In conversation… (interview from November 2010)
How did you get started as a therapist?
Well, I would go back quite a few years to a period when I had to deal with a crisis in my own life and, like a lot of people, if you have a crisis you look to enter into therapy, and that’s what I did. It was because my daughter had been diagnosed with leukaemia, she was two years old at the time, and during the course of her illness I felt I had to have therapy. And it really helped.
And, so for the next five years after that, while my daughter was recovering – and she’s fine, by the way – I guess it had planted a seed, and I began to think about how helpful therapy had been during that time, and thought how I’d perhaps like to become a therapist myself.
So, you took an introductory course on becoming a therapist…?
Yes, and I started out with a person-centred, humanistic counselling course, which proved a really good foundation, in that it teaches you what’s known as “unconditional positive regard” [Carl Rogers], and how to be empathic, and how to listen. That was really the key skill: not just being able to teach someone how to change, but to listen to what the problems are…
Since then, I’ve gone on to do other things, and consolidate that learning.
And today, you specialise mainly in the field of Personality Disorders, and in particular Borderline Personality Disorder. How did you get started in that, how did that come about?
Well, it was quite a long journey, really, from being a person-centred therapist. And, I wanted to do more than just listen to people. I wanted to help them in a more practical way - deal with what I think of as the change aspect. Listening to the problem, and understanding the problem is all well and good, but what then do you do to change it? So I wanted to put in place some more practical, more pragmatic skills that, as a therapist, I could bring in to my work.
I decided to train in Cognitive Behavioural Therapy, and gained a Post-Graduate Diploma in CBT, from Anglia Ruskin University, developing the skills of examining negative thoughts, finding the evidence for and against them, and learning certain change strategies – cognitive restructuring and behavioural experiments. And that’s a really important element of the work that I do.
"…I get a really good sense of satisfaction working with somebody who has had problems with the whole of their life, and then is able to make a small change; to see someone who begins with absolutely no belief in themselves to be able to make small but important changes in their life, and to be able to have a better quality of life…"
And I like to work at both ends of the spectrum, both with very severe mental health problems, and the more everyday emotional issues. I run courses for depression, and anxiety, which are basically psycho-educational, or taught in class, if you like. But have been drawn to the more severe, more chronic cases.
There's no one single reason why I became interested in it. But it is the case that people who have the Axis I problems, like mild depression or anxiety recover fairly quickly; within a few weeks you can see the changes. And, while it’s always satisfying to see any patient move forward, I feel incredible empathy with people who have the more chronic problems, particularly problems to do with their personality; life-long problems that these people seem to suffer.
And I get a really good sense of satisfaction working with somebody who has had problems with the whole of their life, and then be able to make a small change; to see someone who begins with absolutely no belief in themselves to be able to make small but important changes in their life, and to be able to have a better quality of life. To really start to enjoy their life.
You've worked for some time at a private mental health clinic near to your home. And, I understand you brought both Mindfulness and Dialectical Behaviour Therapy to that hospital. What was the reason behind that?
Well, it started with Mindfulness, in 2006/7. But, I’ve been interested in Mindfulness for several years, and been practising it myself. Again, a very personal journey for me, in 'discovering' Mindfulness. I travelled to Thailand, and was taught Mindfulness by a Buddhist monk. When I returned back to England, I started to look into the more clinical practices or applications of Mindfulness, and looked at the research, and so it seemed a logical fit with my Cognitive Behavioural work
Were there writers that particularly inspired?
Yes, and I would point to Jon Kabbat-Zin and Thich Nhat Hanh as really important influences. And I attended lectures by Mark Williams. But what I learned was that there was a lot of research to show that the combination of Mindfulness and cognitive or behavioural strategies had a powerful effect, in particular in preventing relapse in patients. CBT is successful with anxiety and depression, but it was also the case that, probably about a third of people who undergo CBT will suffer some form of relapse of their symptoms, after a certain period of time.
And it proved successful at The Priory in relapse prevention…?
Incredibly so. I brought Mindfulness to the in-patient ward. We had a lot of patients coming in, they were really anxious for about the first week.
I firstly introduced one hour of Mindfulness each week, and the patients responded so well that they would go to their Consultants and ask for more Mindfulness training. And it spread throughout the hospital, and I was asked to teach and disseminate it to other staff, and now Mindfulness has a major bearing on just about all the psycho-educational groups that are run at the hospital.
And, I'm guessing, that this led on to the work of Marsha Linehan, and Dialectical Behaviour Therapy…?
Absolutely! Through my own research around Mindfulness, I was very intrigued to learn that Mindfulness was the core skill in Dr Linehan's work with suicidal women. And given my growing interest in the field, I further researched the area, and started my training.
At the same time I put together a DBT team at the hospital, which became a team of intensively trained [through the British Isles DBT Training organisation – under the auspices of Dr Linehan's Behavioral Tech LLC in Seattle, Washington] DBT therapists. As far as I'm aware the team is still going.
And how successful has the DBT programme been?
The results have been very good. But that needs to be measured in the context of there being no 'quick fix'. These are life long problems. It’s a very intensive course. The work is difficult, and often slow. But it’s been very well received by the various Community Mental Health Teams, GPs, and other referring bodies and NHS Primary Care Trusts, in Essex, and Suffolk. There's a distinct lack of DBT therapists nationally, very few DBT trained therapists, and demand for this service is very high.
And you offer DBT in your private work, outside of the hospital…?
Yes, and to the point now where my private practice accounts for 100% of my work. DBT works with a combination of group therapy, individual therapy and telephone consultation. However, my private work is slightly different, in that it's based around individual therapy, rather than group work. So, my private work is an adaptation, concentrating on the skills training, both in individual therapy and psycho-educational training.
So would you say that Dialectical Behaviour Therapy is your 'natural' home, then, as a therapist?
Yes, and no. DBT's not for everyone, particularly as I approach it in quite a 'purist', 'fundamentalist' way — it's not to be 'fooled around with', or 'mixed-and-matched' — and sometimes you find, quite quickly, that it's not going to be well-suited. And that's when I find the more integrative approach, Schema-focused Therapy (ST), and the way it brings together elements from cognitive therapy (and CBT more generally (and attachement and object relations theory, and Gestalt, and experiential therapies)) extraordinarily helpful for many of my clients.
One last question: outside of emotion dysregulation and personality disorders, who is Amanda Watson?
[Laughing…] Is there life outside of therapy? I'm a mum with two teenage daughters, I think that says it all!
I like to travel, and try to spend as much time in the Canadian Rockies as possible, where I’m fortunate to have a second home. I do try to achieve a good work-life balance, but it doesn't just happen. Like I tell my patients, its something you have to work hard at.
27 November 2010 (updated: 17 February 2012)