Lucy Johnstone walks us through a day in her life working as clinical psychologist on a community mental health team in an area of great social depravation.
She explains how, rather than simply hand them a list of symptom to check off, in order to reduce the process to, as John Read says: “picking a name and choosing a colour” they work by listening, seeking to understand a person’s distress in context of their whole life; to come up with ways of making sense of their distress as normal response to the life challenges they face; and suggest ways to move forward.
Often it’s easy to understand why a person is struggling, sometimes it’s more complex and takes more time and more of the team to share their perspective before it starts to make sense.
It’s often quite easy to see why someone might be low in mood, or panicky, or hearing voices telling them they are worthless.
Sometimes the reasons are less obvious,…
However it manifests within an individual, human struggle and distress always makes sense in context of whole life experiences. if only we take time to listen and open our mind to what we might hear, we can understand.
‘Just because somebody says something that doesn’t make sense, that does not mean they’re crazy. It means we’re not smart enough to understand”
Guardian, Fri 31, Oct 2014
Every day as I drive to work, I know I am going to hear some truly harrowing stories.
I’m a clinical psychologist working in a community mental health team. The first task, if it is a Thursday, is making possible the weekly meeting where we take an in-depth look at the reasons for a particular client’s breakdown. We spend about an hour sharing our thoughts, feelings and knowledge of the evidence, and this enables us to summarise our ideas about the possible reasons for the client’s current distress.
A typical person might have been bullied, neglected or abused as a child; subjected to domestic violence as an adult; and now be on benefits and struggling to feed and clothe their children.
It’s often quite easy to see why someone might be low in mood, or panicky, or hearing voices telling them they are worthless. Sometimes the reasons are less obvious, and we arrange to meet again once we know the client better. There are rarely simple solutions, but by checking our ideas with the client, we can usually come up with a tentative explanation that clarifies the meaning of their distress, normalises their reactions, recognises their strengths, and suggests some ways forward.
We are based in an area of high social deprivation, and many people’s difficulties are augmented by long-term unemployment, poverty and lack of resources. Merthyr Tydfil, just up the road, is often cited as having one of the highest rates of anti-depressant prescribing in the UK. It’s an unhelpful stereotype for a close community with many strengths. There’s lots of good work going on: for example, a pioneering mental health project offering a range of walk-in classes and groups has just been set up.
No one in the team stops for lunch, but sharing an open plan office allows for plenty of informal discussion during the day. I can check whether anyone has been in contact with a client who didn’t keep her appointment with me, or give some thoughts about someone else’s client who may be in crisis.
In the afternoon I see clients for individual therapy. Many of them are multiply traumatised, and it can take months for them to build up enough trust to reveal their most terrifying secrets. Demand for therapy far outstrips supply, and there is constant pressure to keep the psychology waiting list within reasonable limits. I am constantly amazed by the strength of the human spirit, and I never give up hope for someone’s recovery.
Clinical psychologists are often sceptical about the language of diagnosis and illness. From my perspective, people haven’t had the misfortune to develop schizophrenia, bipolar disorder or personality disorder in addition to their other struggles. Rather, they are experiencing understandable reactions to their life circumstances. The core role of a clinical psychologist is to promote this kind of sense-making within teams. Some degree of tension between these viewpoints is common in psychiatry. In day-to-day clinical work, the most important thing is to come up with a workable consensus. I’ve found this easier to achieve here than in some previous jobs, and I feel we work well together as a team. Perhaps the local demographics make it more obvious that people generally have pretty good reasons for breaking down. I wish the media, whose reports on mental health are often infuriatingly ill-informed, could grasp these points as well.
Every day as I drive home, I have to find a way of putting the day’s stories behind me. Like most mental health professionals, I find this has become easier with practice. The trick is to maintain the ability to empathise and listen without despairing or becoming overwhelmed yourself. By the time I greet my family, I have usually succeeded in putting the working day to rest.
Lucy Johnstone is the author of A straight talking introduction to psychiatric diagnosis