Dreaming of a restful sleep

Ian Florance talks to Brad Martin about clinical practice, and his use of imaging rescripting therapy

It’s obvious when you start talking to Brad Martin that he’s not from the North-East, where he presently works as a clinical psychologist.

‘I grew up in Winnipeg and studied at the University of Manitoba but I moved – originally to Scotland – in 2003. I’ve been very lucky in the opportunities that have opened up since I came here.’

Brad’s original degree was in theology, but on completing it he studied psychology. ‘They ask similar questions – there’s a natural bridge between them.’ During his undergraduate degree Brad worked in community care for men with learning disabilities, at an adolescent treatment centre, and also had a night job as a team leader on a mobile crisis team. ‘When I finished I took up an assistant psychologist post, researching occupational stress with the NHS in Fife and Tayside. In retrospect, I was extremely naive. I packed up and moved lock, stock and barrel on the basis that I had an interview rather than a job offer. But it worked out. The job was a good fit with my interests since my undergraduate thesis was on occupational stress and trauma.’

Brad is very specific about why he came to the UK to continue his studies in clinical psychology. ‘North American training is so long. You take an MSc then a PhD – it could easily take you six or seven years after your undergraduate degree. Here I could go straight into my clinical training. Many of my original North American peers are still in university, whereas I’m practising.’

According to Brad, his interest has always been in clinical practice. ‘North American training is often focused on academics and research, which may prepare you well for working in a university but doesn’t necessarily suit the needs of the NHS. Of course there’s an overlap, but what makes a good academic is not identical to what makes a good practitioner. UK training fits better with what I wanted to do. Once again, I was extraordinarily lucky – six months after taking up my job I got accepted on to the Doctorate in Clinical Psychology programme in Newcastle. It trained me to be a practising clinical psychologist in the NHS.’

The trainers and clinicians Brad has worked with have been a huge influence on him. ‘I certainly made choices about my career and education under the influence of impressive individuals. I suspect that’s often the case in subjects like psychology. It highlights the value of dialogue within the profession – within divisions, between different types of psychologists and between different services.’

Brad is now ‘a jobbing clinical psychologist’ at Lobley Hill Clinic, Gateshead, a post he started two days after finishing his doctorate. ‘I’m working in planned care and adult mental health. This involves a wide range of activities from triaging to treatment to taking a postgraduate diploma in cognitive therapy.’

Throughout our interview, Brad referred to his interest in the treatment of trauma and post-traumatic stress disorder (PTSD). ‘My research looked at the phenomenology of intrusions in PTSD. In the literature, nightmares seemed to be set aside as difficult to treat. I came across a therapeutic method called IRT during my literature review and I’m now using it with patients where it’s appropriate. IRT stands for either image rehearsal therapy or imagery rescripting therapy, depending on your view. I prefer the latter since it seems to imply a more cognitive approach and suggests that the purpose is to change the meaning of the nightmares.’

IRT has received some media coverage over the last decade for its use in a variety of conditions. In essence, the therapy focuses on changing the imagery of the nightmare and then practising it while the client is awake. This is a very different therapeutic approach to one that focuses on discussing the incident that may have set the nightmares off, or studying the nightmare’s content.‘I use it with patients for whom nightmares interfere with their ability to get restful sleep. But I’ve also tried it with posttraumatic night terrors – where there’s no narrative or imagery to work with. In this situation, it seems that introducing a new script has a similar effect as when there is an existing nightmare script to replace. We’re still trying to understand the mechanisms at work. It could just be the same as relaxation from guided imagery, which might tell us something about how IRT works. It uses much of the same core skills as imagery-based work for other clinical presentations.’

I asked Brad whether his interest in trauma had a personal source. ‘I was involved in a pretty scary car accident back in the 90s. I didn’t suffer any reaction to it, but I have absolutely no memory of what happened and I wondered – and still wonder – why. That’s why I got interested in trauma and memory.’

Also underlying our conversation was a very strong commitment to clinical practice. ‘One of my mentors told me that a good clinician has to be skilful, compassionate and bright. You need to understand that people’s problems are robust and have a rationale. You have to use your knowledge and skill to help them find a better way through their management. If the solutions were simple they wouldn’t be bothering with us.

I think the compassion is important – as challenging as our work can be, it must be much worse for the person who has to live with the problems. If you weren’t compassionate you could risk giving up on people with genuine needs.’

As for the future, ‘I’m doing some teaching and my research interests include looking at other areas where IRT might help. But my central interest is working with patients, because it’s so rewarding. When your patients respond they really get better. That’s so satisfying.’

 

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