Doctoral Presentation Jan 2009

Clearing the cobwebs of Clearing the cobwebs of misunderstanding about emotional misunderstanding about emotional

distressdistress

Psycho-educational booklets for Psycho-educational booklets for Primary CarePrimary Care

. Background context

. Motivations

. Methodologies

. Knowledge and outcomes

Secondary Care – open-ended therapy, minimal waiting period

Primary Care – brief therapy, lengthy waiting periods

8½ whole-time equiv. therapists8½ whole-time equiv. therapists

• 9 counsellors (6 wt equiv)9 counsellors (6 wt equiv)• 3 psychologists (2½ wt equiv)3 psychologists (2½ wt equiv)

Primary Care Psychology & Counselling ServicePrimary Care Psychology & Counselling Service

South West KentSouth West Kent

• 40 surgeries40 surgeries• 120 referrals per month120 referrals per month• Can serve 800 referrals per yrCan serve 800 referrals per yr• Receive 1500 referrals per yrReceive 1500 referrals per yr

• Brief therapy : 6-10 sessions +Brief therapy : 6-10 sessions +

• 1 PC Mental Health Worker1 PC Mental Health Worker

• Demand for psychology & counselling in Primary Care is high

• 1 in 4 GP patients present with a mental health problem

Waiting ListsWaiting Lists

• Our service : 5-12 monthsOur service : 5-12 months

• 85% Primary Care counselling services have 85% Primary Care counselling services have lengthy waiting lists (Burton, 1998)lengthy waiting lists (Burton, 1998)

• Impacts on : Impacts on :

-- clients and their families clients and their families distress distress-- therapists – professionally unethical + pressuretherapists – professionally unethical + pressure-- GPs – need to hold while waiting + pressureGPs – need to hold while waiting + pressure

Government RecommendationsGovernment Recommendations

• National Service Framework (NSF) – 1999National Service Framework (NSF) – 1999

- reduction of stigma through public education- reduction of stigma through public education- more consistent advice available to those in need- more consistent advice available to those in need- improving access and delivery of services- improving access and delivery of services

• NICE guidelines (National Institute of Clinical Excellence) 2004/5NICE guidelines (National Institute of Clinical Excellence) 2004/5

- self-help literature - self-help literature - psychological therapies - psychological therapies - medication- medication

• Stepped Care – less intensive, less intrusive firstStepped Care – less intensive, less intrusive first- self-help literature- self-help literature- guided self-help – CBT trained non-therapist **- guided self-help – CBT trained non-therapist **- Early Assessment - 1-2 sessions early intervention **- Early Assessment - 1-2 sessions early intervention **- brief therapy – individual and group **- brief therapy – individual and group **- longer term therapy- longer term therapy

• Group therapy :Group therapy :- Anxiety Management- Anxiety Management- Assertion- Assertion- Anger Management- Anger Management- Depression*- Depression*- Social Phobia*- Social Phobia*

Motivations for the projectMotivations for the project

Secondary Care Secondary Care Primary Care Primary Care open-ended, minimal wait brief therapy, long waitopen-ended, minimal wait brief therapy, long wait

Meeting with people I noticed :Meeting with people I noticed :• suffering for all that timesuffering for all that time• difficulties had become entrencheddifficulties had become entrenched• self-esteem had sufferedself-esteem had suffered• relationships had often sufferedrelationships had often suffered• a sense of helplessness and powerlessness evidenta sense of helplessness and powerlessness evident• perceived as personal failing or weaknessperceived as personal failing or weakness• wished they had understood soonerwished they had understood sooner

Reading referrals Reading referrals frustration & desire to share knowledge to : frustration & desire to share knowledge to :

• Increase understanding, self-empathy, self-compassionIncrease understanding, self-empathy, self-compassion• Provide guidance for self-managementProvide guidance for self-management

• Early assessmentsEarly assessments- a lot of information communicated- a lot of information communicated- when distressed memory & concentration affected- when distressed memory & concentration affected- need may be to listen & encourage emotional catharsis- need may be to listen & encourage emotional catharsis

• Brief therapyBrief therapy- time is a premium - time is a premium - approach or difficulty may not allow psycho-educative info- approach or difficulty may not allow psycho-educative info- need may be to listen & encourage emotional catharsis- need may be to listen & encourage emotional catharsis- a lot of information relevant to many, if not all - a lot of information relevant to many, if not all

• Group therapyGroup therapy- information as a guide for therapists and supplement for clients- information as a guide for therapists and supplement for clients

Provide booklets as an adjunct to Early Assessment, Brief and Group therapy Provide booklets as an adjunct to Early Assessment, Brief and Group therapy Resource for therapists and clients, and also able to be shared with loved onesResource for therapists and clients, and also able to be shared with loved ones

MotivationsMotivations (cont.) (cont.)

MotivationsMotivations (cont.) (cont.)

• Resource for GPsResource for GPs

- provide an alternative to medication while waiting- provide an alternative to medication while waiting

- psychological ‘treatment’ option for those choosing not to - psychological ‘treatment’ option for those choosing not to access therapy servicesaccess therapy services

- can be provided very early in the piece- can be provided very early in the piece

- educate themselves about psychological understandings- educate themselves about psychological understandings

““CBT-all-the-way” - going against the grain..CBT-all-the-way” - going against the grain..

• More than CBT manuals More than CBT manuals relational and generic relational and generic

- pure CBT not a good fit for services offering a variety of orientations- pure CBT not a good fit for services offering a variety of orientations

- experience in psychodynamic, person-centred, CBT, hypnotherapy, EMDR- experience in psychodynamic, person-centred, CBT, hypnotherapy, EMDR

- colleagues of various orientations – each has value - colleagues of various orientations – each has value

- Psychodynamic, person-centred, Gestalt, TA as effective as CBT- Psychodynamic, person-centred, Gestalt, TA as effective as CBT

- therapist qualities and therapy relationship most important factor - therapist qualities and therapy relationship most important factor

- CBT effective for some, not appropriate for all - CBT effective for some, not appropriate for all

- not all clients like CBT- not all clients like CBT

CBT in the NHSCBT in the NHS

20032003

• 1000 Graduate Primary Care Mental Health Workers (GPCMHWs) – 20031000 Graduate Primary Care Mental Health Workers (GPCMHWs) – 2003

- non-psychotherapists trained in CBT - non-psychotherapists trained in CBT guided self-help CBT guided self-help CBT

- no impact on waiting lists- no impact on waiting lists- still required therapy with qualified therapist- still required therapy with qualified therapist

20062006

• Improving Access to Psychological Therapies (IAPT)Improving Access to Psychological Therapies (IAPT)- £173 million for 3600 non-psychotherapists trained in CBT- £173 million for 3600 non-psychotherapists trained in CBT

- currently being implemented- currently being implemented

Motivations (cont.)Motivations (cont.)

• Learning from own experiences and from psychotherapy Learning from own experiences and from psychotherapy encounters, in addition to trained knowledgeencounters, in addition to trained knowledge

• Five types of emotional distress explored :Five types of emotional distress explored :- Anxiety- Anxiety- Depression- Depression- Post Traumatic Stress Disorder- Post Traumatic Stress Disorder

- Bereavement- Bereavement- Social Phobia- Social Phobia

• Selected for :Selected for :- prevalence and - prevalence and - personal and professional knowledge and experience- personal and professional knowledge and experience

What did I do and how did I do it?What did I do and how did I do it?

Three major components :Three major components :

- exploring the phenomena- exploring the phenomena

- identifying & communicating beneficial concepts & methods- identifying & communicating beneficial concepts & methods

- creating, evaluating and refining the narratives - creating, evaluating and refining the narratives booklets booklets

implementing the booklets in Primary Careimplementing the booklets in Primary Care

MethodologyMethodology

• Phenomenological Inquiry – inspiring and reflective of goalsPhenomenological Inquiry – inspiring and reflective of goals

To capture the essence of a phenomenon through To capture the essence of a phenomenon through

exploring the lived experience of itexploring the lived experience of it

as independent of existing knowledge as possibleas independent of existing knowledge as possible

What did I do?What did I do?

• 1st person inquiry – explored my own experiences1st person inquiry – explored my own experiences

• 22ndnd person inquiry – explored the experiences of others person inquiry – explored the experiences of others- written descriptions from those awaiting therapy- written descriptions from those awaiting therapy- analysis of case notes- analysis of case notes

• Concentrated ‘mulling’ periodsConcentrated ‘mulling’ periods

• Synthesis of knowledgeSynthesis of knowledge

• Reflection on individual and group psychotherapy encountersReflection on individual and group psychotherapy encounters

• Self-help – reflected on own experiences & psychotherapy encountersSelf-help – reflected on own experiences & psychotherapy encounters

How did I do it? How did I do it? Evaluation & Refinement of the NarrativesEvaluation & Refinement of the Narratives

• provided to colleagues and clients for informal feedbackprovided to colleagues and clients for informal feedback

• provided to participants and Early Assessment clients with provided to participants and Early Assessment clients with a guided feedback questionnairea guided feedback questionnaire

• piloted in two of our largest surgeriespiloted in two of our largest surgeries

communal perspectivecommunal perspective

The NarrativesThe Narratives

• Holistic experience – essential featuresHolistic experience – essential features

• Precipitating eventsPrecipitating events

• Elements of experience Elements of experience - emotional- emotional- physical- physical- perceptual/cognitive- perceptual/cognitive- behavioural- behavioural- relational- relational

• Self-help methods and strategiesSelf-help methods and strategies

The Discoveries..The Discoveries..

PTSD - 1PTSD - 1stst person experiences person experiences

- single incident trauma in childhood - single incident trauma in childhood + cumulative trauma period as a young adult + cumulative trauma period as a young adult concurrent post-traumaconcurrent post-trauma

- single incident traumatic experience in late 20s- single incident traumatic experience in late 20s

- deeper level response emerged- deeper level response emerged

First post-trauma experienceFirst post-trauma experience

- triggered watching a documentary about a similar experience- triggered watching a documentary about a similar experience

- suddenly overwhelmed with emotion- suddenly overwhelmed with emotion

- memory flooded back into the present- memory flooded back into the present

- emotion re-attached to memory- emotion re-attached to memory

Second post-trauma experience :Second post-trauma experience :

- traumatic assault - traumatic assault

- numb and detached - numb and detached - overwhelming need to get as far away as possible- overwhelming need to get as far away as possible- physical and emotional distance from others- physical and emotional distance from others- felt easily intruded upon- felt easily intruded upon- wary – on the lookout for threat- wary – on the lookout for threat- uncomfortable with anger, aggression, dominance- uncomfortable with anger, aggression, dominance- saw threat in innocent/innocuous people/situations- saw threat in innocent/innocuous people/situations- holding breath – waiting for ‘something’ to happen- holding breath – waiting for ‘something’ to happen

Statements extracted from written descriptions & case notesStatements extracted from written descriptions & case notes

Past projected into the presentPast projected into the present

It’s like a demon haunting me. Why? I’d shut it out for years.It’s like a demon haunting me. Why? I’d shut it out for years.

I’m reliving it.I’m reliving it.

Heightened sense of threat and vulnerability (for self and others)Heightened sense of threat and vulnerability (for self and others)

I constantly feel like I’m in danger. I constantly feel like I’m in danger.

I see everything as threatening.I see everything as threatening.

I feel gripped by fear.I feel gripped by fear.

I feel very vulnerable.I feel very vulnerable.

I imagine awful things are going to happen to family. I see images.I imagine awful things are going to happen to family. I see images.

I can’t walk my dog without fear of him getting stuck in a rabbit hole.I can’t walk my dog without fear of him getting stuck in a rabbit hole.

Hypervigilance to threat Hypervigilance to threat

It’s like I’m in a combat zone – always looking for danger.It’s like I’m in a combat zone – always looking for danger.

I ring my partner all the time to check he’s ok.I ring my partner all the time to check he’s ok.

I look around all the time scanning, thinking I’m going to be attacked.I look around all the time scanning, thinking I’m going to be attacked.

I check all the time. If I don’t look, someone could be there.I check all the time. If I don’t look, someone could be there.

Defensive, protective behaviours - loss of trust and securityDefensive, protective behaviours - loss of trust and security

I’m scared to take the barriers down. I’m scared to take the barriers down.

Now I don’t let anyone in. Now I don’t let anyone in.

I feel strangled in a relationship, and just want to get out.I feel strangled in a relationship, and just want to get out.

I’m afraid of trusting.I’m afraid of trusting.

I’m very wary, suspicious of others.I’m very wary, suspicious of others.

I won’t let someone else drive me. I avoid driving myself. I I won’t let someone else drive me. I avoid driving myself. I don’t trust other drivers. I don’t trust myself.don’t trust other drivers. I don’t trust myself.

Hypersensitivity to perceive threatHypersensitivity to perceive threat

I always think if someone looks at me, they’re going to attack.I always think if someone looks at me, they’re going to attack.

A new friend has a fridge in his garage. I thought he was keeping a A new friend has a fridge in his garage. I thought he was keeping a dead body in it.dead body in it.

I saw an old man with a shovel when I was walking the dog. I I saw an old man with a shovel when I was walking the dog. I thought he was burying a body.thought he was burying a body.

I think others are going to attack if I look at them.I think others are going to attack if I look at them.

I have a thing about people waiting behind a tree to slash my throat.I have a thing about people waiting behind a tree to slash my throat.

A sense of powerlessness and need to feel in controlA sense of powerlessness and need to feel in control

I feel like I’m not in control of myself and I don’t like it.I feel like I’m not in control of myself and I don’t like it.

Someone else has that power to take us out – like they did these people. Someone else has that power to take us out – like they did these people.

I need to feel in control.I need to feel in control.

In my dreams I feel small, powerless.In my dreams I feel small, powerless.

Imaginal protective defensesImaginal protective defenses

When I feel threatened, I get images of attacking others, dominating When I feel threatened, I get images of attacking others, dominating others and I feel good, powerful, invincible.others and I feel good, powerful, invincible.

When I walked past him I imagined him attacking me and myself grabbing When I walked past him I imagined him attacking me and myself grabbing the shovel and hitting him over the head, over and over.the shovel and hitting him over the head, over and over.

Intersubjective inquiry and immersion..Intersubjective inquiry and immersion..

• Developing awareness of similarities in presentationDeveloping awareness of similarities in presentation

• Projection of threat onto innocuous others universalProjection of threat onto innocuous others universal

• Interpersonal protective/defensive hostility Interpersonal protective/defensive hostility onlyonly in response to trauma in response to trauma involving personal violation involving personal violation

• Defensive/protective against fear of exposing vulnerability Defensive/protective against fear of exposing vulnerability emotional, physical, sexual, ‘spiritual’ emotional, physical, sexual, ‘spiritual’ annihilationannihilation

Observed from :Observed from :• Personal experience + written descriptions + case-notes Personal experience + written descriptions + case-notes + reflection on past & present psychotherapy encounters+ reflection on past & present psychotherapy encounters

Essence of Post Traumatic Stress..Essence of Post Traumatic Stress..

• Extreme and active sense of threat in the immediate presentExtreme and active sense of threat in the immediate present

Depression Depression focus on undesired past focus on undesired pastAnxiety Anxiety focus on unpredictable future focus on unpredictable futurePost trauma Post trauma avoidance of the past avoidance of the past

blanking of the presence of a futureblanking of the presence of a future focus on the immediate ‘threatening’ presentfocus on the immediate ‘threatening’ present

• Motivated by :Motivated by :- heightened sense of threat and vulnerability- heightened sense of threat and vulnerability- loss of trust in the safety/predictability of others/environment- loss of trust in the safety/predictability of others/environment- efforts to avoid, escape or protect the self from potential threat- efforts to avoid, escape or protect the self from potential threat

Post traumatic stress..Post traumatic stress..

- past projected into the presentpast projected into the present

- emotionally detached from surroundings and others- emotionally detached from surroundings and others

- energy acutely alert and focussed on keeping self/others safe - energy acutely alert and focussed on keeping self/others safe

- heightened perception of own and others’ vulnerability- heightened perception of own and others’ vulnerability

- on guard – waiting for something to happen- on guard – waiting for something to happen

- fears projected onto innocent situations and people- fears projected onto innocent situations and people

- protective/defensive behaviours- protective/defensive behaviours

- fear of exposing vulnerability or weakness - fear of exposing vulnerability or weakness

- avoid looking back but the past keeps intruding - avoid looking back but the past keeps intruding

- trapped in a present dominated by the past- trapped in a present dominated by the past

The Four Elements of AnxietyThe Four Elements of Anxiety

• Situation perceived as Situation perceived as unpredictableunpredictable or or uncertainuncertain - unsure how the situation will turn out- unsure how the situation will turn out - unsure how will react or handle the situation - unsure how will react or handle the situation - unsure about ability to handle the situation - unsure about ability to handle the situation

• Belief that you Belief that you lack controllack control - over event itself- over event itself - over physical and emotional reactions to event (anxiety itself)- over physical and emotional reactions to event (anxiety itself)

• Prediction or fear of a negative outcomePrediction or fear of a negative outcome - perceived as undesirable, intolerable and/or unacceptable- perceived as undesirable, intolerable and/or unacceptable

• Feel Feel hindered, blocked or trappedhindered, blocked or trapped - from escaping the situation and/or the associated feelings of anxiety- from escaping the situation and/or the associated feelings of anxiety - from potentially achieving some desired outcome- from potentially achieving some desired outcome

Extract from client written description..Extract from client written description..

“ “When anxious I often think – “this is doing me harm, my body, and it’s going When anxious I often think – “this is doing me harm, my body, and it’s going to kill me”. “My body won’t cope with all the chemicals it’s making” “I’ll have a to kill me”. “My body won’t cope with all the chemicals it’s making” “I’ll have a heart attack.” “I’ll collapse.”heart attack.” “I’ll collapse.”, , “then what will I do?” “How do I get help?” “then what will I do?” “How do I get help?” “What about the people with me? Will they be able to help?”“What about the people with me? Will they be able to help?”

Unpredictability of outcome – Unpredictability of outcome – Then what will I do?Then what will I do?Prediction or fear of a negative outcome – Prediction or fear of a negative outcome – Death, Death, heart attack, collapseheart attack, collapsePerceived lack of control – Perceived lack of control – How do I get help?How do I get help?Feel hindered, blocked, trapped from preventing – Feel hindered, blocked, trapped from preventing – Will they be able to help me?Will they be able to help me?

Complementary inquiry..Complementary inquiry..

• BereavementBereavement

-- exaggerated perception of omission or commission exaggerated perception of omission or commission guilt guilt

-- guilt often a factor in ‘unresolved bereavement’ guilt often a factor in ‘unresolved bereavement’

- holding onto the bereavement as a punishment - holding onto the bereavement as a punishment unresolvedunresolved

-- not ‘chronic depression’ but ‘unresolved bereavement’not ‘chronic depression’ but ‘unresolved bereavement’

Unresolved bereavement..Unresolved bereavement..

“… “….. I feel guilty because I was resentful of my mum’s illness and .. I feel guilty because I was resentful of my mum’s illness and dependency on me, before she died.dependency on me, before she died.

Dreams/nightmares have increased recently :Dreams/nightmares have increased recently : ..my mum has gone on holiday and I am left at home, but I don’t know ..my mum has gone on holiday and I am left at home, but I don’t know when she’s coming backwhen she’s coming back ..my mum is alive but everyone else thinks she’s dead. Sometimes this ..my mum is alive but everyone else thinks she’s dead. Sometimes this makes me feel like a fraud.”makes me feel like a fraud.”

FAULTY FILES I’m not ok.. You’re not ok..I’m vulnerable You’ll hurt me

don’t trust others don’t let others get too close

critical dominating bullying

(small %age of people)

Nice but also wary

Nice ( ≠ perfect)

Filter through which you view other people and situations.Also represents your protective defensive shield i.e. strategies you employ to defend/protect yourself from feared outcomes

such as negative judgement, rejection, disapproval.

critical dominating bullyingaggressive violent abusive

Negative Past Experiences What You See What is..

FAULTY FILTER

FAULTY FILES I’m not ok.. You’re not ok..I’m vulnerable You’ll hurt meI’m not safe You’re dangerousI’m not in control You’re not trustworthy don’t let others get too close

FAULTY FILING CABINET FUNCTIONAL FILES I’m ok .. You’re ok .. I’m powerful & have You could be decent nothing to fear You might be trustworthyI’m safe where I am. I’ll take a chance on you I create my own security I trust that you’ll respect me I’ll be careful, but I’ll give others a chance until I know for sure whether or not they’re trustworthy

FUNCTIONAL FILING CABINET

Dump the old faulty files.. Start gathering some new functional files..

Refining the Narratives..Refining the Narratives..

Depression….

What is it?

And what can I do about it??

!! Anxiety !!

What is it?

And what can I do about it?

Losing Someone You Love..Losing Someone You Love..

Post TraumaticStress Disorder

(PTSD)

The symptoms of depression can be divided into The symptoms of depression can be divided into four sections :four sections :

- emotions or feelings - emotions or feelings

- physical or bodily symptoms- physical or bodily symptoms

- behaviours- behaviours

- thinking / thoughts / perceptions- thinking / thoughts / perceptions

**You could tear off or copy the list below and place it somewhere to hand eg in a wallet or purse, near your phone or at a bedside table.**

----------------------------------------------------------

Who to Ring When I Really Need to Talk

____________________________________

____________________________________

____________________________________

____________________________________

_____Samaritans _____08457 909090___

“Provided light relief“

“The pictures help a lot.

Easy to scan and see what was relevant.

I really liked the boxes.

It was all ready to be used and telling you to take

control of the situation.”

“I like the writing style. It conveys a really positive

message.” (GP)

Anxiety booklet..Anxiety booklet..

Gulp.!Gulp.!Gulp.! Woohoo!

Anxiety can vary from mild to extreme according to how threatening you perceive the situation to be.

Social Phobia booklet..Social Phobia booklet..

Sometimes the person targeted just happens to be in the wrong place at the wrong time when a bully is looking for someone to victimise.

Confirmation..Confirmation..

• ColleaguesColleagues

““I love the pictures.”I love the pictures.”

““I really like the characters. They’re quite witty and lighten up the mood. I I really like the characters. They’re quite witty and lighten up the mood. I think this will help people feel less alien.”think this will help people feel less alien.”

• ParticipantsParticipants

““Thank you!! Very much. The up-beat way of writing has taken away the Thank you!! Very much. The up-beat way of writing has taken away the worry of anxiety. I know now what I suffer and have a good idea why and worry of anxiety. I know now what I suffer and have a good idea why and best of all what I can do about it!”best of all what I can do about it!”

Feedback from colleagues..Feedback from colleagues..

““I really enjoyed reading the booklets and found them very informative.”I really enjoyed reading the booklets and found them very informative.”

“ “These are well researched, lots of information.”These are well researched, lots of information.”

“ “It is very well done, I have learned a lot from receiving your project. “It is very well done, I have learned a lot from receiving your project. “

“ “I think this is a really useful piece of work and would like to have a copy I think this is a really useful piece of work and would like to have a copy when you’re concluded! I hope my comments are helpful – mostly on when you’re concluded! I hope my comments are helpful – mostly on sentence structure etc. – content’s great!”sentence structure etc. – content’s great!”

“ “This is phenomenal. I have total admiration for how much you’ve put into This is phenomenal. I have total admiration for how much you’ve put into these and wondered how on earth you’ve done it.”these and wondered how on earth you’ve done it.”

“ “Many thanks for preparing all these – they look excellent; really clear and Many thanks for preparing all these – they look excellent; really clear and positive. I’ll start using them on selected patients.” (GP)positive. I’ll start using them on selected patients.” (GP)

“ “You’ve done really well to write these in a style that suits all.”You’ve done really well to write these in a style that suits all.”

Feedback from clients/participants..Feedback from clients/participants.. “ “I read a lot of the depression booklet last night. I'm really impressed, I read a lot of the depression booklet last night. I'm really impressed,

it’s great and very well written. My first reaction was one of relief that I it’s great and very well written. My first reaction was one of relief that I could say that I can relate to the information I'm reading and I don't feel could say that I can relate to the information I'm reading and I don't feel so alone. This gave me hope and I felt eager to read more.”so alone. This gave me hope and I felt eager to read more.”

“ “The knowledge that your body is designed to respond in this way and The knowledge that your body is designed to respond in this way and can easily handle it is very reassuring.”can easily handle it is very reassuring.”

“ “I completely agree that finding a therapist with whom you feel I completely agree that finding a therapist with whom you feel comfortable is more important than the actual approach. At the time I comfortable is more important than the actual approach. At the time I thought I was failing with my second counsellor, but I now realise this thought I was failing with my second counsellor, but I now realise this was not the case. Other helpful suggestions, p60 focussing on others, was not the case. Other helpful suggestions, p60 focussing on others, p83 Lifeline – makes you think about contributing experiences that lead to p83 Lifeline – makes you think about contributing experiences that lead to depression and p64 Writing – I found this helpful.”depression and p64 Writing – I found this helpful.”

Feedback from clients/participants (cont.)Feedback from clients/participants (cont.)

Telephone Message :Telephone Message :

““He has received the PTSD information. It unnerves him that you have got He has received the PTSD information. It unnerves him that you have got into his brain. You couldn’t be more exact if you’d tried. He thinks it is into his brain. You couldn’t be more exact if you’d tried. He thinks it is spooky – he is going to call you Mulder in future. He feels very positive spooky – he is going to call you Mulder in future. He feels very positive and will have a lot to talk about at his next appointment.”and will have a lot to talk about at his next appointment.”


On the language of the booklets :On the language of the booklets :

““Very easy to understand. Not woolly. Informative and straightforward.”Very easy to understand. Not woolly. Informative and straightforward.”

“ “Not condescending and the author gives the impression of really Not condescending and the author gives the impression of really understanding depression and offers helpful suggestions.”understanding depression and offers helpful suggestions.”

“ “Very easy to understand. Very in depth and interesting.”Very easy to understand. Very in depth and interesting.”

“ “Having read a lot of booklets on anxiety given to me from past Having read a lot of booklets on anxiety given to me from past psychologists, I have read a lot of the same information over and over psychologists, I have read a lot of the same information over and over again but I found this booklet wasn’t unnecessarily long and there was a again but I found this booklet wasn’t unnecessarily long and there was a lot of useful, in depth information.”lot of useful, in depth information.”

Feedback from Group MembersFeedback from Group Members

“ “The handouts were informative and challenging and I found them very The handouts were informative and challenging and I found them very helpful to re-read at home. It helped me to re-affirm some of the group helpful to re-read at home. It helped me to re-affirm some of the group sessions. I have referred to the information several times.”sessions. I have referred to the information several times.”

“ “Looking back at them has shown me that I have become much more Looking back at them has shown me that I have become much more stable with the depression aspect of my emotions.”stable with the depression aspect of my emotions.”

“ “The handout information helps to refresh my memory. It’s like going to The handout information helps to refresh my memory. It’s like going to the group but not. You have something to take in and read. That has the group but not. You have something to take in and read. That has been very helpful since finishing the group.”been very helpful since finishing the group.”

The electronic era..The electronic era..

Accessible directly from GP via surgery website :Accessible directly from GP via surgery website :

““I think this is the best idea. Helping people understand that I think this is the best idea. Helping people understand that help is out there and you can try and help yourself through it. help is out there and you can try and help yourself through it. I would have felt a little more comforted if I had had this I would have felt a little more comforted if I had had this information sooner.”information sooner.”

recently implemented at the two pilot surgeriesrecently implemented at the two pilot surgeries

time and cost effectivetime and cost effective


“ “It gave me an overwhelming understanding. The way you word it is just It gave me an overwhelming understanding. The way you word it is just

right. I gained a real understanding of why. This is the first time I have right. I gained a real understanding of why. This is the first time I have ever felt so understood. There were so many things that fitted. When I ever felt so understood. There were so many things that fitted. When I was attacked something snapped. Now I’m more self aware of the was attacked something snapped. Now I’m more self aware of the reactions I’ve had since the attack. I’m more aware of the extent of PTSD reactions I’ve had since the attack. I’m more aware of the extent of PTSD related symptoms.related symptoms.

..

..

..

I really did relate to the way you worded it. The way you simplify it to a I really did relate to the way you worded it. The way you simplify it to a mediocre way of explaining it, even though you have all that professional mediocre way of explaining it, even though you have all that professional knowledge and words. You feel like you’ve achieved some understanding. knowledge and words. You feel like you’ve achieved some understanding.

And the saying, ‘That was back then, this is now’ – do that now, say it to And the saying, ‘That was back then, this is now’ – do that now, say it to yourself. That has helped me so much. I say that to myself. yourself. That has helped me so much. I say that to myself.

I realise now, I have got a good future ahead of me. I have a sense of I realise now, I have got a good future ahead of me. I have a sense of

calm, of being who I really am. I feel like I’ve crawled out of the flames.”calm, of being who I really am. I feel like I’ve crawled out of the flames.”

Doctoral Presentation Jan 2009

Documents

Transcript of Doctoral Presentation Jan 2009