The Psychologist May 2021 by The Psychologist

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psychologist may 2021

Living with cancer

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psychologist may 2021

contact The British Psychological Society 48 Princess Road East Leicester LE1 7DR 0116 254 9568 info@bps.org.uk www.bps.org.uk the psychologist and research digest www.thepsychologist.org.uk www.bps.org.uk/digest www.jobsinpsychology.co.uk psychologist@bps.org.uk

Living with cancer

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Twitter: @psychmag Download our iOS/Android apps advertising Reach 50,000+ psychologists at very reasonable rates. CPL, 1 Cambridge Technopark Newmarket Road Cambridge CB5 8PB contact Krishan Parmar 01223 378051 krishan.parmar@cpl.co.uk april 2021 issue 51,773 dispatched cover Illustration by Soﬁa Sita https://soﬁasita.com environment Printed by PCPLtd

issn 0952-8229 (print) 2398-1598 (online) © Copyright for all published material is held by the British Psychological Society unless speciﬁcally stated otherwise. As the Society is a party to the Copyright Licensing Agency (CLA) agreement, articles in The Psychologist may be copied by libraries and other organisations under the terms of their own CLA licences (www.cla.co.uk). Permission must be obtained for any other use beyond fair dealing authorised by copyright legislation. For further information about copyright and obtaining permissions, e-mail permissions@bps.org.uk.

The British Psychological Society It provides a forum for communication, discussion and controversy among all members of the Society, and aims to fulﬁl the main object of the Royal Charter, ‘to promote the advancement and diffusion of a knowledge of psychology pure and applied’

The Psychologist needs you! We rely on your submissions throughout the publication, and in return we help you to get your message across to a large and diverse audience. For details of all the available options, plus our policies and what to do if you feel these have not been followed, see www.thepsychologist.org.uk/contribute The main message, though, is simply to engage with us. Contact the editor Dr Jon Sutton on jon.sutton@bps.org.uk, or tweet us on @psychmag.

Managing Editor Jon Sutton Deputy Editor Annie Brookman-Byrne Production Mike Thompson Journalist Ella Rhodes Editorial Assistant Debbie Gordon Research Digest Matthew Warren (Editor), Emily Reynolds, Emma Young

Associate Editors Articles Paul Curran, Michelle Hunter, Rebecca Knibb, Adrian Needs, Paul Redford, Sophie Scott, Mark Wetherell, Jill Wilkinson History of Psychology Alison Torn Culture Kate Johnstone, Chrissie Fitch Books Emily Hutchinson Voices in Psychology Madeleine Pownall Psychologist and Digest Editorial Advisory Committee Richard Stephens (Chair), Emma Beard, Kimberley Hill, Sue Holttum, Deborah Husbands, Peter Olusoga, Miles Thomas, Layne Whittaker

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Letters Education, recruiting, learning disability and more

Obituaries

News Covid and community, protest and more

Digest How to train your senses; being ‘tolerated’; and more

Beyond borders in applied psychology Nick Hammond and Nikki Palmer ask whether we are united by commonality or divided by difference

‘You should be over cancer by now’ Cordelia Galgut on living with the long-term effects of cancer

‘Filtering down psychological thinking into cancer care: that’s how we make a difference’ We meet Sahil Suleman

‘We’re all ﬁghting the same battle, with different journeys’ Kate Fulton and Rachel Trimmer on cross-sector working in cancer care ‘Cognitive control can improve the quality of life of women with breast cancer’ Nazanin Derakhshan ‘I can’t remove every obstacle that myeloma patients will face… but I can provide support’ Sarah Dempsey

Careers Ian Florance hears about Assistant Psychologist roles and more from Liam Myles; and talks elite sport and more with Amanda Gatherer

Jobs in psychology

Books Ginny Smith on brain chemicals; and we talk family with Susan Golombok

Culture Carolyn Mair talks identity and more with playwright Paul Anthony Morris

Looking back Francis Huxley and the human condition, by Ron Roberts and Theodor Itten

One on one Mohammadrasool Yadegarfard

This month we have a collection on cancer, and on 18 May a webinar (free to BPS members) on living with and beyond cancer. See p.49 for details. As part of that, it was a pleasure to speak with Dr Sahil Suleman. His drive to work in a crossand inter-disciplinary manner, and to instil a generally psychological approach across the workforce, is something I often encounter in the very best psychologists. ‘We aren’t the arbiters of all knowledge’, we’re just one part of the puzzle, he told me. ‘The key is being as accessible as possible to as many people as possible.’ What is a psychologist? Where, when and how do they work? Are shared values identiﬁable and important? Would a focus on contexts and competencies serve the public better than division and domain? These are huge questions The Psychologist has been grappling with for many years, and will continue to do so… including throughout the issue this month (see p.5, p.10 and p.22). Dr Jon Sutton Managing Editor @psychmag

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Your friendly neighbourhood Psychologists… T

he Community Action and Resilience workstream of the British Psychological Society’s Covid-19 response have launched a ‘resources hub’ which, they say, ‘takes a different approach’ and signposts new ways of working for Psychologists as the world seeks to ‘build back better’. Dr Carl Harris, a Clinical and Community Psychologist based in Birmingham and co-Chair of the group, told us: ‘Some of the other Covid working groups in the BPS have been rapid and focused on producing guidance, whereas we’ve maybe been more slow and steady. We’ve looked to produce and signpost a range of different resources, including articles, videos, infographics, and dialogues with community groups to showcase their vital work and what’s needed for marginalised communities in response to the pandemic. The hub is the consolidation of that. Pulling it together has been a real community effort!’

Learning from the community

The hub features ‘co-created’ content, and Dr Sally Zlotowitz (Community and Clinical Psychologist and also co-Chair) said: ‘We wanted to hear directly from community groups and activists about how they have responded to Covid-19. But in the end we had to do it based on the relationships that we had, because we weren’t able to pay people to participate – something we have challenged the BPS about. These groups can often be consulted in a “box ticking” way: they never hear

what’s happened to their input, so we have tried our best to ensure there have been feedback loops. We also want to encourage people to act on what they learn from these groups, such as on what the asylum seeker and refugee advocates told us about how people can help (see www.bps.org.uk/coronavirus-resources/communityaction/outputs).’ Dr Rebecca Graber (University of Brighton) said the group are ‘keen to amplify the voices of those groups we’ve engaged with. Another example is the work we did with Fiona Sharp. She was talking about the people in the community who’ve been doing frontline support work, but they’re not ﬁrst responders like medics. They’ve been in it for the long haul, without preparation. Those people also need support and partnership from psychologists, to process what they have been through.’ There are resources relating to the experiences of immigrants, refugees and asylum seekers, people with disabilities, those in the criminal justice system and much more. A section on Community Psychology Practice summarises actions psychologists can take in their teams and services right now.

Transforming adversity The group outline their primary aim as recognising the role that communities have played in looking after each other and our essential workers, ‘and in doing so speak

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up for the importance of strengthening communities and inclusive participation processes as we try to #buildbackbetter after this pandemic’. They advocate for a focus on resilience, but centering on Professor Angie Hart’s deﬁnition as ‘Overcoming adversity, whilst also potentially changing, or even dramatically transforming, (aspects of) that adversity’. Whilst community action during the pandemic has brought this resilence to the fore, the group argue that ‘we must not lose sight of the fact that many communities have long faced and struggled to overcome adversity. In particular, we recognise the ways in which structural oppression threatens this resilience and government policies exacerbate, rather than relieve, adversity. Highlighting the nature of these forms of resistance are well within the remit of a psychological approach to the response to the pandemic.’

Working differently This emphasis has implications for the jobs Psychologists may seek to create in the ‘new normal’. Dr Rachel Morley, a Clinical Psychologist on the group, said: ‘One of the things we’re hoping to change is the way that psychologists think about what they do, what they regard as their role. How do we take what we now know about social inequality and the importance of community responses more seriously, and how does that build into our practice?’ This discussion has led to a ‘Neighbourhood Psychologist job description’ [tinyurl. com/bpsneighjd] – ‘prepared by all members of the workstream, but special mention must go to Carolyn Kagan’s input’. The document includes case examples of ‘working differently’. A person specification calls for ‘a range of psychological skills, knowledge and experience to enhancing community resilience, citizen empowerment and positive place identity’. The emphasis is on supporting the local authority, in developing their workforce, and on ‘participatory, asset-based working with local communities’. We put it to Carl Harris that the ‘community’ feel seemed to underpin all this activity: that it is not about working with people from a position of power and expertise, or a place that privileges knowledge, training and qualifications. ‘Yes, I think that’s fair’, he said. ‘The world, and our position in it as Psychologists, is changing all the time. Listening should be at the forefront of everything we do. Build reflective and reflexive practice skills and put these at the heart of every aspect of the work. Know when to pull back and be able to respect and work with a position of “not knowing”. Ultimately, we want Psychologists to offer expertise to their community in a spirit of partnership and curiosity.’ JS Find the hub at www.bps.org.uk/coronavirus-resources/ community-action. Find more community psychology in our archive https://thepsychologist.bps.org.uk/festivalcommunity-psychology – and we plan to follow up with members of the Community Action and Resilience group over the coming months.

‘Recovery will need to be the creation of a future’ A British Academy report has suggested the social, cultural and economic impacts of Covid-19 will persist for at least a decade. The authors, including experts in psychology, history, social and public policy and geography, explored evidence of the potential societal effects of the pandemic in three key areas – health and wellbeing, communities culture and belonging, and knowledge, employment and skills. The Covid Decade: Understanding the long-term societal impacts of COVID-19 was commissioned by the government’s Chief Scientific Advisor Sir Patrick Vallance. It was led by Professor of Social Psychology Dominic Abrams (University of Kent) who also led on an accompanying report Shaping the COVID decade, which considers gaps in public policymaking. Many of the impacts of Covid-19, the authors wrote, are likely to be an acceleration of existing trends and pointed to nine areas of longterm societal impact. These included the exacerbation of structural inequalities and health inequalities, a greater awareness of the importance of mental health, as well as a decline in both trust in the UK government and feelings of national unity. Our editor Dr Jon Sutton recently spoke with Dr Rowena Hill (Nottingham Trent University), a member of the now-decommissioned cross-governmental C19 National Foresight Group, for the third time since the start of the pandemic. They discussed uncertainty and recovery in the face of Covid-19. In an earlier interview Hill had spoken of the pandemic in terms of phases of response, adaptation, stabilisation and recovery. She said that in terms of the recovery phase, we needed to accept that recovery to what we were is not possible. ‘It’s not about restoring what we had… Recovery following Covid-19 will need to be the creation of a future. We need to create new norms which accommodate adaptation and stabilisation phases. We need to do that for the next two to five years until we learn to successfully live alongside Covid-19 and manage it as best we can, so we will continue to be in all four stages simultaneously for the next few years. Then we can move with more certainty to the new future.’ People, organisations, communities and sectors have a need to plan, Hill said, but the pandemic is not over, and no one can say when it will be. ‘We talk a lot in interventions and emotional wellness of sitting with uncertainty, but we’re asking people to engage with uncertainty as a necessity and try and live successfully with it.’ Hill pointed to ‘the true energy and blend across our work and home domains’ as an area which ‘needs innovation and a different approach. How can we truly achieve a healthy work life balance, rather than treating everything as a relentless “to do” list? This would also offer learning to sectors and roles which cannot work from home too. The psychological challenge to gather and focus enough energy, flexibility and agility to look at all the current and future adaptations we will need to make, and the creation and move to a new future, is also a great psychological challenge. Do we have enough left in the tank after everything we continue to go through to do it with kindness, equity… and to do it well?’ ER

For the British Academy report see tinyurl.com/BAcoviddec For the interview with Rowena Hill see thepsychologist.bps.org.uk/ recovery-will-need-be-creation-future

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In a bid to raise the proﬁle of psychology in the care of those with lung conditions, as well as research on these conditions, members of the European Respiratory Society have created a new subgroup for psychologists and behavioural scientists. As part of a wider group for allied respiratory professionals, the new sub-group will also provide opportunities for networking, shared learning and practice. Lisa Brighton (King’s College London) a researcher working with people with respiratory disease, has been promoting the creation of the new subgroup. She said, given that one in ﬁve people in the UK have ever had a respiratory condition,

for example, asthma or chronic obstructive pulmonary disease, many psychologists will at some point work with someone with a respiratory condition. She added that many psychologists may be working in other areas of health where they may have useful transferable learning to share with those working in

respiratory research and care. ‘I think there has been an increasing recognition in clinical and academic respiratory work about the wider impacts of respiratory disease on psychological health, but also the importance of thinking about psychological and behavioural factors in an area where supported selfmanagement is hugely important. Altogether I’d hope this is part of an increasing focus on approaches to health, including respiratory care, that are more holistic and integrated.’ ER

To ﬁnd out more see tinyurl.com/3s7t8uc6 and tinyurl.com/3d8bbpbt

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The Anna Freud Centre has launched a free online information hub for those working in secondary schools and further education settings. Mentally Healthy Schools brings together mental health resources and guidance including lesson plans and activities. A recent report by the centre found that, in a survey of 3000 young people, 93 per cent said they would like to see mental health being brought into the classroom and for conversations about mental health to be normalised in schools and colleges. As well as its new collection of resources for secondary schools and further education colleges, Mentally Healthy Schools also has a primary school hub which has been accessed more than one million times. To access the resources visit: mentallyhealthyschools.org.uk

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Five minutes with… Dr Vuokko Wallace Dr Vuokko Wallace is a clinical psychologist, lecturer and clinical tutor on the University of Bath’s Clinical Psychology doctorate course, who also works as a patient-led researcher exploring the congenital birth defect oesophageal atresia (OA) after being born with the condition herself. OA is a rare congenital condition of the oesophagus and trachea that requires surgical repair in infancy as the upper part of the oesophagus does not connect with the stomach. Dr Wallace has recently published a study in the Journal of Pediatric Nursing on anxiety and depression in parents of children born with OA (known in America as esophageal atresia or EA). Could you tell me about your experience as a patient-led researcher – what led you down this path? I have a long-term interest in health psychology and my clinical experience includes working with children with complex health needs and their families. One of the reasons why I am interested in the paediatric health ﬁeld is my own experience of living with a rare health condition. This has led me to work with a patient charity TracheoOesophageal Fistula Support (TOFS) and to be involved both as a patient member of the charity and a professional member in the charity’s Medical Advisory Group. I am also a member in the International Network of Esophageal Atresia (INoEA)

Transition Working Group, which works to develop multidisciplinary treatment guidelines for the transition from paediatric to adult health care for patients born with OA. Again, I am in the group both as a patient member and as a professional clinical psychologist. It is recognised that living with a rare health condition can impact on people’s mental health. The TOFS charity is committed to engaging with health professionals and supporting research in OA. I realised that I could use my research skills together with my expertise as a patient to help the TOFS charity to develop a better understanding of the psychological needs and mental health of families affected by OA. This has led to my own research focussing on the psychological impact of OA on families and starting a PhD in the University of Eastern Finland. I have also supervised two MSc projects looking at psychological wellbeing and mental health in adults born with OA and I am currently supervising a DClinPsy student research project on people’s experiences of transition from paediatric to adult health care in OA. Could you tell me about your study on anxiety and depression in the parents of children born with OA/EA please? It was an international online survey study, recruiting parents of children born with OA. A total of 240 parents from 17 countries took part in the

News online: Find more news at www.thepsychologist.org.uk/reports For much more of the latest peer-reviewed research, digested, see www.bps.org.uk/digest Do you have a potential news story? Email us on psychologist@bps.org.uk or tweet @psychmag.

To read Wallace’s open access paper see: tinyurl. com/3rj8s6af

study. We found that it was common for parents whose children were born with OA to experience both anxiety and depression and that anxiety and depression were more common in younger parents, and in parents who felt they had less support for caring or experienced more stress related to caring, and those who had financial difficulties. These findings show that parents of children born with OA need more support. Interestingly, we also found that anxiety and depression were more common in parents whose child had OA-related feeding difficulties, which suggests a need for more research on the unique challenges related to the feeding problems and their emotional impact for parents of children born with OA. What are your research plans for the future? I am currently analysing qualitative data from the same survey to investigate the parents’ experience of feeding their young child born with OA, many of whom have swallowing problems. Understandably, swallowing problems can cause anxiety and psychological interventions could potentially be helpful for this. There are currently some research developments for adapting psychological interventions for swallowing problems in adults but very little research on the impact of children’s swallowing problems on families.

How to train your senses Emma Young digests the research

Find our Research Digest at www.bps. org.uk/ digest Editor: Dr Matthew Warren Writers: Emily Reynolds and Emma Young Reports, links and more on the Digest website

We’re all familiar with the phrase ‘healthy body, healthy mind’. But this doesn’t just refer to physical ﬁtness and muscle strength: for a healthy mind, we need healthy senses, too. Fortunately, there’s now a wealth of evidence that we can train our many senses, to improve not only how we use our bodies, but how we think and behave, as well as how we feel. Trapped as we are in our own ‘perceptual bubbles’, it can be hard to appreciate not only that other people sense things differently – but that so can we, if we only put in a little effort. But if we’re going to make the most of using and improving our senses to enhance our wellbeing, we have to consider more than sight, hearing, taste, touch and smell. Aristotle’s desperately outdated ﬁve sense model may still be popular, but it vastly underestimates our extraordinary human capacity for sensing.

Proprioception Proprioception – the sensing of the location of our body parts in space – has been relatively ignored, but it’s critical for conﬁdence in using our bodies. If you now shut your eyes, and extend a leg, it’s thanks to this sense that you know exactly where your leg is. To go for a run, then, or work out in the gym, and not fall or injure yourself, you need a good sense of proprioception. Our sedentary lifestyles are a threat to this sense (and the Covid-19 lockdowns certainly did not help). But climbing trees,

walking along balance beams, navigating obstacles, crossing stepping stones (which you can simulate at home, using small mats placed on the ﬂoor) are all proprioceptively demanding, and so train this sense. According to research by Ross Alloway and Tracy Packiam Alloway at the University of North Florida, these kinds of exercises not only improve physical coordination but also working memory. Yoko Ichino, the ballet mistress at Northern Ballet, based in Leeds, teaches regular proprioception classes, during which students are required to practise complex moves with their eyes shut. ‘We use our eyes too much,’ Ichino says. ‘We need to use all our other senses as well but because our eyes are open all the time, we never develop them. So I put that into my own training.’ She recommends (if it is safe) to move around your home with your eyes closed. This will train not only proprioception but another suite of senses…

Vestibular senses

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Our vestibular system allows us to sense the direction of gravity (and so which way is up), as well as horizontal and vertical movement (as in a car or a lift) and in three dimensions (as on a rollercoaster). Research shows that a healthy vestibular system is important not only for balance but for our sense of being grounded inside a physical body; in fact, people with vestibular problems are more likely to report out-of-body experiences. They’re also more likely to get lost, because a healthy vestibular system is important for a good sense of direction. For all of us, though, the older we get, the duller all our vestibular responses become. (This becomes noticeable at a population level from the not very grand old age of 40). Specific vestibular rehab training exercises have been developed for people diagnosed with definite vestibular problems. But the rest of us will benefit from dynamic movements that require moving the head, like those involved in climbing a tree or practising tai chi, as well as anything that challenges our balance.

Light-detection

We know that our eyes are not just for seeing. When melanopsin-expressing cells in the retina are exposed to light, they send signals to the master body-clock, in the brain’s hypothalamus (without causing us to see a thing). Certain variations in the gene for this protein have been linked to an increased risk of Seasonal Affective Disorder, and stimulating these receptors in the morning with suitable levels of light helps to ward off low mood.

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To improve psychological wellbeing, you don’t need to train these receptors to work better, but you do need to help them to work for you by getting outdoors in the morning and avoiding bright light in the evening.

Smell Smell is not hugely regarded, or developed, in many people in Western cultures. But research with huntergatherer groups, such as the Jahai, who live in the tropical rainforest in Malaysia, shows that we have the biological capacity to smell extraordinarily well. Asifa Majid, now at the University of York, and colleagues, found, for example, that the Jahai took on average only two seconds to precisely describe an odour, while Dutchspeakers took an average of 13 seconds to arrive at a much poorer description (describing the scent of a lemon simply as ‘lemony’, say, rather than using more abstract descriptions). To develop your sense of smell, Majid, and others, advocate consciously smelling different things, often. Professional perfumer Nadjib Achaibou, who is based in London, tells me that his sensitive nose is absolutely trained, not born. The best way to enhance your sense of smell is to use it, and explore it, he argues: ‘You might say, “Oh, I like pepper”. Why? Why do I like it? What is it adding to your dish? That’s the first step to enhance your sense of smell. If you see a rose, stop and smell it. If you have a friend wearing perfume, smell the perfume and describe it. When you buy a shower gel, a toilet detergent or a perfume, ask questions. Read the marketing materials, but also trust yourself. You might think, yes they say there is rose in that but what I can smell is lemon. But what kind of lemon?’ Put in the effort to enhance your sense of smell, and you should enjoy all kinds of other benefits. A 2015 study led by David Lee shows that a fishy smell improves our critical thinking, for example, while a 2018 study in Germany [tinyurl.com/x339kk7p] found that people who are more sensitive to smells enjoyed sex more, and women with a better sense of smell reported more orgasms. ‘The perception of body odours such as vaginal fluids, sperm and sweat seems to enrich the sexual experience,’ by increasing sexual arousal, they wrote.

Temperature We have receptors in our skin that register temperatures within speciﬁc ranges. Stimulation of our ‘warmthsensors’, in particular, has been linked to feeling less lonely, and also ‘warmer’ towards other people. Some of the most-publicised results in this ﬁeld have failed to replicate, leading critics to question them. However, a 2019 study in Social Psychology from Adam Fay and Jon Maner suggested that results might have been mixed because researchers weren’t taking into account the ambient temperature outside, or inside the lab. When they did this in their research – which involved strapping heated backwraps to participants and asking them about their social plans – the team found support for the idea that feeling cold physically is associated with feeling ‘colder’ socially, driving a desire for more contact with

other people. Providing heat (via the backwrap, in this case) could eliminate this effect.

Inner sensing (interoception) About 10 per cent of us are really good at sensing our own heartbeat without feeling for a pulse, 5-10 per cent of us are terrible at it, and the rest fall in between. Research (for example by Hugo Critchley and Sarah Garfinkel) shows that people who are better at socalled ‘cardiac interoception’ experience emotions more intensely, enjoy more nuanced emotions, and are better at recognising other people’s emotions, which is a critical first step in empathy. In contrast, people who don’t experience emotions in the typical way (a condition called ‘alexithymia’, which is thought to affect up to 10 per cent of people, to some extent) suffer from impairments in inner sensing. Could training inner sensing help, then, to improve our emotional wellbeing? It’s still early days for this research, but work led by Garfinkel, now at University College London, suggests that it can. This is a training technique that you could try at home: 1. Sit somewhere quiet and set a timer (on your phone or home digital assistant, perhaps) for one minute, but don’t start it yet. 2. Now start the timer, and try to count your heart beats. 3. Do this again, but feel for your pulse this time, to take an accurate measure (this is the feedback that should help your interoceptive awareness to improve). 4. Repeat all the steps. If you can’t sense your heart beating, try exercising first, because this makes it easier. EMMA YOUNG, RESEARCH DIGEST WRITER, IS THE AUTHOR OF SUPER SENSES: THE SCIENCE OF YOUR 32 SENSES AND HOW TO USE THEM (JOHN MURRAY, 2021).

Being ‘tolerated’ takes its toll Tolerance is often touted as a progressive value, a way of ensuring that society offers equal opportunities to all. But it can also imply ‘putting up with’ something or someone you fundamentally disagree with or dislike – being tolerated isn’t the same as being genuinely valued or respected, for example. As one writer puts it, tolerance has echoes ‘of at best grudging acceptance, and at worst ill-disguised hostility’. Now a new study in the British Journal of Psychology has found that the experience of being tolerated takes its toll on the wellbeing of ethnic minorities in the United States. Sara Cvetkovska from Utrecht University and colleagues find that the experience of being tolerated is closer to discrimination than it is to acceptance – impacting overall wellbeing and increasing negative mood. In the first study, the team looked at how wellbeing related to the experience of being tolerated, compared to being accepted or discriminated against outright. Participants were non-white, belonged to a racial or ethnic minority group, and ranged from 17 to 73 years old. First, participants answered questions about how frequently they felt they were being tolerated, accepted or discriminated against in several social contexts – at work, school, during leisure activities, at clubs or organisations, in their neighbourhood, on social media and overall. Tolerance was described as people objecting to particular cultural beliefs or practices but ‘putting up’ with them nonetheless; discrimination referred to unjust treatment; while acceptance was described as a genuine appreciation for certain practices or ways of life. Participants then rated themselves on five facets of wellbeing: positive and negative affect, self-esteem, life satisfaction and a sense of control. And while perceived acceptance, unsurprisingly, was associated with greater positive wellbeing, tolerance was associated with lower levels, with discrimination associated with the lowest levels of all. Getty images

In the second study, participants were asked the same questions about how often they felt they were being tolerated, discriminated against or accepted. This time, they also took part in a writing exercise, describing a particularly vivid instance of tolerance, discrimination or acceptance which they or someone they know had experienced. Participants then completed wellbeing measures as in the first study. Once again, tolerance appeared to be an intermediate state for participants: wellbeing was higher in the tolerance condition than it was in the discrimination condition, but not as high as in the acceptance condition. But only positive and negative mood were affected by the writing task – more stable facets of wellbeing like self-esteem and perceived control were not. In the final study, participants read that they worked at a company with a ‘casual Fridays’ dress code. On one Friday they had come to work wearing a shirt with symbols reflecting their ethnic group: in the acceptance condition, their boss complimented them on the t-shirt and expressed interest in understanding its significance; in the tolerance condition the boss disapproved of the t-shirt but allowed it to be worn due to ‘freedom of expression’; and in the discrimination condition the boss actively banned the t-shirt from the workplace. The participants then reported their positive and negative affect and how much the experience would threaten their identity – for example how negatively they felt about themselves or how powerless they thought they were. Again, tolerance was linked to greater wellbeing than discrimination but lower than acceptance. This time, people’s sense of identity was less threatened in the acceptance condition than in the tolerance condition. There was no significant difference between the discrimination and tolerance conditions in terms of social identity threat, however, suggesting the two, once again, are intimately linked. Overall, the results suggest that ‘tolerance’ may not be the best way of thinking about diversity. Though tolerance had less of a negative impact than discrimination, and while the two are distinct experiences, it was still linked to lower wellbeing than acceptance. This may be, as the team suggests, because tolerance shares the same negative appraisal of minority identity as discrimination – it’s just a bit more polite about it. Future research could separate out responses somewhat: how an indigenous person experiences discrimination or tolerance is unlikely to be identical to the way a Black person would, for example. It would also be interesting to explore different kinds of relationships – in the final study, for example, the individual tolerating, accepting or discriminating was a boss. How would such behaviour impact wellbeing coming from a professional peer, another kind of authority figure, or even from a friend? EMILY REYNOLDS

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A major new meta-analysis questions the idea that liberals and conservatives show fundamental differences in their moral foundations. While the team ﬁnds support for some basic moral differences, they also conclude that these are less clear cut than had been thought, and the results are also less generalisable across regions, countries and political cultures than has been claimed. (Psychological Bulletin) People who believe in ‘pure evil’ are more likely to support harsh punishments, like the death penalty, for those who have committed gun violence. These participants were also more likely to attribute a shooter’s behaviour to his personality, and endorsed harsh punishments even when they read that the perpetrator had a brain tumour which could have inﬂuenced his behaviour. (Applied Cognitive Psychology) How can companies reduce gender bias during informal recruitment processes? A new paper has one suggestion: make interview shortlists longer. Across a series of studies, the team found that that increasing the length of a shortlist from three to six candidates led to a greater proportion of women being considered for a role. (Nature Human Behaviour)

Engaging in meaningful activity during lockdown, rather than simply staying busy, might have the best outcome for your mental health. A study conducted early on in the pandemic found that people who became busier saw increases in both positive and negative mood, suggesting they had more difﬁculties in regulating their emotions. Those who took part in more meaningful activities, however, showed less extreme moods in either direction. (PLOS ONE)

Turns out you can bullshit a bullshitter You can’t bullshit a bullshitter. Well, that’s the saying – but is it true? Shane Littrell and colleagues at the University of Waterloo, Canada, set out to investigate. And in a new paper in the British Journal of Social Psychology they report that, in fact, people who bullshit more often in a bid to impress or persuade others are also more susceptible to bullshit themselves. Bullshit isn’t quite the same as outright deception, and researchers have treated it as having two separate dimensions. ‘Persuasive bullshitting’ is motivated by a desire to impress or persuade. ‘Evasive bullshitting’ is different – as a ‘strategic circumnavigation of the truth’, it’s the sort that a politician might engage in when trying to cover up a mistake. In an initial study, 219 adults completed the Bullshitting Frequency Scale. (This assesses, for example, how likely you think you are to

persuasively bullshit a contribution to a discussion on a topic that you don’t know much about, or to evasively bullshit if being honest would be embarrassing.) These participants also completed the Bullshit Receptivity Scale, rating the profundity of 10 sentences constructed from pseudo-profound buzzwords, as well as scales that assessed their receptivity to ‘scientific bullshit’ (e.g. feeling that a randomly generated sentence that used a lot of terms like ‘entropy’ and ‘quantum ground states’ is probably genuine) and to fake news. The team found that people who reported engaging in more persuasive bullshitting were more receptive to all forms of bullshit (pseudo-profound, pseudo-scientific and fake news). However, higher scores for evasive bullshitting were not related to susceptibility to the first two forms of bullshit, and

were actually associated with less susceptibility to believing fake news. In subsequent studies, the team found that people who engaged in more persuasive bullshitting were also more over-conﬁdent in their own intellectual ability, scored lower for cognitive ability, and reported less insight into their own thoughts, feelings and behaviours. They also performed poorly at telling apart statements that actually are profound from those that only sound profound. Overall, the results of the three studies are consistent: ‘one can “bullshit a bullshitter”.’ And as the frequent persuasive bullshitters were also more over-conﬁdent in their intellectual abilities, they could be seen as experiencing their own Dunning-Kruger type effect, and suffer from a ‘bullshit blindspot’, the researchers suggest. EMMA YOUNG

Beyond borders in applied psychology

Nick Hammond and Nikki Palmer ask whether we are united by commonality, or divided by difference

he late, great, Wilfred Bion once said about psychoanalysis, ‘I get so sick and tired of hearing about the various different schools of psychoanalysis and their great superiority to the other one – whichever it is’ (Bion, 2005, p.39). Though not necessarily named, issues of hierarchy, division and speciﬁcity are embedded in the histories of applied psychology. They can be seen from frontline roles through to the policies and organisations that are concerned with governing the profession. Yet professional applied psychology, like psychoanalysis, has much that unites the various areas of specialism. As Bion elegantly pointed out in respect of psychoanalysis, ‘the possibility of arguing about their various merits is simply endless – as long as you don’t anchor any of it to facts’ (Bion, 2005, p.39).

A divided profession The British Psychological Society (BPS) has 10 divisions, 19 specialist sections and a further three special groups. This is not a criticism: the BPS and similar organisations play an important and complex role in maintaining excellence and ethicality in practice, as well the development and promotion of psychology. As others have said, such a domain focus demonstrates the diversity within psychology, but may also fragment it (Dias Neto et al., 2019). Indeed, it is in these extensive categorisations that we can see a focus shift from commonality to differences between psychologists. Of course, this can bring beneﬁts; for example, for psychologists seeking out appropriate context and domain speciﬁc CPD and supervision. However, in contrast, we must understand that these categorisations are socially constructed. They give meaning and shape to what a psychologist can and cannot do, and that meaning is implicitly or otherwise embraced by society. Importantly, this can be an inhibiting factor in recognising commonality, which in many cases is far greater than the differences. Let us take a moment to provide a real-world example of what we mean. Clinical, counselling and educational psychology are three branches of applied

practice. Of course, each branch is distinctive in its own right. Educational psychologists specialise entirely on working with children and young people, from assessing learning potential to mental health intervention, and they have extensive knowledge of education and allied systems. Clinical psychologists specialise in the assessment and intervention of complex and enduring mental illness across the lifespan and within families, and they also have extensive knowledge of the application of psychology to neurological and other physical health needs. Counselling psychologists have an unparalleled depth of knowledge in the delivery of therapy for both mental illness and life events, such as bereavement or domestic violence. Moreover, this specialism is the only branch of professional psychology where personal therapy is mandatory. Yet, the three also share many similarities. For example, all can be considered therapeutic practitioners by virtue of their training, and all offer forms of therapy to children and young people (Hammond & Palmer, 2021). Additionally, they all work in a range of settings, including schools, NHS community mental health teams, youth justice services, and voluntary sector organisations, to name but a few. You’ll also find many of these psychologists sharing wide and varied interests, including the impact of power, disability, social inequality and inclusion on mental wellbeing, across a range of communitybased settings. And in 2021, we need applied psychologists to come together, more than ever. Official statistics show that around 18 per cent (1 in 5) of those accessing mental health and learning disability services in 2018/19 were children and young people aged 0-19 (House of Commons, 2020). These figures, however, only capture the children and young people who are known to services. Researchers have found that 69 per cent of young people reported a decrease in their mental wellbeing after returning to school in September 2020 amidst a global pandemic. Yet only 15 per cent of children and young people felt there was enough information and support to meet their mental health needs. The pandemic has therefore seen a rise in mental health needs amongst children and

the psychologist may 2021 applied psychology

young people (e.g., YoungMinds, 2020; Crawley et al., 2020), who are at significant risk of prolonged mental illness (e.g., Loades et al., 2020; Singh et al., 2020). There is, therefore, a profound need for psychologists to provide mental health services throughout the UK. What we suggest is that commonality between branches of applied psychology has been lost amongst our differences and the merits of our own professional community. This can only be at the detriment of the society psychologists are here to serve. For example, in the case of mental health, those psychologists with appropriate competencies and experience can offer various forms of therapy (see Hammond & Palmer, 2021). Whilst there may be differences in context, approach or, in some cases, type of need, it would be inaccurate to conclude that therapy is domain specific. The same can be said for a whole host of examples, from systemic development (e.g., training) to establishing learning profiles. Moreover, psychologists work across settings: clinical in education contexts and educational in clinical or community contexts. The convergence of skills, knowledge and training as well as additional CPD and experience, allows this to be the case. By doing so, society benefits as a whole because psychological knowledge and support can be disseminated in the most efficient and effective way. It is through development of skills and knowledge alongside appropriate experience and supervision, the divergence between applied domains narrows and, in some cases, quite significantly. A professional process of discovery and reflection In 2018 we published a two-year study titled Personalizing Education: A person-centred approach for children with special educational needs. Whilst the book explored the use of a Person-Centred Review (PCR) process in the changing context of Special Educational Needs and Disabilities (SEND), it also lent itself to an unanticipated process of professional self-discovery and reflection. We showed that, for example, psychologists are well placed to deliver such interventions because of their added value of being able to use skills such as flexible problem-solving, facilitating complex group processes, redressing issues of power distribution and, importantly, applying evidence-based psychological theory (Hammond & Palmer, 2018). This prompted us to explore these similarities further in relation to the use of therapy, specifically, but not exclusively, between clinical and educational psychologists (see Hammond & Palmer, 2021). These branches of applied psychology have arguably had their roles and skillset over-simplified, and this has led to specificity in their deployment to support people in a therapeutic capacity. A simplified example would be clinical psychologists are channelled into assessing and treating people with mental illness across the lifespan;

educational psychologists are often faced with the traditional perception that they complete assessment of learning. Whilst there are elements of reality in both assumptions, as we have discussed already, this is far from the whole picture. For example, clinical psychologists are more than able to undertake assessment of learning needs or deliver training to schools. Equally, educational psychologists have a statutory role in contributing to Education, Health, and Care Need Assessments (EHCNAs). But they also have the most extensive training in working with children and young people (see Hammond & Palmer, 2021) and deliver a broad range of therapy and therapeutic interventions to this client group (e.g. Hammond & Palmer, 2021; Simpson & Atkinson, 2019; Squires & Dunsmuir, 2011). This is why many educational psychologists, will often refer to themselves as educational and child psychologists (or a variation thereof). The competence of a psychologist Our initial discovery led us to pose a broader question: is what unites us as applied psychologists greater than what divides us? Or did we simply stumble upon some curious anomalies? To explore this further, we turned to the Health Care Profession Council’s (HCPC) Standards of Proﬁciency for Practitioner Psychologists (HCPC, 2015). There are 227 individual Standards across seven protected titles, namely: clinical, counselling,

educational, forensic, health, occupational and sports. One hundred and fourteen of these Standards (around half) are shared across all seven branches. Whilst our approaches may be different, driven by our client group or context, our skills do substantially overlap. Perhaps more intriguing then, is the breakdown of the other half. Clinical has 17 additional standards; counselling 25; educational 20; forensic 17; health 17; occupational 7; sports 10. In other words, across all branches, the differences in registration Standards equate to no more than 11 per cent in any one branch of applied practice. Moreover, these differences often reflect specific contexts or nuanced specialist skills. Whilst these differences are, of course, important, we do share many of the same competencies and, thus, may be suited to deployment in contexts beyond our specific specialist title (see Catherine Dooley and Hannah Farndon in the March issue, on the new BPS guidance on Best practice in psychology recruitment; tinyurl.com/bpsbppr). Indeed, the BPS issues a single set of Practice Guidelines (2017), developed by psychologists from across the profession. It is of course important to respect these differences too. This is especially the case in respect of continued professional development, supervision and specialist knowledge of context, for example. Yet, overlap in competencies is likely to increase for many, depending on additional training and experience gained by the psychologist (see HCPC, 2015). Is it not time to see beyond the borders and respect the skills and experiences of individual psychologists, rather than assuming a skillset by title alone? We suggest it is important to promote the interconnectivity of different applied branches, whilst Key sources appreciating different training routes as well as individual competence Dooley, C. & Farndon, H. (2021). We’ve and experience. In doing so, got vacancies, and we’re missing out we begin to move beyond on the right people: New advice on best boundaries, which are often practice in Psychology recruitment. The misconstrued and misleading, to Psychologist, 34, 62-63. an arena of applying psychology Dunsmuir, S. and Hardy, J. (2016). Delivering psychological therapies in to support the development and schools and communities. Leicester, UK: wellbeing of humanity as a whole. The British Psychological Society. This is not, however, the same Hammond, N. & Palmer, N. (2021). as saying, for example, one can Between Therapeutics and Therapy: simply become a psychologist in The continuum of therapeutic practice a specialist field by undertaking and the role of ethical blind spots in decision-making. Educational Psychology CPD (e.g. clinical to educational in Practice, in print. or vice versa). Rather, additional Hammond, N. & Palmer, N. (2018). training may well create a greater Personalizing Education: A personoverlap of competencies – as we centred approach for children with special have argued in respect of therapy educational needs. Trentham Books / between clinical and educational UCL-IOE Press. Health and Care Professions Council. psychologists. (2015). Standards of Proficiency: Practitioner Psychologists. London, UK: HCPC. Full list available in online/app version.

Realities and opportunities The role of domain-speciﬁc psychologists goes beyond

competencies. Whilst, to some extent, overlap may occur through additional training, it cannot replace the nature of these initial training routes. Every domain has its specialised client group and context – each of these requires a different knowledge and approach in practice. But is it possible or, indeed, desirable, to bring together training for these different domains? Well, this is not a new concept. The Australian pathway for training psychologist works in this spirit. For example, the first six years of training is to become a general psychologist. The Australian Psychological Society (APS) estimates that over 60 per cent of psychologists are registered for ‘general practice’. These psychologist work across many different settings, undertaking the same range of duties as a qualified psychologist in the UK. These psychologists may then wish to work towards what is known as a practice endorsement. This involves an additional two years of supervised practice in one of nine named areas of endorsement, including clinical, counselling, educational and developmental and community psychology, amongst others. Across Europe, the picture is variable, but there are pathways including generalised training to become a psychologist (Dias Neto et al., 2019). Given the similarities in competencies across the branches of applied psychology, would it be plausible, and indeed, desirable to establish a similar approach in the UK? It has in fact already been debated – many times, in some fields of applied psychology. For example, the Department for Education (DfE) proposed a combined professional psychology training programme at doctorate level, for both clinical and educational psychologists. The proposed programme would combine the specialisms of educational psychology (working with children and young people) with the specialisms of clinical psychology (working with families) (DfE, 2011). This would be an initial generic training, followed by the trainee choosing their specialisation later into the programme. Whichever the trainee chooses, they would graduate as a qualified family psychologist, but would simply be more accustomed to either a ‘clinical’ or ‘educational’ system, orientation and practice customs. Why, then, has this idea not caught on – not only for clinical and educational psychologists, but rather in the way Australia develop their psychology workforce? The answer is perhaps rather complex. One may be tempted to oversimplify the issues, for example, to pigeon-hole applied psychologists into a specialised domain, or lean on the social constructs of each protected title which dictates context and approach. But, as we have seen, there is much diversity between individual psychologists let alone different domains. Moreover, to remove specialisation altogether overlooks the importance of nuanced skills and approaches. Could we, for example, expect an occupational psychologist to offer therapy or assessment of a child? Probably not, unless of course, they can demonstrate appropriate competencies to

the psychologist may 2021 applied psychology

do so through experience and training. Further, psychology sits within wider social constructs. For example, although the DfE (2011) found merit in the proposed new combined programme, they noted several structural issues that prevented this from happening. These included inequality and organisation of existing funding arrangements between the two branches, training structures, and wider social structures (such as the way these two branches of applied psychology are commissioned). The reality then has been provided quite succinctly by others, ‘…it is important to maintain the unity of psychology while respecting professional and scientiﬁc diversity’ (Dias Neto et al., 2019, p.6). In order to achieve this successfully, there must be concerted effort to appreciate not only differences in initial training, but also competencies accrued after qualifying.

Nick Hammond Practitioner Psychologist (Education & Child) nick.hammond@suffolk.gov.uk

constructive difference to human beings. What this look likes, perhaps, is not so much about the branch of applied psychology to which one belongs, but more to do with individual psychologists who build up competencies both within and across borders, as the HCPC states: Your scope of practice is the area or areas of your profession in which you have the knowledge, skills and experience to practise lawfully, safely and effectively, in a way that meets our standards and does not pose any danger to the public or to yourself (HCPC, 2015, p.4).

Thus, a psychologist, with registration within any domain, who can demonstrate competence which is otherwise specific to a different domain, may wish to use a Twitter: @PP_Psychology more generic protected title, that is, Practitioner Psychologist (Dooley & Farndon, 2021). For example, if a psychologist undertook additional training in a different domain, perhaps in psychotherapy, they may Where next? well be able to demonstrate counselling psychologist The publication of Catherine Dooley and Hannah specific competences, such as understand how empathic Farndon’s article in the March issue of The Psychologist understanding can be helped by creativity and artistry in is timely. They suggest that progress will be made the use of language and metaphor (HCPC, 8.17) or be through a gradual culture shift amongst those able to critically reflect on the use of self in the therapeutic employing psychologists. In this article, we have process (HCPC, 11.5). Of course, this is not the same argued for the many benefits of domain generalisation, as being a counselling psychologist or using the whilst respecting domain-specificity to some extent – title. Rather, it becomes another shared competence somewhat of a stalemate, perhaps. and adds credence to us being united as applied However, we do agree with Catherine and Hannah, psychologists both by our initial training routes, to and we further suggest that perceptions and narratives some extent, and additional post-qualification training surrounding applied domains are, largely, misleading, and specialism. misunderstood and misplaced. These have been We recognise that the complexities argued here socially constructed and over time, have become are likely to be emotive. But, as painful as it may feel, embedded in our culture, history, traditions, discourse we suggest the way forward is to name what it is that and, perhaps to some extent, territoriality between makes us feel uncomfortable. From here, we can domains. We do not claim to have avoided these traps reflect on the opportunities these discussions offer ourselves, in fact. in an honest and respectful way. We will end, as we And so, we conclude by appealing to applied began, with some words from Bion as a cautionary psychologists and the wider audience with an interest note to us all as we move forward in considering what in psychology, to re-consider how the language this all means for us, as individuals and as groups of we use may well misrepresent and create much professional psychologists: misunderstanding amongst the people we are here to ‘… the curious thing is that as soon as we are serve. This is not an argument of competencies; in that contained in a group, it seems to be very difficult respect, there is evidently far more that unites than indeed to go in the direction of developing thoughts divides us. Rather, it is in the narrative we have come or ideas or feelings of our own; we are dominated by to use in relation to applied branches of psychology. a need to be like everybody else and to think what We must recognise differences, of course, but also everybody else thinks and feels – although how place a far greater focus on commonality in order to to tell what everybody else thinks or feels may be remove borders, and move towards a shared interest something we would find very difficult to formulate’ (and competence) in applying psychology to make a (Bion, 2005, p.74). Nikki Palmer Trainee Practitioner Psych (Education & Child) nikki.palmer@suffolk.gov.uk

Please don’t, a poem by Cordelia Galgut Please don’t tell me how I should feel Or what I should think about having breast cancer; How I should be ‘over it’ by now; How I should be more positive; How I should be grateful that I’m alive. And please don’t say, ‘You’re overreacting to your situation,’ ‘It’s only you who feels like this,’ or ‘It’s time you got on with your life.’ How can you know? You have never been in my situation. And please don’t ask me what I have contributed to my cancer Or tell me how brave I’ve been. There was no choice is all. It was just the luck of the draw. And please don’t ask me how my breast cancer journey has been. There was no journey There is no journey, because there is no end in sight. And for pity’s sake, don’t say, ‘Well, we’re all going to die in the end, I could get run over by a bus tomorrow.’ It’s different. You have never stared death head on. You have never had breast cancer. We are on different sides of the track now. Tell me instead That you cannot know what it is like living through this hell. Tell me instead that you have an open heart And an open mind, That you’ll listen, That you’ll try and understand, Even when what I’m saying sounds preposterous to you. It is my reality. And please, please try and look beyond your own fears, Or if you can’t, tell me so. Having breast cancer is terrifying And the terror does not diminish, Because the fear that it will come back is ever present. So please, please don’t tell me that I’m one of the lucky ones, That I’ll be back to normal soon, Because my life and I have been changed forever. 28

Soﬁa Sita https://soﬁasita.com

the psychologist may 2021 cancer

‘You should be over cancer by now’

Cordelia Galgut on living with the long-term effects of cancer

efore being diagnosed twice with cancer 16 years ago, I had emotionally supported clients with cancer – from diagnosis, through to life beyond the initial diagnosis and treatments. I believed that I was understanding them well enough and offering them appropriate support. How wrong I was. I found this out to my cost when I started experiencing for myself the seemingly never-ending treatments and psychological impact of cancer. All this came as a shock to me, not least because my training in psychology, counselling and psychotherapy had led me to believe that life after a huge trauma such as cancer should be on the way to a resolution after a year or so. Progress through the various stages of the trauma models should, I thought, be largely linear and relatively smooth. Physical and emotional distress certainly shouldn’t be worsening over time. In my case, nothing was going smoothly. The ‘psychologist me’ began to worry that I was ‘losing it’. I searched high and low, including in the psycho-oncology literature, looking for non-pathologising words of comfort. There was literally nothing I could ﬁnd that offered reassurance that I was reacting normally as someone still in shock three years after diagnosis, still terriﬁed of recurrence and still in a lot of physical pain. The list of my ongoing problems was endless.

‘You’re far too anxious’ My lack of conﬁdence suffered further knocks when I saw doctors and nurses at follow-up appointments, all of whom apparently considered me over-anxious and abnormal for not being ‘over’ cancer at this point. After the surgeries and radiotherapies, I was put on an adjuvant chemotherapy drug that had to be injected into the subcutaneous fat of my abdomen with a nappy pin sized needle on a monthly basis. The injection site often bruised hugely, which used to upset me as well as cause me pain. This treatment lasted four years, a constant monthly reminder that I had had cancer. These are common treatments, so I was not alone in suffering both physically and psychologically several years after diagnosis. Yet my doctor thought it

ridiculous that I was still feeling so anxious and upset. On one occasion he told me I was over-anxious, and should get on with my life and think myself lucky. Of course, like many others, I do consider myself lucky that I am still alive. Yet sadly, the quality of my life was not good then, worse now and there are plenty of days on which my life doesn’t feel worth living. After the first phase of treatments had ended, I stopped having easy exposure to many others in the same boat as me. At that point, ‘conventional wisdom’ about how life was supposed to be after the initial treatments for cancer were finished, started to dominate my thinking and became even more psychologically disruptive. It wasn’t until I started to speak out and write about this mismatch – between what I was actually living and what others expected of me – that I started to internalise more that I was not alone. As a psychologist, I was worried I’d be deemed psychologically unfit to work if I spoke out more about what I was experiencing; that I’d be deemed unbalanced, or worse. So I approached the writing of a short piece for a cancer charity magazine in 2007 with great trepidation. I felt compelled to speak out to try to clarify these misconceptions about how having cancer was, but I thought I could be ridiculed for it. Much to my relief and amazement, I got an overwhelming set of responses from readers relieved that a psychologist who had had breast cancer was saying she wasn’t ‘over it’, and was still suffering a myriad of health issues, seemingly related to the treatments. Some spoke movingly about how my normalising of their thoughts, feelings and experiences had lessened their despair, even to the extent of pulling them back from the brink of suicide. People urged me to speak out for them because they didn’t dare to, in case others deemed them mad, and/or it affected their treatments. That was a turning point for me, giving me the courage to keep speaking out. The validity of the dual perspective The belief that it is just a minority who already have pre-existing mental health issues that don’t ‘move on’ after cancer continues to be a hard nut to crack; not because it holds much water, rather because it is such

an entrenched belief. It is still widely held in healthcare in relation to the psychological care of people after any major trauma, not just cancer. I remember the reviewer who criticised my first book on the psychological impact of cancer using the argument that I had pre-existing mental health issues that had got in the way of me ‘getting over’ my diagnoses. The major issue she mentioned was that I had referred to lying bare-breasted on the radiotherapy table, submitting to doses of radiation, day after day for weeks, and I had written about how that eventually stirred up memories of being sexually assaulted and abused. I remember feeling very pathologised by that comment. It made me question what I had believed was a pretty reasonable psychological response to the situation I was in. When I started to talk to others about how they felt on the radiotherapy table, I was again overwhelmed by others telling me they felt the same. I have also been criticised for speaking from my dual perspective as psychologist and woman who had had breast cancer. When I speak from my patient perspective, I am usually deemed to have no psychological insights worth taking seriously, even though it is known in those situations that I am psychologically trained and experienced. And when I speak as the psychologist, my patient voice can very easily get lost. It continues to amaze me that, despite the fact that there is some great work going on in the ‘living with and beyond cancer’ field, there are still significant numbers of colleagues within healthcare who reject the validity of the dual perspective.

Getting worse? Over the years, I have met with so much resistance when raising the possibility, within healthcare and elsewhere, that some of my physical problems since cancer surgeries and treatments have actually worsened over time. It’s very hard to have conviction in the face of continual opposition and ridicule. It takes great inner strength and self-belief, and I don’t always have either. It has also been a real shock to realise I am indeed more scared. I’ve been trained to believe it would be nigh on impossible to feel more scared so many years after a major trauma. Yet most cancers can recur at any point. The further you get from the initial diagnosis, if you are lucky enough to be free of cancer, the more many of us have invested in living on and not having to have more treatments. Again, when I started to talk to others, I began to realise that I was not alone. Sometimes, it has taken people a while to dare to have these conversations with me; they run counter to what anyone is told to expect or what is deemed a ‘normal’ and ‘reasonable’ response to cancer. Those same people have said they wouldn’t have admitted how they really felt to anyone other than someone who had had cancer and similar longterm problems. If I had to choose only one message it

would be that: so many people have written to tell me that validating their long-term effects, physical and emotional, gives them huge psychological reassurance. This alone can literally save the lives of those feeling desperate, alone, judged. A contentious issue After so many years of dealing with cancer’s unexpected long-term effects, and encountering so much entrenched thinking, I realised that I had to write another book. It wasn’t a job I relished… I knew, for example, that writing a chapter on dread of recurrence would trigger me. I also knew that in my mid-sixties and not in good health, I was setting myself up for more criticism. I also knew I would have to ﬁnd a lot of people who would talk to me for the book, and that would be hard. Indeed it was. It is such a contentious area that I had to meet people clandestinely to interview them, and was asked not to leave paper trails, no email contact etc. Yes, incredible, but true! Why so contentious? I’m not entirely sure, but the greatest fear I encountered came from within medicine. Could it be the fear of the consequences of whistleblowing about, for example, the real but usually unspoken about side effects of some treatments for cancer? That’s not the whole story though, because this same fear exists outside medicine, too. However, my book on long term effects has been out for several months and I know it is both helping and educating, so that is gratifying. I still have my critics, and there is a tendency to relegate me to the ‘loopy fringe’ of psychology, rather than to hear what I am saying on behalf of the many hundreds I have spoken with over the last 16 years. Not everyone who has or has had cancer agrees with me. Not everyone is ready to admit certain things, or even to consciously realise them. Those of us in psychology need to be sensitive to that possibility as well. The more we encourage people to speak without fear of judgement, the more they will feel able to. Why so much resistance? Not everyone working in healthcare denies that longterm problems exist; indeed, there are colleagues who are working hard to raise the proﬁle of those living with and beyond cancer. However, damaging beliefs do exist… You should be grateful: This opinion is prevalent and pervasive, both within healthcare and outside it, and often makes those living with and beyond cancer very miserable. It’s understandable that grief-stricken people feel like this when a loved one dies of cancer, but such sentiments readily trip off the tongue of people who have not lost a loved one to cancer too. I think it is largely borne of a conviction that people should stay silent about any problems they encounter post diagnosis, out of respect for those who have lost

the psychologist may 2021 cancer

their lives. However, I have lost of cancer’s long-term effects – loved ones to cancer myself, yet sits in sharp contrast to the ease I would say that it is valid to feel with which we often ignore the furious, grieve, be respectful and latter, deeming them unpalatable. still speak out. And I have certainly That hits me hard at that moment. been told by people who very sadly There are some clinics that cater have subsequently lost their lives for long-term cancer effects, but to cancer, that they wanted me they are thin on the ground and not to speak out for them after their well-funded, as far as I am aware. Cordelia Galgut, CPsychol, There is a big role for us as deaths, as a way of honouring FBPsS, HCPC Registered them. psychologists to support and Counselling Psychologist, Get treated and then you’re bolster people living with and Registered MBACP Senior all right, or you die: People often beyond cancer; certainly in the Accredited Counsellor/ genuinely don’t understand what areas of psychology where we Psychotherapist having cancer is like – how neverroutinely directly support people www.cordeliagalgut.co.uk ending the treatments often are, emotionally. I worry that too often drcngalgut@yahoo.com and the psychological and physical such psychological care, to the consequences – any more than I extent it is available, is given by did prior to having it myself. I should have educated those who are not adequately psychologically trained. myself better, but I didn’t because I was too scared I hope I have convinced some of you that your of cancer and getting it myself. It’s hard to confront expertise and input is greatly needed, and would be something you feel you can’t cope with. But I really very welcome, in order to help those living with and think you have to if, for example, you are working after cancer through to better days. More of these in cancer care; or admit when you can’t. Otherwise people than we might think, more than a minority, sit the quality of what you want to offer is going to be quietly in the shadows, feeling desperate, powerless, negatively affected. just trying to limp through to a better day. They need In reality, more and more people are surviving help and support. cancer or living with a still present/worsened cancer. For, example, there are lots of people living with Stage 4 cancers. Perhaps it is time to redefine cancer, increasingly as a chronic ailment that results more often than we realise in severely eroded quality of life. It makes sense to put time and energy into how to improve that quality of life for the one in two of us who will get cancer in our lifetime. I’m afraid that quality of life might be so poor, life wouldn’t be worth living anyway – no matter what the media portrayals of life after cancer may say. Many of us cannot run those marathons, or feel endlessly positive! And why should we? At the very least, dread of recurrence is pretty universal after cancer. Life after big traumas should return to near normal after a year or so: Had I not had ways of formulating my thoughts and feelings as a result of my training in psychology, counselling and psychotherapy, plus had years of therapy under my belt, I think I would have gone under. I have pulled myself back from the brink many times because I have been able to work out ways of coping. Even so, I still have very low, depressed times, as human beings do when their backs are against the wall, and quality of life is as bad as mine is. The way forward Many more people suffer from very significant long-term effects from cancer than we might imagine. Yet this appears to be the affliction that dares not speak its name. Compare with the recent surge of interest in ‘long Covid’. The open way in which we are now talking about Covid’s long effects – so similar to many

Living with the Long-Term Effects of Cancer is published by Jessica Kingsley Publishers. A 20% discount is available to readers of The Psychologist via https://uk.jkp.com/ with the code THEPSYCHOLOGIST (valid until the end of 2021).

‘Filtering down psychological thinking into cancer care: that’s how we make a difference’ Sahil Suleman is a consultant clinical psychologist and lead for Macmillan Cancer Psychological Support team at St George’s Hospital in London. Our editor Jon Sutton caught up with him from lockdown…

Everyone on Zoom at the moment explains why they’re tired, but you’re likely to trump me on this: I believe you’re a new parent? New parent to a toddler, no less… I’m learning some new boundaries, learning that actually work does have to be left behind. The world does keep spinning. But it’s certainly a handful.

We were emulating what we would normally do in clinical health psychology and within cancer settings: to work with our staff to embed psychological thinking and to apply that to questions like ‘how do I manage the pandemic? How do I continue to feel like I’m providing good care to my patients?’ It’s that sense of moral injury… people struggling to feel like they could care, and give care in the way they would usually want to do. Then there was more skills-based stuff: what are we using? How can we adapt? How can we change how we communicate? How do we work with families, think about bereavement pathways, check in with junior doctors who were particularly notorious in not coming forward for any of the support.

How has you work changed over the past year? Much like many other Clinical Health psychologists in acute physical health trusts, we have been asked how we can redeploy ourselves in a useful way. Many of us have found ourselves helping in staff support, bearing in mind the psychological impact on the whole workforce here, not just ICU staff, not just ward-based staff, shielding staff, everybody really. Certainly within our trust And in parallel the psychological there was recognition that the staff support service for cancer kept “There were difﬁcult support provision was just not going? decisions that people had Cancer didn’t go away. Cancer adequate. Most staff, in the middle of a pandemic, were not going to be needs were still there. The patient to make, and valid fears picking up the phone and seeking trajectory evolved over time. In the people had to weigh up” a one-to-one therapy session. It early stages, there was a kind of big wasn’t what was needed. We had to full stop panic. Then there were co-ordinate our psychological skills gradual bits of cancer care starting in a different way, at a more systems up again and building. We had an level, helping the organisation to think through existing caseload of vulnerable patients, we couldn’t evidence-based ways of looking after organisational just cut them off. Many of these patients were quite wellbeing. risky or were really going to struggle with the double whammy: they had a cancer diagnosis, plus changes in That’s interesting, because we had a piece quite early their cancer care associated with Covid. And then ‘how on in the pandemic, from a psychologist offering that do I live through a pandemic?’ support to staff and surprised by the low take-up; That being said, we did have a quieter patch in that people saying, ‘other people have got a greater need early phase: many of our patients said to us ‘you guys than me’. go be NHS heroes, you deal with the hospital’. Patients It’s ‘hierarchy of needs’ stuff… what people were were very forgiving of all the cancellations and changes needing was in-reach psychological ﬁrst aid, check ins, in their care early on. Patients were asking staff how supporting managers and leaders to be able to look they were doing, and sending them care packages. after the well-being of a team that they already knew, We worried that patients would be angry and upset, as opposed to parachuting in the psychologist to rescue but in the early phase that wasn’t there as much. them. Pockets of it, absolutely. There were naturally

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had difﬁcult decisions to make, and there have been debates in the news about whether a Covid life is more valuable than a cancer life… it’s a messy one. In terms of your own moral injury around that, is that eased in the context of a global pandemic? There’s no doubt it pushes my buttons when I hear the individual stories of the patients that I work with, or the team bring me stories of the helplessness they feel at not being able to do as much as we would do for our patients… not being able to bring family members in, not being able to work in a holistic way. But perhaps because of the other role I had early in the pandemic, I’ve seen the bigger picture, I was in the ICU, I can justify what has changed through the ‘pandemic-ness’ of it all.

Dr Sahil Suleman is also on the committee of the British Psychological Society’s Division of Clinical Psychology Faculty for Oncology and Palliative Care. Find him on Twitter @sahilsuleman

anxious patients, terriﬁed patients, patients who died prematurely or didn’t get the care they needed, or the optimal care. But also a lot of goodwill from cancer patients who just wanted to keep the NHS going. You didn’t feel like at any point the care fell off a cliff? Certainly not for us. There was probably regional variation in terms of how strict hospitals were about saying ‘you absolutely cannot set foot in this hospital’, how well-equipped hospitals were to adapt to virtual working and the like. There will be patients that would say yes, in their personal experience it did. But for many it felt like a short-term pause, a sense of ‘we’ll get through this, we’ll get back on track’. But during that time, many people’s cancers did progress, and people did get worse. Coming into the second chunk of the pandemic, we started to see more advanced cancers, where patients weren’t seen quickly enough, because they were too scared to come to hospital or go to their GP or because they were balancing risks as, say, an immuno-compromised 70-year-old of walking into a hospital. There were difﬁcult decisions that people had to make, and valid fears people had to weigh up. There are no ‘good options’ really, are there? Quite an impact. We’re seeing people virtually, only bringing people in if they absolutely have to be seen face-to-face. We’ve

The ‘pandemic-ness’ is quite a thing… Do you think there will be lasting changes in terms of how you do things as a result of the pandemic? There are some things where we can’t wait to go back to the way they were, not having family members here has been excruciating, patients sitting on wards by themselves, sometimes nearing end of life by themselves, dying by themselves. But also being able to attend appointments with someone… people having bad news about diagnosis or prognosis and having to absorb that by themselves. We adapt, we accommodate things differently. But people are desperate to be able to work in that broader, holistic, family-oriented way. Are there things we wouldn’t mind keeping? Virtual working. For the year prior to the pandemic, it had been one of my key objectives within my team to be able to broaden access to our service by offering virtual working. We know that we have cancer patients who are struggling with mobility, with travel, we have a specialist cancer service that people travel to from quite far away… so I had been looking to set up virtual sessions. They have their own risks in terms of digital divide for those who aren’t tech savvy, ridiculous things like the Trust Wi-Fi. But there are patients that I think wouldn’t have got to us, or who were more willing to try because they’re sitting at home bored in a pandemic. People who struggle to engage with treatment, to adhere to medication regimens, with decision making… some of the virtual working has actually demystiﬁed and broken down some barriers. We were more in our patients’ lives. Patients that were very ill and laying in bed and still wanting to have a session, patients nearing end of life that would not have got in… that would be where our input would slowly end, but now we were being a part of their process of dying to a different point. That had pros and cons: it could feel invasive, challenging, inappropriate. But other times it felt like it was exactly what the patient needed, to hold on to that connection to us for a little bit longer than they otherwise would have done.

So the future is virtual? On balance, we hate it, it’s hard, we can’t do our jobs as effectively as we’d like. The hands-on physical work, the felt sense in the room has gone, not to mention all the access issues. People may feel they can continue their life and not privilege the therapy session in a way that sometimes you need to get the most out of it… having their session in the middle of Sainsbury’s, perhaps. So there are real downsides, but also aspects we can harness. Whether it’s face-to-face or virtually, what do you see as the cornerstones of psychologically-informed cancer care? In part, a sense that everybody owns it. It isn’t psychology sitting in an ivory tower, and ‘oh, there’s a depressed patient, a crying patient, it’s off to psychology, that’s the mental health over there, and the physical health over here’. It’s the ability of all of cancer care to be paying attention to psychological need throughout, in parallel, as part of your cancer. Our colleagues should feel skilled and equipped, competent, supported to work with psychological need, whether it be at that more universal level that you’d expect all human beings to experience if facing cancer, or the other end of the spectrum where patients may be getting quite stuck, struggling, or navigating this whole world perhaps on top of existing psychosocial vulnerability and challenges.

Working with our colleagues takes up as much of the work for me as the work we do with patients. Filtering down psychological thinking into cancer care: that’s how we make a difference. It’s so sprawling as well… we’re a tiny team here of four or ﬁve people, and cancer care here is 20-odd multi-disciplinary teams, all the different body parts and the cancers that happen in them. We can’t be sat with those MDTs all the time, we can’t be as present as we’d like on all the wards. We’re much better off sharing our expertise, and doing the most complex stuff like the top of a pyramid. When it comes to patients who are ‘stuck’, as you say, is there a particular therapeutic model that you use? We try to provide choice. It might be individually, working with couples, or broader family work. It might be on wards, it might be in our outpatient clinics, it might be in the cancer clinic alongside the consultants and nurses. Within the one-on-one work, there’s a variety too. Clinical psychology, counselling, psychiatrists, all working in this complementary way to ensure the best evidence-based treatment for patients. We’re not coming at it from a pure diagnostic mental health model, we want it to be patient-centred and focused more on supporting adjustment. It might be CBT, broader third wave models, ACT, narrative therapy, systemic ways of working, compassion focused therapy. It’s about assessing where the patient is that would be most useful to them: that’s a real privilege of working in clinical health psychology.

Soﬁa Sita https://soﬁasita.com

It often seems to me that the higher you go within psychology, to a position like yours, the less precious psychologists become about a particular therapy, or keeping their knowledge as psychologists to themselves, or just working with psychologists. The best people are the ones who really emphasise multidisciplinary working, and developing a generally psychological approach across the workforce. You’ve tapped into a key part of my values. We aren’t the arbiters of all the knowledge. Some patients don’t want to see a Psychologist, and that’s ok! I’m not sure I would to be honest. Some people will rely more on peers, or our information centre and a more informal chat, some will like a group-based approach, some might write a blog as a way of processing their emotions. Psychology and one-to-one therapy is just one part of a humongous puzzle here. The key is being as accessible as possible to as many people as possible. It ties in with some of the

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changes we’ve seen in society, paying a bit more attention to culture and race and to the model we’re offering. One-to-one therapy in the ivory tower, is that it? Can we be a bit more creative? We’re psychologists, we should be able to think outside of the box, beyond the therapy room. We can work in a system wide way that pays attention to the community, the needs of our local population, the meaning and stigma attached to cancer… all these things are out there and have to be brought to the centre for us to feel like we’re doing justice to our patients and to our cancer pathways.

oncology need to be thinking about those adaptation processes, learning and changing how we work as a long-term project rather than a panic response. Where do you turn to for support? Where do the psychologists go for support? Often each other. Spaces for us as a group to reﬂect, to connect with other psychologists locally and across London. My team are really fantastic and it is really humbling to see how they’ve adapted to the everchanging way we have to give care, and at times I do wish I could do more to support them. Hearing other services go through similar challenges is also really validating.

You clearly really feel that duty to the patients. We’re all finding it much harder to be useful to our patients. The core aspects of many therapies are I get the impression that personally, for you, it’s never around reactivating patients, reconnecting them with going to be enough… you’re always looking for better meaningful activities, social connections and social ways to do things. support. All these are things the pandemic has taken That’s probably a fair description. away… we’ve lost so many of our I don’t know if it’s a personality ‘go tos’ for patients. For many of thing or the stage of career I’m at, them, we’ve become their only “…we’ve lost so many of but yes, I don’t like looking at a contact with the outside world. our ‘go tos’ for patients. system that is not optimal. They’re waiting for their therapy call, and they’re lonely. That finds For many of them, we’ve There’s an appetite for us. Psycho-oncology as a profession its way into us as therapists, feeling become their only contact is not a new field. We’re just the quite helpless. I don’t think we are with the outside world…” tip of the iceberg in terms of how immune from these challenges that we can help our patients and I’ve described in our nursing and colleagues. We could be used medical colleagues. better, we can use ourselves better. There are gaps, and it’s not good enough. The pandemic just exacerbated Psychology is about interaction really, isn’t it? That’s that. one of the reasons psychologists have come to the Also, we have seen that there are particular patient fore over the last year – we’re in a good position to groups that we are struggling more than others in the explain why people want to get together, how they pandemic, particularly teenagers and young adults, behave when they do, and the implications of not 16 to 25. I’m wondering if that’s down to how much being able to. that cohort relies on peers, and the loss has just been Yes. And I talked about that early phase, where many of our patients were quite forgiving, checking in on us. greater for them. Their A-levels, their futures. And there hasn’t been a lot of messaging designed by That’s gone. Now our patients are terrified and angry and distressed that things are being delayed again, shut them, for them, which is positive and not blaming. That’s important in the context of the new wave, off again, and not having a sense of when it’s going to variants… we are finding it affecting younger people get rescheduled. Our role of psychologists right now more. It’s no longer seen as an illness that only affects in cancer care then becomes about helping to translate older patients, which is perhaps how people treated it that human experience of isolation for our patients to the first time around. ways in which we adapt cancer care and still ensure it is ‘caring’. I see from your sticker you’ve had your vaccine… But I think we need to evolve as a profession now. are you feeling positive about the route out of this? If this is how we’re working for the foreseeable, do we It’s a long road. I think about how we are going to need to think differently about how we work with our do right for our patients, but also I worry for my patients and our teams? Ultimately, it’s the nurses, colleagues and how they manage this work. A lot of it’s the doctors, it’s the allied health professionals that attention is paid to ICU staff and the frontline, and refer patients to us when they identify the needs. rightly so. But anybody working in health care has They’ve been redeployed! The patients have lost their been pushed in different ways. support networks, and we’ve lost the people out there I’ve been privileged to be able to feel useful, to doing the early screening, picking up psychological keep busy, and to see the trajectory firsthand. So I feel needs to get them to us. The need is out there in the community and we can’t quite reach it. There’s a storm somewhat hopeful, even if I hit periods of exhaustion and overwhelm. In the grand scheme of things, there brewing out there… we’re ready for that in terms of are periods where we’ve been able to come up for air, capacity, but we’re expecting the impact of this to be with cancer care for years rather than months. Psycho- there is movement.

‘We’re all ﬁghting the same battle, with different journeys’ Kate Fulton, working within Maggie’s, and Rachel Trimmer, working within The Royal Marsden, both clinical psychologists, share their experiences of cross-sector working on cancer care

aggie’s charity opened a new centre at The Royal Marsden in 2019, sitting within the site of The Royal Marsden NHS Foundation Trust. It provides free cancer support, both practically and psychologically, for those who have a diagnosis of cancer as well as their family. The support ranges from the provision of information, stress-reducing strategies, psychological support and the opportunity to meet other people in similar circumstances. Maggie’s professional staff can offer ‘light-touch’ psychologically informed conversations held by their Cancer Support Specialists, a multidisciplinary team of healthcare professionals, to psychological therapies with a clinical psychologist. Support can be individual or part of a group.

Kate Fulton Kate.Fulton@maggiescentres.org

Introducing Kate I am Kate Fulton, a clinical psychologist for Maggie’s. My work is varied, but commonly I support adjustment to a cancer diagnosis and treatment, tolerating the uncertainty that cancer brings, coping post-treatment with life after cancer and bereavement. I often work with family members of those with a cancer diagnosis. As a relatively new service we have been keen to respond to the needs of our centre visitors

and collaborate with the hospital to help identify those needs. Having previously worked within the NHS, my role at Maggie’s has highlighted the ﬂexibility, autonomy and creativity that third sector working allows. I have been able to prioritise projects that seem most clinically relevant and to manage my caseload accordingly. Alongside these beneﬁts, I have encountered the challenges of working as the only psychologist within the centre team, and being more remotely connected to other psychologists within the organisation than in previous roles. When the opportunity for cross-sector work with Rachel Trimmer emerged, I was keen to pursue it. Rachel and I trained together, and this relationship supported us in taking the leaps involved in collaborating across services. Introducing Rachel I am Rachel Trimmer, a clinical psychologist working in the Paediatric and Teenage Psychological Support Service at the Royal Marsden NHS Foundation Trust. My post is funded by the Royal Marsden Cancer Charity. Our team is made up of clinical psychologists, a consultant child and adolescent psychiatrist, an art therapist, an assistant psychologist and trainee clinical psychologists. We offer psychological therapy, support and advice to any family member throughout the treatment journey of a child or young person aged under 18 with cancer, from the time of diagnosis, throughout treatment, and after treatment has ended. Patients can self-refer to our service or be referred, with their consent, by another member of their team. Whilst this is a specialist paediatric role, my work, like Kate’s, is incredibly varied. I work across the lifespan with individuals, couples and whole families. Support from our team ranges from brief pieces of therapeutic work to longer-term psychological

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intervention and openended support can prevent a more acute need arising. The idea that as a Maggie’s psychologist, Kate would dedicate a proportion of her clinical time to parents who haven’t engaged with the centre before, is slightly at odds with the model. When we began to discuss the logistics of how to create the group across our services, an initial worry was that our two systems might in fact be incompatible. However, compromises were made. As previously mentioned, Maggie’s isn’t The parent support group exclusively there for Royal The idea of a space for parents whose children are Marsden patients, but on active treatment for cancer came from staff on the we had to agree that the paediatric ward in the Oak Centre for Children and Rachel Trimmer group would only be open Young People. They were noticing that parents were Rachel.Trimmer@rmh.nhs.uk to parents whose children struggling with a lack of social support due to the were being treated at the hospital for Rachel to be able coronavirus restrictions. However, this was not an to justify her involvement with the group. A question uncommon experience for parents of these children remained at the back of our minds: does collaborating before Covid-19. Maggie’s was initially approached by to form this group muddy the waters between our the divisional nurse director to think about provision services? Or in some way diminish what each service of support in the form of a group. Keen to avoid can provide on its own? There is so often a drive for overlap with support that the paediatric and young a service to prove itself, and a natural protectiveness adult psychology team might already be providing, comes over us as clinicians. The Kate began collaborating with the dilemmas of who ultimately holds clinical lead of the service. clinical responsibility, and the Working with parents of “… the benefits of being complexity of two services that are children with cancer is something able to create a group to inherently quite different trying which the paediatric team at The to marry up a way of working, are Royal Marsden encounter daily meet an identified need problems to become stuck on. in their clinical work. Whilst it outweighed the challenges easyThankfully, our relationship is not the sole focus of a Maggie’s it posed” created a space of openness to air psychologist, the themes of shock, some of these challenges and work grief, a sense of powerlessness and through them. By voicing these guilt that parents can experience, dilemmas and acknowledging were familiar in both our caseloads. the different positions we were holding from our two Collaborating with one another to create and run a services, we were able to provide sound rational for our parent support group came with its challenges though. involvement in the group. Ultimately, the benefits of The paediatric psychological team have a tighter remit being able to create a group to meet an identified need in terms of what they offer to the patients and families outweighed the challenges it posed. compared to Maggie’s, so the criteria of the group Within the same team, there are typically needed careful thought. Rachel and her team needed opportunities to learn about what each psychologist to ensure that the group would fit with what their service is commissioned to provide, and that the group might bring to their clinical work, and how they might approach a group. Coming from different services would help meet the needs of the families referred to the service, offering a useful additional resource for the we hadn’t had those contact points with one another, so we were tentative in the beginning. We both held team. different experiences and expertise when it came to At Maggie’s, there is a clear pathway of support group facilitation and therapeutic style. Rachel brought leading to psychological input. Typically, anyone who more experience of running systemically informed accesses the centre will be seen through the ‘drop-in’ provision which offers low-level psychological support groups and introduced the idea of us taking on facilitator and reflector roles. Kate brought experience and a referral to psychology groups or individual work of working in psycho-oncology having spent a year in a will be made as indicated. The principle is that early interventions. I provide support to many of the same difficulties as Kate, such as adjusting to a diagnosis of cancer, coping with the effects of treatment, and bereavement. As we are a paediatric and young adult specific team, our work more often involves a focus on factors relating to childhood, parenting and family life. This might involve work with parents around sleep issues, eating difficulties or behavioural difficulties presented by their child that have been impacted by the cancer, or working with a child in developmentallysensitive ways to support them with the challenges of returning to school after treatment. Our team also offer neuropsychological assessments to children who have had a brain tumour or treatment that may affect the brain.

cancer-speciﬁc placement in training and then working full-time in Maggie’s. She had greater experience in online group work so was able to hold in mind how to set up and run the group remotely. Neither of us wanted to take a dominant role or put too much workload or responsibility on the other. Working with another practitioner takes you out of your comfort zone and can feel really exposing. What will they make of my facilitation skills? We acknowledged this worry early on, and negotiated a way of offering one another reassurance as the group progressed. Ultimately, it requires trust and a reliance upon each other that takes time to build.

Working together on recruitment As most people who have run a group intervention will know, recruitment can be one of the most challenging parts of the process. Collaborating with one another’s services enabled access to a wider pool of potential group members and created opportunities for parents to join who may not have participated had the group been delivered from only one of our services. The idea of engaging with a psychological support service holds many different meanings for different people; ideas such as psychological support being for people who lack resilience or who are struggling with severe mental illness. The idea of engaging with a psychological support service can also trigger shame or invite stigmatisation from others. These all create barriers to accessing support. A third sector support organisation such as Maggie’s does not carry the same NHS associations and meanings for many people. Maggie’s centres are designed to be a non-clinical space, to feel more like a home, giving us access to physical and virtual spaces that feel less pathologising or stigmatising. Alongside recruitment from the paediatric team’s waitlist, advertising the parent support group at the Maggie’s centre enabled us to communicate an important message of this being a group relevant and open to Key sources all parents of children receiving treatment, not just those who are ‘referred’ to a Psychologist. Perhaps Hollis, J. (2019). The psychosocial this model of increased accessibility experience of UK immigration detention, is particularly pertinent in psychoInternational Journal of Migration, Health & Social Care,15(1), 76-89. oncology and supporting parents Mallinckrodt, B., Miles, J.R. & Levy, whose children have cancer. Those J.J. (2014). The scientist-practitionerseeking support are often ordinary advocate model: Addressing people who ﬁnd themselves in contemporary training needs for social extraordinary circumstances. justice advocacy. Training and Education Neither of our services prescribe in Professional Psychology, 8 (April 2015), 303-311. to a particularly diagnostic model, Sen, P., Arugnanaseelan, J., Connell, and at the core of our work is E. et al. (2018). Mental health morbidity often the need to normalise and among people subject to immigration validate feelings such as anxiety, detention in the UK: A feasibility study. guilt and grief. In allowing an open Epidemiology and psychiatric sciences, recruitment process, we hoped to 27(6), 628-637. encourage the normalisation that

living amidst your child’s diagnosis and treatment can be hugely challenging for anyone. Advertising at the Maggie’s centre also enabled several parents to step towards the group themselves, rather than have the idea suggested to them by a Royal Marsden team member. Access to the paediatric team’s waitlist of parents allowed us to speak to a large number of potential group members who had already sought out psychological support, and enabled us to offer them an intervention far sooner than if they were to continue waiting for an individual or family intervention. Although the need was most definitely there, a further challenge was how these parents would practically find the space and time in their week to attend an eight-week group such as this without their children, particularly in the midst of a global pandemic. Parents can even feel guilty or self-indulgent about accessing support for themselves when the emphasis of care is firmly on their child’s needs. We needed to be flexible, to not put pressure on our participants to attend if they couldn’t, to ‘just try it and see’. These conversations with parents around their hopes and fears were an important part of what John Burnham (in Carmel Flaskas’ 2015 edited collection The space between: experience, context and process in the therapeutic relationship) has called ‘warming the context’, and may have played a crucial role in the zero dropout rate we experienced. For us, it was significantly easier to share this task across our two different services, offering greater flexibility around when phone calls could be made and committing greater time to supporting them with their dilemmas. Joining forces to offer a shared intervention immediately expanded our capacity and resources for planning, preparation and delivery. Alongside such practical elements, we were also able to use one another to carry motivation and momentum. When one of us was feeling dejected, the other was able to step in. If it had been just one of us holding the responsibility, we may have decided it was too much of an uphill battle from the beginning. Shared trepidations We began to notice parallels between parents’ trepidation about the group and our own. What if hardly anyone turns up? What if the group feels really big? What will the group dynamics be like, especially online? Our experience of working with this population taught us that these worries were likely to be especially pertinent to the parents, who can feel understandably concerned about the impact of hearing other peoples’ stories. Would they encounter less favourable outcomes, or feel guilty if they were in a more hopeful position than others? Others worry about their emotional capacity to hear others’ stories when their own difficult situation feels quite enough to be coping with. One parent said: ‘I was concerned that not having people with the same diagnosis would

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be an issue. It wasn’t though.’ The sense of a shared experience emerged as representing something far greater and more important. One parent said: ‘[I valued] learning that we are all fighting the same battle but in some ways all have had such different journeys. Learning everyone’s journey has helped me cope with mine.’ Another parent said: ‘It was a space where everyone just got what was going on. People without this in their lives try hard but don’t really know what the strengths of each of our services, allowing parents you’re experiencing.’ faster access to psychological support and bringing The group itself was able to provide a space for the greater attention to the wider support Maggie’s can parents to explore the impact of their child’s diagnosis offer as parents such as those in the group continue on them as parents and on their relationships and with their journeys. Clinically, we feel we gave one wider lives. They shared the challenges of how the another permission to create a less structured space cancer diagnosis had forced changes to how they for parents to come together and form a community parented, no longer being able to plan ahead and amongst themselves – a space for their stories to be instead having to tackle things as they arose. This heard and their resilience and coping to be promoted. reactive way of living meant that many didn’t feel they were coping, rather that they were ‘surviving’. We noticed many of the group had strong expectations Final reflections about what they should or shouldn’t be doing or feeling. We used the sessions to uncover the influences We’re left with a couple of key ideas that we feel compelled to share with other clinicians. Firstly, behind these ideas, enabling parents to challenge them sustaining momentum when setting up a group is hard, and re-define what was meant by ‘coping’. This work and maintaining motivation to work out the kinks that was particularly helpful when addressing their feelings can easily arise when you attempt of guilt; guilt that they were not cross-sector working can add to the able to go through cancer treatment challenges. There is always going in place of their child, guilt at “The sense of a shared to be a leap into the unknown having to consent to and administer experience emerged as when forming a new collaboration, medication that made their child representing something and it can bring about discomfort feel unwell, guilt at not being as and anxiety. Despite that, our present for their other children and far greater and more experience was that it is worth even blaming themselves for not important” the pay-off and we want to being able to prevent the cancer. By encourage others to take the creating a safe space for this guilt to plunge. The challenges felt easily be acknowledged, and then moving outweighed by the moral, professional and practical towards a more compassionate response to these support we were able to provide one another. feelings, we hoped those difficult feelings would take Working in this way (a fairly unstructured less hold of them over time. psychotherapeutic group) with parents who are in the A strong theme throughout was that parents often midst of treatment with their child served as a helpful believed they were the only one feeling or thinking reminder that it’s not all about us as clinicians. There some of these things, exacerbating a sense of isolation is great power in simply bringing people together, and feelings of guilt about not being a good enough allowing for shared experiences and a formation of cancer parent. Feedback at the end of the group told a genuine community of support. That’s not to say us that their experiences of hearing that other parents we were insignificant – we put careful thought and had similar worries and feelings to them and receiving planning into the creation of a safe space – but we compassionate responses from other parents to their didn’t need to provide answers in order for the group to own feelings had some of the greatest impact on their be beneficial. Instead, allowing their voices and stories ability to respond more compassionately towards to be heard and witnessed by one another encouraged themselves, an experience of connectedness replacing the fundamentals of normalising, validating and their previous sense of isolation. resilience building, strengthening their coping rather It was encouraging to hear from the parents than pathologising their experiences. that their differences didn’t diminish their shared The collaboration is one that will continue, with a experience. Similarly, although as clinicians we might plan for Maggie’s and the paediatric and young adult have had trepidations about our different services psychological support service situated at The Royal and indeed our differing therapeutic approaches Marsden to offer the group to parents throughout and perspectives, our experience was that our NHS / the year. Our hope is that this will continue to meet third sector collaboration enabled us to combine and the needs of parents, and strengthen the relationship consider varying perspectives from which to plan and deliver a group intervention. We were able to maximise between our two services.

‘Cognitive control can improve the quality of life of women with breast cancer’ Nazanin Derakhshan is a Professor of Experimental Psychopathology at Birkbeck, University of London and founder of the Birkbeck Integrative Centre for Building Resilience in Breast Cancer. Delia Ciobotaru met her.

You are the founder and director of BRiC – the Birkbeck Integrative Centre for Building Resilience in Breast Cancer. Can you tell me more about the aims of the centre? The aims of the centre are twofold. The first aim is to provide psychological support for women who have been diagnosed with primary as well as secondary breast cancer, because psychological support and care are lacking for women with a breast cancer diagnosis… heavily so. The second aim is very much linked – as the name says, BRiC is an integrative centre for research and practice. We do research on understanding the mechanisms of vulnerability in cognitive and emotional health in women with breast cancer, and we try and devise interventions that can boost resilience and reduce psychological vulnerability to anxiety and depression, which they mostly suffer from. BRiC is unique in that, as it is a psychoeducational centre; it teaches the practice of resilience through scientific-based methods. Therefore, the aims of BRiC are to bring educational support to women, so that they learn how to empower themselves in breast cancer survivorship, become more resilient and flexible, improve their self-confidence and self-esteem and learn how to manage the anxiety-related side effects that the treatment and diagnosis have left them with. These aims are very much based on the gaps in the breast cancer care environment.

The very name of the centre – ‘building resilience’ – perhaps begs the question of whether the ‘battle metaphor’ in cancer can be unhelpful and even damaging. It must be a pretty fine line to walk, ensuring an evidence-based focus on some psychological factors which can have an influence, without making people suffering with cancer feel that it’s their fault for not fighting hard enough? Yes, the battle metaphor is highly damaging and unhelpful! I can speak for everyone in BRiC as well as myself that we hate the terms ‘fighting’ etc.

But building resilience is about learning how to be flexible and open to change, accepting our emotions, embracing them. Resilience is not about toughness or being a fighter, it’s about being malleable and flexible, and accepting. What types of projects take place at BRiC? We have a forum called Panning for Gold which showcases BRiC’s Collective Voice, based on the contribution of hundreds of women: support from women with breast cancer to other women with breast cancer, relatives, friends and professionals, in the form of guided discussions which I lead each Sunday. They focus on psychologically relevant issues that women who have breast cancer suffer with… PTSD, anxiety, depression, post-traumatic growth, talking to children about your diagnosis and treatment, etc. We have had over 170 of these discussions so far, which are all summarised for the public to enhance public understanding of the needs of women with breast cancer. We’ve also got very well-attended researchinformed emotion regulation exercises which happen on Tuesday nights; and of course anyone around the world can contribute to Panning for Gold’s blog. The Panning for Gold blog was ranked in the Top 10 UK Breast Cancer Blogs twice, recently by @healthline, due to what it provides for women with breast cancer. We want to enhance public understanding of the needs of women with breast cancer, but also to empower other women with breast cancer. However, we’re not just a support group; we’re an integrative centre for research and practise of resilience, and we are just under five years old. I founded the centre back in October 2015 and we are, to date, 1837 members (UK women with breast cancer, primary or secondary). We’re only UK-based, but anyone in the world can access and benefit from our blog. What inspired you to create BRiC, and how did your research in experimental psychopathology influence the activity of the centre?

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My own breast cancer diagnosis, back in January 2013, was the main motivation for me. I was diagnosed with multifocal breast cancer. I was quite young at the time and had to go through the entire treatment: multiple surgeries, chemotherapy, radiotherapy. That took about a whole year. I wanted to bring to other women in my position – rather helpless and hopeless – some input from the research that I did in psychopathology. Prior to being diagnosed with breast cancer, I worked on anxiety and depression, and on the neurocognitive structures underlying anxiety and depressive vulnerability for many, many years, with the main emphasis on attentional control. I then decided

to get involved with research that used interventions targeting attentional control and its neural correlates to improve quality of life in women with breast cancer. In the past, we had shown that attentional control, an important neurocognitive marker of emotional vulnerability, can be targeted and boosted through interventions that exercised it. There’s a lot of research to show that neuroplasticity-induced change, as a function of cognitive control training, can act as an important mechanism in psychopathology and resilience. Like we’ve done with many populations (anxious, depressed, highly ruminative, high worriers), we’ve

looked at how cognitive control can improve the quality of life of women with breast cancer, how it can empower them and increase processing efﬁciency to manage their emotion regulation and so forth. We’ve had promising results and ﬁndings in previous studies, so it just makes sense to me to apply and tailor these interventions in a parallel fashion to women with breast cancer, whose emotional vulnerability levels are quite high. A high proportion suffer from PTSD for many years post-diagnosis, and up to 40 per cent of women with breast cancer suffer from anxiety and depression at clinical levels. The breast cancer diagnosis and treatment leave you with many side effects, including fatigue, impaired cognitive function, heightened sensitivity to anxiety and distress-related symptoms, so it just made sense. We are looking at numerous factors… how to improve work-ability in women with breast cancer by improving cognitive functioning, how cognitive training alone or in combination with other treatments like mindfulness and expressive writing can improve quality of life on a longer term in these women within longitudinal studies. We are also looking at the qualitative effects of Tamoxifen, which is a drug a high proportion of women with breast cancer take to protect against recurrence; this drug really impairs your cognitive functioning, memory and so forth. We are taking an experiential neuroscience approach to understand the multitude of factors that affect these women and how we can possibly empower them through the strategies we’ve developed.

A large part of your work is based on the influential Attentional Control Theory, which you’ve developed with Professor Michael Eysenck at Royal Holloway. Attentional Control Theory has been very influential, with many applications not just to psychology, but to other disciplines like sports, a number of situations where attentional control is needed for efficient performance. Processing efficiency, i.e. attentional control, refers to our ability to regulate our attention away or towards relevant and irrelevant information. The ACT is based on the tenet that processing efficiency has a huge influence on our emotional states, such as anxiety, depression. Originally, this theory was developed to understand the effects of anxiety on performance, but later it was applied to depression as well. In the same sense, it attempts to explain anxiety and depressive Key sources vulnerability through the role of attentional control. The idea is that the more flexible BRiC Panning for Gold blog & BRiC’s we are in how we can engage and Collective Voice: https://bcresiliencecentre.blogspot. disengage with different types of com/ emotional stimuli, the more plastic BRiC’s Academic page: and the more resilient we are in http://briccentre.bbk.ac.uk/ terms of dealing with stressful BRiC’s Facebook public page: situations. Attentional control can www.facebook.com/ be considered a transdiagnostic resilienceinbreastcancer/ mechanism for psychopathology,

because if it’s being as flexible as it needs to be, then it can protect against emotional vulnerability, it can boost resilience. As such it’s a common mechanism for boosting cognitive and emotional health. There is research to show that people with better attentional control and working memory capacity are more flexible in their approaches. In terms of neurocognitive processing, they are more efficient in completing their tasks than people with higher levels of emotional vulnerability, who can have poorer efficiency. Attentional control is important in addressing worry and rumination in particular, because these are known mechanisms for anxiety and depression. People who worry and ruminate have lowers level of attentional control in general, because they get stuck in these negative cycles of worrying about the future or ruminating about the past, so they lack attentional flexibility. Poor attentional control can exacerbate the effects of worry and rumination, leading to emotional disorders like depression and anxiety. In a nutshell, attentional control is the best thing since sliced bread; it’s a promising mechanism, playing an important role in emotional vulnerability. What’s been the biggest challenge of your career? One of the biggest challenges for me in terms of the research that I do is to be able to communicate the research that we do in the lab out there, in terms of public engagement, public outreach. What is usually lacking is a connection between research and practice. As a cognitive neuroscientist, you want to be able to apply your work in real life, because of the implications that your research has quite widely. More and more researchers are becoming keen on doing this, which is really good, but translational neuroscience needs more resources and more integrative approaches in terms of multidisciplinarity amongst disciplines. Work with industry is important, work in the medical arena is important, but these two disciplines are usually divorced; the more we can integrate and bridge the gap, the better. The more measures you have, the more comprehensive your approach is, the stronger you are in terms of implementation. This is one of the biggest challenges not just for me, but for many researchers in my position. The second biggest challenge in my career has been being a woman and being at a younger age. Age and gender have had a particular impact on my professional trajectory. I’m not just speaking for myself; many other women that I know in academia are often second-rated in terms of the impact of what they want to say; their voices are often unheard. That is changing slightly with the Athena SWAN initiative, but I think there are still strong implicit biases in terms of gender and age, which are related. The Athena SWAN is trying to address that, but whilst women’s roles are being flagged up, they are often not being recognised in terms of strategic planning and management; women do the labour work. Women are not men, women are women in their own rights, and they have been

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more vulnerable in academia for decades. The trend continues, unfortunately. I myself have found that I need to be more aggressive and raise a louder voice to be heard. It doesn’t always work, it often backﬁres: if I am assertive, I get labelled as emotional, whereas if men get angry, people take notice. These biases need to be worked on, because they are deeply ingrained implicit biases. I was promoted at a younger age to full professorship – that was eight years ago, and I don’t feel any different. I also consider myself paid much less than other male professors.

should make you bolder, stronger, and riskier. This is the way to go. Use the fear to motivate you, don’t use it to set yourself back.

What do you think the centre is going to look like 10 years from now? I want us to be a charity for research and practice; a big centre, like Breast Cancer Now, but focused on wellbeing in women with breast cancer. We need funding to do high quality research and we need funding to be able to implement that. Here is an opportunity for women finding themselves, coming to terms, adjusting, and making You mentioned age being one of the big challenges… a good living in the timeframe they have. The median what would you say to early-career researchers who survival rate for women with secondary breast cancer is want to build a career in psychological research? The sky is your limit. There is no limit to what you can three to five years, but quality of life is still important, and it was shown to actually impact mortality. We achieve, and you should be original. There are many need to start looking at ways by setbacks early on in your career, which we can improve quality of but don’t let those disappoint you, life in such women who have been especially if you’re a female. If you “We need to be beyond neglected. The charity will be an think about resilience, the harder that, we need to be the institution of its own, with many you push, the more velocity you thinkers behind the scientists, many practitioners who get, so you bounce back. Early career researchers will have many methods, and that is when want to contribute to this initiative. That’s where BRiC will be in 10 obstacles early on, after PhD etc., you make a difference” years’ time: generating high quality because of high competition and research and implementing it with limited resources. But a good voice precision. and original ideas can take you At the moment, BRiC is a part of Birkbeck College, places. so a part of University of London. What I’m hoping In the areas of affective neuroscience and cognitive to do is to reach out to women in many parts of the affective neuroscience we need to be able to tackle UK, whereby we can have not just online seminars, the questions that have been open for a long time. but face-to-face workshops and seminars, and we need We’ve got good neuroscientific methods, we’ve got funding for that. Perhaps BRiC will expand so widely electrophysiological methods, we’re developing this area called experiential neuroscience, we want to bring and be more inclusive, that it can become part of a European project or maybe collaborate with the NIH in qualitative research to neuroscience. These are in the States. I have had many queries about how it can methods; methods are good, but they shouldn’t lead be incorporated within the infrastructure for mental the way. The ideas need to lead the way. Methods are health funding like in the NIH, to reach out to women just a tool, and for someone who’s taught statistics her all across the world. Why just UK women – why not whole life, statistics can be blinding. We have all these women everywhere, including in poorer countries? fancy analyses, but what’s the point if we do not know Socioeconomic status is an important factor for what they mean or what they are addressing? We need women with breast cancer. I gave a couple of seminars to be more than advanced technicians; we need to be to big crowds of amazing women from Nigeria, more than people who know how to do amazing MRI researchers and practitioners, who want to implement or EEG etc. We need to be beyond that, we need to be the thinkers behind the methods, and that is when you something like BRiC in their country – for example, make a difference and you will succeed. Don’t be afraid for women who have been diagnosed with breast cancer but want to go back to work. BRiC can extend to take that approach; it’s scary, it’s unusual, but it’s its arms to women all over the world and in places worth the risk. like that, where there is more need of help. Of course, When we published the Attentional Control by extending to other parts of the world, we can Theory, there was hardly any research to support it. disseminate the research: we can do cognitive training Since then, it’s become one of the most cited theories there and continue our research on women who are of all time and there have been hundreds of studies abroad. taking it forward. Be bold, be like that, set the way for That’s how I see the future of BRiC going. It’s a others to take over and extend your ideas. To females, research and practice centre, it’s an integrative centre, in particular, I would say that competition is high. Academic research is a marathon, the minute you think so it needs to be evidence-based. We are doing the ‘I’m gonna have a rest now’, hundreds of people will go research behind it, and we will be able to implement this research so we can promote better quality of life in past and they will take precedence. No time for rest, women who deserve it and who have been neglected. keep the momentum going, and every disappointment

‘I can’t remove every obstacle that myeloma patients will face… but I can provide support’ Sarah Dempsey on work as a Myeloma Information Specialist at Myeloma UK

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quickly sense from the caller’s tone and how they respond to my questions that they may be struggling with their diagnosis of myeloma – a complex, rare and incurable cancer where patients experience periods of stable disease or remission, followed by relapses where further treatment is required. Most patients believe their medical team have provided the gold standard of care, but this caller feels there has been a missed opportunity to diagnose their myeloma, although everything they describe seems to follow the normal diagnostic procedures. They ask me to repeat every detail whilst they write down my response wordfor-word… I get the impression other issues were contributing to their distress. A previous MRI scan had been taken some time prior to their diagnosis of myeloma. The caller explains that the scan aimed to determine whether they had a plasmacytoma (a localised build-up of abnormal plasma cells). The results from the scan were inconclusive and their doctors made the decision to monitor them regularly. A year later, the caller received a conﬁrmed diagnosis of myeloma following active monitoring but could not shake the thought that something had been missed. As a Myeloma Information Specialist (MIS) at Myeloma UK, I had the opportunity to provide more context to the disease. In essence, even if a plasmacytoma was found and treated, this would not have prevented the advancement of the

disease to active myeloma or their need for treatment; patients can develop a plasmacytoma, receive treatment and still progress towards active myeloma. A natural curiosity I ﬁrst encountered psychology when I was seven, receiving a diagnosis of dyslexia from an educational psychologist. Reassessed as a young adult, I had a lengthy conversation with the psychologist. Psychology was already on my radar, but that conversation spurred on my natural curiosity and led me to study psychology. I could see that understanding human behaviour and applying that knowledge to improve the lives of the most vulnerable people in society was the right route for me. After completing my degree at the University of Limerick and a further MSc in Developmental Psychology at the University of Stirling, I began working in the community. I provided tailored care and support to individuals with a wide range of complex needs. My clients included people with Autistic Spectrum Disorder, ADHD, severe learning difﬁculties, depression, anxiety, schizophrenia and people with a history of trauma. I had the opportunity to positively impact the people I supported daily, scoping out possible improvements to their care and implementing these changes in collaboration with other staff. This direct experience of supporting people with

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Sarah Dempsey Myeloma Information Specialist sarah.dempsey@ myeloma.org.uk www.myeloma. org.uk

A large part of my role as an MIS centres on complex needs led to my current role in Myeloma supporting myeloma patients to cope with the UK; a role that is both challenging and extremely psychological and emotional impact of a diagnosis, rewarding. the disease and ongoing challenges in the daily lives Initially, I felt that I may be at a disadvantage of patients and their families. In compared to the other MIS team myeloma, plasma cells become members because I had no medical abnormal, multiply uncontrollably training; the other two MIS are “we bridge the gap and produce a large amount of nurses. However, I quickly released and support patients a single type of antibody known my education and experience as a paraprotein, which has no was of great beneﬁt to the team. to be ready for their useful function. High levels of My awareness of the impact that consultations, providing paraproteins in the blood can have traumatic experiences can have on practical advice and a devastating impact on the body a person, and the complexity of if they are left untreated. Myeloma human behaviour, had equipped encouraging them can affect the kidneys, levels me with the level of empathy I to discuss their of haemoglobin (as well as the needed. My research experience, concerns further with other components of the blood), including data collection and cause bone disease that results designing studies, was useful when their medical team” in fractures and the possibility of I supported changes to the service. spinal cord compression, and affect the immune system, resulting in severe or frequent infections. Bridging the gap I give patients the space and opportunity to discuss Through the Myeloma Infoline and Ask the Nurse email services, I help patients and carers to understand their feelings and concerns which helps service users to feel more in control, reassured and less isolated. the complexities of myeloma and related diseases, the Patients and family members often tell us that they available treatment options, the complications and do not want to burden their healthcare team with symptoms. I help patients to understand the medical information they receive from healthcare professionals. questions outside of their consultations or during Our services are provided via a freephone number with their appointments. Some patients say they believe their questions are not critical to their team and they no time constraints on the call; one of the beneﬁts of simply want to get a ‘bit more information’. Patients our bespoke services.

are empowered to move forward and feel they are more knowledgeable. However, we make it clear to each service user that we are not a substitute for their medical team and would not be able to replace the advice they provide. Instead, we bridge the gap and support patients to be ready for their consultations, providing practical advice and encouraging them to discuss their concerns further with their medical team. I am acutely aware of how vulnerable our service users are when they contact us, particularly if they are calling us for the first time. Spending the time to explore service users’ issues and concerns without ‘watching the clock’ is vital as we often need to explain complex medical jargon, dig deeper into their concerns, talk them through the vast array of treatment options and clinical trials for myeloma, as well as discuss some of the practical things they may need day to day. By asking open questions, using a calming tone of voice, repeating back what has been said, giving the caller the time and space to talk, and confirming they have understood what we have discussed, we can explore their needs, thoughts and feelings. I don’t have the benefit of the full array of non-verbal cues, often helpful in face-to-face support. Instead, I rely on how service users convey their views and thoughts and probe further to get to the heart of their questions and concerns.

Changing needs Every interaction with a myeloma patient or family member differs, as their needs change throughout their journey. Each caller brings with them their own unique set of circumstances, personality traits and experiences. Patients and families can find it difficult to come to terms with a cancer diagnosis and this becomes more challenging in the presence of other existing conditions, especially in older patients with co-morbidities. These conditions may impact the ability of service users to cope with the disease and at times, limit the available treatment options. Engaging with services users with acute periods of anxiety and distress in response to the diagnosis and changes in their disease course are common. In addition, we frequently engage with service users with pre-existing mental health issues. So, back to that call… as we continue our discussion, the caller explains they had been struggling with compulsive thoughts and their coping strategies were failing. I immediately think about the need for input from a qualified psychologist, so I approach the subject of returning to their psychologist to discuss their current diagnosis and its impact on their emotional state. ‘It’s completely understandable that your coping strategies are being tested,’ I say; ‘your response is a natural reaction to your diagnosis.’ I feel able to provide the caller with the support and encouragement they needed, and later find out they were actively reengaging with their psychologist. In my subsequent calls with this patient, I felt they were

seeking reassurance at the height of their rumination, but I recognised this during the call and encouraged them to speak with their psychologist again. My background in Psychology, along with a comprehensive training programme at Myeloma UK, felt important in reducing any immediate anxieties or distress this caller had felt. Moving forward Patients are acutely aware that their disease will relapse, and further treatment will be required. Discussing the relapse remitting aspects of myeloma can be challenging. The initial call from a patient or family member may be based on the need for clinical information but can quickly lead to discussions around the psychological impact of the disease. The balance between providing reassurance whilst managing the expectations of service users and not downplaying the life-limiting aspects of myeloma can be challenging, but I do not avoid these difﬁcult discussions. At this critical point, I can contribute to their care pathway, help them navigate the complex NHS system, and provide support at a time where their medical team may be unavailable. In this role, I know I can’t remove every obstacle that myeloma patients and their families will face. But if I can provide support to service users during an extremely difﬁcult period in their lives, that feels incredibly rewarding. I have learned the power of giving a person space and time to explore their concerns and anxieties. They are not alone – other service users talk about the same issues. I recognise the power our services play in releasing the overwhelming fears and concerns that our service users experience daily and that I play a role in reducing those fears. The current Covid-19 pandemic has raised many challenges for myeloma patients as they were asked to shield, had their treatments altered or delayed and needed to adjust to our ‘new normal’. As a result, we have witnessed an unprecedented increase in service use. We recently published a paper in the journal Psycho-Oncology that describes how we rose to the challenge of delivering our services during the pandemic and the issues and concerns patients and families raised in response to Covid-19 (see tinyurl. com/3s3tmzpc). I will always feel passionate about Psychology and look for opportunities to use the knowledge and skills I developed during my degrees. The role of an MIS has provided a unique learning opportunity and experience I would never have expected at the start of my undergraduate degree. Moving forward, I want to develop my knowledge and skills at Myeloma UK and work towards my ambition of becoming a clinical psychologist.

the psychologist may 2021 cancer

the

psychologist may 2021

Living with and beyond cancer A British Psychological Society webinar

18 May 2021 12:00 noon – 1:00pm Free to BPS members A discussion for The Psychologist, featuring a panel who have professional and personal expertise in cancer care. • How can psychological research and practice help people to live with and beyond cancer? • How are people affected by cancer and its treatment, and the narratives around it? • Has cancer care changed with the pandemic? Sian Williams, journalist and broadcaster, will Chair the session. She is coming to the end of a Doctorate in Counselling Psychology, and her research is on cancer, rumination and self-compassion after a

Living with cancer

www.thepsychologist.org.uk

mindfulness based intervention. Sian has been working in the NHS with acute cancer patients, and has written a book which details her own recovery after breast cancer. Cordelia Galgut, Counselling Psychologist and author of Living with the long-term effects of cancer. Sahil Suleman, Consultant Clinical Psychologist at St George’s in London and DCP BPS Faculty for Oncology and Palliative Care. Professor Claire Foster, Director of the Macmillan Survivorship Research Group at the University of Southampton.

www.bps.org.uk/events/living-and-beyond-cancer

My chemical romance Ginny Smith picks out six chemicals from her new book Overloaded: How Every Aspect of your Life is Inﬂuenced by your Brain Chemicals (Bloomsbury Sigma).

or me, one of the biggest appeals of the ﬁelds of psychology and neuroscience is their ability to answer what is, I think, the biggest question in science: why do we behave the way we do? It seems to me that the answer lies not in the wiring of our brains, but in the chemicals that bathe them. Because while the connections between neurons can and do change, this process is slow. This means it can’t be responsible for the millisecond-bymillisecond changes we all experience: the split-second decisions, ﬂuctuations in emotion and the temptations we encounter. Instead, these are all controlled by our brain chemistry. And, as it is our brain that makes us who we are, that means that we are controlled by this turbulent sea of neurotransmitters. There are, of course, a huge number of chemicals that affect our brains and behaviour, but in this article I have picked six of my favourites, to give you a taste of their vital roles, and the complexity of the systems that use them.

1. Glutamate It may not be the flashiest neurotransmitter, but glutamate is the workhorse of the brain. The most common neurotransmitter in the human brain, when glutamate is released by one neuron it travels across the gap (or synapse) and makes the next neuron more excitable. If enough is detected, the second neuron will fire, sending the message on its journey. Glutamate is vital for learning. Repeatedly activating the same pairs of neurons, by revising a fact or practicing a skill, causes the neurons to change. The first neuron begins to release more glutamate in response to each signal, while the second undergoes changes which free up more receptors. Both changes improve the chances of the second neuron receiving the signal and continuing to pass it on each time the first neuron fires. They also increase the speed of the transmission. This is why once you have learnt something thoroughly, it is easier to recall it, and it feels like it takes less effort. It really is easier for your brain to activate these pathways, thanks to the power of glutamate. Glutamate isn’t all sweetness and light though. While it is vital for our brain to function, too much of the chemical can be toxic to the brain, so it is vital it is kept in balance. Sadly, boosting glutamate levels isn’t going to help you remember where you left your keys!

2. GABA Glutamate’s counterpart is Gamma Aminobutyric Acid,

better known as GABA. This chemical has the opposite effect to glutamate; when it binds to receptors, it makes it harder for the neuron to send its signal. This makes GABA an inhibitory neurotransmitter. Neurons that use GABA, then, have a calming effect on the brain, reducing the activity of other neurons. This means they are important for sleep (GABA levels in the cortex are high during deep, slow wave sleep), and for counteracting stress. GABA may also play a role in anxiety and depression. If the balance between glutamate and GABA is off, the brain can be overly excitable, leaving us feeling anxious. Some drugs which are being trialled for treatmentresistant depression, including ketamine and antiepileptic drugs, raise the levels of this chemical, which may, at least partially, explain their beneﬁts. In healthy people, yoga has been found to increase levels of GABA in the thalamus, and this correlates with reductions in stress and improvements in mood – something we could probably all do with at the moment!

3. Acetylcholine Our brain has a huge job to do. Two of its most important responsibilities are taking in information from the world around us, and processing memories. But how does it know which to focus on at any point in time? This is where the chemical acetylcholine comes in.

the psychologist may 2021 books When levels of this chemical are high, you focus on the external world, entering the perfect state to learn new things. After a while, however, acetylcholine levels drop, and your attention starts to drift – you might begin daydreaming, or thinking about what to have for dinner. When you are resting, acetylcholine levels in the hippocampus fall and internal circuits become dominant. This allows memories formed during focused wakefulness to be stored. The same happens when you are in deep sleep. The right amounts of acetylcholine, at the right times, then, are vital to both create memories, and store them for the long term. This explains why drugs that block acetylcholine receptors, tricking the brain into thinking levels are low, can cause severe amnesia. People become unable to learn, their brains stuck in internal mode. These drugs can even cause hallucinations, possibly as a dramatic shift to focus on internal perceptions causes people to start ‘experiencing’ their memories, believing them to be real.

4. Serotonin While it is undoubtedly one of the most important chemicals in the human brain, I have a love-hate relationship with serotonin, because of just how complicated its effects can be! When I started the book, I knew it would be important in my mood chapter, and that it would probably pop up in a couple of others. It turned out to be featured in 7 of the 8 topics I cover. And in each, it has a different effect. Partly, this is because there are at least 14 different serotonin receptors. So neurons respond differently depending on which of these receptors sits on its surface. This means not only can serotonin have different functions in different brain areas, it can even have different effects within the same area. Despite this, I have a soft spot for the chemical. Having the right balance in each brain area is vital for our brains to work optimally. It has a role in preventing us falling asleep during the day, helping us to use emotions to make decisions, and is linked to the obsessive feelings of early love. It can also ramp up or down pain signals, depending on which receptors are involved. Then, of course, there are the links with mood and mood disorders. While the details of these are far from clear, there are lots of ways it might be involved – from helping us collect more positive information from our environment to acting as a growth factor, encouraging the birth and growth of new neurons in parts of the brain. Dysregulation in serotonin systems has also been linked to eating disorders, including anorexia, bulimia and binge eating.

5. Caffeine (adenosine) It may not be a brain chemical, but I couldn’t leave caffeine off this list because its effects on the brain chemical adenosine are why so many of us love it. During the day, adenosine builds up as a by-product of our

cells’ metabolism. While we sleep, it is cleared away. So adenosine tracks how long we have been awake, and when we have had enough sleep. When adenosine levels are low (e.g. after a good night’s sleep), acetylcholine is released in the basal forebrain. This guides our attention towards external stimuli, making us feel awake and alert. When adenosine builds up, it prevents the release of acetylcholine, so we feel sleepy. Caffeine blocks the receptors normally triggered by adenosine, so our brains think the concentration is lower than it actually is. This means more acetylcholine is released making us feel more alert. Unfortunately, we can develop tolerance to caffeine in just a couple of days. Once this has happened, you will feel more tired and sluggish before you have your coffee than if you had never drunk the stuff. All that ﬁrst cup does is bring you back up to your natural baseline – although knowing this doesn’t stop me reaching for a cup every morning!

6. Oxytocin I couldn’t write an article about the chemicals I love without mentioning the love chemical; oxytocin. First discovered to induce labour in pregnant animals and milk production after birth, scientists later found that oxytocin also helps animals bond with their offspring. We now know that the same is true in humans – parents with higher levels of the hormone have stronger bonds with their infants, and giving a parent oxytocin can boost activity in parts of their brain involved in empathy and reward. But it seems evolution has, in some animals, hijacked this system, and tweaked it to create pair bonds between adults. Evidence comes from prairie voles, one of few monogamous mammals. Unlike their promiscuous cousins the montane voles, prairie voles have receptors for oxytocin and a closely related molecule called vasopressin in the reward circuits of their brain. When they have sex, oxytocin is released, triggering these areas, so they learn to associate their partner with the rewarding effects of sex. That drives them to spend more time together. Block these hormones, and you lose the bonding effect. Humans too have receptors for oxytocin and vasopressin in a range of brain areas that have been linked to love, like the reward system and the limbic system. And oxytocin is released when you feel close to someone – either physically or emotionally, so it seems likely these hormones are vital for bonding in humans too. So there you have it – my ‘greatest hits’ of brain chemistry. Of course, in a short article like this I can barely touch on the myriad of effects each chemical can have, and there isn’t room to go into the fascinating stories of the scientists behind the chemicals – from the ﬁghter pilot who revolutionised our understanding of sleep to the scientist who disobeyed her boss and discovered opioid receptors in the brain. But I hope you can begin to see the important role these tiny molecules have on all aspects of our life, and the incredible intricacy and complexity of the brain networks that use each one.

Francis Huxley and the human condition Ron Roberts and Theodor Itten Francis Huxley, born in 1923, was the son of Julian and the nephew of Aldous Huxley. He was also a pioneering social anthropologist, colleague of the maverick psychiatrist Ronald David Laing during the heady and turbulent days of the 1960s, and co-founder of Survival International. When he died, in October 2016, his life and work left behind a string of unanswered questions… many of which have relevance for our discipline of psychology in these uncertain and dangerous times.

‘Francis Huxley was the most intellectually adventurous person that I’ve ever met.’ David Napier

rancis Huxley, described by his friend Rupert Sheldrake as a ‘feral intellectual’, was enormously quizzical about the human condition. Like many before him, he was acutely aware of the inadequacies of any one discipline to confront it. Psychology is considered by many to be best placed to interrogate – academically at least – the nature of the human condition. Huxley, like many others, was aware of the limitations of this view. The philosopher and artist Svetlana Boym suggested that perhaps our discipline’s primary shortcoming for this task was that it lacked the time and space to tell nuanced individual stories. Too many of us – for perhaps too long – have been subverted by the all-encompassing imperative to be not only quintessentially scientific but also answerable to the dictates of the (by now deeply entangled) academiccorporate marketplace. Of course, storytelling still survives amongst our ranks – located as often as not amongst the marginalised, those excluded from the administrative paradise of reason by virtue of class, gender, ethnicity, sexual orientation, disability, profession or assumed morality. These people and many others struggle to have their voice heard and their existence recognised. Then consider the nature of the stories which their lives beget, and the contexts which house them. When tasked, for example, with investigating a pioneering drug rehab in East London, as I (Ron) was earlier in my career, the boundaries within which psychological enquiry proceeds may come to resemble social anthropology. In social contexts a strategy of reductionism becomes less and less successful. Indeed, the crisis in social psychology can be summed up as a conflict between those whose interests lie in discerning the relationships between quantifiable variables and those whose aim is to understand the meanings inherent in the world.

the psychologist may 2021 looking back

Social anthropology itself, Huxley intuited, required a narrative psychological dimension more than it required a formalised mathematical one. ‘God’ he wrote, ‘as William Blake remarked, is not a mathematical diagram’. Francis, was in some respects, trapped within the intellectual fashions of the day and looked to psychoanalysis to provide the requisite ‘healing’ qualitative psychological dimension. This, he and others surmised, might be capable of supplying the unconscious gel that would take healing rituals, religion, the symbolism of the sacred, family structure, the sexual politics of human groups, and bind them all together with the human body as the ultimate mediator for the journey undertaken by thought from the murky depths of the unconscious into the full blossom of social life. Seeing the world through their eyes Unusual for an anthropologist of his time, Huxley had no interest in using Western colonialist categories of thought in order to mould the customs, habits and practices of other cultures into a form which could be comfortingly digested within our own cerebral habits. In this regard he was light-years ahead of many of the debates in contemporary academia. He considered it our duty to adapt to the mental templates of others, to see the world through their eyes rather than the other way round – a direct challenge to the presumed universality of western reason. Laing described the terror which people may have of what their own and others’ minds may produce as ‘psycho-phobia’. For Huxley, this psycho-phobia was endemic in social science, and the remedy for it was not only to embrace others’ ways of seeing but to travel in altered states of consciousness; and he considered madness to be one form. To embrace others’ ways of seeing, however, involves more than just a shift in perspective. It is a political act which involves work in two directions. Firstly, it questions the validity of the opposition between self/us and other. By embracing the position of the ‘othered’ it ceases to be ‘other’; simultaneously this boundary dissolution heralds the dissolution of the familiar comforts of ‘home’ thought. But if Huxley’s twinning of the ‘anthropologised’ and othered with madness was bold, there is a very real sense, in which it did not go far enough. It is true that Huxley challenged the colonial imprint abroad, though its domestic variant, racism at home, went unrecognised, untheorised and unchallenged throughout the entire radical movement to oppose institutional psychiatry. Any awareness of the pernicious and harmful effects of racism was, during the 1960s, largely conﬁned to its victims. Yet there is also a real sense in which an opportunity was missed. Huxley, Laing and David Cooper were visibly present at the Dialectics of Liberation conference in 1968. At this event the Black Power advocate Stokely Carmichael (1968) referred to the ‘mental violence’ and ‘psychological

murder’ inflicted by the White West – not only on African people but on Black Americans in the US. In response to this institutionalised violence Carmichael argued there was a need to develop a ‘revolutionary’ and ‘resistance’ consciousness to oppose both the external oppression and people’s internalisation of it. Opposition to the violence, Carmichael was clear, did not mean adjustment to it. Despite Carmichael’s presence Laing and colleagues continued to theorise the sources of ‘psychiatric’ disturbance in terms of existential-phenomenological and familial influences, stretching in Laing’s case to an awareness that the wider systems in which family life was embedded, including the global capitalist system, were an integral part of the context. Carmichael went much further, describing it as ‘a system of international white supremacy coupled with international capitalism’. Racism thus remained ‘beyond words’ and far from ‘obvious’ to those crusading against psychological despair and psychiatric tyranny. Laing’s key intuition that he was involved in the study of situations, not individuals; and Huxley’s insight that there were meanings of madness which could usefully be imported from abroad; were unable to effectively come together. Perhaps this was because both were already fully occupied fighting against their own effective marginalisation from their respective host disciplines, psychiatry and anthropology. Francis was otherwise well equipped to make the leap, and was acutely aware of the misgivings of colonialism which had emerged in the 1960s. Toni Morrison, some years later summed up what had been overlooked. ‘The trauma of racism is, for the racist and the victim’ she wrote, ‘the severe fragmentation of the self, and has always seemed to me a cause (not a symptom) of psychosis’ (Morrison, 2019, p.177). These were, she added ‘strangely of no interest to psychiatry’. Until recent years this criticism could equally have been applied to psychology, to the extent to which it remained in awe of biological psychiatry’s reductionist declarations. A practical political element So, even as psychoanalysis was brought in to supply some of the missing ingredients to the anthropological enterprise, something profoundly important was missing from it. The failure to explicitly map racism was not the only problem. Huxley’s (1985) talk on ‘Anthropology and Psychoanalysis’ highlighted a number of excesses in the psychoanalytic universe which led to problems in the relationship between the two fields. Prominent among them was Freud’s insistence on the universality of the Oedipus complex. Although sympathetic, Francis had no hesitation in labelling psychoanalysis a ‘caricature of…a philosophical system’ which had logical inconsistencies with anthropology. A critical dimension, for both Huxley and Laing, was the necessity to add a practical

political element to what they were examining. Huxley and Laing were also able to intuit that while the facts of life appear straightforward enough from a distance – we are born, we age, love, mate, work, play, ﬁght, create and eventually die – these facts do not so much deﬁne us as a species as highlight the biological, social, emotional and creative imperatives which orchestrate our existence. Some facts – love, sex, birth and death – in their intangible enormity, point to an inescapably spiritual aspect to the human condition. They also supply the ontological foundations upon which psychoanalysis was arguably erected. Faced with the ineffable mystery of existence, politics and the ontology of unending change, however, psychoanalysis retreated. Psychology for a long time arguably took the same track. To secure intellectual acceptance it substituted the failed aesthetics of a predictable clockwork biology, predicated on Newtonian mechanics. It did so for reasons which continue to haunt intellectual endeavour in psychology: a craving for acceptance in the halls of establishment thought. Perhaps more than most, Huxley was aware that anthropology offered clues – shamanism (a topic with which he was deeply fascinated) being one of them – that fundamentally different views of reality than those present in Western epistemologies had something useful to offer. To his credit he was prepared to work with the ambiguities which come from living and practising in two seemingly incompatible systems. What Huxley and Laing both realised is that essential as disciplined attempts to craft meaning from our presence in the world are, they necessarily come up short in the face of the inexplicable givens of our existence, both material and existential; what Rebecca Solnit (2006, p.202) described as ‘the mystery in the middle of the room, the secret in the mirror… what has been there all along’. Psychology, like psychoanalysis, has largely failed to confront the fact of our existence in the world as ultimately mysterious. An awareness of this sublime mystery is one of the conditions of being.

Key sources Carmichael, S. (1968). Black Power. In D. Cooper (Ed.) The Dialectics of Liberation. Penguin. Huxley, F. (1959/1960). Charles Darwin. The American Scholar, 28(4), 489-499. Huxley, F. (1974). The Way of the Sacred. Doubleday. Huxley, F. (1985). Psychoanalysis and anthropology. In P. Horden (Ed.) Freud and The Humanities, pp.130-151. Duckworth. Roberts, R. & Itten, T. (2021). Francis Huxley and the Human Condition: Anthropology, Ancestry and Knowledge. Routledge.

www.francishuxley.com

The fantastic reality of life Many writers have referenced the celebration of this sublime mystery as underpinning what Abraham Maslow called peak emotional experiences. For Baudelaire (2010, p.20), it was ‘the fantastic reality of life’, for Boym (2005, p.503) ‘the ordinary marvellous’, for Arendt the ‘miracle’ of freedom and for Benjamin (1999, p.63) ‘the renewal of existence in a hundred unfailing ways’. The mysterious nature of being may also lie behind Freud’s concept of the uncanny, a realisation of the

fundamental strangeness of existing in the world. Adam Kotsko (2015) has considered this uncanniness, ‘creepiness’ as he designates it, as intrinsic to the enigma of desire – that our signiﬁcant relationships are founded on a recognition of the ‘strangeness’, and inalienable differentness of another person. Yet despite all this, there is no place in the psychology curriculum for discussion of the unerringly strange fact of our existence. Within the broader mystery of our existence are attendant others; our experiential entry and exit points from the world vis-à-vis the birth and presumed death of consciousness, the nature of experienced time, and the place of love in the fabric of the world. These are central to our experience and understanding of life and cannot be resolved by rational means alone – they rather invite an engagement with one’s total being, one that in Huxley’s (1974, p.3) words ‘must be acted out in order to be experienced and experienced if one is to make it one’s own’. In several works Huxley dived headlong into these waters, charting the symbolic roadmaps of world culture, documenting its riches without ever seeking to reduce the map to the semblance of anything more rudimentary. The mysterious, though it is soaked in the world of appearance, is not synonymous with it. In his book the Way of the Sacred, Huxley charted the divine iconography and mythic symbolism of the world which points us toward the invisible source of mystery. It stands as his answer to the question – what is the world? It is the world, ready-made, and replete with its own history and peoples that we encounter when we are thrust into it newly born; a phenomenology of human sacred symbolism. The requisite attitude behind a good deal of Huxley’s work is thus a reverence for the unknown, an attitude that is antithetical to the epistemologies currently ordained and worshipped in the church of academia. The instrumental bent of the knowledge industries which circle academia, and the kind of information they demand, also underscores an aspect of Francis Huxley’s life which we have sought to delineate here. Huxley’s respect for indigenous peoples, their right to deﬁne their own life in the way they choose, their right to be heard, for their voices to be carried into Western academic and political discourse, speaks of a demand for knowledge to be allied to justice. The allegiance to any notion of a ‘pure science’ places considerable obstacles in the way of such a desire. It is no coincidence that it is the qualitative realm where distant voices have been raised. A call to escape Huxley also accorded people the right to experience the world in a manner consistent with their own customs. Though we now consider it a distinctly postmodern slant, he long ago saw a place for granting different cosmologies rights of co-existence. Raised as he was in the socially privileged bosom of the Huxley

the psychologist may 2021 looking back

clan, educated at Gordonstoun neo-Darwinian thought. School and Oxford University, the What Darwin imputed into distance he covered intellectually nature, for all its genius, Huxley and emotionally, in rejecting the intuited as arising from Darwin’s ideologically constructed norms own masculine tinged view of which bolster the mirage of the world. Huxley was strongly Western superiority, cannot be influenced by the suffering his underestimated. We may ask how mother endured in her marriage and Ron Roberts is Honorary far our own systems of education took a keen interest in the iniquities Lecturer in Psychology at Kingston encourage us to challenge our own which women in the world faced. University, London. precepts. For him, this meant an artistic, even r.a.roberts1955@hotmail.com In our biography of Francis existential appreciation of nature Huxley (Roberts & Itten, 2021) we was needed to compliment the examined the matrix of intellectual, excesses of an impersonal view of emotional, and social possibilities the natural world. The intellectual passed from one generation to heritage of his great-grandfather, another which contained him. For Darwin’s friend Thomas Henry Huxley, as for all of us, escaping that Huxley, weighed heavily on his web is not possible; but weakening shoulders. Yet Francis used his and mitigating its effects is. Francis anthropological experience and Theodor Itten is a psychotherapist was at times aware that he was awareness of the often personal in private practice in St Gallen, trapped, and in various gambits nature of non-Western cosmologies Switzerland. sought to escape. In many ways in order to balance the formative info@ittentheodor.ch his life is a calling card to abandon Huxley picture. His essay on the traditional premises on which Darwin, published as the 1950s drew intellectual merit is assessed and on which higher to a close (Huxley, 1959/60), remains bold, original education is founded. Thus, we have agency even and fully contemporary for our age. if we are not unambiguously free. We can cultivate how to live within the strictures of the given. We can choose to some extent, using our inbuilt and Fun and love acquired resources, what outside influences may be The kind of psychology which Huxley championed granted entry. Huxley rejected aspects of eugenic and which we endorse is a call to broaden the scope of thought which his favoured uncle and father endorsed; enquiry into the human condition. It’s a call to forge a challenged, both in his narrative anthropology and greater alliance between psychology, anthropology and with the creation of Survival International, some of the arts; one in which research is fully embedded in the cultural accoutrements of colonialism and white an investigator’s own conditions of living. In hindsight supremacy; rejected the monotheistic centrepiece one can see Huxley’s life and work, as a fully lived of respectable English society, stood apart from the enquiry into the conditions of his own existence scientism of his esteemed father Julian Huxley and the – familial, cultural, symbolic and religious, a selfliterary bolthole of his uncle; and tried to forge his own designed anthropological program pursued largely way in the world. outside of academia. Its outcome is an answer to the Huxley also challenged the instrumental bent twin questions of ‘what is the nature of the world?’ and of knowledge in another crucial manner. His LSD ‘how do I wish to be known in it?’ experiences and research at Weyburn hospital in All this begs important questions regarding the Saskatchewan accorded love a pivotal place in the pursuit of knowledge. Just what kind of knowledge, human place in the cosmos. Like Chagall, he believed what kind of enquiry, what programs of learning, what ‘the meaning of life and art’ was ‘provided by the kinds of academics and researchers subscribing to colour of love’ (quoted in Newsweek, 8 April 1985). what kinds of values, do we want? Must it all be safe, One can too easily dismiss this as a hangover from obedient, careful? Must we only teach students to the pop philosophy which coursed through the veins follow laid down procedures, capable of guaranteeing of the 1960s. One should look past such fashionable pre-ordained results within a specified time period? dismissal. Huxley was extremely well read in cultural If so, it will remain the case that the existential and anthropology and comparative religious thought as metaphysical dimensions of our existence, not to well as the wide literature on psychedelia, and did not mention truly liberating commentary or art, will make his pronouncements lightly. He drew attention remain off-limits. Then, there will be no place for to an experiential truth which has pervaded world the Francis Huxleys of this world. Any vision for thought for millennia; one which may be as crucial for what the fruits of intellectual life can deliver will be our own survival and the well-being of the biosphere correspondingly diminished. Fun and love, for Huxley, as the material logistics of selfishness, promoted were essential to both life and enquiry. It is up to us to under conditions of capitalism as a central plank of include them in what we do.

We dip into the Society member database and pick out… Dr Mohammadrasool Yadegarfard, counselling psychologist at Hertfordshire Partnership University NHS Foundation Trust.

One book In my 10 years as a counselling psychologist, there have been times when I found it difﬁcult to have compassion for myself. To be kind, empathic and compassionate to ourselves all the time requires constant reminders and practice. The Mindful Self-Compassion Workbook by Kristin Neff and Christopher Germer offers a step-by-step practical approach to cultivating emotional well-being by breaking away from self-judgment and impossible standards. One psychological superpower ‘Wisdom’ encapsulates all the essentials such as experience, knowledge and good judgement, which consequently are associated with being unbiased, non-judgemental and compassionate. I cannot claim that I am already there, but I think having the ability to self-reﬂect, practising in three different countries, working with diverse clients on various issues and presentations, keeping myself informed and up to date with new research, and receiving regular supervision have all helped my CPD and kept me moving in the right direction. One thing psychologists should be proud of We contribute to a better society, whether through research and producing knowledge or by practice and helping people with their mental health or empowering them. I strongly believe that when anyone helps another human being, they are in fact helping society.

One song ‘I’m still here’ by Sia is about overcoming hardship and trauma, more like a victory cry.

one on one

The song speaks of how our past trauma can keep coming back to torment us and drag us down, but Sia continues the good ﬁght. She also knows there’s no-one else that could ﬁght this battle for her. I’ve had a few clients who had experienced trauma in the past or were battling with drugs and alcohol, and they found this song inspirational.

One challenge in my job I work as part of a multiagency team within family safeguarding. I receive my referrals directly from social workers for assessment for therapy and psychological interventions. As can be expected, there are clients who are reluctant or feel under pressure from their family or social workers for committing them to therapy. Many of them do not think they need therapy and others do not know how therapy might help them. Among these clients, the most challenging are those who hold a false belief about psychologists’ power and their ability to solve their problems with a magic wand without any actual effort and commitment from them. The ﬁrst and most important goal with these clients is to work on their belief about psychologists and their role in the process of psychological intervention and its structure and limitations, as well as their own commitment, expectations and goals in the therapeutic process.

coming soon… power posing; lived experience; plus all our usual news, views, reviews, interviews, and much more... contribute… reach 50,000 colleagues, with something to suit all. See www.thepsychologist.org.uk/ contribute or talk to the editor, Dr Jon Sutton, jon.sutton@bps.org.uk, +44 116 252 9573 comment… email the editor, the Leicester ofﬁce, or tweet @psychmag to advertise… reach a large and professional audience at bargain rates: see details on inside front cover maybe you missed… …May 2017, ‘Minds run free’ …Search it and so much more via www.bps.org.uk/thepsychologist

One lesson learnt I would not have lasted this long as a psychological practitioner if I did not take selfcare seriously. Exercise in particular has been one of my main strategies, which is testament to the fact that regular physical activity is the best medicine for many psychical and mental health problems. One thing about the BPS It’s a reliable source for psychologist and clients, a place that helps psychologists to connect, exchange knowledge and share ideas with each other. For many trainee psychologists, BPS is a place that helps them to grow and ﬁnd a direction in their career. More at thepsychologist.bps.org.uk

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psychologist may 2017

Minds run free Christian Jarrett and Ella Rhodes

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