CBT Today Vol 43 No 1 (Mar 2015)

Volume 43 Number 1 | March 2015

BABCP signs up to further commitments on tackling harmful ‘therapy’ BABCP has become one of 14 signatory organisations to a new Memorandum of Understanding on Conversion Therapy in the UK. The memorandum was signed at a meeting with Care and Support Minister Norman Lamb at the Department of Health in January.

offering to change a person’s sexual orientation or control his or her same sex attraction would be likely to reinforce the notion that these feelings are wrong or abnormal.’

Conversion therapy is a form of ‘therapy’ whose function is to ‘reprogramme’ a lesbian, gay, or bisexual (LGB) person’s sexual orientation from same to opposite sex attraction.

Although it largely originated in the US, it has been in decline there for the last five years yet seems to be increasing from a low base in the UK. In spite of being associated with some religious communities, it is practised more widely within secular society. That said, there is no evidence of efficacy, while there is evidence of harm.

In signing the memorandum, BABCP will support actions to end the practice of conversion therapy in the UK, to bolster psychological professionals’ training and improve the emotional support available to LGB clients who seek therapeutic help.

In particular, the memorandum makes clear that NHS England ‘does not endorse or support conversion therapy and will make this clear to Clinical Commissioning Groups’.

This commitment, signed by NHS Medical Director Sir Bruce Keogh, will effectively end the possibility of conversion therapy being provided on the NHS.

The memorandum builds on the groundwork set by last year’s consensus statement on conversion therapy, which BABCP also signed up to and stated:‘We believe that

The memorandum also details how professional therapy bodies will work to develop training and CPD to ensure both new and current therapists are better equipped to handle requests for change from those unhappy about their feelings of sexual attraction appropriately.

BABCP President Professor Rob Newell said:‘I am proud that BABCP is associated with this important initiative.

Through our accreditation services, BABCP has Continued on page 3

Volume 43 Number 1 March 2015 Managing Editor Peter Elliott Associate Editor Patricia Murphy Editorial Consultant Stephen Gregson

Inside 4

2015 Conference season

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More than a Dream

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Telling tales in CBT

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Show me the money

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No more ‘Bonkers Bruno’

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A mind to torture

Contributors Jo Augustus, Giulio Bortolozzo, Fiona Kennedy, Steve Killick, Norman Lockhart, David Pearson, Vishal Talreja 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 posted free to all members.

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

Submission guidelines 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.

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.

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, its Trustees or employees.

Next deadline 9.00am on 13 April 2015 (for distribution week commencing 11 May 2015) Advertising For enquiries about advertising in CBT Today, please email advertising@babcp.com. © Copyright 2015 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.

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The latest information on this year’s BABCP Conference season and the 2015 EABCT Congress in Jerusalem

Fiona Kennedy, David Pearson and Vishal Talreja talk about a mentoring programme for disadvantaged young people in India, its achievements and the lessons it offers for other initiatives in global mental health

Steve Killick discusses the use of storytelling techniques in therapeutic sessions

Patricia Murphy explores the relationship between poverty and mental health in the age of austerity

Peter Elliott finds out how the sports media is helping to change attitudes towards mental health within the industry and beyond

Norman Lockhart considers the implications of the United States Senate report into the CIA’s torture programme for the psychological professions

ALSO IN THIS ISSUE: 3

New membership service now live

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Scottish Government appoints new Mental Health Minister

11 Accreditation team expands 15 Using Tai Chi and Yoga to enhance therapeutic outcomes 21 Shakespeare and Rational Emotive Behaviour Education

Online presenter directory now live BABCP has launched a new membership service, an online presenter directory for internal use only.

The directory is accessible from the Members Area on the BABCP website.

Members are under no obligation to be listed and the directory only applies to those presenting within BABCP. There are terms and conditions, however, that those who wish to be listed will need to comply with. There is also an administration fee of £10.00 for an individual listing for a full calendar year.

The overall rationale behind the directory is to facilitate a mechanism by which members are able to self declare their interest and capability in delivering CPD events on specific topics within BABCP. Those listed will only be able to charge a maximum rate of £650.00 per presenter for a full day or a maximum rate of £350.00 per presenter for a half day or less.

It is hoped that this directory will balance the promotion of CBT with fair remuneration for all members seeking to deliver CPD events internally, for a fee, and value for money for members seeking CPD. It should also encourage a newer generation of members to put themselves forward for delivering CPD events internally.

Committee members will be able to present to their own Branch or SIG providing that certain criteria are met. In particular, no committee member can receive more than £1300.00 per presenter, per calendar year from their own Branch or SIG. There will be no limit on how many events that committee members can present to other Branches or SIGs, provided that the terms and conditions are otherwise complied with. Likewise, as long as the terms and conditions are met, there will be no limit on how many events that other listed members can deliver within BABCP. The directory will remain as a standing agenda item with the Branch Liaison Committee.

To access or join the directory, please visit www.babcp.com/IPD

BABCP signs up to further commitments on tackling harmful ‘therapy’ Continued from page 1 demonstrated an ongoing commitment to raising the standards in the delivery of CBT, so that each intervention takes into account an individual’s specific needs in a safe and supportive environment. For wider society, this initiative helps to challenge the mistaken belief that same sex attraction is a disorder needing treatment.’

Care and Support Minister Norman Lamb said:‘We have always been clear that being lesbian, gay or bisexual is not an illness. Any therapy that claims to change a person’s sexual orientation is not just unethical - it’s potentially harmful. I welcome this commitment from NHS England, the Royal Colleges and professional bodies to help tackle any such practice in the UK.’ The signatory organisations to the Memorandum of Understanding, in alphabetical order, are: 1. Association of Christian Counsellors 2. British Association for Behavioural and Cognitive Psychotherapies 3. British Association for Counselling and Psychotherapy 4. British Psychoanalytic Council 5. British Psychological Society 6. Gay and Lesbian Association of Doctors and Dentists 7. PACE 8. Pink Therapy 9. Relate 10. Royal College of GPs 11. Royal College of Psychiatrists 12. National Counselling Society 13. NHS England 14. UK Council for Psychotherapy To read the full text of the memorandum, please visit www.babcp.com/MoU

CBT Today | March 2015 3

Conference preview Glenn Waller from the Scientific Committee writes about what is in store for delegates this spring and summer This year’s Spring Workshops and Conference will take place on 9 and 10 April at King’s College London. The theme of the two-day event is ‘CBT approaches to personality disorders in adolescents and adults’.

The conference organisers (Troy Tranah, with Kate Davidson’s assistance) have prepared a very exciting programme. Full details of the content and the speakers can be found on the conference website and in the advertisement in this issue of CBT Today.

The first day will consist of five fullday training workshops, while the second day will consist of a conference with multiple presentations. The coverage ensures that there is a very strong likelihood that these presentations will be relevant to the work of most CBT clinicians.

The workshops will outline a range of empirically-supported approaches to

personality disorders and associated problems across adolescence and adulthood. These will include cognitive therapy, DBT, and mentalisation, used to address borderline personality disorder, antisocial personality disorder, substance misuse, offending behaviour, and high-risk behaviours.

Presenting the workshops are Michaela Swales, Jackie Craissati, Katrina Hunt, Tim Meynen and Khodayar Shahriyarmolki, and Troy Tranah and colleagues.

Meanwhile, the conference will be divided into two symposia with multiple speakers - one on borderline personality disorder, and the other on antisocial behaviour and antisocial personality disorder. There will also be two keynote lectures, delivered by Michaela Swales and Jackie Craissati.

We also have a brilliant programme lined up for the Annual Conference, which will take place at the University

of Warwick from 21 to 24 July. The first day will be the pre-conference workshops, while the final day ends around lunchtime so you can avoid the traffic. But what will the content be, I hear you ask? So far, a range of high-quality keynote talks and preconference workshops have been arranged and we also have skills classes, clinical roundtables, debates, symposia, open papers and posters, in multiple streams. This year has seen a massive increase in the number of submissions, so we can be sure that the selection will be from a high-quality field.

Registrations are now open for the Spring Conference, so save the date and get online to book a place at this very exciting event. Keep checking the conference website for updates to this year's Annual Conference programme. We look forward to seeing as many of you there as possible, whether at King’s College London, the University of Warwick, or why not make it both?

For further information and to register please visit www.babcpconference.com

Scottish Government appoints Mental Health Minister Last November, the Scottish Government appointed Jamie Hepburn (pictured right) as Minister for Sport, Health Improvement & Mental Health.

taxpayer, but it ought to lessen the stigma that still accompanies mental health issues in Scotland and, in turn, hopefully break trans-generational patterns.

Hepburn has stated that a large emphasis will be placed on recruiting more staff to work within services for children and young people, as well as indicating that an innovation fund is to be established to focus on providing better services for children and young people. It is pleasing to see that services for children and young people are to receive more in the way of focus and investment, as early interventions can help reduce mental health issues throughout the life-cycle. This is not just good for the

Involving children and young people in processes that seek to establish better services for them looks likely, and it is hopeful that innovative ways of making CBT-based interventions relevant and accessible to young people can be generated and evidence-based practice implemented.

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It is encouraging to read that Hepburn is continuing with the exploration and implementation of the Ginsberg Tool and Mastermind

Pilot online programmes to help improve mental health. Both have a basis in CBT philosophy and interventions.

Meanwhile exploration, investment and implementation of CBT-based services for mild, moderate and severe mental health issues will hopefully remain on the political agenda. This should include CBT delivered in its traditional face-to-face format with the sessions allocated reflecting the severity of the presenting issues.

Andy Gray Andy chairs the BABCP Glasgow Branch

www.babcpconference.com

Spring Workshops and Conference 2015

CBT approaches to personality disorders in adolescents and adults 9 and 10 April, King’s College London Registration now open One-Day Workshops, 9 April

Conference, 10 April

Working with Adolescents Presenting High Risk and/or Offending Behaviour Troy Tranah, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry Borderline Personality Disorder in Adults: Using DBT to treat high-risk behaviours Michaela Swales, Bangor University Dialectical Behaviour Therapy for Adolescents at the Maudsley: Experiential workshop in delivering DBT with young people and their parents/carers Katrina Hunt, South London and Maudsley NHS Foundation Trust Cognitive Therapy for Substance Misuse Tim Meynen and Khodayar Shahriyarmolki, King’s College London Working with Antisocial Personality Disorder Jackie Craissati, Oxleas NHS Foundation Trust

Keynote speakers: 2000 services users, 200 staff and one psychologist: Reflections on the redesign of specialist services for personality disordered offenders Jackie Craissati, Oxleas NHS Foundation Trust Treating personality disorder across the lifespan and across disorders: Applying principles from Dialectical Behaviour Therapy Michaela Swales, Bangor University Symposia: Working with Antisocial Behaviour and Personality Disorder Working with Borderline Personality Disorder and its Sequelae

For more information and to register, please visit www.babcpconference.com

CBT Today | March 2015 5

Dear BABCP friends, We are approaching the 45th EABCT Congress, CBT: A Road to Hope and Compassion for People in Conflict, which will be held in West Jerusalem from 31 August to 3 September 2015.

We, the Israeli CBT Association, together with the EABCT, are committed to organise the 45th European Congress and make it a unique experience. In addition to state of the art lectures by world-known and local scholars, seminars, roundtables, and clinical demonstrations, we will include multi-cultural discussions on topics closely related to conflicts between people, religions, and ethnic groups. We are preparing for an exciting conference which will be filled with cutting edge science, advanced clinical topics, and touches of Israeli culture. We are excited to announce that the opening keynote will be delivered by Professor Mark Williams on Mindfulness and CBT. We have a lineup of world-renown keynote speakers from around the world and locally. There will be the additional benefit of tourist attractions of Jerusalem’s 3000-year history as well as the many outdoor bistros, cafes, restaurants, or discos, to be found all over Jerusalem. We hope all this will make Jerusalem 2015 one of the most positive, memorable Congresses.

The registration to the Congress and the submissions portal are open. Please find them at www.eabct2015.com, and make sure you send them in soon.

We urge you to begin preparing for the Congress and planning your trip to Jerusalem: the earlier the better, the earlier the cheaper, the earlier the more choice you have in terms of flights and hotels or guesthouses. For those who would like to combine the conference with getting to know Israelis in a more intimate way, we offer home-hospitality: an opportunity to stay with members of the Israeli CBT Association instead of a hotel. The earlier we know about your participation, the better we can match you up.

There are many people who can benefit from such a congress by considering the role CBT can play in conflicts and their resolutions as well as by being updated on the cutting edge of science and evidence-based practice of CBT. This is our goal: to have a successful scientific conference that provides the best content to local and international scientists and practitioners. We will continue to try to provide the widest range of access to all who wish to attend.

We look forward to seeing you this year in Jerusalem!

Sincerely, Sofi Marom, Jonathan Huppert and the steering committee of the Congress

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CBT Today | March 2015

www.babcpconference.com

BABCP 43rd Annual Workshops and Conference University of Warwick 21 - 24 July 2015 Some confirmed Keynotes and Workshop Leaders: Max Birchwood University of Warwick David Clark University of Oxford Pim Cuijpers VU University Amsterdam Rob DeRubeis University of Pennsylvania, USA Barney Dunn University of Exeter Steve Jones Lancaster University Tony Kendrick University of Southampton Mike Kyrios Australian National University Michelle Moulds University of New South Wales, Australia

Cory Newman University of Pennsylvania Ray Novaco University of California Ronan O’Carroll University of Stirling Ailsa Russell University of Bath Ulrike Schmidt King’s College, London Sue Spence Griffith University, Australia Lusia Stopa University of Southampton Tracey Wade Flinders University, Australia

For the draft programme and more information please visit www.babcpconference.com

CBT Today | March 2015 7

More than a Dream Consultant Clinical Psychologists Fiona Kennedy and David Pearson have worked alongside Vishal Talreja on developing a mentoring programme for disadvantaged young people in India. CBT Today invited the three of them to discuss the programme’s work and achievements, as well as the lessons it offers for other initiatives in global mental health

Adversity has profound effects on child development and mental health.

India, for example, has 160 million children living in poverty. Disadvantaged children are often significantly physically smaller.

In 2006, 48 per cent of all children under five years old were stunted in their growth. The effects of malnutrition and neglect go further than this. When a child’s physical development falls below the expected trajectory on a growth chart, their growth slows and psychological development slows or stops. Cognitive, behavioural, emotional and attachment problems commonly result.

Dream A Dream is a nongovernmental organisation based in India that uses sport, creative arts and work-readiness programmes to increase the life skills of children and young people, which in turn can help ameliorate the effects of adversity. The World Health Organisation provides guidance on life skills education to promote

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CBT Today | March 2015

‘psychosocial competence’. It suggests 10 core life skills: decision-making, problem-solving, creative thinking, critical thinking, effective communication, interpersonal relationship skills, self-awareness, empathy, coping with emotions, and coping with stress.

Since 1998, Dream A Dream has been delivering its programmes to disadvantaged children and young people who are often rescued from life on the streets, housed in shelters and educated in poorly provisioned government schools. One such programme sought to mentor young people using volunteers from local

companies, but it soon transpired that the mentor-mentee relationship was prone to breaking down. Mentors struggled to understand the behaviour of young people in their care. Often overwhelmed and confused, the mentees could not comply with the mentors’ wellintentioned demands, so became passive or just did not turn up. The mentors became disillusioned and gave up.

When development stops, this is known as ‘failure to thrive’: this can be caused by malnutrition or simply by lack of affection and care.

Psychological development has sensitive or critical periods, the time of maximum potential for acquiring certain skills. Failure to thrive can mean these periods go by without the skills being acquired. Later ‘catch up’ is difficult. Take, for example, a child who was abandoned at the time of her life when she should have been acquiring speech. Even if she were later adopted by a caring family, it could take many years before she could speak, while speech problems would also continue in later life.

Profound psychological problems can occur as a result of failure to thrive, including attention and memory problems, the development of unhelpful attitudes and beliefs, sensitivity or insensitivity to stress, lack of self-soothing, self-harm, social withdrawal, and an inability to tolerate closeness or attaching too quickly. Readers may notice these are similar to problems central to personality disorder in adults.

CBT and DBT, including acceptance (validation), and behaviour analysis and change, these sessions use modelling and role play to teach mentors to manage the relationship, build an attachment and empower the young person to solve problems.

The Life Skills Assessment Scale, a standardised published scale we developed, along with qualitative data, has shown great improvements in life skills acquisition as compared with other young people not receiving the mentoring programme.

Over the past seven years, around 1,500 mentors have been trained and gone onto mentor approximately 3,000 young people. Many are now young adults with jobs and relationships, and an ongoing connection with the mentor that helped them so significantly at a time of transition.

It may prove possible over time to bring CBT to the developing world using existing models of delivery.

Given the vast prevalence of adversity and failure to thrive, however, this type of targeted service using volunteers with no mental health background is an option we believe has the potential to match the challenges posed by the sheer size of the problem.

For more information on Dream A Dream, please visit http://dreamadream.org

Our CBT contributions to Dream A Dream have included developing and delivering training to staff and volunteers based on the above formulation. The training manual is divided into seven half-day sessions along with homework (skills practice).

Information on failure to thrive and its consequences is not widely available, so the first half of each session is devoted to explaining and illustrating the journey from adversity to mental health problems.

Part of the manual is devoted to skills development for mentors. Based on

CBT Today | March 2015 9

Telling tales in CBT Steve Killick, a CBT practitioner and clinical psychologist in independent practice, is the author of several papers and books on the use of storytelling in therapy and education.

A member of the BABCP Children Adolescents and Families Special Interest Group committee, here he explores how telling stories can be helpful in therapeutic settings

I have always had a love of storytelling, that is, the process of one person relating a story to another, and I have increasingly incorporated this into my therapeutic work, not just with children but with young people and adults.

Storytelling has a long tradition at all the major schools of therapy. What better way is there of illustrating the dilemmas, multiple meanings and paradoxes of life? We store our experiences in story narratives, and a story can often illustrate a concept more clearly than an abstract explanation.

One of the most powerful ways that stories communicate is through metaphor. This is, of course, a familiar tool to CBT therapists, but metaphor is a slippery customer. Language is packed full of metaphor – just look at the previous sentence - and it frames how we see the world in many subtle ways. For instance, in that last statement, we are using the metaphor of vision to describe comprehension:‘seeing is understanding’.

(Below) Steve Killick in storytelling mode

Metaphor is not just a figure of speech but central to language and, as the cognitive linguist George Lakoff has described, is fundamental to human cognition. In therapy, the use of both client and therapistderived metaphors can help give the client new perspectives or even explain about the processes of CBT itself. For instance, we explain thought processes with metaphoric terms such as ‘black-and-white thinking’ or seeing things through ‘rose-tinted spectacles’.

Recently we have seen some helpful texts using metaphor in CBT, such as Metaphors in CBT by Richard Stott et al; and, reflecting the interest in

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metaphor in third-wave CBT approaches, Stoddard and Afari’s Big Book of ACT Metaphors. Storytelling becomes a way of building and extending this therapeutic work. A well-placed story can help a client see a dilemma in a new way and help generate their own solutions in finding ways out of it.

The benefits of storytelling are not restricted to just metaphor, however.

Stories also deal with threats, difficulties and trauma.They also show ways to overcome their difficulties outside of the rational domain. I have a particular interest in traditional stories passed down in the world’s oral and wisdom traditions. These stories are clearly not factually true but they still engage us, and they are tools for learning about both internal and external experiences. Stories not only extend and enlarge our experience of the world, they also help us understand our own emotions, thoughts and motivations better.

The work of Keith Oatley has done much to help show how written fiction can develop empathy and insight. I think the benefits of this extend to when we actually tell stories to each other. Storytelling is one of our most ancient ways of communicating – and stories are full of high emotion and also demonstrate human values in how problems are solved. Paul Blenkiron has vividly described how stories can be used for therapeutic purposes in his book, Stories and Analogies in Cognitive Behaviour Therapy.

Beyond this, I think it is not only the content of stories that can be helpful in therapeutic settings, but the process of telling can be useful too.

Stories can be a way of engaging and building relationships, particularly in child work where they can be used as

Stories not only extend and enlarge our experience of the world, they also help us understand our own emotions, thoughts and motivations better

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a form of play that helps to make the therapeutic work safer. Stories can be enjoyed and also discussed.

I have been involved with the Fostering Network, teaching storytelling skills to foster carers to use with the children in their care and prepare the ground for working with trauma. Storytelling can, I believe, help carers understand and build more secure attachments. We have also used storytelling skills to help both foster carers and children talk about their experiences that they want professionals to hear. This way, storytelling is used for service development purposes, to help professionals learn more about the unique experiences of their clients.

There are other ways stories can be

useful too, such as with the use of reading groups in therapeutic settings. Novels, short stories and poetry are read aloud, and can help people find ways of talking about their own experiences, which for some client groups can be a safer way into discussing personal experiences.

I have found an increasing interest among professionals in ways of using storytelling in therapy. I, along with colleagues, ran a symposium on storytelling in health and wellbeing for health professionals and storytelling practitioners in South Wales last summer, and we are currently organising a similar event in Edinburgh for later this year.

practitioners will know from their own experience, it is a powerful tool in therapy.

Steve’s published work includes Telling Tales - Storytelling as Emotional Literacy, which he coauthored with Taffy Thomas.

The Fostering Network also commissioned him, with Maria Boffey, to write Building Relationships through Storytelling A Foster Carer’s Guide to Attachment and Stories (available to download free at www.fostering.net).

Storytelling is an art form, but one that is easily mastered. As many CBT

Accreditation team expands is currently part-time Academic Director at the Centre of Therapy and Counselling Studies as well as continuing as a CBT therapist and clinical supervisor in private practice.

BABCP is pleased to announce the appointment of two new Accreditation Liaison Officers (ALOs) in the Bury office.

Lisa began her career in 1994 as an occupational therapist within mental health. She has worked in both the UK and New Zealand, and has managed and developed occupational therapy services in a variety of settings including Forensics and Community Mental Health. In 2008 she undertook the Post Graduate Diploma in CBT at the University of Manchester, and has been working as a CBT therapist in NHS primary care settings since then. Lisa also operates a small private practice providing CBT alongside clinical supervision, and has worked as a BABCP Accreditor for the past four years.

Andy Gray and Lisa Thomas (pictured above) join existing ALO Mark Addis to work on the expanding number of Accreditation applications and enquiries.

The Accreditation team has also bid farewell to Carolyn Quinn, who left her ALO position in November 2014.

Beginning his professional career as a social worker in the 1990s, Andy was introduced to CBT whilst managing an addiction service in 2002. Between 2002 and 2005, he undertook the SCOTACS Diploma in Counselling and Groupwork at the Centre of Therapy and Counselling Studies in Glasgow. More recently he has been successful in becoming a BABCP Accredited CBT Practitioner, Clinical Supervisor and Trainer. Andy

Senior ALO Charlie McConnochie said:‘As well as giving a warm welcome to the new team members, the entire Accreditation team would like to acknowledge the hugely valuable contribution made over the last few years by Carolyn Quinn who recently stepped out of the ALO role. We wish her every success in her expanding roles in delivery of therapy, training and supervision’.

CBT Today | March 2015 11

Show me the money Income inequality was high on the agenda at this year’s annual World Economic Forum meeting in Davos, Switzerland, whose attendees included 80 billionaires. Now that income inequality is of concern to the most wealthy and powerful in the world, bridging the gap between the richest and the poorest is now the most popular campaign slogan from left to right on the political spectrum.

Whether this posturing translates into meaningful action on a global scale is yet to be seen, even if the impact of income inequality upon society’s most vulnerable has been apparent for generations.

CBT Today Associate Editor Patricia Murphy looks at the relationship between poverty and mental health

The link between poverty and mental health is irrefutable. The probable bidirectional relationship means that those with low incomes are more likely to suffer from poor mental health, whilst those with mental health problems are more likely to experience poverty.

The joint issues of mental health parity and helping people out of poverty have recently shot up the political agenda in the UK and, with the run up to this year’s general election in full throttle, the major political parties are falling over themselves with policy proposals that promise to improve the lives of vulnerable groups in society.

The proof will be in the policy puddings dished up post-election, and it has been argued that future progress will require better integration between health and social care with a greater emphasis on prevention and early intervention.

In a 2013 lecture on US mental healthcare reform given to the UK Centre for Mental Health, Richard Frank, a former adviser to President Obama and Professor of Health Economics at Harvard Medical School, said:‘It is poverty policy that matters in mental health’. Frank argued that it was a mistake to approach complex problems such as mental illness, poverty and substance misuse in isolation, and reasoned that there needs to be a greater understanding of both the way in which people with mental illness are treated in society, and healthcare systems and

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identification of socio-economic factors that impede reform.

Ahead of this year’s annual meeting of the World Economic Forum in Davos, the anti-poverty charity Oxfam published details of research indicating that – on current trends – one per cent of the world’s population will own more wealth than the other 99 per cent by 2016.

Oxfam was determined to use its high-profile role at the Davos gathering to demand urgent action to narrow the gap between rich and poor, and called upon all governments to adopt the following seven-point plan:

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Clamp down on tax dodging by corporations and rich individuals

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Share the tax burden fairly, shifting taxation from labour and consumption towards capital and wealth

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Introduce minimum wages and move towards a living wage for all workers

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Introduce equal pay legislation and promote economic policies to give women a fair deal

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Ensure adequate safety-nets for the poorest, including a minimum income guarantee

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Agree a global goal to tackle inequality

Invest in universal, free public services such as health and education

Anti-poverty charity Oxfam recently published details of research indicating that - on current trends – one per cent of the world’s population will own more wealth than the other 99 per cent by 2016

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These recommendations could present a huge challenge for the Coalition government whose tax and welfare policies, according to a report by economists at the LSE and the Institute for Social and Economic Research, have had the effect of transferring money from the poorest to the better off.The findings claim that those with the lowest incomes have been hit hardest with the poorest five per cent in the country losing nearly three per cent of what they would have earned if Britain’s tax and welfare system of May 2010 had been retained.What makes this most bitter of pills even harder to swallow is that the reforms appear not to have cut the deficit.

and anxiety-provoking experience’ for many claimants’.

Maximus Health Services UK, which has been awarded a £500m threeyear contract by the government starting this March following the early termination of its contract with Atos, advises that it could take as long as 18 months to clear the backlog of fitness to work assessments.

Relying on a welfare system for

financial security can be hazardous.

Some of us may have had direct personal experience of this and many of us have witnessed first-hand just how degrading this experience can be for our clients.

Consider the following real case example of a single mother with a serious physical condition and Continued overleaf

None of us working in mental healthcare can be happy about this.

Many will be dealing on a daily basis with the psychological impact on individuals and families of job insecurity, unemployment, racial discrimination, stigmatisation, debt, low income, urban environments and deprived neighbourhoods, shortage of affordable housing, a life dependent on benefits, long waittimes for access to psychological services, and poor physical health.

Many will also be aware of the detrimental effect that recent Department of Work and Pensions (DWP) policy changes have had on some of our most vulnerable patients.

Earlier this year, the House of Commons Work and Pensions Select Committee found that the assessment system, which is used to determine whether benefit claimants with a disability or long-term illness are capable of working, was so flawed that it should be scrapped and completely redesigned.

TRAINING WORKSHOPS

Compassion Focused Therapy for Depression with Prof Paul Gilbert 8th April 2015, Derby

Compassion Focussed Dialogue with Voices with Dr Angela Kennedy & Jacqui Dillon 15th-16th June 2015, Newcastle

Mindful Compassion As The Guardian reported at the time: ‘The MPs on the committee said the [Employment & Support Allowance] system was crude, simplistic and failed to help claimants return to the workforce. They described the Work Capability Assessment (WCA) test as frequently inaccurate and a ‘stressful

with Prof Paul Gilbert & Choden 19th-21st August 2015, London

Mindfulness Based Compassionate Living with Frits Koster & Erik van den Brink 21st-23rd August 2015 in London and 11th-13th December 2015 in Edinburgh

www.compassionatewellbeing.com

compassion_well@hotmail.co.uk

CBT Today | March 2015 13

Show me the money Continued receiving treatment for PTSD and depression whose benefits were stopped after following advice from Jobcentre Plus to inform the DWP that she had been accepted on to a Teaching Assistant induction course.

For four weeks she was without any income until her payments were reestablished.

During this period, she was unable to put petrol in her car, attend any hospital appointments, visit her parents, take her child to a classmate’s birthday party, buy any fresh food or attend therapy sessions. Add to this the humiliation of opening her child’s contact book to discover a note from the teacher pointing out that her daughter was in need of a new pair of shoes. Like she didn’t know that already.

Similar anecdotes have been collated by organisations, including Mind, the Trussell Trust, and the Joseph Rowntree Foundation, that give voice to the countless others suffering the psychological and financial impact of austerity and welfare reform, which in turn help to flesh out the reality of ‘Breadline Britain’.

The Trussell Trust, which provides a huge share of the UK’s food banks, claims that over 50 per cent of referrals to food banks during 201314 were a result of benefit delays or changes, including sanctions.

According to the Preston Learning Disabilities Forum, those with an ‘invisible disability’ (that is, those with

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a learning disability, who are on the autistic spectrum, or have mental illhealth) are ‘disproportionately at risk of being sanctioned’.

In light of the current climate, it would be reasonable to assume that a current reading on the nation’s happiness thermometer would lie outside healthy parameters. However, early results from Prime Minister David Cameron’s £2million per year long-term project attempting to measure the nation’s happiness have been surprising. According to the Office for National Statistics, 76 per cent of adults in the UK rated their own life satisfaction with a score of seven or more out of 10.

Apparently, as a nation, we are more satisfied and less anxious than at any point in the three years since the research was first undertaken in 2011.

So it is hard to reconcile this data with the fact that mental illness accounts for 28 per cent of the disease burden but receives just 13 per cent of the NHS budget; that one in six children in the UK live in relative poverty and that, according to NHS England, only a quarter of children with mental health conditions are receiving the treatment they need.

Recently Dinesh Bhugra, who is Professor of Mental Health and Diversity at the Institute of Psychiatry, outlined a vision for the future of effective mental healthcare. Professor Bhugra identified how increasing ‘social inequalities, globalisation and

Mental illness accounts for 28 per cent of the disease burden but receives just 13 per cent of the NHS budget; while one in six children in the UK live in relative poverty and that, according to NHS England, only a quarter of children with mental health conditions are receiving the treatment they need

14 CBT Today | March 2015

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resulting urbanisation and industrialisation bring with them challenges of poverty, overcrowding, changing family structures and changing social support which will all affect how mental illness is perceived and treated’. Furthermore, he called upon mental health professionals to ‘advocate for their patients and also for their families to overcome social inequalities and break any generational cycle of poor mental health and mental illness’.

Last year, BABCP President Rob Newell encouraged members to write to their MP and draw on their direct clinical experience to highlight the issue of sub-therapeutic numbers of sessions. If we really want to advocate for those whose chance of success in the future has been compromised by economic inequality and inadequate mental healthcare, why stop there?

To download a transcript or watch a video recording of Richard Frank’s 2013 lecture to the Centre for Mental Health, please visit http://bit.do/Frank_lecture

Collaborating with Eastern techniques to enhance therapeutic outcomes Jo Augustus is Therapy Services Manager at the Priory Hospital in Bristol, an independent hospital specialising in the treatment of acute and complex mental health difficulties for both inpatient and outpatients. In her CBT practice work, she encourages her patients to participate in Tai Chi and Yoga classes.

Here she discusses how these techniques from the Ancient East can help lift depression and lower anxiety It is widely accepted that exercise can reduce the risk of developing physical health problems. Research into the relationship between holistic therapies - including Tai Chi, Yoga and psychological wellbeing - is more complex, however, often leading to more questions than answers. Despite this, there is a limited evidence base to support their effectiveness in managing anxiety and depression related symptoms.

As a CBT therapist I routinely encourage inpatients and outpatients to attend our daily Tai Chi and Yoga classes. Patients consistently provide positive qualitative feedback that the practice of Yoga and Tai Chi helps manage their symptoms. This has further ignited my curiosity in wanting to understand more about how non-therapeutic activities hold vast therapeutic value in a patient’s recovery.

Yoga and Tai Chi provide techniques that can be practised independently, as part of recovery and also provide a welcome break from the often intensive talking therapy groups.

Independently, both Yoga and Tai Chi are recognised as using systems of physical movement and breathing.Yoga practice focuses on specific postures that encourage improved balance, flexibility and strength, in turn reducing the risk of physical injury.

Tai Chi is an ancient martial art involving a series of slow, focused movements that flow from one into

the next, without pause. Inevitably such practice does not address the underlying causes of anxiety and depression; however, they appear to help manage the symptoms.

Patients often join groups local to them following discharge. This not only encourages patients to form social networks, helping both physical and psychological wellbeing, but it also acts to support local community services. From my experience, a combined approach is helpful, where patients are encouraged to actively choose their treatment plan, including medication, exercise, therapy or watchful waiting.

One suggestion is that patients could be signposted by their GP practice to community-based Tai Chi and Yoga groups, to ease the pressure off already stretched NHS services or as a way to manage waiting lists as part of watchful waiting.

Whilst it would be of great interest to provide more robust research into the effects of Tai Chi and Yoga on depression and anxiety, it is perhaps of greater therapeutic value to see it for what it is. In other words, as a form of exercise that enhances physical and psychological wellbeing.

It therefore ought to become an option for patients to choose and also for professionals to encourage. In doing so patients are more likely to understand the benefits themselves and continue to engage. Of course there will be those that do not wish to engage. From my perspective, however, it is more important to empower patients to decide.

CBT Today | March 2015 15

No more ‘Bonkers Bruno’ Time to Change, in association with the BBC, recently held an event for journalists and producers to discuss the handling of mental health issues in sports reporting. CBT Today Managing Editor Peter Elliott went along to find out how the media is changing in its attitudes towards mental health

The high-profile nature of professional sport in the UK and Ireland, along with the advent of digital and satellite broadcasting, as well as newsrooms broadcasting live on numerous platforms, mean that elite sports men and women are in the public gaze more than ever.

As we consume round-the-clock analysis of all aspects of an athlete’s performance, do we take the time to consider the effects that this puts on their mental wellbeing? More often than not, we consume our sports news based only on results, forgetting that these are real people, fallible like you and I. This appetite for sports news creates pressures of its own for the media itself, with the need to get the big scoop, the latest story about who is moving to a new club, or which manager is next for the ‘chop’. Use of terms like ‘psycho’, ‘crazy’ or ‘mad’ have been widespread over the years.

That is now starting to change, however, as the issue of mental illness has become less stigmatised.

Acknowledging the critical role that the media, and sports journalists and broadcasters in particular, can play in shaping or even changing public attitudes, Time to Change recently organised an event at the BBC’s

Michael Yardy faces the camera at the BBC

16 CBT Today | March 2015

premises in MediaCityUK, located in Salford Quays.

Time to Change is an anti-stigma campaign run by the leading mental health charities Mind and Rethink Mental Illness. The campaign is funded by the Department of Health, Comic Relief and the Big Lottery Fund, and aims to end the discrimination that surrounds mental health in England.

This particular event brought together members of the national sports media, represented by Jim White of the Daily Telegraph and Sky News’ Sports Editor Nick Powell, along with England cricketer Michael Yardy and former professional footballer Michael Bennett, now a qualified counsellor and Head of Player Welfare at the Professional Footballers’ Association (PFA).

Time to Change Director Sue Baker opened the event, commenting that, although there were positive changes in attitudes towards mental health, there was still more to be done, in particular with attitudes among men, who were less likely to engage in conversation on the subject.

It was poignant that the event coincided with the third anniversary of the death of Wales football squad

manager Gary Speed. Although the coroner at the inquest said that,‘the evidence does not sufficiently determine whether [Speed’s death] was intentional or accidental’, the inquest nonetheless heard that the manager had suffered from stresses that were harmful to his mental wellbeing.

The coverage of Speed’s death brought mental wellbeing among sportspeople to the fore in a sensitive manner, something that was noticeably lacking in 2003 when The Sun ran with their ‘Bonkers Bruno locked up’ headline, referring to former champion boxer Frank Bruno’s treatment for depression.

Hosting the event was broadcaster Eleanor Oldroyd, who received a Mind Media Award in 2011 for her BBC Radio 5live documentary about German footballer Robert Enke, who took his own life in 2009.

Oldroyd remarked that Enke had only told his wife and his agent of his feelings.‘He felt he would be judged,’ she said, about his lack of ability to open up to colleagues about his depression. That sentiment was echoed by Michael Bennett, through his own experience of football changing rooms and the lack of any clear support during his early career.‘I had to be somebody else,’ he said, referring to his interaction with other players and coaches at his clubs, with a sense that he had no support during his time as a player in dealing with mental ill-health.

Unfortunately, that sentiment still exists in football, with the PFA having carried out its own recent survey among its members, finding that virtually no player would approach their manager to say they were suffering with a mental illness, for fear of being dropped or released from their club.

Jim White recalled the example of Aston Villa’s Stan Collymore, who was diagnosed with depression in 1999.

His club manager released him soon afterwards, having been quoted in the media asking what a player earning £20,000 per week could be

(Above, from left to right): Jim White, Michael Yardy, Eleanor Oldroyd, Michael Bennett and Nick Powell depressed about. White said that, at the time,‘Everyone thought John Gregory [the Aston Villa manager] was right. Absolutely no-one had any sympathy for Collymore’.

comfortable in being so, as it brought the issue of mental wellbeing into the open, but respected the fact that others in similar situations may feel differently.

More recent high-profile cases of sportsmen diagnosed with depression include cricketer Marcus Trescothick and Olympic hurdler Jack Green. Michael Yardy, whose own England career stalled after leaving the World Cup tour of 2011 with depression spoke of his frame of mind before going on that tour:‘I didn’t want to join the England squad. I didn’t want to be there.’ By returning home,‘I felt like I had let a lot of people down’.

When asked by an audience member whether Sky Sports would broadcast news of a sportsperson with depression, Nick Powell answered that each occasion would have to be dealt with on a case by case basis.

Checks would be made with the relevant club or governing body to ensure the accuracy of any information received, as well as ensuring that the sportsperson’s right to privacy was respected.

Fortunately, his England coach, Andy Flower, was sensitive to the situation, providing him with a direct route to help for his depression, though as with other high-profile cases, Yardy never regained his previous status as an international player.

Oldroyd put to him the likelihood that he would now be categorised in the media, as ‘the depressed cricketer’. That statement resonated with him, and he said that he was

Yardy was keen to further promote the discussion around mental wellbeing in the sporting profession, with a hope for sport to play its part in motivating people in a positive way:‘Any player who has had mental health issues and comes back into the England team, that is such a positive story for people to know that you can go on and live your life, and achieve things that you want. I don’t see why someone can’t have their mental health issues and come back to the peak of their powers.’

Time to Change offers a media advisory service and has produced guidelines for media reporting of mental health issues. For more information, please visit www.time-to-change.org.uk/media-advice

In the next issue of CBT Today, Peter Elliott reports on State of Mind, a charitable programme established in 2011 with the aim of improving the mental health, wellbeing and working lives of rugby league players and communities CBT Today | March 2015 17

A mind to torture On 9 December 2014, the United States Senate released a 525-page extract of a full report into the Central Intelligence Agency’s (CIA) detention and interrogation programme. The rest of the 6,000-page report remains classified. The report was particularly damning about the work of two psychologists, who were paid $81 million by the CIA to design the so-called ‘enhanced interrogation techniques’ used to interrogate terrorist suspects. Consultant Psychiatrist Norman Lockhart reflects on this troubling story Psychological torture is not a new idea. George Orwell set it out in all its horror in Nineteen Eighty-Four.

Winston Smith fears rats, so he is confronted with a cage containing large rats. That was dystopian fiction.

In March 2002, the CIA used a psychological assessment of a Palestinian to find his vulnerable points. One of them was a severe aversion to bugs and so it was planned to place insects in the crate in which the prisoner was being kept.

This, on the basis of an agency memo dated 1 August 2002, is dystopian fact.

‘Torture is not just alive and well – it is flourishing in many parts of the world. As more governments seek to justify torture in the name of national security, the steady progress made in this field over the last thirty years is being eroded’, said Salil Shetty, Amnesty International’s Secretary General, launching the organisation’s global campaign. Over the last five years, Amnesty International has reported on torture and other forms of ill-treatment in at least 141 countries from every region of the world – virtually every country on which it works.

Torture divides opinion. Does security and protecting life justify cruel and

inhuman treatment of suspects? Does an act of violence justify the victims in behaving as violently as the attackers? Is it ever justified? And whether or not it is regarded as justified, should health care professionals ever, under any circumstances, take part in torture?

Most clinicians never in their career have to make this decision. Many do make it in very practical ways and there is continuing evidence that some make the decision to take an active – even a hands-on – part in harsh interrogations and torture.

The United States is one of the few countries in the world with the mechanisms to begin an effective investigation of the government’s use of different interrogation methods, and has recently been dealing with controversy over the involvement of psychologists in torture.

A Democratic Senator, drawing on the 2014 Senate report, is quoted as saying that the CIA relied on two psychologists to evaluate the interrogation programme they had devised and in which they had obvious financial interests. The two contractors — who are not named in the Senate report — personally participated in interrogating detainees; one of them is believed to have personally waterboarded Khalid Sheikh Mohammed, who is said to have been involved in planning the 9/11 attacks.

These two psychologists were not the first to be involved. In 2009, the Washington Post reported on US Justice Department documents that described the involvement of psychologists in the ‘increased pressure phase’ of interrogation in the

By Shane T McCoy, US Navy [Public domain], via Wikimedia Commons

18 CBT Today | March 2015

summer of 2002. For one suspect, its first step was to limit his human contact to just two people. One was the CIA interrogator, the other a psychologist. In the weeks that followed, it appears that the psychologist played the major role.

According to the documents, the psychologist provided ideas, practical advice and even legal justification for interrogation methods that would break the suspect, physically and mentally. Extreme sleep deprivation, waterboarding, the use of insects to provoke fear - all were deemed acceptable, in part because the psychologist said so.

The Justice Department documents are reported as showing ‘a steady stream of psychologists, physicians and other health officials who both kept detainees alive and actively participated in designing the interrogation program and monitoring its implementation’. Most of the psychologists were contract employees of the CIA, according to intelligence officials familiar with the programme.

They devised a list of 10 methods drawn from a US military training programme known as Survival, Evasion, Resistance and Escape (SERE), which aims to prepare pilots to endure torture if they are captured, but the methods and concepts have, with the advice of psychologists, been adapted for interrogation.

This adaptation of SERE has been linked to two American psychologists who, according to the Senate report were paid around $81million to consult with the CIA on its interrogation programme. The report confirms that the contract for most of

the CIA’s detention and interrogation programme from 2005 to 2008 was outsourced to the psychologists’ firm.

According to the report,‘Throughout the program, multiple CIA detainees who were subjected to the CIA’s enhanced interrogation techniques and extended isolation exhibited psychological and behavioral issues, including hallucinations, paranoia, insomnia, and attempts at self-harm and self-mutilation. Multiple psychologists identified the lack of human contact experienced by detainees as a cause of psychiatric problems’.

Although research is shackled by secrecy surrounding torture, a study done at King’s College London and published in the Archives of General Psychiatry identified several methods of psychological torture used on survivors of interrogation in the former Yugoslavia. Most of the subjects had endured physical torture, including electric shocks, tooth extractions and suffocation. The second group, much smaller, experienced purely psychological manipulations.

The methods hold few surprises: sham executions, witnessing torture of close ones, threats of rape, threats against family, and threats of death.

Nor is there any surprise in the findings about the effects.

Assessments of the torture survivors for PTSD showed that those who had experienced purely psychological torture had the same prevalence of PTSD as those physically tortured.

The American Psychological Association (APA) has condemned any participation by its members in interrogations involving torture.

Critics have drawn attention to its failure to censure members involved in harsh interrogations. However, the APA policy on torture states that: ‘Psychologists shall not knowingly engage in, assist, tolerate, direct, support, advise, facilitate, plan, design, or offer training in torture or other cruel, inhuman, or degrading treatment or punishment under any and all conditions, nor shall they participate in any procedure where

such treatment is threatened.

Psychologists may not enlist others to employ these techniques in order to circumvent this policy’s prohibition.

Moreover, psychologists shall not provide knowingly any research, instruments, or knowledge that facilitates the practice of torture or other forms of cruel, inhuman, or degrading treatment or punishment.’

The British Psychological Society Code of Ethics makes no reference to these issues, probably because it never had to think about them in the past. That said, in December 2014, the Society responded to the Senate report by condemning and repudiating the practices depicted in the findings alongside reiterating ‘the overriding ethical responsibility of all psychologists and other healthcare professionals to protect and defend fundamental human rights’.

Oddly, however, the Society felt it necessary to note that ‘the Senate report concludes that these interrogation techniques did not deliver life-saving intelligence to the US’, and to add ‘that torture and coercive interrogation is ineffective, especially in comparison to rapportbased approaches’. It is wrong: do not do it. But if you have any doubts about that, remember it does not work anyway!

But, then, maybe that extra reason is needed. Maybe the argument is not settled. We don’t really know what goes on in the UK or in the name of the UK, do we? Maybe vigilance is needed. After all, the consensus is not complete by any means.

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The Washington Post quoted Professor Michael Gross, from the University of Haifa in Israel and the author of Bioethics and Armed Conflict: Moral Dilemmas of Medicine and War, as saying:‘Physicians are faced with a hard dilemma. They have professional obligations to do no harm, but they also have a duty as a citizen to provide expertise to their government when the national security is at stake. In a national security crisis, I believe our duties as citizens take precedence.’

Many people in power seem to believe the same thing. Not only in Nineteen Eighty-Four, but also in at least 141 countries as you read this.

The declassified extract from the Senate report can be viewed at http://bit.do/Senate

The United States Justice Department documents are reported as showing ‘a steady stream of psychologists, physicians and other health officials who both kept detainees alive and actively participated in designing the interrogation program and monitoring its implementation’

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CBT Today | March 2015 19

20 CBT Today | March 2015

In pursuit of nobler mindsImages: Hamlet, Barbican Theatre, 2015. Photographer Tim Gutt, Poster Art Direction Shona Heath.

Shakespeare and Rational Emotive Behaviour

Rational Emotive Behaviour Education (REBE) is the application of Rational Emotive Behaviour Therapy (REBT) principles in teaching practice across all curriculum areas. Albert Ellis’ ABC Theory of Emotional Disturbance is tailor-made to help students understand that an event is not the sole determinant of their emotional and behavioural response to it.

an emotional and behavioural kind), that is A equals C. The aim is to alert students to the idea that their thinking (B for Beliefs) about the event has a lot to do with it! In other words, A plus B equals C.

This is not a new idea, as stoic philosopher Epictetus observed in around 100AD:‘Men are disturbed not by things, but by the view which they take of them’. Educators comment daily on the ‘culture of blame’ in schools where students (and adults) claim,‘he made me angry so I hit him’, ‘the teacher made me angry’, ‘my mum did not set my alarm, that is why I am late’, or ‘maths makes me angry’.

I was asked to talk to a group of year nine students about constructivism, how we construct our philosophical views about the world, others and ourselves. These internalised ‘rules’ for living to a large extent determine how we respond to daily happenings.

Students were very receptive to ideas that we construct these philosophies according to how we are genetically made and how we are socialised through family and friendships.

How do you teach the average high school student that ‘nothing or noone’ can ‘make’ anyone angry? The goal of REBE is to challenge the philosophy that A (Activating event) directly causes C (Consequences of

We studied the following excerpt from Hamlet, with students taking turns to play each part and then collectively discussing its meaning, such as what is Hamlet saying in the last statement?

Where does Shakespeare come into this preventative mental health caper? What has the ‘Bearded Bard of Stratford’ got to do with it?

Education

Act 2, Scene 2: A room in the castle Hamlet: Then is doomsday near: but your news is not true. Let me question more in particular: what have you, my good friends, deserved at the hands of fortune that she sends you to prison hither?

Guildenstern: Prison, my lord!

Hamlet: Denmark’s a prison.

Rosencrantz: Then is the world one.

Hamlet: A goodly one; in which there are many confines, wards and dungeons, Denmark being one o’ the worst.

Rosencrantz: We think not so, my lord.

Hamlet: Why, then,‘tis none to you; for there is nothing either good or bad, but thinking makes it so: to me it is a prison.

Continued overleaf

Giulio Bortolozzo is the founder of the Albert Ellis Professional Learning Centre in South Australia, which opened in April 2012. A Rational Emotive Behaviour counsellor, educator and trainer, he currently works as a counsellor at Para Hills School in Adelaide. Here he shares his method of using Shakespeare to apply REBT principles in schools

CBT Today | March 2015 21

In pursuit of nobler mindsStudents understood Hamlet’s assertion that nothing is good or bad in itself, but our thinking ‘makes it so’.

As the stoic Marcus Aurelius explained, it is our ‘estimation’ of an event that makes it ‘good or bad’, not the event itself. This is an important insight for students as they begin to explore an alternative view to the ‘blame everyone and everything’ philosophy.

If they can understand this, then they can start to take control of their lives.

As Albert Ellis said:‘The best years of your life are the ones in which you decide your problems are your own.

You do not blame them on your mother, the ecology, or the president.

You realise that you control your own destiny’.

So back to Hamlet! I took the liberty of reworking Act 2, Scene 2 from Hamlet (apologies to the Great Bard) to give it an Aussie flavour on the topic of vegetables as follows.

An Aussie take on Hamlet, Act 2 Scene 2 - in a dining room somewhere in Australia Bruce: What bad luck that you are served such yucky food!

Digger: Yucky Bruce?

Bruce: Broccoli is yucky!

Leeanne: Then are all vegetables so Bruce?

Bruce: Yes all vegetables are yuck and broccoli is the yuckiest!

Leeanne: We don’t think so Bruce.

Bruce: Why then is it not true for you?

Because there is nothing good or bad but thinking makes it so. To me it is yuck!

Students were then asked to re-enact the scene and a lot of fun was had by all! We replaced the word ‘broccoli’ with other words and re-read the reworked Act 1 of Hamlet. We established, for instance, that: • He/she is not good or bad, but thinking makes it so • The teacher is not good or bad, but thinking makes it so • My mum is not good or bad, but thinking makes it so • Maths is not good or bad, but thinking makes it so This was a useful activity to acquaint high school students with the idea that nothing is good or bad, but thinking makes it so. Indeed these ideas can be taught to students of all

Continued

year levels in various ways from kindergarten onwards.

REBE is a feature of many schools’ teaching and learning in South Australia across all year levels, and is a core component of the general curriculum which has had very positive outcomes to date. Teachers have been trained in the basic principles and practices of REBT to help students understand how they have constructed the beliefs behind their behavioural and emotional responses to daily situations.

These Rational Emotive Behaviour Educators are continuously alerting students to the powerful influence that their thinking has on their feelings and behaviours in every interaction, across all curriculum areas.

As a very enlightened Albert Ellis said a few decades ago now:‘I think the future of psychotherapy and psychology is in the school system.

We need to teach every child how to rarely seriously disturb himself or herself and how to overcome disturbance when it occurs’.

Thanks Mr Shakespeare, Albert Ellis, Marcus Aurelius, Epictetus, Karen Horney and... Thanks!

Learn more about REBE at the REBTOZ blog (www.rebtoz.blogspot.com.au). Information on the Albert Ellis Professional Learning Centre can be found at www.facebook.com/TheAlbertEllisProfessionalLearningCentre.

You can follow Giulio on Twitter @REBTOZ

Advertisements CBT, EMDR & Integrative Therapists wanted for expanding practice based in Richmond-upon-Thames & Harley Street. Please forward CV’s to info@pinnacletherapy.co.uk.

Therapy room available for hire on sessional basis in Richmond-upon-Thames. Please contact richard@pinnacletherapy.co.uk for further details.

22 CBT Today | March 2015

Lancashire Traumatic Stress Service Working with Trauma - A two day training course to be held in Preston on 7th and 8th May 2015 The Lancashire Traumatic Stress Service is now in its eighth year of operation and has developed a high reputation for the quality of the teaching and training it provides.

New for 2015 the service is pleased to offer places on a two day training course designed to enhance levels of knowledge, skill and confidence in working with trauma and PTSD. Presented by members of the team, these two days will cover Theoretical models Assessment and formulation Intervention strategies Dissociation Sleep and nightmare management Post trauma growth In addition, the course will provide information regarding the use of pharmacological management strategies in the context of trauma. The training will involve the use of a variety of teaching approaches.

Further details of the course and an application form can be found on the website for the Lancashire Traumatic Stress Service www.lancashiretraumaticstressservice.nhs.uk The cost of the course is £200 which includes refreshments and a light lunch on both days.

The venue for the course is centrally located in Preston, close to the main line station and with good parking.

ACT SIG presents www.babcp.com

Supercharging your CBT or ACT Practice with RFT Presented by Dr Yvonne Barnes-Holmes A rare and limited opportunity to attend a two-day Experiential Workshop in RFT 27 and 28 April, Friends House, London Relational Frame Theory (RFT) offers the possibility of a theoretical functional basis for both CBT and Acceptance and Commitment Therapy (ACT) and other types of clinical interventions involving verbal behaviour. The workshop will explore several areas that appear to be central to clinical understanding and intervention and which illustrate the utility of RFT in this regard. These areas are: functional verbal assessment; behavioural flexibility; using the therapeutic relationship; changing perspectives; and assessing target relational networks.

The workshop will be interactive in format and aims to provide attendees with opportunities for acquiring and practicing relevant therapeutic skills and formulating a

scientific understanding of the basic verbal processes that underpin these skills and their impact on clients.

Yvonne is an internationally respected trainer in both RFT and ACT, and has been a tenured lecturer at the Department of Psychology at the National University of Ireland Maynooth since 2003. She is a prolific author and has supervised numerous doctorate students. Her research interests have focused on the early development of cognition and verbal language and how RFT can help clinicians to better understand client perspective and behaviour. She continues to maintain a therapy base with a small case load of complex clients and supervision of ACT clinicians.

Registration Fees Early bird: registrations and payment received up to 30 March 2015 BABCP Member: £160/Non-member: £180/Student: £90* Full registration fee from 31 March 2015 BABCP Member: £180/Non-member: £200/Student: £110* *Evidence of student status to be provided with application

CBT Today | March 2015 23

ACT SIG presents www.babcp.com

Acceptance and Mindfulness Skills For CBT Therapists Joe Oliver & John Boorman 11 June from 9.30am to 4.30pm University of London, Nutford House, Brown Street, London W1H 5UL This workshop is designed for therapists who have some familiarity with mindfulness and acceptance-based CBTs, and would like further develop their skills in using these approaches.

Participants will learn how to: • Engage clients in exploring their personal values to drive behaviour change • Decide when and how to use mindfulness in a flexible, formulation-informed manner • Develop the therapeutic relationship • Work with thoughts and other experiences using a flexibility model of CBT The workshop will be presented from an ACT framework, and involve case formulation, group roleplay, and presenters’ audio/video material of therapy sessions.

Joe and John are both clinical psychologists who are experienced ACT therapists, researchers and trainers.

BABCP Member: £90 Non-member: £120 Student/trainee: £45 For further information including how to register, please visit: www.babcp.com/Events or for further information email actsig@babcp.com

Couples SIG presents www.babcp.com

An Introduction to Cognitive Behavioural Couples Therapy 23 to 25 March 2015 Presented by Professor Dr Kurt Hahlweg Venue: Quakers Meeting House, 7 Victoria Terrace, Edinburgh EH1 2JL

Integrative Behavioural Couple Therapy 27 and 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

24 CBT Today | March 2015

CBT Today | March 2015 25

Chester, Wirral and North East Wales Branch presents

www.babcp.com

Working with Chronic Pain: using Cognitive and Behavioural approaches to manage the impact of persistent pain

Irish Association for Behavioural & Cognitive Psychotherapies presents

Treating Disgust Across the Disorders Presented by Dr David Veale

Presented by Helen Macdonald

Friday 27 March 2015

14 April 2015

The Wellington Park Hotel, Malone Road, Belfast BT9 6RU

The Conference Centre, National Waterways Museum, South Pier Road, Ellesmere Port, Cheshire CH65 4FW

Chronic pain affects a significant number of people, and up to seven per cent of the general population experiences persistent pain at any one time. The impact of pain on a person extends to occupational, social, and interpersonal functioning in addition to the misery of being in pain. People with long term pain have often experienced multiple physical treatments without success before being referred for psychological therapies.

Objectives • To enhance understanding of the evidence-base for a CBT approach to working with people who have chronic pain • To enhance skills in assessing the impact of chronic pain on quality of life and help people with persistent pain to understand their condition and health needs • To enhance knowledge and practical skills in delivering interventions for chronic pain management

Registration fees

Disgust is a core emotion and its derivatives such as selfdisgust (shame and contempt) have been a neglected area in research. Disgust is associated with phobic avoidance but standard exposure is less effective for disgust than for anxiety. Furthermore beliefs associated with disgust are often inaccessible. Disgust elicitors include eating/food; excreting; sex and death but there is also inter-personal disgust and moral disgust.

We will focus on the treatment of disorders that have a large component of disgust or self-disgust, namely fears of contamination and moral contamination in obsessivecompulsive disorder, body dysmorphic disorder, fears of death and a specific phobias of vomiting.

Registration fees BABCP Member: £90 Non-member: £100

BABCP Member: £105 Non-member: £115

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

BABCP Manchester Branch presents www.babcp.com

Cognitive Therapy for Chronic and Persistent Depression Presented by Dr Richard Moore

www.babcp.com

Cultivating Self-Esteem with Cognitive Therapy

19 & 20 March 2015

Presented by Dr Melanie Fennell

The Daffodil Hotel & Spa, Keswick Road, Grasmere, Cumbria LA22 9PR

Thursday 23 & Friday 24 April 2015

Depression is commonly seen as a disorder that can be successfully treated using cognitive therapy, but rates of relapse and continuing symptoms remain high. In this two-day workshop, Richard Moore will illustrate how the problems presented by people with chronic or recurrent depression can be addressed through adapting the model, process and techniques of cognitive therapy.

Throughout the workshop, the didactic teaching will be illustrated through clinical examples and opportunities to reflect and practise.

Venue information: The Daffodil Hotel is offering a limited number of rooms at a preferential rate for delegates attending this event. This will be on a ‘first come, first served’ basis. If you would like to take advantage of this, please contact the hotel directly and make them aware that you are an event attendee when booking.

Website - www.daffodilhotel.co.uk Telephone - 01539 463550

Registration fees BABCP Member: £140, Non-member: £180 Registration closes 12 March 2015

9.30am to 4.30pm

Manchester Conference Centre, Sackville Street, Manchester M1 3NJ Low self-esteem is commonly encountered in clinical practice, and associated with a wide range of emotional and psychiatric problems. The workshop presents a Transdiagnostic cognitive model of low self-esteem which integrates ideas from evidence-based protocols for anxiety and depression with developments in the treatment of chronic, longstanding problems and personality disorders.

These form the basis for a coherent programme of cognitive behavioural interventions designed to undermine old, negative beliefs about the self and to establish and strengthen new, more kindly perspectives.

Registration fees Early bird: registrations and payment received up to 6 March BABCP Member: £100, Non-member: £120, Student: £100* Full registration fee from 7 March BABCP Member: £120, Non-member: £140, Student: £120* * Evidence of student status to be provided with application

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Glasgow Branch presents

Control Theory Special Interest Group Presents www.babcp.com

www.babcp.com

Vicarious Trauma A two-day Control Theory workshop and conference Thursday 9 and Friday 10 April 2015, 9.30am-4.30pm Turing Seminar Room, Coupland One Building, University of Manchester M13 9PL

What you need to know Presented by Andy Gray and Sandra McKenzie Friday 17 April 9.30am to 3.30pm The Centre of Therapy & Counselling Studies, 8 Newton Place, Glasgow G3 7PR Aims of the event:

Day one - A workshop led by Dr Warren Mansell,‘A Transdiagnostic Approach to CBT Using Method of Levels Therapy’. This will involve small group discussions, workshop leader demonstrations, audio and video clips and experiential learning exercises. Delegates should be willing to talk about their own problems and experiences within small group settings for training purposes.

• To clarify what is meant by vicarious trauma

Day two - Oral and poster presentations that are open for everyone to submit, which will include 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.

• To highlight preventative and coping strategies

• To increase therapist’s awareness of the potential signs/symptoms of vicarious trauma • To identify the causes of vicarious trauma

There will be plenty of opportunity for making connections and to engage in discussion to put control theory into the practice of CBT.

The event will be delivered by Andy Gray (Academic Director, BABCP Accredited CB Psychotherapist, Clinical Supervisor, and Trainer) and Sandra McKenzie (Clinical Director, BABCP Accredited CB Psychotherapist, Clinical Supervisor and Trainer) both of whom have extensive knowledge of working with Trauma in Clinical Practice and Supervision.

This event is free of charge, so while tea break refreshments will be provided, lunch will not be provided.

Both Andy and Sandra are Directors at The Centre of Therapy and Counselling Studies.

The deadline for submission of conference posters and presentation abstracts is 20 March 2015.

Registration Fees

To register or for more details email control-sig@babcp.com

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BABCP Member: £80, Non-member: £100 Prices include lunch and refreshments. CPD certificates will be issued.

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Back by popular demand: Dr Russ Harris returns to the UK in 2015 to deliver two highly acclaimed workshops - his best-selling ACT Made Simple workshop and, new to the UK, an intensive ACT Boot Camp Two-day INTERMEDIATE level ACT Made Simple workshop, Cecil Sharp House, Central London on 8th & 9th July Boost your current practice with this extremely accessible popular 2-day workshop This INTERMEDIATE level workshop will cover case conceptualisation in both clinical and nonclinical populations: how to conceptualise any client problem in terms of the ACT model, from clinical disorders such as depression, anxiety, addiction to non-clinical issues such as work stress, performance anxiety, fear of failure and low self-confidence.

It also covers working with mandated or coerced clients; getting unstuck (for both clients and therapists); ‘selling ACT’ to your clients; getting to values when your client says ‘I don’t know’; overcoming resistance and motivating the unmotivated; anger and resentment; compassion and forgiveness.

This workshop is full of experiential exercises and shares fantastic tools for trans-diagnostic case conceptualisation, interrupting disruptive in-session behaviour, staying on track and using the model flexibly.

Registrants are required to have attended introductory level training.

Russ Harris presents ACT in a truly accessible style, seamlessly weaving together theoretical knowledge and practical application. His workshops are entertaining and inspiring, brimming with thoughtful experiential exercises presented with clarity and authenticity.

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Two-day ADVANCED level ACT BOOT CAMP, Cecil Sharp House, Central London on 10th & 11th July Take your ACT skills to the next level with this 2-day hands-on, skills-building “boot camp” In this 2-day intensive ‘hands-on’ workshop, you will get to play around with all sorts of useful tools, techniques and strategies, experiment with new ways of working, and discover for yourself just how creative, spontaneous, and adaptable ACT can be.

You’ll see plenty of live demonstrations, and participate in numerous innovative exercises. You will get to do numerous role-play activities in dyads and triads, and experiment with creating, modifying and adapting ACT techniques to suit your own personal style. This will be challenging, engaging, and lots of fun!

In particular, you’ll be exposed to brand new never-seen-before material from Russ’s forthcoming textbook, Sessions with IMPACT: Interpersonal Mindulness Skills in Acceptance and Commitment Therapy. For example, you’ll learn how to use the four key IMPACT questions, and the ‘S.L.O.W’ technique to instigate, model and reinforce psychological flexibility throughout every session, and how to rapidly spot and target ’The Four Horsemen of Fusion & Avoidance’ - Gating, Baiting, Skating and Stating.

So if you come prepared to apply yourself fully and leap in at the deep end, you will finish these two days with a big increase in your confidence about doing ACT.

For more workshop information, rates and special discounts for booking both workshops, venue locations and how to register please see www.contextualconsulting.co.uk. Early bird rate ends 1st June

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