Reflections on 50 Editions of Clinical Psychology Bite-Size
Reflections on 50 Editions of Clinical Psychology Bite-SizeIssue 50 – September 2017 Authors: Steven Coles and Phil Houghton (firstname.lastname@example.org and email@example.com)
- Trauma and adversity are significant factors in mental health issues
- Power is key to understanding the cause of people’s difficulties and the potential to overcome them through access to resources and supportive relationships
- Making sense of experiences such as fear, sadness and madness is important. Bite-size has advocated for models beyond those which locate the problem inside the person
- Clients can experience services as supportive and nurturing, or as controlling and coercive. The latter may mirror and trigger previous experiences of disempowerment.
- Supportive and therapeutic conversations with clients are important as are positive connections to peers
Historical and Social-Material Context of LifeA person’s history and social-material world is of key importance to our understanding of mental health and distress. We cannot understand a person’s fears, beliefs, and experiences without knowing what has happened to them in life and what is occurring currently. For example, various editions of Bite Size have highlighted the prevalence, significance and devastating impact of trauma and adversity in childhood and adolescence. Others have shown the importance of wider adversities such as poverty, discrimination, unemployment and inequality in shaping how we feel about ourselves and other people. The context is always important and can best be approached with the question: “what has happened to you?” rather than “what is wrong with you?” The context of our lives inevitably includes power and interests. Power can be seen as the ability of a social group or individual to influence others in accordance with their interests. Power is unevenly distributed in society and disempowerment can manifest itself in terms of being overwhelmed by emotions, thoughts and bodily sensations – a state in which people no longer feel in control of their own minds and bodies. Key factors causing mental health difficulties such as child abuse, domestic violence, inequality, discrimination, and neglect are matters of power and its misuse. Access to resources and practical support can be forms of power that can help people to develop and rebuild their lives.
Meaning and Making Sense of LifePower shapes us and how we come to make sense of ourselves, our emotional pain, other people and the world around us. Meaning is not something an individual conjures up from thin air. It is formed within a particular culture, which will have been shaped by power and interests across time. We currently live in a culture that emphasises the individual whilst downplaying the impact of the world around us. This individualistic notion benefits those in power as it justifies their status, but it also means that people struggling in life start to focus on themselves as the source of their problems rather than the world around them. Mental health services also reinforce this individualistic model as they are dominated by a medical model that emphasises individual biological concepts and talks of illness and treatment. A similar narrow view can also be found in psychological models of distress. For example, Cognitive Behavioural Therapy is individualistic in nature and so can minimise the importance of context. These dominant models of understanding mental health have been questioned in a number of Bite-Size articles in the hope that it will broaden how we think about and make sense of people’s experiences.
Aspects of distressKey aspects of distress are a lack of meaning in a person’s life or a restricted view of themselves and the world, as well as confusion as to why they are acting and feeling the way that they do. Helping people to find meaning in their life and to understand their distress is a central task for addressing their mental health issues. It can be an important step forward for service users to begin to understand their feelings and actions and then examine what choices and control, perhaps very limited, they may have in their lives. Bite-Size highlights the limitations of individualistic frameworks, opens up additional understandings of mental health difficulties and invites us to work more collaboratively and benignly.
Relationships and Connections to OthersFrom the moment we are born we are dependent on others for our survival, and as such our brains are socially orientated. We have evolved to focus on and function within a social world and so we are particularly sensitive to the people around us. These people can be a source of support, comfort and strength or they can be one of neglect, fear and disempowerment. As such Bite-size has emphasised the importance of past and current relationships, such as how attachment patterns when we are young can impact on us as adults. Bite-Size has also explored the importance of having supportive and therapeutic conversations with clients and the significance of positive connections to wider peer and community resources. It is important to consider a person’s past relationships, and their experience of using power and having power used against them. Such experiences shape how we approach current relationships and our sense of place in the world. An understanding of current connections gives a sense of opportunities for support and access to resources, and sources of disempowerment and restriction.
Relationships with mental health servicesPeople’s relationships with mental health services at times include nurturing, supporting and providing access to resources. At other times they include control and the imposition of medication and a medical way of understanding their experiences. Often there are shades of both to each person’s contact with mental health services, which can be a confusing experience for both service users and staff. Though there are perhaps times when some degrees of containment and security are necessary, particularly when someone is unable to look after themselves or is a significant risk to others, Bite-Size has always emphasised the importance of collaboration and interpersonal sensitivity such as respect, empathy, acceptance, trust, warmth and compassion. In essence trying to be an ally to clients who may have had limited, confused or traumatic experience of relationships in the past. It is within supportive relationships that people may feel safe and comforted enough to be able to make more sense of their experiences, and who may then be encouraged to explore a world and build a life that they have previously feared, or felt lost within and confused by. There are of course significant challenges in supporting people who have experienced numerous elements of disempowerment, such as poverty, limited housing, family dynamics and an ingrained sense of helplessness, and we also have to be wary of our potential to unwittingly disempower clients. However, ultimately the messages contained within the various Bite-Size editions point to how, whilst our efforts are at times naturally limited, we all have the potential to have a positive impact on the lives of the people we see.
Concluding commentsBite-size has emphasised the significance of the context of people’s lives and their experience of power. As mental health practitioners we also sit within a particular context that at times supports us but can also work against us. We also have our own experience of being able to shape the world around us, as well as the limits and restrictions placed upon us. Having reached 50 editions of Clinical Psychology Bite-Size we hope that readers have gained a greater sense of what is possible and within their control when working in mental health services and that they feel a little more able to understand and work with the clients they see.
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