Is there a gap in practice models?

Dr Cathy Betoin with a letter from the latest edition.

Why are there so many children being referred into CAMHS and Child Development Services?

Why is every school across the country struggling under the pressures of so many children with such poor readiness to learn? And what have psychologists really got to offer other than becoming adjuncts to an essentially psychiatric approach that delivers diagnostic explanations for challenging behaviour?  

Having entered clinical psychology training as an experienced teacher with four years of classroom experience, I expected to have a clear answer to this last question on completion of my course. But the difficult truth was that as I graduated, I wasn’t convinced. I had been introduced to many very interesting ideas, and I valued the process of biopsychosocial formulation, but I could not figure out how the different approaches fitted together and I was disturbed by the sheer variety of practices of psychologists given the stated commitment to evidence-based practice.

When IAPT came along I was pleased to see investment in psychological therapies, but from years of practice serving nine-month waiting lists I still felt that the emphasis was missing something very key and that the delivery models were not well adapted to the scale of the needs that I had observed.

So I hunted and hunted for how to piece the ideas together into something that felt more solid that could feel relevant to the overwhelmed families and staff that I had seen in so many situations. I knew from experience that to impact on the scale of the needs it was vital to influence the understanding and practices of parents and frontline practitioners in schools and wider services, rather than just producing more therapists. But what exactly were the key ideas that young people, parents, professionals and senior policy makers needed to grasp?

I clearly remember the day in which the fog started to lift and I saw how it became possible to piece a lot of key ideas together. With more clarity it became clear to me that what was missing was an understanding of (a) stress and of the way in which the alarm response to threat links a wide range of symptoms and gets shaped up through experiences; (b) the way in which the brain develops and functions in the context of adult–child relationships; and (c) the hierarchical nature of social-emotional development

In my view the lack of understanding of these key details means that our school-based and community-based practices are currently inflicting damage on what children need to experience healthy lifelong relationships. The desire is to deliver literacy and numeracy, but the overlooked elephant in the room is child social emotional development. The overlooked reality has serious implications.

Social emotional development can be assessed and supported, but at present child development is disregarded as significant beyond the early years.  I believe that were there a collective decision to start to take a fresh look at the social emotional competencies of children of all ages in our schools we would be deeply, deeply shocked.

So it is perhaps time to take another look at some key fundamentals?  I have developed a training, which represents my best effort to set out how I think important existing ideas can be pieced together into an I Matter framework that offers a foundation for solid, practical formulations at individual and collective level. I would value dialogue with anyone who would like to pursue this concern with me.

Dr Cathy Betoin
Clinical psychologist, 
teacher and parent
Kendal, Cumbria

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