What is Clinical Psychology?

We asked Paula our Lead Clinical Psychologist here at IntraQuest to answer this question recently …

Wow, this is a tricky question, well not tricky exactly but hard to sum up in a few words!

I think Clinical Psychology is best explained when we look at the meaning of the title so: Clinical = “based on or characterised by observable and diagnosable symptoms”. Psychology = “the science of mind and behaviour”.

So, Clinical Psychology is all about what is happening for a particular individual or family. We look at the difficulty as a whole, whether that be a whole person; mental health, behavioural, physical health, symptoms etc. Or as a family unit, how individuals interact with others, relationship difficulties, parenting issues, mental health, physical health etc.

We observe what they present, what they report and think, and perhaps what others may see or worry about. Gathering all of the relevant information, and coming up with hypotheses (assumptions of what might be going on based on the evidence). Sharing that hypothesis with the client (and family) and working together towards a shared goal that is beneficial to the individual/family.

Clinical Psychologists are qualified to the highest academic standard. We are trained to Doctorate level, following many years of training not only in the classroom but also in clinical settings. Clinical Psychologists are also regulated by the HCPC (Health & Care Professions Council). And as with all Doctors, we are required to continue to maintain our professional standing through learning and research, which continues throughout our careers.

My personal view of Clinical Psychology is that it is a very privileged position, that allows me to help people, who for whatever reason are experiencing difficulties in their lives.

We then work together to find helpful outcomes, using a wide range of psychological interventions, I love the fact that one therapeutic intervention does not fit all, so the skill of a psychologists role is finding the best treatment plan and being flexible and empathic. The most valuable skill that a clinician can have is the ability to form good therapeutic relationships, not only with the individual but with their family and wider systems (education, employment, other professionals etc.), these relationships are key to any therapeutic changes and the ongoing support that may be needed for that individual.

Again, this makes perfect sense to me as you have to be able to trust the person that you have asked to help you with what may be a potentially very difficult journey for you. One of the things that sets a therapist apart from other roles is that we are actually delighted when either our client “sacks” us or we agree together that our time together is done. That doesn’t mean that we are glad that you won’t be coming back to see us, but rather that you have worked hard to resolve your difficulties and you no longer need to see us on a regular basis. Of course, we plan this ending, just like we plan every session so that it is tailored to the individual’s needs, we can offer reduced sessions or check-ins until you are happy to say goodbye. This is why I love what I do!

Another tricky question! Well, two but hope I have answered both here: 

The National Health Service is experiencing unprecedented pressure, the reason for this is both manyfold and complicated, but I am happy to share some of the experiences I faced whilst working in a CAMHs service some 5 years ago: Reduction in funding to health services year on year, this then placed pressure on all trusts and in turn further pressure on individual services, teams and practitioners. Services tried to adapt to the lack of funding, but with ever-increasing costs and ever-decreasing funding the pressure on staff to see more people also increased. Waiting lists climbed to an all-time high and the overall feeling within services was quite bleak. I began to feel that I was not really helping clients as much as I should/could have and felt overwhelmed, after all, I had trained for over 10 years to improve people’s lives, I decided that I had to leave the NHS for my own well-being, sadly not unusual in the current climate. This coupled with the pandemic and even further investment cuts, the NHS to coin a popular phrase is now “on its knees”.

Having worked in private practice for over 5 years, I am delighted to say that there is an alternative to waiting on a waiting list for over 2 or 3 years just to be assessed. At Intraquest we are able to offer initial Consultations to clients and their families, this is usually achieved within a few weeks (rather than years) and this allows us to work together to come to a shared understanding of an individual’s need and come up with a plan. Sometimes this will be to consider neurodevelopmental issues (one of the longest waiting lists on the NHS), we are able to think about and screen for autism, ADHD and learning difficulties, through interview, observation and screening questionnaires. This relatively simple intervention can reassure clients and help them to consider ways to help the individual concerned. The family may decide to embark on one of our Specialised Pathways and could have an answer to their concerns in a matter of months. As we do not have a huge waiting list we can see people relatively quickly and have all of the gold standard (NICE guidelines) psychometric equipment, we are person-centred and absolutely determined to provide a world-class service to our clients.

We also offer therapy to our clients, again once we have discussed what is going on we can decide on a therapeutic package that everyone is in agreement with. We work with a wide range of problems including, anxiety, depression, behavioural concerns, health-related issues, adjustment challenges, gender identity and trauma. Again the benefit ofIntraquest is that we do not have waiting lists and can offer the right treatment package in a timely manner. We are not tied by the constraints of larger national companies and can react to demand quickly and efficiently.

One of my favourite therapeutic interventions with children, and I say favourite because you can see how much this helps people from the first session and, how this can also reduce treatment time, is Animal Assisted Therapy. At Intraquest we have the absolute privilege and pleasure of being able to offer this amazing intervention to children and adults. Not only are we located in an area of natural beauty with wildlife happily roaming free nearby, we also have the space to house and care for animals. At present, we have guinea pigs and rabbits and 2 trainee therapy pups. The small animals are available to children and adults who, for whatever reason are struggling with anxiety, low mood or just struggling to find the words to say how they are feeling. In conventional therapeutic surroundings (office-type locations) this barrier to therapy can take many months to overcome, however, introduce one of our beautifully calm-natured animals and it seems like magic happens, individuals seem to feel more relaxed and able to open up. Coupled with the beautiful surroundings you can see the most troubled souls begin to uncurl and relax at Intraquest. I have to admit it also make for a great working environment for us too and we can’t wait for the expansion of the site to get underway this year so we can add more therapeutic animals to our growing pack.

It is so important to be able to see clients in a timely manner, not simply because people deserve to be seen and treated as soon as possible, but early diagnosis and intervention are directly associated with better outcomes. It makes sense to me that if someone is asking for help then the problem must already be affecting their everyday life, if that person is then left to wait for several years, the problem will only become more established and more difficult to treat. If we can begin to explore those difficulties as soon as possible we are in a better position to begin to change that person’s outlook on life. I think this is even more important when it comes to diagnostic interventions, such as Autism, ADHD and learning difficulties, if we can assess young people at an early stage, this can be literally life-changing for that young person, not only will they and those around them have a better understanding of certain behaviours, but we can begin to scaffold that person’s future and put in place strategies and support (school, college, employment, relationships) to help them become the people they deserve to be. This also applies to adults who have gone through life aware of certain difficulties but never having the chance of receiving a diagnosis or explanation. The effects of early intervention are far-reaching, not only to the individual, their family and loved ones but also to the wider Community.

If you’d like to find out more about Clinical Psychology, you can visit our page on the website and fill out one of the questionnaires and we’ll be in touch with next steps. Click here.

Paula Butroid
Lead Clinical Psychologist
IntraQuest

“Beyond help.”

This is a phrase I’m hearing more and more recently, not from professionals, but from struggling people being given short term therapeutic interventions that just don’t work for them.

Many years ago, partly through my own training as a psychotherapist and partly through retrospective learning around my own journey, I became aware of the notion that failed therapy can be more damaging than no therapy at all. If a person repeatedly accesses therapy but doesn’t feel better, they develop the idea that they are beyond help – this is very damaging and simply untrue. It’s my belief that most people who have experienced this, haven’t been given access to appropriate therapy.

I read and listen to some great thought leaders of our time like Wayne Dyer, Abraham Hicks and Louise Hay and I heard an analogy with a very specific approach to self-healing based on the following metaphor: they describe the journey of life as being like a car journey, you get into your vehicle and set off in a direction but somewhere along the way you find yourself lost. Your car has a satnav and at this point you have two options: you either retrace your steps all the way home in order to establish where you went wrong OR you reset your satnav and move straight forward from where you are. They assert that the former is pointless and that it doesn’t matter how you got where you got to, you can simply move forward and change your life from this point.

Now I get this, it makes logical sense I guess, you can’t change the past after all. I also subscribe to unleashing from the past at some point and carving out a deliberate path forward. Though there are problems with this approach when a person is given this direction when they are not ready for it.

In all honesty I am yet to meet a struggling individual ready to carve out a new path without first understanding the road already travelled.

Here are some strong arguments for travelling home first.

In my experience, when a person feels stuck where they are, they are often frustrated, not only with thelr circumstances but with themselves. They are often experiencing a heavy sense of guilt or shame around being in their current position, and this makes it almost impossible to let go of. Travelling home gives a person the opportunity to understand themselves, the decisions they’ve made, and the direction they’ve taken. Travelling home almost always reveals a multitude of experiences that led to a person’s survival instincts to kick in – and these experiences can seem surprisingly insignificant until properly examined. Travelling home almost always reveals younger versions of self that got stuck in fear along the way, and the survival behaviours have carried forward into the present. In witnessing these parts of self and the experiences that led to the current condition, a person is much more able to find some self-acceptance and forgiveness in their present reality.

The biggest breakthroughs I have witnessed in therapy, have come through thoroughly understanding the present reality through a deeply compassionate awareness of the road travelled thus far. When people can truly see and understand that they are innately good AND also wired to survive, which means they will behave in defensive ways if threatened, I see them begin to forgive themselves for their current condition and this opens the door for a totally different future. These discoveries are amongst the most exciting parts of my work! But let’s be clear, this rarely happens in 6 sessions and never happens without permission to travel home.

Returning to our earlier analogy, and for this moment putting to one side my personal frustrations around the lack of provision when it comes to good, appropriate, and contextual therapy, l’m an advocate of both short-term present to future focussed work AND longer-term past to present to future focussed work when it comes to psychotherapy. My issue is not with either approach to well-being and personal development, my issue is with inappropriate interventions being offered to people simply because it’s all that’s available. This is what leads to people feeling they are beyond help and this needs to change.

If you are someone that is stuck right now, feeling desperate and believing yourself to be beyond help – you are not alone and you are not beyond help. You probably haven’t experienced the right type of therapy yet and it will be out there!

We are brilliant, complicated beings so let’s not assume we can throw simple answers at our complex struggles and come out on top.

My next blog will talk more on the power of self-compassion inspired by my personal journey, professional practice and the great work of Louise Hay. I hope you’ll tune in.

Karen Keates
Founding Director & CEO
IntraQuest

After months of hard work, we are so thrilled to be able to share with you at last that our Award-winning learning programme, ‘Tackling Engagement’ will be launching online in January 2019!
Now Public Service businesses can provide our proven method of successfully engaging with ANYONE to all their staff via their Learning Management Systems, accessible from any web-enabled device, anytime, anywhere!
The programme contains over 60 ‘bite-sized’ learning assets – and we mean ‘bite-sized’, with each asset taking no more than around 10 minutes to complete. There’s short video tutorials, exercises and games, as well as great downloadable tools that learners can use time and time again and links to latest research and articles. But that’s not the best bit!
Because we know that people struggle to find the time to learn and develop, we’ve teamed up with a fantastic Learning Tech partner called Filtered. Filtered have created a revolutionary new intelligent engine called Magpie. By answering a few simple questions from Magpie, learners will be given a tailored recommendation for their specific need. They can follow the recommendation there and then, or save it to their own dashboard for later, putting quick, impactful, tailored learning right at learners’ fingertips.
If you weren’t already aware, many Local Authorities have already commissioned ‘Tackling Engagement’ for their frontline Public Service workers and leadership teams, and it’s seen dramatic results such as:

• Workers solving twice as many issues as nearest comparable boroughs;
• Happier workers and service users;
• Service users themselves reporting greater control and independence;
• Reduction in crime rates;
• Reduced demand on services by an average of 35% – and as much as 70% for some!
• In fact, one Borough identified that they had seen fiscal benefits of over £8m in a year as a result of their people working differently with service users!

But up until now, it’s only been available via ‘Face to Face’ workshops. So why not add our impactful suite of online learning to your development offering and allow your people to access this proven, highly impactful and relevant learning content to achieve some (if not all) of the great results above.
PLUS we’re offering special ‘Early Bird’ rates for pre-orders of over 100 annual licences, with up to 70% off compared to Individual Membership and up to a whopping 92% off compared to workshop rates!
To find out more, or to get your tailored quote, please contact us with your enquiry and the number of licences/users you would like to have access and we’ll get back to you as soon as we can.
But hurry – Early Bird rates end 31st October 2018!
Team IntraQuest

Be the first to hear our BIG news!
 
Join us on Facebook on 4^th October at 3.30pm for our LIVE launch – don’t miss it! www.facebook.com/IntraQuestUK, follow us, add THIS EVENT to your calendar, and we hope to see you there!
 
Team IntraQuest

After months of hard work, IntraQuest have a VERY special announcement to make in the next two weeks. Keep an eye on your Inbox, this blog, LinkedIn, @IntraQuest and www.facebook.com/IntraQuestUK to be one of the first to find out!

Here’s a hint… our Award-winning learning could be closer than you think!
Team IntraQuest

We’re so proud to be able to share our Karen’s story with all of our followers and friends.
As many of you know, IntraQuest was born out of difficult but inspiring personal journeys. One of these journeys is our Karen’s. Part of the IntraQuest approach was inspired by what worked for Karen when she was in crisis, and what has since worked for so many of our own clients and service users.

In making this short film, special thanks go to Bearded Fellows, our incredible animators, Viaduct Video for archive training footage and Gerard Gudgion and Antony Oxley for photography and sound.
Extra special thanks go to Karen for her bravery in sharing her story. We hope it inspires you!

We live in an ever-changing world. So much of what is happening around us is more fluid than ever. This makes it increasingly more difficult to respond, and more importantly, be pro-active. Forecasting based on historic data is becoming less and less reliable – circumstances are constantly changing based on technology, trends, fashion, media influence…the same challenge today could be driven by something completely different than a year ago, and the same factors a year ago create very different challenges today.
One thing that hasn’t changed very much in our culture is how we deal with problems. It’s safe to say that the best way to handle the challenges that life throws at us is to take all the necessary steps and precautions to ensure problems don’t arise, but if they do at times, do the best we can to handle them. However, when what causes issues is ever changing, it can be really difficult to know what steps to take to avoid problems. The danger here is that unforeseen challenges arise and we end up having to be great at crisis management, but ensure that we reflect heavily on how that crisis came about in order to put in preventative measures for the future.
So what happens when we’re stuck in a culture of crisis management, constantly fire-fighting and solving problems with no time to reflect or implement those cautionary steps for the future? It can feel like a vicious circle – a revolving door that just won’t stop spinning. What if we could change to a culture of crisis avoidance? What would be the benefit?

IntraQuest are all too familiar with this concept. As a learning and well-being services company, it’s safe to say that in most cases the phone only rings when there’s a crisis. We generally become engaged in issues when they’ve become so challenging that specialist support is needed. This is when we intervene with different capability for professionals, new approaches, therapeutic interventions and community support. We’ve built our business on responding to people in crisis, but the golden egg for us would be to AVOID crisis if possible. Crisis is a lot more difficult to manage, takes up much more time, resources and energy, and in many cases it’s the symptom of that crisis that ends up being managed, because of safeguarding, risks to individuals or the public – so much time is spent managing the crisis that there is no time to reflect upon the root cause.
We can’t help but wonder…if our learning and well-being services were employed BEFORE crisis hit, would crisis hit at all? Surely prevention is better than cure, especially when that cure only treats the symptom, rather than the cause? And we can’t get away from the fact that crisis is damaging – yes, the damage in a lot of cases can be fixed, but if the damage could be AVOIDED, isn’t that a better state of affairs?
Over the last four years, IntraQuest have been working with Early Help and Prevention teams all over Greater Manchester, and the results have been astounding. Not only have these teams built much better relationships with residents, they have seen a demonstrable increase in self-awareness and decrease in problematic behaviours. Essentially, they have prevented problematic behaviour from escalating, and in many cases, stopped it altogether – crisis avoided! All of this is down to our unique approach – empathically seeking to understand the cause and positive function of problematic behaviour, in order to propose the right long-term solutions for individuals.
Evidence (and several national awards) has told us that this approach is a force to be reckoned with. If you’re part of an Early Intervention or Prevention team, or any response team for that matter, you ae bound to benefit from our learning solutions. We provide practical tools and techniques for building trusted, credible relationships with clients, that will help you understand the honest, positive function that their problematic behaviours serve for them. Only then can you explore solutions that will work for both your service AND your client. And that’s crisis avoidance!
Want to know more? Get in touch with us!

A few years back, the Government introduced the concept of Psychologically Informed Environments – or PIEs – as a critical factor affecting housing and homelessness in the UK. The concept was simple: how does the psychology of homeless people affect their plight? It acknowledged, perhaps for the first time, that homelessness isn’t simply a ‘state of being’, but perhaps a ‘state of mind’. Homelessness might well be the outcome or behaviour of deeper issues – merely a symptom of an unknown root cause. It also explored an incredibly worrying thought: maybe the resolution is about more than putting a roof over a person’s head?

IntraQuest have felt incredibly validated by this notion. As a team of people who have spent time on both sides of the fence – both homeless and responsible for housing – we’ve known for a long time that homelessness is far more than just a ‘state of being’. Our research and our work with countless professionals has only served to strengthen this resolve. In many cases, homelessness is an extreme symptom of relationship issues, and like most problematic behaviours, the key is to understand the positive function that living without housing serves to individuals. If we can work to the general assumption that any behaviour, problematic or otherwise, serves a purpose to the person, whether we agree with it or not, we are likely to get closer to the truth.

It’s All About Connection!

Consider if you will the challenge of the Housing Officer. Their role, perhaps even their vocation, is to help reduce the plight of the homeless, put a roof over people’s heads and give them the security that we assume they so desperately need. So they work tirelessly with their clients, helping them to find appropriate housing, whether that be a flat, house, shelter or hostel, and help them to manage the responsibility of that roof through work and finances. These teams work so hard, like so many frontline professionals, usually with the aim of helping people make positive improvements to their lives. Imagine how frustrating it is to work so hard to help someone, only to find that they end up back on the streets?
Why does this happen? The answer is simpler that the solution. Isolation, to the human being, is like death. We crave connection to SOMETHING – whether that be other people, environments, relationships, interests, pets…the list goes on, but the aim is the same – connection. Here’s an interesting thought to explore – where does the homeless person feel more ‘connected’? In a flat, on their own, with many new responsibilities that they have never understood or felt the benefit of before? Or on the street, perhaps with other homeless people, amongst many other people (even if it is just their legs walking by), living a life that, although may be tough, they have learned to survive? Even the connection they have with their housing officer has come to an end – it has to – so, what or who are they connected to now?
There was a brief interview on the radio recently, with a homeless man discussing his plight. He was homeless as a result of a breakdown in his relationship with his parents. Listening to him, he expressed a desire to have his own space, a sanctuary that was his and his alone. This particular individual may be relatively easy to deal with, as he ultimately WANTS a home. The point to focus in on here was that he had a home, but the relationship – the ‘connection’ – with his parents was so damaged that he fled the perceived ‘security’ of a roof over his head. The lack of meaningful connection made that roof insecure. This tells us that homelessness is about so much more than simply a roof – it’s the meaningful connection an individual has to everyone and everything that is underneath that roof.

The Psychology of Homelessness

Surprisingly, the psychology of homelessness is no different to the psychology of anyone. If we stick with the assumption that homelessness is an outcome, rather than a root cause, surly there’s more work to do? Seeking to understand WHY that person is homeless is key to proposing the right solutions and ongoing support in the future. It’s also a safe assumption about anyone that past experiences, thoughts and feelings absolutely affect our behaviour. So, if we consider homelessness a ‘behaviour’ rather than a cause, surely we need to do more to understand what led to this outcome? This is where PIEs come in. Understanding the psychology behind each individual’s plights can give clues as to why this outcome has arisen – but most importantly, it can help practitioners propose solutions that are sustainable in the long term.
No-One Left Out Solutions Ltd created a report that breaks a PIE down into 5 key elements. Operating consistently within these elements is key to assisting long-term positive outcomes and behavioural change.

• Relationships – no surprise here! Connection is the key to sustainability. Understanding the positive function that homelessness serves to an individual will allow us to propose solutions that maintain those same connections, but with a different outcome. Connecting individuals to other services or communities can also assist sustainability if the solution is right for the individual. Managing expectations within relationships is also a critical factor.
• Staff Training & Support – housing officers and organisations require knowledge and skills to accurately assess the psychology behind their clients plight. This is about building trust and credibility with clients in order to seek the truth behind their homelessness, and the root cause behind the behaviour. Some simple, quick counselling and therapeutic techniques employed by housing officers can make all the difference here, and will allow staff to understand the root cause of the problem, and more accurately propose successful solutions.
• Physical Environment – understanding the psychology behind the outcome is key to understanding what will and won’t work for your client in terms of physical environment. For example, an individual with a deep-rooted fear of responsibility may benefit more from a hostel or shelter initially, rather than their own place. Whether the physical environment is conducive to their psychological health is also a key factor.
• Psychological Framework – if we’re going to apply psychology to practise, we need a method! And this method needs to be embedded throughout ALL practise, from early intervention, through to assessment, outcomes and sustainability. The framework becomes a common language amongst associations, and informs all aspects of delivery.
• Evidence Generating Practise – this is a critical factor. Both the association and the client need to be able to clearly assess and evaluate success, and ‘state of mind’ becomes as important to measure as ‘state of being’ already is.

PIE Culture – Myth or Magic?

There is no ‘quick fix’ PIE injection at present – housing organisations will need to work hard to embed PIEs into their culture. Processes, assessment, support functions, capability and solutions all require the PIE treatment, otherwise the mentality is at risk of not sticking. Fortunately, IntraQuest have a solution that will solve a big part of this problem. Our learning framework, created around the 5 key elements of PIE, will provide staff with the psychological framework, knowledge, skills, tools and techniques required to operate a true PIE service. We can even offer consultancy and support on internal practises, such as assessment forms and processes, to ensure that they align to the PIE service being offered. We have worked with many housing associations in the past who have all testified to the power of our method, and we’re excited about offering our award-winning capability programmes now aligned to creating successful PIE cultures. If you would like to know more, please get in touch with us. IntraQuest have proven the significantly positive impact that the therapeutic approach has as a restorative practise – let us help you create better outcomes and a culture of independence amongst your service users.
If you’re a Housing Trust, non-profit or charity, we may be able to provide you with fully or part-funded learning solutions. Complete our short survey here to find out if we can help you!