An Interview with Dr Lauren Colgan

I have always been interested in understanding people and learning how people's different experiences can shape the way they view and live in the world. I studied philosophy and psychology for my undergraduate degree because both of these fields tapped into this understanding of how the world can exist in different ways for different people. I found this fascinating! Then starting to work with people and being able to help them at times when they feel at their most stuck felt like a priveledge, and clinical psychology became my calling.

Regardless of your training, experience or professional identity, the most effective way to help people is to give them your full, unidvided attention; to listen and try to understand their individual experience; and to believe whole heartedly in their ability to cope. Ultimately, helping is not about strategies or techniques, it is just about being human with another human.

What do I enjoy most about being a clinical psychologist? Firstly, I feel honoured to be trusted with people's vulnerability. That is an incredible act of bravery on the other person's part and it means a great deal to me that people feel able to share that with me. Secondly, I really enjoying the problem solving that comes with helping someone move through challenges until we can find a solution. It feels like using a combination of science and art: the science of technique and the art of responding to the individual in front of you. It is very satisfying to help someone to navigate through that dynamic together.

The first appointment is about the psychologist setting up expectations about therapy and then getting to know you. You can expect it to start with some housekeeping information about the length of sessions, how you were referred, or looking at any questionnaires you might have completed. Then there will be questions about you: what brings you to therapy, what treatments you might have tried before, what has worked or hasn't worked. You also might be asked questions to help the psychologist get to know you, for example, who is in your family, what you do for a job or for fun. Most of the time the first appointment will cover an overview of you and what has brought you into therapy. Sometimes the psychologist might ask more specific questions about the problem that you are looking for help with.

It is important to say that you are in complete control during therapy sessions including assessments. You do not have to answer anything you don't want to and you are welcome to ask the psychologist questions. Therapy is a two way process so feel free to ask whatever you need to feel comfortable and safe.

Unfortunately these days, anxiety (including social anxiety, worry, phobias and OCD) and depression are very common with 1 in 5 adults suffering from these mood disorders. Alongside these difficulties many people have associated low self-esteem and difficulties with insomnia, as these challenges can go hand in hand with mood difficulties. Many people I work with have had early experiences of adversity so I often support people with PTSD and the long term impact of trauma. My specialism is in supporting people with psychosis or other unusual experiences like hearing voices or having strongly held beliefs that others don't share. Finally, the majority of clients I support are also neurodivergent so many people I support want help to manage their ADHD or Autism Spectrum Conditions either as a primary issue or alongisde other mental health difficulties.

Very often when people have had difficulties or found it hard to cope (due to neurodivergence, mental health difficulties or lack of sufficient support from people around them) they blame themselves. Almost universally, people tend to take on problems as their own personal failing and a sign that there is something wrong with them. This has the effect of causing another layer of suffering on top of the already painful original difficulty. I cherish being able to help a client really see this process with open eyes, and slowly to unpick that layer of self blame. The freedom and lightness that people can experience when they no longer criticise themselves is a wonderful thing to experience. This is probably the part that I enjoy people overcoming the most.

Success looks like whatever the client wants it to look like. Goals are completely individual and progress that someone is satisfied with, someone else wants to keep working on. Nevertheless, classic success would look like someone achieving the goals they set out at the start of therapy. That typically includes a reduction in symptoms (e.g. less worrying, better sleep, reduced flashbacks) and better functioning (i.e. being able to do more of the things that they want to do and coping better with them).

There are too many examples to pick just one, but those people who have had to overcome multiple barriers to engage in therapy: those who have been told they don't deserve help, who have experienced others as dangerous and manipulative, those who don't know anyone who has engaged in therapy, those who are utterly hopeless and blame themselves for their situation, and yet come anyway. I am endlessly proud of those people for making that first step, and every step after that.

CBT (Cognitive Behavioural Therapy): CBT helps us understand the links between our thoughts, feelings and behaviours, and how these can sometimes keep difficulties going. We work together to identify and change unhelpful patterns and find practical ways to help you feel and function better. ACT (Acceptance and Commitment Therapy): ACT helps us respond differently to difficult thoughts and feelings, rather than getting caught up in fighting or avoiding them. It focuses on understanding what really matters to you and helping you build a life that reflects those values, even when difficult feelings show up. It often involves techniques like mindfulness to help you respond difficulty to your thoughts and feelings. CFT (Compassion Focused Therapy): CFT helps us understand how our minds and bodies respond to threat, particularly when we struggle with shame or self-criticism. It develops a kinder, more supportive way of responding to ourselves, helping us feel safer and better able to manage difficult emotions. It uses experiential techniques like mindfulness and chair work to help us to respond differently to shame and self-criticism.

I will consider the evidence base for each therapeutic approach for each condition. For example, while CBT has the strongest evidence base for treating a first episode of depression, if someone has recurring depression and experienced multiple episodes with a strong self-criticism element, approaches like CFT can be a better intervention. Alongisde the evidence base I will consider the client's preferences and what they personally have found more or less helpful. This ensures that therapy is always individualised. However, we don't always get it right first time. Sometimes therapy is about trying and approaching, and seeing how it goes. After a few sessions I would review with a client and we both discuss how we are finding the approach we are taking. If we are not seeing progress then we might collaboratively agree to take a different approach until we find the best fit.

If clients are coming in with a relatively straightforward difficulty or if it is their first time trying therapy, I will typically use one type of therapy, often CBT or EMDR. This is in keeping with NICE guideline recommendations and the evidence base. However, if people have already tried therapy, or have multiple difficulties that need input, I will combine different approaches. However, this is always based on the client's individual formulation of their need and in discussion with the client themselves.

People assume they will be judged and analysed. That every word they say, every action they take will be picked apart and used to inform some analysis of all their weaknesses. In fact, therapy can and should be an open conversation about what is happening and what you have been through to make you feel the way. It should be collaborative and you should feel in control at all times. You should leave feeling listened to, understood and hopefully more confident in a path forward.

That you don't have to know exactly what the problem is or what you want to work on, that can be figured out in therapy. But once you are in therapy it will be work. Change doesn't happen spontaneously and the more effort you put in, the faster you will see results.

I am an outdoors person and find myself most restored by being in nature. So when I'm not working you can find me gardening, frolicking along pretty walks or in the sea.

The Body Keeps the Score by Bessel van Der Kolk is well known and lauded, but it definitely had an impact on me. In particular, it brought together things I was seeing in my clients (the whole system impact of trauma), how I wanted to work with my clients (connecting somatically, working on difficulties that go beyond "negative thoughts"), and the evidence base of what interventions can actually make a difference for people with long term distress.

Before that Madness Explained by Richard Bentall was an early introduction for me into non-dianostic ways of viewing mental illness in general and psychosis in particular. This understanding of mental illness as a response to things have happened to people and not as a problem in and of itself is foundational to all the psychology work I have done since.

I try to practice what I preach and prioritise genuine rest. After a day of work I might exercise to help disconnect, but will always spend some time in the garden soaking up nature or read to unwind.

The greatest cause of distress I see across all of my clients, whether they have no diagnosable mental illness or a serious mental health disorder, is when people have to mask who they really are and present a different version of themselves to others. Or similarly, when they have to present their life to be different than it actually is. The internal conflict this causes can eat away at a person. While the disconnection between the actual reality and the presented reality can trigger anxiety and derealisation. So my advice would be, experiment with what happens when you drop the mask, when you tell the truth. Is it as bad as you feared? How did it feel to take that mask off? Notice if it felt better.

You don't have to know all the answers, or be the expert on whether you need therapy or not. That's the psychologist's job. Sometimes coming in and having that conversation is worth it, even if you decide you don't want any therapy at that time.

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