CBT Today Vol 42 No 2 (May 2014)

Volume 42 Number 2 May 2014

Inside this issue: Inaugural CBT4Wales event Pages 11-14

BABCP member backs therapy revolution in Ukraine There is a developing movement in Ukraine to offer more holistic and modern mental health services that are less reliant on models based on services delivered predominantly in institutional settings, many of which have not evolved much since the Communist era. In this article, Euan Hails talks about his work with trainee CBT therapists in Ukraine A number of CBT experts from the UK, Europe, Israel and Canada have visited Ukraine over the last two years to deliver specialist CBT modules covering the core areas of CBT, such as anxiety and depression, to more specialist CBT areas such as schema therapy, mindfulness and, latterly, CBT for psychosis, bipolar disorder and substance user disorders.

During that time, a CBT diploma course has been developed in cooperation between the Ukrainian Catholic University (UCU) in Lviv and the Ukrainian Institute of Cognitive and Behavioural Therapies. This

From the Lead Organisation for CBT in the UK and Ireland

course is accredited by the Ukrainian Institute of CBT (UICBT), which is also a member of EABCT. This course had its first graduating cohorts in February 2014.

These workshops have developed under the UICBT 's direction. I was contacted by UICBT President Dr Oleh Romanchuk, a consultant psychiatrist and director of the Institute of Mental Health at UCU, who was also the first accredited CBT therapist in Ukraine (there are at least 12 accredited CBT therapists there). He invited me to Continued on page 3

BABCP signs up to conversion therapy statement On 2 April BABCP was represented at a round table meeting on gay conversion therapy with Health Minister Norman Lamb at the Department of Health in London.

Gay conversion therapy is a form of 'therapy' whose function is to 'reprogramme' an LGBT (lesbian, gay, bisexual and transgender) 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.

BABCP was joined at the meeting by representatives from organisations such as BPS, UKCP, BACP, the Royal College of Psychiatrists, the NHS and

LGBT groups including Stonewall.

Following the meeting, the BABCP Board agreed to support a Conversion Therapy consensus statement, which states that: 'We believe that 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.

For wider society, it also perpetuates the mistaken belief that homosexuality is a disorder needing treatment.'

BABCP has also committed to working with those present at the 2 April meeting on meaningful next steps. Progress updates will be disseminated to our members using the usual channels.

To read the full text of the Consensus Statement, please visit http://is.gd/consensus_statement

Subscription changes With effect from 1 July 2014, the option to pay subscriptions by monthly instalments will be withdrawn.

Members paying their subscriptions by monthly instalments will continue until the renewal of their current membership. For the first year after renewal, however, the option to pay in two equal sixmonthly instalments will be offered. Thereafter, memberships will be paid by a single annual subscription fee The option of instalments for Reduced Rate subscriptions was withdrawn in 2013 and all renewals will be payable at the annual Reduced Rate.

It is with regret that we have had to make this decision. But the administrative cost involved in collecting small amounts by monthly direct debit is becoming prohibitive, while the new process will be a more efficient manner in using membership funds.

Ian Preston, AFA BABCP Finance Manager

Volume 42 Number 2 May 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 posted free to all members. Back issues can be downloaded from www.babcp.com/cbttoday.

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Submission guidelines

Next deadline

Unsolicited articles should be emailed as Word attachments to editorial@babcp.com, except for PWP-related articles which should be send to pwptoday@gmail.com.

Publication cannot be guaranteed.

9.00am on 25 August 2014 (for distribution week commencing 22 September 2014)

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.

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

© 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.

BABCP member backs therapy revolution in Ukraine Continued from front cover

participate in training students as well as run a number of clinical supervision sessions.

With slides and supporting materials having to be translated beforehand, I delivered the workshops and supervision sessions with the aid of two very skilled interpreters. The workshops were well received by the students, many of whom had little knowledge or experience in working with those experiencing psychosis, bipolar disorder and substance user disorders. I also spent a couple of days there helping with the planning of future training programmes and the development of CBT supervisory training for advanced practitioners.

The trainees were predominantly psychologists, a smaller number of clinical psychologists, a very small number of psychiatrists, some academics and nurses. I was impressed by their efforts to update practice and offer patients evidencebased interventions in a system stymied by a post-Communist healthcare system still heavily reliant on financially compromised institutional care.

The majority of students of the course offer therapy in private practice. There was a general feeling among the trainees that government services were dominated by medical models of treatment, and based on old Soviet protocols, with limited options for the provision of talking therapies.

The presence of psychiatrists at the training was very useful as they were able to expand upon certain

diagnostic and symptom-based areas from a Ukrainian perspective. Training CBT for substance user disorders was also well received as most trainees had either worked in this field or told me,‘it is useful to have these skills here’.

I found the students’ enthusiasm, attentiveness and willingness to learn inspiring and was very pleased when I was made an Honorary Accredited Member of the Ukrainian Association of CBT on the last day of my workshop.

There still remains a great need for these developments to be supported by countries with a more advanced CBT practice and educational base. To this end I have agreed to return to Ukraine to facilitate a number of future workshops, provide clinical supervision, speak at their second Ukrainian CBT Conference, and hopefully work with UCU to help with accreditation of further courses.

enthusiastic practitioners find it difficult to practice without appropriate supervision and CPD. With this in mind, I am presently involved in developing formal links between the Ukrainian Association, the BABCP South & West Wales Branch and the CBT4Wales group.

For more information on the UCU's work, please visit http://is.gd/UCU_Lviv

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As many of us know from past experience, these initiatives often falter without formal support, supervision and training, as BABCP East Midlands Branch presents www.babcp.com

Overcoming challenges in the anxiety disorders Led by Philip Kinsella, Lecturer in CBT University of Nottingham 4 July 2014 Institute of Mental Health, Triumph Road, Nottingham The East Midlands Branch is being relaunched on 4 July 2014, with a training event followed by our inaugural AGM. ‘Overcoming challenges in the anxiety disorders’ will focus in a practical way on typical problems that occur in clinical practice. The topics that are likely to be covered are: • helping patients who are demotivated • making sense of co-morbidity • increasing success with exposure type behavioural experiments We aim to have a thriving branch that meets the needs of the local members, so we hope you can get involved!

Registration Fees: Early Bird (until 30 May) BABCP Members - £35 Non-members - £40

Standard Rate (from 30 May) BABCP Members - £45 Non-members - £50

Download a registration form at babcp.com/events

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Preview

BABCP 42nd Annual Conference and Workshops Sophie Bennett qualified as a clinical psychologist last September and is based at University College London. Here she offers CBT Today her thoughts on attending this year's BABCP Annual Conference and Workshops taking place at the University of Birmingham from 22 to 25 July One of the privileges of my training as a clinical psychologist was being able to listen to the latest research, try out practical therapeutic skills and translate these into my own clinical practice. Colleagues had told me to make the most of it, because it is hard to get that experience once qualified.

When I had the chance to attend this year’s BABCP Annual Conference, then, I jumped at it. Where else do mental health professionals get the opportunity to come together, listen to the latest research developments in the field and learn about how others are translating these programmes to refine their own cutting edge clinical practice? With such a wealth of high quality speakers, I am beginning to select my list of ’not to be missed’ presentations.

I am currently employed as a researcher and about to embark on a PhD investigating a CBT intervention.

Of particular interest to me, therefore, are the panel discussions ‘Behind the research curtain: do research treatments apply to real world settings?’ and ‘Is the scientistpractitioner model still relevant in the 21st century?’.

Dr Adele Hayes from the University of Delaware will talk about whether principles of intervention in anxiety treatments (exposure and emotional processing) can be applied to the treatment of depression. Research that cuts across diagnostic boundaries will also be presented by Dr Ernst Koster. His workshop,‘Beating the biases: real live demos’, promises to deliver material at the forefront of both theoretical and technological advances in CBT, in line with one of this year’s conference themes, ‘advances in technology’. His research investigates cognitive biases and the use of computerised retraining procedures, and he will present training programmes with the potential to prevent or treat affective disorders through cognitive bias modification or neurocognitive training. Dr Koster will also be convening a symposium on ‘New directions in attentional biases’.

Staying with the theme of technology, Professor Heleen Riper will also be delivering a keynote lecture on the use of personalised and embedded mobile CBT for depression. Professor Riper’s research focuses on ‘improving mental health, wellbeing and quality of life for all through the creative usage of emental health’. She will also be chairing a symposium on the upscaling and implementation of online CBT in routine practice. Mobile,

‘Where else do mental health professionals get the opportunity to come together, listen to the latest research developments in the field and learn about how others are translating these programmes to refine their own cutting edge clinical practice?’

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internet and other computerised interventions can make CBT more accessible across the age range, but I am particularly interested to see how they have been, and could be, developed for young people.

Professor in the Department of Psychology at Harvard University Richard McNally will be conducting an ‘ask the expert' session. His research focuses on a range of topics, including social anxiety disorder, OCD, PTSD, complicated grief and depression, and it will be a rare chance to speak with this international CBT expert.

Also travelling from far afield is Professor James Bennett-Levy, who leads a workshop entitled ‘Using behavioural experiments and imagery to create new ways of being’.

I was introduced to Professor Bennett-Levy’s work through the Oxford Guide to Behavioural Experiments in Cognitive Therapy, which he co-edited, during my first clinical training placement.

With this vast range of topics covered, the conference will be a fantastic place to network with colleagues who are interested in all fields of CBT. I very much look forward to seeing you there.

Gavin Warrins

The exclusion of people with comorbidities within research, particularly RCTs, is often presented as an argument for research treatments not applying to real-world settings and I am interested in

research that addresses this difficulty.

www.babcpconference.com

BABCP 42nd Annual Workshops and Conference University of Birmingham 22-25 July 2014

Registration now open!

Full day Workshops 22 July Conference 23-25 July Keynotes and Workshop Leaders: James Bennett-Levy, University of Sydney, Australia Sandra Coffmam, University of Washington, USA Colin Espie, University of Oxford Matt Field, University of Liverpool Janet Feigenbaum, University College London Daniel Freeman, University of Oxford Adele Hayes, University of Delaware, USA Chris Hatton, Lancaster University Paul Gilbert, University of Derby Ernst Koster, Ghent University, Belgium Peter Langdon, University of Kent Carl Lejuez, University of Maryland, USA Ian Kneebone, University of Western Sydney, Australia Christopher Martell, University of Wisconsin, USA Kathryn McHugh, Harvard Medical School, USA Richard McNally, Harvard University, USA Doug Mennin and Dave Fresco, USA Tanja Michael, Saarland University, Germany Emmanuelle Peters, King’s College London Heleen Riper, University of Amsterdam, the Netherlands Josef Ruzek, National Center for PTSD, USA Jasper Smits, University of Texas, USA John Swan and Marianne Liebing-Wilson, University of Dundee Paul Stallard, University of Bath Maureen Whittal, University of British Columbia, USA Plus skills classes, symposia and clinical roundtables

Book before 31 May to get the Early Bird rate!

For more information and registration please visit www.babcpconference.com

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Remembering Gordon Deakin In January, Gordon Deakin passed away. One of the original five Nurse Behaviour Therapists trained by Isaac Marks in 1972, he was very much part of the history of BAB(C)P since the early days of the Association. Here some of Gordon's friends and colleagues within the Association share their memories It is astonishing to look back to 1972, when Gordon was one of the first five people from a nursing background to undertake training in behavioural psychotherapy, and realise quite how controversial a development that was.

extending the range of behavioural psychotherapy from our relatively narrow beginnings to the full range of psychological disorders.

At that time, anything other than the multiple brands of psychoanalytic therapy was considered radical, dangerous and on the fringes of acceptability. While that was bad enough in the eyes of the mental health establishment, the very suggestion that mere nurses could undertake psychotherapy was near to blasphemy and the learned journals were united in warning against such folly.

He was a rarity amongst teachers.

Not only was he personally inspiring, but he had a very coherent educational philosophy and practice.

This meant that his influence on his trainees was an enduring one and there are many in our profession who look back on their contact with Gordon as a pivotal time in their careers.

Five disparate characters were thrown together to form that first cohort for what was to become the ENB650 course, and we were quickly aware of the extent of scrutiny (not all of it dispassionate) that we would face.

Gordon wandered into this, fresh from a stint in a Jungian Therapeutic Community (comparatively mainstream) with characteristic panache and good humour. He treated each new imposition and crisis with a chortle and an assumption that we would all just get on with things. That is how I remember him best.

The other thing he gave the group was his remarkable ability to approach things in a methodical way and painstakingly document things in a way that produced a completely clear record. He set down a tradition of exemplary record keeping that has proved key to the development and credibility of nurse therapists.

After the three-year project was over, Gordon worked in both London and Birmingham before putting down firm roots in Plymouth in 1977.

Throughout his long career, he continued to build on the core skills he developed in those early years and, in his own methodical way,

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He continued to teach and do clinical work with a varied caseload until his retirement last year.

He will be sadly missed and fondly remembered by his colleagues, by his community and by Jenny and his growing extended family.

Bob McDonald Gordon was a man whom I dearly respected. He was kind, thoughtful, honest, and all the qualities of the therapeutic relationship were present within supervision sessions. He was someone who was a constant in my life within all the changes of the NHS, and I could rely on his knowledge and ways of working to help the young people I worked with.

In the three years I worked with Gordon, I learnt so much. Now, as I close each case, it is thanks to his guidance and wisdom that these young people are better. Gordon was inspirational to me and the passion I have for CBT has been as a consequence of the work we did together. I am deeply saddened by his loss both personally and professionally.

Kate Gilham I had the pleasure of knowing Gordon since the late 1980s when I worked in Plymouth. I was fortunate to gain a place on what was to be the last ENBCC650 course that he ran in

Plymouth in 1990/91. I remember spending a pleasant hour going backwards and forwards to the waiting room practising calling out a patient's name and asking them to come into their appointment. A waste of time? Far from it, as it gave me the confidence very quickly to deal with all sorts of difficult situations and surnames! On the course he quickly became mine and everyone else’s hero.

Gordon had the innate ability to communicate new and, at times, difficult theories and techniques to us all in an understandable, practical and interesting manner. I fondly remember his afternoon teaching sessions starting with him coming in, sitting down (mug of coffee in hand) and commencing the discussion (prepowerpoint) by lighting up a cigar (pre-smoking ban) and just talking.

Not to us, but with us about a subject.

He taught me not to over-complicate things, something that I hope has guided my practice to this day and plagued those I have supervised over the years. For example, I was once writing a letter to a patient about a treatment plan for their spider phobia. 'Do not put arachnophobia', said Gordon. 'If the person does not understand it, they may not ask what it means to avoid looking stupid. You do not need to show off using big words. Keep it simple.'

At times, Gordon's knowledge and memory scared the hell out of me.

Not only could he tell you what book to look something up in, he usually knew the page number too.

In my view, Gordon gave me my career. He was kind, compassionate and, I like to think, a friend. More than that, a decent human being.

Dave Hannigan Gordon was a pivotal figure in the transformation of psychotherapy from an elite, esoteric intervention

practised by a shamanic caste to an experience open to an ever-widening range of people, both practitioners and recipients. Non-medical therapists particularly will remember him because of his career-long involvement with developing and teaching multidisciplinary CBT courses.

I did not know Gordon well, but I remember him well. I suspect this is the same for the great number of people whose lives he touched. We met on a small number of occasions, at conferences and as external examiners. I can sum him up in two words - warmth and integrity.

Gordon was always a delight to meet because he had the ability to make you feel at ease, easily falling into good-natured chat as though no time at all had passed since your last meeting. This is a rare gift, and particularly so in translating it into professional as well as personal relationships. I can only speak for myself, but I would bet all his students loved him.

Gordon also commanded respect, and was known for honesty, straighttalking, and intellectual and moral toughness. He could fight his corner.

Running specialist courses in CBT in the university sector is always difficult, but was particularly so during the early days. In a context of professional opposition and declining resource, Gordon kept CBT training alive in Plymouth at a time when opportunities for this training were rare across the country and when political and professional will did not support initiatives to broaden the availability of CBT. Against this background, he not only kept training going, but also made it innovative in both style and content. All with understanding, pragmatism and great good humour.

The world of CBT is poorer without him, as a teacher and innovator, and the world is infinitely poorer without him as a person.

Rob Newell, BABCP President Elect

Couples Special Interest Group In the November 2011 issue of CBT Today, Dan Kolubinski called for change in how we look at couples therapy in the UK. Three years later, in his capacity as chair elect of the BABCP Couples SIG, he is able to report that the landscape is markedly different At the end of 2011, a small but dedicated group of relationship enthusiasts met in Woking to form the BABCP Couples SIG. We spent our first meeting discussing theories, models and interventions and there was a strong desire to improve access to evidence-based interventions for couples.

Since that first meeting, we have met quarterly under the chairmanship of founding member Pavlo Kanellakis. Our guiding aims have been to promote the use of Cognitive-Behavioural Couples Therapy for the treatment of relationship distress and individual psychopathology, facilitate training opportunities, foster collaboration for research and generate a network of couples-based supervision. It has been a rewarding experience and we now have almost 100 members.

Since founding the Couples SIG, we have hosted eight workshops featuring local and international speakers. Most of these have been aimed at rudimentary skills to increase awareness of working with couples, as well as provide a foundation of knowledge amongst therapists who have primarily worked with individuals.

The coming year will see some significant changes, as we move forward to reaching our aims regarding supervision. In October, we are privileged to be able to offer one-day workshops featuring internationally-recognised researcher Professor Don Baucom in both London and Manchester (see the advert elsewhere in this issue for further details).This will be aimed solely at supervising therapists who work with couples. In addition to his supervision workshops, Professor Baucom will also offer a one-day workshop on working with couples who are coping with chronic health difficulties, to be held at the same venues.

Also in March 2015, Professor Kurt Hahlweg will be providing a two-day workshop on basic assessment and intervention skills open to those who attended the first part of Professor Hahlweg's two-part series in either October 2013 or March 2014. Next year he will return to the UK to offer a three-day workshop in Edinburgh combining both parts. Watch this space for future training opportunities, including workshops on CBT for sexual issues.

Finally, after two and a half years of solid leadership, Pavlo will end his term as Couples SIG chair in July, leaving an excellent legacy, having played an instrumental role in shaping the way that CBT therapists view relationships in the therapy room. On behalf of the SIG and the wider BABCP community, we would like to thank him for everything that he has done.

For further information on the Couples SIG, please email couples-sig@babcp.com

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Reducing anxiety in pregnancy Jayne Harris delivers CBT to Gloucestershire women who experience anxiety during pregnancy. Here she explains why reducing anxiety in pregnancy can be good for both mother and baby Many women experience some anxiety regarding the birth of their baby. For some, their anxiety is markedly increased by their view of the likelihood of serious injury to themselves or their baby, together with a reduced confidence in themselves to cope with the pain and uncertainty associated with natural labour and delivery. To avoid this perceived danger, an elective caesarean section may be requested by women in this situation when there is no medical indication.

NICE guidance recommends offering a referral to mental health professionals to address anxiety about giving birth. In Gloucestershire, in the absence of a Specialist Perinatal Mental Health Service, a partnership between Maternity and Mental Health Trusts set up a specialist clinic provided by the IAPT service to offer CBT for anxiety.

Assessment and up to four face-toface sessions are carried out by a psychological therapist. It also provides an opportunity for signposting and referral to other services.

Anxiety in late pregnancy has been shown to increase the risk of the baby developing anxiety, depression and behavioural difficulties in childhood.

Helping women to reduce anxiety, then, potentially benefits their baby as well. Of course, the purpose of the clinic is to address anxiety, rather than persuade women to opt for natural labour. Yet, if a woman is given the opportunity to reduce her anxiety about natural labour, it is often the case that she will be less inclined to opt for an elective caesarean, thereby reducing an unnecessary increase in risks to herself and her baby.

Women who have found this most

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helpful are those who experienced a previous labour as traumatic. Many women approach labour with a strong belief that they will be able to control most aspects of the labour and delivery by doing the right preparation and planning for the event. Indeed, approximately two thirds of women in the UK will have an uncomplicated birth. The one-third of women who need some medical assistance to deliver their baby can be left feeling guilty and disappointed, thinking that they have somehow failed, or that they or their baby were going to die. This may form part of symptoms of PTSD requiring longer psychological therapy, as well as contribute to a vicious cycle of depression with negative thoughts about themselves as a mother. As a consequence, they may see choosing caesarean as way of avoiding recurrence of depression by avoiding 'repeating the failure'.

interpretation of what happened in previous labours. This joint approach can help women in this situation to evaluate risks and benefits of natural labour and caesarean, while promoting a balanced view about their ability to influence the way their baby is born and recognise the biological factors beyond their control.

Women with milder psychological symptoms of trauma after birth may find that prioritising caring for a new baby, along with multiple life changes common at this time, can mean that their distress only becomes apparent with the trigger of the next pregnancy and impending birth.

Techniques proven to be helpful include drawing a responsibility pie, writing out an anxiety equation and challenging unhelpful thoughts about perceived failure to be 'normal', even though one-third of births require medical assistance.

Many of the women who are referred do not have other mental health difficulties and can challenge unhelpful thoughts fairly quickly.

Obstetricians and midwives provide information about risks and clear

on Twitter

www.babcp.com

Notice is given to all members of BABCP of the Annual General Meeting Time: 6.00pm Date: Thursday 24 July 2014 Venue: University of Birmingham

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Acceptance and Commitment Therapy Special Interest Group presents

Essay competition 2014

ACT SIG is pleased to announce the launch of its 2014 essay competition, the aim of which is to encourage interest in ACT.

journal the Cognitive Behaviour Therapist (tCBT). Publication is subject to the journal’s normal review processes.

Essays are welcome from those at all stages of psychology or CBT training in the following categories:

Essay question

• Student • Assistant • Research Assistant • Trainee Psychologists • Trainee CBT Therapists Entrants must be members of the ACT SIG. Membership is free to any BABCP member, with a reduced rate for anyone whose gross income is less than £21,388. To join please visit www.babcp.com/join.

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 will hopefully be selected for publication with the online BABCP

Discuss how skills and knowledge from ACT could complement and enhance practice in another specific cognitive behavioural approach of your choice.

The essay should between 3000-4000 words, including footnotes but excluding references. It must not be in print already, or submitted for publication elsewhere.The style should be semi-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 You should also pay attention to the tCBT ‘Instructions for Contributors’, which can be downloaded here: http://goo.gl/eUi6h 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 1 July 2014

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Diversity matters

Working with women offenders Toby Chelms wrote in the May 2012 issue of CBT Today about a pilot study he had conducted, as part of the Leeds IAPT consortium, aimed at reducing barriers for women who offend or are at risk of offending to accessing talking therapies. CBT Today invited him to update readers on what has happened since his last report

In 2012 I completed a pilot study within the IAPT Leeds consortium where it was identified that women in the probation system would be more likely to engage with therapeutic services if they were seen in a femaleonly environment. An IAPT clinic was subsequently introduced at the Together Women Project (TWP) in Leeds, a women-only space in the city centre providing a safe and confidential environment to support women who offend, or are at risk of offending, to explore and resolve ongoing issues. The IAPT clinic worked closely with an existing counselling service (not provided through IAPT) that was located within Leeds TWP to offer IAPT screenings and the option of referring to an IAPT PWP or CBT therapist. After the first 12 months of this service, my colleagues and I completed an audit report summarising the data we had collected between March 2012 and March 2013.

treatment (CBT or Guided Self-Help) within the TWP IAPT clinic.

Focusing on suitability we found that 49 per cent of total referrals were felt to be unsuitable for further IAPT work at the point of screening. The reasons why these clients were seen to be unsuitable were: childhood trauma as the focus for therapy (35 per cent); sexual abuse as the focus for therapy (20 per cent); current use of alcohol too high to engage with therapy (10 per cent); personality disorder as the focus for therapy (seven per cent); bipolar disorder as the focus for therapy (seven per cent); current drug use as the focus for therapy (seven per cent); anger as primary issue for therapy (five per cent); active risk to self (three per cent); complex PTSD (three per cent); and, bereavement as the focus for therapy (three per cent).

The main aim of the audit was to examine how clients' rates of engagement within the service (including recovery rates and onwards referrals to specialist services) compared with those of published benchmarks. We were also interested in a better understanding of the reasons for inappropriate referrals to IAPT and how we could better educate referrers to make more appropriate referrals as well as feel confident in referring to external services.

With regard to engagement, our results were very positive with a total of 64 per cent of those engaging with IAPT completing treatment. This is comparable to the IAPT national target of 66 per cent and the national average of 60 per cent. Dropping out of treatment were 18 per cent, compared to the 2009 national average of 21 per cent, while 14 per cent were referred to other services following treatment (psychology, counselling and EMDR). One client was deemed unsuitable for IAPT treatment during therapy as issues surrounding personality disorders became apparent as the focus for treatment.

Of the 77 clients who were referred to the TWP IAPT clinic and scheduled for an initial screening session, 12 per cent did not attend their initial appointment and were therefore discharged from the service, 49 per cent attended their screening but did not attend further appointments, while 39 per cent engaged with IAPT

The recovery rate for engaging clients was 39 per cent. Although significantly lower than the national target of 50 per cent, this rate is not far from the national average of 42 per cent identified in first year data of the IAPT programme. This is an area that requires further thought, and research that is being conducted

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across the Leeds IAPT consortium on improving recovery rates could also be used to enhance recovery rates in the TWP IAPT clinic. It should be noted that there may be reasons specific to this client group as to why there are lower than average recovery rates. It might be the case that stressors experienced by this client group are greater than for other populations (higher rates of housing issues, finance issues, domestic violence and childcare issues), which in turn may contribute to difficulties in engagement, or limitations in the degree of symptom reduction that may be achievable given such stress factors. This is another area for further investigation.

There are three main areas of learning and future focus from this audit.

Firstly, as many clients within this population are being inappropriately referred to primary care rather than secondary care mental health services; this indicate that further education of referring clinicians is necessary. Secondly, with engagement rates at this clinic equivalent to the general population, this indicates that the clinic's main goal of engaging hard-to-reach clients is broadly successful. Thirdly, further investigation is needed into why recovery rates in this clinic are slightly below the national average.

Over the next year we will be exploring these areas further before a similar audit towards the end of 2014.

If you would like to know more about the issues discussed in Toby's article, please email him at toby.chelms@leedscounselling.or g.uk. The full IAPT at TWP Leeds audit report can be downloaded at www.babcp.com/TWPAudit

Taking the temperature in a cold climate On 28 March, the inaugural CBT4Wales event took place at the iconic Wales Millennium Centre in Cardiff Bay. CBT Today Deputy Editor Peter Elliott reports

#CBT4Wales

Photographs on pages 12-13 by Mark Lawler

Photograph Wikimedia Commons/Gordon Plant

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(Above and below) Delegates at the CBT4Wales event in Cardiff practitioners, service users and other stakeholders.

CBT4Wales was set up and launched by the three Welsh Branches in BABCP at the OCD-UK Annual Conference held in Cardiff in November 2012. The group behind the initiative were responding to serious concerns about the lack of CBT provision in Wales compared with the scale and investment of the England-only IAPT programme.

Maggie Fookes, who chairs the CBT4Wales group, opened the conference, recognising the dedication, collaboration and imagination of all those who made the event happen, particularly the three Welsh Branches and the BABCP office.

The event at the Wales Millennium Centre was a step change for CBT4Wales, taking the message to a wider audience of policy influencers,

As well as providing the keynote, Professor Paul Salkovskis hosted a masterclass that responded to the question,‘In a cold climate, how

would you prioritise delivering CBT effectively, efficiently, or empathically?’ This led to a keenly debated session about how best to deliver CBT in Wales, given the current constraints.

Among the other speakers were Karen Robinson, who had lived with OCD for 24 years before seeking help, and retired Lieutenant Colonel John Skipper, whose experiences in several combat zones had led to him suffering severe PTSD. During his inspirational talk to the audience, John said,‘I owe my life to my therapist'. Karen echoed that sentiment, saying that for her,‘CBT was completely life-changing’.

Providing much food for thought were Dr Louise Waddington and Dr Tina Alwyn, who gave a comparison of mental health service provision and their outcomes in Scotland and Wales.

The event also featured a video message from Mark Drakeford, Minister for Health and Social Services in the Welsh Government, followed by an overview of the legislative framework in mental health provision in Wales from Phil

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#CBT4Wales Our aims • To raise awareness within Wales of CBT as an evidence-based treatment of choice for a wide range of emotional and physical health conditions in adults, young people and children

Paul Salkovskis presents his masterclass to delegates Chick, the Mental Health Development Lead for Wales.

Concluding the event were a Q&A chaired by Professor Salkovskis and a plenary session with the CBT4Wales organisers on agreeing how to take their agenda forward. There was enthusiasm to develop the role of CBT4Wales in two main areas. Firstly, as a body that would provide accessible and good quality CPD within Wales, with an appetite expressed for an annual CBT4Wales

event. Secondly, delegates saw a role for CBT4Wales in promoting the case for CBT as an evidence-based treatment of choice to policymakers, commissioners and the media.

Commenting on the event, Maggie Fookes said,‘The reaction has been really positive from everyone I have spoken to, which is very encouraging.

The minute we all sat down today, we met the first of our aims, in terms of showcasing CBT as an evidencebased treatment’.

• To promote BABCP Practitioner Accreditation as the best guarantor for protecting the public and raising the quality standards of CBT within Wales • To highlight the NICE guidelines regarding the effectiveness of CBT to Local Health Boards and other health and social care bodies in Wales • To provide high quality training opportunities to improve standards and widen the range of evidencebased psychological therapies, including CBT within Wales Contact us

Karen Robinson shares her story about living with OCD www.babcp.com/wales wales@babcp.com @BABCP #CBT4Wales The CBT4Wales group is Maggie Fookes (North West Wales Branch), John Barber (Chester, Wirral & North East Wales Branch), and Euan Hails and Graham Yeates (both South & West Wales Branch).

For more information on CBT4Wales and related events, visit www.babcp.com/wales

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BABCP Accredited Members by postcode area in the UK

Figures correct at 1 May 2014

0-25 members 26-50 members 51-75 members 76-100 members 100+ members

BABCP Accredited Members per town/city in Wales Aberystwyth . .1 Ammanford . . .2 Bangor . . . . . . .3 Brecon . . . . . . . .2 Bryn . . . . . . . . . .1 Buckley . . . . . . .1 Caernarfon . . .3 Caldicot . . . . . .1 Cardiff . . . . . . . .17 Cilgerran . . . . . .1 Coedpoeth . . .1

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Colwyn Bay . . .2 Corwen . . . . . . .1 Denbigh . . . . . .1 Dinas Powys . .1 Gaerwen . . . . . .1 Haverfordwest 1 Hawarden . . . .1 Hengoed . . . . .1 Holt . . . . . . . . . .1 Holywell . . . . . .1 Lampeter . . . . .1

Llandudno . . . .2 Llandysul . . . . .1 Llanelli . . . . . . . .1 Llansteffan . . . .1 Llantwit Major 1 Menai Bridge .1 Penarth . . . . . . .2 Pontyclun . . . . .1 Swansea . . . . . .6 Whitland . . . . . .1 Wrexham . . . . .5

ACBS UK and Ireland Chapter Association for Contextual Behavioural Science

Irish Association for Behavioural & Cognitive Psychotherapies Cumann Síciteiripe Iompraíoch agus Chognaíoch na hÉireann

Acceptance & Commitment Therapy (ACT) Special Interest Group British Association for Behavioural & Cognitive Psychotherapies www.babcp.com/irish www.babcp.com/irish

www.babcp.com

Acceptance and Commitment Therapy | Relational Frame Theory | Contextual Behavioural Science

Dublin 2014

Conference and Workshops Ballsbridge Hotel, Pembroke Road, Ballsbridge, Dublin

4-5 December (Pre-Conference Workshops 2-3 December)

Confirmed speakers include: • Professor Steven Hayes, University of Nevada, USA • Dr Dennis Tirch, Director, The Center for Mindfulness and CFT & Assistant Clinical Professor, Weill Cornell Medical College, USA • Dr Lisa Coyne, Suffolk University & Harvard Medical School, USA • Dr Ross White, University of Glasgow, UK • Dr Yvonne Barnes-Holmes, National University of Ireland, Maynooth, Ireland We are very pleased to announce that registrations are now open.

Guarantee your place now Register at www.actcbsconference.com This conference is jointly hosted by the BABCP ACT Special Interest Group, the Irish Association for Behavioural & Cognitive Psychotherapies and ACBS UK and Ireland Chapter.

Call for submissions open from 21 May to 30 June inclusive. Early Bird rate closes 17 October.

www.actcbsconference.com

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Towards ending female genital mutilation

Each year an estimated three million women undergo female genital mutilation (FGM) while almost 70,000 women and girls living in Britain have experienced FGM. CBT Today Associate Editor Patricia Murphy looks at the scale of the practice, why it still happens and calls to include FGM on the core syllabus, not just for midwives, gynaecologists and obstetricians but for all mental health professionals

How we respond, at a local, national and international level, to the brutal practice and consequences of FGM was the focus of a panel discussion at the Women of the World (WOW) Festival held in March at London's Southbank Centre. The panel included Minister for International Development Lynne Featherstone MP who outlined the Government’s new programme to reduce the practice by 30 per cent in at least 10 countries across Africa over the next five years.

most common among some African, Asian and Middle Eastern communities. It is usually carried out on girls aged between five and 12, although campaigners at the WOW discussion reported that there was also a disturbing trend of carrying out procedures on infants. It is a form of gender-based violence against women involving the deliberate mutilation of female genitalia typically by one of the following methods:

'Towards Ending Female Genital Mutilation/Cutting in Africa and Beyond' is a programme supported by the UK Department for International Development that is striving to work with the international community to end FGM in a generation. It aims to do this through a global movement advocating social change at community level, as well as promoting research and learning to create an evidence base for future work.

1. Clitoridectomy, which involves the partial or total removal of the clitoris and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).

The social change campaign Forward is based in Nairobi and London and is led by Efua Dorkenoo OBE, Senior Advisor of Equality Now’s FGM programme. It is supported by an extensive range of partners including Comic Relief, the Royal College of Midwives, and the International Federation of Obstetricians and Gynaecologists.

The World Health Organisation stresses FGM not only has no health benefits but is a violation of the human rights of girls and women. It is

(Right) Leyla Hussein, a psychotherapist and FGM activist who also co-founded Daughters of Eve with Nimco Ali

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2. Excision, which involves partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the lips that surround the vagina).

3. Infibulation, which narrows the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner or outer labia with or without removal of the clitoris.

4. All other harmful procedures to the female genitalia for nonmedical purposes, such as pricking, piercing, incising, scraping and cauterising the genital area.

Remarkably, FGM remained legal in the UK until 1985, yet there are an estimated 24,000 girls at risk in this country, and a number of high profile individuals and groups have dedicated themselves to raising awareness by campaigning for an end to this violation. One of these is Nigerian midwife Comfort Momoh, who opened the African Well Women’s Clinic at London St Thomas’ Hospital in 1997 where up to 350 women are treated for ‘reversal procedures’ every year. She claims that FGM is a ‘big problem in the UK’

and urges health workers to be better informed.

Since last month, the Department of Health has required all NHS hospitals to record if a patient has undergone FGM or if there is a family history of it.

The Government says that,‘This is the first stage of a wider scheme to improve the way the NHS will respond to, follow up and support the prevention of FGM’.

Other high profile campaigners include Leyla Hussein, a psychotherapist and FGM activist who also co-founded Daughters of Eve with Nimco Ali. Together they have established a not-for-profit organisation that works to advance and protect the physical, mental, sexual and reproductive health rights of young people from communities that practise FGM. Hussein is also a previous victim of FGM and has talked movingly about her own traumatic experience. She was just seven years old when four women held her down, while a fifth person cut her. The pain was so intense that Leyla screamed for her mother to help her, before passing out. In the BAFTA-nominated Channel 4 documentary film The Cruel Cut, Hussein explores the complex world of FGM and points to the fact that it could be your neighbour, your colleague or the girl next to you on the bus who could either be at risk of or suffering the consequences of FGM. Revealed for what it is, FGM is a

form of gender-based violence that reflects and reinforces inequalities between men and women, and compromises the health, dignity, security and autonomy of its victims.

Fittingly, Hussein and Ali attracted recognition from the judges of the Woman’s Hour Power List 2014, who placed them sixth in the top ten of women who were acclaimed as game-changers.

This clamour for change has now reached the highest office in government, with David Cameron due to play host to Britain’s first Girls Summit, which is aimed at galvanising efforts to end both FGM and forced marriage. Campaigners will also be heartened by the fact that, earlier this year, the Crown Prosecution Service successfully prosecuted two men - one of whom is a doctor - under the Female Genital Mutilation Act for the first time.

Responding to these prosecutions, Efua Dorkenoo from Equality Now said:‘Getting a prosecution after so long is fantastic and a key part of ending FGM. A prosecution will send out a strong message that FGM will not be tolerated. However, we also need to ensure that girls at risk are urgently protected; survivors need to be empowered and given the physical, psychological and emotional support they need to speak out’.

The FGM National Clinical Group has been set up to do just that. This charitable organisation is dedicated

to working with women who have been affected by FGM and related issues, and comprises a multidisciplinary group of health professionals, advisers and academia.

The group advocates that FGM should become part of the core syllabus training not just for midwives, obstetricians and gynaecologists but for all mental health professionals. Although there is scant research available regarding the psychological effects and needs of those affected, the group asserts that there is clear evidence to associate FGM with PTSD as well as negative effects on body image, shame, guilt, anxiety and sexual and relationship difficulties.

With almost 70,000 women and girls estimated to be living with the terrible consequences of FGM in this country alone, it would appear that there is no longer any place for squeamishness. We must hope that a powerful combination of political, social and legal pressure may eventually see an end to this barbaric practice.

More information on the organisations involved in campaigning to end FGM can be found on the following websites: www.forwarduk.org.uk www.dofeve.org www.fgmnationalgroup.org

Are you interested in working towards a better understanding of bipolar disorder?

Then join the BABCP Bipolar Disorder Special Interest Group!

Joining is free to any BABCP member.

Our aims are: • Facilitate dissemination and awareness of developments in the psychological understanding of the experiences of individuals diagnosed with bipolar disorder, and of those with related mood experiences in the wider community.

• Support co-operation of clinicians, researchers, and service users in research designed to develop and evaluate improved psychological

approaches for individuals with experience of bipolar disorder.

Introducing the committee:

• Support dissemination of evidencebased psychological approaches for individuals with experience of bipolar disorder, including enhancing training opportunities for clinicians.

Chair - Steven Jones Deputy Chair - Fiona Lobban Secretary - Graeme Reid Treasurer - Kim Wright Liaison Officer - Alyson Dodd Ordinary Members - Matthias Schwannaeur, Craig Steel

One of our core principles is that the work we do should be directed towards improving service user valued outcomes and developing therapies in collaboration with service users.

If you would like to join us, and be kept up-to-date with the latest news and CPD events relating to bipolar disorder, please email babcp@babcp.com with the subject 'BD-SIG'

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Just what is CBT with children and families?

BABCP Children, Adolescents & Families Special Interest Group (CAF SIG) committee member Steve Killick writes about some of the issues relating to delivery of CBT to this particularly vulnerable group

Historically, CBT with children grew out of social learning theory which called upon behaviourism and the theories of cognitive development from Jean Piaget and Lev Zygotsky. In the process, the question about when children were able to use ideas from CBT became of increasing interest to many practitioners.

Particularly, the success of Paul Stallard’s book, Think Good - Feel Good, helped introduce CBT to many practitioners in child services.

The recent development of Children & Young People's IAPT in England places CBT as an important evidencebased therapy in child mental health.

Third wave therapies, such as DBT, ACT and Mindfulness, are becoming more frequently used in child and adolescent mental health while there are countless examples of innovation and good practice using CBT theory and practice.

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As with CBT for adults, there are many levels of intervention. These include self-help interventions in the form of books and computerised CBT programs. There are also a large number of guided CBT interventions that can be delivered individually or in groups, such as Webster-Stratton parenting programmes or the Friends programme that is used in schools.

There is also a large number of treatment guides for helping with difficulties such as anxiety, OCD and depression. There is also formulationdriven CBT practiced by skilled therapists.

In common with CBT in other areas, interventions must be based in sound cognitive and behavioural theory, and continually developed through supervision and evaluation. Such work with children, however, needs consideration of further elements.

Firstly, interventions need to call upon

a sound understanding of children’s cognitive and social-emotional development, particularly attachment theory, neuro-developmental disorders and potential learning problems. As well as an understanding of development, there needs to an awareness of the family life-cycle and the wider systems that impact on a child’s life.

The family, schools and peer groups can all have a significant impact, both positive and negative, on children’s mental health. An understanding of systemic concepts is important to ensure interventions are focused appropriately. Interventions may be targeted not only at the child but at parents, the family as a whole or even elsewhere.

Typically, an older child may be more likely to have individual treatment, but there will still be some parental involvement. The precise focus may depend on the formulation, and skills in working with relationships in the family are often called for. OCD is a clear example where interventions are most effective if the family is actively involved in treatment. CBT and systemic ideas have been married effectively in such approaches as systemic CBT or multi-systemic therapy.

A further area of difference is in understanding that some of the traditional verbal and written techniques of CBT will not always work as well with many children and young people. Interventions may need to utilise play, drawing, storytelling and other creative techniques.

That CBT is maturing in this area is demonstrated by the recent book by Peter Fuggle, Sandra Dunsmuir and Vicki Curry, CBT with Children, Young People and Families, which outlines the skills that a practitioner needs to work effectively with this population.

Without a good understanding of the areas of difference, CBT with children may be ineffective or even harmful.

opportunity to receive more effective help in the future. In CAF SIG, our understanding of these issues has set the agenda for how we wish to support the development of CBT in children’s services. We think CBT should be a formulation-driven activity and that intervention packages are delivered by appropriately trained and supervised staff.

The widespread success of CBT has led to this particular kind of therapy being delivered by individuals with insufficient skills and training.This experience can prejudice people against CBT and deprive them of the

Over the next few years, CAF SIG wishes to develop the range of appropriate CBT training that is provided nationally. In doing so, we want to work collaboratively with local BABCP Branches to put on

quality training events for practitioners and also at the BABCP Annual Conference. We also want to develop the availability of supervision and the confidence of practitioners in providing it. With this in mind, one of the first workshops we are offering is in supervision of CBT with children and families.

If you are interested in joining CAF SIG or becoming more involved in our work, please email cafsig@babcp.com

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BABCP Southern Branch presents www.babcp.com

Using Compassion Focused Therapy to work with the legacy of disrupted childhood attachments and traumatic experiences Presented by Dr Deborah Lee | Monday 18 & Tuesday 19 August 2014 | 9.30am to 4.30pm Solent University Conference Centre 157-187 above Bar, Southampton, Hampshire, SO14 7NN About the workshop: Compassion Focused Therapy has been developed to help address the restoration of mental wellbeing in those who, through no fault of their own, were not looked after and cared for emotionally, physically and psychologically. The evidence suggests that training people in compassion can have a wide range of physiological and psychological benefits.

Being cared for and connected to others through affiliation is vital to mental wellbeing and psychological functioning. Caring for the psychological development of a child through emotional nurturance is an essential ingredient needed to develop compassionate resilience and the importance of attachment in child development has been widely disseminated by John Bowlby.

Unsurprisingly then, the most pervasive problems in mental health are often experienced by individuals who have experienced poor emotional nurturing and abuse in their early attachment relationships. The legacy of those life experiences can lead to profound difficulties in selfsoothing, compassionate care and struggles with forming supportive loving and connected relationships with self and others. Thus many psychological difficulties are rooted in social relationships as individuals struggle to feel safe in their own minds and in the minds of others.

Traumatic emotional memories linked to abuse can pervade wellbeing and torture the mind.

BABCP Scotland Branch presents

This two-day workshop will use the theoretical framework of social mentality theory to explore and understand the difficulties faced by those who experience psychological pain and trauma through childhood experiences. We will then focus on using compassion focused therapy processes and techniques to develop compassionate resilience to help individuals accept, work through and move on from the legacy of their childhoods.

About the presenter: Deborah Lee is Consultant Clinical Psychologist at Berkshire Traumatic Stress Service & South Central Veterans Service; she is also Honorary Senior Lecturer at University College London. She is author of The Compassionate Mind Guide to Recovering from Trauma and PTSD and The Compassionate Mind Approach to Recovering from Trauma using Compassion Focused Therapy.

Registration fees: Early bird (until 18 July) BABCP Members - £150 Non-Members - £180 Full registration fee (received after 18 July) BABCP Members - £165 Non-Members - £195 Download a registration form at babcp.com/events

BABCP Couples SIG presents www.babcp.com

www.babcp.com

CBT for PTSD: Type 1 trauma and beyond

by Dr Kevin Meares Friday 13 June 2014, 9.30am to 4.30pm Stirling Management Centre, University of Stirling FK9 4LA About the presenter:

This workshop will aim to help participants think about and develop their skills in working with PTSD.

Dr Kevin Meares is a Consultant Clinical Psychologist in Trauma. He works at the Newcastle Cognitive and Behavioural Therapy Centre, part of the Northumberland, Tyne and Wear NHS Foundation Trust.

Using clinical examples and based on Kevin’s experience of working with this population, the workshop will start with Ehlers and Clark’s (2000) cognitive model of persistent PTSD and build from this to consider the broader issues that may arise with Complex PTSD. The workshop will consider the timeliness of a trauma focused intervention and its relationships stabilisation processes. Feedback from previous workshops suggests that participants value the diversity of clinical examples that he draws upon when helping participants develop their understanding and skills.

Kevin’s current case load includes a significant number of Veterans with PTSD, refugees, survivors of domestic violence, and other individuals with multiple traumas across the age span.

Dr Meares’ clinical interest in trauma stretches back over 16 years. He continues to enjoy working with and of course struggle with the complexity of multiple traumas. He is an Accredited CBT therapist, trainer and supervisor and is also an EMDR practitioner. He has been offering training on CBT and trauma for over 10 years. His approach to trauma is not novel, but might be unique in its synthesis.

Dr Meares’ other interest is GAD. He has co-authored two books Overcoming Worry and CBT for Worry and GAD.

Cognitive-Behavioural Couple Therapy: Addressing Health Problems London: Monday 13 October and Manchester: Thursday 16 October 2014

How to Supervise Couple Therapy London: Tuesday 14 October and Manchester: Friday 17 October 2014 Presented by: Professor Donald H Baucom PhD, Richard Simpson Distinguished Professor of Psychology, University of North Carolina

Venues

About the workshop:

LONDON

MANCHESTER

The Royal Foundation of St. Katharine 2 Butcher Row LONDON E14 8DS

Friends Meeting House 6 Mount Street MANCHESTER M2 5NS

Registration fees: (Note - fees are quoted per day) Registration Fees: BABCP Member - £85 Non-member - £105 Lunch and refreshments are included. CPD Certificates will be provided.

Download a registration form at babcp.com/events

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Members - £110 Non-members - £120 Concessions - £90

Download a registration form at babcp.com/events

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