Psychological Therapies Away Day

It's the end of June and last night the heating was put on in the house. Yet I still saw people walking in town this morning wearing SHORTS! It feels like early spring to me. I've gotten to the point where I am not as conscious about sticking out because of what I'm wearing. The 30 minute walk to and from work is much more pleasant when I am dressed appropriately for the weather. 

Yesterday I spent the day with the Psychological Therapies team at the Edinburgh Royal Infirmary for an "Away Team Meeting." One of my coworkers picked me up from the middle of town which was really nice, so I did not have to walk to whole mile and a half yesterday to get to the hospital! The first half of the day consisted of presentations and updates from different therapists about their specific delivery models of therapy, reports on what is going on in the different groups that are being run, as well as some sharing of information about changes going on in the NHS that may influence the structure of services provided. 

There is a movement in the NHS of East Lothian towards a more "trauma- informed approach" to assessment and therapy. In the East Lothian section of the NHS, trauma is a common factor in many of the cases seen, whether it be lengthy physical or sexual abuse, an abrupt loss of a loved one due to violence, or an isolated incident of trauma such as rape. But the psychological therapies services of the NHS don't seem to really do acute care - that is another branch. These services are for patients who may have had many years pass since the incident and who are "ready" for a psychological therapy such as CBASP. It's an interesting difference in the USA system. Since mental health care is privatized in the States, if people have insurance, they likely have much faster access to services. There are other options in the community too for crises. But the NHS, because it is government funded and free for all Scotland's residence, there is a long waiting list. The target for waiting for psychological therapies right now is at an 18week wait list. When I heard that I was amazed. That is SUCH a long time! But people can choose to NOT go through the NHS directly. There are services in the community that are free as well, as well as private practitioners that are paid directly. 

One part of the day that I really liked was getting back to case conceptualization. This was interesting to me because instead of in a class (which was great) it was hearing how all of these different professionals think about their cases. We split into groups and talked about issues such as what past life experiences are important to consider when conceptualizing a case, what if there isn't history provided and the the patient does not want to talk about the past,  The facilitator liked my answer to the question, so that made me happy. Being a student and a foreigner  I think I'm definitely judged a little bit more intensely than others on what I say because I'm from somewhere quite different. I am being exposed to so many different thoughts, brand new theories and therapy models I haven't heard of before, and also a different lens of social context that everything is viewed through. It think that is really going to help me once I return to school. 

It seems here that CBT still has a very large following because it is an "evidence based therapy," and like insurance companies, that is what the government prefers to pay for. However, interpersonal therapy is also very present. Therapies such as CBASP seem to have a basis in both CBT and IPT. I really had not heard of CBASP before, but apparently the therapists here who are trained and certified in this model received their training in Richmond, Virginia! Dialectical Behavioral Therapy is also done here - there is a whole group therapy section devoted to it. Some other groups include "Mindfulness," " Manage your Mood," and "Survive and Thrive." It is interesting to me because while the groups in theory are patient lead depending on symptom and diagnosis, there are some that are labeled by the therapeutic model used, such as CBASP. Also, groups are not started until there are enough patients that have been referred to them. Because of this, sometimes groups are not run that often.

 The second half of the day was spent discussing these groups, which ones we think are needed, if there are better ways to meet the needs of the population than with the ones we have, as well as how we can create a trans-therapeutic format for groups. Most people said that they prefer to have less structured groups and let the patients lead, have it be loose in structure, but with some of the more psycho-educational groups such as "Stress Management" a format is really necessary. 

Tomorrow I will participate in the exercise group again. I think the soreness from last week has finally worn off!