Dr Claudia Bernat, Ellesmere Clinic, High Barnet
PUBLISHED: 00:00 13 May 2020
Dr Claudia Bernat, consultant psychiatrist at Ellesmere Clinic in High Barnet, gives an insight into her working day
The day typically brings a lot of curious, different and often very challenging subjects, and stories. There are people who are suffering emotionally, some of whom are reacting to external stresses of life and others who have suffered for years with difficulties, but most can be helped in the outpatient/community setting.
The assessment of new patients follows a protocol, but the real beauty is finding out about the different cultures, lives and issues of each person. I learn so much from listening to people and making sense of other people’s experiences.
The outcome of an assessment is subdivided into different groups which takes into consideration the options of medication, psychological treatment or both. I discuss all these options with a client, their implications and realistic outcomes and we decide together the best way to move forward.
I’ll leave the broad and complicated subject of medication for another time and concentrate here on the variety of psychological treatments available. A lot of people may not be aware there are a large number of possible treatments, all approaching different problems from different perspectives. Some target symptoms. For example, when someone suffers with attacks of anxiety, the natural response is to avoid situations where one could have an attack. Cognitive behavioural therapy will work on changing the pattern of behaviour and cognition so people learn not to fear the discomfort of anxiety, and eventually the symptomatology will dissipate.
Other treatments target the whole person’s functioning. For example, how one relates to others and how this could impact on his or her wellbeing. Within this type of therapy there are many sub-divisions that can involve short-term or longer-term treatment.
Other clients present with mood deregulation, feeling unable to control their reaction to stimuli. Some consequently self-harm in order to find some comfort. For these sufferers, dialectical behavioural therapy can be the first step towards treatment. Here patients work in groups and individually on establishing and stabilising their personal values and learning to build resilience.
Still another modality is EMDR (eye movement desensitisation and reprocessing). This is a wonderful treatment which is very beneficial for trauma. Trauma is not the memory of the traumatic event but its storage in the body. The body retains a somatic memory of traumatic events and reacts autonomically. The idea is to recall the traumatic image while using bilateral stimulation (the use of visual, auditory or tactile external stimuli in a rhythmic side-to-side pattern). The patient will not relive the trauma but will reprocess the memory in a safe environment.
With clients who suffer with addiction, it is often necessary to undo habits before or while starting to create new ones.
I feel privileged to encounter such a variety of presentations and to work through the maze of information with the client to find a route towards ending the cycle of suffering. My days are always different, full of surprises and bring, with each individual, a new wave of learning and the opportunity to help someone back to their normal functioning.