He’s a jolly good Fellow

Ian Florance talks to Ceri Bowen, an International Fellow at the Royal Hospital for Neuro-disability, Putney

According to Ceri Bowen, ‘it’s been an interesting transition, from working as a clinical psychologist in the NHS to moving into a job where self-motivation and organisation are so important, and where research and publishing are as important as applied work’. So how did Ceri reach his role in a charity that specialises in profound cases of disability, and what are the challenges and rewards of that area of work?

Founded in 1854 as the Hospital for Incurables, the Royal Hospital for Neuro-disability (RHN) offers assessment, treatment and ongoing care to adults who have profound disability as a result of neurological damage or disease. Ceri’s Fellowship sits within the Institute of Neuropalliative Rehabilitation (see www.rhn.org.uk/institute). ‘It’s a virtual, international network which attempts to bring together the best of international thinking. Since complex neurological disabilities are rare as a diagnostic group or as a stage in disease processes, a lot of good thinking and practice goes unnoticed and unexploited. The Institute seeks to apply research to practice and spread the word about good treatment ideas. It has a number of strands, from development of clinical practice to research, academic education and policy development. You could say the Institute drives evidence-based practice in the RHN and in many other institutions internationally. The other international Fellowships reflect the incredible diverse nature of the area: they include Fellows in music therapy, recreation and leisure and nursing as well as specific clinical and research positions. A key skill for each Fellow is networking.’

Ceri’s own role mirrors the Institute’s range of activities. He spends a day a week supervising and overseeing research projects for the RHN and national bodies; another writing; he teaches, trains and is developing the TBIFAMILIES special interest group; and, of course, there is clinical work. His research looks at family processes using systemic therapy ideas in cases of advanced multiple sclerosis (MS). Other current highlights of the working week include developing a new book series for Karnac on brain injury.

Ceri marries a wide range of activities to a focused clinical area, and it’s illuminating to map the training route that got him where he is today. ‘I studied psychology at Newcastle University then, in time-honoured fashion, took assistant psychologist posts in both child and family work and clinical health psychology. I was able to research in neuropsychology, paediatric oncology and cardiac care at St James’s Hospital in Leeds. Assistant psychology roles give you deeper insights into different areas of practice and enable you to get to know inspiring practitioners. They’re a real opportunity for anyone seeking to train in clinical psychology.’

Ceri did his own clinical training at Leeds University. His doctoral research was titled ‘Understanding blaming within families’. This was a sign of things to come.

‘My first job as a clinical psychologist was in Bradford in the area of adult mental health, as well as in a drug-users’ clinic and the hospital staff counselling service. I moved into family work within neuro-rehabilitation in Wakefield’s Community Neuro-abilities Team. I was interested in the area because it seemed more interesting, complex and engaging than general mental health work. I also got interested in peace studies and took an MPhil on the topic of trauma at Bradford University. More recently, I became a systemic therapy practitioner. All these experiences prepared me for my present role.’

The issue of why people choose a particular type of approach cropped up several times in our conversation. ‘I’ve recently read a paper on the subject and the overall finding seems to be that it’s often not an intellectual decision in which you evaluate the evidence and decide that a particular approach is right. Initially you chose something in line with your attitudes, personality and beliefs – your life view. The systemic therapy approach has always appealed to me. My father developed my interest in psychology – in fact he was a big influence on my life. He died of cancer and I suppose I’d been on the receiving end of family support at a time of a member’s illness. Thinking in terms of systems is something I continue to draw on, especially now I have a family of my own.’

Ceri also mentioned Dr Keith Andrews – a former director of the Institute – as a huge influence on him and the area of neuropsychological rehabilitation. ‘Complex disabilities can result from MS, cerebral palsy, Huntington’s and catastrophic accidents, among other things. Many patients exist in what were known as persistent vegetative states. Professor Andrews published a paper in 1996 on misdiagnosis of this state. As many as 43 per cent of patients had been misdiagnosed and were in fact aware. This has huge implications for rehabilitation and the role of the family in such situations. Some of the best work in the area is now being done with fMRI scanners at Cambridge Neuroscience by Martin Coleman and Adrian Owen, in collaboration with the RHN. Because of this work, we’re even getting better at predicting who will ‘wake up’ from vegetative states’. The use of brain–computer interfaces to facilitate communication is another fascinating area.

Despite these developments, it sounds like a challenging job for any professional working with patients and families in such a condition.

‘Often the issues relate to unresolved grief, which then reverberates through the family system and social network. And yes, you must have a good professional support system around you. But the rewards are extraordinary. As in palliative care you have to avoid curative models. Generally, rehabilitation is concerned with maintaining health and giving choice and dignity to people. Imagine someone who’s dreamed of going home for two years and finally gets the chance. It’s also humbling to see families who visit their relation every day, even though there’s no obvious communication or reaction. It seems to me that love needs no reinforcement and that here we’re moving past simple behaviour models to something more profound.’

Asked about the future, Ceri comments: ‘I’m younger and less experienced than the other Fellows. I’m still feeling my way in a less structured environment, in which I can make more of the running. Ask me in a year or so.

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