CBT Today December 2014

Volume 42 Number 4
December 2014
Inside this issue:
The women’s room
Changing the game in wider society
Pages 11-15
BABCP, CBT and
public involvement
This July, Professor Rob Newell (pictured below) began his two-year
term of office as the BABCP President. CBT Today invited him to
introduce himself and his vision for the Association
I write to introduce myself as
President of BABCP. Many BABCP
Presidents have scarcely needed to
introduce themselves to the
membership, and I am humbly aware
that I follow many well-known,
influential and innovative people as
President. By contrast, I am not a
household name in CBT, so I will start
by saying a little bit about myself.
Mainly though, I will talk about how I
see one future direction of BABCP,
and how I hope we will move in that
direction as an organisation.
First off, and perhaps surprisingly, I
have not been a therapist for a good
many years. I was lucky enough to
From the Lead
Organisation for CBT
in the UK and Ireland
train with Isaac Marks back in the
1980s and, following a fairly brief time
as a therapist, moved into roles that
were primarily teaching and research.
I finally ceased to practise as a
therapist in around 2000 and
concentrated entirely on teaching
and research, mainly centred around
my chief area of research, which is
visible difference and disfigurement.
For all that, I am very proud to have
been a BABCP member for over 30
years, and a member of the
Association’s Board of Trustees for the
past three years. Of course, I am
especially grateful to have benefitted
from Trudie Chalder’s example
and advice during my year as
President Elect, at a time when
BABCP has been going through
a challenging period and has
achieved its landmark 10,000
membership. Our growing
membership itself challenges us
to think about the place of CBT
in the UK and Ireland, and what
we might do to be worthy of
that position and respond to
the expectations of people
who use CBT and the wider
public when CBT remains a
scarce resource.
I am very clear that CBT is
much more than a therapy;
much more than something
for people who are defined
as having problems. CBT is a
way of looking at life and, in
an ideal world I would take
Continued overleaf
BABCP, CBT and
public involvement
Continued from page 1
the ‘T’ away and talk about Cognitive
Behaviourism to describe that view of
the world. I know CBT has
transformed my life and, I imagine
that of many BABCP members; those
who use CBT services would echo
that feeling. Yet, at the same time, I
am acutely aware of how little impact
this way of looking at life has on the
world at large.
So here is the challenge: we have a
growing membership, an increasingly
recognised treatment approach, and
yet, in my eyes, the cognitive
behavioural approach is understood
by a vanishingly small percentage of
our population and is more or less
invisible in the broad cultural life of
our country.
“
Our job is to engage with people
and the media to communicate
the message that CBT is
something for everyone
”
Volume 42 Number 4
December 2014
Managing Editor - Stephen Gregson
Deputy Editor – Peter Elliott
Associate Editor - Patricia Murphy
CBT Today is the official magazine of the
British Association for Behavioural &
Cognitive Psychotherapies, the lead
organisation for CBT in the UK and Ireland.
The magazine is published four times a
year and mailed post free to all members.
Back issues can be downloaded from
www.babcp.com/cbttoday.
2
| December 2014
Here are a couple of examples. On
television hardly a week goes by
without some soap hero having
counselling for her anger problems or
the consequences of his early
childhood experiences. Similarly,
television couples in difficulties will
inevitably seek some form of
guidance. Rarely is the intervention
specified and, if it is shown at all, there
is no discernible CBT content, but
most likely an unfocussed discussion,
perhaps with reference to people’s
experiences with their parents.
Likewise, almost every area of
literature, criticism, biography, or
popular song seeks to ascribe
motivations to people based on
arcane belief systems or folklore
explanations of behaviour. I am
always, for example, amazed that the
use of psychoanalysis to explain the
behaviour of dramatic protagonists
has not really changed since I studied
literature as a schoolboy. Once again
cognitive behavioural perspectives
do not shape our collective life as a
nation. Of course, I am only following
BF Skinner’s introduction to Beyond
Freedom and Dignity here. Fans will
recall that he deplored the
prevalence of mentalist explanations
for behaviour current in everyday life.
I do not think much has changed
since Skinner wrote this in 1971.
Do not think that I am after evidencebased TV and a fairer profile for CBT
in fiction - although these are
interesting ideas! Rather, I am
illustrating ways in which public
views of what therapy is and how we
come to act as we do are shaped.
Why should BABCP have a role in all
this? I believe we should because we
have a duty to point to a different
way of looking at life: one that offers
credible, testable explanations for our
behaviour without seeking to
pathologise our difficulties, and one
in which CBT is freely available to all
because it is not just offered by
therapists. Instead, it is offered by
everyone; your friends, your next door
neighbour, because we all understand
the basics as a normal part of our
culture. Sounds far-fetched? I do not
think so. I believe everyone has a
basic understanding of CBT principles
- that is why our parents often told us
not to shy away from things that
made us anxious. Everyone does
informal CBT sometimes. Imagine if
that was increased and refined.
Our job, then, is to engage with
people and the media to
communicate the message that CBT
is something for everyone. This is very
much part of the aims of the
Submission guidelines
Advertising
Unsolicited articles should be emailed as
Word attachments to [email protected].
Publication cannot be guaranteed.
An unsolicited article should be
approximately 500 words written in
magazine (not academic journal) style.
Longer articles will be accepted by prior
agreement only.
For enquiries about advertising in the magazine,
please email [email protected].
In the first instance, potential contributors are
advised to send a brief outline of the
proposed article for a decision in principle.
The Editors reserve the right to edit any
article submitted, including where copyright
is owned by a third party.
Next deadline
9.00am on 26 January 2015 (for distribution
week commencing 23 February 2015)
Disclaimer
The views and opinions expressed in this
issue of CBT Today are those of the individual
contributors, and do not necessarily reflect
the views of BABCP.
© Copyright 2014 by the British
Association for Behavioural & Cognitive
Psychotherapies unless otherwise
indicated. No part of this publication may
be reproduced, stored in a retrieval system
nor transmitted by electronic, mechanical,
photocopying, recordings or otherwise,
without the prior permission of the
copyright owner.
Association, but will take effort from
us. In developing our continuing
strategy, I hope BABCP will seek new
ways to be part of the structure of our
society.
I hope we will expand our
membership so that more members
of health and other professions who
are not therapists want to join us. We
will also seek ways to provide
meaningful membership to lay
people who are interested in CBT, and
we will have a user involvement
strategy at the heart of our work. CBT
has always been the most clientcentred of therapies, but that is often
lost on professionals and lay people
who have not directly experienced
CBT. I believe CBT has a powerful and,
above all, positive message we can
promote through seeking more
media opportunities.
This will not be completed overnight.
But I hope BABCP members will want
to work with me and the Board to
support these continuing initiatives
towards making CBT part of our
society as a whole for the future.
Advertisement
'Supervision in Southampton', by Supervisor with 20 years’ therapy
experience plus Eating Disorder Specialism; £65 per hour or negotiate
group fee. Phone or text Vicky Duddridge 07810 870788 or email
[email protected].
2015 EABCT congress in Jerusalem
Statement from the Board
At BABCP’s AGM the following motion was carried with the following numbers voting:
BABCP regrets the decision of the European Association for Behavioural and Cognitive Therapies to hold the 2015
EABCT congress in Jerusalem. We believe that the choice of Jerusalem as the host city will do little or nothing to
promote unity and inclusion but inevitably lead to division and exclusion. We recognise our members’ concerns
that:
1) their attendance at a conference in Jerusalem may be used to promote and or legitimate Israel’s continued
occupation of Palestinian land;
2) the choice of Jerusalem as the host city precludes the attendance of many people including Palestinian mental
health professionals from the West Bank and Gaza, EABCT members who support the academic boycott of Israel
and others who, by attending would face the disapprobation of their communities;
3) the Israel Cognitive & Behaviour Therapies Association (ICBTA) chose to disregard our members’ recommendation
in 2012 that a less insensitive venue be found.
We urge those members of BABCP planning on attending or presenting at the conference to consider the
statement made by the UK Palestine Mental Health Network in relation to this event.
In favour - 45
Against - 2
Abstentions - 10
Accordingly, this motion represents the agreed position of BABCP regarding this congress and, in keeping with this
position, BABCP will not be sending a representative to the 2015 EABCT Congress in Jerusalem.
| December 2014
3
Collaborative solutions
for children’s CBT
This summer Steve Killick attended a course run by Ross Greene, the
founder and Director of Lives in the Balance and the originator of the
Collaborative Problem Solving approach (now called Collaborative
and Proactive Solutions). Here Steve reflects on the experience
I read Ross Greene’s book The Explosive
Child a few years ago and found it
sufficiently intriguing to go on a threeday course run by him at the
University of York in June earlier this
year. He has a very specific model for
dealing with challenging behaviours
across a range of diagnostic disorders.
His focus is not on the diagnosis but
rather on the ‘lagging’ cognitive or
emotional skills that might be
underlying the behaviour.
The approach aims to help parents or
staff in residential or educational
settings understand the difficulties to
which the behaviour is the response,
and give them a method to help the
child develop the skills to overcome
the difficulty. Greene is very critical of
behavioural approaches that focus on
reward and punishment and seeks to
find ways of developing cognitive
flexibility in children and young
people, especially those with extreme
challenging behaviour.
There is some promising evidence
described on his website that this
approach can make a big difference,
especially in institutionalised settings
whether there can often be an overreliance on sanction- and rewardbased systems. His argument is that
focusing on consequences is often
counter-productive, while adult
theories and attributions about the
causes of the behaviour can get in the
way of accurately recognising
antecedents and intervening in a way
that helps develop skills.
His model, which follows prescribed
steps, involves a thorough assessment
of antecedents and triggers to identify
situations that the child finds difficult,
rather than what the actual behaviour
is. After identifying possible lagging
skills in areas such as executive
function, emotional regulation, social
4
| December 2014
skills and so on, the intervention then
focuses on a very thorough and
patient use of problem-solving
conversations. Reflective listening and
guiding is then used to help the child
develop specific skills with an adult
commitment to negotiation, empathy
and creative thinking.
Greene describes his model as a
family or team-based approach that
fits within a CBT framework. Although
he was highly critical of behavioural
approaches on the course, I feel that
what he was describing was the
misapplication and abuse of
behavioural approaches which I
have certainly observed on a
frequent basis.
What is more radical is his movement
away from consequences to a focus
on identifying difficulties in lagging
skills or unsolved problems. There
were some extended role-plays on
the course with a focus on using
reflective listening for extended times
to help really explore and develop the
child’s point of view.
Many of the participants seemed
taken aback by how hard it was to
keep their own theories and
explanations out of the conversation. I
learnt many useful skills, but was also
surprised that a model emphasising
negotiation and flexibility actually
followed a very structured process. My
view is that it could be very useful for
organisations that routinely work with
challenging behaviour to develop
skills in this, but I am not sure whether
I would think it so applicable
elsewhere without combining other
approaches. Although this model is
not so well known in the UK, I am sure
that this will not be his last visit here.
Ross Greene’s website can be found
at www.livesinthebalance.org
www.babcpconference.com
Annual Conference
and Workshops 2015
University of Warwick
21 - 24 July 2015
The 2015 Annual Conference will take place at the University of Warwick,
with full day workshops on Tuesday 21 July, and the conference itself running from
Wednesday 22 to Friday 24 July.
Confirmed presenters at the 2015 Conference are:
• Max Birchwood
University of Birmingham
• Rob DeRubeis
University of Pennsylvania
• Melanie Fennell
University of Oxford
• Mike Kyrios
Swinburne University of Technology,
Australia
• Michelle Moulds
University of New South Wales, Australia
• Ronan O’Carroll
University of Stirling
• Vikram Patel
London School of Hygiene and
Tropical Medicine
• Alisa Russell
University of Bath
• Michael Scott
Sheffield Hallam University
• Sue Spence
Griffith University, Australia
The scientific committee invite submissions of Pre-Conference
Workshops, Symposia, Clinical Roundtables, Panel Discussions, Skills Classes,
Open Papers and Posters.
Deadline for Workshops, Symposia and Skills Classes:
12 January 2015
Deadline for Open Papers and Posters:
27 February 2015
For more information please visit www.babcpconference.com
| December 2014
5
Why we proposed the motion
David Raines and Mohammed Mukhaimar put forward the motion about the 2015 EABCT congress at this year’s BABCP
Annual General Meeting in Birmingham. CBT Today invited them to explain their reasons behind the motion
David Raines, who proposed the
motion, writes:
At the AGM in Birmingham a motion
was passed that ‘BABCP regrets the
decision of the European Association
for Behaviour and Cognitive
Therapies to hold the 2015 EABCT
congress in Jerusalem’, saying that,
‘We believe that the choice of
Jerusalem as the host city will do little
or nothing to promote unity and
inclusion but inevitably lead to
division and exclusion’. There were
45 votes in favour, two against and
10 abstentions.
The background to this motion
follows a meeting of the EABCT in
Reykjavik in 2011 at which Austria
announced that it had withdrawn
its application to host the 2015
conference, leaving Israel as the
only applicant.
Although our representative was
unable to attend the meeting, I
understand concerns were raised and
reassurances given about engaging
with the Palestinian community.
I doubt that many of the EABCT
representatives knew that six weeks
earlier the Israeli Parliament had
passed the ‘Law for Prevention of
Damage to the State of Israel through
Boycott’. This makes it an offence for a
person of ‘any nationality’ to call for
economic, cultural or academic
boycotts. Few will have understood
that they had voted to hold the
congress in a place where any of their
members advocating a boycott of the
conference could face punitive
damages and withdrawal of funding
for the institution they represent.
CBT Today, September 2013), I
discussed the proposed conference
with as many Palestinian mental
health professionals as possible and
the response was pretty unanimous.
Those people I met did not believe
that the conference should be held in
Jerusalem. They insisted that the
choice was, by definition, a political
act, and feared that it would be used
to promote and or legitimate Israel’s
continued occupation of Palestinian
land. They argued that, while
Palestinian citizens of Israel may be
able to attend, Israel’s discriminatory
system would mean that many
Palestinian therapists from the West
Bank and Gaza would be excluded
from the proceedings. Even if they
could attend they would be likely to
face opprobrium from their
community. They reminded me that
the ‘law against boycott’ applied
to me.
Sofi Marom, the President of the
Israeli Association, had asked for my
help in developing contacts in the
Palestinian community and, in my
emails, I repeatedly expressed my
concerns about the choice of
Jerusalem and urged them to change
the venue. My concerns and
suggestions were politely rebuffed.
At the BABCP Annual Conference in
June 2012, I talked with as many
Board members as possible about my
concerns but was unsuccessful in
my attempt to have the issue
included in the AGM agenda under
‘Any Other Business’.
It is an admittedly small group of
BABCP members who give their time
helping Palestinian mental health
workers to develop the services their
people so desperately need. They
come together with likeminded
European colleagues whose
professional organisations are
affiliated to EABCT. Would they
publicly support a boycott? Have
they been gagged? If, like me, they
would like to return to
Israel/Palestine, they had better
remember that any public support for
a boycott may result in them being
denied entry or facing court
proceedings and punitive damages.
During my visit to Palestine in
December 2012 (see my article,‘CBT
training behind the wall’, published in
I proposed the motion not least
because I felt that it was regrettable
that EABCT should have decided to
6
| December 2014
hold their congress in a country that
has passed laws prohibiting the
members from publicly saying,‘This is
not a good idea, please don’t come,
our organisation is hosting the
conference in a divided and occupied
city where the people in most need
will inevitably be excluded’.
I also called on BABCP to take the
motion to the EABCT AGM and call for
an amendment to the constitution to
include a clause stating that EABCT
will not hold their congress in any
country that has passed laws
prohibiting their members from
calling for a boycott of the congress.
Our representative, Katy Grazebrook
reported BABCP’s motion at EABCT’s
General Meeting, and the full text of
the motion will be circulated to the
representatives of all EABCT’s
member associations.
More details about the debate can be
found on my postings on the CBT
Café forum.
Mohammed Mukhaimar, who
seconded the motion, writes:
Consider the challenges of a
psychological therapist in Palestine.
As therapists they are dedicated to
building hope and psychological
resilience among people who have
been repeatedly traumatised by the
Israeli military occupation since 1948.
Yet they themselves are being
subjected to the same traumas from
being delayed or humiliated at an
Israeli checkpoint while trying to
reach their clients or clinics, in some
cases being arrested and in others
facing torture. Many have
experienced the personal loss of
family members during an Israeli air
strike or a ground invasion of their
areas. Our colleague in Gaza, Yasser
Abu Jame, a psychiatrist, has lost 26 of
his family members, while Hassan
Zeada, a psychologist, lost his mother
and five members of his family in the
current Israeli attack on Gaza. Hassan,
in a recent statement to the New York
Times, said,‘Scared parents cannot
reassure scared children’. His words
give some indication of the grim
challenge in managing others’
feelings of hopelessness, entrapment
and severe vulnerability while facing
the ongoing dangers imposed by the
Israeli occupying forces.
Compared to their Israeli colleagues
from established and supported
mental health services, Palestinian
therapists face the challenge of
limited access to mental health
training and ongoing supervision
made worse by limited resources,
restrictions on movement and siege.
And here comes the EABCT congress
next year in Jerusalem to add more
salt to the wound. The congress
delegates are invited to view the
conference as an inter-group
relations event that might even make
some contribution to ‘political
negotiations, peace-making and
conflict resolution’. This gives a highly
distorted picture and completely
ignores Israel’s signal failure to
integrate those people for whom
Palestine has been home for
centuries, and its policies of military
occupation and systematic
dispossession of the Palestinians. CBT
therapists who live within a few miles
of the congress venue will find it
almost impossible to attend because
of the difficulty of obtaining travel
permits and of getting through the
Israeli checkpoints. Israeli therapists
living in the illegal settlements in the
Occupied Territories will be free to
come and go.
The motion we proposed at the AGM
invited our BABCP colleagues to
express regret at the EABCT decision
to hold the congress in Jerusalem and
gave voice to the concerns of many of
our members that the people most in
need of the training opportunities
afforded by the congress would be
excluded. Our goal is to increase
training opportunities for Palestinian
health workers and the motion was
framed with the hope that more
colleagues will help to develop
mental health training in Palestine.
Over the last two decades many
Western professionals have
committed themselves to the
development of Palestinian local
mental health organisations. These
include BABCP members such as Alan
Kessedjian, whose invaluable work
over six visits to Bethlehem has
helped to establish CBT practice in
the Palestinian community there.
As a Palestinian British CBT therapist (I
was born and raised in Gaza), I have
tried to help develop desperately
needed services and support for
colleagues struggling with the day to
day reality of occupation. In 2012 we
established Sumud Palestine, a small
project that sponsors UK-based
psychotherapists to deliver structured
training programmes to local mental
health professionals in the West Bank
and Gaza. Since Sumud was
established, we have provided four
CBT courses in partnership with the
Palestinian counselling centre in
Ramallah. The training has been
delivered by BABCP colleagues
including David Raines, Helen
Macdonald, Harry O’Hayon and Lisa
Williams and I would like to thank
them for their invaluable help and
support.
The healing of deep psychological
wounds will be needed to achieve a
sustainable peace, but I do not think
we cannot afford to wait for a peace
treaty to start training people to heal
these wounds.
I hope you may consider how you
could help.
To learn more about Sumud Palestine
visit http://sumudpalestine.org.uk.
If you would like further information,
please email Mohammed Mukhaimar
at [email protected].
You can also join the UK Palestine
Mental Health Network by emailing
[email protected].
If you would like to respond to
any of the issues raised in these
articles, email [email protected].
A selection of responses may be
included in a future issue.
Accreditation
Supervision update
At the Accreditation & Registration
Committee meeting held in February
2014, there was discussion relating to
increasing the minimum monthly
supervision.
It was decided to increase this to 1.5
hours for full-time clinical practice.
Discussion was broad-ranging and
included views such as the evidence
base supporting quality, rather than
quantity, aspects of supervision.
The importance of BABCP taking
responsibility as a standard setting
body for ensuring that previously
set ‘minimums’ cannot be
misinterpreted by those not fully
supportive of Accredited
practitioners, was considered.
The advisability of bringing our
standard more into line with
standards within psychotherapy more
generally was also taken into account.
It was considered on balance, taking
aspects of these factors into
consideration, that an increase would
be generally beneficial, and
supportive of those who might need
to lobby more locally for adequate
support for their practice.
With this in mind all Accredited
practitioners should make the change
to 1.5 hours CBT supervision per
month, or 18 hours per annum, by
December 2014 at the latest.
There are allowances made for those
working less than full-time hours.
Please contact the accreditation team
at [email protected] if you
have any queries about this change.
Accreditation Team
| December 2014
7
t
n
e
m
t
i
m
m
o
C
d
n
a
e
Acceptanc
5
1
0
2
n
o
i
t
i
t
e
p
m
o
c
y
a
s
s
Therapy SIG e
Essay questions
Essays are welcome from those at all
stages of psychology or CBT training
in the following categories:
• Student
• Assistant
• Research Assistant
• Trainee Psychologists
• Trainee CBT Therapists
In addition to offering prize money,
the purpose of this competition is to
provide applicants with experience of
preparing papers for publication. The
winning essay will receive £500 and
publication with the online BABCP
journal the Cognitive Behaviour
Therapist (tCBT) will be supported and
encouraged. Publication is subject to
the journal’s normal
review processes.
Choose one of the following:
• Discuss how skills and knowledge from ACT could complement and
enhance practice in another specific cognitive behavioural approach of
your choice.
• To what extent is ACT an evidence-based therapy?
The essay should be 2,000 words in length, including footnotes but
excluding references. It must neither be in print already nor submitted for
publication elsewhere. The style should be formal, such as in a book
chapter or professional magazine.
Judging criteria
Essays will be judged on the
following criteria:
• Understanding and ability to write
clearly about ACT relevant processes
• Understanding and ability to write
clearly about concepts and
philosophy
• Understanding of empirical
evidence base of ACT
• Accessibility and originality
• Quality of writing in terms of
grammar, style, spelling, economy
of expression
How to submit
The essay must be submitted by
email as a single Word document
attachment, together with references
and a cover sheet, to Henry Whitfield
at [email protected].
The cover sheet template can be
downloaded as a Word document
from www.babcp.com/actcomp
Please do not include details of the
author on the essay itself. Failure to
incorporate the cover sheet will
render disqualification.
The closing date for submissions is 31 March 2015
You should also pay attention to the tCBT ‘Instructions for Contributors’, which can be downloaded here:
http://assets.cambridge.org/CBT/CBT_ifc.pdf
Spring Conference
CBT approaches
to personality
disorders in
adolescents and adults
9 and 10 April 2015
King’s College London
8
| December 2014
www.babcp.co.uk
Picture by Finerain/SXC
The Acceptance and Commitment
Therapy (ACT) SIG is pleased to
announce the launch of its 2015
essay competition, the aim of which is
to encourage interest in ACT.
Diversity matters
Increasing access for
Birmingham’s communities
Birmingham Healthy Minds is an NHS primary care psychological therapies service that has taken
innovative steps to increase access to CBT for the city's diverse population. CBT Today invited
Birmingham Healthy Minds’ Joanne Gill and Kully Ingram to explain
Birmingham Healthy Minds, the IAPT
service for the city, has developed an
innovative ‘walk-in’ service in order to
increase access to psychological
therapies, and CBT in particular.
Although we use a self-referral system
in addition to GP referral, we realised
that particular communities in the city
were still not accessing the service.
Two communities and geographical
areas in Birmingham were targeted
where we knew that referrals to the
service did not reflect the expected
prevalence of common mental health
problems in this population.The service
was advertised in different languages
on the local radio station and at bus
stops near the walk-in centres.
We understood that possible reasons
for this were shame and stigma,
difficulties in travel, language barriers,
fear of confidentiality issues with a
GP, and lack of knowledge about the
service, to name but a few. We
decided that, instead of waiting for
people to be referred to us or to refer
themselves, we would need to go to
them in their communities and in
their languages.
The Amman Walk-In Service is run
weekly at two health care centres in
the middle of the target
communities. We ensure that we have
qualified practitioners that reflect the
population we serve, and that our
staff have a good understanding of
faith and cultural issues as well as
being able to speak the main
languages of Punjabi, Urdu, Bengali
and Hindi.
Realising that the whole referral
process may in itself be a barrier to
access, we removed that barrier and
encouraged people to simply walk in
off the street for a screening
appointment, hopefully in their
preferred language.
We called this initiative the Amman
Walk-In Service (Amman meaning
peace in Punjabi and faith in Islam).
This name was chosen in response to
existing patients from diverse
backgrounds telling us that, if our
service had a name they could relate
to and engage with, this may have
helped them to seek our help earlier.
We also wanted people to identify
with the benefits of CBT and achieve
their main goal, which for many
people was described as needing to
find inner peace at distressing times.
People can simply walk in off the
street and be triaged for the
problems they are experiencing and
the help they are seeking. They are
seen in the order they arrive and will
be seen the same day without an
appointment. Following triage, they
are either signposted to the
appropriate community service for
their needs or offered a range of
treatments within Birmingham
Healthy Minds. We have adapted
many of our Step 2 interventions,
such as the psycho-educational
workshops, so that they are delivered
in the appropriate languages. We
also use faith and culture as a
strength to help people make the
changes they want in their lives.
Over 400 service users, aged between
16 and 88 years, from a range of
diverse communities but
predominantly self-classified as Asian
or Asian British, have walked in to our
clinics and accessed the service in the
first 12 months. Patient feedback has
indicated that people using the walkin service felt their concerns had
been taken seriously by staff while
the service had helped them better
understand and address their
difficulties. GPs have also stated how
pleased they are that patients can be
seen face-to-face so quickly.
For more information on the
Amman Walk-In Service, visit
http://bit.do/Amman
| December 2014
9
Control Theory Special
Interest Group relaunched
The members of the newly relaunched Control Theory SIG take a unique and progressive approach to
practising CBT. This approach can be hard to describe in a brief article, so we have provided some questions
to which we might expect you to answer ‘yes’ if you are a good fit for our SIG.
Some questions about theory
Some questions about practice
Do you think that we need to better understand the way
people engage in control and ‘self-regulation’ if we are to
improve the science and practice of CBT?
Do you put your clients’ needs, purposes and intentions at
the heart of your approach to therapy?
Are you interested in a transdiagnostic, or universal,
approach to mental health and wellbeing?
Do you think that all effective psychological therapies
might tap into the same process of change, and that we
could harness this process more efficiently?
Can you imagine that there might be a quantitative,
mechanistic theory that explains this process, along with
such cherished concepts as purpose, free will,
intentionality and values?
Are you particularly interested in helping clients to raise
awareness of their ‘background’ experiences – such as
focusing on their fleeting thoughts, affect change, mental
imagery and metaphors?
Do you often end up noticing that your clients are in ‘two
minds’ about their problems or that they begin to see their
problems ‘from a new perspective’?
Are you the kind of therapist who believes your clients can
find their own answers to their problems, just through your
curious questions and your focus on the present moment?
If your answer to many of these questions is ‘yes’, then we
think our SIG is likely to appeal to you.
The aims of the SIG are to:
Hertfordshire Partnership University NHS Trust (HPFT) IAPT services are
expanding and we have exciting opportunities for Qualified CBT
Therapists and Psychological Wellbeing Practitioners to join our services.
We are seeking to recruit Qualified Psychological Wellbeing Practitioners
at Band 5 and High Intensity CBT Therapists at Band 7 to join our
services in Hertfordshire and Essex.
Hertfordshire was one of the original eleven 2007/08 IAPT Pathfinder
sites and has recently taken on two additional services in Mid and North
East Essex. We have IAPT teams based in Stevenage, Welwyn Garden City,
Ware, Hemel Hempstead, Watford, Borehamwood, Braintree and
Colchester.
You will bring your knowledge and experience to work alongside our
multi-disciplinary team including social workers and consultant
psychiatrists. There are opportunities to develop areas of expertise by
working as part of our special interest groups focussed on clinical areas
such as trauma, older adults and individuals with long term conditions.
Supervision will be provided from BABCP registered psychologists and
senior clinicians.
For all posts, the Trust operates a robust Continuing Professional
Development system within a Performance Management framework,
including an annual appraisal and CPD review.
For further information and details of how to apply please contact:
Dr Jo Wood, 07880 794494 or Alison Smith 07796263149
Car driver and access to a car essential (unless you have a disability as
defined by the Equality Act 2010 which prevents you from driving)
We offer our staff a wide range of benefits including work life balance
policies, childcare savings, a free Counselling Service, Occupational
Health Services, excellent pension scheme and NHS shopping discounts.
To view the job specification or to apply for this role, please log on to
www.jobs.nhs.uk and enter the reference number:
Psychological Wellbeing Practitioner - Ref: 367-HPFT981
High Intensity CBT Therapists – Ref: 367-HPFT982
10
| December 2014
• Disseminate a control theory understanding of
psychological function and dysfunction
• Disseminate a control theory perspective on
the science and practice of cognitive and
behavioural therapies
• Facilitate the development and evaluation of
transdiagnostic psychological interventions based on
control theory, such as Method of Levels
We are holding a free two-day event at the University of
Manchester on Thursday 9 and Friday 10 April 2015. The
Thursday is a full-day workshop titled ‘A Transdiagnostic
Approach to CBT Using Method of Levels Therapy’ led by
Warren Mansell. Friday is a day of oral and poster
presentations, which is open to everyone to submit, and
includes clinical cases, clinical research studies and basic
science research, as well as our Annual General Meeting
where we plan to elect the new SIG committee. There will
be plenty of opportunity for making connections and to
engage in discussion to put control theory into the
practice of CBT.
If you would like to reserve a place on either or both
days, or to join the Control Theory SIG, please email
[email protected]
Further information on control theory approaches to CBT are
discussed in greater detail at www.pctweb.org and
www.methodoflevels.com.au
The women’s room
Changing the game in
wider society
Concluding our series of articles
on women, feminism and mental
health, are profiles of four female
‘game changers’ who have made
a significant difference outside
the CBT world
Changing times:
Sue Baker
Sue is the Director of Time to
Change, England’s biggest
ever programme to end mental health
stigma and discrimination. Time to
Change is a multi-million pound
programme funded by the Department of
Health and Comic Relief, which is
delivered by leading mental health
charities Mind and Rethink Mental Illness.
Here Sue writes about her work,
inspirations and vision for the future
It does feel that after many, many years
of us all battling to get more attention
on mental health we are being heard.
Mental health has been under the
spotlight far more than I can remember
over the last 20 years, and we are all
waiting for parity of esteem to become
a reality and for people to have timely
access to appropriate treatment,
services and support.
We recently published the latest survey
of public attitudes (carried out in
England since 1993) showing that we
are starting to change the nation’s
thinking about mental health; attitudes
have improved significantly in England
with the highest rate of positive change
evidenced in 2013. An estimated two
million people have improved their
attitudes over the last two years.
We have also seen the media cover
mental health in more responsible
ways and feature more people with
life experience, as well as the
emergence and growth of a powerful
and empowering movement of
individuals and organisations wanting
to work together to combat stigma
and discrimination.
People are taking action against stigma
and supporting each other to do so
both online and offline in communities,
workplaces, schools and universities,
churches, and even in the House of
Commons. Many people feel more
empowered to use their experiences
of mental health issues in order to
drive change.
After many years of campaigning, I was
reminded the other day that it is not my
generation (as I near 50) who will drive
the next stages of social change. We
have said from the outset that ending
mental health stigma and
discrimination is the work of a
generation. Having started to see
change in recent years, the real test will
be when we look back over a much
longer chapter in our history to see if
long-term and irreversible change has
been secured; when having a mental
health issue is seen as unremarkable.
So this is the work of the next
generation and I think we have many
reasons to be optimistic; I recently met
some of the young people with
experience of mental health problems
from our youth panel who are leading
the campaign and delivering antistigma activity in schools. It was a very,
Continued overleaf
| December 2014 11
very emotional day as well as a very
humbling experience.
I am often left deeply moved by the
many people I meet who have had to
deal with prejudice and discrimination
at the same time as learning to cope
with a mental health problem. They
have had such a huge battle on so
many levels, but have shown enormous
guts and determination, and built the
strength to overcome the major hurdles
that other people and systems have put
in their way. I am often left in awe.
In my life so many women have
inspired me, and some still do. These
women include my Mum and
Grandmother who were dedicated
nurses, writers and wise souls like Maya
Angelou, Mo Mowlam, and here I have
to bring in Princess Diana (she showed
a level of compassion not traditionally
expressed by the Royal family at the
time when she visited a ward with
HIV/AIDS patients back in the 1990s).
Others I have a deep respect for include
Clare Balding who stood up to
prejudice and has enhanced her career,
and as a teenager from the 80s I have
got to also include French and
Saunders, Julie Walters, Whoopi
Goldberg, and Sandi Toksvig for making
me laugh out loud and help me see the
lighter side of life.
In a professional capacity in the mental
health sector two women inspired me
in my early days at Mind in the mid
1990s; Judi Clements (Mind CEO at the
time) and Liz Sayce (Policy Director). We
worked closely on many policy
campaigns related to ‘care in the
community’ and on the first survey of
“
stigma and discrimination that I wanted
to do in order to highlight the human
impact of stigma. I was inspired, or
incensed, by a story I had heard about a
woman who had had a brick thrown
through her window simply because
she had just returned home from a stay
in the local psychiatric hospital. Horrific
prejudice from her own neighbours.
More recently another woman has
shown real leadership in a way I hugely
admire both on a personal and
professional level. Lisa Rodrigues is the
recently retired CEO of the Sussex
Partnership Trust. She decided to share
her many experiences of depression in
the Health Service Journal on World
Mental Health Day 2013 – not
something that many people in senior
NHS positions (or at any level) have
done which shows us how much
stigma exists in many workplaces
including the NHS.
When things get tough for me mentally
and emotionally a number of things
help. Firstly I remember how very low
and unhappy I was when I was very,
very depressed and didn’t want to live
on this planet anymore (I was having
suicidal thoughts) and nothing can feel
as bad as that. Secondly I have got the
most dedicated, passionate and
supportive people around me at work –
I could not wish for a better team as
well as the large movement of people
and organisations who want this
programme to work and are all adding
their energy and getting behind the
same goal (of ending stigma). I am also
very fortunate to have the love and
support of my partner (I do not like to
After many years of campaigning, I was reminded the other
day that it is not my generation who will drive the next
stages of social change. We have said from the outset that
ending mental health stigma and discrimination is the
work of a generation
12
| December 2014
”
say ‘wife’), family and friends, and finally
I take care of myself – even when
passion can squeeze so much more
energy from you I have learnt, from my
breakdown and many useful reminders
from insightful people on twitter and
practitioners, that I need to look after
myself. I live in Whitstable, and in an
effort to switch off at weekends more
and go running by the sea, I look out for
the early signs that I am pushing myself
too hard and I am trying to learn to be
more patient for change - but that is
the one thing I may never learn!
My advice to young women is be
inclusive and approachable and willing
to continue to learn and adapt
whatever you do with your life – but be
true to yourself and your values. I am
fortunate (or maybe I crafted my own
‘fate’) because I am doing the job that I
have always wanted to do but it did not
even exist when I started my career. It
took me 20 years of working towards
this (before I set up Time to Change in
2007) but the wait has been well worth
it. If you have passion and drive and
have the utmost belief that things need
to change – never give up and do not
let anyone tell you it cannot be done.
For more information on Time to
Change and how you can help reduce
mental health discrimination visit
www.time-to-change.org.uk. You can
also follow Sue on Twitter
@suebakerTTC
Muslims, mental health
and misunderstandings:
Nazmin Akthar-Sheikh (top
left) and Dr Iram Sattar
Nazmin and Iram are part of
the Muslim Women’s
Network UK (MWN-UK), a
national charity sharing
knowledge, experience, best
practice and opinions among Muslim and
other BME (Black and Minority Ethnic)
women and those working with them in
order to strengthen these women's ability
to bring about effective changes in their
lives and communities. Here they write
about their work in changing attitudes to
mental health, which is one of the current
priority areas for MWN-UK
Mental health matters are universally
misunderstood. Stigma, denial and
misinformation are prevalent
throughout the wide cross-section of
communities of varying faiths and
ethnicities, which is why it is imperative
that collective action is taken across the
board to raise awareness and change
the status quo.
The women’s room
There are, however, particular hurdles
and barriers faced by sufferers within
the Muslim and BME communities,
upon which our work is focused.
Take Ayesha, who gives birth to a
daughter and suffers from post-natal
depression. She feels emotional and
unable to cope. Family members see
her crying and do not understand why.
They become exasperated with her
‘moping around’ especially as it is
embarrassing when guests arrive to see
her and the newborn baby and she
cannot make the effort to look her
usual immaculate self. Her mother-inlaw is annoyed by her inability to carry
out any housework and complains at
how she had given birth four times
herself and managed to do everything
immediately on her own. Ayesha hears
these comments from her mother-inlaw and others, and feels even worse.
The nurse who visits to check on
Ayesha and her baby notices that she is
distant, or on other occasions, overly
affectionate towards her child as if to
prove a point. She discusses this with
her colleagues who come to the
conclusion that Ayesha must be upset
she gave birth to a girl instead of a boy
because that is her cultural upbringing
and they know of other examples
where this had been the case.
professionals either
missed her state or
misunderstood due to
stereotypical notions. In
another case, a GP ruled
out the possibility of
PND within a patient
because it was apparent
that she was constantly
surrounded by family
members who were
providing a helping hand – so not
appreciating the internal nature of
health matters. In turn, this highlights
the need to raise awareness not only
within Muslim and BME communities,
but also within medical professions in
order to ensure that signs are not
missed when faced with Muslim and
BME sufferers.
Please note, whilst this case study has
focused on PND, we have found
misunderstandings to be prevalent
across the board from OCD, eating
disorders to schizophrenia. In our case
study, Ayesha found that the blame for
her situation always ended up with her.
She was seen as lazy, a bad mother, and
ultimately a bad Muslim.
A guest who visits one day suggests to
Ayesha’s sister that perhaps she is
suffering from post-natal depression
(PND). The sister rebukes her saying
that she suffered from PND and it only
lasted a few days and, if that was the
case, Ayesha should have recovered by
now. Ayesha must just be a bad mother.
The fact that Islam teaches all trials and
tribulations are a test from Allah SWT
with emphasis on forgiveness rather
than punishment were not considered,
highlighting a lack of understanding of
their own faith within the Muslim
community. As we reiterated at our
AGM in May 2014, which was dedicated
to raising awareness of mental health
issues:‘Would you tell someone with
diabetes that their condition is due to a
lack of imaan (faith)? No? The same
applies to mental health.’
Ayesha becomes increasingly
withdrawn and attempts to hide how
she feels in order to stop the negativity
being directed towards her. Someone
suggests she may have been possessed
by ‘Jinns’ (spirits), and the family take
her to various healers in an attempt to
‘cure’ her. Ayesha’s situation continues
to deteriorate and she shows signs of
paranoia. The healers blame Ayesha’s
lack of faith in her religion for her
situation, claiming that if she had faith
their methods would have worked.
Islam teaches us of the existence of the
unseen or supernatural, and more
specifically, of Jinns (spirits). Most
Islamic scholars believe that Jinns are
able to possess humans, although a
small number disagree. What really
needs to be understood by the Muslim
community, however, is that even
within our belief framework, Jinn
possession is to be a very rare
phenomenon and most importantly, a
belief of spirit possession should not
act as a barrier to seeking medical help.
This case study was compiled using the
many examples that MWN-UK has
come across, highlighting a range of
issues that need to be addressed. Lack
of understanding, or the existence of
misunderstandings, have been key
factors in this situation. Family and
friends either did not know of PND or
showed a lack of understanding as to
what it consisted of. Meanwhile medical
It is an inherent part of the Islamic faith
that where we suffer from an ailment,
we are to seek medical treatment, for
Prophet Muhammad (PBUH) has said:
‘There is no disease that Allah has
created, except that He also has created
its remedy’ (Bukhari, 7:582). It is also
necessary to look towards all possible
solutions as the remedy may not lie in
just one path.
In turn, even where you think spirit
possession may be the cause and you
wish to seek the help of healers, there is
no harm in also seeking medical and/or
psychological opinion/treatment. There
may however be great harm in only
relying on spiritual healers for what is
likely to be a medical or psychological
matter. In one case study, for example,
the use of spiritual healers actually
exacerbated the paranoia that was
being experienced by the bipolar
sufferer and led to a worsening of
the situation.
We are aware of the fears that
practitioners may immediately
prescribe medication thus causing
biological harm, or being forcibly
sectioned. However, such decisions are
to be made after proper assessment
taking all alternative measures into
account. If you feel that your GP or
other medical practitioner has been too
hasty in doing so then there are
complaint procedures as well as legal
measures, which can be considered.
We must also warn of the existence of
opportunistic healers who have
physically and emotionally abused
sufferers by taking advantage of their
vulnerability and we urge everyone
involved to be alert in this regard.
The key to success is an open and
honest conversation. For this we need
the medical profession to show a better
understanding and be alert to the
various dynamics that may be at play. In
one case study, a Muslim woman
suffering depression mentioned to her
doctor that she feels she may have
been possessed; the doctor flags up the
possibilities of bipolar, schizophrenia
and sectioning under the Mental Health
Act, not appreciating the cultural
normality of the comment being made.
Of course, in some situations, this will
be a cause for concern, and this is why
better awareness and training is
needed so as to allow proper
assessment on a case by case basis.
There have also been various instances
of failures in approach and
Continued overleaf
| December 2014 13
“
It is an inherent part of the Islamic faith that where we
suffer from an ailment, we are to seek medical treatment
Continued from page 13
understanding by police when dealing
with sufferers. Racial stereotypes and
prejudice towards Muslim and BME
individuals has led to both physical and
emotional mistreatment of sufferers
highlighting further barriers to seeking
help. In turn, better training and
guidance from a faith and cultural
perspective is required, together with a
multi-agency approach in order to
address the issues in an effective manner.
A matter which is a part of our overall
health and well-being is now only seen
to be a problem. It is relatively easy to say
we are suffering from a cold, yet how
many are able to say the same when just
feeling down? Similarly, when someone
has been suffering from flu for a long
while we all know to take them to a
doctor, yet leave alone the person that
has been feeling depressed for perhaps
much longer.
It is this understanding that needs to be
instilled within the Muslim and BME
communities, as well as generally, in
order to allow diagnosis and treatment
of mental health matters early on. And
whilst we work on raising awareness,
we need all other stakeholders to be
aware of the hurdles and facilitate
access to help.
For more information about MWN-UK,
visit www.mwnuk.co.uk
Private grief and public
inspiration: Joanne
Thompson
Millie's Trust was established
by Joanne and Dan Thompson following
the sudden death of their nine-month-old
daughter.The charity's main aim is to
make First Aid training readily available
for minimal costs and in as many places
as possible. Here Joanne, who was recently
named Inspirational Woman of the Year
by ITV's Lorraine Kelly show, talks to CBT
Today Deputy Editor Peter Elliott about
her experience in dealing with the loss of
her daughter
Millie Thompson died after a choking
14
| December 2014
”
incident at nursery in October 2012. The
inquest held into her death recorded a
verdict of misadventure, with the
Coroner scathing in his assessment of
the assistance provided in the early
stages of the emergency.
Joanne instinctively wanted to do
something to prevent the same thing
happening to another child, and setting
up Millie’s Trust was the outlet for her
and husband Dan. Despite throwing
herself into her work with the charity,
Joanne found it difficult to cope with
the trauma of losing her daughter:‘We
went to a private counsellor who had
been recommended to us. It was what
was needed at the time. I was on a lot of
medication to help me through things,
and, although Dan was going through
the same as me, he did not see Millie in
the hospital the way I had.
‘It got to a stage where he could see
that I was a lot farther behind him, in
terms of dealing with our grief, and I
could see it myself. Between us we said
to ourselves that it was not a normal
grief that I was suffering. So I went back
to our GP, as there were regular
occasions where I was wanting to end
my life. I was looking through some
diaries and, there was one night where I
asked Dan to take away all the pills at
the side of the bed. I did not like the
fact that it was too easy. When it got to
that stage, I knew it was not right. The
doctor referred me to Stepping Hill
hospital, which is where it happened
with Millie. The psychology team came
to visit me and, three to four weeks
later, I got a letter saying that I was just
suffering from normal grief.
“
‘At the time I thought that I must be, as
they were the experts. But it was a
couple of months later that I was on the
road outside our offices; I got stuck in
the middle of the road and froze. There
was a bus coming the other way. I was
so close to the bus, with cars beeping at
me to move. I could not move. As soon
as I got to the other side, I broke down.
‘My GP told me he was going to refer
me again. I was referred to
Wythenshawe hospital, to a
psychologist there. They had my case
notes from the doctor and, within 24
hours, they were ringing me to come in
as an emergency case. I had a full
assessment lasting about two-and-ahalf hours, which was a lot longer than
all the sessions I had had previously.
After that session, she told me that she
wanted me to return and start CBT
sessions with her. I was back within a
few days after receiving a letter to say
that I had been diagnosed with severe
PTSD, anxiety and depression.’
Joanne initially struggled to accept this
diagnosis:‘I knew I needed help, but I
did not want to see a psychologist.
There is still a stigma. I had thought, I
cannot see a psychologist; Millie has
died, and other babies and children die,
so why do I need to see a psychologist,
and not other people? I sat down and
thought about it. I actually had to deal
with more than Millie passing away, as
most people do not see what I saw in
hospital that day. That was what a lot of
my problems were, with the flashbacks
that I was getting, with nightmares of
what I saw in the hospital.
‘After a few days of thinking about it, I
I knew I needed help, but I did not want to see a
psychologist. There is still a stigma. I had thought,
I cannot see a psychologist; Millie has died, and other
babies and children die, so why do I need to see a
psychologist, and not other people?
”
The women’s room
went along to the first CBT session. I sat
there and cried; in fact I cry in them
now, but the first session was
particularly hard. They are massively
draining. When I come out, the rest of
the day is a bit of a write-off, as there is
that much emotion being brought to
the fore.
‘I was scheduled in for a block of twelve
sessions, which I think is the normal
period. At the end of that block, I was
told that I was not being discharged.
We continued through that next block
of sessions and, some time in that
period, my psychologist said she
wanted to try EMDR. I did not have a
clue what it was, but I was given some
information, looked it up online, and
was given the choice as to whether I
wanted to try it. A lot of people do not
want to try it, but at that point I was
ready to try anything. I did not want to
be dealing with this 10 years down the
line for not having dealt with it sooner.
So I started EMDR, which I found bizarre
at first.'
A long holiday at the start of 2014
interrupted the therapy but, on her
return, Joanne was happy to
acknowledge the benefits of the
treatment she had received up to that
point:‘We had a review before we went
on holiday to New Zealand, and I said to
my psychologist that I knew that the
treatment had massively helped me,
that I was a completely different person
since I first saw her in June last year.'
Joanne Thompson with
daughter Millie
On her return from holiday, Joanne’s
progress was reviewed once more:‘I
was worried that she was going to
discharge me, but I have been booked
in for at least another twelve sessions.
When I got home, I felt that, because I
thought she was going to discharge
me, I was on a downer for days. I
thought to myself again that I do not
want to be dealing with this in 10
years, so got used to the idea of
continuing the therapy. Now I want to
carry on doing it until they say that I
am much better.’
For more information about Millie’s
Trust, including how to donate to the
charity, visit www.milliestrust.com
| December 2014 15
Showcasing
Irish excellence
in CBT practice
This September the Irish Association for Behavioural &
Cognitive Psychotherapies (IABCP) held a one-day event
in Dublin on the subject of ‘CBT in Practice across Ireland’.
Here, outgoing IABCP Secretary Mairead Ryan reflects on
the day's proceedings
Our event - the first of its kind
hosted by IABCP - was very well
attended, proving to be such a
success that it is hoped it will
become an annual occurrence.
Siobhan Lydon, a CBT therapist at St
Patrick's Hospital in Dublin, presented
on ‘Keeping Compassion in Mind’
with a soft-spoken gentleness that
makes her the ideal candidate to do
justice to the work of Professor Paul
Gilbert. Compassion Focussed
Therapy recognises that, above and
beyond the chance circumstances of
our birth and our genes, we all share
a common humanity, as well as
promoting the development of nonjudgemental, non-shaming
formulations. Rather than trying to
think our way out of shame, we need
to feel our way out by accessing
emotional memories of safety and
self–soothing. Where these are
absent, we need to facilitate their
development and strengthen the
capacity for self-compassion and
self–kindness in each of us.
Charlotte Wilson, a lecturer in Clinical
Psychology at Trinity College Dublin,
spoke about ‘Ten Things We Have
Learned about CBT from Working
with Children and Families’, which
included the effective use of the
language of cartoons and puppetry,
and applying flexibility to the length
of sessions. Joint child/parent
formulations which help to highlight
18
16
| December 2014
variations in interpretation of
behaviours can lead to better clarity
and understanding.
It is known that children have the
basic knowledge and skills required
to engage with CBT from at least
seven years of age, although much
less is known about their cognitiveemotional development and mood
induction procedures that do not
work very well in pre-school children.
Charlotte paid tribute to the work of
Dr Gary O’Reilly from University
College Dublin who, along with his
team, has developed child-friendly
interventions in the form of computer
games and apps called ‘Pesky Gnats’
where children go ‘gnat catching’
accompanied by a David
Attenborough-style voiceover.
Paddy Love and Julia O’Grady, Senior
CBT therapists with the Belfast and
South Eastern Health and Social Care
Trusts, spoke about their experience
of ‘Implementing Stress Control
Classes throughout Northern Ireland’.
This consists of a series of six-session
didactic CBT classes developed by Dr
Jim White, provided without fee or
the need for booking as a rolling
programme in community venues. It
is also provided to communities in
the Republic of Ireland through the
Health Service Executive.
Classes do not involve discussion of
personal problems, and feedback is
anonymous. Ages of those attending
class ranged from
early teens to over-65s with
a 30:70 ratio of men to women which
is a noteworthy statistic. One
participant commented:‘I have learnt
more through stress control than
attending other services for years’.
Social media is used to advertise
classes, as are sporting groups. There
is a constant review and evaluation
by a Stress Control Regional Group
and it is hoped that findings will be
presented at an Irish symposium on
Stress Control at the proposed BABCP
Annual Conference in Belfast in 2016.
Andrea Nulty is a straight-talking CBT
therapist who works with the
National Forensic Mental Health
Services. Her presentation on
‘Psychotherapeutic Practices in
Forensic Mental Health Care’ provided
us with a short history of the ‘What
Works’ movement, which culminated
in an upsurge of interest in the
application of CBT-based
interventions over the past decade.
Having been influenced by this
movement and developed a working
relationship with one of its pioneers
Professor James McGuire, Andrea
convinced her managers in Dublin to
introduce a comprehensive threepart CBT pathway of programmes.
Influenced by economist Richard
Layard and the English IAPT
programme, the skill level of the
practitioners were matched with the
level and intensity of the
intervention. This resulted in a
marked increase of patients’
accessibility to psychotherapy where
the emphasis is always on recovery.
Debbie Van Tonder, a CBT therapist
with St Patrick’s Mental Health
Services who was recently awarded
an MSc in CBT with first class honours,
presented on ‘Evocative Imagery in
the Treatment of Emotional Arousal in
GAD’. Although well-documented in
conditions such as Social Phobia and
PTSD, the imagery aspect of cognition
is unfortunately all too often
forgotten in the treatment of other
disorders such as OCD and GAD.
There is no specific literature on
imagery in GAD, although it is
generally accepted that images allow
a person to access emotions more
effectively, are rich in detail, and
provide information about future
fears, catastrophic predictions, rule
systems, core beliefs and fears. Images
are disorder-specific and can be
retrieved or evoked deliberately,
while the processing of previously
avoided affect by means of effective
exposure can trigger an automatic
cognitive shift.
Roy Cheetham is Senior CBT Therapist
and CBT Professional Lead with the
South Eastern Health and Social Care
Trust. His presentation on ‘CBT for
Bipolar Affective Disorder - A Working
Model’ informed us that CBT is the
dominant psychotherapeutic
treatment for bipolar disorder
available today. In 1967 Aaron Beck
talked about the ‘negative cognitive
triad' of depression and the 'positive
cognitive triad' of mania. Roy
dismissed this as one of the myths
about bipolar disorder, the others
being that therapy can be employed
solely for the depressive phase (a
unipolar approach) and that comorbid problems should be treated
when the bipolar illness is stable.
Roy has been working for the past 12
years with a client caseload that
includes 60 to 70 per cent with
bipolar disorder. He uses an
adaptation of a cognitive behavioural
model of mood swings and bipolar
illness and incorporates aspects of
Relational Frame Theory, with a clear
focus on longitudinal formulation, an
emphasis on the mechanisms and
hypotheses that lead to
overcompensation and avoidance in
the maintenance of bipolar disorder,
and a recognition that a control
agenda and the role of self-criticism
are key components within Bipolar
Affective Disorder.
As I stand down from the IABCP
Committee, I would like to pay tribute
to all of the presenters who spoke so
eloquently and respectfully about
their work, and to all the IACBP and
BABCP National Committees Forum
members with whom I have worked
over the past years. I would also like
to wish the new IABCP committee
well in the further unfolding of their
development plans and to
acknowledge all members who work
tirelessly in the promotion of mental
wellbeing through the practice of
CBT.
(Left to right) Paddy Love, Andrea Nulty, Charlotte Wilson, Debbie Van Tonder, Roy
Cheetham, Siobhan Lydon and Julia O'Grady
| December 2014 17
On course
to a career in CBT
Having just completed the CBT PG Dip at the University of Hertfordshire and recently starting work as
a High Intensity therapist, Jerrie Richards reviews his experiences of the course and gives some advice
to others considering training in this field
Choosing the right course
I found it difficult to decide
when and where to do my
CBT training.The NHS can sponsor
individuals to complete a CBT PgDip,
however these places are highly
competitive and are few and far
between, so I decided to fund the CBT
training myself. This, at the time, felt
like a big commitment as it required
me to reduce my paid working hours
and borrow a large sum of money,
with no guarantee of full-time
employment when I qualified.
The level of accreditation is an
important factor to consider when
choosing a CBT course, as not every
course is accredited. A few colleagues
of mine who were CBT trained had
the additional stress of waiting to see
whether their hard work would be
recognised by BABCP due to their
university being in the process of
acquiring accreditation. This also
seemed to impact on the course
structure and content as the diploma
programme had yet to be fully
established.
BABCP offers course accreditation at
either Level 1 or Level 2. However,
having completed a Level 2
accredited course and comparing my
experiences to others, it seems levels
of accreditation relates to the amount
of support a course will give you. My
colleagues who completed a Level 1
accredited course spent less time in
lectures and had to provide
significantly more paperwork and
supporting documentation when
applying for Provisional Accreditation.
In comparison, completing the Level
2 accredited course meant I
automatically met all the training
requirements for provisional
accreditation with BABCP and that
my university was able to mark my
Knowledge Skills and Attitudes (KSA)
18
| December 2014
portfolio and my CBT logbook
themselves, which saved me time and
money. In addition to comparing
course content, I would recommend
reading the BABCP Provisional
Accreditation guidelines to compare
the differences in requirements
between Level 1 and Level 2
accredited courses.
Placement considerations
Most courses require you to
find a suitable placement
where you can practice CBT before
starting training. As I previously
worked as a PWP for IAPT, it was easy
to arrange a placement within my
current service, though I did consider
other charitable organisations in my
local area (such as Mind).
Whilst long waiting lists mean many
services would be grateful for the free
labour provided by a trainee, some
are unable to provide casemanagement supervision. It is
therefore worth seeing whether the
course would be able to provide
adequate supervision as part of your
training or if you would have to fund
this privately (which might mean a
group of you get supervision
together in order to reduce costs).
Also, don’t be afraid to think outside
the box when looking for placements.
I had a couple of colleagues who
worked in services such as liaisonpsychiatry and forensic settings,
which gave a different perspective to
how CBT principles can be utilised
outside of the standard
moderate/severe depression and
anxiety cases seen in IAPT.
Money
There is no getting away
from it. If you are going to
self-fund your CBT PgDip it is going
to be costly. Whilst I had some savings
I could put towards course fees, I was
heavily supported by a Career
Develop Loan (CDL). Some high street
providers and can lend you up to 80
per cent of your total course fees,
though you can borrow up to £10,000
in total, meaning extra money for
expenses such as books and travel
expenses if required. As the
government currently backs the
scheme, my CDL was interest free
whilst I was studying and I did not
have to pay anything back until two
months after completing training.
Workload
I had to sacrifice a fair few
weekends and evenings
whilst completing my training and I
can vividly remember my feelings of
apprehension when I started
applying the CBT learned in lectures
in my clinical practice. It felt a massive
transition moving from the highly
efficient case studies in text books to
the real-life person in front of me,
who was not sure how to answer my
questions and would give me
information that seemed highly
relevant to them but only served to
confuse me (and my formulations)
further.
Supervision was invaluable in helping
me work through this time and to
realise I was not alone in struggling to
fit disorder-specific fit models to
clients (in the most ideographic
manner I could muster). I was
regularly informed by well
established therapists that I would
never reach a stage where I knew
everything there was to know about
CBT and whilst I have come to realise
that they were right, I find my training
has enabled me to take comfort in
my understanding of core CBT
principles and how these can be
utilised into useful treatment
programmes.
| December 2014 19
Couples SIG
presents
www.babcp.co.uk
Overview, Models and Assessment: Basic Training in Couples CBT,
Part 2 Skills-Based Practice Workshop
(for delegates who attended Part 1 in October 2013 or March 2014)
19 and 20 March 2015
Presented by Professor Dr Kurt Hahlweg
Venue: The Royal Foundation of St. Katharine, 2 Butcher Row, London E14 8DS
An Introduction to Cognitive Behavioural Couples Therapy
23 to 25 March 2015
Presented by Professor Dr Kurt Hahlweg
Venue: Hilton Edinburgh Grosvenor, Grosvenor Street, Haymarket, Edinburgh EH12 5EF
Integrative Behavioural Couple Therapy
27 to 28 April 2015
Presented by Professor Andrew Christensen
Venue: The Royal Foundation of St. Katharine, 2 Butcher Row, London E14 8DS
To find out more about these events, including how to register, please visit www.babcp.com/events
18
20
| December 2014
Chester, Wirral and
North East Wales Branch
presents
Scotland Branch
presents
www.babcp.co.uk
www.babcp.co.uk
Compassion Focused Therapy for
Shame-Based Difficulties:
Learning it from the Inside Out
CBT for Persistent Pain a Practical Skills Workshop
(Intermediate Level)
Presented by Dr Mary Welford
Friday 20 February 2015
Presented by Helen Macdonald
Murrayshall House Hotel, Scone, Perth PH2 7PH
Thursday 5 to Saturday 7 February 2015
The Conference Centre, National Waterways Museum,
South Pier Road, Ellesmere Port, Cheshire CH65 4FW
Compassion Focused Therapy (CFT) is referred to as a thirdwave CBT approach and was developed by Paul Gilbert to
address difficulties associated with shame and self-criticism.
This three-day workshop will allow participants time and
space to develop their own compassionate mind. Upon this
foundation ideas will be developed in respect to how
individuals can use CFT and compassion-based approaches
to help others.
Registration fees
Early bird: payment received up to 12 December 2014
BABCP Member: £345, Non-member: £365
Full registration fee from 13 December 2015
BABCP Member: £405, Non-member: £425
This workshop aims to offer an opportunity to consider
knowledge and skills for working with people who have
chronic pain. Evidence-based cognitive-behavioural
interventions will be presented. The emphasis will be on
skills which can be used to help manage the impact of pain,
and opportunities to practice assessment, formulation and
engagement techniques, as well as interventions. Case
examples will be used, and participants will be encouraged
to bring their own experiences and cases to discuss, as well
as to participate in small group work and role play exercises.
The workshop should be helpful for people who have
existing CBT skills, but not necessarily experience in working
with chronic pain conditions specifically. It could also be
useful for people who have experience in persistent pain
work, but wish to refresh their knowledge of applying
cognitive-behavioural approaches.
Registration fees
BABCP Member: £85
Non-member: £105
To find out more about these workshops, or to register, please visit www.babcp.com/events or email [email protected]
Manchester Branch
presents
West Branch
presents
www.babcp.co.uk
www.babcp.co.uk
Anxiety Traps! CBT Solutions
Presented by Dr Christine Padesky
Friday 29 & Saturday 30 May 2015
CBT for Clinical Perfectionism
9.30am to 4.30pm
Manchester Conference Centre, Sackville Street,
Manchester M1 3BB
Presented by Professor Roz Shafran
Attend this workshop to learn principles underpinning
anxiety treatment methods and to practice the skills
required to effectively use CBT anxiety protocols. Enjoy this
workshop for all Dr Padesky’s embedded creativity, humour,
and optimism which help you learn to treat your clients’
anxiety disorders more effectively.
Ideal for intermediate level CBT therapists who already have
experience working with anxiety disorder protocols; more
expert CBT therapists who attended reported the workshop
includes useful new ideas (danger/coping disorder
framework) and methods (assertive defence of the self for
social anxiety) that make this workshop suitable even for
experienced CBT therapists.
Novice CBT therapists are also welcome to attend to learn
treatment methods, principles, and Dr Padesky's organising
framework that will speed mastery of anxiety therapies.
Registration fees
BABCP Member: £200
Non-member: £220
Thursday 12 March 2015
Clifton Pavilion, Bristol Zoo, Bristol BS8 3HH
‘Clinical perfectionism’ is a highly specific construct designed
to capture the type of perfectionism that can often pose
problems in routine therapeutic practice. The core
psychopathology of clinical perfectionism is an over
evaluation of achievement and striving that causes
significant adverse consequences.
By the end of the day, participants will learn how to assess
clinical perfectionism and determine when it may warrant a
specific intervention. They will also be familiar with relevant
cognitive-behavioural strategies. The workshop will be
interactive and include both experiential and didactic
teaching and videos. Participants will have a chance to
discuss their own cases.
Registration fees
Early bird: payment received up to 23 January 2015
BABCP Member: £65, Non-member: £75
Full registration fee from 24 January 2015
BABCP Member: £75, Non-member: £85
| December 2014 21
22
| December 2014
| December 2014 23
24
| December 2014