Category Archives: United Kingdom

The great divisions in modern Britain

This week I have been reading the extracts (published in the Guardian) from Polly Toynbee & David Walker’s new book, Unjust Rewards. The book is a contemporary look at class divisions in British society.

The first extract “Meet the Rich” is based upon group interviews with City workers, and their views on disparities in wealth and opportunity in the UK. Predictably, the attitudes reported from these City workers were ill-informed, intolerant or full of self-serving justifications for their position and wealth:

One woman banker described escaping from a provincial town where the main employer was the public sector: “If you aspire to anything beyond that you’re not going to live [there] any more, and that’s the choice you make.”

They had chosen a life that would make them rich while others, making different and morally equivalent choices, had abdicated their right to complain. “Some of these are vocational, things like nurses . . . It’s accepted – they go into it knowing that that’s part of the deal.” Another said: “Many people, like teachers, don’t do things for the pay. But you won’t find a teacher that works as hard as we do.” This was categorical, evidence unnecessary. They spoke of heroic all-nighters drawing up contracts for clients in time zones on the other side of the globe, a Herculean effort that justified fat pay. But did they work 10 times as hard as a teacher on £30,000 a year or, in the case of some lawyers and bankers, 100 times as hard? Such disproportionality did not enter their scheme of things.

What is reported is almost a parody of itself, “Guardian journalist finds out that rich people think that money spent on poor people is wasted”, were there going to be any surprises?

The second extract “Breathless with Amazement” is more touching and in its way heartbreaking. It recounts a visit to Oxford University by a group of high-achieving high school students from a poor London borough, a number of the students from minority backgrounds and none of whom have had family members experience further education. For these kids the trip opens their eyes to the possibilities of what can happen with academic success, but as the article contends, without a change in the disparities of opportunity, the chances are slim that any of them will make it to Oxbridge.

They left the gleaming spires with a vision of university as a place of pleasure – a new thought and perhaps the most important one at this stage in their lives. Would any of them make it back to Oxford after their A-levels? Their teacher thought two of them were in with a chance as they were exceptionally clever. But it would depend on admissions tutors appreciating how much they had overcome in how short a time. Several were Afghan refugees, who in the course of the two days, had talked movingly of American gunships firing on their towns and villages. One boy was African-Caribbean, UK-born and in care for years. In year 9 he barely attended school and was shunted from pillar to post, but once settled in year 10 he had become pupil of the year and was now destined to do well, despite everything. Would an Oxbridge tutor ever hear these stories – and get to assess how their potential stacked up against the attainment of a young person who had no obstacles to overcome?


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ACT in the UK symposium, BABCP National Conference Edinburgh 2008

Acceptance and Commitment Therapy had more of a presence at the British Association for Behavioural and Cognitive Psychotherapies National Conference this year, with pre-conference and half-day workshops, and several symposia on ACT and ACT-related research. Also, for those interested in the broader contextual approach to CBT there were workshops and symposia on Behavioural Activation, as well as a keynote speech by Christopher Martell on “Twenty Years of Behavior Therapy: Trends and Counter Trends”. It seemed that, compared to recent BABCP conferences, there was much more on offer for the behaviour analytically inclined clinician.

I participated in the ACT in the UK symposium, which was held on Saturday morning. The details of the presenters are below. Unfortunately Frank Bond was unable to present at the symposium as scheduled; similarly so for Tom Ricketts, although Giselle Brook presented in his place. The powerpoint presentations as well as audio are available for each presenter.

Saturday 19th July 2008, BABCP National Conference Edinburgh

Acceptance & Commitment Therapy: ACT in the UK
Convenor: Simon Houghton, Sheffield Care Trust, UK

Chair: Joe Curran, Sheffield Care Trust, UK

Group ACT for OCD: Development of the approach and initial findings

Tom Ricketts, Sheffield Care Trust, UK. Presenter: Giselle Brook  [Presentation (.ppt)  Audio (.mp3) ]


A significant proportion of clients with OCD are known not to respond to traditional exposure and response prevention (ERP) with alternative treatments such as cognitive therapy pr medication seeming to offer little additional benefit. A group treatment based on ACT was developed and delivered to a number of clients that had failed to respond to ERP. This presentation will describe the group process and report the initial clinical outcomes of this approach.

Measuring psychological flexibility and mindfulness skills with people who hear distressing voices

Eric Morris, Institute of Psychiatry, King’s College London & South London & Maudsley NHS Foundation Trust, UK  [Presentation (.ppt)  Audio (.mp3) ]


This study involved validating the Acceptance and Action Questionnaire-II (AAQ-II) with a sample of people who hear distressing and disabling voices. The relationships of psychological flexibility and mindfulness skills with general distress, social functioning, topography of voices, symptom distress, beliefs about voices, and thought control strategies are explored.

Living successfully with pain: The role of illness representations, catastrophising and acceptance in chronic pain functioning

Sujata Bose & Tammy Spencer, NHS Tayside, UK; David Gillanders, University of Edinburgh, UK (presenter)    [Presentation (.ppt)  Audio (.mp3) ]


Background: Psychological factors are known to influence adjustment to chronic pain. Beliefs or appraisals relating to pain, as well as catastrophising responses to pain have both been found to influence adjustment. Recent research has shown the importance of acceptance in living successfully with pain. Acceptance is a behavioural construct defined as willingness to experience pain whilst continuing to engage in important activities. The present study examined how appraisals relating to chronic pain interact with the processes of catastrophising and acceptance to influence physical and emotional functioning.

Method: 153 individuals attending NHS pain clinics and pain support groups completed validated questionnaires measuring appraisals of chronic pain, catastrophising, acceptance and emotional and physical function. Path analyses were conducted to investigate direct and moderated relationships between pain related appraisals, catastrophising, acceptance and emotional and physical functioning.

Results: A range of direct and moderated relationships are described, with important differences between the psychological variables associated with emotional dysfunction and physical dysfunction. Whist some direct relationships between appraisals and both emotional and physical functioning were observed, catastrophising moderated the relationship between appraisals, acceptance and emotional functioning. By contrast, acceptance moderated the relationship between appraisals, catastrophising, and physical functioning.

Discussion: The findings suggest that different psychological processes many underlie successful emotional and physical functioning in chronic pain. Interestingly, appraisals relating to the controllability of pain do not show significant relationships with either emotional or physical functioning. The clinical and theoretical implications of the results are discussed, as are directions for further research.

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Filed under Acceptance and Commitment Therapy, CBT, cognitive behavioural therapy, Mental Health, Psychology, United Kingdom

Even MPs struggle with the stigma of mental illness

Despite there being accurate information more available to the general public, it appears that stigma of mental illness continues to affect the lives of millions of Britains, including the powerful and influential.  A recent survey has found that 1 in 5 British MPs  have experienced a mental health problem but fear to disclose this because of stigma and discrimination:

An anonymous questionnaire completed by 94 MPs, 100 Lords and 151 parliamentary staff has revealed that:

  • 27% had personal experience of a mental health problem including 19% of MPs, 17% of Peers, 45% of staff
  • 94% had family or friends who have experienced a mental health problem
  • 86% of MPs said their job was stressful
  • 1 in 3 said work-based stigma and the expectation of a hostile reaction from the media and public prevented them from being open about mental health issues.

The report is critical of the law forcing MPs to give up their seat for life if they are sectioned under the Mental Health Act for six months. By comparison, if an MP is physically incapable of working for six months due to a serious illness they would not be forced to stand down. The majority of MPs who responded thought this rule was discriminatory and urgently needs to be changed.

Challenging and changing the mainstream response to those who experience mental health problems involves persistence, courage and clout. Changing the law to reduce discrimination is part of this.

A compassionate view involves recognising that these problems and the stigma attached to them are not the issues of faceless “other people”:if not directly experienced by yourself, then in all likelihood it is a family member, friend, or workmate who struggles with this.  There is a good op-ed piece here about the survey, and it is worth checking out the comments below – the number of jokes at the expense of those experiencing mental health problems AND who happen to be MPs suggests we still have a long way to go as a society.

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Filed under Mental Health, Politics, United Kingdom

The UK is “an endemic surveillance society”

As a country with the the world’s largest CCTV network and a government keen to propose various intrusions on civilians’ privacy, is it any surprise that Britain achieved the rating “endemic surveillance society” by civil liberties watchdog Privacy International? (along with such privacy luminaries as the United States, Russia, Singapore and China)

I guess that we can be reassured that the UK government knows how to safeguard the personal data of citizens… unless you: receive child benefitreceive a pension, are learning to drive, or have accessed healthcare, of course.

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The Commute…

For 2 years I commuted by train from Brighton to work in London.

At best, the trip door to door took 1 hour 20 minutes, at worst… well, those who have experienced the exquisite delights of being a “customer” of the British transport system can fill in the gaps.

An article by Nick Paumgarten in the “New Yorker” a few months back describes the
seemingly rational calculus made by many Americans between lifestyle, a good job and time spent commuting. It would seem that for a lot of people the “lifestyle” ends up being several hours each way to work in their car. As the author writes,
A commute is a distillation of a life’s main ingredients, a product of fundamental values and choices. And time is the vital currency: how much of it you spend—and how you spend it—reveals a great deal about how much you think it is worth“.

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Foreign-trained clinical psychologists in the UK: More tips to get through the SoE

Another post about surviving the British Psychological Society’s Statement of Equivalence in Clinical Psychology (see previous entries on this site)….

Joalida Smit writes a personal reflection in Clinical Psychology Forum (Number 169, January 2007) about the “feelings of professional inferiority as the result of subtle mechanisms of ‘othering’ inherent in the SoE”. At the close of her article (a lot of which I could relate to) she lists a number of basic suggestions that would have been helpful when planning to start the SoE:

1] Settle in first – relocation is a huge personal investment. Don’t start before you have stability (externally and internally) .

2] Be realistic – the SoE takes mental and physical energy, don’t expect to make strides in your “real” job until the process is completed.

3] Be practical – have a structured, task focused approach.

4] Don’t get sucked into the emotions of what this further training implies.

5] Beware of the SoE Summer School – refer to 4 above.

6] Don’t make it personal – the SoE requirements do not say anything about you as a person.

7] Don’t expect the Society to make it personal – follow procedures, don’t try to jump the system (it only leads to frustration and anguish).

8] Hold the ambivalence – don’t let the anxiety get the upper hand.

9] Be careful of paranoia – “the Society” are people too.

10] Hold on to yourself and your skills – after all that’s why they gave you the job.

11] Don’t lose your voice – despite your Trust’s investment and support, you have to speak up if things are not working for you. People will listen.

12] Buy a car – you will be required to travel. Public transport is not a good idea.

13] Remember to enjoy the journey – after all, you are getting paid to learn more.

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Filed under Clinical Psychology, Psychology, United Kingdom

Acceptance and Commitment Therapy in the United Kingdom

For the past 6 months or so I have been working on a committee to set up a Special Interest Branch of the BABCP that focuses on Acceptance and Commitment Therapy (ACT). It has been good to get involved again in organising training and the promotion of evidence-based psychological therapy, something that I used to do when I lived in Perth (when I was in the West Australian branch of the AACBT). Aside from the appeal of letting others know about ACT, I’ve enjoyed having contact with other therapists and researchers who are keen about the science and therapeutic stance that ACT takes.

In my experience, the ACT community has been welcoming and inspiring, living the values of the approach, which includes emphasising the key role of science in developing methods to help people: the hard graft of research, open to skepticism and debate, and remaining linked to basic research and philosophical assumptions. It has seemed a good fit for me with my background training as a scientist-practitioner in clinical psychology.

I hope that the work of the ACT Special Interest Branch in the UK will continue this trend. For those who are curious, the link to the homepage of the ACTSIB is here.


Filed under Acceptance and Commitment Therapy, CBT, Clinical Psychology, cognitive behavioural therapy, Mindfulness, Psychology, United Kingdom