Letters May 2016
Don’t ignore biological factors
I am unsure which part of my letter (‘Keep looking for biological causes’, February, 2016) was unclear to Richard Hassall (‘Schizophrenia and biology’, Letters, March 2016) and made him think I was perhaps offering a defence of the scientific or clinical validity of schizophrenia, or otherwise commenting on ‘whether or not schizophrenia is a distinct illness with a biological basis’.
Richard may have missed my point. I was merely advocating for continued tolerance of the potentially diverse origins of future advances in the understanding and care of people with ‘functional’ mental health conditions – as exemplified, so strikingly in this instance, in the encephalitis/psychosis/ (diagnosis of) schizophrenia findings. I also wondered if there is a small group within our profession that is becoming intolerant of such issues: it sounds like Richard, for one, thinks there might be.
Either way, if there was lack of clarity in my letter there was surely none in Anna Galloway’s powerful account of her own family’s experience of encephalitis presenting atypically as a severe ‘functional’ mental health condition (Letters, March 2016). A similar narrative has been popularised in Brain on Fire: My Month of Madness (Cahalan, 2013).
Those affected by such conditions will be better served by due acknowledgement of potential ‘biological’ bases of their condition (where they pertain), and also by avoidance of the presumption that their psychological distress, disturbance or difference necessarily or singularly arises from factors such as trauma, adversity or mal-attachment (nor do I understate how often those factors are relevant).
Patients/clients are ultimately be better served by biopsychosocial formulations rather than psychological ones.
Consultant Clinical Neuropsychologist
Nottingham University Hospitals NHS Trust
Cahalan, S. (2013). Brain on fire: My month of madness. Harmondsworth: Penguin.
A therapy for each client
I was reading Jemma Broadstock’s letter ‘Tailoring the treatment’ (March 2016), where she movingly described how she designed an app to help her brother through his feelings of anxiety and pointlessness because his CBT ‘homework’ failed to engage him. Her aim was to signpost the need for treatments to take into account the individuality of each person, especially young people. Then I read a sentence that made me jump straight out of my armchair and onto my PC: ‘Whilst I appreciate that developing a therapy for each client would be time-consuming and impractical…’. Well, good news, Jemma – this therapy already exists and it’s called integrative psychotherapy (or integrative counselling psychology).
I have to admit it makes my blood boil to see how much CBT has become a synonym for counselling through its near monopolistic use by the NHS, and how little awareness there is of alternatives. I trained as an integrative psychotherapist to learn from many modalities, such as CBT, psychodynamics, gestalt, transactional analysis, existentialism, phenomenology, mindfulness, precisely because I do not believe that ‘one size fits all’.
Change happens not when we apply one method or technique to all but when the client is the starting point and feels seen and understood as a unique individual. I say it is high time our accrediting professional bodies such as the UKCP and BACP, or ourselves as practitioners, make people like Jemma aware that what they wish for is already out there, although unfortunately mostly unavailable on the NHS.
Shy of reward
I understood what the letter titled ‘Discipline in schools’ (February 2016) was getting at. Those who misbehave in class are likely to be encouraged to behave better by the incentive of getting their names up on a board via a joint classroom reward system, creating almost an environment for healthy competition with the generally good students who can get their names on the board rather easily. Thus, class behaviour as a whole is likely to be improved and control for the teacher can become easier.
However, throughout the letter I could not help but think back to my own childhood in primary and secondary education, where such a reward system was used in class, and the idea that while behaviour is improved by such a system, there is negative effect on those remaining children in class who are well behaved yet shy. Being one of those children myself, I remember always feeling inadequate after class at not being able to have the confidence to get my name up on the board. In fact, the lack of confidence was enhanced by such a regime, meaning that I felt class feeling negative and deflated. I have seen this occur many times in classes having worked with children for over six years in a classroom environment as my family run a Saturday school. Even with other incentives such as stickers, etc. I saw that the idea of competing with the more confident members of the class for the same goal was too intimidating for them and they often left class crying because they remained without such praise or sense of achievement.
Perhaps there is a reward system that can still engage the students without amplifying the insecurities of shyer pupils or without causing any negative effects at all? Maybe even something that could encourage these pupils to contribute in class is possible.
I decided to write this letter after reading the advice Roxane L. Gervais gave to aspiring psychologists in the latest issue of The Psychologist (March, 2016): ‘Network, volunteer, get involved with the BPS. You will always find someone willing to help you to progress your career’ (emphasis added).
I became a member of the BPS from my first year of undergraduate study. I attended conferences, talks, and was eager to show my genuine interest and enthusiasm for the field by approaching researchers and professionals. I sent dozens of emails following such networking events, expressing my availability to work or volunteer on their projects. I still wonder if anybody read them.
After having applied to a CAP course (the Scottish equivalent of IAPT courses) and being unsuccessful on the interview, I requested feedback on my performance. The email with the feedback came three months later and it consisted of five sentences of general statements, including the famous ‘…however, on the day there were candidates who were able to demonstrate stronger understanding and responses to all questions’. After over two weeks of mulling over whether it would be appropriate to ask for more detailed information, I finally sent an email requesting further clarification. I am still waiting for a reply.
Following my experience of applying for several assistant psychologist jobs and failing the interview, I believe that honest, personalised feedback is rather an exception. A rare, fortunate opportunity and the only thing, apart from hard work, that can actually make you a better applicant.
I don’t believe I am entitled to receive anything. I am aware that competition is fierce and the pressure is high on candidates and employers equally. I am trying my best to follow every piece of advice I receive. My message to employers and interview panels: please take the time and send your feedback to that oblivious aspiring psychologist. Be that helping hand. The silence is earsplitting.
I much enjoyed the piece on blogging in the April edition of The Psychologist (‘Welcome to blogademia’) but would like to emphasise that you do not need to be a computer whizz-kid to blog. I find it simple to write blogs in conventional text and submit them to the LSE Impact of Social Sciences Blog ([email protected]). Here all the text settings, including the addition of pictures, and links to any papers you refer to, are done for you and, since this blog reaches over 50,000 readers a month, why not take a look?
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