The Walden Model

Saffron Walden, Essex, October 2015. We meet local church pastor, Jonathan Burton, for the conversations that would lead to the 'Walden Well-Being Walk-in'. We were keenly aware that our community, like so many others across the country, was suffering from stretched resources (both in the statutory and voluntary sector) that left many vulnerable people, particularly those with mental health needs, 'falling through the net'. Could we find a creative way of using our psychological expertise to support those at risk in our local community?

Evolution and ethos

Although we decided to base the scheme at the Saffron Walden Community Church, it was clear from the beginning that it should never be or become a faith-based initiative. The church has been instrumental simply in providing a central community location and a welcoming environment. However, it was built into our thinking from the outset that all human beings are spiritual to the extent that they need some form of belief and meaning in their lives to feel healthy.

The model promotes the idea that individuals thrive best when they belong to a network of supportive and sustaining relationships in their community. The aim has been to provide a friendly hub for visitors and a link to other existing local sources of help. The model is about creating a safety net in the community that helps to maintain mental well-being and prevent mental decline. The role of the psychologist is facilitative and supportive, rather than formally clinical or intervention-based (more of this below). It is not a psychology service as such but a friendly community facility with psychological expertise embedded within it. However, assessment and signposting based on professional expertise are on offer.

Safeguarding is a key feature – a safe and consistent place for the visitors, reducing risk not just through specific therapeutic conversations but also through greater integration within the community and reduced isolation during the time between sessions. In order to maintain the safety of the environment, all volunteers, having been initially selected for their personal psychological qualities such as authenticity, resilience and self-care, are also given training and ongoing support in terms of safeguarding, ethics and boundary issues in helping relationships. Having the ability and knowledge to make external referrals and signposting for what we are unable to cater for also reflects our limitations.

Sitting alongside the psychologists is the church pastor as a supportive community leader, and also selected volunteers who bring their own experience and local knowledge – thanks go to the team, in particular Fiona, Amanda and Kathryn. Everybody involved is unpaid and provides their time for one day a month for a minimum of three hours. This allows us to provide a constant presence, available indefinitely and on a monthly basis. Large-scale public sector mental health services can all too easily become depersonalising, but our model is based upon the fundamental principle that a secure and consistent attachment, along with the provision of empathy and compassion, are critical in creating a foundation for psychological development and security. This does not mean encouraging dependency but offering dependability that leads to greater confidence and independence.

All this adds up to a 'professional family' with a 'bio-psycho-social' approach to well-being that is rooted organically in the community that it serves. The Walden Model is not led by any professional agenda, or defined by any single psychological therapy brand or approach. It does, however, have roots in person-centered relationship-based principles and the universal psychological needs of the human condition. Attachment theory and some psychodynamic principles have also influenced the overall vision of providing a safe and consistent space for local visitors so that their feelings and anxieties may be better contained. Ideas from all the major psychotherapeutic approaches (including CBT and systemic models) can at times be brought to bear when they are relevant and in keeping with the training and expertise of the psychologists.

The Walden Model has also been strongly influenced by the 'befriending' culture first created by Chad Varah within the voluntary organisation, Samaritans, in its early years from 1953 onwards. However, we have been careful not to follow a traditional charity model. We haven't become dependent on external funding of any kind. This is vital if we are to guarantee the continuity of the scheme and provide the psychological safety net required for vulnerable members of our community on a sustainable basis. It's about consistent relationships where good enough and 'corrective emotional experience' can accumulate through the longer term support provided.

People do not need to be referred, they are welcome just to drop in. There aren't the constraints of a traditional appointment system. At the same time, as GPs and others in the community become aware of this facility through posters, advertising and word of mouth, they have begun to direct people to us and this is equally welcome. Sessions to date have been two hours long and are held regularly every month in the large church lounge with tables, chairs and sofas available as required. Sessions are not planned in advance or stage-managed but develop flexibly and spontaneously depending on who chooses to attend on the day and their individual needs. The psychologists and volunteers create informal one-to-one or small group conversations. Leaflets and information about other local services are provided on a side table. Where more formal input is required – for example to help a visitor with a mental health crisis or with securing their welfare benefits – a more confidential and formal space can be created temporarily using a side room.

The atmosphere is one of warmth, friendship and human connection. The physical setting in a comfortable church lounge area helps to achieve this along with the provision of tea, coffee, cakes and biscuits. The well-being of volunteers and psychologists is also a vital part of the Walden Model. We ensure we process the emotional impact of the work on ourselves, accepting our own equal humanity and susceptibility both to vicarious trauma and the stirring of our own mental health issues. Feedback, support and reflective practice is promoted by providing a regular debrief (up to a further hour) amongst the psychologists and volunteers after every monthly session. The Walden Model promotes a bottom-up approach which is evolving in line with community needs.

This 'user-led' nature of the model means that visitors enjoy more control and spontaneity than they would have when receiving support from a conventional statutory or voluntary mental health service. This gradually increases a sense of integration, responsibility and belonging. It's a 'psychologically-informed befriending', with more formal episodes of support where required. This also allows us and the visitors to join forces in order to get a grasp on the issues they bring, rather than taking a more traditional clinical diagnostic approach. Listening and connecting invites listeners to tell their story and over time – this can have a powerful cumulative impact especially if this is the first time the visitor has experienced such a relationship.

The specialist role of the psychologist

In addition to being part of the befriending team and the professional family simply as people, the psychologists can add value with their professional expertise. Contributions we have sought to make have included monitoring the development of the group; providing a professional psychological opinion, advice and support where necessary in keeping with clinical training and competency; signposting or referring where necessary, or recommending psycho-education and self-help material; and practical help including accompanying the visitor to the Citizens Advice Bureau or welfare benefits assessment centre, or writing letters.

We believe that the blend of volunteers and specialists is the primary strength of the model. A group of volunteers alone would not have the clinical skills, the experience or the confidence to make certain judgments and assessments that are vital in moving things forward for people. At the same time, a larger group of clinical professionals operating without volunteers, even if they could be found in sufficient numbers, would create a very different atmosphere that would in essence become just another clinical service. However welcome, that would lack the family atmosphere, the community links through the church and the rich interplay between the psychologists and volunteers who also bring their own local knowledge, life experience, creativity and ways of thinking.

At all times, psychologists operate within their own professional ethical and practice frameworks and at all times volunteers remain within the limits of their own role as befrienders. However, volunteers and psychologists constantly enrich each other by working alongside each other and by sharing their ideas in the regular debriefing sessions. Ultimately, because we are emphasising human connection, relationship and empathy as the key elements of our model, we believe that the essential humanity of all of our team members is universal and potentially therapeutic.

Is it working?

Since its inception in the autumn of 2016 the Walden Model has continually developed and evolved. With each month, attendance has increased, starting from less than five visitors and now averaging between 10 and 20 visitors at each session. Some might attend once or twice, some regularly and some spontaneously. It was originally envisaged that psycho-educational groups on themes chosen by visitors might be needed to deal with the numbers of visitors, but so far small group conversations have evolved naturally as people have got to know and trust each other, indicating a sense of belonging. These relationships between visitors have also in some cases carried on outside of the sessions – a move away from isolation to a greater sense of integration, support and belonging for visitors within the wider community.

Individuals have fed back that they have felt helped to cope with their lives, increased their understanding of their problems and resolved many issues that were troubling them. In some cases visitors have reported that the support has been 'life-saving'. While maintaining confidentiality and anonymity, we can at least give a flavour of how the lives of our visitors have been changed. That might include being helped to escape a difficult relationship, move home and gain a new sense of freedom and independence in late middle-age; being helped to appeal successfully against welfare benefits reductions, thus improving quality of life, reducing anxiety and lifting mood; being helped to cope with the psychological impact of a serious and lasting brain-injury; being helped to manage and make sense of distressing mental states whilst on a long NHS waiting list; or caring for caregivers.

The impact on us

Volunteers and psychologists have reported that they find the role rewarding and uplifting, providing them with a greater sense of involvement with their local community and a real sense of satisfaction in making a difference to the lives of others where they live. There's a sense of both giving back to the community and receiving more from it. In a climate of uncertainty with statutory services not equipped to deal with changing and increasing needs of the population, this model, though a drop in the ocean, offers the chance to provide community based support, where we can continue to make a difference with our expertise. Perhaps it's not in a way we had envisaged when we set out on our training. But there is the hope that this 'drop' may assimilate into the wider context, where we can continue to use our skills in varied and meaningful ways.

There have been all manner of emotions associated with what we're doing. We've felt anxious about who is going to walk through the door, and then inspired by the unplanned conversations that develop. We've worried that no-one will turn up, and then found that two hours have passed just like that. There has been the joy of seeing spontaneous small group conversations develop between visitors. Of course we've felt inadequate at being unable to fill the void or meet all the needs of all our visitors, but there's also a real sense of satisfaction at seeing sad, troubled and lost people start to find a voice and some sense of security and belonging. And all the time we're learning, from each other and our visitors, in ways that often don't happen within professional circles.

The future

The Walden Model has become a sustainable community support initiative, which is not constrained by funding. We appear to be developing and maintaining the well-being of visitors by offering support, befriending and signposting to other local sources of help. We are growing into an essential part of the community which promotes self-care, development and integration.

Further evolution is inevitable, most probably as demand increases. We hope to undertake research to measure the benefits more formally, without compromising the premise of the initiative. There have also been conversations about spreading the model to other neighbouring communities. We would urge other psychologists who might be interested in developing similar schemes to get in touch with us (see below for contact details). We would gladly offer advice and support based on our own experience to date. We would also welcome the opportunity for dialogue with psychologists who might already be trying similar schemes across the country or even outside the UK.

-  Martin Seager is a Consultant Clinical Psychologist and Adult Psychotherapist who worked in the NHS for 30 years. Since taking early retirement from the NHS he has worked mainly in the Voluntary Sector (including the Central London Samaritans). He is currently working part time with 'Change, Grow, Live'. [email protected].

- Heena Chudasama is a Chartered Counselling Psychologist who works with adolescents and adults. Whilst working in the education, health and care context she also has an independent practice. [email protected]