‘We should celebrate rather than diminish’

Dr Cole is Author, Visiting Lecturer, Clinical Psychologist, Founder and Clinical Director of Lifespan Psychology – The Diverse Practice®. She is also on the British Psychological Society's committee of the Specialist Interest Group for Independent Practitioners (SGIP), and the Division of Clinical Psychology Diversity and Inclusion Sub-Committee.

The name of Esther's practice, 'Lifespan Psychology – The Diverse Practice', reflects both her life experiences and the resulting views she expresses about psychology and society.

'I'm a third-generation British Jamaican Psychologist who grew up in North London. My Mum was the first member of our family to go to university, taking a degree in Social Policy. I, in turn, received an assisted place for a selective private school, and then went to Oxford University for my degree.'

In primary school, Esther was top of her class and was pushed up a year. However, despite 'world-class teaching', Esther tells me that some staff predicted lower grades, 'I believe due to my humble background. I was on free school meals. Breaking the cycle of poverty and achieving social mobility wasn't easy psychologically. In the 1990s, most pupils were intrigued to make black friends. 
I was one of two and later three black pupils in the entire school, and I used to get comments like "Ooh, your hair is different, can I feel it?" and "Is that your twin sister?"'

The experience of assimilation at Oxford University was completely different. 'It was a breath of fresh air: empowering. I don't recall experiencing any stereotyping; and during my time there I felt I could do anything.'

The 'different soup' every one of us lives in

By the age of ten, Esther had changed from wanting to be a ballerina to hoping to become a writer. 'I've achieved this with the book I co-edited in 2019, and various other chapters and articles I've written.' How did she become interested in Psychology? 'I was a carer from an early age: there were mental health problems in my family including male suicides and episodes of psychosis.' On her website, Esther lists men's mental health as one of her interests.

'That probably stems from those experiences. Men tend not to seek help in this area. And then there's a double stigma in seeking mental health support if you're black and male. The connotations for that group are perceptions of madness and violence. Minority communities get stigmatized more. Once you start taking other areas of intersectionality into account – sexual preference, religious beliefs, physical health issues – you can see many layers of otherness leading to discrimination and stigmatisation.'

By the time she was 20, Esther says her 'brain was firmly in the CBT framework. There is a heightened risk of schizophrenia in the black community in Britain, and naively I started out confident that I'd be able to use CBT to solve most psychoses.' Given this, what was your experience of learning psychology at the undergraduate level?

'Wonderful, but I was focused on there being a clinical reason for what we studied, so I was disappointed with talking about brain synapses for the first year at Oxford! Of course, I'm interested in neuropsychology – the function, structure, and purpose of the brain – but I always craved knowledge of the brain for the purpose of helping me understand, formulate, and treat cognitive and psychological conditions. I enjoyed statistics. I loved numbers and using them to create quantitative models and theories, which had practical applications. When I did my doctorate, my thesis was about people hearing voices. The research was based on almost 200 people and involved a lot of numbers! I later went on to publish my thesis on hearing voices.'

Overall, Esther's degree at Oxford, her clinical experience and her doctorate at Surrey taught her 'the importance of having a wide range of different models and approaches, as well as being innovative in how you worked with people. 'I learnt to be more relational and systemic; to take into account contextual, generational, cultural, and other factors. In other words, I gradually became more and more aware of the importance of "the different soup" every one of us lives in!'

Her clinical experience pre-doctorate included work in older adult mental health, 'which I loved because, I suspect, of my close attachment to my grandparents. And I think you can see that work experience as one beginning of my interest in lifespan psychology – and therefore my practice.' Esther was also a research assistant at UCL on a peer support project in women's cancers. She also undertook IAPT training and worked as a low-intensity CBT therapist before commencing her doctorate in 2009.

'To deny lived experience is to marginalise'

'The structure of the trainee clinical psychology doctoral course at Surrey was really stimulating, involving a combination of lectures, placements, research, and study. You learnt and applied the learning constantly. Working with children was a real game changer. The CAMHS service demanded a different pace of work than anything I'd come across before.

I had to repeat my first child placement, possibly because I was out of my depth when I first did it and was confronted with a deeper need to explore the impact of my own childhood on my development as a Clinical Psychologist. The children I worked with as a trainee nearly all did much better, and had great outcomes, so I lived in hope that, given the right supervision, I could also excel in my work with children and families. Thankfully, in my last placement as a trainee clinical psychologist in 2012, I discovered the serendipitous reason for repeating that placement.

I met a 12-year-old boy who survived a cancerous brain tumour at the age of 10. He had a multitude of problems: suicidal ideation, depression, PTSD, and mobility issues. To help treat these conditions, I adapted narrative therapy techniques and, after three months of fortnightly sessions, he no longer needed a wheelchair and had gone back to a mainstream school part-time, progress that was sustained a year later.

'Typically, I looked around for literature on the area and found a real gap. I tried to write his experience of therapy up a case study, which was rejected as, "not really narrative therapy." Not to be put off, I started contacting specialists in paediatric brain injury and with the support of a mentor, I co-edited our book with Dr Jenny Jim: Psychological Therapy for Paediatric Acquired Brain Injury: Innovations for Children, Young People and Families. Families and medico-legal companies have told us that the book has had a practical effect on funding and therapy for the family.'

Given you were recently qualified, and your relative experience in the area, this was a very brave project to take on. 'Foolhardy! I didn't know what I didn't know about collaborating with a team of writers; but I'm on a mission in what I do, fuelled by my desire to collaborate with, lead and galvanise teams to make a difference in the lives of people. I had to get the word out. The statistics quoted in the book show what a huge issue this is.

For instance, every 30 minutes a child suffers a brain injury; 40-60 per cent of offenders have sustained a traumatic brain injury and account for 77 per cent of the most persistent, violent crime; the associated lifetime costs per child are around £5 million. It was the challenging, but immensely rewarding process of writing this book, which led to me receiving the honour of being the first Black Clinical Psychologist to receive the May Davidson Early Career Award from the BPS.'

Esther worked for the NHS for 12 years, across the lifespan, but largely with older people. 'I missed working with children. I had some private patients during my last year in the NHS which created variety. In 2019, I developed a rare kidney disease and just received news I was expecting our third child. I left the NHS very reluctantly because I couldn't juggle all the tasks I had. When I got very ill, I had to refer my clients to others. That is the real start of Lifespan Psychology – The Diverse Practice®.

We're an international team from the UK, Tahiti, Hong Kong, Ireland, West Africa and more. We're focused on clients' recovery, collaborative therapy, and satisfaction, and on using outcome measures (despite some of the difficulties with them). Our slogan is: "We're an award-winning team because of you [our clients]." During my third pregnancy, my kidney function improved and the organisation coalesced. Pre-Covid the organisation was rather siloed, but we plan to get together more now the lockdowns have passed.'

Many interviewees, especially clinical psychologists, suggest a mismatch between psychologists' identities and those of many of their clients. One example given to me was the question: can a young white atheist middle-class woman understand the issues and culture of, say, an 80-year-old, male Trinidadian Evangelical Christian? Esther answered at length. 'It's about intersectionality. In my view no-one, absolutely no one should feel marginalised – including a White therapist.

In any case, most of us have more mixed heritages than we realise. We don't always have an exact match of psychologist and client. Given the kaleidoscope of humanity that would be impossible. The important thing is to be culturally informed and open to these conversations. Supervision, ongoing CPD, and your own therapy are key here. In addition, it is critical that you do not deny the client's lived experience. You start from there. To deny lived experience is to marginalise. This is the approach I use to support teams to work cross-culturally.'

An inspiration

When I asked Esther if there was anything else she wanted to talk about, she paused and then spoke carefully. 'I was once fortunate to have been nominated for another award. It should have been an uplifting, celebratory experience, but the person reached out to my white British friend, assuming she was the nominee. OK, we all make those sorts of assumptions. But when challenged the person made an excuse to me: 'Your hair is different than your picture in the brochure.'

In fact, I was the only black person in the brochure and the only black person in the room. It really hurt, not so much because of the initial mistake, as the excuse, and the fact that this could have been a celebration of one of the few Black professionals who had been nominated. We all stereotype but we should acknowledge when we do it. And we should celebrate rather than diminish.'

Two issues that thread Esther's career: lifelong psychology services and finding appropriate ways of treating every diverse individual, whatever identity they have or claim. They have come together in her practice, which won the 2022 Prestige Award for Psychological Therapy Specialist Provider of the Year. Esther is extraordinarily inspiring to talk to, very funny, constantly interested in new ideas and an inveterate communicator. I think we'll hear more from her.

Are you an Independent Practitioner Psychologist, or thinking about Independent Practice?

Have a look at the British Psychological Society's Special Group of Independent Practitioners microsite.

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We cover things to consider when setting up; marketing and the financial aspects; and questions around running a successful practice. It's all highly pertinent to Independent Practitioners!"

Christine Hamilton   
Chartered Psychologist   
Co-Chair of the Special Group of Independent Practitioners (SGIP)