Latest / The STA Clinician Podcast / Ep.287 "Psychological Patterning Process (PPP)'' with special guest Serena Simmons

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Ep.287 "Psychological Patterning Process (PPP)'' with special guest Serena Simmons · The STA Clinician Podcast

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You're listening to the STA Clinician Podcast, connecting clinicians across healthcare.
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Five and a half years of the STA Coalition podcast, formerly known as the Sports
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Therapy Association podcast.
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My name is Matt Phillips, credit at onechatlive.com. And as always,
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this episode has been recorded live on the Sports Therapy Association YouTube
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channel and Facebook page at eight o'clock UK time on a Tuesday.
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Definitely caught the sun today. If you listen to the podcast,
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then probably not a good idea to watch YouTube. You'll burn your own retinas.
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Anyway, we arrive at part four, the final part of
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our focus this month on communication skills for msk clinicians
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it's been a fantastic month i'm really excited with part four which
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is going to be psychological patterning process p
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p p i'm going to be joined very shortly by the wonderful serena simmons charter
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psychologist educator behavioral change specialist for more than 25 years and
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has worked in psychology behavior change teaching human complexity across health
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care higher education coaching and forensic settings more on that later,
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Serena is going to be discussing psychological patterning process,
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PPP, a structured way of recognizing the patterns that sit underneath your client
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or patient's behavior and understanding what to do next.
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So if you've joined us live, thank you very much. If you have joined us live,
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then remember you can ask questions by just typing into the comments,
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whether you're on YouTube or Facebook, and I can bring them up on the screen.
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Although we're obviously not expecting too many people, given the holiday and
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bank all day feel and the sun out there.
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But for anyway, Before we continue that, I must thank my guest from last week,
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who was the amazing Ben Wybrow in an episode entitled Explaining Diagnoses.
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Ben is a clinical communication skills facilitator at Norwich Medical School.
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He's a specialist physiotherapist in the NHS Pain Clinic and also host of the
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Clinical Communication podcast.
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And in that episode, which is episode 286, Ben explores how MSK clinicians can
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explain diagnoses clearly, confidently, and compassionately.
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He discusses asking about patients' expectations, meeting people where they're
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at, timing explanations, using simple relatable analogies like the cocktail,
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which you'll need to listen to discover what that's all about and checking understanding.
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Full to the brim as always with practical tips on explaining diagnoses in MSK
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practice available on YouTube, Sports Association YouTube channel and all popular podcast apps.
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Right then, I've left her down in the galleys for long enough.
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Let's get back to tonight's episode, Psychological Patterning Process,
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PPP, with my special guest, Serena.
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How are you doing? Hello, Matt. I'm well. Thank you so much for inviting me. It's lovely to see you.
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It's wonderful to see you again. It's been a while, but yeah,
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it's been too long, actually. So thank you very much for giving up your time, first of all.
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I suppose we should just jump straight into it. I mean, we've already had a
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nice chat off air, and I'd kind of like to continue that conversation,
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but this is for the podcast.
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So for people who don't know you, then maybe, unnecessarily it's tricky,
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but maybe a little introduction so people know who you are and how you got to where you are today.
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Oh, you did a great intro there. Could you not just continue that?
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No, it's lovely. Thank you. So yeah, for those that don't know me,
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thank you so much for inviting me again. It's lovely to be here. I am Serena.
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As you said, Matt, I am a chartered psychologist here in the UK.
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And I've worked, gosh, yeah, you said 25 years. I know, sorry about that.
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I've been writing 25 years for at least the last four years,
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so it's probably longer.
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So a long time, and I've worked in various settings over that time.
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So I started always in clinical practice in kind of like hospitals,
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I've worked with patients with brain injury, worked with neurodiverse populations.
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Psychogeriatric units, so various different kind of populations.
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But really my passion early on was forensic psychology. So for the most part,
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I trained and qualified in that area before transitioning out of really more
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of a forensic psychology setting into academia and then behavior change.
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Although behavior change informs a lot of the work that you do,
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obviously, in forensic work as well.
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So that's a little bit of a plotted history. Amazing. How did you fit that all
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into a minute and a half? It's incredible. You've done this before.
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Sometimes I think it's a bit boring if people go on about themselves.
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I have to keep that nice and short.
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That's great. Very compact. Wonderful. I think you mentioned,
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but you're still a lecturer at university, don't you?
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I do. So at the moment, my week looks like two days teaching.
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So I still teach at Nottingham Trent University as a senior psych lecturer there.
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And I've done that for 20 years now. Gosh, a long time.
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What's out of interest? What keeps you doing that? What is it you like about
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still going and doing that?
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Two main things, I'm still doing research, research active, so I like to keep my hand in that.
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I do think it keeps me really current, it forces me to think differently,
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and yeah, just so research active, really.
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And then I do really, really genuinely love teaching.
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So, you know, teaching students who, and there are still students there,
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but actually do love psychology.
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Yeah there's nothing like taking someone through that process and seeing them
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get those aha moments and change themselves when they're when they're at uni
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I could do without the admin we won't go there,
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it's the bane of my existence that and marking which is obviously admin I just yeah.
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I don't think so. No, I know. That's a whole episode in itself. Really? Yeah.
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That's really cool to hear. I'm not surprised at all what you say.
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It was a bit of a leading question because we had the pleasure of your presence
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at the STA and ST School Conference in Exmouth.
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And I mean, all the speakers there are wonderful, but in particular,
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and I'm not just saying this to kind of pick you up, but people mentioned quite
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a few times how amazing it was such.
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Our intention was to show that the speakers are not these gurus sitting on,
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you know, pedestals and talking down at people.
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Our whole desire with Anna Maria and myself and Andy Hosgood was just to show we're chatting.
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It's a discussion. There's no levels here. The same as it should be with a clinician
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and their patient or client.
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And you just provided that wonderfully. You were so accessible and gave such
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a great talk. So I thank you again for that.
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It was so wonderful. It was so nice. It was wonderful. Lovely,
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great. It was everything you wanted. So thank you very much for that.
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And it was great. That was the last time I saw you. That was back in September 2025.
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But you've just dropped the bombshell am I allowed to announce it now about the therapy?
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Oh yeah, of course yeah, not am I told you Oh yeah, there's five bombshells
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let's go for the therapy show bombshell Yeah, you're going to be there, yeah?
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I am, yeah I've been kindly invited again and a nice invitation,
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so I'll be there on the Wednesday so can't wait to see everyone and to have
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coffees with everyone behind the scenes and see everyone else's talks as well so yeah,
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really looking forward to that That's amazing, and will the You see me on the Wednesday.
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I don't think it's quite up in the program yet, but is it going to be related
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to what we're talking about tonight?
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Yeah, I'm going to do a broader talk to kind of make sense of why I think this
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is needed, which I'm sure we'll get into.
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But the title I've got at the moment, I'm just going to look down here at my
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notes, it says, your patient is not resisting you.
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So, so far, that's what I'm looking at. So the resistance that we might see
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in patients when looking at that, obviously, through a psychological lens.
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That's going to be so exciting. That's great. I can't wait till it goes in the program.
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I'm going to have to give Liam a little bit of a call and try and make sure
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it's definitely in a place where I can get access to it. I can't have a clash.
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I've already changed the presentation once so I can't change it again.
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Yeah, I will work that out. I'll talk to the governor. That'll be fine.
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So yeah, very exciting on Wednesday, which is going to be the 25th,
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I think. I think it's 25th, 26th. Yeah, I think it's the 25th of November.
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So that'll be very exciting.
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In the Birmingham NEC, people, as always, if you're an STA member,
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then don't forget you've got your discount.
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Go to the members page or chuck us an email. Still very competitive prices.
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If Serena now has finally sold it to you, which you should have done,
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a reason to go, then that's great.
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But you sure yeah you sure discount code
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um and also we can't let this go if you're listening to the podcast and thank
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you very much but this might be an opportunity for you to go to youtube and
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watch it there because it's very interesting visual that i love i love bringing
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up without saying what's going on serena would you just describe what the picture
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shows for our audience really annoyed me.
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So in my forensic life and i
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still do a lot of work in profiling essentially is
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i specialize in serial murder so this was for
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some education i was putting together on
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how people go about hiding a
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body so i just in
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case you think that you didn't hear
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that it was yeah how people hide a body yeah continue serena
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i go to great lengths in
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my training to make things as realistic as possible so yeah
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this was a part of the props that i was using for that but yeah
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i still work in that area people often just to kind of
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say a bit about that because people do often wonder why and how you know how
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am i kind of doing this other stuff but there it is very linked obviously the
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underlying psychology of why someone does what they do is is there whether unfortunately
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someone's doing something really sinister or someone's doing something really,
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really good. So there is a link.
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Although, yeah, you might see the old forensic case study pop up as well.
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So I like to bring a little bit of kind of, you know, to bring the worlds together.
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No, that's great. I think it's really exciting. And it is. I mean,
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it's really interesting.
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There's some schools of thought, like Carl Rogers would argue that however much
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someone has fallen off the rails, if they're in their environment which supports
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them and they feel that non-judgment,
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then they can still have that natural desire for self-actualization or something.
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I know a lot of people still try and do that, but that must be such a challenging
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group of people when they've gone that far.
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Yeah, and I think, again, that's the link to the behavior change world.
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It's kind of why I ended up very happily, obviously, working in that.
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It came from actually, to be fair, it was quite overwhelming at one point because
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it is very dark. It can be very dark when I'm doing that work day in, day out.
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But, you know, essentially in the UK, we have a rehabilitation system.
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So arguably, you are saying someone has the capacity to change,
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even if they've done something really bad.
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And they are a very very challenging very embedded cognitively embedded group
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of people to work with so taking a lot of the teaching and the learning from
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that and bringing it into this space is really useful I think,
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Very interesting. Oh, great. We could do a whole episode on that.
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But yeah, it's just lovely to hear that that's part of, you know, what drives you.
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And if you're joining us watching YouTube now, then obviously you want the video version of this.
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If you listen to the podcast, and just in case you missed it,
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basically we've got something which looks like,
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it was a collection of plant pots or somewhere, some kind of terracotta kind
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of pots stuck together with brown parcel gaffer tape or something and wrapped around with,
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yeah, so it's kind of a segmented kind of centipede type structure,
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which Serena is holding this kind of head-shaped object at the end and then
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if we go to the video then it says when you're an expert in murder and basically
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serena trying to demonstrate how heavy a dead body can be and how much gaffer
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tape you really need to keep those shots and also the nice thing is when you
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post these things i don't know if this is going to play.
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It's lovely we've got a little bit of music with it just to take the edge off it a little bit,
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it's really nice yeah that's fine i'll only play a little bit of it so i get
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banned from facebook right there we go that's the introduction oh no of course
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that's not just the introduction because there's been also i'm very impressed
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to say i don't sound like too much of a fanboy but some tv appearances as well
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i mean where do we start loose women,
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Oh, stop. You do your research. I'm a fan. Yeah.
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Yeah, so this is why I kept my history potted, a potted history. I like the pun.
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Yeah, so I still, I'm really fortunate actually. I still do a lot of television
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and it's mostly documentary work, which is really fascinating.
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And it's lovely to be able to choose the projects that you want to be involved
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in. So I'm really lucky that I get to do that. It's incredibly hard work.
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You work very very hard on those things but it means I get to do something although
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the subject matter is obviously very very dark the process itself is a fun one
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and you meet the most amazing people when you do those things so yeah I'm still
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really fortunate to do a lot of documentaries,
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yeah but it's really cool to see that you're involved because often in these documentaries trees.
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I'm not going to name any names, but they'll just bring along somebody thinking,
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oh, no, this is just not going to be evidence-informed or it's just part of
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the machine. But then you turn up, obviously take your work really seriously.
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And it just seems like really kind of encouraging that they are reaching out
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to people who've got a little bit more weight in terms of the evidence department.
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So it's cool. Yeah, thank you for saying that. Yeah, and actually I say no to a lot.
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So if I think that like a sniff of, you know, it's being overly dramatized,
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which is gratuitous, I don't say yes.
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And actually some, you know, they work really hard to find someone who is expert
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and you have to fill out a lot of forms and you're interviewed and you have
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to show your CV and your qualifications a lot of the time. And they check your workplace.
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They get people to provide character references.
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So it's, you know, they do their due diligence. Yeah. I love the fact you managed
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to say that whilst the video is playing next to your head of you.
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We'll change that now. Let's come away from that. There we go.
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Just keep it right. I've got my I've got my minute cut now for reals that's
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perfect wonderful right let's get into the chat then tonight psychological passing
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process I've seen you advertising this for a while now and it's,
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really intriguing from a personal point of view and i think also it's so linked to,
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evidence-informed kind of therapy and just critiquing
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things even things that you have done it's just so healthy to see
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professionals like yourself who aren't who are ready to say you know what actually
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i'm missing something here it just shows a humility which is so encouraging
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what we need as therapists so i'm really exciting really excited for you to
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tell us about it so yeah go on tell us how did you come across this and um yeah
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let's bring up the website first of Let's bring this up.
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If you're interested in what we're talking about and you want to go to the website,
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then go along to thepsychologyschool.co.
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So it's thepsychologyschool, one word, .co.
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And then you'll see on the front there, well, if you click on courses and things,
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you'll see some information. Lovely venue, by the way. Well done on that. It's beautiful.
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And then just to bring up, I think one of the pages on the website,
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in big letters it says, this is not a communication skills course and it's not
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another behavior change framework, which I think is probably a segue into what
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you're trying to do, isn't it?
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Yeah I think to be really honest with
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you I've been struggling I don't
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want this to turn into my therapy session but I take
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your time it's a safe space yeah just in front of a few thousand people I just
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I've been struggling with what I've been teaching for a while if I'm honest
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like you know when you can feel that creep coming in and I felt that creep and
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that little voice in my head And for anyone who is listening,
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but also trains people or teaches people,
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especially when you're doing your own work like you, Matt, I don't know how you feel,
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whether you've had this as well, but you're kind of getting to that point in
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your training or you go and do another training and you reach that kind of point
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in the training where you feel uncomfortable with what you're teaching now.
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I'm like no I'm not really it's good stuff and I stand by everything I'm saying
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I'm always really proud of the teaching that I do and I stand by it.
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Basically, in the training that I do, it felt like when I was establishing the
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initial parts of the training where I always go into the psychology.
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Kind of more of a broader human psychology to start with when I teach people
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behavior change. I don't just launch into what behavior change is.
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I always give people a little bit of a context to that first.
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So it always looks like looking at how humans make decisions.
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You know, why do people behave in a particular way and
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all of that good stuff around kind of predictive processing identity theory
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might look a little bit as schemas and I
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felt like that was just so
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important but I wasn't spending long enough in that space
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and that for me became uncomfortable
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because it's like I went from this really deeper psychological understanding
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to well there's all this stuff and I'll mention some
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things like identity or schema therapy or schemas
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but then let's go on to look at how we help someone change and
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it was there that I started to feel the angst and I
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knew something had to change so about a year and a half ago I was just like
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what am I going to do because I don't really want to go back into another training
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and keep doing this again as proud of the work as I am and how robust it really
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is and it's really good it just felt like there was something missing and what
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I was teaching and I needed to go a bit deeper into that I'm really honored the psychology about
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background I have as well so that's why this came to be is I just I stopped
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basically I didn't take on any more training and I just thought I've got to
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rethink how I teach this I've got to do something different.
17:41
That's great. That's really humble. I mean, I think that's so honest of you
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to say that and how there's nothing wrong with that.
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Even clinicians should be happy to do that. And if you get that feeling,
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I'm not quite convinced what I'm saying here, even when you're a client,
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just think I need to act on that one, just ignore it and brush it under the
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table and keep doing what you're doing.
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So to elaborate then, could you give us an example of something which you used
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to kind of train and kind of stand by and that now you're thinking,
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oh, you know what, I'm not quite sure about that. Well, I think this is the thing.
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If I kind of jump to a potential thought that people might have about what I'm
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trying to do, which is, is it a replacement of other things or,
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you know, the last thing I would want people to think when they hear me talking
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about this is that I think that what is already being taught is useless,
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basically, because it's absolutely not.
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So, as I said, I stand by the things I was teaching and that includes the things
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that people would have heard of and that they're very, very familiar with.
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So, you know, excellent communication, building rapport is vital.
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And, you know, the things that you're teaching, so important. and COMB
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and all of those models that people know about so important they
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still have they have a place really you know vital to
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our understanding and building our knowledge and having
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another tool motivational interviewing really good
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really useful I teach a
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lot of those things and incorporate them into my training you
19:12
know nudge theory a really quick win something really simple to
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look at habits habit stacking I've always
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taught the why I've taught the why knowing what someone's wise
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in my own way and pairing that with visualization super
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powerful neuroplasticity there's
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loads of things that are super useful but where
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this process fits is actually upstream of all of that and that is the process
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that I'm trying to bring into this space is this is really a lens that gives
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you the discernment to know what tools to choose so I think at the moment people are
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learning behavior change, and I've been a part of this.
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We're kind of giving people these tools without telling them when they should be using them. Oh, wow.
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And certainly in my world, in psychology, you don't do that.
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In psychology, in the world of psychology, you spend a lot more time understanding
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the person that you're working with, deciding what their needs are,
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you know, risk assessing them.
20:19
Deciding what the function beneath their presentation actually is before you
20:25
go in and you prescribe the next thing to do.
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And so I think for me, that's just been something that's been really missing.
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And so I'm trying to bring what would be maybe a psychological formulation.
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I'm trying to bring a version of that, I guess, into this space that is appropriate
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for people within their scope, but also easy to use as well.
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So it allows them really to have, I hope, more of a robust process when it comes
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to helping someone change.
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Your head's touched. Where have you got on?
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Am I putting you to sleep? No, not at all.
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No, no, no. I'm just keeping quiet as you continue talking. That's what I'm
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doing. So if it makes you feel... So important.
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Not at all. I would like, if possible, a bit more of a concrete example, if that's possible.
21:20
What do you mean by concrete example?
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That's very good. Well deflected. So imagine I've got someone listening now
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who's in clinic and maybe they've done an MI course or something and they're
21:31
excited by it and they have seen some excess.
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They've realized now they've been talking too much and they realize that their
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whole idea of kind of opening questions and reflections, summaries and chucking
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out flowers and making bouquets, all these sort of things.
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It's working nicely, but like you say and imply, there's some moments where
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they think that hasn't worked.
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Why did it work? What went wrong? and then I have got this kind of like I'm
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missing something here what can you give us a scenario when that is going to
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happen um and and why it's not working as is intended.
22:04
So okay yeah you said quite a lot there so sorry no
22:08
it's fine I try so what you're trying to say is basically if someone
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is in clinic they've been given tools typically say for example motivational
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interviewing they're using it to the best of their ability but
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someone isn't changing is that what you're saying yeah and how
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would you what where do you think ppp as
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it should now be known yeah it could help so what
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i wouldn't do is so what ppp what the patterning process will do essentially
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is it will help you have a better understanding via a mapping process there's
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the process associated with it as to whether mi is even the right thing to pursue
22:45
with that particular the patient.
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So the idea of it is, is.
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Basically to give you this lens of discernment when you're working with someone.
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So in the very early stages of working with someone, instead of saying,
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I know motivational interviewing, so I'm going to use that.
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And obviously, as you well know, and as I'm sure all have spoke to,
23:04
even people who know motivational interviewing or teach that would never say
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you use it on everyone and it's needed at all times.
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So that's perfect. But how do you know when to use it?
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And so part of this process is I will
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in the process help you map what you're
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seeing in front of you and therefore what tools
23:26
will be best to help someone change but actually part of understanding what
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you're seeing in front of you might also help you see that this person is not
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psychologically organized to be able to change at that time so instead of thinking
23:43
the things that you're doing aren't working,
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in terms of the mapping itself, if you've done that early on in the process,
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which is the process I will teach you, you will have a much better understanding
23:51
of whether a tool would even work on someone at that stage.
23:55
Because that's the level of discernment that I think isn't taught,
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essentially. Does that make sense?
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So you're not taught, I think, in healthcare to know how you can apply these
24:07
tools. It's just a case of a little blanket approach.
24:10
Well, someone has to adhere, so we're going to kind of use these tools that
24:13
we have to help someone do the thing.
24:17
And we don't know whether that's the right thing to do until we've discerned
24:20
what we're seeing in front of us.
24:22
So like I said, in psychology, we would have that as a formulation process.
24:25
You would actually spend a little bit more time understanding what you're seeing,
24:30
what the presentation is before you choose a tool, before you choose a process,
24:34
before you choose a pathway of treatment.
24:36
And so that's what I'm trying to introduce here is a little bit more discernment
24:40
regarding how we treat someone and how we might help them change.
24:44
And actually, if change is even appropriate, whether someone can,
24:47
like I said, psychologically reorganize themselves around what is being asked
24:51
of them at that time, because they might not have capacity to.
24:55
So instead of the practitioner, and this is one of the things I'm passionate
24:58
about the process doing, is there's less critique of the practitioner.
25:04
Because what I notice is when someone isn't changing, it's always a practitioner
25:08
that feels, well, I didn't motivate them enough. I didn't do something.
25:11
I didn't communicate well. there's always a
25:14
default to the practitioner thinking that they need to do more that
25:16
they need to train in something else that they didn't see
25:20
something whereas what I want to do
25:22
is give the practitioner the tool to discern that to
25:25
start with so that maybe then what they choose has a better chance of actually
25:31
working makes sense thank you very much and is this would is this something
25:37
which can be applied quite quickly or do you need a lot of training before you
25:42
can start kind of using in clinic or.
25:44
Yeah, I mean, the idea with the training that I've got coming up,
25:47
so the September training is about giving a foundation in it.
25:50
So my intention with that training is that you walk away with an understanding
25:55
of what you might be seeing. So we'll definitely look at case studies.
25:58
So that's what I'm working on now are the different kinds of case studies.
26:00
So kind of going back to what you said before, you know, if you're seeing what
26:03
you perceive to be a lack of motivation, if you perceive someone is not adhering
26:09
for whatever reason, those yes, but patients.
26:12
So we'll look at the kind of all the different kinds of cases that you might see.
26:16
But what we'll do is we'll map them psychologically and I'll help you do that
26:20
so that you can start to make sense of the patterns that you're seeing,
26:24
both in terms of function and behaviour, which is, again, more of a psychological lens.
26:29
My challenge is to do that within scope because
26:33
what I don't want to do is you know help people or
26:36
think that have people think that they need to be a psychologist to
26:39
do this because we have to stay within our ethical bounds so I'm
26:43
trying to do this as best I can in a way that's
26:46
deeply ethical and in actual fact just
26:49
as a side note that was one of the things that you know that I
26:52
wanted to do this for is I've I've had
26:55
a little bit of a bugbear about the ethics of
26:58
forcing people to change or feeling like there's a change is
27:01
always the destination when actually maybe right now
27:04
this is not the right thing to pursue and so
27:07
part of the process is discerning that actually but
27:11
my hope is that people walk away from that foundation training with
27:14
a better understanding of what they are seeing in front of them which makes
27:19
sense then as to why they might see non-change down the line or why the tools
27:23
are not working and the idea being that you map it in a very very simple way
27:29
because one of the other challenges I've had is I don't want to give,
27:32
something that's so complex that it's another thing to integrate because there's
27:36
too many things that I think practitioners are bombarded with so I really want
27:40
this to feel like it brings the ease to the consultation more than anything
27:44
that you spend time deepening your understanding.
27:47
And I think being able to go deeper into the psychology is going to help anyway,
27:51
because we often don't have that.
27:55
And then you will be able to have a much better understanding of what you're
27:59
seeing when you're working with someone and why they're behaving in that way.
28:04
Excellent. Amazing. And you've mentioned already, and it's commendable,
28:09
it's lovely that the desire you've got to help practitioners use this without
28:13
moving outside of their scope. That's really important.
28:15
The last thing you want to see is a load of practitioners creeping into psychology
28:19
territory and getting overconfident.
28:21
But does this kind of pattern,
28:24
would that work across whether you're helping somebody who's
28:27
got Achilles tendinopathy all the way to somebody who's
28:30
suffering from chronic pain or something you kind of draw a linear line like
28:33
that could it fit into places like that you
28:36
know regardless of what person's coming with yeah absolutely
28:39
I mean the idea is that you would be able to map anyone where
28:42
change is expected so they
28:45
absolutely could be presenting with anything and actual fact I
28:48
always say that the work I do is anyone who works
28:51
in that interface of change anyway so it includes healthcare practitioners it
28:54
also includes coaches so people who are helping
28:57
someone make a change absolutely but
29:01
again like any tool it's not a panacea it's
29:04
it's a it's a discernment lens it's but by giving you the understanding giving
29:08
you the mapping process I the intention is that you have enough information
29:12
to decide as and when it's needed although I would expect that it would be useful
29:18
to integrate that any way to start with so that you can make sense of the pattern going forward.
29:24
Because it will help you, I think, ultimately make sense of what,
29:27
like I said, what you're seeing.
29:30
For example, if someone doesn't change, you can kind of go, my intention is
29:35
that you go back to the map that you created and you'll be able to make sense
29:38
of, okay, that person potentially didn't change because at this point in time
29:43
they were mapped to this particular threat.
29:45
So now we have a better understanding of why they didn't do that.
29:48
Versus oh my god I don't know why they didn't change I've been using all my
29:51
skills I've been trying to motivate them they said in that last session that
29:55
they would do the thing but actually if you've been able to map early on that
29:59
actually there was a particular.
30:02
For example a threat to their identity which
30:05
we part that will be something that we will map then we will
30:08
have a better understanding of why they didn't do it like you
30:11
wouldn't do a psychological formulation yeah yeah so
30:16
within part of that you mentioned you've worked with kind of
30:19
neurodiverse populations part of
30:22
that it's just it from my own interest is coming it
30:25
could be the case that you're failing to recognize some
30:28
kind of neurodivergent trait and that's why rather
30:31
than thinking oh they're not interested or not motivated with this passing help
30:34
maybe identify something like this that you've missed would that show up
30:37
it would I mean I wouldn't specifically say it's
30:40
for specific groups but yes arguably you could map someone I mean there might
30:45
be some things that are absolutely obvious from the start but you're absolutely
30:49
right it could be very useful in those populations because the idea behind the
30:53
mapping is it helps you then adapt to the process and that's the beauty of it is.
30:59
Again, at the heart of everything is ethical practice for me.
31:03
Because again, one of my kind of angst from doing the teaching was,
31:09
I'm teaching you that psychologically, if someone is unstable to start with,
31:14
and instability can look like many different things.
31:17
That to jump from, well, there could be all this stuff, but then let's just look at changing.
31:24
There's where's this big gap is in
31:27
the middle why are we jumping from there could be all
31:29
this stuff that's informing why someone
31:32
has the capability to change or not
31:36
but then let's look at how we start to move into behavior
31:39
change strategy and it was that oh no that I
31:42
don't feel comfortable with this anymore we need
31:45
to spend longer I need to help practitioners spend just
31:49
a little bit longer understanding the patterns that
31:52
they can see but they probably haven't been taught how to
31:54
see them so let's spend a bit longer understanding that
31:58
because then you get to choose your tools what i what i describe it as is the
32:03
psychological anatomy we need to go to the anatomy before we choose the tool
32:07
before we before we perform the surgery before we give the treatment let's understand
32:12
what's happening underneath again in a scope appropriate way so that whatever
32:17
tool you actually choose has a better chance of
32:20
working versus oh my god I need to motivate them they're not adhering because
32:26
actually if there's something deeper in terms of the pattern you may not have
32:30
a very good chance of helping them change anyway but a good practitioner I found
32:34
will always go to what did I do what didn't I do.
32:38
Amazing. So is it a case that for each, ideally, then if you put this process into effect,
32:46
then you're going to be creating a profile for each client that comes in by
32:51
using this and identifying a pattern and maybe it might change your treatment
32:56
or it might not. You might think, okay, let's go ahead. Yeah.
32:58
So at the moment, what I've actually done is basically put together a very simple
33:03
pathway. So you will map a patient, which is a co-mapping.
33:08
It's not hidden because that's unethical in my mind.
33:12
So it would be a co-mapping. They will see kind of what you're mapping with
33:16
them and have input into that.
33:18
And you kind of decide together. And it's very much honoring an NHS approach,
33:23
which is like kind of working with the patient, which is how it should be done
33:28
in my mind, because this isn't a population.
33:30
For example, it's not a forensic population. It's not an addiction population.
33:34
This isn't where you changing is everything to me.
33:40
I need you to make this change because you're not safe to society.
33:43
Or you know if you don't make this
33:46
change again you know things that
33:49
have been developed in terms of behavior change have often come from
33:52
those populations where there is an addiction or there's something maladaptive
33:56
we're often working with highly autonomous individuals where change is a choice
34:03
and I think that's really really important that we realize who we're working
34:07
with in many of the domains that we work in.
34:10
So a lot of this process is completely transparent. So it's like a co-mapping.
34:16
They have a say in kind of what's happening. Yeah.
34:20
But, yeah, you will essentially be able to have a mapped profile for that person that you refer back to.
34:27
That's interesting. So when you say co-patterning, so they're aware of what
34:31
you're doing and you're okay with that?
34:33
It doesn't kind of turn it into a little bit of them wondering what you're writing
34:35
down or why you've asked them a certain question?
34:37
No, that won't facilitate change anyway.
34:40
So that's, yeah, because we don't want that status and that hierarchy.
34:45
So everything's done through. So I guess it's a little bit similar to other modalities like MI.
34:51
You know, there's an ethical basis to it. I think MI, I forget the terminology.
34:56
The spirit, I think it is of MI, you know, the way that you approach it.
35:00
And it's the same with PPP.
35:03
So I actually presented the vectors of change at the STA conference.
35:07
So that would be what would inform this.
35:09
And it's almost like the approach that we should have to making this work.
35:14
And that looks like always working from a place of compassion. always.
35:18
And also inspiration as well is another part of the vectors of change that I've devised.
35:23
And I think that's really, really important. So if we're working compassionately
35:27
and we're working in a way that's inspiring to that person, then we have to
35:32
include them in the process.
35:33
It doesn't work if you look at the other side of the vectors that I look at
35:37
as a lens to change, if you like.
35:39
The other ways would be discomfort and coercion, and we don't want to go into
35:42
that. And someone might feel uncomfortable.
35:44
I always say actually to people I teach, if you're writing something always
35:47
explain what you're doing anyway make them a part of the process.
35:53
So yeah you would do it kind of with them because there's a series of questions
35:57
that you will run through with them to kind of map that,
36:00
It sounds very exciting. It sounds quite mysterious still. That's fine.
36:04
Because I guess if you're interested, guys, it's September. There's still spaces going.
36:09
It's definitely hooked for me. I'm like. I think it sounds mysterious because
36:13
the first training is in September.
36:15
I mean, arguably, you know, I can sit here and talk about behavior change for hours if you want me to.
36:19
This is a whole new way of doing something within scope that's formulation based,
36:24
but it's ethical and it's within scope. And I think it's going to speak to practitioners
36:29
who sense that there's something missing, basically.
36:32
And that's the sense I'm getting from people who are talking to me.
36:35
And I don't mean that there's, I want to keep reiterating, I am not persecuting any of the modality.
36:41
I'm saying I've been teaching those things for years as well, and they're fantastic.
36:46
However for me there's something missing and how we've been approaching how
36:53
you help people decide what is going to be useful for that person and what isn't
36:57
and I think we know that really because if you think about you or if I think
37:02
about myself and someone trying to facilitate change in me.
37:07
I, you know, just this blanket approach to, you know, for example,
37:11
if I said I'm really struggling for time at the moment and I had someone simply
37:15
try to help me find time in my diary, I would get really annoyed.
37:20
And I think actually I did a post on that a few weeks ago on social media and
37:24
I think it was something like, my diary doesn't seem full to you, but it feels full to me.
37:30
And so someone may
37:34
well you know have a very simplistic conversation with
37:37
me about where they can help me find some time but again
37:41
in a mapping process we wouldn't have done that
37:43
with someone with my profile it would
37:47
be a very different conversation and so again helping
37:50
practitioners have that level of discernment around how we
37:54
have those conversations is really really important fantastic
37:58
all makes great sense now i meant mysterious in
38:01
the sense that i mean one thinking is it's really
38:04
healthy that i mean we've created
38:07
and i feel like i'd like to say i've i'm part of this but we've created a tendency
38:13
now a healthy tendency of clinicians to become critical of themselves and to
38:18
notice when clients aren't coming back when things don't work and And it's taken
38:24
us about 10 years, but I think a lot of clinicians,
38:26
particularly the Therapy Expo, we can see in the audience who come along now,
38:29
people are happier to kind of question what they're doing and look for,
38:32
a bit like science really, look for when things don't support the hypothesis
38:36
and kind of act on that, which is so healthy.
38:40
But there is a little bit of a void out there when you realize,
38:42
okay, the structuralism and this approach doesn't work. So what do I do?
38:45
There's kind of like a bit of a gap.
38:47
There's some things you get into, but it sounds like your course is kind of
38:49
filling that gap for people who discover things.
38:52
Well that some of the stuff they're doing is not quite working or
38:55
it's not hitting the spot and rather than just going i'll forget about them my
38:58
clinic's doing fine everything's great and really not feeling good at all they've
39:02
got something to turn to so it sounds yeah definitely a necessity.
39:06
People need this sort of thing i'm interested in just checking you
39:08
said like in september the course starts what sort of people have
39:12
you got joining up already is it kind of on the website it suggests
39:15
is across you know careers professions physios osteos.
39:18
Sports therapists yeah for the people that typically do my
39:21
courses are all the things that you've said or all of the above so
39:24
a lot of physios I'd say mostly physios from healthcare
39:27
come and do the training osteopaths speech
39:32
and language therapists people from things
39:34
like youth services so where people are working with like
39:37
challenging populations and lots of coaches
39:40
lots of very very different coaches as well so executive coaches
39:45
life coaches people are helping people through transitional change
39:48
basically and also I think
39:51
it's interesting I find that a lot of the people that come are often
39:54
clinic owners and managers as well so yeah
39:57
really really mixed but anyone who's at that interface of change
40:01
really and wants to help people make a
40:04
positive change of some of some kind or as
40:08
the process will highlight or not as I've
40:12
always been very out of focus about that particular element I've
40:15
always said what I've always actually said is if
40:18
someone doesn't change that's perfect and I and I think what I want to be able
40:22
to do with the process is to go deeper into why that looks that way and actually
40:27
how you know when someone has a pattern and what we'll look at is like protective
40:32
patterns and how change often isn't coherent for that person at that particular time.
40:39
We might be doing more harm than
40:40
good if we push change and I think that's something that we don't look at.
40:44
It's always, change is the goal, I'm right that this needs to happen. Even if,
40:51
It doesn't look like it. It's still this thing, this goal that you've come to
40:55
me with, or this thing that you're supposed to be doing is the aim.
40:59
And I think, yeah, I just want to bring that kind of deeper level of discernment
41:03
early on in that process so that we know whether that's the right thing to do.
41:08
Sounds really cool. Sounds really important. And like I say,
41:10
it sounds like a gap because like, as you say, it's like often you don't know
41:15
whether to kind of push a bit more, hold back.
41:17
And I think you said on the description for the course, like,
41:19
yeah, do you change? Do you refer on?
41:21
And we haven't really got the tools as clinicians, definitely not on traditional
41:24
kind of courses of skills of how to make that decision. We don't know.
41:28
We kind of just wait until they go and say, but I see you next week and think,
41:31
oh my God, what am I going to do?
41:33
You know if you're a sports therapist you'll talk to a physio because you
41:36
think they're gonna know the answer and guess what they don't and if you're a physio you're
41:39
going to talk to a gp and guess what they don't you just kind of go up but it
41:42
sounds like you really are kind of yeah giving information
41:45
that's missing yeah and i really hope
41:48
i keep saying that i really hope what it does is it really it
41:52
frees practitioners up in a way that that may
41:55
not let's say they're not they've not had it before it sounds like i'm
41:58
trying to be really revolutionary i just want to bring it ease into
42:01
the consultation in that I
42:04
don't you know I think there's this pressure on practitioners
42:07
to like I said you know if someone's not changing it seems
42:10
to be this default what have I done what have I not done I'm
42:14
not doing this thing right I'm not doing the motivational interviewing
42:17
right I'm not building enough rapport I mean
42:21
I need to go back and learn to be better at communicating
42:24
because I'm not really communicating this and again
42:28
with PPP what I'm trying to do is if you
42:30
know to help you have that level of discernment so that you can
42:33
see if the communication is going to work in the first place is that the best
42:39
route with this particular person in front of you is that the best pathway for
42:43
this particular person in front of you is motivation is and even MI is that
42:48
the tool that I now choose to use with this person because they're ready for it,
42:53
So it's kind of sitting, I guess, kind of a little bit upstream from that readiness for change.
42:58
But before we start to pick the tools we use as well.
43:02
And I should say also that there will be a little bit of you as a practitioner
43:06
kind of mapping yourself into the process as well, because I think that's also
43:10
vital and that's something that we don't talk about.
43:13
Sounds good. Sounds good. And listening to you, I'm thinking that,
43:16
again, I mean, the sign of a good course and one of the signs of a good course,
43:20
I think, is anything that takes the pressure off the therapist and kind of takes
43:23
them out of that kind of, I'm sitting in the saddle, I'm responsible for everyone's benefit.
43:26
But it sounds like the pattern you teach would also help relieve some of that
43:30
pressure, which comes in and that burnout, which a lot of therapists suffer from.
43:35
Absolutely. Again, I've spoken about that. I'm very outspoken about that kind of stress.
43:40
And also the fact that, you know, practitioners in this space,
43:43
they don't get supervision. They don't get that kind of clinical support.
43:47
They're seeing most of the practitioners I work with in healthcare are dealing
43:51
with a great deal of complexity, a great deal of trauma.
43:54
People don't just come and talk about you know
43:57
the rehab they talk about their life and they
43:59
talk about all of the complexity of their life and their difficulties
44:03
and so just helping
44:06
people do the work within scope is always a challenge because people
44:09
you know are bringing their whole life to you but it's another reason I wanted
44:13
to create this is you know we can't deny that people are dealing with complexity
44:18
so why are we not giving them the tools to understand the psychology in the
44:23
first place and why don't we give people a deeper understanding of what they're seeing,
44:28
and then we know kind
44:31
of why someone is going to behave the way that they are because it now makes
44:35
more sense and I do hope that brings an ease to the practitioner who like I
44:41
said typically goes to I'm not doing something right so I hope this really does
44:46
ease that for them and also the reflective processes that are integrated into the mapping,
44:51
will help that person check in with their own regulation as well because.
44:55
Yeah, well, that's a whole other podcast.
44:59
I thought you were going to give something away then. I just think that it's
45:02
important that practitioners kind of have an awareness as they're doing the
45:05
work as well. Yeah, yeah.
45:08
Because often I think, and again, we'll look at this in the psychological patterning
45:13
process itself, but it's very easy to slip into our own patterns that create
45:19
a regulation for our own emotions.
45:21
And that's not covered anywhere. And I think we really need to be careful about that.
45:27
So the person that likes to build rapport might just keep building rapport.
45:33
Interesting. So is this part of it? Do you end up having the attendees doing
45:37
psychological patterning process on themselves then? Would that be?
45:40
No, so you will co-map with the patient or client, but you will,
45:45
aside from that, you will do some mapping yourself.
45:49
It's almost like a self-supervision just to check in and make sure that you're
45:52
not slipping into your own maladaptive patterns.
45:56
Because I do see it, if I'm being honest, I see that a lot in healthcare as well.
46:01
That you know I teach a lot around the psychodynamic theory of kind of rescue
46:04
a victim and so I'm kind of integrating some of that into the process so that
46:08
you stay mindful and objective about what you're what you're doing which which is really important.
46:16
Very cool that sounds I mean it sounds so cool and it's so cool that you're
46:19
helping MSK professionals with this you really are kind of I don't want to say
46:25
putting a psycho into biopsychosocial it's a bit like that because we learn
46:27
I'm a biopsychosocial and And I'm not going to be interested in the bio now.
46:31
And it's like, I'm biopsychosocial, but you haven't done any studying in the
46:33
psycho or the social. Yeah.
46:35
This kind of makes me think that's what this is about. It's helping not step
46:39
outside of your kind of scope of practice, but you need some of that psychology
46:43
if you want to be biopsychosocial.
46:45
Exactly. And like I said, you're dealing with that. You're dealing with someone's
46:48
psychology and complexity anyway.
46:51
But at the same time, you're not being taught how to deal with it.
46:54
And so we need to call out what's in the room, what's happening in the room
47:00
and you need to be not you but people need to be trained and given the skills
47:04
to be discerning in terms of what they're seeing and protect themselves as well,
47:09
Sounds great. So, psychological patterning process, PPP.
47:14
How long did it take to find something that had the same letter,
47:17
or was that a problem for you, or eventually it just... Complete mistake,
47:20
a complete fluke that it had. Come on, I just knew I wasn't.
47:26
If people want to sign up, there's still, you mentioned September,
47:30
it'll be the inaugural course, I guess, that's when the release of it.
47:33
Is that, is there still places on that?
47:34
There are some places, yeah. I think people yeah
47:37
so people can go along to psychology school.co on
47:41
social media you're active if people want to follow you and learn
47:44
more about it yeah i'm saying a lot more about it at the moment i'm trying i'm
47:48
it's not my it's not my comfort zone but i'm trying to push myself out of it
47:53
it's not your processing process is it using social media definitely shy away
47:56
from it but yeah so you've got instagram the psychology school.co or serena
48:00
psychologist both of those you're active on more yeah,
48:05
and then Facebook as well where
48:07
people like you I have a psychology school page that people can visit.
48:13
Instagram mainly or check out the website there's lots of information on there
48:16
to get some more I mean there's loads, it's a great website there's loads of
48:19
information on there about it so very exciting look at that 8.52 already well
48:24
thank you so much for that.
48:26
Thank you for the invite I'm going to talk about it all pans out it's going
48:31
to be really cool and having feedback for some people on the course.
48:34
I mean, at some point, it'd be really nice to maybe, what's your diary like? No, I'm just joking.
48:40
Like, have you back with somebody who is, has been on the course or something to talk us through it?
48:44
Because we're kind of like hooked out there and interested in it.
48:46
It'd be nice to hear from somebody without giving too much of your way.
48:49
But yeah, it's definitely a door that's open now.
48:51
Very interesting. Yeah. Thank you for that.
48:54
Thank you. Well, thank you for the invitation to speak about it for the first
48:58
time. Absolute pleasure.
49:00
Right, people. Thank you so much for the people who joined us live.
49:03
We are just to let you a little bit know about next week, but we are going to
49:08
be, I thought I'd have a slide for that. Okay. I don't think I have.
49:10
Next week, we start a new month.
49:12
It's going to be June. We don't start it. It is June and we just join in, but June, 2026.
49:16
So what we're going to have next week is my guests are going to be Sarah Mihag
49:19
and Rosie Sexton, who are co-founders of Neuroflect.co.uk.
49:22
You may recognize the names from the recent month we did on neurodiversity.
49:27
And they're two of the moderators in my neurodivergent MSK clinician Facebook group.
49:32
So, and they're going to be at Therapy Expo on the neurodiversity panel talk
49:37
that we're doing as well. So it's fantastic to have them in the studio.
49:40
But they're going to be talking about a book they've recently published,
49:43
like about a week ago or something, the Reflective CPD Journal.
49:46
Which is a personal record tracking journal designed for healthcare professionals
49:49
to help you develop reflective, practical, and realistic approaches to improving
49:53
health outcomes for neurodivergent people.
49:55
And I've got a copy myself, and it's great. It's a classic example,
49:58
which I'm always harping on about. I don't want to bore you to death with more of it.
50:00
But if you are interested, you can go to Substack and find me there.
50:03
But if you get an idea of what neuroaffirmative is, and you're keeping your
50:07
eye open for potentially neurodivergent clients, or even questioning yourself,
50:12
then you end up looking after everybody.
50:13
Yeah, it's like, if you look after this, I think it's what's going to save the world,
50:17
but that's probably a little bit too much but yeah it's going to be a fascinating chat
50:20
and it's a really good journal which i think everybody could benefit from
50:23
because it's just going to make you a better therapist and give true patient-centered
50:27
care so um rosie and sarah are going to be with me
50:30
tuesday june 2nd for the live recording so join us then if you can if not then
50:35
please do leave a rating and review on the podcast as that helps the good word
50:39
of our speakers like serena simmons just reach high on google which is what
50:42
the podcast is all about i'm just trying to put quality information out there
50:45
So it can be challenging sometimes in our society, but we manage it a little bit.
50:50
But anyway, just for now then, thank you once again to my special guest tonight,
50:53
Serena Simmons. Thank you so much.
50:57
And thank you everyone who joined us tonight, especially as it's been a lovely
51:00
day, probably where I don't think it's so lovely where Serena is,
51:02
but down South, it's been a lovely day, 31 degrees all day long.
51:06
And so those of you who did join us in the Live Lounge, thank you very much
51:08
for giving out your time. And if you have enjoyed it, like I say,
51:11
do leave a rating or a review.
51:12
Hopefully we'll see some of you next week. Until then, take care of yourselves and each other.