Renew’s Graduate Celebration Day 2025: In conversation with our special guest, Dr Sami Timimi
This July, we’re honoured to welcome child and adolescent psychiatrist and author Dr Sami Timimi to our Celebration Day at Renew. Known for his challenges to conventional mental health thinking and his belief in the power of relationships, Dr Timimi’s work has so many parallels with our ethos at Renew.
Ahead of his talk, we asked about the ideas that shaped his thinking – from challenging dominant narratives around diagnosis to the importance of relationships, culture and context. He shared what this means for those entering the profession, and what he hopes new counsellors will carry with them.
Read on to learn more about Dr Timimi – and if you’d like to learn more about our training offer, please do get in touch.
You’ve spent a lot of your career challenging dominant ideas, especially around children’s mental health. What first sparked that shift in your thinking?
That’s one of those stories where you could start at several different points!
Looking at my own personal history, I grew up in Iraq with political parents who had different belief systems to the religious ones that dominated the culture. The deteriorating political situation meant that I had to come to the UK when I was 14, where I was exposed to a very different way of life. As a result, from a young age, I had experiences that showed me that people have many ways of understanding, interpreting and being in the world, which led to a certain scepticism in me when I encounter “truth” claims.
“People have many ways of understanding, interpreting and being in the world”
I became interested in transcultural psychiatry, and anthropological and sociological studies during my training. When I was a senior trainee in child and adolescent psychiatry in the mid-1990s, the concept of ADHD was beginning to filter into the academic and professional discourse in this country. I was being supervised by a consultant who was looking into the issue of children from ethnic minorities, and particularly those from an Afro-Caribbean background, being disproportionately expelled from school. He became interested in whether this might be related to undiagnosed ADHD and asked me if I would help by doing a literature on the subject.
I kept having this “will-o’-the-wisp” experience – there was nothing concrete to hold onto that explained what ADHD “is” beyond the circularity of defining it by the behaviours it described. I came to realise that it was an invented concept being accepted without the necessity of scientific support. All sorts of assumptions were being made before there was material evidence to back them up. I was watching castles being built on sand – there were no solid foundations. This experience provoked me to re-examine concepts I had previously accepted. It was an important moment in developing my critical thinking.
Do you think that’s an important message for our graduates – the idea of questioning assumptions and stepping back from what’s often taken for granted?
Yes. What I eventually came to realise is that our concepts of mental health and behavioural difference are subjective. What we call symptoms are just experiences or behaviours, and the framework of interpretation that we put around them has significant consequences. In our line of work, we don’t discover the “truth” or the “real” meaning – we construct it.
“Our concepts of mental health and behavioural difference are subjective.”
The models we use to construct the system of meaning we then impose, has consequences. We should always be thinking about our paradigm of meaning, what assumptions are embedded and what the possible consequences of using such a paradigm might be.
You’ve described diagnoses like ADHD and autism as social constructs rather than objective medical facts. What does that mean, and why does it matter?
One of the things that first drew me into child and adolescent psychiatry was my first placement in a child and adolescent psychiatric department in central London, back in 1992. At that time, the work was strongly influenced by a systemic approach. This led me to an understanding of the importance of two things.
First, it highlighted the importance of context. Children don’t make most of the important decisions in their lives and come into being within a system that is already in existence. Of course, that’s true for all our life, but it’s particularly obvious when working with children and young people. This means the real-life contexts and important relationships are key components of what happens to them and sets up possibilities and limitations for the beliefs and practices they grow up with.
“One of the worst things I think we can do during that process is to embed the idea that there is something “internal” in their wiring, neurology or sense of self that is fixed and life-long. That can have big implications for an individual.”
The other one is the idea of development. Development in its broadest sense is the understanding that life is always in motion and that change is the one constant. Again, this is particularly clear when working with young people. As they grow up, their body changes, their experience of emotion changes, their ability to think in an abstract manner and to search for broader existential meanings develops, their interests change, friendship groups change and so on. One of the worst things I think we can do during that process is to embed the idea that there is something “internal” in their wiring, neurology or sense of self that is fixed and life-long. That can have big implications for an individual.
At a societal level, it seems to be part of a culture of hyper-individualism, which atomizes people and relegates the importance of social connectedness. This has contributed towards creating what I call a ‘human typology’. We’ve got various categories of people and we keep inventing more subcategories within those categories. This leads us away from social solidarity and change at the social level. At the societal level the message becomes that you experience liberation through a kind of radical individualism. That is not the way for society to change at the political and economic level, let alone for individuals to be liberated.
You often emphasise the role of relationships, culture and context in understanding distress. For someone training to be a counsellor, what does that shift in thinking invite?
Two building blocks are really important: Context and development.
Context should lead you to be aware that people have a life that is also a relational life. They have relationships with things external to them. The things that might be helpful in shifting their mental state are also in their context, so the context isn’t just where distress might be developed and experienced, it also has the potential for resources. We should always be thinking – what’s happening in the real lives of people? What’s going on in their material life and in their relationship lives? We should take that into consideration rather than exclusively focusing on what’s going on “between the ears”.
Helping people shift their mental state might be part of that process: it’s not ignoring what’s going on between the ears, because there are so many people who are in various forms of distress that have a history of various types of adversities, and this history often leads them to have great difficulty with trust. But this is relational too as helping people shift their sense of trust and being able to take risks can be important in helping them reconnect and re-engage with a relational life.
“Even when people are struggling for weeks, months or years – again and again, I see people taking a step that they never imagined they would at some point.”
Development is important because we should always keep in mind that people change. My experience is that change tends to happen in steps. Psychological change doesn’t happen as a gradual thing. There might be a gradual thing that leads to you taking a step. It’s like learning to ride a bike – you practice and practice, you may fall off, but eventually you get it. Then you have to learn how to turn a corner and you might fall off again and so on. Psychological development takes place steps like that. This means that even when people are struggling for weeks, months or years – again and again, I see people taking a step that they never imagined they would at some point.
I say this to clients all the time: “change will happen. I don’t know what it will be like. I don’t know how you will discover it, and I don’t know when you will discover it, but it will happen.” In planting that idea I’m choosing a framework with certain consequences – particularly one that keeps hope alive and maintains the centrality of the inevitability of change.
We’re about to celebrate a new group of trained counsellors. What’s the one message you’d want them to carry with them as they start working with clients?
This might seem like an odd one! I’ve had many trainees, and it might be more pertinent to doctors, but a lot of them come with a Saviour syndrome. Please beware of your need for your clients to get better. Don’t burden your clients with that. When change has happened, it is because they have made a change.
Want to know more about training with us?
Whether you’re a Renew graduate just starting out in practice or you are many years into the work, Dr Timimi’s words are a reminder to stay curious, question assumptions and keep people at the centre of our practice.
We’re so looking forward to welcoming him to our Celebration Day and to sharing the moment with our brilliant community of trainees, graduates and tutors.
If you’d like to find out more about training with Renew, please get in touch with Michelle Allen and the training team via michelleallen@org.uk or 01245 264348.
