senSI Clinical Psychology
We try to provide context for distress and psychological difficulty – people become distressed because of adverse life events and the meanings that they make of them.
Dr Ian Newey, Dr Imogen Tatchell and Dr Nicky Martin
Dr Newey describes that his main therapeutic orientations are (first wave) behavioural, (second wave) cognitive behavioural and third wave behavioural and cognitive psychotherapies.
- The first wave was the behavioural approach which sought to identify and help change potentially self-destructive or unhealthy behaviours. It functions on the idea that all behaviours are learned and that unhealthy behaviours can be changed. Behavioural therapies help people modify behaviours of concern that may be causing them or their families’ difficulty.
- The second wave was the cognitive behavioural approach whereby the links between thoughts, feelings and behaviours were made explicit and people were encouraged to change thoughts. CBT focuses on challenging and changing unhelpful cognitive distortions and behaviours, improving emotional regulation, and the development of personal coping strategies that target solving current problems.
- Third wave therapies that I have trained in include Acceptance and Commitment Therapy (ACT), Compassion Focused Therapy and Mindfulness.
ACT takes the view that trying to change difficult thoughts and feelings as a means of coping can be counterproductive. Instead, ACT has six core processes: acceptance, mindfulness, cognitive defusion, “self as context”, defining values, and committed action. Essentially this involves being clear about what is really important in our lives; what our values are. Then we make sure that we behave in a “values congruent” manner, and managing any thoughts feelings and behaviours that act as hurdles to do this.
Mindfulness Practice
Mindfulness practice has been shown to help anxiety and depression in research studies. Mindfulness means knowing directly what is going on inside and outside ourselves, moment by moment. It is easy to lose touch with the way our bodies are feeling and to end up living ‘in our heads’ – caught up in our thoughts without stopping to notice how those thoughts are driving our emotions and behaviour. An important part of mindfulness is reconnecting with our bodies and the sensations they experience. This means waking up to the sights, sounds, smells and tastes of the present moment. That might be something as simple as the feel of a banister as we walk upstairs. Another important part of mindfulness is an awareness of our thoughts and feelings as they happen moment to moment. This allows ourselves to see the present moment clearly which can positively change the way we see ourselves and our lives.
Compassionate Focused Therapy
Compassionate Focused therapy (CFT) starts from the philosophical position that humans have evolved with at least three primal types of emotion regulation system: the threat (protection) system, the drive (resource-seeking) system, and the soothing system. The central therapeutic technique of CFT is compassionate mind training, which teaches the skills and attributes of compassion. Compassionate mind training helps transform problematic patterns of cognition and emotion related to anxiety, anger, shame and self-criticism. People can learn to manage each system more effectively and respond more appropriately to situations. Compassion focused therapy is especially appropriate for people who have high levels of shame and self-criticism and who have difficulty in feeling warmth toward, and being kind to, themselves or others. CFT can help such people learn to feel more safeness and warmth in their interactions with others and themselves.
Both Psychologists have expertise in working with adults and young people who have experienced trauma and Dr Newey is trained in the NICE guideline approved therapies for post trauma presentations, i.e. Trauma Focused Cognitive Behavioural Therapy or TF-CBT and Eye Movement Desensitisation Reprocessing (EMDR). TF-CBT is an evidence-based psychological therapy that aims at addressing the needs of people with post-traumatic stress disorder (PTSD) and other difficulties related to traumatic life events – it does include the accessing and processing of distressing memories. EMDR is a form of psychotherapy developed by Francine Shapiro in the 1990s in which the person being treated is asked to recall distressing images; the therapist then directs the patient in one type of bilateral sensory input, such as side-to-side eye movements or hand tapping.
Our Clinical Psychologists have considerable experience working with people on the autistic spectrum and with other neurodevelopmental differences.
Mentalization
Mentalization is a term used to describe thought processes that can be used to help us understand the feelings or actions of others. It is where the thinking part of the brain can be used to manage the emotional part of the brain in order to foster rational thoughts and feelings.
Mentalization based therapy for children has been developed by the Anna Freud Centre and draws from attachment theory using systemic thinking and psychodynamic principles as a framework for the approach. It is about thinking about your thoughts and feelings, alongside thinking about your child’s thoughts and feelings to then understand your own behaviour and their behaviour.
Understanding each others’ thoughts and feelings can be an effective way of improving relationships which is why it can be used effectively with families. It can be helpful in aiding parents and children’s ability to ‘read’ each other and reflect on each other’s reactions or behaviour, encouraging some curiosity about what might be being communicated. Children (and sometimes adults) tend to ‘act or play out’, when they are having strong feelings that they cannot articulate or understand.
Mentalizing can be a stance, position or state of mind that can be adopted when you, your child or anyone else is emotionally dysregulated. Therefore, can be a helpful way to de-escalate potential, or explosive confrontation, or conflict.
A Mentalizing stance can be learned as a way of understanding yourself and your child as well as developing attachment especially with children in adoptive or fostered families.
Mentalization is a versatile approach which can be integrated with other therapeutic interventions; or used as a stand-alone intervention. It can be offered as part of working with the whole family, or with parents alone and sometimes children separately. This can be assessed and reviewed throughout any therapeutic programme undertaken.
Psychological Formulation
Dr Lucy Johnstone defines formulation as the process of co-constructing a hypothesis or “best guess” about the origins of a person’s difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them. It provides a structure for thinking together with the client or service user about how to understand their experiences and how to move forward. Formulation draws on two equally important sources of evi- dence: the clinician brings knowledge derived from theory, research, and clinical experience, while the service user brings expertise about their own life and the meaning and impact of their relationships and circumstances. In this way, formulation is “the tool used by clinicians to relate theory to practice” (Butler, 1998, p. 2). The development of this personal story or narrative has been described by clinical psychologists as “a way of summarising meanings, and of negotiating for shared ways of understanding and communicating about them” (Butler, 1998, p. 4). This provides the basis for an intervention plan tailored to the individual and their needs.
Unlike diagnosis, formulation is not about making an expert judgement, nor is it based on deficits. Instead, a best-practice formulation draws attention to the service user’s resources and strengths in surviving what are nearly always very challenging life situations. Most important, and in contrast to psychiatric diagnosis, psychological formulation approaches all expressions of distress with the assumption that “at some level it all makes sense” (Butler, 1998, p. 2). From a formulation-based perspective, the work of every mental health professional, whatever their training, should be based on this principle: that however unusual, confusing, risky, destructive, overwhelming, or frightening someone’s thoughts, feelings, and behaviours are, there is a way of making sense of them. The central task of all mental health professionals is to work alongside service users to create meaning out of chaos and despair. Formulation is a powerful and effective way of doing this.