News & Reflections

Art Psychotherapy online in the time of COVID 19.

Kirsty Toal, Art Psychotherapist

Online therapy is a much discussed and documented subject at the moment, as therapists of all disciplines have been forced to reframe their practice and adjust to working away from their clients. There is extensive advice and opinion being shared about confidentiality, safe working and how to make the best of the situation so I want to simply describe some of my experience and how it has helped the work in new ways from a distance as I shield due to my own health, away from the therapeutic community in which I work as an Art Psychotherapist.

Perseverance

Right now, I am fortunate enough to be close to woodland and I can walk over hills and splash through muddy puddles and fields in my free time. One warm day my partner picked some nettles (stinging his hands somewhat in the process despite his gloves) and announced that he was going to make nettle tea. It brought to mind the Hans Christian Anderson story of ‘The Wild Swans’ (which was introduced to me recently, in Psychologist Sharon Blackie’s book, “The Enchanted Life”). In the tale a young princess rescues her eleven brothers who have been cursed, turned into swans and banished from their home. She saves them from suffering on the advice of a fairy queen, spinning the stalks of the nettles into yarn and weaving them into eleven coats, one for each brother to wear. This breaks the spell, frees them from the curse and returns them to their human form, and to their home. The harsh stinging nettles were worked into healing and restorative garments and the nettles in my kitchen, after drying in the sun and soaking in warm water, have been calmed into soothing, warm tea.

Since that walk I’ve had nettles on my mind, especially the way they push us away and stop us from accessing their helpful qualities. They really force us to value their worth if we have courage to endure their stings and to see what lies behind them. It has been a meaningful metaphor in my adjustment to working remotely in a therapeutic community. Working with technology has come with prickly incidents of sound disappearing, cameras malfunctioning, wifi dropping out and, that one big sting, not being physically present. It has, however, been worth persevering and I am regularly heartened by, and learn from, the resilience and adaptability of our residents and their willingness to do their best despite the challenges.

Resetting

As an Art Psychotherapist I was particularly concerned about how I would see subtle gestures through a screen, like the way pastels are pressed into paper, paint splashed onto canvas or fingers pushed into clay. I might not hear gentle sighs or notice the shuffling feet under the table, and I might not be able to effectively show my own responses.

When working with the broad experiences of those living with psychosis and other issues, I have learned that it is often the subtleties that matter, where words are not enough. After some initial difficulty, we have begun to renegotiate what therapy could be, what it could look like and how it would work. Now, each of my clients are figuring out a different way to either carry on our work or to put it on hold until we meet in person again or review again later.

Some people may welcome the distance of online working and feel free to express themselves while others might not want to be seen or worry about security so turn off their cameras or choose not to attend therapy at all. Some may feel abandoned and others may feel that even at a distance they are remembered and valued. There can be a sense of closeness and connection through the small window of a laptop or phone screen but there can also be a frightening sense of aloneness that comes from sitting in a room looking at an image of someone who seems not as real as they were in person.

Right now there is a resetting of personal limits amidst unsettling changes that may mirror what is happening out in a world where there is an, all too often heard, narrative that says “everything is uncertain, risky and unsafe”. I’m reminding myself daily that all of the above responses are ok because we are all finding our way in new territory.

A safe space

A few years ago, while training as an Art Psychotherapist, I researched the potential of digital environments being used in therapy. It seemed exciting and almost limitless with so many possible new ways of people relating and recovering through carefully designed virtual environments and avatars. I then went on to do some inspiring introductory training in Environmental Arts Therapy. Since then I’ve worked on skype a little and have taken people to work outside in nature among nettles and bluebells alike. These two very different experiences have been valuable in working out what it takes to create the possibility of safety in an environment that we do not always have control over. For some people safety feels an impossible state but as a therapist I hope to at least introduce the idea of it for people by considering questions together such as:

What is uncomfortable about this and how can we make it more comfortable?

What past experiences are being recalled as we face this change?

How can this new approach help us?

Being on camera can be exposing, uncomfortable and restrictive but I’ve also discovered (quite unexpectedly) that it can become connecting, comfortable and incredibly therapeutic for people.

In therapy, welcoming someone into the same room each week may offer some certainty in what can be an unstable time in someone’s life. The space itself can become meaningful. The chair, the clock on the wall, the plant on the windowsill and the art work made and kept safe can become symbolic of all that is revealed, examined and left behind over the course of therapy. This, I am finding, is also possible (with some figuring out with my clients) in the virtual space that connects us during therapy.

Now amidst social-distancing restrictions therapists and clients alike will be redefining how we all work.  The ways we find to do this will be varied and will depend on the modality of the therapist and the preference of the client among other things like what is actually available to us. Together we will need to consider the meaning in distance, the virtual space and what is revealed within the metaphorical stinging nettles that can actually be healing and supportive. I am planning to work safely indoors again soon, as well as outdoors and online, but with a refreshed view of what therapy can be and how creativity and flexibility can enrich the work.

Links used:

London Art Therapy Centre

‘The Wild Swans’

Psychosis & social distancing: opportunities and challenges of support online

ISPS UK webinar. 4 June 2020 18.30-20.00.

In these times when face to face meetings are not possible and mental health services are moving online, what is it like for those living with psychosis? Our speakers look at the different aspects of this new way of life.

There will be a time for questions to the panel.

To go to bookings for the webinar at our Eventbrite page please click here.

A Paranoid World?

Clinical Psychologist Richard Bentall talks about the difference between extreme belief and delusion, exploring the social and psychological roots of paranoia, and what separates paranoia, conspiracy theories and extreme beliefs, in this new video from the Institute of Arts and Ideas.

Click here to watch Richard Bentall’s talk.

The Institute of Art and Ideas runs an online ideas platform IAI.TV and has been described as “Europe’s answer to TED” (Total Politics) that features debates, talks, articles and courses from the world’s leading thinkers.

BBC Film about mental health

BBC Films are looking for a male lead in a fictional story about a man under mental health services and his journey towards recovery.  No acting experience is needed, and BBC Films are not looking for a professional actor.

For more information, including who to contact if you are interested, please click here: FILM FLYER

Advanced Studies Seminar: Supporting Voice-hearers in the Workplace

The Educational Voice-hearing Network 

presents an Advanced Studies Seminar:

Supporting Voice-Hearers in the Workplace

St Catherine’s College, University of Oxford

Wednesday 23rd October 2019  10 am to 4 pm

Organized by Drs Roz Austin and David Crepaz-Keay

Co-Leads of the Educational Voice-hearing Network,

Collaborating Centre of Values-based Practice in Health and Social Care

Confirmed speakers:

Lord Dennis Stevenson

Debbie Richards, Managing Director of Mental Health Services and Learning Disabilities, Oxford Health NHS Foundation Trust

Dr David-Crepaz-Keay, Head of Empowerment and Social Inclusion, Mental Health Foundation

This Seminar will cover the following areas:

  • Employers who provide inclusive workplaces. The role of Employment Law and the Disability Discrimination Act
  • Developing ‘Reasonable Accommodations’ for voice-hearers
  • Issues of stigma and discrimination in the workplace

Limited places are available. If you would like to have a place to attend the Seminar, please email Dr Roz Austin – rozaustin2017@gmail.com

Psychosis: Origins, Experience and Meaning

Talks from ISPS UK conference are now on YouTube https://www.youtube.com/playlist?list=PLxnwakHRXD6HI71Mkz-tkHqg7V1pljiE3

 

 

 

 

 

Conference review by Isobel Todd, journalist:

“Let’s be clear, ” declared Professor John Read, near the start of this unique Brighton conference on the topic of psychosis; “whenever somebody uses the word schizophrenia, they’re talking nonsense”.

Open to practitioners, people with lived experience, families, carers, and anyone else with an interest in the subject, Psychosis: Origins and Meanings was a one-day event aimed at discussing and promoting good practice developments in the field. It shared its title with the morning plenary from Read, a clinical psychologist known for his research into the psychosocial causes of psychosis, and his dogged persistence in drawing these to wider attention. And it began with a wry warning from Bill McGowan, South Coast lead for ISPS (the International Society for Psychological and Social Approaches to Psychosis) UK, that “with John at the helm, it is going to be a choppy sea”.

But the day went remarkably smoothly for an inclusive, multi-organisation event brought together in just over six months. The main logistical sticking point was the amount of background buzz during the morning workshop programme – which probably resulted from the release of extra tickets due to unprecedented demand.

And in the end, for all his rhetorical directness, Read’s lecture was of course eminently sensible. Though that’s not to say it didn’t shock. He explained that schizophrenia (a word steadfastly absent from the conference’s own literature) was invented – yes, invented – by German psychiatrist Emil Kraepelin, the 19th Century founder of pharmacopsychology. Kraepelin identified hundreds of ‘symptoms’ associated with this new ‘disease’, such as ‘going in to church with a lighted cigar’. As Read pointed out, this is no list of symptoms, but rather a catalogue of broken social norms.

In relentlessly challenging the reductionist medical model ideology that dominates mental health services – with research that has proven strong links between what are commonly referred to as ‘mental disorders’ and experiences of childhood sexual abuse, parental loss and relative poverty – Read himself is breaking a norm. For this, he observed, he is often labelled ‘anti-psychiatry’, allowing his arguments to be easily dismissed as radical ravings. Read drew a comic but sharply instructive parallel with the way in which people who contest their schizophrenia diagnoses are said to be demonstrating the ‘symptom’ of schizophrenia known as ‘lack of insight’. It’s some catch, that catch 22.

Responding to an audience question about community treatment orders, Read declared forced medication to be “the last human rights battle”. So what is to be done? His response: join forces; don’t suffer in isolation. Cue punk activist Sascha Altman DuBrul, co-founder of peer-based mental health group and media project The Icarus Project, and Director of Learning at the Institute for the Development of Human Arts. DuBrul describes his interests as lying ‘at the intersection of the public mental health system and the Mad Underground’, and had just finished a UK tour on the subject of ‘Mental Illnesses or Dangerous Gifts?’

The charismatic New Yorker’s afternoon plenary was an at times frustratingly wide-flung but always vibrant ad-lib in praise of the role of creative social movements. Diagnosed with bipolar as a teen, he found solidarity and support amid the Eighties punk movement and the squat communities of the Lower East Side. DuBrul found that the drugs helped him survive, in a world that was hard to survive in. But creativity and community helped more. Now, his training for Peer Specialists and Peer Workers always begins with a history lesson, locating the origins of their role within the disability rights, feminist and LGBTQ+ movements, and the enduringly essential slogan, ‘Nothing about us without us’. DuBrul reminded us that, if you want to facilitate change in any sector, you should set about creating culture.

If psychosis isn’t a biological disease to be treated solely with psychiatric drugs, then how else should we understand it? The emphasis in the conference title was on the ‘s’ – psychosis has a plurality of meanings. Fittingly, the broad workshop programme offered an opportunity to experience a multiplicity of readings and responses.

Members of peer support group the Hearing Voices Network Brighton welcomed us in to their circle for an open version of their weekly meet-ups. Members spoke about very different relationships with their voices, some negative, some positive. We heard how voice dialogue work (similar to Gestalt chair work) helps some to gently engage with their voices. One member felt that voices aren’t always a symptom of psychosis, but do always have meaning.

Another way of being with, and responding to, psychosis was proposed by poet and Assistant Psychologist Mica Gray. She explores her own experience of psychosis in her recent poetry collection, When Daisies Talk. ‘Don’t get caught in the metaphors’ ran one memorable refrain, addressing the concept of grandiose and paranoid delusions. What might someone be telling you about their sense of purpose and their experience of persecution when they tell you they are Jesus? What might they be expressing about their lack of agency when they say they are being bugged by the CIA? Such communications about selfhood are easily dismissed in the medical model. Try listening and responding in the register of poetry, and they may reveal themselves to be potent with meaning.

A similarly hopeful reframing was proposed by Spiritual Crisis Network Brighton group. Their workshop explored how the psychological difficulties and loss of shared reality associated with psychosis might also be understood in terms of spiritual awakening. What we think of in terms of pathology may in fact, they suggest, be profound personal transformation.

Two further workshops were run by Yasmin Ishaq, on her work developing the NHS Open Dialogue approach in Kent, and Soteria Brighton, which is working towards the establishment of a Soteria House and related services in Brighton. The organisation introduced its new Managing Medication Group, starting this Autumn, which will help participants manage small reductions in antipsychotic medication, should they wish to. When Read cautioned, at the end of his rousing talk, that “It is not a good idea on the basis of one person’s lecture to start coming off your meds”, Dominic Pearson of Soteria Brighton was able to stand up and respond with this offer of specialised practical support. Unlike so many conferences, this felt like a place for words and actions to meet. With the conference’s collaborative organising committee already planning a second event, we seem to be edging closer to a genuine paradigm shift.

Isobel Todd

Extreme Experiences: Mental Illnesses or Dangerous Gifts?

Notes from ISPS UK event, June 2019

Sascha Altman Dubrul, the co- founder of the Icarus Project was doing a tour of the UK doing a series of talks so we invited him to Manchester to speak.  Sascha is a social worker and has worked  setting up peer support initiatives in New York and internationally.

Sascha explored his experiences of being taken in by the mental health system.  He went into the influences into his thinking spending his youth radical political perspectives and the consequent instinct to challenge the idea put forward by the mental health system that he was mentally ill.  After several admissions to hospital he came to the conclusion that he was different in some way and identified this to being sensitive, something he saw as a dangerous gift.  He drew on this to challenge the mainstream ideas about mental health and talked about his experience of setting up the Icarus Project. 

Sascha then opened the floor to questions and comments and we had an in-depth discussion with the audience.  People made points from their own experiences of mental distress and professional backgrounds from a variety of perspectives.  The feedback from the event was positive.

Neil Caton, ISPS UK

 

 

 

 

ISPS Executive Committee Elections – vote by 17th July

 

 

 

REMINDER

ISPS Executive Committee Election (2019-2022)

All ISPS members are encouraged to vote in this election.  The closing date is 17 July and votes must be received by midnight Central European Time.  The 8 nominees with the most vosts will be elected.

All fee paying members of ISPS are eligible to vote.  For enquiries please contact isps@isps.org

Nominees:

Ludi van Bouwel (Belgium)

 Cecilie Brøvig Almås (Norway)

 Melissa Connell (Australia)

 Michael Garrett (USA)

 Marjaana Karjalainen (Finland)

 Jen Kilyon (UK)

 Julie Kipp (USA)

 Debra Lampshire (New Zealand)

 Anna Lavis (UK)

 Margreet de Pater (Netherlands)

 Dag Söderström (Switzerland)

 Pat Wright (USA)

 

 

 

 

ISPS Australia and ISPS New Zealand events on the Power Threat Meaning Framework

 

 

There are a number of Power Threat Meaning events being organised in Australia and New Zealand, in partnership with ISPS New Zealand, Blueknot and ISPS Australia, in Auckland, Sidney, Brisbane and Melbourne, and Adelaide. The PTM Framework was previewed at the ISPS conference in Liverpool in 2017.

Book review of CBT for Psychosis: Process-Orientated Therapies and the Third Wave

Book Review of: CBT for Psychosis: Process-Orientated Therapies and the Third Wave (2019)

Edited by Caroline Cupitt (Published for ISPS by Routledge)

Third wave approaches to psychosis have been around for at least 10 years alongside burgeoning interest in the role childhood adversities and later trauma play in the emergence of psychosis.  Broadly-speaking, third wave cognitive behavioural therapies focus on emotions, compassion and de-centring from distressing experiences and process rather than content is emphasised. Such relational emphasis contrasts with second wave Cognitive Behavioural Therapy such as ‘traditional’ CBT for Psychosis (CBTp) recommended in current UK national guidance which emphasises the centrality of cognitions. Though offering potential for benefitting people living with psychosis, the sheer range of third wave approaches can seem overwhelming to experts by experience and practitioners alike. As a seasoned CBTp practitioner with training in several mindfulness-based approaches, I’m pleasantly surprised how this publication tackles this complexity in an accessible and meaningful way whilst remaining true to the unique aspects of each therapy.

The book is a collective work from eminent contributors all national or international experts within their fields with extensive lived and/or professional experience of therapeutic delivery of, or researching, third wave CBTp interventions and models. It skilfully collates the main developments and controversies regarding the applicability of third wave CBT, and process – orientated, approaches to psychosis. Starting with robust overviews of current and emerging theoretical perspectives regarding metacognitive, attachment-based, and, dissociative factors in the development and maintenance of psychosis, Part 1 sets the scene. An excellent chapter on attachment proposes future research priorities to develop clinical interventions for those with psychosis and complex traumatic relational histories. The pervasiveness of disorganised attachment patterns in relation to therapy and to people’s social and familial relationships is also considered.

Part 2 identifies the key features of the main third wave perspectives on CBTp, many of which seem trans-diagnostic. This whets readers’ appetites for discovering more about particular approaches whilst steadfastly focusing on person-centred collaboration, prioritising shared meaning-building and alleviating suffering. This part also stimulates interest in the delivery and evaluation of third wave CBTp and highlights lived experiences of those undergoing such therapies. These third wave ways of sense-making are presented not as devaluing traditional CBT which is acknowledged as providing firm foundations for these newer but equally valid interventions. However, this work definitively shifts away from the predominantly symptom-focused approach advocated in traditional CBTp to instead questioning how we relate to difficult (or unusual) experiences. All chapters (implicitly or explicitly) encourage this new stance for people living through psychosis and their supporters be they family members, friends or mental health staff. The publication also emphasises ‘getting alongside’ people arguably much more so that traditional CBTp (the Method Of Levels approach for instance advocates patient-led apt scheduling).

The final part of the book (Part 3) insightfully critiques earlier parts by considering some potential (though not necessarily insurmountable) disadvantages of ‘third wave CBTp’ including deconstructing the concept itself. It also elucidates similarities, differences and overlap between the various therapies. This is done in a grounded and accessible way which celebrates the complexity and diversity of CBTp and the fact   that ‘one size doesn’t fit all’. This part also imaginatively and succinctly sets out future challenges for CBTp – including adopting a more social view of psychological distress- and reiterates the value of supporting alternative therapies (i.e. ‘alternative’ in that they are not currently in national guidance for Psychosis) as well as alternatives to therapy. This proposed direction of travel which prioritises social justice and advocates a shift towards more integrative and pluralistic refinements of CBTp is described as a possible ‘fourth wave’ of CBTp.

One minor criticism is not all the chapters on specific therapeutic perspective include case vignettes. Also, scant reference is made to supervision and training requirments but in fairness this book never sets out to be a treatment manual.

This book will be extremely useful for clinicians unfamiliar with some or any of the therapies and for people living with psychosis and their supporters looking to better understand the pros and cons of different third wave CBTp approaches. I also recommend this eminently readable and thought-provoking publication to psychologists, therapists (of all modalities not just CBT), psychiatrists and mental health nurses; trainees in all those and similar professions as well as early career psychosis researchers, and, managers and commissioners of therapy services. In recognition of the empowering and potentially radical spirit of much of the volume’s content, maybe not only therapeutic teams but also co-constructed special interest groups or joint EBE/staff forums should aspire to read and discuss it together. Doing so will undoubtedly inform future developments in local delivery of CBTp to enhance people’s recovery journeys and meaningfully challenge social factors implicated in psychosis.

Reviewer: Jenny Droughton (Consultant Cognitive Therapist/Trainee Counselling Psychologist) 27/01/19