You do the hokey cokey and you turn it around…

When I asked Kerenza about the future of forensic psychology she answered immediately: 'I'd like to see a recognition that it has moved away from the stereotype of being based in prisons and purely focused on offence management. My role at Bradley Complex Care is person-centred and formulation-led. It looks at the factors that perpetuate risk, not just at the offence itself. It's hugely varied. Of course I conduct risk assessments but a lot of my role involves collaborating with a multidisciplinary team, developing treatment plans underpinned by a positive behavioural support approach.'

Kerenza sees service users individually and in groups. 'We're a psychologically-informed environment and I deliver training packages. For instance, at Bradley, I'll explain what psychology is, discuss autism and learning disability awareness, and explore positive behavioural support.'

Available to everyone

I was interested that Kerenza uses Makaton – a communication system that uses speech with signs and symbols. I had come across it when I published for speech and language therapists in the 1980s. I asked her how she applies it. 'It's a huge interest of mine, stemming from my belief that psychological therapies should be available to everyone. Few therapies have been adapted for those with complex needs and communication difficulties. Makaton helps aid my work here.'

Do you have to teach the system to service users? 'Many of them will have a basic knowledge of the system from school, so I only have to reintroduce basic vocabulary. I also encourage support staff to use it. You can adapt all sorts of material – nursery rhymes and pop songs – into Makaton to make it fun and exciting for everybody involved. Every model from CBT to psychoanalysis should be adapted in this way. The benefits are huge… it gives everybody a platform to advocate for themselves and helps give service users independence. Technology can also be an immense help, increasing accessibility in making therapies less dependent on linguistic expertise, offering this through flexible forms that meet the needs of different people.'

Kerenza shared a linked ambition in changing psychological practice. 'I'd love for all therapies – especially compassion-focused therapy, which is where my passion lies – to be accessible to 100 per cent of the service users whether they have a learning disability or not.'

Kerenza's interest in this area seems to stem from a volunteer job she undertook in Sri Lanka in the first three months of 2016. This was a turning point in her training. 'At school, I was told that studying psychology would be more useful than sociology if I wanted to be a teacher, as I did at the time. My favourite part of my psychology A-level was learning about memory, especially in relation to the fallibility of eyewitness testimony. I then enrolled on my psychology undergraduate degree at Lincoln, where I enjoyed most aspects of the course. I was all set to complete a PGCE qualification but decided to take time out of my education to volunteer for the role in Sri Lanka between my degree and my Master's course.'

Kerenza went to Sri Lanka with SLV Global, which ran for ten years, offering practical experience around the world to psychology graduates and students. It has recently closed down due to the pandemic. 'It was a humbling experience, highlighting how developed we are in the UK in our approach to mental health provision. Volunteers worked at the Sri Lankan National Institute of Mental Health, which was housed in a building akin to our old style "asylums". We offered support in areas as diverse as schizophrenia, bipolar disorder, dementia, and addiction. We also shadowed the only psychiatrist in Northern Sri Lanka. It was really sad to see huge queues of people outside outreach clinics to see the psychiatrist, desperate to get the help they needed. We also worked in a boys' detention centre and in schools for people with learning disability. That's only a flavour of the many experiences we had. A lot of our people had sadly experienced huge trauma from the tsunami that happened on Boxing Day 2004, not to mention the civil war and terrorism.'

I asked Kerenza what she's learned from those experiences. 'First, never take things for granted. Second – and I realise how far Makaton has strengthened my interest – that speech and written language are not the only way of communicating. I did not know Sinhala, and few people in Sri Lanka knew some English, so I had to be creative in my communication. Songs and music helped. For instance, two songs in particular helped us develop positive, therapeutic relationships: Bob Marley's Buffalo Soldiers and the Hokey Cokey.'

From physical to therapeutic safety

Kerenza returned to the UK and worked in a supermarket before she discovered her career path in healthcare. 'A job came up at what was then Bradley Woodlands Low Secure Hospital as a support worker. One of the Assistant Psychologists there had taken the Forensic Master's at Lincoln, inspiring me to follow a similar route. Elysium, which owns the hospital, and my boss Paul, promote and encourage CPD. With their support, I began my Master's whilst continuing to work at Elysium, who were very flexible and offered me shifts that fitted around my education. I am now working towards Chartership with their support.'

Did the hospital's transition from a low secure focus to complex care cause obstacles? 'When the physical security lessened, people understandably became very apprehensive. The key in a locked rehabilitation service is relational security. That's why therapeutic relationships and communication are so important.'

Kerenza's account of Forensic Psychology echoes similar experiences among Clinical Psychologists. I asked if the two disciplines were becoming closer. 'In fact, there are huge similarities, not least how difficult it is to get qualified! I was lucky that I had parents who accepted my choices and an employer and a boss who fully support my CPD. More fundamentally though, Forensic Psychology, like Clinical Psychology, is about understanding service users on the basis of formulations. We do risk analysis and management work but our focus is on the triggers of behaviour and the experiences and environments that are causal factors.' 

'I believe that underlying all psychological applications is a core of knowledge and techniques; the difference between different types of applied psychology is often the people they focus on and therefore the specific issues they address. What I love about psychology is that it is constantly developing, I'm slowly learning that I can't know everything and that's okay. So, in 20 years' time, I hope I'll still be working with people therapeutically and applying new concepts in an accessible way.'