Last Friday I took a bus out to Ninewells to meet Lesley Howells. Lesley is the centre head of Maggie’s Dundee. Alongside this, she is also a practicing clinical psychologist with 18 years experience in the NHS prior to her current role. As a result, a coffee conversation with her would be one of the most insightful experiences I have had during this project.


Key-points from the chat:

  • She encouraged me to stay away from clinical anxiety as it can be such a varied subject.
    • She instead acknowledged that anxiety (specifically when linked with stress) is a huge problem in the UK. These are the cases which make up the majority of the following stat.
      • “Anxiety is one of the most prevalent mental health problems in the UK and elsewhere, yet it is still under-reported, under-diagnosed and under-treated.” (Mental Health Foundation, 2014)

    • One of her reasons from staying away from clinical anxiety is her experience of facilitating treatment of it.
      • Specifically at Maggie’s -> the anxieties which manifest through terminal illness are perfectly rational ones.
  • She instead suggest I focus on ‘unhelpful’ thoughts
    • This massively expands my user group
      • Thinking about everyday stress etc
  • She introduced me to the concept of ACT
    • ‘Acceptance and Commitment Therapy’ is a ‘is an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological flexibility’
      • In Lesley’s words, ‘ACT works!’
        • She has seen it work first hand throughout her career.
    • ACT’s main goal is to increase psychological/emotional flexibility
      • This is defined as “contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.”
    • She gave me a copy of “ACT Made Simple” by Russ Harris – an introduction to the frameworks & methods of ACT.
  • At the core of ACT is the ‘Psychological Flexibility Hexaflex’.
    • The Hexaflex is composed of six harmonious “core therapeutic processes of ACT” which together create psychological flexibility.
    • hexaflex-01
    • My project is about creating a tool to facilitate three of these ingredients: acceptance, defusion and self-as-context.
      • hexaflex-this-01-01
    • The key focus, and the one I’ve been looking at in recent divergent prototypes is defusion
      • Defusion is all about ‘stepping back’ and detaching ourselves from thoughts imagines and memories – acknowledging them as what they are and then letting them go.
        • “Instead of getting caught up in our thoughts or being pushed around by them, we let them come and go as if they were just cars driving past out house”
        • “We hold on to them lightly instead of clutching them tightly.”
        • “Don’t buy into it, just let it pass”
          • This is partly what ‘seven:’ was about. The other part was about recording perceived anxiety levels to encourage pure self awareness (discussed below).
      • Writing is one way to acknowledge negative thoughts and cathartically detach & defuse them while also recording them for future reference.
    • The tool I’m aiming to create will also focus on facilitating ‘Self-As-Context’ through encouraging pattern awareness.
      • Pattern recognition helps acknowledgement of common times or events which trigger negative thoughts. These can be useful to work through in therapy/counselling sessions.
  • ACT tools must be pragmatic
    • In order to encourage outside, rational thinking/detachment, the tool I’m designing must employ a pragmatic tone of voice and visual language.
  • The best way to encourage use of a therapeutic tool is to encourage self-ownership.
    • Lesley often encourages clients to keep a notepad which they can jot down thoughts in. She has a stack of different notepads which she lets clients pick from. Allowing the client to take control and use it how they want provides better results.
      • She also finds if she asks them to do it as part of a project they are often more likely to use it.
        • “As a favour to me”


Below are some of the scratch notes I made in my back-pocket-book during the interview.