The Pocket Guide to Therapy: A ‘How to’ of the Core Models

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Stephen Weatherhead & Graeme Flaherty-Jones

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    Dedication

    For Claire and Elliott

    The voice of reason and reason for being.

    G.M.F-J.

    For Claire and Euan (my world), Dad (my inspiration), and John Allen (The Pioneer of Fun)

    S.J.W.

    About the Editors

    Stephen Weatherhead qualified as a Clinical Psychologist in 2008. Since then he has specialised in brain injury within the NHS, and private practice. Stephen has just taken up a full-time position with Lancaster University and Lancashire Care NHS Foundation Trust as a Lecturer in Health Research and Clinical Tutor, with the DClinPsy course. His publications and research reflect his therapeutic interests in neuropsychology, narrative and systemic therapies, qualitative approaches, cultural issues, and evidencing outcomes. Stephen thinks therapy is as much an art as it is a science, and that part of the role of the therapist is to make it accessible. That's why he aimed to write this book in a way that demystifies the theory and application of therapy for the newcomer. http://www.neurofamilymatters.co.uk

    Graeme Flaherty-Jones is a Specialist Clinical Psychologist based across Middlesbrough, Redcar and Cleveland, where he has the pleasure of working with older people within Tees, Esk and Wear Valleys/NHS Foundation Trust. Outside of the NHS he also has a private practice called Clarity Psychology. Aside from his clinical work Graeme enjoys contributing to publications on behalf of his professional body, the British Psychological Society, and providing teaching on the doctorate course in Clinical Psychology at Teesside University. An overarching ethos to all aspects of his professional work is a desire to make psychological theory accessible so that it may benefit others. He hopes that this ethos will come across in the pages of this book which offers an introduction to the exciting world of therapy. http://www.claritypsychology.com

    About the Authors

    Phillippa Calvert qualified as a Clinical Psychologist in 2009 from the University of Liverpool (UK). She works part-time in the NHS with adults who are experiencing severe and enduring mental health problems and those with a diagnosis of personality disorder. Phillippa also works part-time in the independent sector specialising in neuropsychology, offering psychological therapy to individuals who have been involved in serious accidents and family interventions. It was during her third year specialist placement that she participated in a Dialectic Behaviour Therapy (DBT) Skills Group and the approach had a significant impact on her. Since then she has applied the philosophy and techniques alongside other approaches such as Cognitive Analytic Therapy (CAT) and Acceptance and Commitment Therapy (ACT).

    Kara Garforth is a Clinical Psychologist and qualified from the Lancaster Training course in 2009. She is currently employed in Pennine Care NHS Foundation Trust in Bury, Greater Manchester as part of a Secondary Care Psychological Therapies Service. Kara works with adults with severe and enduring mental health problems, conducting individual therapy and also works closely with staff in Community Mental Health Teams in a consultancy role. She is particularly interested in working with people with interpersonal difficulties and personality disorders and uses a psychodynamically informed approach to promote understanding of the impact of these difficulties on individuals' lives.

    Claire Robson began her career in clinical psychology working in a drug and alcohol inpatient unit as an Assistant Psychologist, where she trained to use Motivational Interviewing (MI). She later completed her formal clinical psychology training at Lancaster University. She now works with adults who have moderate mental health difficulties in a primary care psychological therapies service, using an integrative approach to therapy. Claire hopes that her chapter will provide an accessible summary of MI and inspire clinicians to use an ‘MI style’ of interacting with clients who are ambivalent about changing their behaviours.

    Jane Toner qualified as a Clinical Psychologist in 2008 and is a busy mum of two boys. Since qualifying as a Psychologist she has worked with looked after children. Jane now works in the independent sector, working therapeutically with young people with complex mental health and emotional needs. This work requires a lot of creative use of therapy, but also lots of consultation, teaching and training with other professionals. Jane finds this a really rewarding role. Prior to her clinical training Jane worked in the NHS as a Mental Health Nurse and CBT therapist.

    Amie Smith is a Clinical Psychologist working across the lifespan with people with learning disabilities, their families and carers. She draws on a range of therapeutic approaches in her work, most notably systemic and psychodynamic. She puts particular value on therapists reflecting on the process of therapy, including the therapeutic relationship, and sees both of these approaches as providing frameworks to enable this reflection.

    Katie Splevins is a journalist and Clinical Psychologist. Her passions include working cross-culturally, with specific interests in trauma and post-traumatic growth. Meditation is something Katie values enormously as part of her own life and enjoys sharing with other people.

    Fiona Syme is a Clinical Psychologist based in the South-West of England and really enjoys her current post working with children and young people with learning difficulties and mental health issues. Outside the NHS, she has a developing private practice called ‘Clarity Psychology’ which she shares with Graeme Flaherty-Jones. Fiona has many clinical interests including paediatrics, eating disorders and autism. She particularly enjoy working creatively with the ‘supporting system’ around clients, be that families or staffing groups, to enhance clients' care. Forming strong therapeutic relationships is at the heart of her work and she prides herself on being able to meet the unique needs of her clients in a style that suits them. As a recently qualified Clinical Psychologist, Fiona is delighted to contribute to a book which seeks to bring together different types of therapy in one accessible volume.

    Sharon Twigg started her career as a qualified counsellor and college mentor on the Wirral. She later worked as an Assistant Psychologist at Alder Hey Children's Hospital and the Walton Neurological Centre in Aintree. Sharon then continued her career by formally qualifying as a Clinical Psychologist at the University of Lancaster. She now works in the NHS and provides psychological support for children and their families on the Wirral. Sharon works part-time within paediatric liaison and part-time within the Wirral children's CAMHS service.

    Acknowledgements

    There are many people who have been pivotal in bringing this book to fruition. Given the early stage we are at in our careers, it has meant them putting a tremendous amount of faith in us. We are grateful to all of you. Special thanks to: ‘The Claires’, who share the same name, the same commitment, and the same faith in us, and ‘The Little Dudes’, Elliott and Euan – all four of you keep us smiling. Our wider families, from whom we gain strength and unconditional love. Michael Carmichael, Alice Oven, Kate Wharton and Katherine Haw from SAGE, thank you for all your guidance and positivity. Tim Cate, Laura Golding, Anna Daiches and Jane Simpson, thank you for giving us the confidence to take the first strides. Steve Fuller, you are and forever will be our guru. All the co-authors, you have been brilliant, without you there would be no book, and Sally, thank you for your hawk-eye reviews.

  • The Challenges

    Every author in this book has qualified within the last three years, and so can remember what it's like to try to get to grips with a how-to-'do' therapy. Here's some thoughts on the challenges each model presented when writing about them.

    Chapter 2 Motivational Interviewing
    Claire Robson

    Whilst I longed for a brief and ‘hands-on’ introductory text during my own training, I found the process of describing MI in this way to be a real challenge. I felt that there was a huge risk of oversimplifying MI, and focusing too much on the techniques at the expense of the ‘spirit’. It was tricky to provide the reader with a summary of the approach as a whole, whilst also bringing it to life and enabling the reader to come away with a sense of how it could be applied in day-to-day practice. Hopefully at least some of this has been achieved, and that it is clear how an MI style can be used in any situation in which there is some ambivalence to change a problem behaviour.

    Chapter 3 Cognitive Behavioural Therapy
    Jane Toner

    I wanted to present CBT as a credible form of therapy, not just a handful of ‘techniques’ and ‘tools’ that some people perceive (and promote) as CBT. I wanted to give priority to the therapeutic relationship within CBT, and emphasise the importance of a mutual and trusting relationship. I wanted to show how particular aspects of CBT can actually enhance that with many people. I wanted to write about skills that are often overlooked, particularly Socratic dialogue. I also wanted to mention that ‘textbook’ formulations can be used if they help, but that formulations have to be individualised and developed according to need. I believe that if people are taught CBT well, it can be adapted to most people's situation, but I also wanted to get the message over that CBT is not the ‘be all and end all’. We can adapt our therapeutic approach in accordance with the person's needs, at that time, and CBT can be a very useful tool to have.

    Chapter 4 Cognitive Analytic Therapy
    Sharon Twigg

    My aim for this chapter was to break down the many misconceptions I have heard about the complexity of CAT therapy. However, trying to explain the CAT model using basic terminology and limited word space was no easy feat. It is a model that has a number of important parts that need explaining before you can understand how they fit together. The snag was trying to do this without falling into the trap of using too much CAT jargon or waffling over the word limit.

    Chapter 5 Psychodynamic Therapy
    Amie Smith and Kara Garforth

    There are so many models which fall under the umbrella of psychodynamic therapy. We tried to present concepts that are broadly shared by all these models, but we worried that we may be oversimplifying it at times. In terms of application, a big challenge is that there is no single set way of practising psychodynamic therapy. The model is process based, and so may feel less concrete than other models. For those new to practising the approach this may create a challenge, as you tend not to plan sessions and have to be flexible and responsive to the person, which can often create anxiety. Beginning to work with transference can be quite unnerving but really you have to do it and feel it, and then reflect on it. It is important that you are able to reflect on your part of the therapy process, which can really shake your confidence. It really helps to have good supervision to support you with this.

    Chapter 6 Systemic Therapies
    Amie Smith and Stephen Weatherhead

    Given the many schools, different approaches and ways of practising systemic therapy, we found it challenging to reach a consensus on which concepts to include. In systemic therapy the focus is on process and the bigger picture; as a therapist this can feel less concrete, more complex and at times perplexing. In the chapter, what we hope to have done is given you the overall concepts, and then offered techniques that could help you apply each concept (for example, to apply the concept of context you may use genograms). We hope that this brings the model to life a bit.

    Chapter 7 Narrative Therapy
    Stephen Weatherhead

    Narrative therapy is very closely linked to the philosophy on which it is built. This has led to many writers using language that feels unfamiliar, and a bit difficult to understand. It was important to me that this chapter explained the philosophy and practice of narrative therapy, but in an accessible way. Many of the better known texts in narrative therapy emphasise the work done in child and family settings, so I also wanted to show its applicability to a wide range of settings, regardless of age, context and other factors that people often think are outside of the remit of narrative therapy. All this was a challenge, but hopefully it makes sense.

    Chapter 8 Person-Centred Therapy
    Sharon Twigg

    This chapter was the more challenging of the two I wrote. Initially, the model seems straightforward to write about. However, I underestimated the complexity of trying to explain the different developmental stages of the selves and how outside factors affect these stages. I found myself drawing numerous diagrams in the hope of finding one that would explain the whole model, but ended up only confusing myself. Instead, I settled on ‘bite-size’ diagrams, which I hope are helpful to the reader.

    Chapter 9 Mindfulness
    Katie Splevins

    The main challenges when writing about mindfulness were in trying to explain a concept and way of being, which can really only be lived or experienced. Words are not really adequate to explain this and so trying to convey a sense of mindfulness in the broader sense was a challenge. Using words at times seemed to take something away from the concept, and I felt there was a risk I could oversimplify it (and while it is a very simple concept, the depth of the experience is vast). When practising the model it is a real challenge to commit enough time to your own development of mindfulness. For you to be a really effective mindfulness clinician it needs to be something you develop in your own life and work, which can require a lot of time and commitment.

    Chapter 10 Solution-Focused Brief Therapy
    Graeme Flaherty-Jones and Fiona Syme

    SFBT is typically adapted to use the person's unique language and interests in therapy. While this is clearly a strength of the model, and one of the reasons we value the approach, it presented a challenge when trying to demonstrate how to apply the model in practice. As SFBT has such a non-mechanical approach, this may mean that professionals need to be more creative in how they evidence its efficacy. We have tried to show in the case examples how, regardless of the person's situation, their language and interests can be drawn on to guide interventions. True to SFBT, we hope this guides the reader in a non-directive manner on how to apply the model in therapy.

    Chapter 11 Dialectical Behaviour Therapy
    Phillippa Calvert

    Respect, understanding and validation are explicitly built into DBT, with specific strategies to help the therapist retain this stance. I really like that DBT acknowledges that individuals with complex difficulties may need a therapeutic approach that aims to provide support and interventions in different ways. The biggest challenge was trying to summarise all the different elements and stages in DBT as the approach doesn't just include one-to-one therapy. Providing enough detail to allow the reader to learn about DBT and hopefully think about how to use the approaches in their own practice was difficult to say the least. I also wanted to demonstrate that the ideas could be used in a variety of settings. I only hope I have done it justice.


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