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Interview with a CR Therapist in Finland

by Noora Sjösten, CR Therapist & Clinical Psychologist at Turku University Hospital, Finland

I am a clinical psychologist practicing at a psychosis rehabilitation outpatient clinic in Turku University Hospital. Our hospital is part of the Hospital District of Southwest Finland consisting of 28 member municipalities with a total of over 470 000 residents. In our clinic we take care of both acute and more chronic psychosis patients aged 18−69 years.

1. What is your main reason to train and work in mental health?

I think I’ve always been interested in the brain, how it defines our personality and our behavior. From early on I’ve also been somewhat scientifically oriented, probably because of my father who was a researcher. However, psychology wasn’t my first choice, but nursing, probably due to my lengthy stays at hospital after an accident that happened to me during my early teens. I actually learnt to like hospitals and certainly learnt to appreciate the work the nurses (and the physicians) were doing. However, I never had the mathematical skills needed for physicians’ training, so nursing felt like a good choice. Very early in my nursing career, I realised I wanted to study more. So I started studying health sciences (as a continuation to my nursing career) and took psychology as my secondary subject, which then later on became my other main subject. Psychology just felt right for me from the very beginning and I’ve never regretted my choice.

2. How did you become aware of the impact that cognitive difficulties have on the recovery prospects of people with mental health conditions?

I think that actually my current working place has been a real eye opener for me in the above mentioned sense. It is always heartbreaking for me to see how young people may lose their studies, careers, and even family dreams i.e. the whole life they had been waiting for, often due to their severely compromised cognitive abilities. As health care providers, we should have some tools to help them. 3. When did you start using CRT?

I started using CRT about four years ago, so rather soon after having started my work at the outpatient clinic. Our clinic has much longer traditions in using CRT, as being one of the first clinics in Finland pioneering this rehabilitation method. Since I happened to be the one to continue the work of our former CRT coordinator, I got a chance to make a rather quick, but deep dive into using this method myself.

4. How did you train in CRT?

I trained during my first year at our clinic, first paper and pencil method. The training was a pretty intensive 3-day course with a reasonable amount of scientific evidence and exercises packed into those days. The seed was planted; I got interested and super eager to learn more. In some instance I heard about the digital version of CRT (CIRCuiTS) which was already in use in Helsinki (capital) area and contacted the psychologists working there. We got a thorough introduction from their wonderful psychosis team and many concrete tips on how to start using the Circuits. After that, all went very smoothly, I contacted KCL team in London and with their genuine help we were able to start the Circuits training programme in summer 2020 initially with 12 therapists. Now our team has grown into 16 active therapists and six more to come.

5. Can you describe a success and a challenge in using CRT in your clinical work?

I can particularly well remember one of my patients, a young woman in her thirties, who had difficulties in pursuing her studies at the university after been diagnosed with schizophrenia. She started in our rehabilitation programme before Circuits i.e. with pen and pencil CRT. She got better, but not enough to be able to meet her own life goals. So after a year or so, when we got the Circuits programme, she was ready to continue her cognitive rehabilitation. Along with Circuits, she was able to make some great progress; her overall information processing got so much better as well as her reasoning and verbal skills. We were able to work a realistic study plan for her and she was able to finish her studies (bachelor degree), she also found a part time job and started exercising more regularly. I know that working or studying isn’t a realistic goal for all of our patients, so I try to concentrate on smaller things. For someone success might mean learning a new recipe, managing to watch a youtube video for 15 minutes instead of ten or getting a grocery list done before going to the store in order to avoid the overwhelming feelings often linked to shopping.

Challenges, as I see them, are often linked to more chronic situations. Even though we try to select our patients carefully, sometimes three sessions per week is just too much for our patients and they drop out. 6. What is your favourite CIRCuiTS task? Why?

I could easily name several tasks, but if I have to pick one, it would be the letter shuffle (sanapeli in Finnish). Verbal skills are so crucial to us in everyday life and many of our patients really struggle with verbal fluency issues. This is also a task where you can really see the benefits of using different strategies.

Screenshot from CIRCuiTS task in Finnish, 'Sanapeli'

7. What do you think is a key therapist skill for delivering CIRCuiTS effectively to clients?

To start with, I think you get a pretty solid base to act as an effective CIRCuiTS therapist by going through the KCL’s CIRCuiTS training. So it is pretty easy to start your journey as a therapist. As to personal skills or one’s mode of working, I think it helps a lot if you have a genuine interest in cognitive functioning/neurocognitions and of course in every person’s individual story and are willing to support them towards their own life goals. It is also very important to have a positive attitude towards change, as in rehabilitation in general, I think. To be able to see possibilities rather than obstacles. I personally think that some kind of change is always possible. It is just a matter of how big it is or how far it allows you to go.

8. If you could be granted a wish to improve mental health, what would it be?

This is tough! But I think I would start with children and teens. I’d launch a new subject ”supporting one’s psychological well being/mental health” as part school curriculum in order to spread the message of the importance of mental health and in order to lower the stigma around mental health issues.

Otherwise, I would certainly call for a better access and equality in mental health services. For example psychotherapy is almost impossible for persons with lower income.


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