Cognitive Behavioural Perspectives on Mental Distress – promoting recovery

Duration: 8.49 mins 

Speakers: 

Interviewer, Tracey Holley 

Professor Max Birchwood, Birmingham and Solihull Mental Health Trust and School of Psychology, the University of Birmingham 

So, how can your perspective help promote people’s recovery? 

Well, as I often say, I’m as much influenced by Marx as Freud and I’m very of the view that the social context and how it influences the way people think and interact with the world is important.  So in the service for example that I lead in Birmingham here for young people who’ve developed major mental health problems, I’m very strongly of the view that it’s really important to get those young people back into a kind of lifestyle and a life trajectory that their peers would expect and not to kind of compartmentalise them or place them in context which is going to exacerbate that sense of loss of status or of entrapment in a serious mental health problem. Your question was ‘well how can we help people recover?’ and so at one level I feel strongly it has to do with the way in which the values and the structures and the relationships that are a service for people who’ve had mental health problems is operated. Very very important. In our service we have a lot of young people who’ve recovered and their lives have moved on this trajectory and are employed in the service or come back to provide mentorship and support to their peers to sort of show them that life can be, you know, that life’s not come to a full stop because they’ve developed a mental health problem.  So I suppose that’s one, that’s a general level and something I feel very strongly about, the structure of mental health services, their relationships and their values.  I think that’s really, really important. At an individual level, OK, well how would you help someone recover and move along in life? Well, again as a psychologist, as we’ve been discussing in the earlier parts of our discussion, the way in which people, the kind of beliefs that people have and their early life trajectories and so on are, again, very important in trying to assess how you even help someone and move on.  So the kind of things that I’d be interested in is well, you know, what beliefs or appraisals do you have about having a mental health problem – appraisals of loss, shame and entrapment that we discussed earlier.  I’d be very interested in understanding particular beliefs people might have about certain experiences. We talked about voices earlier and I particularly would focus on how people fare and feel in their social relationships, because this is often the litmus test and the touch-tone of someone’s wellbeing, how at ease they feel in inter-personal relationships. So I’d focus on that a great deal and try to understand how people feel when they go into a kind of social context or a social relationship and what beliefs the individuals might have about what they think other people are thinking about them.  This is the cognitive behavioural tradition. So these sorts of beliefs and appraisals are the building blocks of the kind of cognitive behaviour therapy that is kind of well-known now and which is often misunderstood I think as being a kind of controlling, professionally driven therapy, whereas in fact it’s the complete opposite. It’s a therapy that helps individuals to understand how they are negotiating their way through particular life events at work or in particular social relationships and helps them to understand how their own assumptions about themselves or the world are brought to bear on a particular event or relationship that’s causing them distress. So it’s a very liberating kind of therapy and it’s the kind of therapy that is directed by the individual and the individual is completely in the driving seat. Well, at least that’s what a good cognitive behavioural therapist should do. It’s an empowering therapy and it enables individuals to understand and get control of particular situations causing them some distress.  So I think just in summary then, those two things for me are very important in trying to develop the social and service context in which people can recover and feel they can be liberated and fight free of some of the internalised stigmas and so on they may generate about their illness.  And also I work very much within a cognitive behavioural framework, as I say, a liberating one, enabling people to understand and to get control of their mental distress. 

And finally can I just ask one quick question about my experience in the past as a service user, experiencing a lot of mental distress, and my interactions with social workers and nurses, is that they are often very, they don’t know what to do with emotion when emotion arises in somebody and my very good therapist has told me that always honour your emotions, but not necessarily attach yourself to them so that you can go on, you know, when it’s inappropriate to be really upset and crying so that you can go on and live your life.   I think it’s very important, and I’d like your view on how emotionally intelligent people in the care services should be when they’re actually dealing with vulnerable people. 

Well, it’s interesting isn’t it? A lot of the training – for a lot of mental health professionals, I’m not going to pick any out in particular – it’s very much within the kind of conservative biomedical tradition that a lot of psychiatry follow, but I think it is true that in the training of a lot of mental health professionals we tend to focus on, you know, when someone has a diagnosis and delivering a certain kind of treatment and I’m not terribly good at learning to deal with and respond to distress, other than passing someone some tissues and feeling uncomfortable. It’s interestingly one of the reasons I think why a lot of carers actually don’t often receive the help and support they always need because a lot of carers are often very upset, for all sorts of reasons very angry, and sometimes that gets directed at mental health professionals. Now there’s quite a skill in being able to deal with that and not, as it were, taking it personally.  The emotional intelligence as you say and I think it’s one of the reasons actually why a lot of relatives don’t get a fair crack of the mental health services whip because mental health professionals are not very well, not very good and not very well trained at being able to deal with that. 

At the moment. 

At the moment, and translating that into something positive. 

Thank you very much. 

END OF RECORDING