‘You had me at hello’: Paul Sams offers a personal reflection on the importance of the therapeutic relationship

  • May 2019

‘You had me at hello’: the ACP-UK inaugural conference inspired Paul Sams, Expert by Experience, to offer a personal reflection on the importance of the therapeutic relationship

Simon Mudie, ACP-UK Director and Expert by Experience writes: Paul Sams from Northumberland Tyne and Wear Foundation Trust shared a moving account with the ACP team describing how his life was changed when he finally met a clinical psychologist, Selma Ebrahim, who was the first person to actually listen to him. Paul is an absolutely amazing man whose achievements are incredibly inspirational, changing lives for the better in an astounding number of areas. This is what he had to say.

I was honoured to be invited to the inaugural ACP conference in Edinburgh (28/3/19), especially as I was able to hear the leading lights of the clinical psychology world discussing the current developments in the field.

I was particularly struck by the contribution of Prof. John Taylor. He discussed leadership and the Responsible Clinician (RC) role within MDT working, specifically his role as an RC on a ward in Northgate Hospital. The outcomes for patients with access to a Clinical Psychologist RC had been proven to be better over a prolonged period, with shorter stays in hospital and lower readmission rates.

This got me thinking about my journey through mental health services and the difference that might have been made if I’d had access to a Clinical Psychologist RC or any type of psychological intervention sooner.

To set the scene, I presented to services at the age of 19. I was severely malnourished due to an eating disorder that was developing as a result of a psychosis that took the form of eight internal voices and one external, all of whom attacked me without let up, all day and into the night. I was struggling to sleep because of night terrors and at this point I had been reliant on drugs and/or alcohol since the age of 11.

My partner of only a few months at the time suggested I speak to my GP as she could not support me to eat and could see I was in severe emotional distress most of the time. I did this and very soon had a Community Psychiatric Nurse (CPN). After a few visits to my home my CPN decided I should be assessed for admission to the local psychiatric hospital.

My assessment was carried out by a psychiatrist, he asked me about myself and asked why I was there. I told him I couldn’t eat, every time I tried I felt physically sick and I was worried that I might die. I was under 8 stone at the time, quite light by any standards and especially as a 5’10” young man. I was honest and told him I took drugs. I explained that the thought of a day without drugs filled me with dread, also explaining that a day without drugs made me feel desperately sad and tormented.

I also explained that from as early as I could remember I had been abused by my father, neglected by my mother. That I had been taken into care as an 11 year old, had been set on fire by my best friend as a 15 year old, almost losing my life and severely damaging one of my legs with lasting results, and that I had been to a young offenders institute and my local authority had relieved themselves of their duty to me when I was just 16 years old.

I further explained that I had been surviving in bedsits on food parcels until meeting my then girlfriend a few months earlier. The response of the psychiatrist is something I will never forget. He focussed on my drug taking and told me ‘you’ve brought this on yourself’. As you can imagine, I was furious, but also deflated. I’d been desperate enough and brave enough to ask for help and this was the response of ‘a professional’.

I was taken into hospital and the team on the ward started to plan how to get some calories into me and I was started on some anti-psychotics and anti-depressants. I should also add I was put into a dormitory bedroom, something which horrified me and cemented my belief I would be safer at home.

This initial experience set in motion fifteen years as a service user. For the first decade I had regular appointments with a psychiatrist who gave me varieties of medication, asking me to ‘give them a try’. I followed this plan for years hoping to feel less sad, less mad, more like other people.

I saw the same psychiatrist for most of this decade. Every time I saw him he’d ask the same thing: ‘why do you think you are the way you are Paul?’, and each time I would recount how traumatic my life had been and how I was convinced the next bad thing was just around the corner.

Eventually my wife supported me to think about life without medication as none of them had ever truly helped with my symptoms. I had almost totally given up illicit drugs by this point, only smoking cannabis in small amounts.

When I broached this idea with my psychiatrist he was aghast. He threw his arms in the air and said, ‘I can’t help you anymore’. I told him I still needed help but the medication had never really done anything good – in fairness I’d given them a try for a decade. He then asked if he could bring in a colleague and I agreed. He came back with a lady and talked to her a little about me, as if I wasn’t there, and asked if she would work with me. She agreed and we arranged an appointment that suited us both. In fairness I had every day free, it was Selma who needed to look for a spare spot.

I then became the problem of Selma Ebrahim, Clinical Psychologist at the Bede Wing in my home town. We met the next week and Selma asked me to tell her about myself and the issues I was facing. She was very good at active listening, something I hadn’t really encountered before. The following week something magical happened: she gave me what turned out to be the beginnings of a formulation, MY formulation. We went through it, reflected on it and over the next months it grew into something that I could understand. More importantly it contained tools I could use to deal with distress, it normalised my reactions to things and set in motion an important shift. I was now an active participant in my care and wellness; previously I had received care. This change turned out to be life changing.

I needed a further two years of support. This included CBT (Cognitive Behaviour Therapy) and DBT (Dialectical Behaviour Therapy), the development of a robust formulation and a WRAP (Wellness Recovery Action Plan) plan that I still live by today. I have gone from an individual who was scared to plan a day ahead to a Durham University postgraduate with a career in the very Trust that eventually gave me access to the trauma informed care I needed.

If you would like to learn more from Paul about how clinical psychology can change and rebuild lives he can be contacted via just one of his day jobs here [email protected]