mental-health – Midlands Psychology Group

Grace Blakeley’s latest blog on Substack is a welcome read.

Even before considering the call for resistance, readers might note how validating it is to read something which makes so much sense. Not just validating. It’s actually reassuring for any of us to know we’re not the only one. We’re not going mad. What’s happening is actually happening and it’s deeply shocking.

The latest Netflix documentary, Plastic Detox, is yet another of the endless examples of how this is all a natural result of capitalism. This plastic, which very possibly caused some of our cancers, our immune disorders, our inferitlity, is the result of greed and the pursuit of profit for a small minority, whilst the rest of us pay, in some cases, with our lives.

Mark Fisher was a speaker at one of our Midlands Psychology Group conferences, not many years before he took his own life. We would have liked to reference his talk but unfortunately it’s not on our website and we can’t find record of it anywhere in our back catalogues. Memory is not playing ball either. But, it being a critical psychology conference, Mark Fisher would no doubt have been making the links between mental health problems and capitalism.

But it was the final few paragraphs of Grace’s piece, inspiring the need for resistance, which grabbed one of us (Penny Priest) the most. I became interested in acts of resistance in psychological work many years ago, when I came across a paper I fell in love with (never having fallen in love with an academic paper before): Small Acts of Living: Everyday resistance to violence and other forms of oppression, by the Canadian family therapist, Allan Wade. The paper describes Wade’s approach to therapy which is based on the observation that whenever persons are badly treated, they resist. It described so well how many of the people I had the privilege of meeting in my clinical work had engaged in acts of resistance in order to survive. Wade goes on to say how ‘alongside each history of violence and oppression, there runs a parallel history of prudent, creative, and determined resistance.’ People who have been on the receiving end of violence and oppression may well recognise this and have their own stories about their survival methods. That paper led me to the book, Small Acts of Resistance: How Courage, Tenacity, and a Bit of Ingenuity Can Change the World.

We’re human beings. Our imaginations are one of our most defining human characteristics. We can imagine a better world. And we can inspire each other in the process of doing so. Who knows what powerful acts of resistance could emerge from us?

Click here to read Grace Blakeley’s reader supported piece. https://open.substack.com/pub/graceblakeley/p/capitalism-is-killing-the-future?utm_campaign=post-expanded-share&utm_medium=web

What are service evaluations actually for?

This month Clinical Psychology Forum, the UK profession’s in-house journal, published ‘a service evaluation of a dialectical behavioural therapy-informed skills group for community mental health service users with complex emotional needs’. The authors’ rationale, in the context of staff shortages, burnout, recruitment difficulties, long waiting lists and limited funding, was that DBT-informed skills group (DBTi-S) can ‘treat multiple clients simultaneously and its minimal, low-cost training requirements for staff’. Whilst their results showed a significant reduction in dysfunctional coping and blaming others (as measured by the Dialectical Behaviour Therapy Ways of Coping Checklist (DBT-WCCL), there were no significant results from the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), the Work and Social Adjustment Scale (WSAS) nor the Difficulties in Emotion Regulation Scale (DERS).

As is so often the case with research into the effectiveness of psychological therapies, this service evaluation is replete with methodological problems, not least with self-report as a way of assessing outcomes, including: the unreliability of introspection and memory; participant reactivity; (i.e. response/behaviour change due to being aware of being observed); response bias (e.g. responding according to social desirability); demand characteristics (e.g. picking up information regarding what the study is looking for) (see Rust & Golombok, 1999).

More importantly perhaps, the paper also seemed to gloss over the fact that there was a 62.5% drop out rate: 24 service users across three CMHTs were accepted to attend DBTi-S groups, however only NINE of them completed the six-month programme. Interestingly, their qualitative data included the feedback that ‘three patients expressed a preference for smaller group numbers as it provided more opportunities to learn and practice the skills’. This seemed to be reported as something positive, and yet this was said by only three of the nine people who completed the programme (so 12.5% of the original cohort). With the groups running across three CMHTs, this must have meant that on average each group had 3 people in attendance.

It’s maybe also worth noting that the groups were delivered by at least two trained facilitators – Assistant Psychologists, CMHT Keyworkers and Associate Psychological Practitioners who had done the DBT Essentials training, that is, a 2 day introductory workshop.

They conclude that ‘Overall, the continuation of this intervention is likely to prove beneficial to its participants and the Trust.’

We should be surprised at this conclusion, on the basis of the limited outcomes and the drop-out rate. But it’s not surprising. This is happening all over the UK and precisely one of the reasons for our books, Team Of One and Outsight.

Is this really the best that clinical psychology has to offer?