Clinical Psychology

Clinical Psychology

“The unsavoury history of Clinical Psychology makes some people worry about seeing a psychologist.  But times have changed, and now psychological therapy and counselling have been proven again and again to help a wide range of people, both those suffering with mental and physical illnesses and those that are healthy but benefit from a trustworthy person to talk to.”

Dr Amber Johnston, Consultant Clinical Psychologist at Circle Rehabilitation

Find out more about Dr Amber Johnston’s background here

Clinical Psychology is a discipline where doctorate-level professionals study the human mind, behaviour, mental illness, and the scientific method/statistics. Clinical Psychologists can specialise in many areas, with some becoming academics focused on research and others attracted to direct work with people giving talk therapy. Though historically Clinical Psychologists worked with people with more severe mental illnesses in hospital settings, now many professionals engage with those struggling with common mental health complaints, such as anxiety, depression, stress, and grief.

Clinical Psychologists specialise in therapies that talk out problems and look at thoughts, behaviours, and future goals to plan treatment strategies.  Medication is not involved in these treatments, though many Psychologists work close with Psychiatrists or GPs if medication options are warranted. Clinical Psychologists may specialise in sub-fields and work with people of specific populations, such as those with health related illnesses (Health Psychology), those caught in the legal system (Forensic or Corrections Psychology), or those with injury to their brain from physical trauma or acquired brain injury like stroke (Neuropsychology).

Dr Amber Johnston is a Clinical Psychologist at Circle Rehabilitation who specialises in Health Psychology and Neuropsychology. She helps people who are struggling to cope with everyday stressors or previous traumas but are otherwise healthy individuals, as well as those who are struggling with medical illnesses. Such illnesses include those needing support through short-term medical interventions, those adapting to chronic or long-term health conditions, and those who have had significant changes to their brain and minds after acquired brain injury. Support for those coping with pain is another sub-specialty of Dr Johnston, as she is a provider for Circle Rehabilitation’s Pain Management programme.

“Some Clinical Psychologists specialise in therapies that overlap quite a bit with the more public ally-accepted work of counsellors- and that means in terms of appropriateness, there is no harm whatsoever in going to talk to a psychologist. The biggest hurdle many face is simply making the decision to invest some time in taking care of themselves.”

The short answer is it could be for anyone. Psychology is for those simply looking for help and support with their mental wellbeing. It does not require a formal diagnosis and does not mean you will receive a diagnosis if you attend a psychology session. For a Health Psychologist, there is an understanding that receiving a medical diagnosis of illness can be a huge shock – unwanted, scary, and unsettling. It is not part of your life plan, and symptoms, treatment, or side-effects can interfere with previous ways of living your life. You may not enjoy the same leisure activities as before, may not participate in the same sort of social or family events, or you may feel unable to work or meet financial obligations so are worrying about supporting your family. All these changes can increase worry while limiting your ability to utilise your previous coping strategies, creating stress and heightening emotional responses which may make coping with the medical condition harder. This is where a Clinical Psychologist can help.

Dr Johnston says, “We know that increased stress lowers people’s resources to cope. Their immune system is affected, which makes them feel more run down, possibly more ill. Stress can use symptoms that may be confused with illness symptoms, such as lack of sleep or over tiredness, loss of energy, irritability, loss of appetite or overeating, and low motivation to exercise or engage in previously enjoyed activities. These are classic signs of stress symptoms act like a big interlocking grid that may be confused with illness symptoms or may interact to worsen illness symptoms, therefore increasing suffering.

“Psychology helps to look at these symptoms, unpick them, and address them by providing coping ideas and resources that enable the person to handle something that they weren’t asking for.

“Usually with a short term condition, the expectation is that a person will get better, and they can see an end point. Psychologically, it makes a difference if one feels, ‘I just need to get through the next few months’.  It can be more difficult when things develop to become chronic, such as when a diagnosis has a questionable ending, there isn’t a quick treatment, or if a diagnosis hasn’t been found to match the symptoms. These circumstances make the experience much more unsettling.

“When you don’t know how long you’re going to have to function in a sub-par manner, there will be an emotional reaction. Some may feel that they just aren’t themselves, that they don’t have the spirit or the energy to do the same things they used to do. When they begin avoiding enjoyed activities or social events, they are cutting out activities that bring joy and stress-relief. This may be one piece of the recipe for prolonged suffering.

“The role of the Clinical Psychologist is to intervene at this point, before the cycle worsens and leads to severe anxiety and depression.”

Dr Johnston says, “there is a continued stigma around the concept of mental illness. It is something many people are fearful of – that they’re going to be labelled as having a mental disorder, which has many negative connotations with some members of the public. Patients sometimes say to me, ‘If I see you, what will people think?  Will it go on my record and affect my job? Are you or everyone else going to think I’m crazy?’

“People don’t realise how prevalent mental health concerns really are. Statistics show that one in four people have struggled at some point in their lives with diagnosable symptoms. In general, most people can empathise with challenging times, having struggled with grief or bereavement, coping with negative changes to life circumstances, being over ridden by worries, or having suffered with overwhelming low mood.

“When it happens, being able to speak to someone who’s trained with a whole array of techniques empowers the person to be able to feel like they can cope better with what they’re experiencing. It first can normalise their experiences and reassure them that these struggles are OK and workable.  To get a personalised view of what’s going on and which techniques may be most effective to enhance coping, going to a psychologist changes from being a threatening one to a preventative measure that ensures wellness rather than illness. The goal is to create a healthy mind in addition to a healthy body.

There are lots of treatments available when you see a Clinical Psychologist. This professional will have trained in the practice of many different theories, specialising in some more than others depending on the individual.  Some common options are as follows:

  • Cognitive Behavioural Therapy (CBT)

For presenting problems to do with stress, depression, anxiety, and coping with illness/pain, CBT techniques may be an option. These techniques look at your thinking systems and the behavioural reactions that you have to your emotions and thoughts. The intention is to help identify unhelpful thought patterns and responses and to alter them to make new, adaptive habits. This is an older technique, though still relevant, but many off-shoots of this theory have been developed and studied/proven. Though all have different methods, many have overlap, and all are considered shorter-term, time-limited treatments. Some of these include:

  • Acceptance and Commitment Therapy (ACT)
  • Dialectical Behavioural Therapy (DBT)
  • Compassion Focused Therapy (CFT)
  • Solution-Focused Therapy
  • Interpersonal Therapy

Some of these techniques encourage relaxation and mindfulness exercises, some focus on identifying value systems and life goals, and some strengthen adaptive patterns of relating to yourself and others to make greater self-confidence.  All involve increasing effective functioning within the natural stresses regular people encounter day-to-day.

A different type of treatment is available for those wanting a longer, more in-depth exploration of their selves and their emotional functioning.

  • Psychodynamic Therapy

This kind of treatment is more commonly reserved for Clinical Psychologists rather than counsellors or other therapists. This type of treatment involves the subconscious, defence systems, and looking into how events of your past shape your present and future. The focus will be on drives and motivation, your sense of self and your understanding of the world around you.  It will hope to discover unhelpful patterns and behaviours performed outside of your awareness or those that are done despite being harmful or making no logical sense. This exploration gives greater choice to allow you to carry out new paths in the future.

A third kind of treatment focuses on behaviour and motivation. The idea behind this short-term therapy is to identify what changes a person would like to make (or has been told to make- ie committing to a better exercise and diet plan; cutting down on smoking/drinking) and exploring resistance. Goal-setting, reward-setting, and breaking down barriers are part of this work. The focus is narrow with this kind of treatment and helps people achieve lifestyle changes that are otherwise difficult to achieve.

After you meet your Clinical Psychologist, the first step is to chat through what your interpretation of psychological support is. You may be asked questions like:

  • What brings you here today?
  • What goals do you have?
  • Are there particular struggles you want to discuss?
  • Do you want practical exercises and coping strategies or are you looking for something more exploratory to discover the roots of problems?
  • What recent stresses have you experienced?
  • What strategies work for handling stress? What doesn’t work?
  • How are you eating and sleeping at the moment?
  • Do you have social support, and how do they help you?
  • What do you do now for fun or to relax?

The Psychologist is using this time to get to know you, your strengths and difficulties, and to look at the severity of your symptoms. They are getting a feel for who you are and how they can be of help.

Part of the initial consultation is to chat through some of the different techniques. Searching for resources online can be great but can also be overwhelming, filled with competing strategies and advice. It can be difficult to choose which techniques to engage in without the full knowledge base and application rationale for what may be most appropriate to your personal situation. It takes a lot of effort to create change, so if you feel out of your depth about whether a technique is right for you, you’re more likely to struggle with committing to it without some experienced guidance.

Most importantly, the consultation will go at the pace you’d like it to. Some people expect that everything may be fixed with one or two sessions, and you’ll get told something that magically slots everything into place. Others may fear they will be told they’re doing everything wrong and will be given clear and easy concrete steps to follow to make everything great. This isn’t how it works.

“A consultation is a safe place to slowly discuss things at your pace and collaboratively come up with ideas to try out and test for effectiveness. It can take time and practice to learn new skills, but these new ways will be tools you can use for a lifetime.”

The key is to be open and honest, although this can take some preparation before you arrive.  Being open and vulnerable about potentially upsetting topics can be a challenge. A consultation is the beginning of a relationship. Like all relationships, it can take time to feel fully comfortable opening up, though you have the security in knowing that confidentiality is highly prioritised, and your psychologist has heard many, many stories in the past. It can take time for a full understanding to develop and for trust to grow, but the process is proven to be highly successful when given the correct nurturing.

Don’t expect everything to be said in the first session. Your entire history and all your experiences, genetics, and learning has interacted to create the path you are on. That can’t possibly all be addressed in the first session or two – nor does it need to be. As the relationship develops and the goals are clarified, the Psychologist will help you narrow the focus and find the techniques relevant to your needs. And yet again, your openness to the experience highly influences what you get out of it.

Brining someone with you to the hospital is great, but sessions should be had on a one-to-one basis, unless discussed otherwise. The reason is specific. In your life, you have roles that you play, e.g. mother, husband, son, friend, etc. With all of those labels comes a set of expectations for how you react to the other person and the boundaries of your relationship. When you come in to the session as that person, you are still in that role, which may limit your freedom to be truly open and honest.

No, you can see a Clinical Psychologist privately by paying for your own treatment. Many patients will be referred by a medical professional however, such as a GP or Consultant. Though this is not essential, many people can get treatment covered on their private insurance policies if referred by a GP or Psychiatrist. To book an appointment, call 0118 922 6970 or email rehab@circlehealth.co.uk

The British Psychological Society has a very helpful website full of information about psychology and how it can help. You can access it here: https://www.bps.org.uk/public

MIND, the mental health charity, also has good resources available. Access their website here: https://www.mind.org.uk/

Searching for symptoms online can be misleading, so seeking the help of a qualified professional ensures recommendations are specific to you and your situation. If you feel your situation is urgent or your safety is at risk, contact emergency services or go to your nearest A&E department.

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