THERAPISTS INTERVIEWS
THERAPIST 1 (T1, 2015)
Name: Martin Smith
Job Role: Specialist Training Consultant and Therapist at Nottingham Trent University and ITC Consultancy
Date of Interview: 4th December 2015 at 12.00pm
Recording:
Transcript:
Perfect. Okay. So, do you think the environment or space in which you do currently treat patients, or speak to them, is effective?
Well, because I’ve got a private practice, then probably yes, yeah because the, the benefits I’ve got is er, quite erm, a sort of a private office space, erm, which is ideal for sort of, erm, individual, one to one sessions, so that helps a great deal. The disadvantage can be sometimes that it might be a bit off putting for people to come to [crosstalk] But, er, overall yes, it’s, er, its as, er, nice and comfortable as, er, people would, I think, want.
[interposing] Yes, of course.
Could you maybe explain a little bit about what your environment is like?
Yeah, it’s basically a first floor, well, it’s er the, it’s the first floor of a large sort of Victorian House. Erm, the, I, I rent the top, the, er, first floor of it so, erm, you’ve got quite a sort of, erm [pause]. Yeah quite an ornate, er, elaborate sort of setting really. Er, a very nice, comfortable setting but erm it’s erm, it’s very open and able for people to, er, find it quite easily.
Perfect. So, what, er, anything about the, er, maybe the lighting, or colours or room layouts?
The [coughs], er, the room layout is, is er typically sort of quite, er, you know the, the -- a couple of chairs, er, sort of spaced out relatively far. Erm, it’s, it’s an office look but not too office based — [inaudible at 00.01.20]
[interposing] Okay.
I’m trying to find a - It’s always when you’re training therapists about the, er, you know, how do you get the balance between too official and too casual, er, each time. So, erm, some therapists work from home, or a lot of therapists work from home which is something I have never done and I think it’s not probably a good idea to do [background noise] —
[interposing] Okay.
— er, personally, because you get that situation where, erm, you know, there is an infringement of sort of family and, and sort of, personal items. Lighting wise, [coughs] er, er, much, er quite a lot of natural lighting, so although in the evening times there is normal lighting processes but keep it fairly sort of standard so it’s not too dim or too, too low lighting. I think that keeps it [crosstalk] [inaudible at 00.02.03] —
[interposing] Yeah, no, great that’s perfect. So you mentioned about, erm, treating people at home, why would you say that a more clinical or [crosstalk] office environment would be —
[interposing] My personal view and a lot of feedback from, er, groups like E.A.P’s (employment assisted programmes) have found that, er, criticism from clients has been that they have got to a lot of peoples houses and, you know, it’s seems very much, you know, like they’ve been climbing over, sort of, washing or the dogs are there or things like that [crosstalk]. So, I do think that unfortunately with therapy work that sometimes we’re not quite as, as, professional as sometimes people should be.
[interposing] Of course, yep.
Okay. Have you worked in any other types of environments? You say you haven’t worked in the home, but you do work in an office?
Yeah.
Have you worked in any other type of —?
[Interposing] No, no [crosstalk] it’s all been private practice.
[Interposing] keep to doing this?
Okay.
Erm, so prior to the office I’ve got now, I had a much more functional office when I started which was a bit more basic office look, this has got a bit more to it in terms of atmosphere I think.
Have you had any negative experiences in the space that you work, such as negative responses from clients or…?
Erm, no, not really. Erm, I suppose… no, not in terms of the environment or setting [crosstalk]. No, I think it’s appreciated.
[Interposing] Okay.
Are there any environmental qualities, so again, lighting, er, or, that could negatively impact the space, if you were maybe to design…?
Oh I think, er, I think one of the key things is not so much the lighting or the layout, it is more the issue around the balance between a personal and too clinical setting. It’s like, the argument is about, how, you know -- if you think about putting certificates and things like this. Is that too imposing or does that reassure? Sometimes [crosstalk] it’s that balance between. There’s an argument that if you put too many, erm, certificates up does that overpower people? If you don’t put anything up, does that make it look as though you don’t have any sort of, qualifications? So I think that’s a bit of a balance there, erm, you know, sort of —
[Interposing] Okay.
[Interposing] Maybe a personal preference or do —?
[Interposing] Erm, personal preference is to keep, er, er, maybe one or two particular, er, items, or something, you know, a qualification of, I wouldn’t say significance, but things like, erm, BACP accreditation certificate or something like that would be quite important there.
Okay. Erm and with regards to treatment and treating somebody maybe with anxiety or a phobia, what would you say are the most successful treatments?
Ooh [laughs]. Open ended question [crosstalk] because it is a very difficult… er, er, if you go on the evidence base, then, erm there, erm, are a number of things like er, CBT, cognitive restructuring, er, erm in, in, terms of CBT work is successful. I work from what is called a third wave CBT model now, which is act, acceptance and commitment therapy which has a lot of, er, evidence base to suggest that act is a successful, erm, erm, process to help with, with anxiety and, and, er, and certainly with traumas, erm [pause]
[Interposing] [laughs] Yeah.
Okay.
But, erm, the problem here is, erm, that it is more, er, that research has shown over the years that, er, it is not necessarily, er -- the school of thought or theory is not as, er, as important as the rapport with the individual [crosstalk]. That has been a significant, a more -- a significant impact is if the client likes the therapist then there’s a likelihood of more success no matter what school of thought, whether you’re doing psychodynamic, CBT or play therapy or whatever, there’s a more successful outcome with the, with the client if the rapport is there.
[Interposing] Okay.
So do you think that people can treat themselves and use like a self, erm, desensitisation or a… or do you think seeing a therapist is more —?
[Interposing] Erm, the bottom line is that, er [coughs], excuse me, er, they cant [pause] erm, can they treat? Er, any therapist giving homework out and helping -- it’s, it’s a guidance process, er a lot of that. I find that people do a lot of that. In my experience over the, er, past number of years, clients do a lot of things that don’t help and don’t realise that they’re not helping —
[Interposing] What kind of things would those be?
Well, er, classically, they will try to fight their way through, er, anxiety… ‘I’ll try and beat it, I’ll try and force myself to do some of these things’ as opposed to increasing the anxiety levels each time. Erm, self-medication, these, these sorts of things, you know, don’t actually address the main core issue. So if you give them guidance and help, I think that, erm, it’s definitely needed. The therapy helps to guide them forward but the, the focus, certainly these days, should be on making the, and enabling the client to carry on with the techniques and ideas you’re giving them so they can carry on and do their own self-treatment. But, er, in the first instance it’s like giving them a guide to what works and what doesn’t.
Okay, and you mentioned homework…what kind of things would you give them to go and do?
Classic ones for anxiety will be small, er, small tasks of, er, desensitisation. You know, if you’ve got a trauma on something, starting to learn skills of getting more comfortable with anxiety. Erm, but equally I do a lot of mindfulness, er, work, er, as well as within act, and mindfulness has been proven again [crosstalk] to be a, a, significant reducer of, er, trauma and, erm, anxiety.
[Interposing] Okay.
Okay.
In fact there’s two, er -- the, the one research in America which is starting to teach the, er, armed forces, er, erm, mindfulness techniques before they go into, er, engagement as reducing the amount of PTSD coming back.
Okay.
So, the, if we do it in the start, we get less PTSD coming back on the back end.
Okay, perfect. What, going back to the environment you do currently work in, what do you think could be changed, erm, to make it more successful? Maybe make patients respond in a more positive way or you could maybe treat them in a better way? What, what do you think could be changed?
I think it’s more about the encouragement of getting the person in the room first of all.
Okay.
Well, that’s, that’s, with anxiety, er, erm, and, which PTSD is one part of anxiety, but all anxiety problems, come, stem from this, you know, my fear of what will happen. So it’s trying to encourage people to get through the door. I think the environment necessarily in the room doesn’t have as much impact as getting them through the door in the first place [laughs].
Oh okay. So it’s maybe the experience as they come into —
[Interposing] Yeah but also er, it’s how we sell, the, er, er, the, dare I say, the product so to speak as again it’s like, that importance of experience and qualifications. To a degree people do want to know, you know, what’s your background, how long have you been doing this because there’s a fear of, you know, we’re talking about doing some quite, er, you know difficult processes here.
Yeah definitely.
So, so if we can get, get them, er if a more professional way of doing things and to sell it more in, the, er, in a, erm, encouraging way, I think that’s one of the things.
Okay. Do you need any, erm, specific equipment or any, sort of, products or anything that would help your treatments? So when looking at a space do you need specific —
[Interposing] Not, not specifically, erm, for most of it. What, I will have is like sort of, erm, guide sheets, or things, which you know, er sort of, er -- if I’m, if I’m going to give them an exercise to do at home, erm, classically a mindfulness exercise, I might give them that as a written document and er, also as an audio, erm, you know, on a disk or USB stick, you know, to take away and that way they can have a go at the exercise, erm, because sometimes we do it in the room, er, and yes it’s fine there but it’s again encouraging them to do it afterwards so —
[Interposing] So it needs to be repeated?
Yes, yeah, repeating the, the processes, that’s the difficult thing. So giving them, erm, a prompt sheet, er, I have a number of little sheets of, er, that I can give people out to, to do so they can take it away and work on it from there.
Okay. Erm, if I give you a list of qualities would you be able to tell me if you think they do have an impact or whether they don’t?
Mmm, yeah, mmhmm.
So, if a room was light or dark? Which do you think would —?
[Interposing] The problem here is back to peoples, er, er, [crosstalk] preferences, er, for instance with PTSD, if, if, you -- because PTSD is about a trigger, er, response, er, er, and how, and how an event has been imprinted on the brain. So if the trauma is linked to a darker environment, then a darker environment in the therapy room will trigger more [crosstalk] trauma. So the catch 22 here is, is whether or not, er -- and that’s a problem I don’t think you can really, erm -- I think obviously too brighter light or too dim, I think, er, er -- a mid-light, mid-level sort of standard lighting is absolutely fine for people.
[Interposing] Preferences.
[Interposing] Of course.
And do you think it should be natural or artificial?
Natural as much as possible.
Okay.
A lot of people do, and human beings, do react better to natural light. So yes, the, the setting I’ve got up at the moment has got quite a large, er [background noise] bay window setting so that’s quite useful at daytime. At night you can tend to tell there’s a difference in the lighting so natural lighting would be a great benefit and obviously at night, you’re struggling with that [laughs].
[Laughs] Okay. Erm, what about maybe inside and outside spaces. Do you think they need to have interaction with the outside, so large windows or maybe, open —?
[Interposing] There’s er, there’s no doubt about, er, about the idea of, er, space, er bigger, a bit larger space and also, erm -- yes, being able to see outside but also being able to see exits and doors. You know [crosstalk] for anxiety again, it’s like the ability to know where they’re going, coming in and going out of.
[Interposing] Okay.
Ah okay. Quiet or noisy?
Erm, well, quiet, is, is obviously a benefit.
Yep.
Er most definitely. So, so, unless disturbance is, you know -- not having situations where -- that’s the beauty what I’ve got, is, er, er, a building that I can control rather than you don’t have, er -- a GP practice that has a lot of hustle and bustle going off outside.
Okay. Empty or cluttered?
[Laughs] Again it’s a person—
[Interposing] Personal—
[Interposing] Because I do a lot of personality types [crosstalk] and erm, so personality wise, er encroaches on this one. Erm, unfortunately, the environment is not dictated by the therapist [background noise] and you know, my, my, environment is a lot, sort of, more, erm, it’s certainly not cluttered but yeah, it’s not minimalistic. I think it’s a balance again, you don’t want to, certainly -- erm, anxiety again, and er, things like anxiety and PTSD [background noise] are, er, er, issues of erm lack of control and, and, and, sort of struggle and so if you are too chaotic in the room, then that can actually really reflect on the process.
[Interposing] Okay
Okay. Erm, calm or busy? So, do you think that maybe they should be able to see other people interacting, maybe outside of the room or do you think that they should [crosstalk] very much be on their own?
[Interposing] Yeah, very much, yeah, erm predominantly on their own because again, er, anxiety again, certainly if you’re looking at anxiety in PTSD, er, it’s a heightened state of awareness, er, so a hyper-vigilance is a common process around anxieties.
Okay.
So, er, any movements going off around or noises outside can trigger, er, so it a distraction really, it’s trying to get them to focus on the situations in the room.
And what if, those people maybe had the same anxieties? Do you think that would be comforting or more off- putting?
There’s an argument about group therapy. There’s an argument to say that group therapy is helpful, which is can be, erm, but equally to some, it can be very much more problematic because you’re actually, er, focusing in on more peoples problems than, the, the, individuals. So you’ve got a group of people with anxiety [crosstalk] as opposed to not. So I think erm, you know, it’s trying to model -- erm, so one of the things is modelling this, modelling you know, what is a better behaviour. But coming from a solution focused such as a CBT model, it’s more about sort of remodelling people into thinking how can I do calm and controlled as opposed to chaotic and rushed.
[Interposing] Okay.
Okay, perfect. And do you have any other opinions about the environments and how they can affect, affect, er, maybe people specifically with fears or —?
[Interposing] I think, er, it is, er, the two reiterations for my view is to er, keeping it, er, not too cold and clinical but, but not to homely -- er, er, I do, er, my personal opinion on home -- er, I understand why therapists do it because it’s a cost implication but since -- right from the very start when I first started I made a conscious effort to go and get an office [crosstalk] because it gives out, it gives that sense of slight detachment from the person, and, and you can gain a sense of more control from that.
[Interposing] Okay.
And have you worked in any erm, obviously you’re in an educational environment here but do you think that has an effect, maybe teaching people about their fears more so than trying to —?
[Interposing] Oh definitely. Yeah, educational processes and, er, you know, er -- a lot of GP practices and the NHS are trying to do more -- you know, psycho-education is the first format of this, er, in any, er, clientele scene. First educating them at to what’s happening and why it’s happening and how we might tackle it, yeah [crosstalk], and if we can do that more for people generally, you know, stress management, anxiety management -- that’s why mindfulness programmes are picking up quite a lot, because it teaches that.
[Interposing] Okay.
Perfect. So do you think, er, an educational environment would have an impact as well as —?
[Interposing] In terms of erm, as, as [crosstalk] In terms of the impact on learning for the, for the, client?
[Interposing] As in maybe —
Yeah, as well as maybe treatments? So if they were in more of a classroom environment or a -- less so than an office or maybe a home, if we look at it from the educational side, such as in a university or a school or in a museum, or just as maybe a layout of a classroom, do you think that would be maybe be effective in treating —?
[Interposing] I think, er, because, erm, a lot of it is about the person themselves. I think the fact, that, er, something like an educational setting or a classroom would, would, seem to be, er, encouraging that idea of education but it doesn’t value the persons anxieties that they’ve got.
Okay.
So they might feel, might feel, er it’s not something that I’ve looked at too much but er, there might be a feeling of well, you know, I’m, I’m, yes I do, I’m here to learn but I’d I’d like more one, one, one on one, connection. Even in group therapy, you know, if you look at group settings, er a lot of it’s not classroom based, it’s a group, a much more inclusive group therapy work.
Okay, perfect. Well thank you very much for talking to me [crosstalk]. Thank You.
[Interposing] That’s alright.
Hopefully that’s been of use? [laughs]
It will have.
Recording:
Transcript:
There we go.
Yeah we were talking about the, er, layout of the room but erm, particularly colours have an impact. We know that er, things like, er -- because I use a, a light blue, er, in the room, to sort of, which has a general calming effect light blues, greens, the green room of, of theatres has been, quite, quite synonymous with, sort of, calming effects.
Okay.
Erm, but er, er, strangely enough my previous background, er, is in policing and er, the, er, if you look, at police cells are painted in a light green for the idea of calming [crosstalk] and controlling.
[Interposing] Oh really?
Yeah,yeah. So that’s their purpose. All drawn from the idea of theatre, you’ve got the green room in theatres, erm, which are, er where the actors would go, actresses would go before the performance.
Okay. So do you think space does have an emotional impact on —?
[Interposing] I think yes, too far, I think the colour, er, is more, er well certainly from the research side, the colour has been something that people do know is an impact. You know, how we react to colour is, is one thing. I suppose, space, also if it’s too enclosed, it’s that sense of, er, of too tight so. But then again too wide, you know, a very big open space is too much, so I think it’s that, the room size, er, could, open space and outside views like you say can be effective.
Perfect, thank you very much. [Crosstalk] Thank you.
[Interposing] That’s okay. Great.
THERAPIST 3 (T3, 2015)
Name: Carol Owens
Job Role: Certified Transactional Analyst with Psychotherapy Speciality
Date of Interview: 11th December 2015
Recording:
Transcript:
So, do you think the environment or space, in which you do currently treat your patients, has an effect on how successful that treatment is?
I, I think it probably does but I, I mean there’s no way of measuring it but yes, I would, I think it does.
Okay. Erm, can you describe the environment in which you do currently treat your patients?
Yes, sure. Erm, I have a little consulting room in my house. So, erm, to get to it, they have to come through my lounge. Erm, my consulting room is a small room off my lounge. Erm [pause] for that reason I don’t have any, sort of, personal family photographs or anything that they see on their way through.
Okay.
Erm, that’s important, erm [pause] because if they have any, sort of idea about my family life, or my personal life that can affect, erm, the transforms, and, so, you know, that’s important. Erm, I, I have to be a, sort of, blank screen for them, if you like [crosstalk] so they can project whatever they need to onto me. Yeah?
[Interposing] Yeah sure.
Yeah.
Does that make sense?
Yeah, yeah, yeah, definitely.
Yeah, yeah? So, so I’m very careful of that. Erm, there are, er, my house is by the canal, so when people come in, erm, and into my consulting room, they sort of see out of the window and they always say ‘oh it’s lovely out there’, you know, I, I kind of think that probably helps [crosstalk] [laughs] but… it’s quite, it’s very peaceful.
[Interposing] Yeah.
Yeah.
Erm [pause] and although I’m by the canal, er, nobody walks past. Erm, you know, like the towpaths, er, because it’s actually a little offshoot off the canal where people keep their boats, so we don’t have a lot of people walking past while people are in here, so it’s very private and I think that’s really important.
Yep.
Erm, the room itself [pause] erm, I, er, its this helpful?
Yeah [crosstalk] yeah yeah —
[Interposing] I’m not sure what you —
[Interposing] No, this is brilliant.
Erm, yeah the room itself, er, is, is quite, is painted a very, very pale, sort of, duck egg blue, erm, which is quite a restful colour I think. Erm, it’s comfortable, they’ve, we’ve got, sort of, comfortable chairs. Erm, I don’t have a facility for people to lie down [crosstalk] but I do have, er, erm, if, if they need to lie down, er there’s a couple of things I do. One is I’ve got, sort of, a very comfortable foot rest, erm, and blankets and things so they can lie down like that, they can recline a lot anyway.
[Interposing] Ah okay.
Yep.
Or, if they really need to lie down, and sometimes I do, do that with people, we actually use my lounge and they lie on the sofa.
Okay.
Er, because if you get people to lie down, it seems to, er, get into, earlier, erm, it seems to, you know, a good way to get into earlier memory.
Oh Okay. Okay brilliant. Erm, what do you think works particularly well about your current space? Whether it’s to do with, erm, the physical furniture items that are in there or whether it’s light or dark or you mentioned you can, you kind of have a, a, a relationship with the outside. Erm, what do you think works well?
Erm, well I, I don’t know. I think, it’s really hard to define because I think what’s really important is, I think the most important thing, actually, is the relationship [crosstalk]. But, the, the space, I think because it’s comfortable it, it does help people to feel safe.
[Interposing] Yep.
Yeah.
You know, I’m always, I’m always conscious of, you know, whether it’s warm enough, and, erm, that kind of thing, erm, I’m careful about the lighting as well. I give people a choice with the lighting, I have erm, you know, there’s a, there’s a lamp, because I do, I do do quite a lot of work in the evening when it’s dark, especially at this time of year when it’s dark by four thirty [crosstalk], I’m often seeing people when it’s dark outside and so, you know, there are lights on the ceiling, there’s also a, sort of, erm, floor lamp. So, I ask people, you know, I’ll say ‘would you like this light on?’ ‘Or just the lamp, or…?’ [Crosstalk] and whatever [crosstalk] so —
[Interposing] Yeah.
[Interposing] and what do you —
[Interposing] what do you —
What do you find the general response is to the lighting?
Er, it varies. It varies a lot actually. [Crosstalk] Some people want the, the full light on.
[Interposing] Okay.
Yep.
[Pause], erm, yeah, other people just want, in fact, one, one client in particular always asks for just the lamp [crosstalk]. Erm, he felt it made it, yeah, sort of, more, er, he preferred the ambience and stuff like that [laughs], so —
[Interposing] Okay.
[laughs] a bit more comfortable?
Yeah, yeah.
Okay. Erm, have you had any negative experiences in your current space?
[Pause]. Erm, no.
Okay.
No, I haven’t. Nope.
Okay perfect. Erm, is there any particular environmental qualities that you think could negatively impact your treatments? So, maybe things that you don’t currently, erm, have in your space but if were put in, could negatively impact the experience?
Erm, well I suppose if you had sort of, obviously if you had, I guess if it was, er, er, I think I’m, the, the colour. I think the colours important [crosstalk]. I think, erm, erm, if it was painted bright red or something that might not be good for people. Erm, I think, also the erm, I just think if it wasn’t as physically comfortable [crosstalk]. Er, erm, most people walk in and say ‘what a lovely room’.
[Interposing] Yep.
[Interposing] Okay.
Okay.
Erm, and I think, if, you know, it was really untidy or, you know, if you’ve got somebody who suffers from OCD, or something, they may struggle if it wasn’t -- I mean it’s not -- I, I mean I haven’t got OCD [laughs] so it’s not immaculate but er you know, I think, erm, people are pleasantly surprised.
Okay.
I think it’s, er, I think it’s, I think it’s a good compromise because it’s, I mean I’ve got my qualifications, er, you know, so my certificates are on the wall [crosstalk] so people can see that I’m qualified but it’s also quite a homely room [crosstalk]. I think people sometimes are expecting something a bit more clinical.
[Interposing] Yep.
[Interposing] Okay.
Okay and do you think there is, erm, a better success rate in a room that say is more homely than it is clinical? Do you think [crosstalk] that they respond better?
[Interposing] I couldn’t, I couldn’t say because I haven’t, I haven’t worked in a, in a clinical space [crosstalk]. So, I, I don’t have anything to compare it with but my sense is [crosstalk] that yes, people need to feel comfortable.
[Interposing] Okay. Have you —
[Interposing] That it would?
Okay—
[Interposing] and they absolutely need to feel comfortable in all kinds of ways, you know, so physically and -- I don’t know. It’s hard to define how the environment affects things but erm, yeah, it’s, I think it’s. Well, lets see, it’s interesting because I think that’s the sort of, that, that could be, erm, a double edged thing that, that, if I’m, I think the reason I have my qualifications on the wall actually, is because if I didn’t it, it might not [laughs] be clinical enough.
Okay, so there are elements that you do —
[Interposing] Do you know what I mean? It might seem like they were just coming to somebodies house.
Of course. So there are, there are elements that need to make sure there’s a professional —
[Interposing] Yes
Kind of, part to it but [pause] [crosstalk], keeping it comfortable and homely? I see.
[Interposing] Yes
Yes, yep.
Have you, I know you’ve mentioned that you haven’t worked in a clinical environment, but have you worked in any other types of environments, so maybe schools or, erm, hospitals—?
No, I’ve, I’ve, I did work in a erm, I did work in a place, er [pause] erm, well it’s called ‘Counselling Works’, erm, and they, they have, I used to use their consulting rooms [crosstalk] erm, they were more neutral than my rooms, they were all painted, sort of, you know, magnolia and they had very neutral carpets, and, and things like that but, erm—
[Interposing] Okay.
[Interposing] Did you find them as successful as your current space?
Wow, that’s a really difficult question. Erm—
[Interposing] Or can you, could you, [crosstalk] could you, can you compare them?
[Interposing] Erm, no, I don’t think I did looking back. I mean erm, no, no, I think, but, but I think er [pause] that’s a really difficult question [inaudible at 00.08.43] —
[Interposing] What, what, what would you have maybe changed about the more clinical spaces, if you, if you could to maybe get a better [crosstalk] response?
[Interposing] Oh, I would definitely have made them warmer, I would had—
[Interposing] Okay.
Pictures on the walls and erm, yeah I just would have made them a bit, a bit, a little bit more homely [crosstalk] I think. I mean it’s, it’s a huge step for people to come into therapy, you know.
[Interposing] Okay.
Yeah definitely.
But it’s a huge step and I think, yeah, they, they have to feel as safe and comfortable as possible as quickly as possible.
Yep definitely.
Yeah?
With regards to your therapy, erm, what are the most successful treatments, for treating maybe fears or phobias or anxiety, do you find?
[Pause] Erm, that’s really [laughs] erm again that’s difficult to define [crosstalk] erm
[Interposing] Or, we can reword it and say what treatments do you use erm, to treat, to treat your patients?
Well, I use, erm, relational transactional analysis is how I work.
Okay. Could you explain a little bit about it and what, what it is?
Erm, well transactional analysis is a, a theory of personality that, erm, devised by somebody called Eric Burns, erm, back in the 1960’s I think.
Okay.
Erm, it uses simple concepts to, erm, describe complex processes really. So, erm, I don’t, you might have heard of it but you, er, things like parent, adult and child ego states and -- have you, have you heard of that?
It’s, it has come up in my research, erm—
[Interposing] Okay. Okay now the thing is that, in 2002, erm, transactional analysis changed a bit, er, it used to be quite CBT, in, in a way because it just helps people to, understand their own thought processes and be able to er, you know, be able to change them, really. Erm, but actually, I, think it, it changed. It, it sort of, er introduced more of the person centred, erm, idea. Erm, [crosstalk] er, because I think that because people who come are damaged in some way, I think that some of the language of T.A, which was designed to be helpful, could sound a bit persecutory.
[Interposing] Okay.
Okay.
Er, and so I, I, very, er, I, I sometimes explain, er, theory to some clients, if I think it will be helpful to them, erm, but mostly, er, I, I, it’s really hard to explain. I mean you know, I don’t have the sort of -- I do have treatment plans I suppose, erm, and they go through stages.
Yep.
So, the first, the first stage is, is, is always establishing a good relationship, establishing the therapeutic alliance, we call it.
Yep.
Er, the second stage is something we call decontamination, which is, erm, helping them to understand that some of the things they believed about themselves or about the world, might not be true, they might just be things that they’ve accepted that other people have told them about themselves.
Okay.
Erm, the next stage we call de-confusion, which is where they start to realise that the decisions they made about themselves can be changed. So, er, a good example of that is [pause] er, if somebody wasn’t loved as a child, erm, they can have made a decision that they’re not loveable.
Okay.
And that obviously affects their relationships [crosstalk]. But it’s not true that they’re not loveable, they just had parents who didn’t love them in the right way. Yep, [crosstalk] so there’s, there’s something about that stage, the de-confusion stage, which is when they realise that, that decisions they make, not just things that they were told, but what they did with that information is something that they can change. Erm, then the next stage we call integration.
[Interposing] I see.
[Interposing] Okay, I see.
Yep.
Which is where they, erm, they realise, that they kind of put all that, put it all together really [crosstalk] and they really have changed, they really are different, they realise I’m not that person anymore. Erm, and they notice that they’re doing things differently in their lives and making different decisions and that kind of thing. Er, and then the last stage is ending, which can, because I do long term therapy, the recommendation is that ending takes about a quarter of the time of the whole therapy, so, erm, is quite a long process.
[Interposing] Yep.
Yep.
Because part of what will have happened is that they will have attached to me [crosstalk], and they need to separate in a way that feels safe [crosstalk]. So as long as they need, er, yeah. So those are, those are the stages that I think of.
[Interposing] Okay.
[Interposing] I see.
Yep.
Erm and pretty much, I do that with everybody, but I, everybody’s different and everybody’s problems are different so—
[Interposing] Yeah definitely.
Yeah?
Yeah—
[Interposing] Is that helpful?
Yeah, no, that’s really helpful.
Erm [crosstalk] do you need any specific equipment or, erm, facilities, in order to undertake that process?
[Interposing] Good.
No, no, no
Okay, so it’s just—
[Interposing] Just lots of training. [laughs]
[Laughs] just lots of training, lots of background. Erm, and do you—
[Interposing] Yeah, no, no, all you need is a comfortable [crosstalk] place and stuff.
[Interposing] Comfortable space.
Okay —
[Interposing] And, and, an empathic way of being with people really.
Yeah. Do you, erm, give them homework, or, erm things [crosstalk] that they can do on their own?
[Interposing] No. Oh well occasionally. Very occasionally, I do [crosstalk] Er, but not usually no, no.
[Interposing] Okay.
Okay, do you think —
[Interposing] Erm, I, I mean if I do it’s not, nothing written. Erm, I mean, I might do some like, erm -- yeah, I mean like for example, okay I can give you an example of a young woman [crosstalk] that I’ve been working with who is very traumatised having had a very, very violent mother, who used to beat her pretty much everyday. Erm, and then, erm, the thing that triggered her coming to see me was that somebody tried to rape her [crosstalk]. Er, and so she was very, very traumatised and she doesn’t trust people.
[Interposing] Yeah.
[Interposing] Oh, okay.
Yeah.
Er, she now has two people that she trusts, one of them being me. Erm, and she starts, she’s starting to talk to someone at work.
Okay.
Erm, you know, develop a friendship at work. And what, what, she, so, she, she likes to have little tasks to do [crosstalk] but one is, one task is that she’s going to tell this person at work, something personal about herself. Erm, and start, er, we call it, er exploring the edges of her comfort zone.
[Interposing] Okay.
Okay.
Because she wants to make more friends but she’s [crosstalk], very, very reluctant to tell anybody anything because in the past, anything that she told anyone when she was a child, was used against her. So, you know, there’s thing’s like that where they can, you know, but it’s specific to the person.
[Interposing] Yeah.
Yeah, definitely, definitely.
Yeah?
Do you think, erm, like, self-treatment, er, strategies work? Through my research I found that, erm, there are ways that patients can treat themselves and help them through their daily lives. Do you think that they work, they’re successful or do you think, erm, coming to see a therapist in a more professional environment is, is…?
Well, er, I, I, I don’t really know. Erm, I, I think if someone is seriously traumatised then, there, its not very likely that they’re going to be able to, er, deal with that by themselves.
Yeah. Do you think the home, their home environment and the environment, in which they live, and is comfortable in and is very personal to them, do you think that could affect how treatment goes?
Oh definitely, definitely. If they’re not, if they don’t, I mean often the people I see, don’t feel safe at home [crosstalk]. So—
[Interposing] Okay
[Interposing] Getting them away from it is a, is a positive?
Yeah.
Okay. And my final question, er, do you think like, education and educating your, you mentioned as part of your process you need them to understand, maybe, theories or understand about their phobia, do you think education plays an important role in people overcoming their fears, their phobias, their anxieties?
Erm [pause] yeah, I think it does [crosstalk]. I think it does.
[Interposing] Okay
Okay. Perfect. Brilliant. Well thank you very much for your, for your time and for all your help.
That’s okay. I hope it is helpful.
THERAPIST 2 (T2, 2015)
Name: Stephanie Jeans
Job Role: Psychotherapist and Clinical Supervisor
Date of Interview: 9th December 2015
Recording:
Transcript:
Perfect. So, first question. Do you think the environment or space, in which you treat your patients currently, has an effect on how successful the treatment is?
[Pause] Erm, so just let me confirm I heard the question right. So the space, my therapeutic space, does that have anything to do with whether the client, you know, makes progress or not?
Yes, of course, yep.
Erm [pause] I, er, I, I like to think so because I’ve thought very carefully about my therapeutic space and I’ve tried to make it, erm, right so that it is as tranquil as possible, as warm and inviting as possible. Because a lot of the places I have counselled, have felt very -- I have a lot of clients who say to me are very -- other spaces I’ve seen, essentially the NHS, and I’m not knocking them at all [crosstalk] but you’re working in quite a clinical space. Erm, the décor necessarily, is very, is, is not great, can be quite bland and stark, and, some places smell a bit like hospitals and things like that. So, erm, I do often get clients who will say to me, gosh, I really love this room or it’s just so relaxing and we overlook like a garden and a pond and, I have very neutral sorts of colours and furnishing. And I think when people are in a state of anxiety and stress, if your environment is conducive to relaxing and non-threatening, I think it has to play a part.
[Interposing] Yep.
Yeah, perfect. So you mentioned that you have, er, views onto ponds and greenery, can you maybe describe the environment a little bit more?
Erm [pause] yes so I work from home and I have a portion of a room that I have. Erm, I’ve got like, I have very earthly colours and so I’ve got like wicker, I don’t know how to describe it, rattan type of furniture and a screen. So when you’re behind the screen, we’re in a bay window, erm, and, which overlooks the garden. So I have four chairs, I have a sofa and two chairs and I let the client obviously choose, which seat they want to sit in, when they come for the first time. Some will choose to look at the garden, others will choose to look out, you know, the other way. Erm, but everything is very, erm -- well, I’m, I’m, from South Africa so things are quite ethnic-y, but very neutral, so there’s nothing that, you know, anyone could put anything on, so just sort of, creams and browns and [pause] [crosstalk] cushions, you know, that sort of thing.
[Interposing] Yep.
Yeah, no, brilliant. You also mentioned, erm, the other environments that you had worked in.
Yeah.
What other environments have you worked in? Could you maybe explain a little bit about those?
Yes, so, for example one place that I worked, erm, was part of another charity and they very kindly gave us rooms that we could work out of. The problem was, it was like a boardroom and so we just had to, sort of, set our own chairs up, you couldn’t really offer them water or a drink, I had to take in my own tissues for people, you know, the standard counselling sesh. Sometimes there’d be yelling and noise out in the corridor because it was a place that worked with, sort of, juvenile kids who have been excluded from school. Erm, you’d walk through the building and there’d be signs like ‘no spitting in the building’, ‘no licking of the windows’ and stuff, so [laughs] it was quite a, a rough environment, but you know, amazing, you know, that we had that space and the charity then started doing amazing things. Erm, other spaces I’ve worked, erm, [pause], quite a homely environment -- I’m trying to think when I worked at the compassionate friends, which is a support organisation for bereaved parents. It’s a lovely, inviting home and a very lovely room, erm, but lots of people coming and going [crosstalk]. So, there’s no perfect environmental space obviously, or therapeutic space, but, as you can’t predict everything. I mean, I might suddenly have a window cleaner who appears at the back and then I have to go and say ‘oh my god, I’m sorry’ and chase him away but I try and have everybody trained in the household and, and around, from the dogs to the gardener, you know, keep away when there’s a councillor, er, when I’m counselling [crosstalk]. So yeah, I just think to try and make a space, unlike the ones I’ve been in – I like flowers and just, it, needs to smell nice and look nice [crosstalk]. I think, compared to what I’ve been in before.
[Interposing] Okay.
[Interposing] Okay.
[Interposing] Okay.
Okay. So keeping on the aesthetics of the space, what do you think works well about your current space?
[Pause], erm [pause] by [crosstalk] the sounds of this, I’m really amazing in my space, aren’t I… it’s like you all need to come back to mine [laughs], I don’t mean it like that. Erm, I think [pause] I’ve just, you know how when you’re counselling you just have to be your authentic congruent self, and so consequently I just make the space reflect me and who or what I am. So, there may be some clients who come in and don’t like it, I don’t know, but I get on a very regular basis, people saying ‘oh I just come [sighs] and, I just relax’ and ‘oh it’s so nice, you’ve got such a lovely home’ and so yeah, I just, I don’t know, it seems to work and seems to make a difference and make an impact. I’ll send you a picture [crosstalk] I’ll email you a picture and then you, you have an idea.
[Interposing] Maybe —
[Interposing] Yeah—
That would be brilliant. Erm, do you think there are certain qualities such as, er, lighting, or erm, I know you’ve mentioned noise, or how cluttered or erm, open or enclosed…are there qualities like that, that you think, erm, effect how successful your therapy sessions can go?
Yeah, I think so. Erm, what did you say at the beginning of the question, what things [crosstalk] are you looking at?
[Interposing] So for example, lighting, erm —
[Interposing] Yeah, lighting—
[Interposing] Open or enclosed, empty or cluttered —
[Interposing] Yes, so, I don’t have any clutter, I am quite minimalist.
Yep.
Erm, you certainly would never have anything personal so if you’re working from home, no photos or anything. So my paintings on my wall are very neutral, you know, like scenes as opposed to, anything that, erm, you know I wouldn’t have a, a, painting with like a face in or something like that because things that someone else is afraid of/reference might feel threatened by something. Erm, lighting, yeah, I think, especially at this time of year, many clients really suffer with the darkness and so I try and create a very cosy atmosphere. So, half the clients are coming and going in the dark. Erm, and so I will have nice lighting -- I don’t have big, bright, overhead lighting, that’s bit remote, so I have little side lights. Erm, the space feels open enough, I think, I don’t think people will like to be closed in. Erm, so obviously some people choose to look out over the garden, but some people will choose to face the room so they can see obviously where the exit is, and still, so they don’t have their backs to a door. So yes, so, no clutter, neutral furnishings, nice black thin lighting. Erm, yep.
Okay. Do you think there could be, erm, anything that could be changed about the space to make it more successful or do you think it works, erm, very well just as it is?
I think it works very well as it is. Erm, and I can only base that on that fact that I have a hugely busy practice, with up to 7 clients in a day and I get referrals, so people are sending people to me, so that’s something good. I do look at it now, I’m looking at my couch thinking, at my sofa thinking, ‘oh gosh, these cushions need reupholstering, they look a bit dirty from everyone sitting there’, stuff like that, ‘oh my carpet needs re-doing, they’re too grubby I need new carpets’ so that sort of [laughs] updating, yes, I could certainly do with.
Okay. Perfect. So have you had any negative experiences, erm, in your space, whether a patient hasn’t liked it or a treatment hasn’t gone so well?
Erm [pause], let me think, anything negative? Er, not off the top of my head.
Yep.
But I think, erm, I’ve had for instance, like the gardener, he’s suddenly appeared round the back and then when he knows to stay away, I’ve had to sort of say, ‘oh gosh, I’m so sorry about that, just give me a minute, I’ll go, tell him to leave’ but then people are quite like, ‘oh no, that’s okay’. Erm [pause] sometimes I don’t know, the doorbell might ring but obviously I ignore that doorbell but sometimes, if it’s something I absolutely have to sign for, I will flag up before the session if the doorbell rings.
Yep.
I’ve had, erm, sometimes yeah, a window cleaner, appear, erm, sometimes the dogs escape and then they’ll come [laughs] and bash on the door. So, there’s things, you know, whatever space then, there’s going to be interruptions and things that I’m always just then I’m apologetic.
Yep.
Erm, things, oh I know what I would say has been bad, erm and this fortunately has not happened very often, but it can when you don’t have a secretary and you’re juggling everything. Sometimes, I, mix up like a client coming [crosstalk] erm which fortunately I’ve now got a really rigorous policy in place but there’s nothing worse than a client ringing the doorbell and you just think, ‘oh my goodness, I wasn’t expecting you right now’ and then I’ve got the dogs at my feet, I’m probably in slippers and not my court shoes and it’s like ‘oh no’, but that sort of thing does happen but you know, sometimes it’s not me that’s made the mistake, sometimes it’s the client. [crosstalk]. But I would say those sorts of hazards would be my worst experiences but then I’m always -- yeah I remember I had a client who erm, she came for an assessment and then she came back for her first appointment and I was in session, I heard the doorbell, the banging and all of that and I thought, ‘oh crumbs, I don’t know what that is’, and I came out of the session to, you know, to make it so I was here with a patient and no one answered the door and, and my first thought was, ‘oh crumbs, please don’t let that be me’. And it turns out, she was completely wrong, she had written the time, ‘oh I’m sorry I had got it wrong’ but until that point I just said, ‘oh I’m so sorry this, this wasn’t the time, but, I, that must be so distressing for you coming anyway, listen, I won’t charge for the next session’. So even if they’ve made the mistake -- but of course she phoned back and said ‘no it was my mistake, of course I’ll pay for the session’-- but I will always try and rectify [crosstalk] so the client who comes to the door doesn’t, it’s my mistake, I’ll take money off the session, I’ll go ‘okay I’ll charge you thirty-five, not forty because gosh, I’ve, you know, mixed up the times’.
[Interposing] Yep.
[Interposing] So, do you —
[Interposing] Yep.
Yeah.
So always apologise and make up for it if I can.
So [pause] do you think this could be avoided in a more clinical environment and why would you, if so, why would you not swap the environments?
I think, in an ideal world, [laughs] it would be nice to just have a secretary, who you know in like in a clinical setting, the secretary takes all the bookings and [crosstalk] looks after the diary and the new arrivals for the day and it’s like, ‘okay this is your client list for the day’.
[Interposing] Yep.
Yep, okay —
[Interposing] Erm, so something like that I guess.
Yeah, brilliant. So, erm, just generally, are there any particular environmental qualities, again talking of lighting, erm, open and enclosed, quiet, noisy, that can negatively impact a treatment or make, maybe, a fear or an anxiety worse?
[Pause], erm, yeah and it depends what somebody is presenting with, so, erm, and it depends what they’re anxious about so for example I was working with a, an eighteen year old for a while, and she, at one point, said to me -- and she’s been coming about maybe five sessions already, and she suddenly said as she was leaving, she said, ‘oh, are there other people in this house?’ So I said, ‘yeah sometimes’, because obviously my family live there, I have a husband and a son and two dogs, but they’re never seen, it’s a real accident if they are seen. It’s very, very rare that ever happens and so she was not happy with that and she said to me’ oh, oh, I don’t like that’. Erm, so yeah it depends what they’re worried about. Loud noises or sudden bangs or interruptions could upset people but that’s never happened for me.
Okay.
Erm, yeah.
No, brilliant. Erm, looking at your treatments, what do you think are the most successful treatments for treating, erm, anxiety or fears?
[Pause], erm, see I’m person centred, so I will just provide the core conditions and you know, try and help them to explore the, the cause of the roots of the anxiety and the upset and things like that. Erm, but I would imagine, certainly a lot of my clients who come to me, have been already served things like CBT.
Yep.
Erm, again, its, I suppose my three things about what makes counselling work is that the type of therapy has to be right for them. So for instance I had a, erm, employee assisted programme with a client yesterday who ended with me because it was clear he needed CBT and person centred wasn’t going to work for him. So the right therapist and all of that but then I’ve had clients who have come and they’ve had a horrendous time with, lets say, CBT, you know being told we’re going to flood you with your anxiety, erm, and, and they can’t cope with that. So for me, I think just working with core conditions, being very empathic and non-judgemental, trying to sort of, erm, let them understand that they’re not crazy for the way they think and feel to try and normalise their experience and to try and give them some understanding of what is going on for them. I also, with severe anxiety and stress, so when peoples hearts are racing and they’re having panic attacks, I will do a lot about explaining how the mind and body work, you know, the, the instinctive responses from the amygdala and all of that. Erm, so sometimes for clients it helps when they have an understanding of why their bodies are sort of going into this terror overdrive stuff.
Okay.
Erm, so yeah.
So do you think that education does play quite an important role in treating, erm, anxiety or fears? Do you think people need to understand more about their subject or maybe how the body works?
I think so, because when you’re trying to, er, lets say, give a client some tools, let’s say teach them how to do a body scan if they can’t sleep or, how to use some grounding techniques, erm, why would you try and ground yourself or anchor yourself if you don’t understand why your body, emotionally and physically needs to be stabilised, for example. So you know, when people start to look inwards, and, and, think about what’s going on for them in their bodies, I think it helps take a little bit of the, the terror away because they can, sort of start to lower the panic by focusing on things like their breathing and then they understand this is going to bring their heart rate down and then they’re not going to feel so scared and, so yeah I do think it’s worth while.
Do you think it could prevent, erm, fears, if maybe say in younger children if they’re educated about, erm, certain subjects, so for example, insects? Do you think if they were told more about their environmental importance and how they do impact our lives, do you think that that could potentially prevent the fears occurring in the first place?
[Pause], erm, it could play a part. I don’t know whether it could altogether prevent because there are all sorts of reasons why people end up developing these anxieties and phobias and things. Erm, and there are certain factors that just come into play when they can’t do anything about. Let’s say a dysfunctional family or they’re being traumatised in some way. Erm, but certainly it could help to, erm, maybe reducing [background noise] you know I mean, with, with, let’s say if people try to explain to them maybe how, you know, we have a trigger point and, and then, we water the seeds that we’ve planted and so it grows and then something else happens and reinforces them and so it grows and grows and grows and how, how to try and reverse that. So it all helps, whatever, all these things they all help, but I think there’s no one thing that’s going to be the miracle.
Yeah of course. Erm, going back to the treatments that you do, is there any specific equipment required, that you need, to undertake your sessions?
No, no special equipment. I mean I’m, I’m, as I say person centred, so it’s not really about tools necessarily as in like I’m going to use equipment. But that said, in some ways I am integrative if, somebody needs a bit more input from me because they don’t quite know how to access their feelings or whatever so I would, I could use like sand trays, I’ve got things like that. Erm, doing little exercises, like lets create your worry bully or your anxiety gremlin, lets try and personify it a bit, so because it’s also abstract at the moment for you, so stuff like that I would do, as opposed to equipment.
Okay. And, what’s your view on self treatment and erm, individuals self treating themselves, maybe in their home environments or where ever they feel comfortable? Do you think it works? Do you think it’s effective?
Erm [pause] either really, again it depends on the person. I certainly think thought that if you’re doing therapy like CBT, you’re going to be given, sort of, homework as it were, exercises to continue at home. So yeah, absolutely that’s worthwhile. Sometimes clients will buy self help books or they’ll research on the internet, which is, is, then helping themselves and doing something in their own space. Sometimes it frightens them more and makes them a bit more despairing and very often it helps [crosstalk]. So, it’s all part of, you know, if their, for them to think that they can try and take a little bit of control, when their world is feeling unsafe and not contained, it’s then empowering themselves which generally is useful.
[Interposing] Okay.
Do you think the fact they’re in their own home environment could impact this? Do you think it could make it more or less effective?
So again it depends what’s happening for them in their home [crosstalk] because you’re seeing clients for one hour and you don’t know what they’re going back to [crosstalk]. So for instance somebody who’s, erm, yeah, you know, lets say got a terrible fear of enclosed spaces, let’s say, that then goes back to a home where they’re being abused and a partners locking them in a cupboard, you know, they’re, they’re not going to progress at all going back to their home.
Interposing] Yeah.
[Interposing] Of course.
Yep.
So it just depends but for the, the client who is safe and comfortable at home, then, yeah it can help but for those who are going back to sort of re-traumatising environments or dysfunctional environments, erm, that may be where a lot of the problem is stemming and so in that instance, I’d say probably not so much.
Okay. And final question, you mentioned, erm, patients may be given homework, could you explain what that might be, what that might entail?
Erm, so, I might say to a client [pause] once I’ve explained maybe some grounding techniques, you know, ‘why don’t you just go away and, and try them and see how it feels next time you feel your anxiety rising’ or, you know, ‘go away and practise that breathing I told you about’. Erm, so it would be minor things like that or, you know, you, ‘you suggested that maybe keeping a journal might help you so, so yeah see how you go on that this week, see, see if it does help, see if you can write, you know, your worries down’. So it would be that sort of stuff and, but, because I’m very client lead, it would never be instructive, you know, I would never say ‘right I need you to do this and, and then we’ll discuss it next week’, it would be more like you know, ‘give it a go, see how you go, if it doesn’t work for you, if its not something you enjoy doing then don’t’. You know, so there’s no pressure from me on anything I might suggest.
Brilliant.
Especially if like I’m working with couples, then you know that, that, they’re not working with phobias really, but you know, you might say to a couple okay ‘go away and try you know, X, Y, Z’, and [crosstalk] to get that connection, so yep.
[Interposing] Yep.
Perfect. And that concludes the interview.
Okay. Fantastic Katie.
MAGGIE'S CENTRE THERAPIST, NOTTINGHAM (MCT1, 2015)
Name: Sonja Zadora-Chrzastowska
Job Role: Cancer Support Therapist
Date of Interview: 11th December 2015
Recording:
Transcript:
Okay, so what does the Maggie Centre offer in terms of support and counselling?
Okay, so we offer a wide range of workshops, classes and individual sessions. So when people come into the centre, they -- if they’re coming in for the first time we will sit them down and go through our programme with them. Erm, we offer relaxation sessions, Yoga, Tai Chi, workshops based around nutrition. We run courses on anxiety, dealing with stress, living with stress and, also courses on how people can move forward after they’ve finished all their treatments [crosstalk] as well… and loads of other stuff in between. Erm, in terms of dealing with anxiety issues, which, to be honest I would say the majority of people that come into the centre have, have these issues and need to deal with them. As counselling support specialists we will see people on a one to one basis, as a booked appointment which is what I do a lot of the time with people [background noise]. So that, we can help them talk through those issues and help them find a way forwards from that.
[Interposing] Okay
Okay.
And that may mean that we may see them for several months.
Okay. [background noise] [inaudible at 00.01.24]
So, yeah. But, I think the really good thing about this is that, when people go through perhaps a GP, to get counselling, they, there’s always a really long waiting list, you know, sort of months and months. When they come to us, if we can’t see them that week, we can certainly see them the following week so it’s very quick and they get the help as they’re asking for it, as much as we can.
Brilliant. How does the design of the space affect these treatments and how successful do you think that is?
I think it has a huge impact, on how people feel when they come into the centre. Erm, if you think about the fact that these people, when they’re diagnosed, are spending a huge amount of time in the hospital. For some people they’re having radiotherapy treatments daily, over a period of four or five weeks, so they are constantly, surrounded by uniforms, medical equipment, buzzers and people who are really, really busy. So to come into a space where you can talk to registered nurses and other health care professionals that work within the centre, in a place that appears very homely and very natural light and, just cosy and comfortable and, there’s no uniforms [crosstalk] for barriers, I think it makes a huge difference. One of the things that people always remark upon when they come into the centre, is just, when they walk in just, [sighs], the, the feeling that they get, they feel like they can just breathe again because they have time in the space here.
[Interposing] Yeah.
Yeah, that’s lovely. Do you think anything could be changed that could make this specific space more successful?
Ooh [laughs]. Mmm, gosh. Yeah, I think, I, personally [crosstalk] I’d like a bigger kitchen [laughs].
[Interposing] Yeah.
Okay.
Because, when the centre is really, really busy—
[Interposing] Yep.
— and depending on the day and depending on what, what sort of sessions we have running so if we’ve got Tai Chi -- Tuesdays are particularly busy -- so if we’ve got Tai Chi and different things happening, we have loads and loads of people coming into the centre, and the kitchen gets full very, very quickly and if we just had a bit more—
[Interposing] A bit more room?
A bit more wriggle room in there I think that would be quite good—
[Interposing] How many people would you, would the maximum kind of be, that you would get at one time?
Oooh [sighs] —
[Interposing] Very roughly [laughs].
[laughs] god… In the whole centre?
Or just in the [crosstalk] kitchen—
[Interposing] Oh just in the kitchen! On a really busy day [pause] we can have upwards of thirty people
Really?
Easily! Yeah! Easily.
Wow. So it can be a bit of a squish?
Yeah! So, it’s quite nice to have the little lounges and the library so that people can go and use those spaces as well.
Because it gets quite squished, do you think that affects people? Do you think that can make them feel uncomfortable or do you think people aren’t really [crosstalk] worried about it?
[Interposing] Everybody’s, mmm, everybody’s very different with that and for some people they like that kind of, you know, ‘oh, I really wanna have a good chat’ and its really nice.
Yeah.
For newer people coming in, I think sometimes that can be a bit overwhelming because, they’ll often say ‘oh is there a group happening down there’ or ‘is something happening’ and so, it’s just sort of, for newer people I think that can be a little more difficult [crosstalk] but thankfully we do have those quieter areas so that people can sort of, go and [crosstalk], sort of, get used to it before they hit the kitchen.
[Interposing] Okay.
[Interposing] Okay.
And what’s your opinion on the kitchen’s design? I mean it’s down a set of stairs, which is quite unusual for Maggie Centres as they usually want to be on one floor. What’s your opinion on that? Have you had any problems with it? Do you [crosstalk] think it’s successful?
[Interposing] No, it, it works because the, our lift, actually accesses all the floors so when people come in through the main door, they can get the lift down to the kitchen.
Okay.
So it’s very accessible, so, I think people quite like coming down into [crosstalk] a kitchen.
[Interposing] Into a space?
Okay.
Erm, it seems quite nice, it takes them out right out of the sort of, main entrance area and they come down some steps into a nice, little, cosy kitchen or they get the lift down depending on what their needs are.
Okay. Perfect. Have you had any negative experiences as a result of the space or maybe the operation of the centre? Or again, do you think it works very well as it is?
[Sighs]. The only negative comments we seem to get, erm, and you may noticed yourself as you were coming up to the centre, is, it’s up quite a steep hill.
Yep.
And then you’ve got steps. For some people, that’s quite a difficult way to get into a centre like this. Depending on which way they’re coming from the hospital, they can either come across, to sort of like, the main door, or they have to come up that hill and for some people that’s, that’s [crosstalk] quite tough.
[Interposing] Quite difficult.
Yeah.
What do you think works particularly well about the space? What do you like about being here? What do you think patients particularly like?
I think they like the non-clinical environment. I think, everybody remarks on the fact it’s so homely and lovely colours and lovely furnishings. And the fact that, as a team, we’re able to sit and talk to people. Erm, when people are going into hospital or they’re going for an appointment, and they often have lots of things they want to ask but they can see everybody’s quite busy and sort of, dashing around and got lots of things to do. Whenever people come into the centre to see us, if they want to talk to me, for example, one of my funny little ways is I’ll make myself a drink and go and sit with them because that instantly says to them ‘well I’m having a drink as well, I’m not in a rush [background noise] I’m going to sit and have a cup of tea with you’, and they like that because they think ‘oh, yeah, I can, I can just talk now, I can open up here and I can say what I need to say’. Erm, I think they just, just love the whole, feel of the place and the activities that we offer as well.
Okay. So my next question was going to be, can you explain why you think Maggie Centres are so successful? Erm, whether that’s emotionally or physically? What do you think their benefits are compared to, maybe, another type of erm, therapy space?
Yeah. I think, their quite unique as a, as an organisation in the fact that, we, we will see people as, as drop-ins, they come in. So they can, you know, they don’t have to be referred through a GP or a nurse or a consultant. If they hear about us, they can come in. And that’s not just for the person who has cancer, that’s for their families, their friends, anybody who is affected by somebody with cancer can come and use this centre. And they don’t, you know, anybody who’s affected, by someone with cancer can come and do the activities on the timetable, and they can just come to drop-in, and they can talk to somebody. And that’s quite unique because there aren’t many places, that, support people with cancer but that have such a big timetable of activities and support groups and courses that are totally free, that people can access, as and when they want them. And I think that makes a huge, huge, difference to people and I think that’s why it works.
Okay. Erm, have you only ever worked in a Maggie Centre or have you worked in another type of —?
[Interposing] [laughs] No, I’ve not just worked in a Maggie Centre. Erm, er, my, I’m a registered nurse [crosstalk], erm, so my background has been, based in many setting really. So, the last, sort of, eight and half years, before coming to Maggie’s, I worked in a palliative, a specialist palliative care unit for end of life cancer patients. Before that, I’ve worked in secure units with adults with, erm, challenging behaviour. Er I’ve worked a lot in mental health, I’ve done a lot of stuff [crosstalk] over my time. Erm, and I’ve been with Maggie’s a couple of years now.
[Interposing] Okay.
[Interposing] Over—
Okay.
So yeah, I’ve done a lot [laughs]
[Laughs]. Lots of experience.
Yeah.
So, what would you say, is the benefit of the Maggie Centre compared to them? Do you, which do you think is more successful?
I think they all work in their own way!
Okay.
And I, I think, that, we need specialist palliative care centres, we need places for people with challenging behaviours, we need places like Maggie’s, and we all offer something different.
Okay.
And, and it’s, it’s, just how things are and I don’t think any one place, you know, is, sort of, better than the other and I think they all have their qualities to offer the people that access them.
So do you, are the spaces designed in a similar way, would you say? Or do you think—
[Interposing] The hospice that I worked in, erm, was very homely as well [crosstalk] so that, that, it had a lovely, it’s, it still has, it’s got a lovely family room and lovely, sort of, areas for relatives to, sort of, get up the ward and do that so, it, it has nice spaces as well, not on a level with this, very, very, different because obviously, it’s still a medical area.
[Interposing] Okay
Yep.
But it’s got a lovely day care centre, and a complimentary therapy suite that looks like a great big log cabin so there’s nice, sort of [background noise] spaces within that as well. Erm, so, but we work very closely with that, that centre, erm, and, you know, we see a lot of their people that say, you know, ‘go over to Maggie’s and you’ll be able to get some support from them’ or we, we sort of support them, vice versa so we will go over there—
[Interposing] So they all work hand in hand?
Absolutely
Okay—
[Interposing] Absolutely! [Crosstalk] Yeah.
[Interposing] Okay brilliant. Erm, if you were to maybe design and set up your own, kind of centre, similar to a Maggie, what characteristics, whether it’s in the design or the operation, would you adopt into your own [crosstalk] policies?
[Interposing] Oooh [laughs], I’ve never been asked that one before. That’s a new one! Er, I think, I think what I’m, I’m really impressed with the most about, and what I would want to take is the big windows.
Okay.
Erm, and the quirkiness of the buildings. I don’t know if you’ve look at the other Maggie Centres and how they’re built - they’re all completely different to each other [crosstalk]. And they’re quite quirky, and they look a bit new age, some of them, just look a bit strange and funny, a bit like this one [laughs] [background noise]. Erm, I love the big, big windows, I love the littler quiet areas that people can come away to and just the homely touches, I think. The little lamps and the little, I don’t know, just the homely touches [crosstalk]. I think that’s what I would, I would copy [laughs] [crosstalk], if I had to take anything with me.
[Interposing] Yep.
[Interposing] Yep.
[Interposing] Okay, perfect.
And what about the operation and running of the centre, what do you think particularly works well about that, that you’d maybe take [crosstalk] or adopt?
[Interposing] Okay, yeah. I think it, it actually is a really good way that they work because we’re, we’re a very small team, erm, and I think that’s good because, in an environment like this where we’re dealing with, well you never really know who’s going to come through the doors, in a, a centre like this, so being able to support each other as a small team, I think there’s only about seven of us employed at this centre, we really do support each other, we’re able to talk to each other if we’ve had a particularly difficult case. Erm, that’s, that definitely works, very, very well, and, hand, goes hand in hand with the amount of volunteers that we hand pick very, very carefully to come and support us in the centre as well, so they, we couldn’t do our jobs without them.
Okay.
You know, and I think having volunteers that want to come in and, and support us with that is really, really important.
Okay.
Yeah.
So what, erm, who makes up your team exactly, so [crosstalk] what professionals—
[Interposing] Erm, okay yep. So we have a centre head.
Right.
So she overseas, really, all of the staff and the whole centre, so she manages the whole of the centre and what goes on here. But she’s also a counselling support specialist, so she does a bit of that role as well.
Okay.
Erm, then we have myself and Carolyn, who are the other two counselling support specialist. We have a benefits advisor; we have a counselling psychologist and two fundraisers.
Okay.
So, together, we all, we all share an office, we’re all throw in there together [laughs], so that we all sort of, get to know each other incredibly well, erm and that’s wonderful. And then we have volunteers who help just with the fundraising side of things, so they’ll go out to events, they’ll help with admin stuff, they’ll do all that kind of, out there kind of stuff. And then we have volunteers, as you’ve met, who help in the kitchen; coming into the centre, greet people, make them comfortable, go through various sort of, things that they can sign them up to courses and stuff like that, so, that’s kind of how, how it all, sort of [crosstalk] comes together.
[Interposing] Okay, functions?
Brilliant. My final question, do you see a relationship between patient’s emotions and the space? Is there, erm, maybe a difference as well in the different rooms?
Yes hugely!
Could you maybe explain a [crosstalk] little bit about it?
[Interposing] Yeah! Erm, one of the things you may have noticed when you’re going round the centre, is every single room is different. It’s a different colour, it’s a different style. Erm, it, it’s quite random in a way. The way that it’s all sort of thrown together. When people come into the centre, and, particularly the ones that come in and they’re really, really tearful and sort of, you know it’s all there. What we tend to do, is we will guide them into a quieter area, we won’t take them down in the kitchen, it’s busy, there’s people sitting around, so we’ll take them into a quieter room. And, you see things change because the environment is very homely, and they instantly, you see them relax, because they think ‘oh, actually this feels really okay’ and it helps people to open up. There’s something about, it, it’s difficult in a way for me to, because I’m here everyday and I sort of see, you kind of get used to this but to imagine it for someone who is seeing it for the first time, they’re not being lead into a doctors office off, off a corridor from a ward, they’re actually coming into a really odd looking building that doesn’t have nurses and doctors chasing around in it, and they’re coming into what feels like a little lounge or a sitting room with nice sofas and it really, really helps people to relax and feel like they can talk. And again, I know I’ve mentioned it earlier but they see that they have time to talk with people and that is okay, they’re not taking up our time, they, they’re, we’re happy to spend as long as they need. You know, and I think, I think the rooms and the way that they are play a huge part in people feeling that actually, they want to come back again and what an amazing place this is to, how much nicer it is to come in and sit here and talk to somebody.
And what do you think the, maybe, the communal areas do for patients? And also the gardens? You’ve got terraces and decking, how do you think they help?
Well, the communal areas, erm, I’ll have to talk about the kitchen with that, because it’s quite unique to Maggie Centres and what, if you ever go to any of the other Maggie Centres, what you’ll see is they all have a massive, big kitchen table. The way it works is that, if people, as they do, and they’re diagnosed with cancer or they’re supporting somebody through cancer, they spend an awful lot of time at the hospital waiting for appointments that are often late so they’re sort of sitting looking at their watch thinking ‘oh, this is awful’. There’ll be loads of other people waiting in those areas as well, but they won’t talk to them because every body’s just fed up their waiting, taking ages. When people come into Maggie’s, and you take them into the kitchen, and you sit them around the table and give them a cup of tea, they start to talk to each other, where as they wouldn’t normally, if they were anywhere else. But they start to talk to each other, and they start to build friendships up, they start to support each other, and amazingly, last year we had a couple of ladies, both bereaved, who started to, coming into the centre, met each other, got to know each other, they go on holidays now [laughs]. They’ve built up an amazing friendship but that’s what it does, this kind of, people just start to talk to each other and it’s incredible and it’s, we’ve got some amazing little friendship groups going on within the centre, of people that come in and maybe they start going to the Tai Chi, and then get to know each other through the Tai Chi group or something and then they meet here for coffee one day or they’ll, they’ll come here, erm, due to start some chemo, meet someone and say ‘oh I’m due to start as well, we’ll go to chemo’, see each other over in chemo.
Aww.
So, it, it really helps each others support each other, not just here, but in other parts through their treatment as well. The gardens are amazing. So the balconies, you know, again people will go and sit out there and then somebody else will wander out and say ‘oh, hello!’, you know ‘how are you doing’, and sort of have a little chat. The gardens’ lovely. Erm, we’ve got a little bench or something somewhere down one, to one side and they get used a lot. People, when the weathers nice, will go and sit out in the garden and we have a gardening group so often people will get involved in that and actually help to maintain the garden [background noise] with our gardener and sort of grow things and we grow lots of vegetables and fruit and everything, so they’ll, perhaps one day someone will come into the centre and say ‘do you fancy going out to pick some runner beans’ or something and then everything that we grow, we give away to the people that come into the centre as well, so, it, it just all, it goes round and round really.
Goes round.
Yeah.
Perfect, well thank you very much [crosstalk] for agreeing to speak to me.
[Interposing] Not a problem, not a problem!
