Great question. Think this absolutely is a risk of interventions which only target individual staff members. The one I am designing is intended to be a multi-level intervention – so to target both staff members with things they can do that might help, and also to try to tackle some of the more systemic problems, via influence on managers and creative thinking about how to overcome massive workloads and tricky rota-ing issues etc. It doesn’t help with the chronic underfunding of the NHS and undervaluing of the nursing profession. I’m really hoping that the current strikes will prompt some engagement from the government and the possibility of some solutions to that.

Similar situation going on in children's residential homes. We're often working with teens who have just left hospital or secure units but chronic underfunding and lack of appropriately trained/ competent staff combined with ludicrous red tape and unrealistic expectations means all to often they end up going back.

Therapeutically parenting traumatised children and teens is challenging and compassion fatigue is a very real issue that definitely needs greater awareness and intervention. It is, however, something that needs to take place alongside a complete overhaul of health and social care services. My fear is that what sounds like it has great potential would be used to allow complacency with the current standards which are seeing vulnerable people failed on an alarming scale.

ETA wrote this without seeing Dr Lucy had responded. It's great to hear you've acknowledged wider issues and the need for systematic change!

Or that your just saturating an already super over-saturated self-help market? Or are there some novel ideas in your book?

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Wow fab thing to think about. I think it depends on which aspects of modern life and how we are using those aspects. Some things I think are definitely not helpful, for example exam culture for children and young people. Others are more nuanced, for example social media can be both positive and negative depending on how it’s used.

What do you think about the possibility that “compassion fatigue “ is an honest assessment of reality. I work(ed) in the arena of homeless services and permanent supportive housing where self sufficiency is voluntary. I’ve seen so many people give up because they’re just waiting for their free apartment and case management services. Why should I bust my butt as a taxpayer to support those folks? What are your thoughts about that?

Fab question. I think probably a lot of the same mechanisms are at work, but the context is quite different so would affect how an intervention could be delivered and what would feel acceptable. It’s a huge issue in caregiving in general though. Lots of work done with foster carers too.

It seems you might not have full understanding of how CBT works and its scientifically proven benefits? Or maybe it did not work for you or someone close to you? Personally, it has helped me overcome many negative thought and behavioural patterns, it has helped me reflect over my thoughts and actions as well as giving me a great set of tools to tackle worry and anxiety.

I highly recommend it, but we do need to bear in mind CBT is not a fit for all and every challenge of the mind. That said, it has been scientifically proven to be more effective on more than most treatments, for a number of conditions.

The answer is, as always, broad economic and social reform, but since they profit from the system as it is, nothing will be done. Psychology is a joke field. Always has been. Therapy is a crap shoot and almost never works, it just teaches you how to hide your symptoms. Then they foist highly addictive meds on you. It’s an embarrassment.

This is a very interesting new area of research. I don't know enough about it but good people to read/listen to include Suzi Gage who has a fab podcast on all things drugs: https://play.acast.com/s/saywhytodrugs and Val Curren who does really interesting research in this area: https://www.ucl.ac.uk/pals/people/valerie-curran

I couldn't agree more! I've got increasingly interested in organisational and systemic elements of compassion fatigue and compassionate care in general. I did a masters in organisational psychology recently and I'm hoping to be able to pull together knowledge about individual level interventions for staff with more organisational level interventional components which tackle work conditions. It's a bit of a tall ask but that's the plan!

Yes! Couldn't agree more. I got very interested in the organisational aspects of compassion fatigue. I ended up doing a masters in organisational psychology and thinking about how some of these ideas about workplace conditions might influence staff ability to provide compassionate care. I'm in the very early stages now of a 5 year project but the aim is to develop a multi-level intervention, not something which is just for staff, but which also involves managers and possibly commissioners.

As a social worker in direct service

Hi! Firstly, I am really sorry that you've had this experience. I hope you've got good support around you now. It's really difficult to feel like you've missed out on a lot. I hope you have found someone to talk to about the negative coping mechanisms you mention too - to help with finding and practising alternatives.

In terms of improvements to assessment of mental health in children now - it depends which country you are in as to what is available, but in the UK there is a new initiative to bring mental health workers into schools with a new type of worker (educational mental health practitioners). Historically sometimes clinical psychologists or counsellors were embedded in schools but funding for this dwindled and the new EMHPs are a response to try to get to students earlier if they are having problems. It has only just started so it's too soon to say how it's going but I think the idea of getting in early is a good one. There are also some fab research projects looking at early intervention, for example CUES: https://cues-ed.co.uk/what-we-do/

Just wrote an absolute essay and then saw this 😂

Wow that's a tricky one! It's a lovely question actually because it makes me realise that there are so many very special moments. It's always great to feel like therapy has made a difference to someone's life, but even the moments when things are not going so well can feel important, especially if the person is able to tell you that they feel bored or like things aren't helping. It feels like there is a genuine connection and then you can try to do something differently. Many special moments happened when I worked on an adolescent ward in London where I also felt very connected to the team and to my supervisor, as well as to the young people I was working with.

Worst moments... I once got sent home from work because my clinical registration had lapsed without me knowing due to an admin error. It was awful! I had to be escorted from the building and I felt like a criminal! It's obviously very important to make sure that professionals are properly registered so it was absolutely the right thing to do, but it was horrible!

I think of most psychological diagnoses as on a spectrum with more common experiences, and I suppose I feel fascinated by the relationships with the people who I see rather than thinking about an illness in particular. Having said that I’ve worked a lot in wards with teenagers, and worked with some young people who are experiencing psychosis, and I think that’s one areas which is open to misunderstanding, with people seeing it as something dangerous or totally “other”, when again it is actually a spectrum of experience that we all lie on somewhere. All of us can experience paranoia and lots of people have beliefs that others don’t necessarily share. The difference is when it affects someone’s life negatively.

This sounds tricky... And christmas is a time when we often find ourselves stuck in repeating patterns in relationships with people we have known for a long time. One thing that can sometimes help is thinking about what you can do differently to shift the dynamic slightly. Can you make a conscious effort to talk more about your own stuff and not wait to be asked? The results might be surprising!

I hope you & Lucy don't mind if I jump in here with my own 2p worth! I had Compassion Focused Therapy (CFT) for several years & found it of very limited effectiveness. Some techniques e.g. imagining looking at your ideal compassionate self from the outside were actively unhelpful. Eventually I received a diagnosis of OCD and had OCD specific CBT. Made more progress in 20 sessions than in years of CFT.

My sense, from personal experience, hearing other people's experiences, studying psychology and working for a short time in mental health research is that different things work for different conditions & people. Usually there will be evidence pointing towards a particular treatment for the person's diagnosis, which is where treatment should start. If it doesn't help then need to give careful thought as to why before next steps.

Support worker is good experience prior to being an AP.

Research assistant can also be good experience

Hi! I'm a big fan of compassion focussed therapy but I don't think the evidence base is there to suggest it should be prioritised over CBT. I think it's important to be guided by what the evidence says is most effective, and for a lot of problems that is CBT at the moment. It doesn't mean that won't change as more studies are done with other modalities though. I also think patient choice is important - giving people the information about what the research says helps, but also telling them what the different therapies are like so they can be involved in the decision making. One of the reasons I made the podcast Let's Talk About CBT was to demystify the different types of therapies which are based on cognitive behavioural principles. There's an episode on CFT in there too! https://letstalkaboutcbt.libsyn.com

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With clinical psychology - if AP positions are hard to find you might have more luck with a research assistant post on a study which has clinical components. Voluntary work can also help if you are able to do a bit of that on the side (e.g. things like phone lines often provide training). Good luck!

Such an important thing to think about. We spend a lot of time with ourselves and if we're having a go the whole time it can have a negative effect. One question I find useful is to ask yourself what you would say to a good friend. We're often much meaner to ourselves than to someone else we love.

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This book by Mary Welford is a good one too: https://www.amazon.co.uk/Compassionate-Mind-Approach-Building-Self-Confidence/dp/1780330324/ref=asc_df_1780330324/?tag=googshopuk-21&linkCode=df0&hvadid=310805565966&hvpos=&hvnetw=g&hvrand=18171044736043241899&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9045631&hvtargid=pla-537293131368&psc=1&th=1&psc=1

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And in the new book I just have out one of the chapters is all about speaking to ourselves more kindly (April's chapter). This is on sale at only 99p for a few days if you want the e-book. https://www.amazon.co.uk/Year-Change-Your-Mind-Therapy-ebook/dp/B0B4BTF8RH/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=1671200145&sr=1-1

Wowser this is a big'un!

Main changes I would like to see in the mental health field relate to adequate funding. There has been so much talk of "parity of esteem" between mental and physical healthcare but I would like to see "parity of funding" and also proper investment in social care and third sector services. I'd also love our knowledge of staff wellbeing and the impact on compassionate care to advance so that we can more effectively help both patients and staff.

The picture here is very interesting and researcher Amy Orben has done some fab work in this area: https://www.amyorben.com

It depends on how we use social media. If we use it to compare ourselves negatively to others and to isolate ourselves then it's unhelpful. If we seek out accounts which are affirming and social links which help us feel connected then it can be helpful.

We need to be careful though, I think, as some dilemmas which occur online e.g. sharing personal photos with wide groups of people, can have devastating effects on young people

Hello!

I'm really sorry to hear you have complex post traumatic stress disorder. That's so difficult to live with. I would really recommend seeking some professional help with it if you can - if you are in the UK your GP is usually first point of access or you can self refer to some Improving Access to Psychological Therapies services. If the waitlists are too long then private therapists often often sliding scales of fees. It's important to get someone who has training and experience in dealing with CPTSD. If it is related to childhood experiences then this book is also a good resource - although not a substitute for individual therapy https://www.amazon.co.uk/Overcoming-Childhood-Trauma-Helen-Kennerley/dp/1841190810

Best of luck with it.

Aha I found your question! Thank you for writing this. I'm so sorry that things are so hard at the moment. It feels like things have always been difficult but in recent years have really bene stretched so so thin. I do think that staffing problems contribute to barriers to care. That's not to say that some agency staff aren't brilliant, but I think it's harder to have the same sense of continuity and team cohesion. It's also so stressful for the senior nurses managing the rota and trying to fill shifts. I do also think there is hope though because retention of staff is better in some wards than others, so I think we can learn from what is working in some places as well as from the research.

Ooh fab question.

I would say that things vary for individuals - there's no one thing, but things that tend to help daily are (obvious but still helpful): trying to move your body, eating well and sleeping enough (if possible!), trying to treat yourself with kindness like you would a good friend, trying to spot things you enjoy and things you feel proud of throughout the day.

Things that are usually unhelpful: too much of any one thing - e.g. too much isolation or too much busyness, not enough rest (even if it's tiny micro rests in the day), beating yourself up about things, ruminating on things that have already happened or worrying too much about things that are out of your control.

It's obviously easier said than done to make changes to these things, but they are worth considering in my opinion! There are more ideas in my most recent book which is only 99p on kindle for a few days: https://www.amazon.co.uk/Year-Change-Your-Mind-Therapy-ebook/dp/B0B4BTF8RH/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=&sr=

This is a really great point. I think they are different too. Some people have made a similar argument to yours: https://www.researchgate.net/publication/336746147_Contesting_the_term_%27compassion_fatigue%27_Integrating_findings_from_social_neuroscience_and_self-care_research

I think we maybe don't know quite enough about the subtleties of the differences yet, but this is something I'm trying to get my head around at the moment.

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Not yet but hopefully soon! Article here is based on some of the chapter on December: https://www.bps.org.uk/psychologist/coping-christmas

Also another angle, we in developed countries look at the clients with compassion because they have low funding, always micro-managed, controled food and spending etc. whereas I have heard from staff from underdeveloped countries that people with these problem get 0 help or funding. People from underprivileged countries might look at these clients as “privileged” compared to the people they have seen back home. Is our compassion based on the comparison of our own quality of life?

Some are quoted on the amazon page: https://www.amazon.co.uk/Year-Change-Your-Mind-Therapy/dp/1838959092

Very happily for me it was one of Apple books' best books of December and also one of the Independent's best books of December.

I use mindfulness, both myself in my personal life and professionally with other people. It's not for everyone but I find it very useful.

Hopefully at some point but it isn't yet

Hello! I'm nearly out of time again but here's a paper I published recently: https://pubmed.ncbi.nlm.nih.gov/35915459/

And self-reflection is hugely important. I use a mix of things - supervision and writing and peer supervision. I probably use self reflection and peer supervision more as time goes on but it's still really important to have regular supervision from someone who is just doing this for you - we can all have unconscious biases and can benefit from someone helping us to spot them and improve our practice.

ooh and the book - I'd recommend Yalom - Love's Executioner. It's quite psychodynamic in model which is not what I use but it's brilliantly written and I like the way he acknowledges his mistakes.

If you are UK based:

• Get a degree that gives GBC. I think every Psychology undergraduate degree is BPs accredited and gives GBC, but if yours isn't you'll have to complete a Masters that does give GBC.

• try to get a 2:1 or higher. It is not impossible to become a clin psych with a 2:2 but it's much harder. Some universities would only offer you a place if you have a "high 2:1 or better".

• if you get a 1st class honours that's great, focus on clinical experience. Assistant Psychologist roles are the best route for this, but Psychological Wellbeing Practitioner is also another valued role. Although just to warn you, the latter is associated with high levels of stress and burnout and there's some talk of "locking" trainees into the role, meaning they can't leave for 2 years post-qualification. Research assistant roles can also be good for research experience. Just to warn you that these roles are very competitive amd you will likely need experience prior to getting them e.g as a support worker. If financially feasible you could also get experience in a voluntary role.

• if you don't get a 1st class honours (I.e 2:1 or 2:2), I'd suggest following the previous steps but maybe also consider doing a Masters to further prove your academic competence.

• choose which courses you want to apply for purposefully. Some may have entry requirements that don't suit you. For example a couple institutions count your A level results, some require you to take tests of GMA, etc.

• be prepared for a really competitive field. I'd only recommend it if you are truly passionate and focused on it as a career. I'd say most people are looking at 3-4 years minimum of experience after undergraduate before they get onto the course, which is then another 3 years. I was fortunate to get onto the course with "only" 2.5 years of experience. Most of my colleagues have more.

Research jobs in clinical settings can be good, support worker posts, charity roles, voluntary work (e.g. Childline or Samaritans). There are lots of ways to get experience and see if you like the role. Talk to clinical psychologists if you can too to get a sense of what the role is like and also what other roles are around. Good luck!

Hi!

Firstly I am really sorry, that your partner had these experiences and that you have both had to manage difficulties with the healthcare systems in response.

I think there is no easy answer to this one, and unfortunately the risk assessment questions which are needed from a clinical point of view can feel like they get in the way sometimes. They are the best tool we have and it's important to try to assess risk but they're not a very good one.

In terms of what can be done in response to a lack of compassion - I think it depends on your level of energy partly. You could write to an individual clinician to give feedback, or it's always possible to complain - in the UK the Patient Advisory and Liaison Service is independent and can manage complaints about the service you have been involved with. Making a complaint means it gets put on record and the clinicians involved will get that feedback, which hopefully will help improve the service. However it depends on whether you feel that this would be helpful for you as well - if you feel like you have the time and inclination to put a complaint together. I'm not saying this to put you off at all - just to acknowledge that this can sometimes feel like an extra burden.

Whatever you decide, I really hope you find some support which is helpful for both your partner and you.

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Why the downvote, thought it was a legit question ?

Hi! Such a good question. It's very confusing I think to find this sort of information out clearly. Clinical Psychologists should be registered with the Health and Care Professions Council (HCPC) but this doesn't tell you about specialisms. You can ask them though - have you had special training in this, do you have any accreditation, what is your experience? For example CBT therapists are often accredited with the British Association for Behavioural and Cognitive Psychotherapies. I'm really sorry you had this experience though - it's not good. I hope you were able to give feedback. If they are a clinical psychologist you can also complain to the HCPC, or through the NHS service if it was through one of those. Best of luck and hope you find a therapist who is more helpful.

Not necessarily the case for everyone but sometimes strong unusual thoughts might be protective against things in reality which feel very hard to manage.

It has some stats involved but you get taught that. Don't let it put you off!