PWPs: The Thin Slice of the Cake

It is a great pleasure to host a guest blog by Liz Kell this week. Liz is the Chair of the BABCP Low Intensity Special Interest Group, Chair of the North West PWP Professional Network, Senior Lecturer in Psychological Interventions and PWP Course Lead at the University of Central Lancashire. Liz has featured pretty heavily in several of my posts thanks to her consistent championship of Low Intensity Therapies and the practitioners who deliver them, and her generous interaction with this blog. It’s past time for Liz to have her own space on this site, so here it is!

A focus on the PWP workforce

The world changed so much for us all when lockdown started in the middle of March.  We’ve all had to make huge changes to our ways of working, as well as the worry, fear, potential illness, and practical issues that have arisen for everyone in different ways (multi-tasking has taken on a whole new meaning for me!) and, as a course leader for a PWP training course, my focus has of course been on the PWP workforce – including how amazing the trainees are who are training in the middle of all this chaos, many of them having started just a week or two before lockdown!

In the First couple of weeks I put out a Tweet:

A note to all PWPs – remember you are all highly skilled in working in flexible and innovative ways including via telephone and online platforms. Use those amazing skills and share your experiences with colleagues who may be less comfortable with this way of working! 👊

— Liz Kell (@eclectic80) March 17, 2020

I really believed this, and at the time I tweeted it in part in frustration of the lack of recognition or attention that was being paid to this, but, over the weeks, I’ve almost wondered if saying this has in some ways been unhelpful, because, while I do still believe it is true, I also feel like, in some settings, that has led to an assumption that PWPs can ‘carry on as normal’ and all the attention and additional help and support needs to go to the Step 3 practitioners (HITs in particular) and, once again, PWPs seem to be at the bottom of the pecking order for help, support and resources.  There is nothing ‘normal’ about this situation, and NONE of us are fully prepared for working like this!

It’s been fantastic to see all the resources and additional training coming out to help people to recognise the need to shift and make adjustments, and at such fast pace, but again, I can’t help but be a little bit frustrated that there was one session for PWPS, and an ever increasing number for HITs (and only one for each of the other modalities as well but that’s probably for another blog!) and I’m not convinced that all the differences in how PWPs are having to work can actually be covered within one session, just because they don’t necessarily work to diagnosis specific models?

I don’t want to complain – I know everyone is working in challenging situations and having to make decisions at very high speed, and what the national team have pulled together is nothing short of amazing in terms of the amount and quality of the resources.  I know it’s never possible to always get it right, but part of me does feel that it reflects a longstanding view of where the attention always goes within services while PWPs are left to get on with the highest volume of work within their teams.

[there’s] an assumption that PWPs can ‘carry on as normal’ and all the attention and additional help and support needs to go to the Step 3 practitioners… PWPs seem to be at the bottom of the pecking order for help, support and resources

What I’ve learned about PWPs since lockdown

So, for what it’s worth, here are my thoughts on what I’ve learnt about PWP working during lockdown, and if this is useful, and people are interested, maybe it gives an opportunity for another webinar or two….

• Using platforms to do video work rather than telephone can really help with engagement, but it is definitely still very different to ‘In Real Life’ (it is absolutely not for everyone, but like all things, the choice of both is really useful)
• Using self-help materials on virtual platforms is VERY different and requires you to think about lots of additional things, including if there is a way for them to have the same materials in front of them as you have (e.g. email them over prior to the start of the session)

Picture from http://clipart-library.com/cartoon-computer-images.html

What you might want to think about if you’re working as PWP on virtual platforms:

• You need to ‘narrate’ what you’re doing when you’re using self-help materials.  If you’re beginning to fill in a table of a list of activities they’ve stopped doing as part of BA, or a hierarchy as part of Exposure, then you need to tell them that is what you’re going to do.  If you just start asking them questions to populate the information and don’t explain the purpose first, the collaboration quickly disappears.  And collaboration is essential for the interventions to be effective.
• Where possible, find a way to share that table with them, whether that’s through ‘screen sharing’ or them already having a copy, then they don’t feel that something is being done ‘to them’.
• While PWPs are always thinking about being collaborative, this needs to be increased ten fold if you’re working virtually – really think about the balance of how long you are speaking for before you get input from them
• If you are using screen-sharing, think about how frequently you are doing it and how you can maybe do it in ‘chunks’ showing a few different elements to support the session rather than jumping in and out of it which can start to feel a bit jarring – or make you a bit dizzy!
• Ensure they know they’re going to get a written copy of all the information you tell them within the session – again IRL they can probably see the booklet and work that out, but you need to give that reassurance – probably before you start talking – that they’re going to get a copy and not have to remember everything you’ve told them during the session
• Think about providing information to your patients about how they can get the most out of the session e.g. having time before and after the session to prepare and then reflect on what has been said, and to be able to focus on the session without distractions during the session – and ensure you try to stick to these principles too!

Using self-help materials on virtual platforms is VERY different and requires you to think about lots of additional things

I’m sure there are lots more things that you’re all beginning to work out as well: there is probably a never ending list, but the self-help aspect of the PWP role is so important in terms of the patient’s engagement with the materials, so we really need to think about how we get this right for them in this new world, and that will probably vary quite a lot depending on the particular intervention you are doing as well!  I never cease to be amazed at how the PWP workforce support each other, especially when the support feels less forthcoming from other sources.  I feel privileged to be a part of this community, and if people are interested in more webinars for PWPs, then maybe we work together to make these happen as well!