‘It's not all about therapy, but about embedded psychological work'

Can you tell me a bit about your background and what has brought you to this point? 

I didn't want to be a psychologist when I was at uni – at least not to begin with. Studying psychology, sociology, and politics, I was going to be a politician, but I gave up on that, which is quite a relief now! I come from a working-class background and thought psychology would be the most practical way to have a career.   

When I first started in psychology, I worked in older adult services, across both physical and mental health teams. My grandad had dementia when I was a teenager, and that gave me a passion to want to do something in the field. I had a sense of how often, older adult's voices were discounted, in services and in life. So I have always had that social psychology outlook. 

Moving to the South of England, I found that even though there's a high proportion of older adults, there were fewer services. I worked in adult psychology for about five years, before starting in UHS in physical health – it felt a bit like coming home.  

Working with cystic fibrosis for about sixteen years, what I loved was the systemic way of thinking. After my clinical psychology training, I completed my systemic MSc. Instead of positioning problems in people, you'd think about how do we position people, what opportunities will we offer them, how do we respond to illness?  

What was it about clinical health psychology that made you feel so at home?  

As a constructionist, it's so integrative. I love working in acute physical health – there's something about the use of frames. It's not psychiatrically /diagnostically driven or dualistic. 

You're working with people's distress and where they want to get to, not telling them what to do. Working in an acute hospital has quite a fun side to it as well – there's a real flip between things being very sad, and knowing people intimately, sharing moments where you connect and make a difference. 

You've talked about your love for systemic working – I'm curious as to whether there are specific models that have influenced your practice. 

I draw on lots of social constructivist ideas. There's one theory called the Coordinated Management of Meaning (CMM) (Pearce & Cronen, 1978) – which is the idea that in order to understand something, you have to think about the hierarchies of context that inform how people respond in a moment. But I think you must start with the basics of systemic thinking – what goes on between people and that idea of self-reflection in action. 

You currently work as clinical lead within UHS, specialising in cystic fibrosis, asthma, and staff psychology. You also work in private practice, and balance work as a visiting lecturer with the University of Southampton. Can you tell me about what your week looks like? 

I'd say about half of my time is spent working within my team and working with different leads in the Trust. At the moment, I do more work with staff than with patients. Around half a day of work is one-to-one therapy with patients who have difficult-to-treat asthma. I also do consultations around joint care planning with more complex patients – for me, this is the bonus of being integrated into the hospital. 

I love EMDR. I finished up my training in 2017, and I use it a lot with both patients and staff. Even though it sounds unusual, there's a clear evidence base you can point to. One of the things I love is how creative it is, and how people's brains take them to places I could never come up with. 

When you're doing attachment work you might be re-scripting and you can bring in characters such as superheroes. Sadness also has its fun aspects.  

Quite often I'd use EMDR with a systemic lens with the staff. I have a day and a half working with staff – sometimes individual short-term therapy, and also consultations with teams.   

I do love my therapy with clients and staff. With staff, you get a real appreciation of people's roles or pressures because my role as a psychologist is quite different from being on the wards. In clinical health psychology the therapy is an aspect of the role. We make a case for paying for embedded psychology because of all the conversations you have around ongoing patient care alongside health professionals.  

How have you seen clinical health psychology as a discipline develop over time; and what would you like to see? 

Locally, our services have extended hugely, although clinical health psychology is variable across England and depends on local commissioning. When I started there were no NHS talking therapies, and now we link in nicely into those pathways, particularly with those who work with long-term conditions.   

I think what would be really good to work towards is having a clear sense from commissioners about when you need psychologists embedded in an organisation. There's something about being embedded which means you can have conversations, that are harder to have if you're placed externally – because it's a relational thing built on trust. 

With the NHS 10-year health plan, for instance, where they're thinking about having services in the community, they need to consider what might be needed in acute care to move people across, and what needs to be done in the hospital to link in those specialist care teams? How do we view things at a systemic level? The evidence would say if you have something that's embedded, it will cut costs in different ways.  

What I'm thinking is, how do we work smarter? How do you create systems that give us maximum capacity? 

It's not all about therapy, but about care pathways. Pathways that consider a person and whether something will be traumatic for them. How do we create systems that are a little bit more thoughtful and psychologically minded? One-to-one therapy is important, but you're not going to be able to do that for everyone. 

So how can we think about our set-up to make it less distressing for people, and how do we work with different professionals to offer psychologically informed care? If we could get to a point where we think as trauma-informed organisations, that would be really beneficial to patients, wouldn't it?  

There's also a change in terms of how we work with other psychological professionals. When I qualified, it was pretty much just psychologists; and now there are a range of different roles we work alongside. For me, it's about how we complement each other. 

Tell me about why you are involved in the BPS Clinical Health Psychology Faculty, and why you think it's important. 

For me, there's something about having papers to refer to in terms of good practice, evidence base, and how do we sing about our profession? How do we show what we're doing is good? Probably psychologists are not the best at blowing their own trumpets. The Faculty has authored different papers over the years which have definitely been helpful for me in terms of building our service. 

When we're approached by government for comment, people can bring their expertise, we can pull together evidence. Putting myself forward in the committee, it's nice to meet other people around the country with different expertise. I am always learning from them. That process of sharing knowledge and linking up is really beneficial.  

What advice would you have for early career or aspiring clinical health psychologists? 

So I think it's nice to have some honorary experience during university to have a sense of what it's like to work there.  You can ask, do I like that setting? How does it fit with me? What am I like around physical health problems? Do hospital settings make me feel uncomfortable? What does it bring up for me? What makes me tick? I'm not sure if I really had that at the beginning – which is interesting.  

A healthcare setting isn't the easiest place to work, so you need to have a real sense of what your drivers are. That's what gets you through the difficult times. There are days when it feels like there's no impact, and then there are days when you can really see the pin drop and the change you are making. You've got this combination of rewarding work within a difficult, stretched system.