Pockets of resistance and change

Ella Rhodes and Jon Sutton with a few highlights from the Annual Conference of the British Psychological Society's Division of Clinical Psychology, in Solihull.

It’s not often you’re asked to tickle a stranger in the first session of a conference (or the second session, for that matter). Konrad Jacobs’ pet hate is the framing of so-called medically unexplained symptoms in children. To induce such symptoms in the gathered audience he got us to split into pairs and to ask each other the most ticklish parts of our bodies, before slowly moving a finger toward that particular body part. We winced, we laughed, we tensed up and backed away. 

‘You felt those sensations but you weren’t being touched – you’ve just experienced a medically unexplained symptom. A symptom with associated avoidance behaviour which is not associated with illness, disease or pathology.’ A Consultant Clinical Psychologist and joint clinical and programme lead of the Oxford Centre for Children and Young People in Pain, Jacobs has worked with many children who experience persistent pain, tenderness and avoidance of contact in areas of their bodies which were injured but have long since healed. 

Jacobs said the term 'medically-unexplained' was a misnomer given that many physical symptoms people experience cannot be explained by medicine, that medicine does not fully understand the mechanisms and aetiology of all recognised diseases, and the term separates the mind and body when they are inextricably linked. He said we should use a term such as 'persistent physical symptoms' instead, which has been found to be more acceptable to patients in this position. 

In a session on the use of Psychologically Informed Environments (PIEs) Consultant Clinical and Forensic Psychologist Dr Helen Miles spoke about her work with Centrepoint – a homeless charity for young people. Since joining the charity in May, Miles said she had aimed to increase staff training in psychological tools to support the young people they work with, increase the use of reflective practice, make the housing for young people more welcoming and homely, and embed evidence-based practice. 

Catherine, a former Centrepoint resident, and Morgan, a current resident, have been working with Miles as PIEineers giving their feedback on the PIE strategy and asking other residents what they’d hope to see in their environment. They shared some quotes from a poster they put together outlining what young people expect from a PIE. 'When we’re at Centrepoint we want to feel we belong and we’re at home'.

In his keynote address Dr Dave Harper, Reader in Clinical Psychology (University of East London) pointed out the huge rise in anti-depressant prescriptions in the UK since 1998 as well as high levels of inequality and its role in distress and mental illness. Unfortunately the picture isn’t improving – in the 1960s the gap between the rich and poor was much smaller in the UK and incomes have not grown for a majority of the population in recent years. However, Harper noted there is still little public appetite for changes in tax rates or support for lower-earners.

Harper suggested that the way issues are framed and the narratives surrounding them affect how we understand our own and others’ experiences – outlined in the Power Threat Meaning Framework published by the DCP as an alternative way of understanding mental illness. He said clinical psychologists themselves have blind spots to inequality – there is very little BAME representation in the profession, with the workforce not reflecting the make-up of the population. 

However Harper was quick to point out that there was hope. Prevention is on the government’s agenda and there is acknowledgement by the UN and other bodies that social issues can affect mental health. He suggested that clinical psychology could be a voice for taking a psychosocial and preventative approach to mental health, and pointed to the work of Psychologists for Social Change and the potential role for clinical psychologists in shifting the public’s perception of the social determinants of mental health. 

What really matters

On day two, Louise Hayes led a workshop on Acceptance and Commitment Therapy (ACT) for young people. ‘Anxiety is like a big elephant in the room', she said, and we must ‘push it out of the way to see the vitality and value. ACT suggests that what you love and care about should be the biggest thing in the room, along with what in you makes it hard to get that. What would give you a rich and meaningful life? We can’t hide from the fact that facing what is important to us can make us feel vulnerable. Our ‘British Anglican heritage’ – all stoicism and ‘pull your socks up’ – hasn’t, Hayes argued, served us well. ‘It certainly isn’t serving young people well… we need to help young people open up to the normality of being human.’

As a practitioner, that can involve creating contexts that empower young people to clarify what they value or what brings them vitality, and to choose value-consistent actions. Techniques might include encouraging the young people to do ‘weird, quirky things that have no emotion in them… break the rule, say “I can’t do it” and then just do it’. Hayes outlined the Discoverer Noticer Adviser roles that make up our minds, and what happens when you get ‘stuck insider an adviser space that is all about rules and risk’. Young people need to step outside of thinking and see it as a tool; to explore in order to develop skills and resources, and expand their context. ‘It’s an active, engaged way to work with clients to help them get what they care about', Hayes concluded, ‘and I love it’. 

Emma Watson (Sussex Partnership NHS Trust) spoke passionately about her work with Sara Meddings on peer support and the lived experience. ‘I’m obsessed with peer support’, she admitted, describing her personal experiences of feeling lost and lonely and then coming to view lived experience ‘as a strength I could use’. Sharing that lived and life experience can ‘sometimes be quite a political thing to do’, Watson admitted, pointing to surveys which suggest a third of people are still afraid of the stigma attached to it. Common fears are that peer support workers will be ‘too fragile’, or won’t know the difference between friendships and working relationships. Role clarity is important, Watson said. She ended with a fascinating consideration of when / how to share life experience, and what happens when an approach based on mutuality meets a hierarchy – peer workers can find their lived experience is both a source of power and a source of feeling powerless.

There followed an inspirational set of talks from Sheffield, the UK’s first ‘City of Sanctuary’. Claire Bone (South Yorkshire Housing Association / University of Sheffield) described her work with the Cuthbert Bank Homeless Families Service, and Diane Morrison from the Sheffield Group of Psychologists for Social Change talked about ‘pockets of resistance and change’ in such projects. 

That led nicely into ‘Make my city fair’, a stirring account of change in Birmingham. Martin Straker Welds, a Labour Councillor in the Moseley Ward, described how austerity has ‘eroded Birmingham’s capacity to support our community’. Psychologist Lawrence Moulin joined him in arguing that austerity divides, equality unites. ‘We need to tell the stories of what we have lost’, Moulin said, ‘and change public attitudes about the positive societal impacts that follow from early investment’. Angela Hewitt called for research on how to communicate austerity, and its ‘false economies – there are no savings… it’s not acceptable and it’s not fair.’ Emma Bridger (Birmingham City University) looked to find a way to ‘bring people’s stories to the budgetholders – a “balance sheet” of the real cost of cuts’. Moulin concluded with a call to ‘challenge austerity head on’, and to work in partnership on how ‘doing something different can enable other parts of the system to do more, support people better and reduce pressure on services’.

Speaking to many of the delegates – admittedly a select sample of those psychologists willing to attend the conference – it was notable how they reported feeling 're-energised' by the prominence of a 'social justice' agenda over the two days. This seems to have emerged in recent years, in parallel to the Society's own increasing focus on policy areas such as children and young people, and 'from poverty to flourishing'. Psychologists are out there, working in partnership with community and third sector organisations, to effect real change in people's lives. And they seem increasingly open about their own personal and political stance on such topics, willing to share their 'lived experience', rather than by implying by omission that these things don't matter. The person is firmly back at the heart of psychology, filling pockets of resistance and change.  

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