Volume 42 Number 4December 2014 Inside this issue:

The women’s roomChanging the game in wider societyPages 11-15

train with Isaac Marks back in the1980s and, following a fairly brief timeas a therapist, moved into roles thatwere primarily teaching and research.I finally ceased to practise as atherapist in around 2000 andconcentrated entirely on teachingand research, mainly centred aroundmy chief area of research, which isvisible difference and disfigurement.

For all that, I am very proud to havebeen a BABCP member for over 30years, and a member of theAssociation’s Board of Trustees for thepast three years. Of course, I amespecially grateful to have benefitted

from Trudie Chalder’s exampleand advice during my year asPresident Elect, at a time whenBABCP has been going througha challenging period and hasachieved its landmark 10,000membership. Our growingmembership itself challenges usto think about the place of CBTin the UK and Ireland, and whatwe might do to be worthy ofthat position and respond tothe expectations of peoplewho use CBT and the widerpublic when CBT remains ascarce resource.

I am very clear that CBT ismuch more than a therapy;much more than somethingfor people who are definedas having problems. CBT is away of looking at life and, inan ideal world I would take

Continued overleaf

This July, Professor Rob Newell (pictured below) began his two-yearterm of office as the BABCP President. CBT Today invited him tointroduce himself and his vision for the Association

BABCP, CBT andpublic involvement

I write to introduce myself asPresident of BABCP. Many BABCPPresidents have scarcely needed tointroduce themselves to themembership, and I am humbly awarethat I follow many well-known,influential and innovative people asPresident. By contrast, I am not ahousehold name in CBT, so I will startby saying a little bit about myself.Mainly though, I will talk about how Isee one future direction of BABCP,and how I hope we will move in thatdirection as an organisation.

First off, and perhaps surprisingly, Ihave not been a therapist for a goodmany years. I was lucky enough to

From the LeadOrganisation for CBT in the UK and Ireland

”“

| December 20142

Managing Editor - Stephen Gregson

Deputy Editor – Peter Elliott

Associate Editor - Patricia Murphy

CBT Today is the official magazine of theBritish Association for Behavioural &Cognitive Psychotherapies, the leadorganisation for CBT in the UK and Ireland.The magazine is published four times ayear and mailed post free to all members.Back issues can be downloaded fromwww.babcp.com/cbttoday.

Submission guidelines

Unsolicited articles should be emailed asWord attachments to editorial@babcp.com.Publication cannot be guaranteed.

An unsolicited article should beapproximately 500 words written inmagazine (not academic journal) style.Longer articles will be accepted by prioragreement only.

In the first instance, potential contributors areadvised to send a brief outline of theproposed article for a decision in principle.

The Editors reserve the right to edit anyarticle submitted, including where copyrightis owned by a third party.

Next deadline

9.00am on 26 January 2015 (for distributionweek commencing 23 February 2015)

Advertising

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

Disclaimer

The views and opinions expressed in thisissue of CBT Today are those of the individualcontributors, and do not necessarily reflectthe views of BABCP.

© Copyright 2014 by the BritishAssociation for Behavioural & CognitivePsychotherapies unless otherwiseindicated. No part of this publication maybe reproduced, stored in a retrieval systemnor transmitted by electronic, mechanical,photocopying, recordings or otherwise,without the prior permission of thecopyright owner.

Volume 42 Number 4December 2014

BABCP, CBT andpublic involvementContinued from page 1

recall that he deplored theprevalence of mentalist explanationsfor behaviour current in everyday life.I do not think much has changedsince Skinner wrote this in 1971.

Do not think that I am after evidence-based TV and a fairer profile for CBTin fiction - although these areinteresting ideas! Rather, I amillustrating ways in which publicviews of what therapy is and how wecome to act as we do are shaped.

Why should BABCP have a role in allthis? I believe we should because wehave a duty to point to a differentway of looking at life: one that offerscredible, testable explanations for ourbehaviour without seeking topathologise our difficulties, and onein which CBT is freely available to allbecause it is not just offered bytherapists. Instead, it is offered byeveryone; your friends, your next doorneighbour, because we all understandthe basics as a normal part of ourculture. Sounds far-fetched? I do notthink so. I believe everyone has abasic understanding of CBT principles- that is why our parents often told usnot to shy away from things thatmade us anxious. Everyone doesinformal CBT sometimes. Imagine ifthat was increased and refined.

Our job, then, is to engage withpeople and the media tocommunicate the message that CBTis something for everyone. This is verymuch part of the aims of the

Here are a couple of examples. Ontelevision hardly a week goes bywithout some soap hero havingcounselling for her anger problems orthe consequences of his earlychildhood experiences. Similarly,television couples in difficulties willinevitably seek some form ofguidance. Rarely is the interventionspecified and, if it is shown at all, thereis no discernible CBT content, butmost likely an unfocussed discussion,perhaps with reference to people’sexperiences with their parents.

Likewise, almost every area ofliterature, criticism, biography, orpopular song seeks to ascribemotivations to people based onarcane belief systems or folkloreexplanations of behaviour. I amalways, for example, amazed that theuse of psychoanalysis to explain thebehaviour of dramatic protagonistshas not really changed since I studiedliterature as a schoolboy. Once againcognitive behavioural perspectivesdo not shape our collective life as anation. Of course, I am only followingBF Skinner’s introduction to BeyondFreedom and Dignity here. Fans will

the ‘T’ away and talk about CognitiveBehaviourism to describe that view ofthe world. I know CBT hastransformed my life and, I imaginethat of many BABCP members; thosewho use CBT services would echothat feeling. Yet, at the same time, Iam acutely aware of how little impactthis way of looking at life has on theworld at large.

So here is the challenge: we have agrowing membership, an increasinglyrecognised treatment approach, andyet, in my eyes, the cognitivebehavioural approach is understoodby a vanishingly small percentage ofour population and is more or lessinvisible in the broad cultural life ofour country.

Our job is to engage with peopleand the media to communicatethe message that CBT issomething for everyone

| December 2014 3

Statement from the BoardAt 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 2015EABCT congress in Jerusalem. We believe that the choice of Jerusalem as the host city will do little or nothing topromote unity and inclusion but inevitably lead to division and exclusion. We recognise our members’ concernsthat:

1) their attendance at a conference in Jerusalem may be used to promote and or legitimate Israel’s continuedoccupation of Palestinian land;

2) the choice of Jerusalem as the host city precludes the attendance of many people including Palestinian mentalhealth professionals from the West Bank and Gaza, EABCT members who support the academic boycott of Israeland others who, by attending would face the disapprobation of their communities;

3) the Israel Cognitive & Behaviour Therapies Association (ICBTA) chose to disregard our members’ recommendationin 2012 that a less insensitive venue be found.

We urge those members of BABCP planning on attending or presenting at the conference to consider thestatement 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 thisposition, BABCP will not be sending a representative to the 2015 EABCT Congress in Jerusalem.

2015 EABCT congress in Jerusalem

Association, but will take effort fromus. In developing our continuingstrategy, I hope BABCP will seek newways to be part of the structure of our society.

I hope we will expand ourmembership so that more membersof health and other professions whoare not therapists want to join us. Wewill also seek ways to providemeaningful membership to laypeople who are interested in CBT, andwe will have a user involvementstrategy at the heart of our work. CBThas always been the most client-centred of therapies, but that is oftenlost on professionals and lay peoplewho have not directly experiencedCBT. I believe CBT has a powerful and,above all, positive message we canpromote through seeking moremedia opportunities.

This will not be completed overnight.But I hope BABCP members will wantto work with me and the Board tosupport these continuing initiativestowards making CBT part of oursociety as a whole for the future.

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| December 20144

I read Ross Greene’s book The ExplosiveChild a few years ago and found itsufficiently intriguing to go on a three-day course run by him at theUniversity of York in June earlier thisyear. He has a very specific model fordealing with challenging behavioursacross a range of diagnostic disorders.His focus is not on the diagnosis butrather on the ‘lagging’ cognitive oremotional skills that might beunderlying the behaviour.

The approach aims to help parents orstaff in residential or educationalsettings understand the difficulties towhich the behaviour is the response,and give them a method to help thechild develop the skills to overcomethe difficulty. Greene is very critical ofbehavioural approaches that focus onreward and punishment and seeks tofind ways of developing cognitiveflexibility in children and youngpeople, especially those with extremechallenging behaviour.

There is some promising evidencedescribed on his website that thisapproach can make a big difference,especially in institutionalised settingswhether there can often be an over-reliance on sanction- and reward-based systems. His argument is thatfocusing on consequences is oftencounter-productive, while adulttheories and attributions about thecauses of the behaviour can get in theway of accurately recognisingantecedents and intervening in a waythat helps develop skills.

His model, which follows prescribedsteps, involves a thorough assessmentof antecedents and triggers to identifysituations that the child finds difficult,rather than what the actual behaviouris. After identifying possible laggingskills in areas such as executivefunction, emotional regulation, social

skills and so on, the intervention thenfocuses on a very thorough andpatient use of problem-solvingconversations. Reflective listening andguiding is then used to help the childdevelop specific skills with an adultcommitment to negotiation, empathyand creative thinking.

Greene describes his model as afamily or team-based approach thatfits within a CBT framework. Althoughhe was highly critical of behaviouralapproaches on the course, I feel thatwhat he was describing was themisapplication and abuse ofbehavioural approaches which I have certainly observed on a frequent basis.

What is more radical is his movementaway from consequences to a focuson identifying difficulties in laggingskills or unsolved problems. Therewere some extended role-plays onthe course with a focus on usingreflective listening for extended times

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

Many of the participants seemedtaken aback by how hard it was tokeep their own theories andexplanations out of the conversation. Ilearnt many useful skills, but was alsosurprised that a model emphasisingnegotiation and flexibility actuallyfollowed a very structured process. Myview is that it could be very useful fororganisations that routinely work withchallenging behaviour to developskills in this, but I am not sure whetherI would think it so applicableelsewhere without combining otherapproaches. Although this model isnot so well known in the UK, I am surethat this will not be his last visit here.

Ross Greene’s website can be foundat www.livesinthebalance.org

Collaborative solutionsfor children’s CBTThis summer Steve Killick attended a course run by Ross Greene, thefounder and Director of Lives in the Balance and the originator of theCollaborative Problem Solving approach (now called Collaborativeand Proactive Solutions). Here Steve reflects on the experience

| December 2014 5

Annual Conferenceand Workshops 2015University of Warwick21 - 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.

The scientific committee invite submissions of Pre-ConferenceWorkshops, 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

www.babcpconference.com

For more information please visit www.babcpconference.com

• Max BirchwoodUniversity of Birmingham

• Rob DeRubeisUniversity of Pennsylvania

• Melanie FennellUniversity of Oxford

• Mike KyriosSwinburne University of Technology,Australia

• Michelle MouldsUniversity of New South Wales, Australia

Confirmed presenters at the 2015 Conference are:

• Ronan O’CarrollUniversity of Stirling

• Vikram PatelLondon School of Hygiene and Tropical Medicine

• Alisa RussellUniversity of Bath

• Michael ScottSheffield Hallam University

• Sue SpenceGriffith University, Australia

| December 20146

David Raines, who proposed themotion, writes:

At the AGM in Birmingham a motionwas passed that ‘BABCP regrets thedecision of the European Associationfor Behaviour and CognitiveTherapies to hold the 2015 EABCTcongress in Jerusalem’, saying that,‘We believe that the choice ofJerusalem as the host city will do littleor nothing to promote unity andinclusion but inevitably lead todivision and exclusion’. There were45 votes in favour, two against and 10 abstentions.

The background to this motionfollows a meeting of the EABCT inReykjavik in 2011 at which Austriaannounced that it had withdrawnits application to host the 2015conference, leaving Israel as theonly applicant.

Although our representative wasunable to attend the meeting, Iunderstand concerns were raised andreassurances given about engagingwith the Palestinian community.

I doubt that many of the EABCTrepresentatives knew that six weeksearlier the Israeli Parliament hadpassed the ‘Law for Prevention ofDamage to the State of Israel throughBoycott’. This makes it an offence for aperson of ‘any nationality’ to call foreconomic, cultural or academicboycotts. Few will have understoodthat they had voted to hold thecongress in a place where any of theirmembers advocating a boycott of theconference could face punitivedamages and withdrawal of fundingfor the institution they represent.

At the BABCP Annual Conference inJune 2012, I talked with as manyBoard members as possible about myconcerns but was unsuccessful inmy attempt to have the issueincluded in the AGM agenda under‘Any Other Business’.

During my visit to Palestine inDecember 2012 (see my article, ‘CBTtraining behind the wall’, published in

CBT Today, September 2013), Idiscussed the proposed conferencewith as many Palestinian mentalhealth professionals as possible andthe response was pretty unanimous.Those people I met did not believethat the conference should be held inJerusalem. They insisted that thechoice was, by definition, a politicalact, and feared that it would be usedto promote and or legitimate Israel’scontinued occupation of Palestinianland. They argued that, whilePalestinian citizens of Israel may beable to attend, Israel’s discriminatorysystem would mean that manyPalestinian therapists from the WestBank and Gaza would be excludedfrom the proceedings. Even if theycould attend they would be likely toface opprobrium from theircommunity. They reminded me thatthe ‘law against boycott’ applied to me.

Sofi Marom, the President of theIsraeli Association, had asked for myhelp in developing contacts in thePalestinian community and, in myemails, I repeatedly expressed myconcerns about the choice ofJerusalem and urged them to changethe venue. My concerns andsuggestions were politely rebuffed.

It is an admittedly small group ofBABCP members who give their timehelping Palestinian mental healthworkers to develop the services theirpeople so desperately need. Theycome together with likemindedEuropean colleagues whoseprofessional organisations areaffiliated to EABCT. Would theypublicly support a boycott? Have they been gagged? If, like me, theywould like to return toIsrael/Palestine, they had betterremember that any public support fora boycott may result in them beingdenied entry or facing courtproceedings and punitive damages.

I proposed the motion not leastbecause I felt that it was regrettablethat EABCT should have decided to

hold their congress in a country thathas passed laws prohibiting themembers from publicly saying,‘This isnot a good idea, please don’t come,our organisation is hosting theconference in a divided and occupiedcity where the people in most needwill inevitably be excluded’.

I also called on BABCP to take themotion to the EABCT AGM and call foran amendment to the constitution toinclude a clause stating that EABCTwill not hold their congress in anycountry that has passed lawsprohibiting their members fromcalling for a boycott of the congress.

Our representative, Katy Grazebrookreported BABCP’s motion at EABCT’sGeneral Meeting, and the full text ofthe motion will be circulated to therepresentatives of all EABCT’smember associations.

More details about the debate can befound on my postings on the CBTCafé forum.

Mohammed Mukhaimar, whoseconded the motion, writes:

Consider the challenges of apsychological therapist in Palestine.As therapists they are dedicated tobuilding hope and psychologicalresilience among people who havebeen repeatedly traumatised by theIsraeli military occupation since 1948.Yet they themselves are beingsubjected to the same traumas frombeing delayed or humiliated at anIsraeli checkpoint while trying toreach their clients or clinics, in somecases being arrested and in othersfacing torture. Many haveexperienced the personal loss offamily members during an Israeli airstrike or a ground invasion of theirareas. Our colleague in Gaza, YasserAbu Jame, a psychiatrist, has lost 26 ofhis family members, while HassanZeada, a psychologist, lost his motherand five members of his family in thecurrent Israeli attack on Gaza. Hassan,in a recent statement to the New YorkTimes, said, ‘Scared parents cannotreassure scared children’. His words

Why we proposed the motionDavid Raines and Mohammed Mukhaimar put forward the motion about the 2015 EABCT congress at this year’s BABCPAnnual General Meeting in Birmingham. CBT Today invited them to explain their reasons behind the motion

| December 2014 7

give some indication of the grimchallenge in managing others’feelings of hopelessness, entrapmentand severe vulnerability while facingthe ongoing dangers imposed by theIsraeli occupying forces.

Compared to their Israeli colleaguesfrom established and supportedmental health services, Palestiniantherapists face the challenge oflimited access to mental healthtraining and ongoing supervisionmade worse by limited resources,restrictions on movement and siege.

And here comes the EABCT congressnext year in Jerusalem to add moresalt to the wound. The congressdelegates are invited to view theconference as an inter-grouprelations event that might even makesome contribution to ‘politicalnegotiations, peace-making andconflict resolution’. This gives a highlydistorted picture and completelyignores Israel’s signal failure tointegrate those people for whomPalestine has been home forcenturies, and its policies of militaryoccupation and systematicdispossession of the Palestinians. CBTtherapists who live within a few milesof the congress venue will find italmost impossible to attend becauseof the difficulty of obtaining travelpermits and of getting through theIsraeli checkpoints. Israeli therapistsliving in the illegal settlements in the

Occupied Territories will be free tocome and go.

The motion we proposed at the AGMinvited our BABCP colleagues toexpress regret at the EABCT decisionto hold the congress in Jerusalem andgave voice to the concerns of many ofour members that the people most inneed of the training opportunitiesafforded by the congress would beexcluded. Our goal is to increasetraining opportunities for Palestinianhealth workers and the motion wasframed with the hope that morecolleagues will help to developmental health training in Palestine.

Over the last two decades manyWestern professionals havecommitted themselves to thedevelopment of Palestinian localmental health organisations. Theseinclude BABCP members such as AlanKessedjian, whose invaluable workover six visits to Bethlehem hashelped to establish CBT practice inthe Palestinian community there.

As a Palestinian British CBT therapist (Iwas born and raised in Gaza), I havetried to help develop desperatelyneeded services and support forcolleagues struggling with the day today reality of occupation. In 2012 weestablished Sumud Palestine, a smallproject that sponsors UK-basedpsychotherapists to deliver structuredtraining programmes to local mental

health professionals in the West Bankand Gaza. Since Sumud wasestablished, we have provided fourCBT courses in partnership with thePalestinian counselling centre inRamallah. The training has beendelivered by BABCP colleaguesincluding David Raines, HelenMacdonald, Harry O’Hayon and LisaWilliams and I would like to thankthem for their invaluable help andsupport.

The healing of deep psychologicalwounds will be needed to achieve asustainable peace, but I do not thinkwe cannot afford to wait for a peacetreaty to start training people to healthese wounds.

I hope you may consider how youcould help.

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

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

You can also join the UK PalestineMental Health Network by emailingukpalmhn@gmail.com.

If you would like to respond toany of the issues raised in thesearticles, email editorial@babcp.com.

A selection of responses may beincluded in a future issue.

At the Accreditation & RegistrationCommittee meeting held in February2014, there was discussion relating toincreasing the minimum monthlysupervision.

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

Discussion was broad-ranging andincluded views such as the evidencebase supporting quality, rather thanquantity, aspects of supervision.

The importance of BABCP takingresponsibility as a standard settingbody for ensuring that previouslyset ‘minimums’ cannot bemisinterpreted by those not fully

supportive of Accreditedpractitioners, was considered.

The advisability of bringing ourstandard more into line withstandards within psychotherapy moregenerally was also taken into account.

It was considered on balance, takingaspects of these factors intoconsideration, that an increase wouldbe generally beneficial, andsupportive of those who might needto lobby more locally for adequatesupport for their practice.

With this in mind all Accreditedpractitioners should make the changeto 1.5 hours CBT supervision per

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

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

Please contact the accreditation teamat accreditation@babcp.com if youhave any queries about this change.

Accreditation Team

AccreditationSupervision update

| December 20148

The Acceptance and CommitmentTherapy (ACT) SIG is pleased toannounce the launch of its 2015essay competition, the aim of which isto encourage interest in ACT.

Essays are welcome from those at allstages of psychology or CBT trainingin the following categories:

• Student

• Assistant

• Research Assistant

• Trainee Psychologists

• Trainee CBT Therapists

In addition to offering prize money,the purpose of this competition is toprovide applicants with experience ofpreparing papers for publication. Thewinning essay will receive £500 andpublication with the online BABCPjournal the Cognitive BehaviourTherapist (tCBT) will be supported andencouraged. Publication is subject tothe journal’s normal review processes.

Essay questions

Choose one of the following:

• Discuss how skills and knowledge from ACT could complement andenhance practice in another specific cognitive behavioural approach ofyour choice.

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

The essay should be 2,000 words in length, including footnotes butexcluding references. It must neither be in print already nor submitted forpublication elsewhere. The style should be formal, such as in a bookchapter or professional magazine.

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The closing date for submissions is 31 March 2015You should also pay attention to the tCBT ‘Instructions for Contributors’, which can be downloaded here:

http://assets.cambridge.org/CBT/CBT_ifc.pdf

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www.babcp.co.uk

Spring Conference

CBT approachesto personalitydisorders inadolescents and adults9 and 10 April 2015King’s College London

Judging criteria

Essays will be judged on thefollowing criteria:

• Understanding and ability to writeclearly about ACT relevant processes

• Understanding and ability to writeclearly about concepts andphilosophy

• Understanding of empiricalevidence base of ACT

• Accessibility and originality

• Quality of writing in terms ofgrammar, style, spelling, economy of expression

How to submit

The essay must be submitted byemail as a single Word documentattachment, together with referencesand a cover sheet, to Henry Whitfieldat actessay@presentmind.org.

The cover sheet template can bedownloaded as a Word documentfrom www.babcp.com/actcomp

Please do not include details of theauthor on the essay itself. Failure toincorporate the cover sheet willrender disqualification.

| December 2014 9

Birmingham Healthy Minds, the IAPTservice for the city, has developed aninnovative ‘walk-in’ service in order toincrease access to psychologicaltherapies, and CBT in particular.Although we use a self-referral systemin addition to GP referral, we realisedthat particular communities in the citywere still not accessing the service.

We understood that possible reasonsfor this were shame and stigma,difficulties in travel, language barriers,fear of confidentiality issues with aGP, and lack of knowledge about theservice, to name but a few. Wedecided that, instead of waiting forpeople to be referred to us or to referthemselves, we would need to go tothem in their communities and intheir languages.

Realising that the whole referralprocess may in itself be a barrier toaccess, we removed that barrier andencouraged people to simply walk inoff the street for a screeningappointment, hopefully in theirpreferred language.

We called this initiative the AmmanWalk-In Service (Amman meaningpeace in Punjabi and faith in Islam).This name was chosen in response toexisting patients from diversebackgrounds telling us that, if ourservice had a name they could relateto and engage with, this may havehelped them to seek our help earlier.We also wanted people to identifywith the benefits of CBT and achievetheir main goal, which for manypeople was described as needing tofind inner peace at distressing times.

Two communities and geographicalareas in Birmingham were targetedwhere we knew that referrals to theservice did not reflect the expectedprevalence of common mental healthproblems in this population.The servicewas advertised in different languageson the local radio station and at busstops near the walk-in centres.

The Amman Walk-In Service is runweekly at two health care centres inthe middle of the targetcommunities. We ensure that we havequalified practitioners that reflect thepopulation we serve, and that ourstaff have a good understanding offaith and cultural issues as well asbeing able to speak the mainlanguages of Punjabi, Urdu, Bengaliand Hindi.

People can simply walk in off thestreet and be triaged for theproblems they are experiencing andthe help they are seeking. They areseen in the order they arrive and willbe seen the same day without anappointment. Following triage, theyare either signposted to theappropriate community service fortheir needs or offered a range oftreatments within BirminghamHealthy Minds. We have adaptedmany of our Step 2 interventions,such as the psycho-educationalworkshops, so that they are deliveredin the appropriate languages. Wealso use faith and culture as astrength to help people make thechanges they want in their lives.

Over 400 service users, aged between16 and 88 years, from a range ofdiverse communities but

predominantly self-classified as Asianor Asian British, have walked in to ourclinics and accessed the service in thefirst 12 months. Patient feedback hasindicated that people using the walk-in service felt their concerns hadbeen taken seriously by staff whilethe service had helped them betterunderstand and address theirdifficulties. GPs have also stated howpleased they are that patients can beseen face-to-face so quickly.

For more information on theAmman Walk-In Service, visithttp://bit.do/Amman

Increasing access forBirmingham’s communitiesBirmingham Healthy Minds is an NHS primary care psychological therapies service that has takeninnovative steps to increase access to CBT for the city's diverse population. CBT Today invitedBirmingham Healthy Minds’ Joanne Gill and Kully Ingram to explain

Diversity matters

| December 201410

Some questions about theory

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

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

Do you think that all effective psychological therapiesmight tap into the same process of change, and that wecould harness this process more efficiently?

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

Some questions about practice

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

Are you particularly interested in helping clients to raiseawareness of their ‘background’ experiences – such asfocusing on their fleeting thoughts, affect change, mentalimagery and metaphors?

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

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

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

The aims of the SIG are to:

• Disseminate a control theory understanding ofpsychological function and dysfunction

• Disseminate a control theory perspective on the science and practice of cognitive and behavioural therapies

• Facilitate the development and evaluation oftransdiagnostic psychological interventions based oncontrol theory, such as Method of Levels

We are holding a free two-day event at the University ofManchester on Thursday 9 and Friday 10 April 2015. TheThursday is a full-day workshop titled ‘A TransdiagnosticApproach to CBT Using Method of Levels Therapy’ led byWarren Mansell. Friday is a day of oral and posterpresentations, which is open to everyone to submit, andincludes clinical cases, clinical research studies and basicscience research, as well as our Annual General Meetingwhere we plan to elect the new SIG committee. There willbe plenty of opportunity for making connections and toengage in discussion to put control theory into thepractice of CBT.

If you would like to reserve a place on either or bothdays, or to join the Control Theory SIG, please emailcontrol-sig@babcp.com

Further information on control theory approaches to CBT arediscussed in greater detail at www.pctweb.org andwww.methodoflevels.com.au

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

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

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

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

You will bring your knowledge and experience to work alongside ourmulti-disciplinary team including social workers and consultantpsychiatrists. There are opportunities to develop areas of expertise byworking as part of our special interest groups focussed on clinical areassuch as trauma, older adults and individuals with long term conditions.Supervision will be provided from BABCP registered psychologists andsenior clinicians.

For all posts, the Trust operates a robust Continuing ProfessionalDevelopment 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 asdefined by the Equality Act 2010 which prevents you from driving)

We offer our staff a wide range of benefits including work life balancepolicies, childcare savings, a free Counselling Service, OccupationalHealth Services, excellent pension scheme and NHS shopping discounts.

To view the job specification or to apply for this role, please log on towww.jobs.nhs.uk and enter the reference number:

Psychological Wellbeing Practitioner - Ref: 367-HPFT981

High Intensity CBT Therapists – Ref: 367-HPFT982

| December 2014 11

Concluding our series of articleson women, feminism and mentalhealth, are profiles of four female‘game changers’ who have madea significant difference outsidethe CBT world

Changing times:Sue Baker

Sue is the Director of Time toChange, England’s biggest

ever programme to end mental healthstigma and discrimination. Time toChange is a multi-million poundprogramme funded by the Department ofHealth and Comic Relief, which isdelivered by leading mental healthcharities Mind and Rethink Mental Illness.Here Sue writes about her work,inspirations and vision for the future

It does feel that after many, many yearsof us all battling to get more attentionon mental health we are being heard.Mental health has been under thespotlight far more than I can rememberover the last 20 years, and we are allwaiting for parity of esteem to becomea reality and for people to have timelyaccess to appropriate treatment,services and support.

We recently published the latest surveyof public attitudes (carried out inEngland since 1993) showing that weare starting to change the nation’sthinking about mental health; attitudeshave improved significantly in Englandwith the highest rate of positive changeevidenced in 2013. An estimated twomillion people have improved theirattitudes over the last two years.

We have also seen the media covermental health in more responsibleways and feature more people withlife experience, as well as theemergence and growth of a powerfuland empowering movement ofindividuals and organisations wantingto work together to combat stigmaand discrimination.

People are taking action against stigmaand supporting each other to do soboth online and offline in communities,workplaces, schools and universities,churches, and even in the House ofCommons. Many people feel moreempowered to use their experiencesof mental health issues in order todrive change.

After many years of campaigning, I wasreminded the other day that it is not mygeneration (as I near 50) who will drivethe next stages of social change. Wehave said from the outset that endingmental health stigma anddiscrimination is the work of ageneration. Having started to seechange in recent years, the real test willbe when we look back over a muchlonger chapter in our history to see iflong-term and irreversible change hasbeen secured; when having a mentalhealth issue is seen as unremarkable.

So this is the work of the nextgeneration and I think we have manyreasons to be optimistic; I recently metsome of the young people withexperience of mental health problemsfrom our youth panel who are leadingthe campaign and delivering anti-stigma activity in schools. It was a very,

Changing the game inwider society

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12

very emotional day as well as a veryhumbling experience.

I am often left deeply moved by themany people I meet who have had todeal with prejudice and discriminationat the same time as learning to copewith a mental health problem. Theyhave had such a huge battle on somany levels, but have shown enormousguts and determination, and built thestrength to overcome the major hurdlesthat other people and systems have putin their way. I am often left in awe.

In my life so many women haveinspired me, and some still do. Thesewomen include my Mum andGrandmother who were dedicatednurses, writers and wise souls like MayaAngelou, Mo Mowlam, and here I haveto bring in Princess Diana (she showeda level of compassion not traditionallyexpressed by the Royal family at thetime when she visited a ward withHIV/AIDS patients back in the 1990s).Others I have a deep respect for includeClare Balding who stood up toprejudice and has enhanced her career,and as a teenager from the 80s I havegot to also include French andSaunders, Julie Walters, WhoopiGoldberg, and Sandi Toksvig for makingme laugh out loud and help me see thelighter side of life.

In a professional capacity in the mentalhealth sector two women inspired mein my early days at Mind in the mid1990s; Judi Clements (Mind CEO at thetime) and Liz Sayce (Policy Director). Weworked closely on many policycampaigns related to ‘care in thecommunity’ and on the first survey of

stigma and discrimination that I wantedto do in order to highlight the humanimpact of stigma. I was inspired, orincensed, by a story I had heard about awoman who had had a brick thrownthrough her window simply becauseshe had just returned home from a stayin the local psychiatric hospital. Horrificprejudice from her own neighbours.

More recently another woman hasshown real leadership in a way I hugelyadmire both on a personal andprofessional level. Lisa Rodrigues is therecently retired CEO of the SussexPartnership Trust. She decided to shareher many experiences of depression inthe Health Service Journal on WorldMental Health Day 2013 – notsomething that many people in seniorNHS positions (or at any level) havedone which shows us how muchstigma exists in many workplacesincluding the NHS.

When things get tough for me mentallyand emotionally a number of thingshelp. Firstly I remember how very lowand unhappy I was when I was very,very depressed and didn’t want to liveon this planet anymore (I was havingsuicidal thoughts) and nothing can feelas bad as that. Secondly I have got themost dedicated, passionate andsupportive people around me at work –I could not wish for a better team aswell as the large movement of peopleand organisations who want thisprogramme to work and are all addingtheir energy and getting behind thesame goal (of ending stigma). I am alsovery fortunate to have the love andsupport of my partner (I do not like to

say ‘wife’), family and friends, and finallyI take care of myself – even whenpassion can squeeze so much moreenergy from you I have learnt, from mybreakdown and many useful remindersfrom insightful people on twitter andpractitioners, that I need to look aftermyself. I live in Whitstable, and in aneffort to switch off at weekends moreand go running by the sea, I look out forthe early signs that I am pushing myselftoo hard and I am trying to learn to bemore patient for change - but that isthe one thing I may never learn!

My advice to young women is beinclusive and approachable and willingto continue to learn and adaptwhatever you do with your life – but betrue to yourself and your values. I amfortunate (or maybe I crafted my own‘fate’) because I am doing the job that Ihave always wanted to do but it did noteven exist when I started my career. Ittook me 20 years of working towardsthis (before I set up Time to Change in2007) but the wait has been well worthit. If you have passion and drive andhave the utmost belief that things needto change – never give up and do notlet anyone tell you it cannot be done.

For more information on Time toChange and how you can help reducemental health discrimination visitwww.time-to-change.org.uk. You canalso follow Sue on Twitter@suebakerTTC

Muslims, mental healthand misunderstandings:Nazmin Akthar-Sheikh (topleft) and Dr Iram Sattar

Nazmin and Iram are part ofthe Muslim Women’sNetwork UK (MWN-UK), anational charity sharingknowledge, experience, best

practice and opinions among Muslim andother BME (Black and Minority Ethnic)women and those working with them inorder to strengthen these women's abilityto bring about effective changes in theirlives and communities. Here they writeabout their work in changing attitudes tomental health, which is one of the currentpriority areas for MWN-UK

Mental health matters are universallymisunderstood. Stigma, denial andmisinformation are prevalentthroughout the wide cross-section ofcommunities of varying faiths andethnicities, which is why it is imperativethat collective action is taken across theboard to raise awareness and changethe status quo.

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”“After many years of campaigning, I was reminded the otherday that it is not my generation who will drive the nextstages of social change. We have said from the outset thatending mental health stigma and discrimination is thework of a generation

| December 2014 13

Continued overleaf

There are, however, particular hurdlesand barriers faced by sufferers withinthe Muslim and BME communities,upon which our work is focused.

Take Ayesha, who gives birth to adaughter and suffers from post-nataldepression. She feels emotional andunable to cope. Family members seeher crying and do not understand why.They become exasperated with her‘moping around’ especially as it isembarrassing when guests arrive to seeher and the newborn baby and shecannot make the effort to look herusual immaculate self. Her mother-in-law is annoyed by her inability to carryout any housework and complains athow she had given birth four timesherself and managed to do everythingimmediately on her own. Ayesha hearsthese comments from her mother-in-law and others, and feels even worse.

The nurse who visits to check onAyesha and her baby notices that she isdistant, or on other occasions, overlyaffectionate towards her child as if toprove a point. She discusses this withher colleagues who come to theconclusion that Ayesha must be upsetshe gave birth to a girl instead of a boybecause that is her cultural upbringingand they know of other exampleswhere this had been the case.

A guest who visits one day suggests toAyesha’s sister that perhaps she issuffering from post-natal depression(PND). The sister rebukes her sayingthat she suffered from PND and it onlylasted a few days and, if that was thecase, Ayesha should have recovered bynow. Ayesha must just be a bad mother.

Ayesha becomes increasinglywithdrawn and attempts to hide howshe feels in order to stop the negativitybeing directed towards her. Someonesuggests she may have been possessedby ‘Jinns’ (spirits), and the family takeher to various healers in an attempt to‘cure’ her. Ayesha’s situation continuesto deteriorate and she shows signs ofparanoia. The healers blame Ayesha’slack of faith in her religion for hersituation, claiming that if she had faiththeir methods would have worked.

This case study was compiled using themany examples that MWN-UK hascome across, highlighting a range ofissues that need to be addressed. Lackof understanding, or the existence ofmisunderstandings, have been keyfactors in this situation. Family andfriends either did not know of PND orshowed a lack of understanding as towhat it consisted of. Meanwhile medical

professionals eithermissed her state ormisunderstood due tostereotypical notions. Inanother case, a GP ruledout the possibility ofPND within a patientbecause it was apparentthat she was constantlysurrounded by familymembers who wereproviding a helping hand – so notappreciating the internal nature ofhealth matters. In turn, this highlightsthe need to raise awareness not onlywithin Muslim and BME communities,but also within medical professions inorder to ensure that signs are notmissed when faced with Muslim andBME sufferers.

Please note, whilst this case study hasfocused on PND, we have foundmisunderstandings to be prevalentacross the board from OCD, eatingdisorders to schizophrenia. In our casestudy, Ayesha found that the blame forher situation always ended up with her.She was seen as lazy, a bad mother, andultimately a bad Muslim.

The fact that Islam teaches all trials andtribulations are a test from Allah SWTwith emphasis on forgiveness ratherthan punishment were not considered,highlighting a lack of understanding oftheir own faith within the Muslimcommunity. As we reiterated at ourAGM in May 2014, which was dedicatedto raising awareness of mental healthissues: ‘Would you tell someone withdiabetes that their condition is due to alack of imaan (faith)? No? The sameapplies to mental health.’

Islam teaches us of the existence of theunseen or supernatural, and morespecifically, of Jinns (spirits). MostIslamic scholars believe that Jinns areable to possess humans, although asmall number disagree. What reallyneeds to be understood by the Muslimcommunity, however, is that evenwithin our belief framework, Jinnpossession is to be a very rarephenomenon and most importantly, abelief of spirit possession should notact as a barrier to seeking medical help.

It is an inherent part of the Islamic faiththat where we suffer from an ailment,we are to seek medical treatment, forProphet Muhammad (PBUH) has said:‘There is no disease that Allah hascreated, except that He also has createdits remedy’ (Bukhari, 7:582). It is alsonecessary to look towards all possiblesolutions as the remedy may not lie injust one path.

In turn, even where you think spiritpossession may be the cause and youwish to seek the help of healers, there isno harm in also seeking medical and/orpsychological opinion/treatment. Theremay however be great harm in onlyrelying on spiritual healers for what islikely to be a medical or psychologicalmatter. In one case study, for example,the use of spiritual healers actuallyexacerbated the paranoia that wasbeing experienced by the bipolarsufferer and led to a worsening of the situation.

We are aware of the fears thatpractitioners may immediatelyprescribe medication thus causingbiological harm, or being forciblysectioned. However, such decisions areto be made after proper assessmenttaking all alternative measures intoaccount. If you feel that your GP orother medical practitioner has been toohasty in doing so then there arecomplaint procedures as well as legalmeasures, which can be considered.

We must also warn of the existence ofopportunistic healers who havephysically and emotionally abusedsufferers by taking advantage of theirvulnerability and we urge everyoneinvolved to be alert in this regard.

The key to success is an open andhonest conversation. For this we needthe medical profession to show a betterunderstanding and be alert to thevarious dynamics that may be at play. Inone case study, a Muslim womansuffering depression mentioned to herdoctor that she feels she may havebeen possessed; the doctor flags up thepossibilities of bipolar, schizophreniaand sectioning under the Mental HealthAct, not appreciating the culturalnormality of the comment being made.

Of course, in some situations, this willbe a cause for concern, and this is whybetter awareness and training isneeded so as to allow properassessment on a case by case basis.There have also been various instancesof failures in approach and

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understanding by police when dealingwith sufferers. Racial stereotypes andprejudice towards Muslim and BMEindividuals has led to both physical andemotional mistreatment of sufferershighlighting further barriers to seekinghelp. In turn, better training andguidance from a faith and culturalperspective is required, together with amulti-agency approach in order toaddress the issues in an effective manner.

A matter which is a part of our overallhealth and well-being is now only seento be a problem. It is relatively easy to saywe are suffering from a cold, yet howmany are able to say the same when justfeeling down? Similarly, when someonehas been suffering from flu for a longwhile we all know to take them to adoctor, yet leave alone the person thathas been feeling depressed for perhapsmuch longer.

It is this understanding that needs to beinstilled within the Muslim and BMEcommunities, as well as generally, inorder to allow diagnosis and treatmentof mental health matters early on. Andwhilst we work on raising awareness,we need all other stakeholders to beaware of the hurdles and facilitateaccess to help.

For more information about MWN-UK,visit www.mwnuk.co.uk

Private grief and publicinspiration: JoanneThompson

Millie's Trust was establishedby Joanne and Dan Thompson followingthe sudden death of their nine-month-olddaughter. The charity's main aim is tomake First Aid training readily availablefor minimal costs and in as many placesas possible. Here Joanne, who was recentlynamed Inspirational Woman of the Yearby ITV's Lorraine Kelly show, talks to CBTToday Deputy Editor Peter Elliott abouther experience in dealing with the loss ofher daughter

Millie Thompson died after a choking

incident at nursery in October 2012. Theinquest held into her death recorded averdict of misadventure, with theCoroner scathing in his assessment ofthe assistance provided in the earlystages of the emergency.

Joanne instinctively wanted to dosomething to prevent the same thinghappening to another child, and settingup Millie’s Trust was the outlet for herand husband Dan. Despite throwingherself into her work with the charity,Joanne found it difficult to cope withthe trauma of losing her daughter:‘Wewent to a private counsellor who hadbeen recommended to us. It was whatwas needed at the time. I was on a lot ofmedication to help me through things,and, although Dan was going throughthe same as me, he did not see Millie inthe hospital the way I had.

‘It got to a stage where he could seethat I was a lot farther behind him, interms of dealing with our grief, and Icould see it myself. Between us we saidto ourselves that it was not a normalgrief that I was suffering. So I went backto our GP, as there were regularoccasions where I was wanting to endmy life. I was looking through somediaries and, there was one night where Iasked Dan to take away all the pills atthe side of the bed. I did not like thefact that it was too easy. When it got tothat stage, I knew it was not right. Thedoctor referred me to Stepping Hillhospital, which is where it happenedwith Millie. The psychology team cameto visit me and, three to four weekslater, I got a letter saying that I was justsuffering from normal grief.

‘At the time I thought that I must be, asthey were the experts. But it was acouple of months later that I was on theroad outside our offices; I got stuck inthe middle of the road and froze. Therewas a bus coming the other way. I wasso close to the bus, with cars beeping atme to move. I could not move. As soonas I got to the other side, I broke down.

‘My GP told me he was going to referme again. I was referred toWythenshawe hospital, to apsychologist there. They had my casenotes from the doctor and, within 24hours, they were ringing me to come inas an emergency case. I had a fullassessment lasting about two-and-a-half hours, which was a lot longer thanall the sessions I had had previously.After that session, she told me that shewanted me to return and start CBTsessions with her. I was back within afew days after receiving a letter to saythat I had been diagnosed with severePTSD, anxiety and depression.’

Joanne initially struggled to accept thisdiagnosis: ‘I knew I needed help, but Idid not want to see a psychologist.There is still a stigma. I had thought, Icannot see a psychologist; Millie hasdied, and other babies and children die,so why do I need to see a psychologist,and not other people? I sat down andthought about it. I actually had to dealwith more than Millie passing away, asmost people do not see what I saw inhospital that day. That was what a lot ofmy problems were, with the flashbacksthat I was getting, with nightmares ofwhat I saw in the hospital.

‘After a few days of thinking about it, I

Continued from page 13 ”“It is an inherent part of the Islamic faith that where wesuffer from an ailment, we are to seek medical treatment

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

| December 2014 15

went along to the first CBT session. I satthere and cried; in fact I cry in themnow, but the first session wasparticularly hard. They are massivelydraining. When I come out, the rest ofthe day is a bit of a write-off, as there isthat much emotion being brought tothe fore.

‘I was scheduled in for a block of twelvesessions, which I think is the normalperiod. At the end of that block, I wastold that I was not being discharged.We continued through that next blockof sessions and, some time in thatperiod, my psychologist said shewanted to try EMDR. I did not have aclue what it was, but I was given someinformation, looked it up online, andwas given the choice as to whether Iwanted to try it. A lot of people do notwant to try it, but at that point I wasready to try anything. I did not want tobe dealing with this 10 years down theline for not having dealt with it sooner.So I started EMDR, which I found bizarreat first.'

A long holiday at the start of 2014

interrupted the therapy but, on herreturn, Joanne was happy toacknowledge the benefits of thetreatment she had received up to thatpoint: ‘We had a review before we wenton holiday to New Zealand, and I said tomy psychologist that I knew that thetreatment had massively helped me,that I was a completely different personsince I first saw her in June last year.'

On her return from holiday, Joanne’sprogress was reviewed once more: ‘Iwas worried that she was going todischarge me, but I have been bookedin for at least another twelve sessions.When I got home, I felt that, because Ithought she was going to dischargeme, I was on a downer for days. Ithought to myself again that I do notwant to be dealing with this in 10 years, so got used to the idea ofcontinuing the therapy. Now I want tocarry on doing it until they say that I am much better.’

For more information about Millie’sTrust, including how to donate to thecharity, visit www.milliestrust.com

The women’s room

Joanne Thompson withdaughter Millie

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

Siobhan Lydon, a CBT therapist at StPatrick's Hospital in Dublin, presentedon ‘Keeping Compassion in Mind’with a soft-spoken gentleness thatmakes her the ideal candidate to dojustice to the work of Professor PaulGilbert. Compassion FocussedTherapy recognises that, above andbeyond the chance circumstances ofour birth and our genes, we all sharea common humanity, as well aspromoting the development of non-judgemental, non-shamingformulations. Rather than trying tothink our way out of shame, we needto feel our way out by accessingemotional memories of safety andself–soothing. Where these areabsent, we need to facilitate theirdevelopment and strengthen thecapacity for self-compassion andself–kindness in each of us.

Charlotte Wilson, a lecturer in ClinicalPsychology at Trinity College Dublin,spoke about ‘Ten Things We HaveLearned about CBT from Workingwith Children and Families’, whichincluded the effective use of thelanguage of cartoons and puppetry,and applying flexibility to the lengthof sessions. Joint child/parentformulations which help to highlight

variations in interpretation ofbehaviours can lead to better clarityand understanding.

It is known that children have thebasic knowledge and skills requiredto engage with CBT from at leastseven years of age, although muchless is known about their cognitive-emotional development and moodinduction procedures that do notwork very well in pre-school children.Charlotte paid tribute to the work ofDr Gary O’Reilly from UniversityCollege Dublin who, along with histeam, has developed child-friendlyinterventions in the form of computergames and apps called ‘Pesky Gnats’where children go ‘gnat catching’accompanied by a DavidAttenborough-style voiceover.

Paddy Love and Julia O’Grady, SeniorCBT therapists with the Belfast andSouth Eastern Health and Social CareTrusts, spoke about their experienceof ‘Implementing Stress ControlClasses throughout Northern Ireland’.This consists of a series of six-sessiondidactic CBT classes developed by DrJim White, provided without fee orthe need for booking as a rollingprogramme in community venues. Itis also provided to communities inthe Republic of Ireland through theHealth Service Executive.

Classes do not involve discussion ofpersonal problems, and feedback isanonymous. Ages of those attending

class ranged fromearly teens to over-65s witha 30:70 ratio of men to women whichis a noteworthy statistic. Oneparticipant commented:‘I have learntmore through stress control thanattending other services for years’.Social media is used to advertiseclasses, as are sporting groups. Thereis a constant review and evaluationby a Stress Control Regional Groupand it is hoped that findings will bepresented at an Irish symposium onStress Control at the proposed BABCPAnnual Conference in Belfast in 2016.

Andrea Nulty is a straight-talking CBTtherapist who works with theNational Forensic Mental HealthServices. Her presentation on‘Psychotherapeutic Practices inForensic Mental Health Care’ providedus with a short history of the ‘WhatWorks’ movement, which culminatedin an upsurge of interest in theapplication of CBT-basedinterventions over the past decade.

Having been influenced by thismovement and developed a workingrelationship with one of its pioneersProfessor James McGuire, Andreaconvinced her managers in Dublin tointroduce a comprehensive three-part CBT pathway of programmes.Influenced by economist RichardLayard and the English IAPTprogramme, the skill level of thepractitioners were matched with thelevel and intensity of the

ShowcasingIrish excellencein CBT practiceThis September the Irish Association for Behavioural &Cognitive Psychotherapies (IABCP) held a one-day eventin Dublin on the subject of ‘CBT in Practice across Ireland’.Here, outgoing IABCP Secretary Mairead Ryan reflects onthe day's proceedings

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intervention. This resulted in amarked increase of patients’accessibility to psychotherapy wherethe emphasis is always on recovery.

Debbie Van Tonder, a CBT therapistwith St Patrick’s Mental HealthServices who was recently awardedan MSc in CBT with first class honours,presented on ‘Evocative Imagery inthe Treatment of Emotional Arousal inGAD’. Although well-documented inconditions such as Social Phobia andPTSD, the imagery aspect of cognitionis unfortunately all too oftenforgotten in the treatment of otherdisorders such as OCD and GAD.

There is no specific literature onimagery in GAD, although it isgenerally accepted that images allowa person to access emotions moreeffectively, are rich in detail, andprovide information about futurefears, catastrophic predictions, rulesystems, core beliefs and fears. Imagesare disorder-specific and can beretrieved or evoked deliberately,while the processing of previouslyavoided affect by means of effectiveexposure can trigger an automaticcognitive shift.

Roy Cheetham is Senior CBT Therapistand CBT Professional Lead with theSouth Eastern Health and Social CareTrust. His presentation on ‘CBT forBipolar Affective Disorder - A WorkingModel’ informed us that CBT is thedominant psychotherapeutictreatment for bipolar disorderavailable today. In 1967 Aaron Becktalked about the ‘negative cognitivetriad' of depression and the 'positivecognitive triad' of mania. Roydismissed this as one of the mythsabout bipolar disorder, the othersbeing that therapy can be employedsolely for the depressive phase (aunipolar approach) and that co-morbid problems should be treatedwhen the bipolar illness is stable.

Roy has been working for the past 12years with a client caseload thatincludes 60 to 70 per cent withbipolar disorder. He uses anadaptation of a cognitive behaviouralmodel of mood swings and bipolarillness and incorporates aspects ofRelational Frame Theory, with a clearfocus on longitudinal formulation, an

emphasis on the mechanisms andhypotheses that lead toovercompensation and avoidance inthe maintenance of bipolar disorder,and a recognition that a controlagenda and the role of self-criticismare key components within BipolarAffective Disorder.

As I stand down from the IABCPCommittee, I would like to pay tributeto all of the presenters who spoke soeloquently and respectfully about

their work, and to all the IACBP andBABCP National Committees Forummembers with whom I have workedover the past years. I would also liketo wish the new IABCP committeewell in the further unfolding of theirdevelopment plans and toacknowledge all members who worktirelessly in the promotion of mentalwellbeing through the practice ofCBT.

| December 2014 17

(Left to right) Paddy Love, Andrea Nulty, Charlotte Wilson, Debbie Van Tonder, RoyCheetham, Siobhan Lydon and Julia O'Grady

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Choosing the right course

I found it difficult to decidewhen and where to do my

CBT training.The NHS can sponsorindividuals to complete a CBT PgDip,however these places are highlycompetitive and are few and farbetween, so I decided to fund the CBTtraining myself. This, at the time, feltlike a big commitment as it requiredme to reduce my paid working hoursand borrow a large sum of money,with no guarantee of full-timeemployment when I qualified.

The level of accreditation is animportant factor to consider whenchoosing a CBT course, as not everycourse is accredited. A few colleaguesof mine who were CBT trained hadthe additional stress of waiting to seewhether their hard work would berecognised by BABCP due to theiruniversity being in the process ofacquiring accreditation. This alsoseemed to impact on the coursestructure and content as the diplomaprogramme had yet to be fullyestablished.

BABCP offers course accreditation ateither Level 1 or Level 2. However,having completed a Level 2accredited course and comparing myexperiences to others, it seems levelsof accreditation relates to the amountof support a course will give you. Mycolleagues who completed a Level 1accredited course spent less time inlectures and had to providesignificantly more paperwork andsupporting documentation whenapplying for Provisional Accreditation.

In comparison, completing the Level2 accredited course meant Iautomatically met all the trainingrequirements for provisionalaccreditation with BABCP and thatmy university was able to mark myKnowledge Skills and Attitudes (KSA)

portfolio and my CBT logbookthemselves, which saved me time andmoney. In addition to comparingcourse content, I would recommendreading the BABCP ProvisionalAccreditation guidelines to comparethe differences in requirementsbetween Level 1 and Level 2accredited courses.

Placement considerations

Most courses require you tofind a suitable placement

where you can practice CBT beforestarting training. As I previouslyworked as a PWP for IAPT, it was easyto arrange a placement within mycurrent service, though I did considerother charitable organisations in mylocal area (such as Mind).

Whilst long waiting lists mean manyservices would be grateful for the freelabour provided by a trainee, someare unable to provide case-management supervision. It istherefore worth seeing whether thecourse would be able to provideadequate supervision as part of yourtraining or if you would have to fundthis privately (which might mean agroup of you get supervisiontogether in order to reduce costs).

Also, don’t be afraid to think outsidethe box when looking for placements.I had a couple of colleagues whoworked in services such as liaison-psychiatry and forensic settings,which gave a different perspective tohow CBT principles can be utilisedoutside of the standardmoderate/severe depression andanxiety cases seen in IAPT.

Money

There is no getting awayfrom it. If you are going to

self-fund your CBT PgDip it is goingto be costly. Whilst I had some savingsI could put towards course fees, I was

heavily supported by a CareerDevelop Loan (CDL). Some high streetproviders and can lend you up to 80per cent of your total course fees,though you can borrow up to £10,000in total, meaning extra money forexpenses such as books and travelexpenses if required. As thegovernment currently backs thescheme, my CDL was interest freewhilst I was studying and I did nothave to pay anything back until twomonths after completing training.

Workload

I had to sacrifice a fair fewweekends and evenings

whilst completing my training and Ican vividly remember my feelings ofapprehension when I startedapplying the CBT learned in lecturesin my clinical practice. It felt a massivetransition moving from the highlyefficient case studies in text books tothe real-life person in front of me,who was not sure how to answer myquestions and would give meinformation that seemed highlyrelevant to them but only served toconfuse me (and my formulations)further.

Supervision was invaluable in helpingme work through this time and torealise I was not alone in struggling tofit disorder-specific fit models toclients (in the most ideographicmanner I could muster). I wasregularly informed by wellestablished therapists that I wouldnever reach a stage where I kneweverything there was to know aboutCBT and whilst I have come to realisethat they were right, I find my traininghas enabled me to take comfort inmy understanding of core CBTprinciples and how these can beutilised into useful treatmentprogrammes.

On courseto a career in CBT

Having just completed the CBT PG Dip at the University of Hertfordshire and recently starting work asa High Intensity therapist, Jerrie Richards reviews her experiences of the course and gives some advice to others considering training in this field

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Couples SIGpresents

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 HahlwegVenue: The Royal Foundation of St. Katharine, 2 Butcher Row, London E14 8DS

An Introduction to Cognitive Behavioural Couples Therapy23 to 25 March 2015

Presented by Professor Dr Kurt HahlwegVenue: Hilton Edinburgh Grosvenor, Grosvenor Street, Haymarket, Edinburgh EH12 5EF

Integrative Behavioural Couple Therapy27 to 28 April 2015

Presented by Professor Andrew ChristensenVenue: 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

www.babcp.co.uk

| December 2014 21

Chester, Wirral andNorth East Wales Branchpresents

Compassion Focused Therapy forShame-Based Difficulties:Learning it from the Inside Out(Intermediate Level)Presented by Dr Mary Welford

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 third-wave CBT approach and was developed by Paul Gilbert toaddress difficulties associated with shame and self-criticism.

This three-day workshop will allow participants time andspace to develop their own compassionate mind. Upon thisfoundation ideas will be developed in respect to howindividuals can use CFT and compassion-based approachesto help others.

Registration feesEarly bird: payment received up to 12 December 2014BABCP Member: £345, Non-member: £365

Full registration fee from 13 December 2015BABCP Member: £405, Non-member: £425

www.babcp.co.uk

Scotland Branchpresents

CBT for Persistent Pain -a Practical Skills WorkshopPresented by Helen Macdonald

Friday 20 February 2015Murrayshall House Hotel, Scone, Perth PH2 7PH

This workshop aims to offer an opportunity to considerknowledge and skills for working with people who havechronic pain. Evidence-based cognitive-behaviouralinterventions will be presented. The emphasis will be onskills which can be used to help manage the impact of pain,and opportunities to practice assessment, formulation andengagement techniques, as well as interventions. Caseexamples will be used, and participants will be encouragedto bring their own experiences and cases to discuss, as wellas to participate in small group work and role play exercises.

The workshop should be helpful for people who haveexisting CBT skills, but not necessarily experience in workingwith chronic pain conditions specifically. It could also beuseful for people who have experience in persistent painwork, but wish to refresh their knowledge of applyingcognitive-behavioural approaches.

Registration feesBABCP Member: £85Non-member: £105

www.babcp.co.uk

Manchester Branchpresents

Anxiety Traps! CBT SolutionsPresented by Dr Christine Padesky

Friday 29 & Saturday 30 May 20159.30am to 4.30pm

Manchester Conference Centre, Sackville Street,Manchester M1 3BB

Attend this workshop to learn principles underpinninganxiety treatment methods and to practice the skillsrequired to effectively use CBT anxiety protocols. Enjoy thisworkshop 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 haveexperience working with anxiety disorder protocols; moreexpert CBT therapists who attended reported the workshopincludes useful new ideas (danger/coping disorderframework) and methods (assertive defence of the self forsocial anxiety) that make this workshop suitable even forexperienced CBT therapists.

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

Registration feesBABCP Member: £200Non-member: £220

www.babcp.co.uk

West Branchpresents

CBT for Clinical PerfectionismPresented by Professor Roz Shafran

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

‘Clinical perfectionism’ is a highly specific construct designedto capture the type of perfectionism that can often poseproblems in routine therapeutic practice. The corepsychopathology of clinical perfectionism is an overevaluation of achievement and striving that causessignificant adverse consequences.

By the end of the day, participants will learn how to assessclinical perfectionism and determine when it may warrant aspecific intervention. They will also be familiar with relevantcognitive-behavioural strategies. The workshop will beinteractive and include both experiential and didacticteaching and videos. Participants will have a chance todiscuss their own cases.

Registration feesEarly bird: payment received up to 23 January 2015BABCP Member: £65, Non-member: £75

Full registration fee from 24 January 2015BABCP Member: £75, Non-member: £85

www.babcp.co.uk

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

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