Community psychiatric nurse Liz Potts describes her experience as one of the few primary care professionals in Coventry using the human givens approach.

WHEN I was training to specialise as a mental health nurse, my fellow students and I assumed our role was very different from that of clinical psychologists. We did the caring and supporting. Psychologists, we believed, did 'something else', something mysterious. They had skills in their toolboxes that were superior to anything we could offer to people in distress. We felt somewhat the same about psychotherapists and counsellors.

Psychiatric nurses aren't fully trained in any particular psychotherapy. We learn a bit of this and a bit of that: some listening and counselling skills and some elements of cognitive-behavioural therapy (CBT) and so on. The cognitive approach made the most sense to me but it didn't seem to have all the answers — and neither did I, when patients said to me, "But, if it is my thoughts that are making me anxious, how come I wake up suddenly at night in a sweat of panic?" It felt as if we were trying to fit people's behaviour into neat boxes and had to ignore or discard anything that stopped the lid from closing.

Then I went to a seminar on the human givens approach and, from the broadness of its base, it seemed to answer so many more questions — it felt like a ray of sunshine. Here, through the concept of essential human needs and innate resources, was a simple explanation of what it is to be human and an approach to helping people that was brief and focused on their skills and abilities, enabling them to engage in their lives. I also realised just how damaging some psychological approaches can be to people suffering from depression, if they embed the depression (by getting sufferers to 'explore' it more deeply) instead of helping lift it.

By that time, I had taken a job as a community psychiatric nurse (CPN), working within a primary care team for Coventry Primary Care Trust. Unusually, I work at a GP surgery, sharing an office with health visitors, district nurses and occupational therapists. (Normally, CPNs work from within community mental health teams based, for instance, in mental health resources centres.) My proximity to the seven GPs at the practice, and to my colleagues in other disciplines, means that, obliquely, I have been able to increase awareness of the effectiveness of the human givens approach.

For instance, shortly after I joined, one of the GPs asked if I felt up to seeing a young girl who had been traumatised by a rape a year previously, or whether he should refer her to a psychologist at the hospital. I had just attended a MindFields College workshop on how to treat post-traumatic stress disorder quickly and safely with the rewind technique, so I agreed to take her on myself. Jenny was 16. She had seemed to cope with the awful event that had happened to her until six months afterwards, when the young man responsible was arrested and she had to give evidence in court. The memories and associated fear came flooding back; her behaviour at school deteriorated dramatically and she started drinking, in order to cope with her emotions.

When I assessed her, to her surprise, I focused on her resources, rather than on what was 'wrong' with her. Previously, she had been confident and outgoing, enjoyed school and going dancing. Now she had lost all of her confidence and her friends, was unhappy and habitually binge drinking. The rewind technique had an instant effect. When I saw her two weeks later, the intrusive memories had all stopped and she had re-established contact with some friends. I worked at relaxing her and helped her to identify and imagine achieving what she wanted to do in her life. The third time I saw her, she was completely back to her old, bubbly self. That really convinced me that I could help people put something awful behind them and get on with their lives. It wasn't some long-drawn-out process that only psychologists or 'highly trained' psychotherapists or counsellors could do.

When the NICE (National Institute for Clinical Excellence) guidelines for treating PTSD were published, the GPs had little idea what to make of them. They have no time to spend struggling to get to grips with treatments like CBT and EMDR (eye movement desensitisation and reprocessing) — which weren’t even defined in the short version of the guide produced for GPs. Contrary to the belief of psychologists and perhaps psychiatrists, GPs are not necessarily well versed even now in what CBT is all about. Having learned from me a little about the human givens approach, and seen how successfully I have been treating people, they feel confident in referring patients suffering from PTSD to me instead of, as per the NICE recommendation, committing them to a lengthy waiting list for CBT. Because I am on the premises and communication is so easy, I can usually make space to see their patient within a week, if necessary.

As a community psychiatric nurse, part of my work is to administer depot injections of antipsychotic medication to those prescribed them and monitor the effects and side effects of medication that patients are taking. I work alongside psychiatrists and secondary mental health services, when my patients are under their care, and I will accompany patients to appointments to support them, if this is their choice. I feel that it is unfortunate that psychiatry is still so firmly rooted within a medical model, with medication the first line of treatment, and I am happy to help patients' voices be heard, if their wish is to reduce their medication. Patients' expectation is often of a 'magic pill' that will cure all their troubles. When one medication fails, another may be tried, or added to the first, resulting in the polypharmacy that appears to me to be fairly commonplace within mental health services.

Unhelpful labels

Psychiatrists and psychologists all too often seem to try and fit people into categories dictated by the diagnostic criteria used within mental health services, so that people often end up with distressing labels such as 'schizophrenic' or 'personality disorder'. One woman, whom I had been helping with anxiety and depression, was shocked and understandably distressed when she was given a prescription by a psychiatrist in the outpatients' department, on which was written a diagnosis of 'borderline personality disorder' and 'adjustment disorder'. These diagnoses had never been mentioned to her in her two years of contact with the mental health service! The 'label', I discovered, had been applied by a junior doctor during her initial two-week inpatient admission, when she had not been cooperative with the nursing staff. I know from my own experience of working on a psychiatric ward that patients deemed 'difficult' often end up with this label — and it colours other professionals' views of them thereafter. Therefore, as I didn't, in my own professional opinion, think the diagnosis was warranted, I wrote to my patient's consultant psychiatrist to say so and attended her next appointment with her. The upshot was that he agreed to 'work with' the diagnosis of anxiety and depression, instead of borderline personality disorder, but refused to overturn or change the previous diagnosis because it had been agreed by a consultant psychiatrist senior to himself who, as far as I am aware, had not actually met the patient!

Whereas the human givens approach starts from the perspective of the person, their emotional needs and resources, this simple understanding is missing in so much of psychological medicine, particularly in the way that services are run. For instance, the first time people go to a hospital outpatients' appointment, the psychiatrist may spend up to an hour taking a thorough history. Patients feel heard and, therefore, hopeful. When the psychiatrist prescribes a drug, they often assume that it will cure their troubles. They return for their next appointment, expecting the same amount of time and attention but are sometimes shocked to find that, at best, they receive a 10-minute review of their medication. Very often, each time they go to an appointment they see a different doctor, which again can be very distressing.

The case of Rosalind, a woman in her early 50s, also illustrates how the way a service is organised can feel as though it lacks human understanding. She was referred to me by one of my GP colleagues because she had chronic anxiety and depression. Seven years previously, when living in a different

READ ON >>

© Human Givens Publishing Limited and Liz Potts 2008

This article is from An Idea in Practice in 2007. Read more about the beneficial inroads the human givens approach has made into education, mental health and social services in this new book: An idea in practice: using the human givens approach >>

LIZ POTTS is a primary care community psychiatric nurse working full time in an innovative project in Coventry to provide a wide range of services at a local level. She receives referrals for people with a diverse range of emotional difficulties and ‘psychiatric
disorders’ and has been applying the human givens approach to her work since 2003.

> More information can be found in the following book, by Joe Griffin and Ivan Tyrrell

Human Givens: A new approach to emotional health and clear thinking

> You can find out more about the rewind technique MindFields College workshop:

The fast trauma and phobia cure

Return to top

Return to top