiting to see whether their hard work would be recognised by BABCP due to their university being in the process of acquiring accreditation. This also seemed to impact on the course structure and content as the diploma programme had yet to be fully established.

BABCP offers course accreditation at either Level 1 or Level 2. However, having completed a Level 2 accredited course and comparing my experiences to others, it seems levels of accreditation relates to the amount of support a course will give you. My colleagues who completed a Level 1 accredited course spent less time in lectures and had to provide significantly more paperwork and supporting documentation when applying for Provisional Accreditation.

In comparison, completing the Level 2 accredited course meant I automatically met all the training requirements for provisional accreditation with BABCP and that my university was able to mark my Knowledge Skills and Attitudes (KSA) 18

| December 2014

portfolio and my CBT logbook themselves, which saved me time and money. In addition to comparing course content, I would recommend reading the BABCP Provisional Accreditation guidelines to compare the differences in requirements between Level 1 and Level 2 accredited courses.

Placement considerations Most courses require you to find a suitable placement where you can practice CBT before starting training. As I previously worked as a PWP for IAPT, it was easy to arrange a placement within my current service, though I did consider other charitable organisations in my local area (such as Mind).

Whilst long waiting lists mean many services would be grateful for the free labour provided by a trainee, some are unable to provide casemanagement supervision. It is therefore worth seeing whether the course would be able to provide adequate supervision as part of your training or if you would have to fund this privately (which might mean a group of you get supervision together in order to reduce costs).

Also, don’t be afraid to think outside the box when looking for placements.

I had a couple of colleagues who worked in services such as liaisonpsychiatry and forensic settings, which gave a different perspective to how CBT principles can be utilised outside of the standard moderate/severe depression and anxiety cases seen in IAPT. Money There is no getting away from it. If you are going to self-fund your CBT PgDip it is going to be costly. Whilst I had some savings I could put towards course fees, I was

heavily supported by a Career Develop Loan (CDL). Some high street providers and can lend you up to 80 per cent of your total course fees, though you can borrow up to ÂŁ10,000 in total, meaning extra money for expenses such as books and travel expenses if required. As the government currently backs the scheme, my CDL was interest free whilst I was studying and I did not have to pay anything back until two months after completing training.

Workload I had to sacrifice a fair few weekends and evenings whilst completing my training and I can vividly remember my feelings of apprehension when I started applying the CBT learned in lectures in my clinical practice. It felt a massive transition moving from the highly efficient case studies in text books to the real-life person in front of me, who was not sure how to answer my questions and would give me information that seemed highly relevant to them but only served to confuse me (and my formulations) further.

Supervision was invaluable in helping me work through this time and to realise I was not alone in struggling to fit disorder-specific fit models to clients (in the most ideographic manner I could muster). I was regularly informed by well established therapists that I would never reach a stage where I knew everything there was to know about CBT and whilst I have come to realise that they were right, I find my training has enabled me to take comfort in my understanding of core CBT principles and how these can be utilised into useful treatment programmes.

| December 2014 19

Couples SIG presents www.babcp.co.uk

Overview, Models and Assessment: Basic Training in Couples CBT, Part 2 Skills-Based Practice Workshop (for delegates who attended Part 1 in October 2013 or March 2014)

19 and 20 March 2015 Presented by Professor Dr Kurt Hahlweg Venue: The Royal Foundation of St. Katharine, 2 Butcher Row, London E14 8DS

An Introduction to Cognitive Behavioural Couples Therapy 23 to 25 March 2015 Presented by Professor Dr Kurt Hahlweg Venue: Hilton Edinburgh Grosvenor, Grosvenor Street, Haymarket, Edinburgh EH12 5EF

Integrative Behavioural Couple Therapy 27 to 28 April 2015 Presented by Professor Andrew Christensen Venue: The Royal Foundation of St. Katharine, 2 Butcher Row, London E14 8DS To find out more about these events, including how to register, please visit www.babcp.com/events

18 20

| December 2014

Chester, Wirral and North East Wales Branch presents

Scotland Branch presents www.babcp.co.uk

www.babcp.co.uk

Compassion Focused Therapy for Shame-Based Difficulties: Learning it from the Inside Out

CBT for Persistent Pain a Practical Skills Workshop

(Intermediate Level) Presented by Dr Mary Welford

Friday 20 February 2015

Presented by Helen Macdonald Murrayshall House Hotel, Scone, Perth PH2 7PH

Thursday 5 to Saturday 7 February 2015 The Conference Centre, National Waterways Museum, South Pier Road, Ellesmere Port, Cheshire CH65 4FW Compassion Focused Therapy (CFT) is referred to as a thirdwave CBT approach and was developed by Paul Gilbert to address difficulties associated with shame and self-criticism.

This three-day workshop will allow participants time and space to develop their own compassionate mind. Upon this foundation ideas will be developed in respect to how individuals can use CFT and compassion-based approaches to help others.

Registration fees Early bird: payment received up to 12 December 2014 BABCP Member: £345, Non-member: £365 Full registration fee from 13 December 2015 BABCP Member: £405, Non-member: £425

This workshop aims to offer an opportunity to consider knowledge and skills for working with people who have chronic pain. Evidence-based cognitive-behavioural interventions will be presented. The emphasis will be on skills which can be used to help manage the impact of pain, and opportunities to practice assessment, formulation and engagement techniques, as well as interventions. Case examples will be used, and participants will be encouraged to bring their own experiences and cases to discuss, as well as to participate in small group work and role play exercises.

The workshop should be helpful for people who have existing CBT skills, but not necessarily experience in working with chronic pain conditions specifically. It could also be useful for people who have experience in persistent pain work, but wish to refresh their knowledge of applying cognitive-behavioural approaches.

Registration fees BABCP Member: £85 Non-member: £105

To find out more about these workshops, or to register, please visit www.babcp.com/events or email workshops@babcp.com Manchester Branch presents

West Branch presents www.babcp.co.uk

www.babcp.co.uk

Anxiety Traps! CBT Solutions Presented by Dr Christine Padesky

Friday 29 & Saturday 30 May 2015

CBT for Clinical Perfectionism

9.30am to 4.30pm Manchester Conference Centre, Sackville Street, Manchester M1 3BB

Presented by Professor Roz Shafran

Attend this workshop to learn principles underpinning anxiety treatment methods and to practice the skills required to effectively use CBT anxiety protocols. Enjoy this workshop for all Dr Padesky’s embedded creativity, humour, and optimism which help you learn to treat your clients’ anxiety disorders more effectively.

Ideal for intermediate level CBT therapists who already have experience working with anxiety disorder protocols; more expert CBT therapists who attended reported the workshop includes useful new ideas (danger/coping disorder framework) and methods (assertive defence of the self for social anxiety) that make this workshop suitable even for experienced CBT therapists.

Novice CBT therapists are also welcome to attend to learn treatment methods, principles, and Dr Padesky's organising framework that will speed mastery of anxiety therapies.

Registration fees BABCP Member: £200 Non-member: £220

Thursday 12 March 2015 Clifton Pavilion, Bristol Zoo, Bristol BS8 3HH

‘Clinical perfectionism’ is a highly specific construct designed to capture the type of perfectionism that can often pose problems in routine therapeutic practice. The core psychopathology of clinical perfectionism is an over evaluation of achievement and striving that causes significant adverse consequences.

By the end of the day, participants will learn how to assess clinical perfectionism and determine when it may warrant a specific intervention. They will also be familiar with relevant cognitive-behavioural strategies. The workshop will be interactive and include both experiential and didactic teaching and videos. Participants will have a chance to discuss their own cases.

Registration fees Early bird: payment received up to 23 January 2015 BABCP Member: £65, Non-member: £75 Full registration fee from 24 January 2015 BABCP Member: £75, Non-member: £85

| December 2014 21

22

| December 2014

| December 2014 23

24

| December 2014