February 2013 - BABCP

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Volume 41 Number 1 February 2013

With this issue: News and views from the BABCP Independent Practitioners Special Interest Group in this CBT Today supplement

The three Welsh Branches within BABCP have launched an initiative in response to serious concerns about the lack of CBT provision in Wales. Wales misses out In 2007, Lord Layard made recommendations to the UK Government which led to the establishment of new NHS outpatient services to improve access to psychological therapies for common mental health problems. Funding was also made available to train the required number of CBT therapists and these services have now been rolled out across England only.

From the Lead Organisation for CBT in the UK and Ireland

Within Wales, health provision is devolved to the Welsh Government and equivalent services have not been automatically set up there as well as other parts of the UK. On 2 November 2010, the National Assembly for Wales passed the Mental Health (Wales) Measure into Welsh law. Although the provision of psychological therapies is included, there is still no promise of any financial investment which is pivotal to training competent therapists and expanding service provision.

(Pictured above, from left) Keith Fearns and Deon Gorle with Neil Kitchiner from South & West Wales Branch, Maggie Fookes from North West Wales Branch and Graham Yeates also from South & West Wales Branch

Raising the profile of CBT in Wales The Welsh Branches have highlighted this inequality, including to the Welsh Government, for some time, as well as established the National Wales Forum at the BABCP Annual Conference in 2011. Following another successful meeting of the National Wales Forum at the Leeds conference last year, the three Branches agreed to work together on an initiative to raise the profile of CBT in Wales with a view to securing the kinds of improved access enjoyed by England. This initiative, called #CBT4Wales, was launched in Cardiff at the OCD-UK Annual Conference in November. The launch took the form of a joint presentation by Keith Fearns, BABCP Accredited CBT therapist and North West Wales Branch committee member, and Deon Gorle, who has been helped by CBT in the treatment of his OCD. Continued overleaf

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#CBT 4 Wales Continued The initiative emphasises that CBT is an evidence-based, NICE recommended treatment of choice for many common emotional and physical health problems. CBT is also backed by a number of user groups as their preferred treatment. Another key message is to promote BABCP Practitioner Accreditation as the best guarantor for protecting the public and raising the quality standards of CBT within Wales. It is anticipated that the initiative will include the provision of high quality training opportunities to improve the standards and widen the range of evidence-based psychological therapies, including CBT, within Wales. Media interest Following the November launch, Keith Fearns was invited to discuss these issues on BBC Wales television programme The Wales Report with presenter Huw Edwards and Welsh Assembly Member Eluned Parrott. Since Keith’s appearance on The Wales Report, Eluned Parrott has been in contact with Keith and has pledged to raise this issue with her Assembly colleagues. Special feature To coincide with the launch, CBT Today has commissioned a series of articles which powerfully depict the human cost behind the lack of adequate CBT provision in Wales. These articles can be found on pages 11 to 14.

Volume 41 Number 1 February 2013 Managing Editor - Stephen Gregson 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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Albert Ellis posthumously recognised for outstanding contribution The American Psychological Association will this year posthumously recognise Albert Ellis with its Award for Lifetime Contribution to Psychology. This is the Association’s highest award and will be presented to Dr Ellis’ wife and collaborator Dr Debbie Joffe Ellis (pictured below, with Albert Ellis) at its Annual Convention in Hawaii this August. 2013 also marks the centenary anniversary of Ellis’ birth. He died in 2007. This award recognises the significance of Ellis’ work, particularly in creating Rational Emotive Behaviour Therapy (REBT) which laid down the intellectual foundations for CBT and other popular approaches in therapy. About her husband’s posthumous award, Dr Joffe Ellis said:‘If Al were here, he would have been very happy to accept the award. Not for any self-aggrandising reasons, but because of the depth of his care about people and his desire to help as many as possible to suffer less emotional misery, and to help them enjoy and relish the gifts of life as much as possible. He would have realised that the honour would bring fresh attention to his contributions, which include his vigorous and empowering approach of REBT. His hope would have been that, as a consequence of the award,

more people would want to learn REBT and apply it. He would have hoped that they would particularly notice its emphasis on unconditional acceptance of oneself, others and life. And I share Al's wish that the wisdom of REBT will continue to touch the minds and hearts of many, making their lives more inspired, sweet and happy.’ Robin Thorburn Dr Debbie Joffe Ellis will be presenting REBT: The Pioneering Cognitive Approach Which Revolutionised Psychology and Counselling at the Eric Liddell Centre, 15 Morningside Road, Edinburgh EH10 4DP on Saturday 26 October 2013 between 12.00-2.00pm and at 11.00am-1.00pm on Friday 1 November at the British Psychological Society, 30, Tabernacle Street, London EC2A 4UE. Visit www.exclusivehypnotherapy.com for further information.

Submission guidelines

Next deadline

Unsolicited articles should be emailed as Word attachments to [email protected], except for PWP-related articles which should be send to [email protected]. Publication cannot be guaranteed.

9.00am on 15 April 2013 (for distribution week commencing 13 May 2013)

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 [email protected].

© Copyright 2013 by the British Association for Behavioural & Cognitive Psychotherapies unless otherwise indicated. No part of this publication may be reproduced, stored in a retrieval system nor transmitted by electronic, mechanical, photocopying, recordings or otherwise, without the prior permission of the copyright owner.

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www.babcpconference.com

BABCP 41st Annual Workshops & Conference Imperial College London 16-19 July 2013

Registration is now open! Confirmed topics Anxiety Disorders, Acceptance and Commitment Therapy, Basic Processes, Behavioural Medicine, Children and Adolescents, Dissemination, Depression, Eating Disorders, Impulse Control, IAPT, Intellectual Disabilities, Long Term Conditions, Low Intensity Therapies, Older Adults, Mindfulness, New Developments, Policy, Primary care, Selfesteem, Serious Mental Illness, Suicide Prevention, Therapeutic Techniques, Training, Schema-Focused Therapy

Confirmed keynote and workshop speakers Eni Becker, David M. Clark, Michelle Craske, Christopher Fairburn, Melanie Fennell, Elaine Fox, Simon Gilbody, John Green, Dougal Hare, Jennie Hudson, Sheri Johnson, Ian McPherson, Susan Michie, Rona Moss-Morris, Rory O’Connor, Martin Orrell, Lars Goran Öst, Tom Prout, Silvia Schneider, Imogen Sturgeon-Clegg, Mark Williams, Lucene Wisniewski, Marc van de Gaag, Jeff Young For further details of topics and programme updates, please see the draft programme and visit www.babcpconference.com

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Spring Conference preview

Cognitive approach to complex and traumatic grief Michael Duffy, well-known for his work with Anke Ehlers and others in developing and disseminating effective PTSD treatment, is delivering a one-day workshop on 3 April at the BABCP Spring Conference, which this year takes place at Queen’s University Belfast. Here Michael outlines the history of working with grief and where his novel approach fits in Freud saw grief as the necessary process of breaking attachment to a love object. Much of the thinking later in the 20th century was in the form of stages to complete in the process of adjusting to the loss. These stages can help people recognise their experience. If, however, they are seen as ‘normal’ and expected to be rigidly followed, people can get unhelpful thoughts that their grief is ‘wrong’ if it does not fit the model. Bereavement by unexpected traumatic or violent incidents can complicate grief, while information about the deceased or the death may not be so easily processed cognitively when images or memories are traumatic. A sense of losing control or helplessness differentiates more ‘normal’ grief from ‘complicated’ grief, with symptoms associated with PTSD. Complicated grief is not a formalised diagnosis, but experts suggest it is

distinguished by a sense of disbelief regarding the death; anger and bitterness over the death; recurrent pangs of painful emotions, with intense yearning; and, intrusive thoughts and preoccupation with thoughts of the deceased. Avoidance of situations and activities is common. Research shows shock, intrusive thoughts about the deceased and resentment are most predictive of complicated grief. The overlap with PTSD in terms of mechanism and symptom starts to increase. Manualised complicated grief treatment, mixing elements of interpersonal psychotherapy for depression with elements of CBT for PTSD, has been shown to be effective in RCTs. Meanwhile, recent data is encouraging: exposure and cognitive restructuring was more effective than supportive counselling in one study,

while one RCT has been more effective than interpersonal psychotherapy in another. Whilst there are clearly major differences to some other kinds of trauma, it has been proposed that an approach modelled on cognitive therapy for PTSD might be helpful. After all, the cognitive model for PTSD has been shown to be effective in several studies and tested specifically in relation to conflict-related PTSD in Northern Ireland. The components of a cognitive approach to complicated grief will be presented in my Belfast workshop. For more information on other workshops, keynotes and symposia taking place during the Spring Conference, please visit www.babcpconference.com

Lancashire hosts IAPT demonstration site for psychosis Lancashire Care NHS Foundation Trust’s Early Intervention Service (EIS) is one of only two in the country to be selected by the Department of Health as a demonstration site for psychosis under the IAPT in Severe Mental Illness (IAPT SMI) programme.

currently experiencing, first episode psychosis. The EIS delivers specialist interventions through a modular programme, which will provide new opportunities for clients and their carers, and promote optimism through to recovery.

we can ensure people get the right help and support that is needed. The successful sites have been chosen for their experience in delivering successful support and treatment and I look forward to seeing the results of this initiative.’

The wider IAPT SMI programme aims to improve access to a range of NICErecommended psychological therapies for those with psychosis, bipolar disorder and personality disorders. The ultimate long-term ambition of the programme is to ensure that everyone with psychosis, bipolar or personality disorders who could benefit from evidence-based psychological therapies has access to these interventions.

Lancashire Care was also awarded funding last year to transform children and adolescence mental health access to psychosocial services. As such Lancashire is one of the few sites nationally to offer IAPT across its range of mental health services.

Lancashire Care Chief Executive Heather Tierney-Moore said,‘This is a fantastic example of one of the Trust’s services working at national level to contribute to the further development of improved outcomes for service users and their families.’

The EIS specialises in working with individuals aged 14 to 35 at risk of, or

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Care Services Minister Norman Lamb said:‘These sites will benefit those with the most severe mental illnesses and personality disorders, and will help policy makers, commissioners and providers better understand how

Following the demonstration project, an evaluation will take place to identify any improvements which can be made nationally within mental health service services for service users who experience serious mental health difficulties.

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Titanic Struggles for CBT Queen’s University Belfast Thursday 4 - Friday 5 April Registration is now open! For further programme information and details on how to register, please visit www.babcpconference.com

Keynotes Opening Pandora’s Box: Clinical Implications of the Paradox of Unwanted Intrusions and Intentional Mental Control David A Clark, University of New Brunswick, Canada Challenges for CBT in Dealing with Personality Disorders Arnoud Arntz, Maastricht University, Netherlands Innovations in the Treatment of Health Anxiety Freda McManus, Oxford Cognitive Therapy Centre, UK

Workshops Complex and Persistent Anxiety: Alternative Interventions for Recurring Intrusive Cognitions David A Clark, University of New Brunswick, Canada Schema Therapy for Personality Disorders Arnoud Arntz, Maastricht University, Netherlands Cognitive Behavioural Therapy for Low Self-esteem Freda McManus, Oxford Cognitive Therapy Centre, UK A Cognitive Approach to Complex and Traumatic Grief Michael Duffy, Queens University Belfast, NI Psychosis: Struggling to Break Free from the Biological Dominance Alison Brabban, Durham University, UK

Symposia have now been added Developing CBT for Challenging Problems Kate Gillespie From the Inside Out: Supports for Therapists Peter Armstrong, Newcastle University

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Annual Conference preview Glenn Waller, incoming Co-Chair of the Scientific Committee, updates readers on what is in store at this year’s conference, which runs at Imperial College London from 16 to 19 July

As usual, the pre-conference workshops (held on Tuesday) will be delivered by a wide range of world class speakers while the three days of the conference proper (Wednesday to Friday) will be a mix of presentations on the whole gamut of topics guaranteed to appeal to the CBT practitioner. This is the ideal place to learn and participate, developing skills and updating your CPD. This year’s themes include child health, long-term conditions, CBT in the workplace, sex and sexuality, and suicidality. All of these themes will be well represented, with a lot more besides. Whatever your area of interest or practice, there will be plenty for you. The Scientific Committee has worked hard to ensure that you will have a diverse selection of workshops, keynotes and symposia which have practical as well as theoretical implications. The submissions have been coming in over recent months, and this process does not end until the final submissions (open posters and papers) arrive in early April. The final programme will go online when the submissions are all in and the review process is finished. In the meantime, visit the conference website to get a flavour of what is to come.

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There are keynotes and workshops by national and international figures, including (in no particular order): • Mark Williams (mindfulness and suicidality) • Michelle Craske (exposure therapy for anxiety) • Jeff Young (schema therapy) • Jennie Hudson (anxiety in children) • Melanie Fennell (self-esteem) • Lars Goran Ost (one-session treatment of specific phobias) • Lucene Wisniewski (DBT for eating disorders) • David M Clark (social anxiety, dissemination) • Christopher Fairburn (training) • Martin Orrell (dementia care) • Mark van der Gaag (EMDR, psychosis) • Simon Gilbody (depression) A more complete list can be found on the conference website. The conference venue is located in London’s West End, with parks, museums and great shopping close by. London is not as hilly as Leeds or Exeter, but neither does it have Brighton’s beach. You cannot have

everything! Accommodation has been arranged close by, within easy reach of the venue and other parts of central London. You can choose between rooms within a new student residence or rooms in a Grade 2-listed hall of residence adjacent to the Royal Albert Hall. Last but not least, the conference’s social programme. At the time of writing, details are not confirmed, apart from one hint:‘boat disco’. The Scientific Committee hopes that conference delegates will make full use of the opportunities to socialise and network in the evenings, and London does have a lot of opportunities! Keep checking the conference website for the latest news and updates. Remember that the conference is even better value if you book before 31 May 2013. Looking forward to seeing you in London in July. www.babcpconference.com

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BABCP 41st Annual Workshops & Conference Imperial College London 16-19 July 2013

Call for papers Submit your research or clinical work as an OPEN PAPER or POSTER to the 2013 BABCP Conference We are delighted to receive submissions relating to clinical research and clinical practice, including case reports. Work in progress is also welcomed. BABCP Excellence Awards, judged by leaders in the field, are available for oral presentations, posters and case reports by trainees and new researchers. Winners will receive free registration at the 2014 Annual Conference as part of their prize. Poster presenters will be offered the opportunity to publish their poster online.

Closing date - Tuesday 2 April 2013 For more information and to submit please visit www.babcpconference.com

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Future leader BABCP member and CBT therapist Rebecca Minton (pictured) was awarded a place on the NHS Clinical Leadership Fellowship in competition with clinicians across all disciplines in the NHS. Run by the NHS Leadership Academy, an organisation which promotes the development of future NHS leaders, this one-year programme involved a combination of academic study, experiential learning and application of leadership skills through a service improvement project. Rebecca was the only CBT therapist on the programme, out of a cohort of 60. CBT Today invited her to reflect on why CBT therapists should be leading

Leadership is a choice and not a role for everyone, and great clinicians do not necessarily make great leaders. Yet CBT practitioners have valuable skills and qualities which can be applied to leadership. Clinical leadership is at the heart of recent healthcare reforms and key to improving the quality of care which patients receive. As clinicians we are on the frontline and directly exposed to the problems affecting patient care, so we are well equipped to judge the need, quality and safety of services. Clinicians often have ideas for improvement and innovation so need to be at the centre of planning, decision-making and delivery of services. Much of the focus has been on doctors and nurses taking on leadership positions. Yet clinical leadership must be dispersed and shared across professions and at all levels. We all have a part to play and diversity in leadership supports the reduction of health inequalities among patients. With the emergence of IAPT and changes to mental health services, CBT therapists have the opportunity to lead innovative and novel ideas. As CBT therapists we want to make a positive difference to individual lives. Leadership offers the opportunity to make a positive difference through improved patient experience and improved services, as well as to staff teams. Leadership is not a magic wand and does not necessarily mean holding a formal leadership role. Rather, it is about engaging and empowering others to continually improve healthcare on both a small and large scale. Many of the skills used by CBT therapists overlap with those required in leadership. Leaders need to appreciate the system and the context in which they work in, just as CBT therapists need to understand the context in which the individual facing them and their problem exists.

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Engagement, collaboration and the ability to form and maintain effective relationships are skills which we use with our clients everyday. They are also crucial to effective leadership. Leaders help manage and lead change, helping teams to develop new ways of working which can present anxiety and resistance. Are these not the same challenges we face in the therapy room? Leaders also enable people to manage times when the plan does not work; with patients we teach coping strategies to help when situations do not go to plan. Leadership involves having a vision and working towards a goal and this is what we help our clients to do also. The ‘plando-study-act’ quality improvement tool used by leaders relies on the same principles as behavioural experiments used in CBT: forming a prediction, planning an experiment, testing this out and reflecting on the learning. Meanwhile, the use of data to drive decision-making is becoming increasingly important for leaders in healthcare and, again, is mirrored in CBT

sessions where we might collect and measure data on the frequency of checking behaviours. Last but not least, CBT therapists are reflective, emotionally aware and passionate about their jobs, highlighting further qualities which give us the potential to be successful clinical leaders. Medical training is putting a greater emphasis on leadership and management, could this be incorporated into CBT training too? I would love to see more CBT practitioners in leadership roles and helping to lead the future of healthcare. Rebecca works as a CBT therapist in a NHS IAPT service in London. She can be emailed at [email protected]. The views in this article are personal and do not necessarily represent those of the organisations she is associated with. Details of the NHS Clinical Leadership Fellowship can be found at: http://is.gd/NHSLeadership

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BABCP members recognised in New Year’s Honours Leading BABCP members have been recognised in the Queen’s New Year’s Honours List for their services in the field of behavioural and cognitive psychotherapies. Professor David M Clark (pictured) has been awarded a CBE for services to mental health. His research has focused on cognitive approaches to the understanding and treatment of anxiety disorders, which has led to the development of new and effective cognitive therapy programmes for four different anxiety disorders: panic disorder, hypochondriasis, social phobia and PTSD. Professor Clark has been involved with the IAPT programme since its inception and is currently the National Clinical Advisor. He currently holds the Professor of Experimental Psychology at the University of Oxford, where he established the Oxford Centre for Anxiety Disorders and Trauma. He is also a Visiting Professor at the Institute of Psychiatry, King’s College London. Professor Janet Treasure, Director of the Eating Disorder Unit at the Institute of Psychiatry, has been awarded an OBE for services to people with eating disorders. Professor Treasure is a Consultant Psychiatrist who has specialised in

Professor Malcolm Adams Professor Malcolm Adams, CoDirector of the Clinical Psychology Programme at the University of East Anglia, passed away on 2 January 2013, aged 62. Although Professor Adams was not a BABCP member, he was known to many in the Association. One of his legacies will be the work he was commissioned to undertake by BABCP on Standards of Proficiency. Professor Adams’ family is inviting people to make donations to Mencap or Amnesty International in his memory.

the treatment of eating disorders for more than 20 years. She is Chief Medical Adviser of the eating disorders charity B-eat, and is Director of South London and Maudsley NHS Foundation Trust’s inpatient unit at the Bethlem Royal Hospital. Steve Regel, Principal Psychotherapist at Nottinghamshire Healthcare NHS Trust and co-Director with Stephen Joseph of the Centre for Trauma, Resilience and Growth, has also been awarded an OBE for services to victims of trauma. BABCP President Professor Trudie Chalder said: ‘I know all three members and am delighted that their efforts have been rewarded appropriately. All three have dedicated their working lives to addressing the needs of people with specific problems through CBT. On behalf of the Board, I want to say how proud we all are of their achievements. I am sure I also speak for the whole Association too.’ Knighthood for Leeds keynote speaker Professor Simon Wessely, who gave a keynote at last year’s BABCP Annual Conference in Leeds, was awarded a knighthood for services to military healthcare and psychological medicine. Sir Simon is currently Professor of Psychological Medicine, Director of King’s College London’s Centre for Military Health Research and Vice Dean for Academic Psychiatry at the Institute of Psychiatry.

Children, Adolescents and Families Special Interest Group British Association for Behavioural & Cognitive Psychotherapies www.babcp.com/cafsig

Workshops and Conference 2013

CBT for Children, Young People and Families Addressing the challenges faced by users and practitioners in accessing and providing services

11-12 April 2013, University of Birmingham Online registration is now open: www.formstack.com/forms/eyas-cafsig

Conference themes:

Keynotes and Pre-conference workshops by: • Bill Yule • Paul Stallard • Robert Friedberg • Sabine Wilhelm • Susan Bogels • David Trickey • Anne Stewart

• Improving access to CBT services for young people, and families • Training and supervision • CYP IAPT • CBT for specific populations such as young people with developmental disorders and learning difficulties • Ways of communicating with young people using novel and old technologies • Clinical skills in both disorder specific and transdiagnostic approaches For further information please visit www.babcp.com/cafsig

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Transforming service user involvement in South London Sinead Brennan, Clare Coppock, Jocelyne Kenny and Frances Westerman write about their experience of developing Bromley IAPT’s Associates Programme Bromley’s IAPT service is a partnership between Bromley Mind and a statutory provider. Bromley Mind provides low intensity CBT interventions to people experiencing mild to moderate anxiety disorders and depression, as well as employment support and job retention services to people accessing both high and low intensity interventions. The statutory provider offers high intensity CBT interventions and counselling for people experiencing moderate to severe anxiety disorders, depression and PTSD. We began developing and piloting ways of involving clients at Step 2, in line with recommendations in the 2006 NHS Act that both service users and members of the public be consulted in the planning and provision of services, as it is believed that this produces better outcomes of care. When developing our model, which was initially limited to service users in the low intensity CBT part of the service, we noted that ‘service user’ implies a continuous relationship with a service. The time-limited nature of IAPT therapeutic interventions means that service users typically develop relationships with individual therapists, rather than with the whole service. We were also aware of the possibility of fostering a dependency on the service by encouraging clients to volunteer their time beyond giving feedback about the experience received, which runs counter to the IAPT focus on self-management of symptoms and recovery.

Programme are paid and involved at all levels from strategic planning to focus groups. There are a number of other opportunities available to clients after they have been discharged from the service, which include attending and facilitating focus groups, training new Associates, writing promotional literature, reviewing self-help materials, involvement in staff recruitment and delivering PWP training. In addition to providing therapy, IAPT services can help people back into employment or to stay in work. Our model reflects this by providing an opportunity for Associates to develop transferable skills which are valuable when seeking employment. Associates have a role description and person specification and each one is contracted to deliver consultancy to the service. In turn, the service is able to provide references for Associates, which can enhance their prospects of returning to work if currently unemployed. Our Associates Programme has been popular with clients, to the extent that there are currently more Associates on the database than opportunities. This could result in opportunities for Associates being created which are not genuinely required. We must, therefore, manage Associates’ expectations by emphasising that opportunities for involvement are time-limited and task-specific, while not encouraging Associates to offer support over a long period of time.

As we wanted service user feedback to be a focus for real changes to service delivery, service users were encouraged to position themselves as ‘consultants’ to the service, volunteering their time in a short-term and task-specific manner. In return we were able to gain advantage from feedback and use service users’ input in specific ways, such as sitting on interview panels and advising partnership forums.

Presently, white, middle-aged women form the majority on our database, which is consistent with the current demographics of those accessing the service. We expect to see an increase in service users from diverse backgrounds when it is open to selfreferral, which we hope will be subsequently reflected in the demographics of the Associates Programme. Links are being made by the service with community groups to encourage self-referral when this option becomes available.

In Bromley’s IAPT service we call our service user consultants ‘Associates’. All service users on the Associates

As a result of feedback from Associate focus groups, there have been a number of changes to the service,

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including self-help workshops for clients on waiting lists, clients being seen in more appropriate locations, completing routine outcome measures prior to (not during) appointments and providing clearer information on treatment options at the point of optin to the service. There have also been a number of positive outcomes for staff including increased opportunities to reflect on practice, and enhanced motivation and morale. Associates have reported positive outcomes too, including being able to ‘give back’ to the service, having a sense of value as paid ‘experts by experience’ and developing knowledge, skills and confidence. The Associates Programme is gradually being rolled out to the service as a whole. In our opinion, the optimum way to encourage meaningful service user involvement is to share best practice by discussing our work with colleagues in other IAPT services. Some of you may have heard our paper about the Associate Programme presented at last year’s BABCP Annual Conference in Leeds. We also believe that service user involvement is a vital part of staff development within our IAPT service and have included Associates in staff training. We welcome contact from other IAPT services and are happy to provide more details of the Associates Programme, as well as BABCP members interested in setting-up a forum or discussion group on service user involvement. Please email [email protected]. Sinead Brennan is a Senior PWP at Bromley Mind and a Clinical Tutor at University College London Clare Coppock is a PWP at Bromley Mind Jocelyne Kenny is a Trainee Clinical Psychologist at Royal Holloway, University of London Frances Westerman is a Senior CBT Psychotherapist and Psychological

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Welsh vistas

To mark the launch of #CBT4Wales, CBT Today has commissioned a series of articles which tell some of the personal and professional stories inspiring this initiative

The service user’s story As a CBT service user in North Wales, I (like so many) feel a real need to stand up, shout out loud and give my story in order to try and raise awareness about the lack of CBT therapists and services within the NHS here in Wales. I have suffered with OCD for over 30 years. Due to the lack of knowledge from doctors and NHS therapists, as well as the lack of NHS services, I spent 23 years with an undiagnosed illness, which was no fun, believe me. I got passed from pillar to post and was given various kinds of medication, from beta blockers to diazepam to antidepressants. Nothing was working, and for sure the tablets were having absolutely no effect whatsoever, except turn me into a walking zombie. I was referred to an NHS therapist for the usual six to eight sessions. To be brutally honest, they just hadn’t got a clue what OCD was, and I’m certain they had no CBT training whatsoever.

About seven years ago, my OCD was so bad I had not far off 500 separate and differing ‘OCD habits’. These would occupy up to 95 per cent of every day and quite literally made life unbearable. On numerous occasions I had contemplated ending it all. Once again I was going back and forth to the doctors, and once again being handed more and more medication. Things just became ‘too much’ and it was having a very large and direct impact on my 19-year relationship with my wonderful wife. She was also at her wits’ end and felt so frustrated herself that she couldn’t help me. My eyes still fill up to this day when I remember the pain I must have put her through. On my last and final bid for help, I went back to the doctors and, fortunately for me, I was seen by a locum. He had heard of OCD and CBT (I had never even heard of OCD or CBT until then). He was able to refer me to my local mental health team in Bangor, which is where I met my CBT therapist Keith Fearns (who, might I add, has quite literally saved my life). Not only did I now finally know what was wrong with me, but I wasn’t alone! There were other people just like me with the same problems. You cannot imagine what a relief it was to know that I wasn’t on my own. I continued to receive my weekly CBT sessions with Keith in my own home, which was hugely helpful because that was where the problem resided. This continued right up until the NHS decided that they didn’t need a CBT service in Bangor anymore and, as a result, my therapist retired! So there I was, finally knowing what was wrong with me and what treatment I

needed, yet having absolutely no NHS services to help me and other sufferers. I have continued to see Keith privately on a weekly basis. It does cost, but what cost can you put on life? Fortunately, my wife has a pretty good job so we are able to afford the sessions. God knows what I would do if she didn’t. CBT has been a life saver for me. It hasn’t just given me my life back, but it has given my wife her husband back and our little girl her daddy back (a proper daddy rather than one who spends 16 to18 hours a day consumed by OCD). Without my amazing therapist working tirelessly to give me CBT for OCD, I am certain that I wouldn’t be here today writing this article. Thank you to everyone who is working tirelessly to get CBT recognised as a genuine treatment for OCD. Now let’s see what we can do to get it recognised in Wales as well. Deon Gorle

The CBT therapist’s story Currently, Wales has 56 BABCP Accredited CBT therapists living within its borders. It is likely that a good number of these live in Wales but actually work in England, given that that pay structures and career opportunities are much more favourable across the border. Whichever way you look at it, this is disappointing reading for people in Wales in need of CBT. Put another way, for a population of three million, there is one BABCP Accredited CBT therapist for every 54,000 people in Continued overleaf

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Welsh vistas Wales. This compares unfavourably with England (one for every 17,000 people), Northern Ireland (one for every 21,600 people) and Scotland (one for every 30,900 people). On 2 November 2010, the National Assembly for Wales passed the Mental Health (Wales) Measure into Welsh law. This makes it a legal requirement to provide assessment for people with mental health problems. This will mean a massive shift of resources into the process of assessment to the detriment of therapeutic intervention. There is already talk of a 24-page assessment document, and of staff being moved away from intervention into assessment roles. Last March, the Welsh Government launched its policy implementation guidance on psychological therapies in Wales at a conference promisingly called ‘Improving Access to Psychological Therapies in Wales’. At the outset, this Welsh IAPT document claims that it intends to follow the NICE guidelines for the treatment of mental health problems. The briefest of scans of the NICE guidelines should lead anyone to the conclusion that the most frequently recommended talking therapy is CBT. Yet the document proceeds to propose a ‘range of psychological therapies’. It contains an appendix listing the range of talking therapies

Continued

presently available in Wales. This is mysterious since most of the therapies on their list do not appear in NICE recommendations. A study carried out by Rebecca Jury and Louise Waddington at Cardiff University drew some stark comparisons between Scotland and Wales. Scotland ‘specifies the characteristics of patients who can expect to receive high intensity therapy, the number of sessions that they can expect, and crucially the level of training and competence required for their therapists’. Wales, however, has ‘not yet specified which patient groups or level of difficulties should access formal psychological therapies, which psychological therapies are considered to be evidence-based, the recommended number of sessions patients can expect, or the qualifications of the practitioner. No competence model or minimum training criteria are specified for CBT therapists.’ The Welsh Government has provided no funding for their IAPT initiative such as it is. There is only one CBT training centre in Wales, at Cardiff University. This is presently undergoing the BABCP Accreditation process. If it is successful, it will provide only 16 places for students and will receive no funding from the Welsh Government. Welsh Local Health Boards, then, are

left with real dilemmas. Do they bumble along with a range of psychological therapies or try to provide some sort of service which approximates to what is recommended by NICE? Many Boards will be tempted to opt for quick and cheap in–house CBT training courses for existing staff, with the inevitable outcome of poor continuing supervision leading to interventions spuriously purporting to be CBT. The presentation that Deon and I delivered at the OCD-UK conference in November was entitled ‘Chwarae Teg’ (Welsh for ‘Fair Play’). It is evident that the people of Wales are not being treated fairly when it comes to CBT. Keith Fearns

The nurse’s story I am committed and passionate about training in CBT. I have conducted a lot of research and attended conferences outside of my work time and I have worked in healthcare, including mental health, for over a decade. Until this enormous shortfall in access to psychological therapies is addressed and improved in Wales, I do not think mental health services can call themselves person-centred. I work on the frontline with people experiencing acute mental ill-health who have to wait 18 months for

Deon’s story launches BABCPtv A video, in which Deon Gorle talks to his CBT therapist Keith Fearns about how CBT has helped him claim back his life from OCD, is the first to appear on BABCPtv.

The video offers powerful testimony from someone whose life has been positively transformed by CBT, which in turn has significantly improved the quality of life for their loved ones.

Using the popular video-sharing website YouTube, BABCPtv has been set up to help raise awareness of CBT to a wider lay audience as part of the Association’s public outreach activities.

To watch the video, please go to www.babcp.com/tv.

The video, called CBT for OCD,was made in support of #CBT4Wales and shown during the initiative’s launch at the OCD-UK conference in November.

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It is hoped that more videos, particularly from members of the public talking about their experience of CBT, will be added to the BABCPtv page on YouTube soon. If you would like to submit a video for inclusion on BABCPtv, please email [email protected].

The comments expressed in videos on BABCPtv are those of the presenters and do not necessarily reflect the views of BABCP or any of its Trustees.

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psychological therapies. The sheer frustration is what keeps me awake at night! This does not reflect a service which meets the needs of a person. I struggle with this on a personal, professional, ethical and a caring human being level. The service will not allow me to be the nurse I want to be. I have also lived with mental ill-health for almost 30 years and have just functioned enough to always work. I have friends and relationships but it has been the biggest struggle of my life to date. My mental ill-health has permeated every aspect of my life like a dark fog seeping into everything I think and do. Apart from medication and five out of the standard six free counselling sessions through my GP, I have never received a psychological intervention. Incidentally, the therapist cancelled the sixth one as it was deemed I needed long-term therapy so there was no point to a final session - don't get me started on people being expected to fit their story into six 50-minute slots! My options are to wait 18 months for CBT or pay to access it privately, as it is for so many others.

BABCP Accreditation figures correct as of 31 December 2012

Scotland Population: 5.25 million BABCP Accredited CBT therapists: 170 One BABCP Accredited CBT therapist per 30,900 people

Wales Population: 3 million BABCP Accredited CBT therapists: 56 One BABCP Accredited CBT therapist per 54,000 people

Northern Ireland Population: 1.75 million BABCP Accredited CBT therapists: 81 One BABCP Accredited CBT therapist per 21,600 people

I feel utterly disheartened about the service I work in not meeting the needs of the people who use it, especially when I see the distress. I know that the help is out there, but it is not here in Wales! Lots of people, including myself, would love to train as a CBT therapist but there are currently no BABCP Accredited courses in the whole of Wales. Don’t get me started on that one, either! CBT is the gold standard treatment for so many mental illnesses as recommended by the NICE guidelines. The fact that it is so difficult to access is, in my opinion, neglect and must be addressed as a matter of urgency. Name withheld

The charity’s story During the recent OCD-UK conference, held in Cardiff, we heard many harrowing tales from Welsh service users who were failing to access suitable CBT to help them overcome, and recover, from the debilitating nature of their OCD. Many of these service users had to wait months, even years for CBT. Even

England Population: 53 million BABCP Accredited CBT therapists: 3,079 One BABCP Accredited CBT therapist per 17,000 people

then, they were offered treatment which lacked a quality understanding of OCD. This can, perhaps, be best echoed by the following story. During the summer of 2011, OCD-UK was approached by the anguished mother of a young man in his 20s living just outside of Newport. To protect anonymity, we shall call him Steve. Despite having been previously diagnosed with OCD prior to the summer of 2011, Steve attended an appointment with an OT Mental Health Worker following a relapse of his OCD. During his appointment, Steve reported that he was having intrusive thoughts about harm coming to his family in addition to thoughts that he may cause harm to

his family. At no point did he indicate that he wanted, or intended, to cause harm. Intrusive thoughts of harming a loved one are a common symptom of OCD. Since OCD-UK was formed in 2004, we have never been informed about a single case of an OCD sufferer actually acting on their thoughts. What happened next was a tale of woe and a catalogue of failures to assess the situation, and the risk, which Steve posed. The OT reported Steve’s intrusive thoughts to other members of the service, including Social Services. A care meeting was convened to discuss risk, but Steve Continued overleaf | February 2013 13

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Welsh vistas was not in attendance. Neither was he assessed again prior to the Police being sent to his house. Steve was removed from his property, informed to stay away from his children and forced to spend that night sleeping on the back seat of his car. At no point did any of the various agency workers involved ask if these thoughts could be related to his prediagnosed OCD. It then took the Local Health Board nearly two weeks to arrange an assessment to identify if Steve was a risk to his family or not. Thankfully, that second assessment cleared Steve to return to his family home, and no long-term damage was done to Steve or his children. All of this could have been avoided by having some basic understanding of how OCD can manifest itself in some patients. It should no longer be acceptable for a patient with OCD to be put through such a traumatic experience, especially when the patient already had a diagnosis of OCD! That story, and others like it, happen because there is a severe lack of awareness and education amongst health professionals about OCD. Even today, some people, including GPs and mental health professionals, still think OCD is just about hand-washing. Wales could, and should, steal a march on offering quality mental health services in comparison to

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Continued

other parts of the UK – if they wanted to? Whilst IAPT across England has improved access to services (arguably), we are still hearing daily tales from service users that their IAPT health professional simply fails to understand OCD. Dare we suggest that IAPT is focussed too much on quantity rather than quality? I am sure many BABCP members will not applaud us for suggesting this. From an OCD perspective, however, IAPT is generally failing those who suffer with OCD. The time has come for health professionals to start listening to charities working on the frontline. This is where Welsh Health Boards could take a lead in providing quality services. The formation of #CBT4Wales, launched by Keith Fearns and Deon Gorle at our Cardiff conference, can only serve to improve access to CBT. But, we have to send a warning and issue a challenge: providing CBT across the whole of Wales is important, but it is pointless if CBT therapists’ knowledge and understanding about conditions like OCD is flawed and lacking in quality. You must focus on quality training and treatment, and make CBT in Wales the envy of the rest of the UK. Kylie Cloke and Ashley Fulwood, OCD-UK For more information on OCD-UK, please visit www.ocduk.org

Get involved If you would like to see how you can support #CBT4Wales, please email [email protected]. There is also a dedicated page on the BABCP website at www.babcp.com/wales.

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Wikimedia Commons - o2ma

opera Wikimedia Commons - On Dit

Lessons we can learn from

Opera and me I became interested in opera through my dad. When I was young, one of his favourite pastimes was listening to Beniamino Gigli (an Italian opera singer, the most famous tenor of his generation). My mother hated opera with a vengeance and became quite hysterical every time she ‘caught’ my father indulging his passion. Now aged 86, he can only repeat my mother’s verdict, that opera is ‘awful, just some fat people screaming about nothing, I don’t understand why you like it’. But I still remember the absolute stillness, the sparkle in his eyes and the occasional tear when he played some of Gigli’s tapes. Badness and madness Opera has so many things to offer for mental health professionals, from clear-cut examples of evil-doing (in Otello, Lucia di Lammermoor, Tosca, Turandot, Don Giovanni and Rigoletto, to name a few) to examples of irrational thinking (L’Elisir d’Amore, Carmen and all the above). It shows stories focused on all of humanity’s weaknesses: greed (Lucia di Lammermoor); jealousy (Otello); psychopathy (Don Giovanni) and love (La Bohème, L’Elisir d’Amore). This is by no means an exhaustive list of the topics which operas deal with. Opera is full of drama. Indeed, the audience at the Metropolitan Opera House in New York got more than it bargained for with the actual death mid-performance of one of its greatest stars. In March 1960, while performing Verdi’s La Forza del

Destino, the great baritone Leonard Warren completed his second act aria, O Gioia (Oh Joy, which begins ‘morir, tremenda cosa’, meaning ‘to die, a momentous thing’), and pitched forward dead. That evening, for one of the very few times in its history, the Met’s show did not go on. La Bohème Many operas contain lessons on life as well as helpful hints for practising mental health clinicians. To illustrate this, I have chosen one of Puccini’s grand operas, La Bohème. This is an opera in four acts with an Italian libretto by Luigi Illica and Giuseppe Giacosa, based on Henri Murger’s French novel Scènes de la Vie de Bohème. The world premiere of Puccini’s La Bohème took place in Turin on 1 February 1896 at the Teatro Regio, conducted by the young Arturo Toscanini. Bohemians were seen as people practising an unconventional lifestyle, often in like-minded company, with few permanent ties, involving musical, artistic or literary pursuits. This use of the word ‘bohemian’ first appeared in the English language in the 19th century to describe the nontraditional lifestyles of marginalised and impoverished artists, writers, journalists, musicians and actors in major European cities. Five of the main characters in La Bohème are artists: Rodolfo is a poet, Marcello is a painter, Schaunard is a musician, Colline is a philosopher and Musetta is a singer. The two remaining characters are non-bohemian: Mimi is

Henck van Bilsen is known to many readers as a highly-regarded CBT therapist, trainer and supervisor. He is also a self-confessed opera buff who recently admitted that his recent attendance at a conference may have been best explained by its close proximity to the world famous La Scala opera house in Milan (pictured above). CBT Today invited Henck to talk about his operatic passion and what insights this art form offers those working in mental healthcare a seamstress and Benoît is a landlord. The story is as follows: In 1830s Paris, four arty types shiver in their apartment, owing rent. When one of them - the musician Schaunard earns money, they are all set to go for a meal in a nearby restaurant. Rodolpho, the poet, stays behind to finish his writing and is interrupted by Mimi, a seamstress, from a neighbouring apartment. They are instantly attracted to each other and catch the others up at the restaurant, where Rodolpho's painter friend Marcello is re-acquainted with his flirtatious ex-girlfriend Musetta, who dumps her current lover after getting him to pay everyone's bill. Sometime later, Musetta and Alfredo are living together, as are Mimi and Rodolpho, but he is aware that she has tuberculosis and is mean to her hoping she will leave him for someone who can take better care of her. Eventually she does, while Musetta also splits from Marcello. The four men resume living together in an apartment. They are visited by Musetta, who has sought out Mimi, now living with a wealthy count, but dying, and has brought her back to die in the presence of her true love and friends. Musetta and Marcello reunite as Rodolpho cries over the dead body of his Mimi. Lessons from act one I have selected a scene from the first act of La Bohème to focus on lessons we can learn as practising mental health professionals from opera. Continued overleaf

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Continued Rodolfo and Mimi are alone in the apartment, all the candles have been blown out, it is dark, Mimi is about to leave, but before she does Rodolfo takes her hand and introduces himself to her (in the form of a rather beautiful aria). They have been searching for Mimi’s key to her apartment. Rodolfo has found the key, but hidden it as he wants to spend more time with Mimi. Even when it is completely dark you can find happiness Mimi and Rodolfo have been searching in the dark and they still find ‘something’: happiness in meeting. In forensic psychology and psychiatry, there is a strong emphasis on evidence-based interventions and formulation-driven treatment programmes. This is all based on knowing exactly what one is doing and why it is being done. However, in very complex situations, it can pay off to apply nature’s best approach, which in the end always produces results. You do not always need to know where you are going in order to get somewhere. With complex and multi-problem patients, it may be a good idea to carefully start ‘somewhere’ with interventions, instead of waiting until all the facts are known, evaluated and weighted. In other words, even without a nicely polished formulation (you are in the dark), tentative and careful steps can produce satisfying results.

interventions has become a ‘notdone’ in this Zeitgeist of protocolised and manualised interventions. Finding the protocol (‘the key’) and continually being open to adaptations are what we learn from this excerpt. Let’s face it, if Rodolfo, upon finding the key would have said,‘Oh, found it, here it is, goodbye’, we would have missed out on a fine opera. Not all irrational thinking is bad and needs to become the focus of therapy Rodolfo sings,‘Where in spirit I am a millionaire’. Put another way, he is very poor but feels as if he is a millionaire and it makes him happy. In mental health, we frequently behave like the ‘thought police’ and pursue relentlessly any thought or idea which does not conform to our own perspective of rationality and reality. Reality is simply an option. If someone chooses to believe in an option of reality not shared by us and it does not cause problems, perhaps we should congratulate the patient on their creative problem-solving instead of challenging their ‘incorrect appraisal of reality’. It is better to lead a life worth suffering for, than to avoid all suffering in life ‘Yet sometimes from my safe, all my gems are stolen by two thieves, a pair of lovely eyes!...Beautiful dreams I'd cherished, immediately vanished without a trace’. When Rodolfo sings these words, he is indicating that he knows that he is on a path which will bring suffering, but he accepts it as

Keep an open mind, even if you have found what you were looking for Mimi and Rodolfo continue looking for the key, even after Rodolfo has found it. Sometimes the answer is really blowing in the breeze and therefore not important. It is the breeze which counts, letting it dictate where you are heading even after you have found the answer. This may lead to interesting and uplifting results. In the field of mental health, the efforts of a clinician or clinical team too often come to grinding halt after a diagnosis has been identified or a treatment programme pathway has been selected. How the patient responds to the specific interventions almost becomes a sideshow (because we know, based on the evidence, how a patient ought to respond and patients responding differently are just difficult…). Going with the patient’s idiosyncratic response to our

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part of life. Too often in the field of psychiatry and psychology, suffering is mistaken for pathology. Yet, suffering is part of life and we should not teach our patients to avoid suffering but how to lead a life which is so good, it is worth suffering for. Finale Opera is an experience which is dependent on all its individual components working well together: conductor, orchestra, singers and mise-en-scène all need to be in harmony. In mental health practice, it is exactly the same. Conducting CBT demands that the right questions are asked at the right moment; to start with agenda-setting at the end of the session is not really the done thing! The words need to be spoken with the right emotional tone. In residential mental health settings, there are even more components which need to work together in order to create a meaningful treatment programme. Just like in opera, many of the critical factors may not be immediately visible. In opera, the orchestra is often not visible, while the creative team (design, direction and choreography) are never found on stage, but their contributions all have an impact on the quality of the end product. The same goes for mental health practice: the actual physical surroundings are often taken as a given, while the first greeting may go unnoticed. Nevertheless, they are important factors in the quality of our care.

Chester, Wirral & North East Wales Branch Spring Programme 2013 www.babcp.com

12 March 2013

Introduction to Narrative Exposure Therapy One-day workshop by Katy Robjant 10.00am to 4.00pm (registration from 9.30am) Venue: Chester Rugby Club Booking for this event is via BABCP, please email [email protected] or telephone 0161 705 4304

24 April 2013

Exposure Therapy for Anxiety Disorders Evening talk by Mike Davison 6.30-8.30pm Free to BABCP members, £10 for non-members (no need to book) Venue: Chester Rugby Club

15 May 2013

Is CBT a Profession - Yes or No?* Evening talk by Ken Lewis 6.30-8.30pm Free to BABCP members, £10 for non-members (no need to book) Venue: Chester Rugby Club * This event is followed by the Branch AGM

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Diversity matters

Class act

The 2010 Equalities Act 2010 makes economic and social differences a diversity issue. Barbara Swinburne asks to what extent CBT practitioners consider social class in their delivery of therapy

I have been a mental health practitioner since 1981 and in CBT practice since 1987. Throughout my career, I have noted the difficulties caused by clinicians or services who fail to recognise and cater for the specific needs of people from different cultural backgrounds. Huge efforts have been made in some areas to ensure greater equality in access to, and delivery of, quality services designed to effectively support clinical needs. There has been slow but steady growth in the awareness of trans-cultural psychological issues, gender, sexual orientation and age, as well as improvements in the understanding and support for specific areas of difficulty in patients’ lives. However, there remain blind spots. There is one ‘cultural issue’ which transcends ethnicity, age, gender and sexuality, and that is the matter of class. I was born into a working class family from a working class area of London. My generation of the extended family has ‘done well for ourselves’ educationally and professionally. Yet, since my time as a student RMN at a South London teaching hospital through the many stages and diverse geographical locations of my mental health career, I have been curious as to why, what remains essentially a middle class profession seems to struggle so hard to be able to identify with, understand and support the needs of working class individuals. This is particularly true for the ‘underclass’: the unwaged, welfare benefit-dependent section of our society. How come a profession which

encourages an understanding of the workings of the mind, the structure of thinking, the development of belief systems and their impact on behaviour and emotion, so often fails to recognise where the other person might be coming from? Is it because, even now, most clinicians in healthcare come from middle class backgrounds with the experience and attitudes which this entails? Working class and upper class individuals do not appear to have the same difficulty recognising and accepting the diversity in thinking which class conformity may generate. To illustrate, let me describe how, early in my training when I was a secondyear student nurse, I was allocated to a placement at a Cottage Day Hospital (CDH) within a large psychiatric hospital, with a catchment area covering much of South West London. It is the days of the weekly grand round, the whole team has met to review patient treatment programmes. I am the most junior member there, but still expected to contribute. We are discussing a depressed young man in his early 20s who has been attending the CDH for several weeks. He does not appear to be making any progress and, despite being placed into several therapy groups, appears reluctant to engage with therapeutic activities. The key worker in this case is our dance therapist, who has given us feedback about her concerns regarding his failure to engage. Possible solutions and treatment options are discussed with much concern expressed about his reluctance to engage and his resistance to treatment. The discussion moves around the room

with each member of staff in turn expressing opinions, giving feedback about interventions and making suggestions for further treatment. I am asked for my opinion.‘Has anyone thought that maybe this bloke has just been placed in the wrong group?’ Silence. All eyes turn to me as the consultant asks why I feel I can question the experience and decisions of more senior staff. In for a penny, in for a pound, I replied,‘His family and friends all work in the building industry. When he walked out of the dance session, he said that, if they knew he had been asked to express himself as if he were a tree buffeted by strong winds, hell would freeze over before they stopped making jokes at his expense.’ This experience has been repeated many times over the years. It is sad that many clinicians lack the ability to understand the real circumstances of their patients’ lives and the cultural determinants of their behaviour. I went into independent practice in 2007. The issues around engagement with therapy, which I observed in the NHS, leading to mutual misunderstanding, frustrations and misperceptions, equally apply here. The proportion of working class patients in my caseload is in fact higher than at any time during my NHS practice. This may explained by the number of referrals from the motor insurance sector following RTAs and personal injury claims. My experience of talking to many blue-collar workers, who possess practical skills but few academic Continued overleaf

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Branch news

Eastern Counties Branch Therapies Manager at Bromley Mind

Class act Continued qualifications, is that often selfesteem and confidence are invested in being good at what they do. When illness or injury takes that away, entering into a process of therapy is not only alien to their usual coping strategies, but further impacts negatively on esteem and confidence causing both stress and difficulties with mood management. Attendance at sessions may be difficult for many reasons. These might include financial problems, difficulties in travelling independently, or a reluctance to ask for help to attend due to feeling a burden or not wanting to disclose weakness. These circumstances are not exclusive to the working class patient, but many middle class patients have better access to money, knowledge or a social network, together with a greater understanding of the treatment on offer. I do not have any definitive answers. But, I think it is time for our industry to look at the issue of class discrimination alongside other better publicised diversity and equality issues. We need to present the process of therapeutic change in a manner that makes it acceptable to all of our patients.

The Branch hosted Roz Shafran and her workshop on Clinical Perfectionism at the Suffolk Showground in Ipswich on 10 October Roz proved to be an inspiring speaker and demonstrated an easy mastery of her topic. She presented the theoretical background and the transdiagnostic aspect of the subject, focusing primarily on the assessment and treatment of this relevant and sometimes overlooked issue. We explored the most effective ways of assessing and formulating, keeping the formulation simple, relevant and understandable and differentiating which domains of the client’s world were affected and which remained intact. We had the opportunity to discuss the model of treatment, which Roz has been involved in developing, identifying problems in engaging this client group and exploring engagement approaches, treatment strategies, treatment evaluation and blueprints for staying well. We took time to reflect on the structure and content of sessions,

identifying how treatment will differ from standard CBT sessions as well as therapy blocks which we might expect to encounter in the course of treatment. This was complemented with DVD and case study examples from Roz’s own clinical practice. There was plenty of time for discussion and questions from a very engaged audience and the day came too a close too quickly. If there is something innovative you have done in your work area or practice or a topic in which you have a specific interest or skill and you feel you would like to share it with us at one of these evenings, then please contact one of the Eastern Counties Branch committee members for an initial chat. To find out about our future events, including a series of evening workshops, please visit www.babcp.com/CPD.

Roz Shafran (third from right) with Branch members

Branch news is moving online News, views and reviews from the thriving network of Branches and Special Interest Groups is moving to ‘The Roots’ area of BABCP’s online forum CBT Café. Share your experiences, presenter feedback and upcoming events, while enjoying the benefit of getting the word out as soon as possible and engaging interactively with current and potential new recruits. If you haven’t registered already for CBT Café, go to www.babcp.com/cafe and register your details to make full use of the online forum. Make sure you create a user name which is the same as that of your Branch or Special Interest Group. If you need any assistance, please email [email protected].

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West Branch presents

Couples Special Interest Group presents www.babcp.com

Schema Focussed Therapy and the Use of CBT in the Treatment of Complex Trauma Helen Kennerley, D Phil Consultant Clinical Psychologist

9.00am to 5.00pm (registration from 8.30am) Venue: Bristol Zoo, Clifton Pavilion, College Road, Bristol BS8 3HA Before 5 February

After 5 February

BABCP members:

£60

£70

Non-members:

£70

£80

Price includes two-course buffet lunch, refreshments and entrance to the zoo for the day of the conference. For further information including how to register, please visit www.babcp.com/cpd

A one-day workshop by Carla Swan and John Williams Thursday 21 March 2013 from 9.30am to 5.00pm (registration from 9.00am) David Lloyd Conference Centre, David Lloyd Gym, Livingstone Drive, Newlands, Milton Keynes MK15 0DL (telephone 01908 207901)

Presenters Carla Swan is an accredited CBT therapist who has worked with couples over many years primarily as part of the Relate organisation, IAPT and in private practice. John Williams is a Consultant Clinical Psychologist and Systemic Family Therapist and accredited CBT practitioner and supervisor. He has worked in adult, and child and family mental health services in private practice and the NHS for over 20 years, developing and delivering family and couples therapy services. Fees BABCP member - £75 Non member - £95 Students - £75 Tea and coffee is included and sandwiches are available in the David Lloyd dining area. Free parking is available at the centre For more information including how to register please visit www.babcp.com/cpd

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www.babcp.com

The workshop is likely to be helpful for clinicians working in IAPT, NHS adult primary and secondary mental health care teams, CAMHS professionals working with parents, Relate therapists or therapists working in private practice who are interested in involving clients’ partners in individual therapy cases. No experience of couples or family therapy is required although basic knowledge of CBT theory and practice would be necessary to get the most from the day.

Tuesday 26 March 2013

Cost:

An Introduction to Cognitive-Behavioural Couples Therapy (CCT)

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