Last updated on 27th April 2010
So here I am sitting in a cafe at Euston station. I came in on the sleeper half an hour or so ago. I slept well, which was a blessing. I love it. A full day's work yesterday, travel while asleep, well set up for a full day today. Sleepers don't always work out so well, but my old tricks of aiming to be pretty tired when I get on board and using earplugs seemed effective this time. I didn't even resort to the further favourite of having a good slug of whisky before tucking in to the rather narrow bunk.
So now it's two days of the British Association for Behavioural and Cognitive Psychotherapies (BABCP) Spring Workshops and Conference. Most years I manage to get down for this shot of good quality information in the spring. It's usually fun, relaxing, interesting and helpful. Today is the day for workshops - and tomorrow for the conference. The overall theme is "Relationships and relating in CBT: science and practice". I kind of had to come. I'm very committed to the importance of the therapeutic relationship and I think, as cognitive-behavioural therapists, we often don't pay enough attention to this aspect of our work.
There's a choice of half a dozen workshops today - a couple on a compassionate mind approach (interesting that Paul Gilbert and Deborah Lee are running workshops separately - maybe an increasing demand for this kind of training), Paco Fearon on "Mentalisation based techniques", and Andrew Gumley on "Cognitive interpersonal therapy for recovery after psychosis". There's also a workshop that I was very tempted by - Arlene Vetere on "Working 'within' and 'between': the relationship between the intra-personal and the interpersonal". Happily Arlene Vetere is giving a plenary presentation at the conference tomorrow, so I should get a chance to find out more about what she's been exploring. The sixth workshop, which I plumped for, is Willem Kuyken & Rob Kidney on "Collaborative case conceptualization: building relationships and relating into conceptualization". Last year I bought the book Willem wrote with Christine Padesky & Robert Dudley "Collaborative case conceptualization" (New York: Guilford, 2009). After a fairly quick glance through it, the book joined many others sitting on my shelf waiting vainly for a time when I would magically find I had free space to sit and read it. Coming to this workshop should tumble me into chewing at these ideas more productively.
I've been attracted to a series of points made both in the book and in this workshop's publicity blurb. Willem Kuyken writes "Case conceptualization is at the heart of cognitive-behavioural therapy (CBT) because it is where evidence-based therapies and clients' unique presentations come together. When done well conceptualization empowers clients and increases CBT's effectiveness." This second sentence of the blurb has me raising my eyebrows a little. It appears to be claiming that there is evidence that well performed conceptualization increases CBT's effectiveness. This may be so, but I've never seen research demonstrating it. Lovely if there is - I look forward to finding out. The blurb goes on to say "In this workshop you will learn a new case conceptualization approach that we call Collaborative Case Conceptualization. Our model incorporates three key principles: collaborative empiricism, incorporation of client strengths, and levels of conceptualization." This is interesting. For years, I have tried somewhat inefficiently to pay more attention to client strengths as well as the much more routine, expected attention we give to their 'weaknesses' and problems. I don't think I do this very well. If this workshop helps me pay attention to strengths more effectively it may well be worth the entry price just for this gift. "Therapist and client work collaboratively to first describe and then explain the issues a client presents in therapy." Yup, I like this too. As a medical doctor, trained in the 1970's I was too exposed to a set of The-doctor-knows-best attitudes. I do think that evidence supports the notion that when someone takes ownership of a conceptualization, or an approach, or a proposed set of actions, they are likely to commit and persevere more productively than when the conceptualization or proposed actions are simply given to or suggested to them without their input to the process. I guess I'm pretty happy with the way I conceptualize cases already. I distinguish vulnerability, precipitating, and maintaining factors - see the diagram "Onset and maintenance of distressed states". I also put together an overview and brainstorm possible interventions onto a "Problem solving diagram" that seems to work very well (the client also gets a copy of this completed diagram). However I'm sure it is possible to learn how to do all this even more helpfully. Time to walk along to the conference venue at Westminster University. It looks a lovely day and great to get some air and stretch my legs. See tomorrow's "BABCP spring meeting, second post" for what happens next.