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Every moment matters: therapeutic relationships within inpatient CAMHS

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The last six years of my career almost didn’t happen. A memory I’ve shared with many colleagues in our service is how I started in inpatient CAMHS as my final year training placement as a clinical psychologist. Although I had never worked on a ward before, I had enjoyed community working with adolescents and asked my supervisor, Jamie , if he knew of somewhere I could work with a similar cohort for my elective placement. He suggested getting in touch with Gordon at the Hope and Horizon Units at Pennine Care in Bury, which I duly did and I was then allocated the placement for a year. During my first few weeks, I used to walk to my car crying most days at the end of a shift. I felt de-skilled, under confident, distressed and out of my depth. The level of emotional pain in the system, the restriction, the seemingly chaotic nature of some of the processes, the unfamiliar guise of the psychologist role there all felt really destabilising. I confided in my course mates and said I was plan
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Movement with meaning

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I've been thinking of writing this post for some time and, as often happens, the threads of thought, ideas and narrative knitted themselves into something more coherent and active during my run just now through some local parks.  Movement is very important to me; I love to run and supplement this with yoga, pilates and strength work when I can. The form my movement has taken has shifted and evolved during the course of my life; reflecting, facilitating and changing the nature of my experiences at each given time. Exploring the meaning of movement, how it both influences and is influenced by my sense of self is something that I believe illustrates well the idea that actions and activities can have quite different impacts depending on their relational context and meaning . Writing this is as much to give myself space to explore as to offer an invitation to you, the reader, to explore your own relationship with movement.  I was always an active child; the daughter of a PE teacher, I d
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Finding empathy in connection: managing emotional responses as clinicians

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"When I work with that person, I feel on edge/ all over the place/ hurt/ confused/ frustrated". How often have we read, spoken or heard those kinds of words....? In relation to therapeutic or mental health care practice with people who might have been ‘given’ a diagnosis of ‘personality disorder’* and who, more often than not, have experienced persistent and severe developmental abuse, neglect or trauma, alongside iatrogenic harm….? I feel cautious about writing and sharing this blog. What I am talking about here relates, ultimately, to deep personal pain people have experienced. I write to understand, to explore, to learn, to share and, I guess, to try and catalyse change. I am open to learning from the responses to this too. To be clear from the outset, my position is one of the right for everyone to have compassionate care. This is my central point. If there are times where that is not clearly in view, it is in my failure to articulate it well rather than a shifting of the
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A step forward....?

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I have written previously about the current status quo regarding cross-country running and the gender inequality  that is rife in the sport.  In short, many local leagues do not permit women to run the same distances as men.  Since then, our group has worked to raise the issue at local level, meeting stiff resistance and concluding with a refusal to discuss the matter further for at least three years.  In this context, we were left with no choice but to pursue a top-down approach of liaising with UK Athletics to work with them to facilitate the necessary change. Our aim is to ensure equality, in whatever way that is achieved.  We were delighted to receive a response from UKA that acknowledged the need for change, alongside the complexities and challenges.  We have now replied and made clear that we believe there cannot be the option to retain the unequal status quo. Inequality cannot persist. This might be resolved in a number of ways and therefore it is esse
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The shape of formulation

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Below is a collection of wonderings, hypotheses and ideas. It draws on my clinical experience, research, training, knowledge and conversations I have had with clinicians and people who use services, with activists and academics. There is an attempt to make sense of some of the dilemmas, divisions and difficulties with the concept of formulation. It is driven by reflective processes, is situated in a given context and is open to change. It is not a completely comprehensive or finished piece; it’s the start of a conversation, not the last word. As such, this blog is not dissimilar from formulation as I see it. The word, divorced from its connection with mental health services, means the putting together of components in appropriate relationships or structures. A way of making sense of ourselves and others. It’s about understanding how different aspects of experiences develop, are maintained and could be changed- how they link together. It draws together personal events and mean
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Kindness in context

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Kindness – virtuous or vacuous? I was asked to do a video  (cringe)  about kindness, where I tried to emphasise how, for me, kindness is about compassionately giving what’s needed. There wasn’t the space or scope there to fully explore some of my ideas on the topic, which have continued to be shaped by my personal values, clinical practice, research and training, and reading testimony of users and survivors on Twitter.  I have noticed a lot of frustrated and angry accounts of how this year’s Mental Health Awareness Week  and its kindness theme is dismissive and damaging for those who use/ have used services, many with  impressive wit . Although I don’t share the same level of vitriol as some (probably because I haven’t experienced the same level of hurt caused by mental health services that occurs in some cases), I do agree that a simplistic model of kindness and its supposed virtues is not helpful. I don’t think that means we should do away with the concept or the drive
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Echoes across the landscape: CAT in my practice, politics and personhood

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What follows is a reflective essay originally composed for Cognitive Analytic Therapy (CAT)  practitioner training , with the more personal elements now removed for wider dissemination. CAT is a model of understanding our humanity and psychology; it is a therapeutic approach that grounds itself in the relationships we learn, enact and occupy with ourselves and others. If we are treated in ways that are bullying, neglecting or caring, we will duly learn to act in those same ways to ourselves, to elicit and interpret those responses from others and to do to others as we have been done to. This can leave us stuck in cycles that maintain problems and exacerbate emotional and relational difficulties, or to act in ways that seek to so fervently avoid this repetition that we find ourselves in opposing but equally futile positions. CAT argues that the self is dialogically constructed and therefore we cannot understand or help individuals without understanding and utilising relationships. You
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