2020 visions

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Extraordinary times see ordinary people doing extraordinary things. And so despite the pessimism, the constant examples of care in the community offer considerable optimism.

Small groups of people are springing up with offers of help to those who have needs or find themselves on their own. Thus dark clouds are transformed with silver linings and I cant help but feel joy and faith in the future.

We need to find better descriptions for human beings than those written albeit poetically by Shakespeare when he describes the acts of humans as folly and as quickly forgotten just as fast as they were done:

“Out, out, brief candle! Life’s but a walking shadow, a poor player that struts and frets his hour upon the stage and then is heard no more: it is a tale told by an idiot, full of sound and fury, signifying nothing (Macbeth Quote (Act II, Scene I).”.

We can console ourselves with other great works that have described apocalyptic events and found the best (and the worse) in human nature. I am reminded of Cormac McCarthy’s “The Road” – which people love and people hate. I love the description of parental love which oozes throughout the novel made more potent due to its backdrop: a worldwide calamity.

I have yet to do big events with big significance but have done many small events with small significance and for the moment I am satisfied with that. Learning to live with blame and responsibility, but quietly and without resorting to anger – that alone makes life significant.

We don’t know what the future brings – catastrophe and redemption sit alongside each other and we can all strive to performing small events which have great significance.

Positive – positive – positive ..

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Difficult to find any positivity with all that’s going on but I am feeling positive about next week. Teaching new students, providing supervision to eager supervisees, and then holidays.

I am also feeling positive on the back of some of my reading. In a couple of weeks I will be teaching case formulation and in preparation looking at books on this. Ann Garland who wrote an excellent book on persistent depression has a chapter in a book on case formulation and she makes difficult material easy to understand.

People with depression find it hard to remember positives, through no fault of theirs. Ann Garland describes the research on the depressive process that leads to difficulties in accessing pleasurable memories.

Ed Watkins has more recently made a case for helping people describe in detail their past difficulties and how this can help people to achieve a more balanced memory of the past. This made me consider how person centred counselling may also facilitate this process.

Interestingly, Ann Garland points to difficulties in goal setting for people with low mood and makes me wonder whether this reinforces the importance of enabling people to specify in detail future goals to be achieved.

The speed of EMDR is scary

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I have just completed part one of my EMDR training.

Like many other participants on the training, it is hard to believe the speed and power of the process.

Within seconds quite difficult memories are surfaced, and without care it is easy to appreciate how re-traumatisation can happen. That is not to say that I don’t appreciate the need for past events to be processed rather than ignored. It is just that the pace is quite frightening and one that I wasn’t prepared for.

I was slightly disappointed by the unmet promise that EMDR offers a less confrontational approach to dealing with trauma – this wasn’t my experience on this training. I will need to do much more reading, training and supervision in order to explore a more gentle approach to the provision of EMDR.

I will use my early experience of CBT practice which was both “clunky” and awkward to stop me making that mistake with EMDR. Thus a gentle approach will be my special goal as I aim to work with people who have a history of “let downs” as well as traumatic events. People deserve nothing less than to work with a practitioner who is determined to offer an alternative experience to what they may have had in the past.

Feeling the fear – helping people to face up to difficult things

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It is such a privilege working with young people and their families and one I take very very seriously. My work sees me helping people approach rather than avoid situations.

I spend a lot of my time reflecting on my time with avoidant people and how to make difficult things easier and also questioning whether in making it easier I may not be helping.

I am constantly on the look out for books that help me to do difficult things better and came across a gift of a book: Exposure Therapy for Anxiety which is written by Jonathan Abramowitz and his colleagues. It is a recent book having been published last year (2019).

I loved the book in that it helped me scrutinise my work and helpfully steered me towards doing exposure work even more effectively. Although it wont necessarily lessen the stress of facing up to what is avoided, it gives me the courage to keep on helping young people when it gets tough – and in a caring way.

I guess the only shortcoming that stuck out for me was the very only occasional minimising of the experience for people who find their anxiety overwhelming. The chapter on social anxiety (like all the other chapters) is full of helping strategies but I wish they didn’t write as if confronting social situations is that easy. The nature of social anxiety often means that young people beat themselves up for some of the things they said or things they did, or didn’t say or didn’t do at a social event. Its often the hours after that the person dreads.

There has been research (I need to relook for it) that says if we interrupt the post-mortem process following a public outing then this may reduce the negative impact and encourage future socialising. Of course, we need to do this without somehow giving the message that experiencing negative emotion is a truly awful thing.

The book borrowed from a local trust library is now on my buying list and one that I will be recommending to the students I teach.

Its more than just cricket

When teaching students about complex terms such as transference and countertransference, I am always on the lookout for useful short cuts. That is those stories that engage people through understanding such stuff that could easily switch them off – “I just don’t get it”.

This podcast featuring Mike Brearley is full of insights into quite challenging psychological processes. Mike Brearley is a well known cricket captain known for his ability to manage people. He makes a strong argument for learning self awareness – and yes that it can be learnt.

Here he describes psychoanalysis and its links with emotional intelligence and is worth listening to just for the confession tat he has never heard of Daniel Goleman!


Surviving and thriving in practice

Great to be teaching nursing students at university about surviving and thriving in clinical practice. First experiences can make and break some people and we can waste so much potential. We can not afford to recruit and lose future nurse professionals. Busy developing a toolbox that students can use when they hit difficult times – more or less bound to happen and they can use such experiences productively.

Out of the mouth of babes

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Working in CAMHS and perhaps especially as a grandparent looking after small children I have a rich supply of new angles on relationships with children. I have more troubled sleep over both roles than ever before. Despite my grand old age there is no slacking in my seriousness and still want to work well both professionally and personally.

The joy of working with children is the honesty you often get in the moment. When you get things wrong you know about it – or if they wont tell you direct they know an adult who can.

Its not always so. A wise old owl once told me that good news finds you but you have to go hunting for bad. He was sort of right in that some children are so sensitive and take on so much responsibility for things going wrong that they think it must be something they’ve done despite some of the appalling errors I have made (I am human). Thus, bad feeling (and thoughts) get buried.

I am part blameworthy for this – my seriousness and wanting to do well is somehow conveyed. I suspect that empathy on their part enables them to spot brittleness and they bite their tongue rather than risk my feelings. They are then wrongfooted when I “go a hunting” and sometimes put my own foot in it: “Why ask me how therapy is going for me when I am not ready to be honest”.

At home, I have had some time to reflect on my own honesty as I strive to be a “good enough grandad”. So I mask my frustrations and my distaste for all manner of bodily fluids and try and communicate an unconditional love for children regardless of what they have done in their pants or demands on time and energy.

What I haven’t squared (just yet) is in hiding my feelings do I somehow communicate something else which can be interpreted in all manner of ways: “Being honest is wrong” “What I have done is so wrong that he cant find the right words to express his disgust”. Fascinating stuff, well to me it is.

I am hoping I might be more clear headed when I go and do my talk with a local charity where I share how working with children has improved my work with adults – which it indeed has. Its putting these learning moments into words which others can grasp rather than leaving them thinking “What an old fuddy duddy if he weren’t so old I might have understood a word of that”. Or, if I am feeling very brave I might go hunting for honest thoughts as to whether the talk did make sense – and they may give an honest reply or maybe quietly smile but think its time for me to hang my boots up.

Light holiday reading!

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Before you consider me a sad person indeed for taking textbooks on holiday, in my defense I did finish a cracking thriller written by Kate Atkinson and at least started (a potentially great read) Sally Rooney’s Normal People.

But the book I did find quite inspirational is about Integrating Contemplative Practices (into other psychological therapies) edited by Victoria M. Follette and others. When I picked it up, I knew that I needed the luxury of time to best appreciate it – and what a good book it is.

Many of the chapters explore the use of mindfulness as a way in to helping people with mental and physical trauma. I came away feeling my ambition tempered and perhaps less likely to rush the whole process – no bad thing.

It reminded me of the room where I first attended creative therapies in order to increase my own psychological insights. There on the wall was a postcard that had the simple yet profound extract: “Tread softly as you tread on my dreams” (WB Yeats).

How great to be reminded what a privilege it is to work with the minds of others.

Super Books

Two super books that I will be sharing with both clinical staff, and students in the universities I teach:

Doing CBT: A Comprehensive Guide to Working with Behaviours, Thoughts and Emotions (2016) by David F Tollin is one of the best basic books on CBT;


CBT Strategies for Anxious and Depressed Children and Adolescents (2017) by Eduardo L. Bunge is a great resource book full of illustrations to share with older children.

My teaching session with staff will refer to this and other resources I have recently used.

Child Anxiety & Predicting Depression

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1 Podcast with Cathy Cresswell highlights that anxious children are not accessing evidence based treatment. Some promising work taking place on social anxiety and look forward to reading about the interventions that may work.

2 Predicting depression. Nice attempt here to balance science and personal experience in this podcast from MQ Open Mind Podcasts.