After undergong initial training as a General Practitioner, realising that much of the work of a GP is in fact mental health, I decided to spend some time in psychiatry.
An inspiration and occasional mentor on this journey was Jeremy Holmes. At a joint meeting organised by the RCGP and Psychotherapy Faculty of the RCPsych, he presented an early version of his view of the 'citadel and the souk'.
My time as a GP had made me realise that the vast majority of mental health management takes place in primary care. In the late 1980s access to psychological therapies was patchy. The citadels of dynamically oriented psychotherapies were the only source of higher training and CBT struggling to be heard despite its growing evidence base.
Psychotherapy researchers were beginning to penetrate the citadel and ask searching questions about what works for whom. My own research, as an psychodynamic specialist registrar, took me from Leicester to Nottingham. Work on the CORE-OM which enables psychotherapists to measure effectiveness in clinical settings was part of the early research that informed the much later Improving Access to Psychological Therapies project.
My other research interest explored how contemporary metaphor theory ,a branch of linguistics and embodiment theory, a branch of neuroscience, could inform our clinical models.
Cognitive Linguistics has a helpful answer to the depressed patient with multiple unexplained physical smptoms who says, often angrily, 'so you think it is all in my mind then, doc?' Knowing that the mind and language are inextricably linked to our bodily experience can lead to a more compassionate response, more helpful behaviours and better mood.
This research into the underpinnngs of psychological therapies can been seen as supporting the practical use of the Five Areas Model, a cognitive behavioural approach to consulting. This model and the related website provide a simple visual tools that any GP can use to facilitate understanding of the ways our thoughts, body, behaviours and emotions are inextricably linked and interact with the situations in which we find ourselves.
GPs are already expert in communicating quickly and effectively with distressed patients. GPs are already familiar with the biopsychosocial approach to illness. My current interest is in building on GPs broad based training and specialist skills in managing undifferentiated presentation by promoting the use of flexible, well-informed, CBT based consultation models.