Isabel Clarke — Clinical Home Page
The publications and therapeutic approaches that follow employ ICS as a way of approaching CBT across diagnoses – because: ICS provides a cognitive science based rationale for:
Cognitive Therapy and Serious Mental Illness
Cognitive Therapy and Serious Mental Illness. An interacting Cognitive Subsystems Approach. Clinical Psychology and Psychotherapy, 6, 375 - 383. 1999
Powerpoint Introduction to this initiative which incorporates:
The Emotion Focused Formulation Approach. (EFFA)
Forthcoming book: Third Wave CBT Integration for Individuals and Teams: Comprehend Cope and Connect. Isabel Clarke and Hazel Nicholls. Routledge. Due to appear: January 2018.
CCC/EFFA is a therapy approach that starts with collaborative, individual formulation – which can then inform the thinking of the wider system.
A Relational Approach
From this perspective, our very being is founded in relationship and we only make sense in the context of a web of relationships. Family and those close to us are clearly key to this, but it extends to the widest and deepest experience of relationship, the spiritual or religious. In emphasising the primacy of the emotional/relational aspect of the human being, CCC is in tune with non Western cultures. Experience and felt sense are at the heart of the approach and ‘symptoms’ are viewed as understandable, but ultimately self defeating, ways of coping with an intolerable internal state, which will have come about because of disruption in the web of roles and relationships that hold an individual together, and/or disruption in the crucial self/self relationship.
Theoretical Background and more detail.
CCC represents an integration of third wave CBT approaches, on the theoretical foundation of the cognitive science based Interacting Cognitive Subsystems (ICS) model of cognitive architecture (Teasdale and Barnard 1993). This can be seen to underlie Dialectical Behaviour Therapy’s States of Mind diagram (Linehan 1993 ) of a separable Reasonable and Emotional Mind. Working at the level of felt sense is strongly indicated by ICS.
Felt sense informs the individual formulation at the heart of the programme, but a central objective is spreading a psychological understanding of mental health difficulties throughout the service through engaging the staff at all levels with the task of supporting the use of new skills to manage unbearable felt sense. The contribution of past trauma and context are emphasized, but intervention is targeted at the behavioural cycles set up by the individual’s understandable but ultimately self defeating attempts to cope.
Programmes designed to teach alternative coping skills are provided and the delivery of these is distributed as widely as possible through the staff group. The Trans-diagnostic programmes include Dialectical Behaviour Therapy (DBT) based Emotional Coping Skills, Mindfulness, Stress and Anxiety management, Compassionate Mind and managing unusual experiences and beliefs. Thus the wider staff group can aid generalization of new skills through coaching, in preference to simply offering medication.
Applications of CCC.
Acute services, inpatient and community acute (see CBT for the Acute Care Pathway)
Making Sense of Crisis. A one or two day training package to introduce this approach to a service.
For a full account of the formulation used both with individuals and with teams see:The Emotion Focused Formulation Approach: bridging individual and team formulation.
(Clarke, I. (2015). The Emotion Focused Formulation Approach: bridging individual and team formulation. Clinical Psychology Forum 275. 28-33).
Primary Care. Increasing Access to Psychological Therapies (IAPT).
italk, the Hampshire IAPT service, conducted an audit of a patient cohort who made limited recovery with the existing interventions. The Strategic Health Authority funded a project to develop a service for this group. The audit identified the target group as having problems exacerbated by complex trauma (normally characterised by relationship difficulties and chronicity). CCC/ EFFA was used as the approach incorporates consideration of past trauma and relational aspects of therapy into its collaborative formulation and facilitates motivation towards clear treatment protocols for IAPT therapists.
Culturally Adapted Therapy. A project to use CCC in a Culturally Blind form of therapy with a Mindfulness focus is in its early stages, linking three centres in Pakistan, Canada and Southampton.
Bridging the gap between Cognitive theory and therapy
ICS Symposium 2008: Bridging the gap between Cognitive theory and therapy: using ICS to inform CBT, including talk by I Clarke:
The Construction of the Self