After years as a consultant clinical psychologist in different fields, Dr Cheryl Rezek considers the need to see the whole person sitting in her office. This article sets out a multi-dynamic framework which includes aspects from various psychological concepts and practically applicable mindfulness theories.
- People are influenced by past and current experiences, as well as the context in which these have taken place, in addition to genetics, social, familial and cultural heritage
- Regardless of setting, the practitioner can better serve the client by considering them as a product of all these different factors
- The multi-dynamic therapeutic mindset allows for formerly disparate precepts and theories to be integrated into one framework, from which the therapeutic concepts and interventions can be applied.
The field of clinical psychology has traditionally advocated the use of set models of intervention, such as psychodynamic psychotherapy or cognitive
behaviour therapy. Through my many years working as a consultant clinical psychologist in a variety of fields, with both children and adults, I came to recognise the importance of viewing conditions and people from a broader perspective.
“Whatever the setting, there was always the need to understand the person within a wider context.”
Throughout my career I’ve worked with people struggling with addiction, and counselled people in a hospice. I’ve worked in secure forensic settings, in inpatient psychiatric wards and in community mental health teams. I found that whatever the setting, there was always the need to understand the person within a wider context, as that is from where many of the infiuences came that were impacting on people’s lives. It was through this ongoing experience in the different settings that my approach evolved. It has infiuenced my work as well as the programmes and services I developed, the doctoral lectures and teaching units with which I was involved, and the many trainees and professionals whom I have supervised over the years.
This multi-dynamic therapeutic approach combines into one framework the concepts and theories of the following
- biopsychosocial model
- psychodynamic constructs and theory of mind
- the principles and practice of mindfulness.
When developing the model, the aim was to create an integrated and multidimensional approach, a unique therapeutic model based on sound psychological concepts combined with those that have evolved regarding the applicability and utilisation of mindfulness ideas and practices. Such a mindset allows for formerly disparate precepts and theories to be integrated into one framework, from which the therapeutic concepts and interventions can be applied.
The terms ‘model’ and ‘approach’ are used interchangeably as, strictly speaking, this isn’t a model of therapy as it doesn’t provide set techniques as one would find in, for example, psychoanalytic psychotherapy, cognitive behavioural therapy or even mindfulness-based cognitive therapy. Instead, it acknowledges that clinicians will already be familiar with different techniques, but highlights the importance of how we view the person sitting in the chair, and what attitude and mindset we have when listening to, understanding, making sense and assisting this person. We ask questions, make interpretations and bring together ideas and formulations based on what we have within our own minds as the cause and consequence of emotions, behaviours and actions.
“Individuals and cultures are constantly adjusting to the transient nature of their environments.”
Theories of mind and their accompanying models of intervention have tended to be kept separate from other models, perhaps leading to similar concepts being given new guises and ring-fenced as belonging to only one model. The drive behind this approach is to allow for various dynamics to co-exist within it. This is based on the premise that life is a varied and dynamic process, as is the person who exists within it.
Individuals and cultures are constantly adjusting to the transient nature of their environments. Certain factors become more fixed and entrenched, leading to the development of patterns of beliefs,interactions and processes developing over time. These patterns are both internal to the individual (the person’s genetic inheritance and internal psychological conscious and unconscious structures) and external (such as powerful familial attitudes and social structures). The way in which such processes are regarded can also vary according to philosophies. Mindfulness looks to view the present as the single moment of primary relevance and one’s attention to it as paramount. Psychodynamic theories focus on how the development of the individual and his or her experiences influence the present moment, and the ideas within the biopsychosocial model take into account the genetic, psychological and social (and cultural) environment of the individual.
The foundations of these principles have been synthesised and constructed into a more flexible and dynamic therapeutic approach that allows for the individual to exist within a broader context, which can include nature and nurture, mind and body, the past and the present. In this way, individuals are not reduced to one of the three domains of cognitive, biological/genetic or environmental but can be seen and understood as an interplay of all the dynamic areas that have influenced his or her present moment. If these factors are dynamic then it permits the individual to view him or herself as both static and dynamic, knowing that what is static may change in some way and that what is dynamic may become more fixed for a period of time.
Incorporating mindfulness as one of the key ideas encourages people to stay with both the ease and discomfort of their experiences, whether previous or current, and to refocus their perspective on what is taking place right here, right now. This permits one to move beyond thoughts and include sensations, instincts, drives, barriers, reactions and responses.
This multi-dynamic therapeutic approach looks to place the individual within a framework of past and present, as we need to make some sense of the past in order to make sense of the present. Once we can recognise and acknowledge that we are, today, a combination of all of our existence, in all forms (genetic, social, familial, psychological), then we can become more aware of what drives us and how we react to such forces that infiuence our everyday existence. This existence includes our relationship with ourselves and how we react and interact as friends, partners, colleagues, parents and leaders. Mindfulness assists in allowing us to recognise and stay with our responses. With its emphasis on focusing and refocusing our attention, it can help to increase our awareness of ourselves, our reactions to others and to the world around us by bringing an intentional awareness to them. It has a bearing on our personal lives, our psychological and physical health, our workplace attitudes and the choices we make as managers of ourselves and those around us in private and organisational settings.
This model not only looks to increase insight and awareness but to build resilience and develop the individual’s own resourcefulness and stability to deal with pleasant and difficult emotions or experiences, both psychological and physical. It encompasses working with the mind and the body, sensations and thoughts, fiexibility and rigidity. It allows for a more fiuid and wider perspective of how we understand ourselves and manage our lives, looking to gather together and permit the existence and infiuences of what was and what is, so that the complexities of our individual personality structures, our social and familial structures and our experiences can stand as one unit where we can exert personal choice over how we wish to be within this moment of time.
This approach can be used in all mental health settings, with an emphasis in research on anxiety and depression. This is of great importance as depression is the leading cause of disability worldwide, across high-, middle- and low-income countries, and is a major contributor to the global burden of disease (World Health Organisation). However, the approach is as valid and effective in assisting with physical health conditions, as we know that around half of people with physical conditions suffer from anxiety and/or depression, which frequently go undiagnosed as they are regarded as an inevitable emotional response to having a chronic physical condition. Pain is the primary cause of people seeking medical help. The statistics on the cost of mental health and physical health conditions, in terms of quality of life, lost workplace days and cost to the economy in the UK and USA are staggering, yet adjunctive interventions are still seldom recommended even though we know that mindfulness and psychological input have been shown to be as effective as medication in treating depression, and mindfulness for pain management has sufficiently sound evidence on its efficacy for it to be included in the Center for Diseases Prevention and Control (USA) as a valid intervention.
As a way of integrating this approach into mainstream life situations, I have written several books on how it can be applied to different conditions as well as to managing life without a specific condition. It has shown itself to be a unique and constructive approach that creates a curiosity in people about themselves and provides an easily accessible and straightforward framework within which the individual can move through each section, one building on the next, leading to a greater sense of integration between all the dynamics. I have written about the ways this approach can be useful to carers, for those with anxiety and depression, for pain management, quitting smoking (and other addictions), and managing cancer symptoms. I have also written more generic books on how a mindful approach can help you towards a better life, and one on making sense of our lives as life happens to all of us. It shifts the focus from getting through life to getting involved with it. In addition to these adult books, I have written for children on how to manage their lives now and in the future, and have created a dynamic and interactive children’s programme for primary school children on mindfulness, mental health and resilience. This encouraging and engaging programme has taken on the task of helping children at such an influential stage in their lives to learn skills on how to understand themselves within their worlds, how to take care of themselves and how to manage all that life brings with it. There is also an app for people on the go (walking, commuting, taking a bike ride and so forth).
Perhaps the most important part of working in this way, regardless of whether one believes in, or uses, the mindfulness component, is that it gives respect and acknowledgement to the individual’s past and current experiences and the context within which these have taken place. By holding in mind that greater sense of awareness, it opens further opportunities through which to engage and understand the human being sitting in the room with you.
Dr Cheryl Rezek is a consultant clinical psychologist, author and mindfulness teacher. She has developed an innovative model (affectionately known as Life Happens), based on academic knowledge and her extensive clinical experience. In addition to her longstanding clinical and academic career, Dr Rezek is the author of several books and a children’s programme.