This month, we speak with Dr Susie Henley, who has recently brought her expertise in Clinical Psychology to a clinic at the Queen Square Private Consulting Rooms. Dr Henley has particular expertise in working with individuals who have neurological disease, and those who have concerns over their mood or mental health.
Q: Dr Henley, thank you for taking the time to speak with us today. Firstly, would you be able to elaborate a little on your particular area of expertise?
A: Like all Clinical Psychologists I’m trained to use talking therapy to help people with a range of concerns about their mood or mental health, but my work tends to have a particular focus on helping people who have a neurological problem – such as dementia, stroke or epilepsy – and are perhaps anxious, low or frustrated in part because of that neurological problem. For example, I’ve worked with people with a dementia diagnosis who are very anxious about forgetting what to say in social situations and have become a bit withdrawn as a result, and people whose speech is much slower than normal after a stroke which has really knocked their self-esteem and affected their mood.
Q: How can your work help patients who are trying to manage the physical effects of a neurological condition?
A: There are lots of ways in which a talking therapy can help. Sometimes people with a neurological condition really want to understand the condition better, and I’ll use my neuropsychological knowledge, and a little model brain I work with, to sit down and spend time helping them understand how the brain works, what parts are working less well in their case, and how that translates into the day-to-day difficulties they are experiencing. This can be really useful for families and friends as well as the patient themselves. Sometimes people are really very anxious or low about their symptoms or what the future holds. In that case I would tend to suggest a Cognitive Behavioural Therapy (CBT) approach (which has a really good evidence-base for anxiety and low mood) to help them identify certain patterns of thoughts, emotions and behaviours that are perhaps maintaining their anxiety or low mood, and think with them about ways of trying to do things differently to break out of those patterns. Sometimes the work is more about giving people and their families just some space and time to talk through how the diagnosis has impacted on them and their relationship; patients might find they have had to give up their job or retirement dreams, and partners often find they have taken over various household tasks that they’ve never had to do before. They often say that it is helpful to talk about these changes.
It is also really important to stress that a neurological or mental health condition can have a huge impact on partners and families as well as the patient. A lot of my work includes partners and families, even involving time with them on their own, without the patient present. Sometimes it is helpful to have a partner in the session – for example they might help the patient put into practice some of the things we have talked about – and sometimes partners and family members appreciate time on their own to share feelings such as guilt and anger that they prefer not to talk about in front of the patient.
Q: You also work with people who are anxious that they might have a neurological condition but have been reassured by your neurology colleagues that there is no evidence of one. How does your work help in these cases?
A: Yes, a significant part of my work is with people who are worried that something is wrong with their brain but for whom all the medical investigations have come back as “normal”. Most typically this is people in their 30s-50s who have noticed that they have forgotten some key events or appointments, and are anxious that they might be developing dementia. First of all, I try to get a good understanding of the bigger picture with these people; more often than not there are lots of other things going on in their lives, for example bereavement, difficulties at work, financial worries or a work-life balance that they are unhappy with, and we start to build up a picture of how all these things might be contributing to their worries. Secondly, I spend time helping them to understand the links between anxiety and thinking; many people are surprised to learn that when we are anxious, the hormones that our body produces actually affect our brain as well as our bodies and can impact on our thinking, and memory in particular. Again, I find the model brain really useful here and I’ve also got some standard information that we go through and that people can take away and look at in their own time. Finally, once we have that wider picture of the situation, and the person has developed that understanding of the links between anxiety and thinking, I would again typically suggest a CBT approach in which we work together to come up with ways of making some changes.
Q: When holding a clinic at the Queen Square Private Consulting Rooms, you are surrounded by consultants with a diverse range of clinical specialities. Do you think there are advantages in holding a clinic within a setting such as this?
A: Yes, I think this setting in Queen Square very much mirrors the multi-disciplinary approach that we use in the NHS, and it is helpful to me as a professional to know that there are a range of other professionals to whom I could refer someone if it seemed necessary. For example, if I saw someone who was worried about their memory, and I didn’t think, after an assessment, that this really could be explained by psychological and lifestyle factors on their own, I would be able to suggest that I refer them to a neurology colleague within the same clinical setting. Of course, it is really helpful to be based physically in the same place as those other colleagues because that makes it much easier to pop in and have a face-to-face chat with them about a patient.
Q: Wednesday 4th November 2015 was National Stress Awareness Day. Do you feel that management of stress and anxiety is getting sufficient attention, or do you think patient outcomes could be improved with more time dedicated to patient’s mental wellbeing?
A: I think that in Queen Square we are quite good at keeping a patient’s mental wellbeing in mind when we assess them, but not always aware of the resources that are available post-assessment that could be used to help with mental health issues alongside the standard medical pathways, which are of course really important for the patient. Nationally, in the field of dementia for example, there is evidence that a huge number of people with dementia feel anxious or depressed1, yet also lots of evidence that talking therapy can alleviate this and improve quality of life for both the person with dementia and their partner2.
Q: Finally, how are patients able to access your services? Do they need a referral?
A: It’s nearly always most appropriate for patients and families to come and see me after they have been assessed by a medical colleague, usually a neurologist. That means that when they start work with me we both have a good understanding of their condition or the fact that they have had investigations that have come back normal but they remain worried about their thinking. In that case, a referral letter from that other medical colleague is usually the best way to start.
However, I am happy for people with concerns about their mental health to contact me directly via my website, or via the private consulting rooms, without a referral. If they already have a diagnosis I would ask to see recent letters from their neurology consultant in order to make sure that I had a good understanding of that diagnosis, and I would also ask their consent to let that other consultant know that they were seeing me.
2 Orgeta, V, A Qazi, Spector Ae, and M Orrell. 2014. “Psychological Treatments for Depression and Anxiety in Dementia and Mild Cognitive Impairment (Review).” Cochrane Database of Systematic Reviews (online) http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009125.pub2/abstract
Dr Henley holds regular clinics at the Queen Square Private Consulting Rooms. Appointments can be arranged by contacting the consulting rooms directly on 0203 448 8948, or via Dr Henley by email to firstname.lastname@example.org. More information on Dr Henley’s services can be accessed on her website www.susiehenley.co.uk.