SMARTER-life-GROWTH is an integrated CBT approach (i-CBT) that skills people to be more Aware, Reflective and Insightful and provides them with a range of strategies to empower and facilitate their ability to chose wise growth orientated Action to take control of their Wellbeing and Happiness. The aim of the approach is to help people Increase the helpful and Decrease the unhelpful through a problem solving approach.

1. The relationship between positive psychology, wellbeing
coaching, peer support and clinical/therapeutic approaches to
wellbeing and happiness.
Dr Patrick G Gwyer CPsychol CSci AFBPsS
SMARTER-life-GROWTH
AICTP – Association for Integrative Coach-Therapist
Professionals
3rd Annual Conference on Integrative Practice 2019
9th February 2019
London, WC1N 1HT

2. SMARTER-life-GROWTH
an integrated CBT approach (i-CBT)
The SMARTER-life-GROWTH approach skills people so they are more Aware, Reflective and
Insightful and gives them a range of skills so that they have a choice the wise Action to take
The aim of the approach is to help people;
Increase the helpful
and
Decrease the unhelpful
SMARTER-life-GROWTH

3. SMARTER wellbeing and happiness goals are
SMARTER-life-GROWTH
Specific
Measurable
Achievable
Relevant
Time-framed
Evaluated
Reflected upon

4. SMARTER-life-GROWTH
Making sure you include in your goals …
The things you Love and are passionate about
The things that Interest, motivate and are meaningful to you
Remembering to be Fair, kind and companionate to yourself and others
And to include the things you Enjoy and that give you a sense of connection
life wellbeing and happiness goals involve

5. SMARTER-life-GROWTH
Growth orientated
Realistic
from all the … Options, Obstacles, Opportunities
identify … Ways to achieve the goal
find the Tactics
that make the outcome a Habit
GROWTH promoting wellbeing and happiness goals are

6. SMARTER-life-GROWTH is an approach that …
• Is not limited to one type of experiences or
diagnosis, for example;
• Anxiety
• Depression
• Eating Disorders
• Enhancing happiness
• Self-actualisation
• Self-esteem
• Self-improvement
• Sports
• Stress
• Substance use
• Trauma
• Work issues
• Teaches a basic set of skills that can be
applied across situations by a range of people
(e.g., Therapists, Coaches, Positive
Psychologists, Skilled helpers)
• Draws from a number of theoretical
approaches (e.g., Applied Cognitive, Clinical,
Coaching and Positive Psychology)
• Looks at the whole person (e.g., the
Biological, Psychological, Social and Spiritual)
• Teaches practical problem solving skills and
views change simply a problem to be solved
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7. SMARTER-life-GROWTH
Breaking the internal Vicious cycle: “You only have power over yourself, your mind, your emotions, your body and your
actions - not outside events. Realize this, and you will find strength.” ― Marcus Aurelius

8. SMARTER-life-GROWTH promotes…
SMARTER-life-GROWTH
Autonomy, responsibility and choice, a real choice not a Hobson’s choice.
Hobson’s choice
A Choice Of Taking What is Available or Nothing At All
It’s only a choice if you have an alternative to choose
People do not chose to be unhappy, self harm, be abused, use substances, suffer and
struggle. This happens because they feel there are no other options available to them other
than those they have. They can not choose what they do not have.

9. SMARTER-life-GROWTH is an approach that …
Empowers, facilitates and enables choice by providing skilled alternatives
Our actions and reactions are the conduit between our internal and external worlds
(and the only thing we have control over)
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Change is within their
their power and
authority
To make change as easy
as possible
By providing the skills
and resources

10. SMARTER-life-GROWTH
Awareness, Reflection and Insight, lead to Wise Action creating
a cycle of continuous learning and growth
SMARTER-life-GROWTH
Awareness, Reflection and Insight, leading to Wise Action
a cycle of continuous learning and growth
External world
Internal world

11. SMARTER-life-GROWTH
Awareness, Reflection and Insight, leading to Wise Action
a cycle of continuous learning and growth

12. We experience a wide range of “human” experiences
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Pleasant
Growth facilitating
Pain
Suffering
Struggling
Distress
Overwhelming
Unpleasant
Growth inhibiting
Pleasure
Flourishing
Thriving
Happiness
Manageable

13. We experience a wide range of “human” experiences
The range of human experiences
In a number of separate but connected areas
SMARTER-life-GROWTH
Pleasant
Growth facilitating
Pain
Suffering
Struggling
Distress
Overwhelming
Unpleasant
Growth inhibiting
Pleasure
Flourishing
Thriving
Happiness
Manageable
We feel a wide range of emotions
We have many different thoughts about ourselves, others, our future and our ability to cope
We have different abilities and strengths
We don’t stay in one place on the range we can move up and down depending upon what is happening to us

14. As a result, one size does not fit all
Because we are unique, and no one approach has all the answers SMARTER-life-GROWTH integrates a number of
different approaches.
Integrative approaches draw upon a number of different approaches to create the best fit between the person,
their experience and the therapist. Integrative approaches are more flexible and inclusive and differ from
manualised approaches, because quite simply people don’t fit manuals. Integrated therapies differ from elective
approaches because they integrate the separate parts into a coherent whole.
These parts can be the different therapeutic approaches or the separate parts of the individual, their Bodily
sensations, Emotions, Actions and Thoughts, their Biological, Social, Psychological and Spiritual aspects as well as
their Potential self, Ideal self and Actual self.
SMARTER-life-GROWTH

15. This is not a new idea
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16. SMARTER-life-GROWTH
Different approaches
• Acceptance & Commitment Therapy - Hayes
• BioPsychoSocialSpiritual - Engel
• Cognitive Analytic Therapy - Ryle
• Cognitive Behavioural Therapy - Beck, Ellis, Padesky
• Compassion based - Gilbert, Neff
• Dialectical Behavior Therapy - Linehan
• Gestalt - Perls
• Holons - Koestler
• Humanistic - Rogers
• Meaning (Logo) - Frankl
• Mindfulness - Kabat-Zinn
• Personal Construct - Kelly
• Positive Psychology - Seligman
• Schema - Young
• Time Perspective Therapy - Zimbardo
SMARTER-life-GROWTH
Connected through the common factors
• Ability to regulate emotions
• Collaboration towards agreed goals
• Enhancing self-compassion, acceptance, forgiveness and
kindness
• Explanation for current difficulties and a solution for
resolving
• Improve interpersonal relationships
• Modelling
• Non-judgemental acceptance, understanding and empathy
• Normalisation of experience
• Possibility of alternative perceptions and actions
• Provision of hope
• The helping relationship (Therapeutic working alliance /
Reparative / developmentally needed / Person-to-person/
Transpersonal)
(Bergin, Clarkson, Frank, Garfield, Grencavage, Lambert, Lazarus, Luborsky,
Rogers, Rosenzweig, Norcross)
The approaches integrated in SMARTER-life-GROWTH

17. Best
Possible
Self
Potential
Actual Ideal
SMARTER-life-GROWTH Slide 7
SMARTER-life-GROWTH
A coherent whole
What we have the potential
to be and the potential to
achieve
Where we actually are in life
What we would ideal like to
be and achieve, our best
possible self, our ideal life
Wellbeing and happiness
involves getting the
greatest amount of
overlap between three
different “self’s” and the
non denial or distortion
of experiences

18. Creation of the approach
• 1993 to 1996 – “Transfunctional tendencies” (Cambridge - Unit for Research in Applied Psychology, 1944)
• 2005 to 2010 Crisis Resolution Home Treatment, Assertive Outreach, Acute & Intensive Psychiatric Units
• A range of varying presentations with common themes
• As with the previous example of anxiety, these varying presentations and themes can be placed on a
complexity*severity dual continuum.
• Placement on the continuum can be used to allocate intervention
• 2010 to 2015 Creation and use of a Departmental allocation matrix
• 2015 to present date continually being developed
Wellbeing and happiness is a continuum that can be matched to a stepped staging framework based on Severity,
Complexity and Risk regardless of diagnostic label.
SMARTER-life-GROWTH

19. Continuing refinement and development
• 2014 Incorporation of Positive Psychology and Coaching to Clinical approaches – less stigmatizing
• 2015 Thematic Analysis of clinical notes (Inpatient, CMHT, Primary care, Supervision, Private work)
• 2016 Sub sample of notes used for MSc dissertation
• Transdiagnostic themes to help allocation to the Severity, Complexity and Risk matrix
• 2018 to present date application to inpatient setting and in private practice (adolescents and
adults)
• Incorporation of standardised risk assessment criteria (Severity * Complexity * Risk)
• Continued evaluation of efficacy
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20. SMARTER-life-GROWTH
What do we mean by Severity and Complexity?
Level of complexity
Levelofseverity
Petrified
Terrified
Panic
Frightened
Fearful
Alarmed
Afraid
Scared
Fretful
Anxious
Worried
Uneasy
At the more intense (severe) end of the continuum,
other areas of life are more likely to be impacted.
For example, if feeling fearful, a person may become
more avoidant of social situations and so may become
socially isolated. This could impact their mood and
make the situation more difficult to resolve (i.e. more
complex) as now fearfulness and depression need to
be addressed
At the lower end of the continuum,
the person is able to function
without impairment or impact in
other areas. Thus the complexity of
the problem faced is lower.
.

21. Risk (Care Act 2014)
• Adult risk
• Self-neglect
• Financial
• Physical
• Sexual
• Psychological
• Organisational
• Domestic Violence
• Modern Slavery
• Discrimination
• Acts of omission
• Child risk:
• Neglect
• Physical
• Sexual
• Emotional abuse
(NB Parental mental health,
Substance/Alcohol, Domestic Abuse)
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22. Ethical questions
What would you do if a client presented as at risk of;
Self-neglect
Self-harm
Financial abuse
Physical abuse
Sexual abuse
Psychological abuse
Domestic Violence
Modern Slavery
Discrimination
What would you do if running a course or workshop for an
organisation, and possible issues of Organisational abuse
became apparent?
What would you do if working with a parent you had
concerns about possible risks to children, of;
• Neglect
• Physical abuse
• Sexual abuse
• Emotional abuse
What would you do if you suspected a client (who is a
parent) was experiencing poor mental health, using
substances or alcohol and was experiencing domestic
abuse at home?
SMARTER-life-GROWTH

23. SMARTER-life-GROWTH
Defined criteria allowing Practitioner assessment

24. Complexity
Overall
Presentation
Severity upon functioning. Overall presentation
Mild impact upon
functioning
Moderate impact
upon functioning
Severe impact upon
functioning
Low
Signpost appropriate
agency
Watchful waiting
Bibliotherapy
CCBT /Course
Counselling
CBT
EMDR
CCBT/Course
CBT
CAT
EMDR
Medium
CCBT/Course
Counselling
EMDR
CBT
Counselling
CBT
EMDR
CAT
CBT
Schema / CAT
EMDR
High
Counselling
CBT
EMDR
Schema / CAT
CBT
Schema / CAT
DBT
CBT
Schema / CAT
DBT
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Assessment outcome. Presence of risk [Harm to self or others, from exploitation &/or neglect] indicated by red shading.
Severity*Complexity matrix used in a clinical setting
(MDT: Nurses, Counsellors, Clinical/Counselling/Assistant Psychologists)
Risk in red (lighter shading represents “lower” assessed risk – Dashed line Risk cut off)

25. SMARTER-life-GROWTH
Severity*Complexity matrix used to place Positive Psychology, Wellbeing
coaching, Peer support and Clinical approaches
Allocation to PP, Coaching, Peer support, Lay counselling or Skilled helper (blue shading) following appropriate assessment (Severity, Complexity & Risk)
Complexity
Overall
Presentation
Severity upon functioning. Overall presentation
Mild impact upon functioning Moderate impact upon
functioning
Severe impact upon
functioning
Low
Signpost appropriate agency
Watchful waiting
Bibliotherapy
CCBT /Course
Positive Psychology
Wellbeing coaching
Peer support
“Lay counselling/Skilled helpers"
Counselling
CBT
EMDR
CCBT /Course
Positive Psychology
Wellbeing coaching
"Lay counselling/Skilled helpers"
CBT
CAT
EMDR
Medium
CCBT/Course
Counselling
EMDR
CBT
Positive Psychology
Wellbeing coaching
"Lay counselling/Skilled helpers"
Counselling
CBT
EMDR
CAT
CBT
Schema / CAT
EMDR
High
Counselling
CBT
EMDR
Schema / CAT
CBT
Schema / CAT
DBT
CBT
Schema / CAT
DBT

26. SMARTER-life-GROWTH
Where would you place your cut off point as to the degree of Severity,
Complexity and Risk that you could safely manage?
Complexity
Overall
Presentation
Severity upon functioning. Overall presentation
Mild impact upon functioning Moderate impact upon
functioning
Severe impact upon
functioning
Low
Signpost appropriate agency
Watchful waiting
Bibliotherapy
CCBT /Course
Positive Psychology
Wellbeing coaching
Peer support
“Lay counselling/Skilled helpers"
Counselling
CBT
EMDR
CCBT /Course
Positive Psychology
Wellbeing coaching
"Lay counselling/Skilled helpers"
CBT
CAT
EMDR
Medium
CCBT/Course
Counselling
EMDR
CBT
Positive Psychology
Wellbeing coaching
"Lay counselling/Skilled helpers"
Counselling
CBT
EMDR
CAT
CBT
Schema / CAT
EMDR
High
Counselling
CBT
EMDR
Schema / CAT
CBT
Schema / CAT
DBT
CBT
Schema / CAT
DBT
?

27. • Themes
• Shared Formulations (conceptual maps)
• Collaborative journey
• Insight, Awareness, Reflections leading to wise Action Choice
• Skills and strategies
• Forward looking and Growth promoting
• Integrates the parts and the whole
• Metaphors
SMARTER-life-GROWTH
Using the SMARTER-life-GROWTH approach

28. SMARTER-life-GROWTH
Themes identified
(focus of intervention can be on one or many themes)

29. SMARTER-life-GROWTH
Example questions from collaborative measure (based on themes identified)

30. SMARTER-life-GROWTH
Hierarchy of theme use
Growth
Stabilisation
Safety risk reduction

31. Use of themes
• Provide a baseline for pre and post assessment and session-by-session monitoring
• Identifies areas to focus upon and informs the severity*complexity matrix. Risk assessed separately
• Use as outcome measure (reasonably well correlated to CORE-OM)
SMARTER-life-GROWTH
SMARTER-life-GROWTH Slide 10
Clinical Outcomes in Routine Evaluation Outcome
Measure (CORE) 34
Severity&Complexityof
PresentationEvaluation(SCOPE)
r = +0.58
Commonthemesscore

32. Use of themes
• Creation of collaborative, diagnostic free formulation, based upon individual’s whole experience
• Creates Specific and Measurable goal directed actions SMARTER-life-GROWTH - Wellbeing goals
• Combines the parts and the whole
• Helps increase individual’s self monitoring and self awareness of their wellbeing – the parts and
the whole
• Use as a mindfulness exercise (similar to body scan)
SMARTER-life-GROWTH

33. Shared Formulations (conceptual maps)
A formulation offers a hypothesis about the cause and nature of a problems, what
keeps it alive and what can be done to break its hold on a person.
Why we draw them out together.
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34. SMARTER-life-GROWTH
The whole remains in the background providing
the context for the parts.
Emotions
Actions
Thoughts
Body
sensations
Anticipation of
Outcomes
(Future)
Current
experience
(Present)
Past experiences
Interpretations
of experiences
Creation, Utilization, Depletion of
Biological, Psychological, Social, Spiritual
Resource Capital
Mindful
Awareness
Reflection
Insight
Action
The area of intervention (the part) moves to the
foreground and is the focus of current attention.
The other parts create the background (the
whole) to the part.
The reciprocal connection between the parts,
mean that change in one, leads to change in
others.
The constructive nature of memory means that
past, current and future experiences alter
recollection. The event is fixed but the meaning,
recollection and impact is flexible. Meaning and
emotional impact of experiences can alter.

35. SMARTER-life-GROWTH
Emotions
Actions
Thoughts
Body
sensations
Anticipation of
Outcomes
(Future)
Current
experience
(Present)
Past experiences
Interpretations
of experiences
Creation, Utilization, Depletion of
Biological, Psychological, Social, Spiritual
Resource Capital
Mindful
Awareness
Reflection
Insight
Action
Insight based
(top down)
Skills based
(bottom up)

36. The central spike
SMARTER-life-GROWTH
Unhelpful ways of coping that
keep the spike alive

37. SMARTER-life-GROWTH

38. Metaphors
Although the spikey feeling is uncomfortable, it is familiar, like an old pair of
slippers. It is painful and unpleasant but it feels safe because it is familiar. We
might even feel that we deserve to feel this way. Sometimes the unhelpful
actions can feel like a protector because they keep the difficult and
unpleasant memories, emotions and thoughts away – or the possibility they
might occur. But all of this comes at a cost, the cost of a life worth living, the
life all human being deserve.
SMARTER-life-GROWTH

39. What does SMARTER-life-GROWTH look like
SMARTER-life-GROWTH

40. SMARTER-life-GROWTH
Confusion to ….
Clarity ….

41. SMARTER-life-GROWTH
Childhood trauma

42. SMARTER-life-GROWTH
PTSD

43. SMARTER-life-GROWTH
Low mood and anxiety

44. SMARTER-life-GROWTH
Complex trauma

45. SMARTER-life-GROWTH
Workbook template

46. SMARTER-life-GROWTH
Workbook template examples

47. Some of the workbook skills
Life is what you make it. Make it better and I.M.P.R.O.V.E the
moment
Invest - Invest in yourself
Meaning - Find the nugget of gold
Passion - Follow your passion
Resilience - Get up when you stumble
Openness - Try news things
Values - Stick to your values
Engagement - Connect to what you do
SMARTER-life-GROWTH

48. Some of the workbook skills
If you want to improve your wellbeing and happiness try to B.R.I.M with serenity
Breathing - slow and rhythmic
Relaxation - progressively tense and relax your muscles to calm your body
Imagery - use a guided imagery to calm you mind
Mindfulness - notice with curiosity but don't get caught up with your observations
SMARTER-life-GROWTH

49. Some of the workbook skills
• The B.E.A.T of your own drum
• Chain analysis
• Appreciation
• Gratitude
• Self and other;
Acceptance
Kindness
Compassion
Forgiveness
SMARTER-life-GROWTH

50. Data collected (n = 27)
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200 . . . . . . . . . .
190 . . . . . . . . . .
180 . . . . . . . . . .
170 . . . . . . . . . .
160 . . . . . . . . . .
150 . . . . . . . . . .
140 . . . . . . . . . .
130 . . . . . . . . . .
120 . . . . . . . . . .
110 . . . . . . . . . .
100 . . . . . . . . . .
90 . . . . . . . . . .
80 . . . . . . . . . .
70 . . . . . . . . . .
60 . . . . . . . . . .
50 . . . . . . . . . .
40 . . . . . . . . . .
30 . . . . . . . . . .
20 . . . . . . . . . .
10 . . . . . . . . . .
0 . . . . . . . . . .
Assessment
Baseline
Session
1
Session
2
Session
3
Session
4
Session
5
Session
6
Session
7
Session
8
Follow
up

51. Is the approach affective?
Clinical Outcome Routine Evaluation (CORE) data
0
0.5
1
1.5
2
2.5
Wellbeing Problems Functioning Risk
CORE-OM
Pre Post Cut off
(Clinically Significant if above red line)
SMARTER-life-GROWTH

52. The SMARTER-life-GROWTH book and workbook will be
published Summer 2019
Thank you for your time and attention
SMARTER-life-GROWTH
Contact details
Email: drpatgwyer@gmail.com
Website: drpatrickgwyer.com
LinkedIn: https://www.linkedin.com/in/drpatgwyer/