by Roisin Quinn, trainee Clinical Psychologist
I trained as a Cognitive Remediation Therapist as part of a research trial looking at the delivery of CIRCuiTS™ remotely via MS Teams. Prior to training, I had worked as a Care Coordinator and Occupational Therapist in an Assertive Outreach Team for clients with psychosis who find traditional teams difficult to engage with.
Training as a CR Therapist felt a very natural fit with my background as an Occupational Therapist, given its focus on creating goals around meaningful occupations, building independence through identifying thinking skills needs, and implementing strategies to support those needs. Rather than feeling like starting from scratch with a new therapeutic modality, it felt like it enhanced my existing skills and felt true to the philosophy of Occupational Therapy.
I particularly liked the focus CR places on strengths. Often, people who experience psychosis that struggle with their thinking skills (e.g., attention, planning, organisation) also experience low self-esteem and can be critical of themselves. Identifying strengths means that people can lean into these and learn to use them effectively. It was fulfilling to watch clients completing tasks and seeing existing skills shining through, especially when encouraging clients to recognise these skills in themselves rather than focusing on their flaws. I was surprised by the range of cognitive abilities that CIRCuiTS™ can cater for and I enjoyed the flexibility the therapy allowed. Differences between people but also session-by-session differences meant that sometimes a heavy focus on the tasks, with a brief check-in about their day-to-day thinking skills and goals was more beneficial, and at other times (especially later on) some brief tasks followed by an in-depth discussion about how their progress or barriers towards their goals was better. I found with practice and experience I learnt to be more flexible, and supervision was a helpful space to think through how to adapt therapy to fit the person.
The therapy itself is intensive and I was struck by how low the drop-out rate was and how well clients were able to engage with the therapy at least twice a week alongside independent practice. Although more challenging, clients on inpatient wards were able to engage in the therapy and this provided them with routine, structure, and a space to plan for goals both while they were on the ward, and planning for when they were back at home.
It was a real joy to witness the successes of CIRCuiTS™ - this could look like someone leaving the house for the first time in a long time, starting a new job, or getting a bus to see their friend. For people who were particularly struggling with being around other people and going outside, CR offered a chance to build relationships and access therapy in the only way that the individual can engage.
I am now training as a Clinical Psychologist at the University of Oxford. I feel my understanding of how to break tasks down has been very helpful in my clinical work, and having a heightened awareness of how someone’s thinking skills impact both therapy and in a wider sense has enhanced my practice.