Human givens in primary care
continued...

area, she had been referred to the psychological services team, to see a psychologist. Before her appointment, she was sent a lengthy and complicated questionnaire, which she was expected to complete by herself and return. She found the task horribly daunting, and anxiety inducing, but just about managed to make herself do it. On arrival at the assessment, she discovered that she was expected to complete another questionnaire, the prospect of which, this time, threw her into a panic, and she refused to do it. Her case was closed, as far as the psychological services team was concerned.

Working with Rosalind

By the time I met Rosalind to offer her ongoing support, she was on high doses of a variety of different psychiatric medications because, over the intervening years of no progress, it had been continually upped; she is very damaged by all she has been through. I spent a long time engaging with her and she revealed to me that she believed the root of all her problems was that, for all her married life, her husband had been cross-dressing. This was something she had never felt able to come to terms with and they had kept this secret from everyone they knew. She thought of herself as a victim, who had been weighed down and oppressed by this secret for all these years. I helped her reframe her idea of herself as victim by exploring with her the choices she had made; the reasons why she had stayed in her marriage and why she and her husband had chosen to keep their secret.

Rosalind had taken early retirement about six years previously, due to her problems with anxiety, and she had not yet come to terms with her loss of status and independence. She felt very angry and let down by the mental health services but she has gradually started to trust me, and this led to my being able to work with her to set some small goals. She had once loved walking and gardening, but a knee problem had curtailed such physical activities, so we worked to help her recall and rediscover the enthusiasms she used to have for other more sedentary activities. As a result, she took up tapestry again. With the help of her GP, we are also working on gradually reducing the medication she is on.

About a quarter of the patients I work with are chronic sufferers from mental ill health. Unlike those who actively choose to seek help, many of these are people who have spent 20 or 30 years shuffling around within the mental health services, dulled by hefty doses of psychiatric drugs. Some are not motivated to make changes in their lives. They identify with their diagnosis — it is what defines them and grounds them — and they would be frightened to move on. However, I'll always try to say or suggest something that might open minds to different possibilities, without threatening their status quo.

Brenda's story

Brenda is 60 and has chronic, active psychosis. She has fixed delusions, such as that her water is being poisoned, and has fantastical, complex beliefs in different godlike creatures and the signs they send her. She lives alone and, although well supported by her daughters, is clearly lonely — largely because she resists people's efforts to help, even when the effects are beneficial. For instance, her support worker took her to a local painting group, which she enjoyed enormously, but she didn't want to go again. I have built up rapport with her and it seems that having someone she can trust, and to whom she can tell the strange things that make up her private world, is a comfort to her. (Her daughters refuse to listen to her 'madness'.) So I listen to her and, when she describes some delusion that causes her panic, I'll normalise it at a physical level by saying, "It must be frightening, feeling that way. What I find really helpful when I'm fearful is doing something called 7/11 breathing." I'll then demonstrate how to breathe in to the count of 7 and out to the count of 11, and how it calms down a thudding heart. She seems to find such interventions helpful.

Moving on

Sometimes, however, I am thrilled to be able to play a part in helping someone really move on with their life and it is the human givens approach that has given me the skills to do this. Bob is only 50 but has had chronic anxiety for the past 13 years. At that time, he had suffered a mental breakdown, largely arising from overwork, and had ended up in a psychiatric hospital. His experience there had so traumatised him that he was terrified of ever going in there again. He didn't dare do anything that might challenge and overwhelm him and, as a consequence, had become virtually an agoraphobic. At the time I was asked to see him, he had managed to collect his wife from work in the car, for the first time in all those years. Usually, he didn't dare, because he feared he would have a panic attack if he was kept waiting.

I congratulated him on what a huge step he had achieved in collecting his wife and the fact that he had achieved that without any help — stressing that he clearly had the inner resources and the motivation to move forward in his life. I worked with him over a period of six months, during which time I used the rewind technique to deal with the hospital trauma, gave him techniques for relaxing himself and helped him set goals and believe in his ability to achieve them. The biggest one was to take a holiday with the family in a caravan — he had not been on a holiday in 13 years. He achieved it; he and the family thoroughly enjoyed themselves, and he now has the motivation to set even bigger goals. He is even thinking of returning to some kind of employment, something he was unable to contemplate when I first saw him.

Gradually, my CPN colleagues are becoming more aware of what I can do. When I meet with them to discuss our caseloads, I talk through how I've helped people and what techniques I've used. Currently, I am planning to introduce a needs assessment with clients — to scale how well, or poorly, their needs for connection, status, attention, safety, privacy, and meaning, etc are being met — and, in due course, I'll share that idea, and its impact on patients, with my colleagues. I have planned a lunchtime training session at the surgery to talk about the human givens approach and teach some helpful skills. This session will be for the GPs and other primary care colleagues — health visitors, occupational therapists and district nurses — and may well lead on to other sessions for colleagues in different primary care teams, and maybe the community mental health teams in the city.

My primary care colleagues will come to me for advice if they have any concerns about a patient's mental health. The health visitors will ask me to see a new mum on their list, if they suspect post-natal depression,
and the district nurses and occupational therapists, if one of their elderly patients seems to be getting depressed.

However, as the only person in Coventry that I know of using the human givens approach, I do feel professionally quite lonely, in some respects. So I hugely value being a member of the Association of Human Givens Practitioners in the NHS, which is centred at Milton Keynes. We come from all different specialities but what we have in common is the need to manage NHS bureaucracy, and to find 'quiet' ways to pursue and introduce new approaches within it. I hope, for instance, that the positive feedback I receive from patients and the speed and effectiveness of my work will continue attracting the interest and curiosity of my colleagues, and show them that things can often be better done differently. Just as I used to think that psychologists and psychotherapists must be so much better trained and equipped than I to deal effectively with human misery, so do many GPs and other health professionals still believe that particular myth — and, like most myths, it is powerful and pervasive. We must patiently keep working and wait while the wellspring of change fills slowly, drip by drip.

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© Human Givens Publishing Limited and Liz Potts 2007

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 >>

> 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

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