JSA Psychotherapy Logo JSA Psychotherapy Logo JSA Psychotherapy Logo

Author Archives: Staff writer

  1. Trauma-informed therapeutic caregiving – What makes a therapeutic model?

    Leave a Comment

    In recent years, there has been an ever-increasing trend towards recognising and acting on the importance of residential care for children and young people in the care system to be conducted in a way that is fundamentally therapeutic in nature. More providers than ever are adopting such an approach in an attempt to provide therapeutic care rather than mere accommodation, or worse, containment.

    However, from conversations that we have had with various providers in the industry, it seems that the criteria of what constitutes therapeutic care is not as widely agreed upon as its overall necessity. Many providers who are making earnest changes to their provisions to achieve this are finding that regulatory bodies such as Ofsted are asserting that further or alternate changes must be made before these outcomes can be considered met.

    Further, it seems that much of this confusion is occurring as a result of the understanding that the most direct means of meeting these stringent goals is to approach external clinicians to source therapeutic intervention for the children and young people in question. However, providing therapy on its own isn’t all that’s required for a child’s placement to be considered as therapeutic care.

    True therapeutic care, wherein a child or young person is supported to recover from the trauma that they have endured, can only be achieved within a cohesive framework of trauma-informed working that is integrated throughout the entire provision, not merely as an additional modular element to be contracted on top of it.

    Carers and children

    In this article, we will be setting out what we understand to be the four key defining elements of a therapeutic model. It’s our hope that by outlining the essential features that make a therapeutic model recognisable and functional as a therapeutic model, we can make the process of devising one much more approachable for providers who are keen to integrate therapeutic care into their practice but are currently being stalled by how vague and abstract the process of achieving this can be.

    To help illustrate and contextualise these elements, we will also be providing examples of the therapeutic model that we’ve helped to formulate for use in our sister company Life Change Care, known as the TIER system.

     

    What is a therapeutic model?

    Simply put, a therapeutic model is the overall framework of trauma-informed care that your provision will use as a reference point to inform the operation of the homes and the care of the children and young people. Much like each child in care will have an individual care plan that is worked from to recognise their individual needs and tailor their support, building upon this with a trauma-informed approach on both a macro and micro scale will transform the caring process into one that is designed with a therapeutic perspective that can be followed to achieve therapeutic care.

    This is relevant when considering the aforementioned half measure of outsourcing therapeutic care to an external clinical provider. A child or young person can receive a course of therapy and receive therapeutic care from their assigned clinician for an hour a month/week on an individual basis, but if this doesn’t form a component of an overall therapeutic model that the provider is working from, then it will only exist in isolation and the child will be returning to a home environment which is not therapeutic.

    As such, therapeutic care becomes something that they leave the provision to receive for significant minority of their time, rather than something with is actually integrated into their lived environment. This is what assessors are looking for providers to be able to demonstrate.

    In fact, many of the intended outcomes of therapeutic intervention, especially where trauma recovery are concerned, can’t be expected from taking on a case where the child’s home environment is not conducive to this. It has been the case where we have been unable to agree to supply these services for provisions who have inquired about them in the past, on the grounds that they don’t have a therapeutic model in place that our therapy could fit into.

     

    Element 1 – Trauma assessment

    The first element to be decided on of any therapeutic model also constitutes the first stage of the process of putting it into place for any new child or young person entering your care. In order for your care to be considered trauma informed, you first need to be informed of the specific impact of developmental trauma for any given individual child. Since the effects of trauma are different for everyone, so too will they have unique needs, difficulties and behaviours to recognise and accommodate when attempting to provide care for them.

    As such, there needs to be a standard assessment tool in place that is always employed at the beginning of the care process, beyond the background context that has been included in a referral document or anecdotal observation (though these can both be helpful in and of themselves). This is to establish a reliable insight into the complexities of the specific developmental trauma that each and every child has experienced, as well as what that means for your care team.

    There are various metrics and assessment tools that can be used to ascertain this. For example, the TIER system uses the Neurosequential Model of Therapeutics as its trauma assessment tool. NMT assessments examine historical adverse childhood experiences and currently presenting needs and difficulties to identify where an individual has experienced delay in meeting expected age-appropriate milestones in cognitive function, emotional regulation, relational skills and many other areas.

    All of these findings are plotted on a ‘brain map’, which can provide a clear indication of where a child will struggle far more than may be expected for their chronological age. This then allows carers to set their expectations accordingly and adjust the child’s care plan to facilitate reaching these key areas of development while therapy is taking place to address the trauma that caused the delay.

     

    Element 2 – Individual response

    This brings us to the second element, which is putting the information acquired from the assessments into practice. Once the initial assessment has happened and a child’s care can be considered trauma-informed, there needs to be an established approach for making this information actionable by everyone involved in the process. In short, there needs to be a standardised operating procedure to devise responses for meeting individual presenting needs.

    What this looks like will depend on the resources, aims and approach of any given provision, but within the TIER system, the list of potential strategies and interventions that house managers are equipped to pull from in devising an individual response includes the following:

    • A child’s individual care plan, to be followed by all staff and made available to relevant professionals. This can include individual goals and expectations for trauma recovery, key working sessions, education & psychotherapy engagement.
    • Trauma-informed risk assessments for accommodating the child’s unique needs and vulnerabilities, especially where they might not fall under common sense for the majority of children. For example, inclusion of personal trauma triggers which are likely to make them immediately unsafe.
    • Boundaries and key working to place parameters on the child’s own expectations within care and to cooperatively reflect on their own agency and involvement in the recovery process.
    • Enrichment activities and daily therapeutic caregiving, both as a means of providing enrichment for unmet developmental milestones and accessible, non-judgemental soothing care for unmet emotional regulation needs.
    • The sourcing of tailored education and psychotherapy provision, which can both in and of themselves be informed by an NMT/NME or similar assessment to be the most suitable for meeting an individual child’s presenting needs.

     

    Element 3 – Reviewing and monitoring

    At the same time as we are putting these trauma-informed actions into place, we need to have ongoing assessment strategies in place to ensure that we remain informed following the initial assessment. Therefore, whether it works from the same tool as the initial assessment or not, there has to be some metric by which progress towards intended recovery outcomes can be measured to assess if the children are benefiting from the therapeutic care that they are receiving.

    If a provider can acquire compelling evidence to suggest that the children in their provision are being supported to overcome developmental trauma and meet their recovery goals, then they will not only have a clear idea of how effective they are being, but they will also have record of exactly the sort of justification that bodies like Ofsted are looking for to indicate integrated therapeutic care.

    Additionally, this monitoring information can also indicate where it is necessary to adjust the individual response that preceded it. This can be for positive reasons as well as a negative indication that care isn’t working. It might be that a child has successfully met a development goal and the short-term intervention that contributed to it is no longer necessary, or the child themself may have proactively raised a suggestion of their own in a key working session that they would like to be supported to attempt together.

    Elements 2 and 3 shouldn’t be confused for temporary phases of a child’s care that occur one after the other and can then be forgotten about. Both occur in a constant cycle throughout the entirety of that child’s time in placement and require continual, active involvement to monitor and review the impact of care and, if necessary, reformulate the application of that care accordingly.

    The reviewing and monitoring element of the TIER system involves an individual TIER tracker that is examined in monthly therapeutic management meetings between the child’s clinical NMT assessor and the residential manager of the home to ascertain their development towards unmet milestones, their progress in psychotherapy (if applicable) and what care outcomes should be prioritised for the coming month.

     

    Element 4 – Team regulation

    Much like elements 2 and 3 are continual factors that repeat throughout the remainder of a child’s care after their initial assessment, element 4 is not a final conclusion of the process but one that has to be considered and carefully maintained at every stage of providing therapeutic care.

    In order to actually put the approach devised above into practice, it is a fundamental necessity for the carers providing this care to also receive necessary support. It is a foundational conceit of trauma-informed therapeutic caregiving that grounding, recuperative care and support can only be provided by carers who possess that grounding themselves. If the team of people surrounding a vulnerable child or young person do not feel emotionally safe and stable, then they won’t be able to impart the feelings of safety and stability that are needed for recovery.

    There are various ways to ensure that the needs of the care team are met as a continual prerequisite to meeting the care needs of the children placed in the home, many of which can be identified if not addressed in management supervision and oversight. The TIER system addresses this element through the caring for carers model. This involves providing the carers with frequent clinical supervision, in the same vein as is mandated for other caring professions such as counsellors and psychotherapists.

     

    Next steps

    If you are a provider of therapeutic care for residential children’s homes, then we sincerely hope that the information set out in this article provides an illuminating and constructive insight into the expectations and possibilities that are available to you in meeting the complex needs of the children and young people within your provision.

    This is also a topic that we are eager to elaborate upon further, where it seems there are any further obstacles to achieving these goals, so if you have any questions for us about how best to apply this, or would like to inquire about any of our services or an in-person discussion, please get in touch on 01282 685345 or at office@jsapsychotherapy.com

  2. ADHD month 2022 – Challenging our understanding of ADHD

    Leave a Comment

    Among many other things, October is recognised as ADHD awareness month, an opportunity to develop conversation and deepen understanding across social media and in person about Attention Defecit Hyperactivity Disorder. In particular, the theme that’s been chosen for this year’s awareness month is understanding a shared experience.

    This is the last entry in our series of micro articles for October about several different awareness campaigns happening over the month. As with the previous posts, our contributions to the current discourse is connected by the theme of recognising accessibility needs for marginalised groups of the population, as well as actionable steps to address these. So far we have addressed the access needs of Dyslexia, complex mental health issues and adoptive children suffering the lingering effects of developmental trauma.

    If you are only now beginning the series here, you might want to read our first article, where we outline this in greater depth.

     

    How is ADHD defined?

    Though many more people are familiar with the term at this point in time than in previous decades, there is also an ever widening breadth of interpretations that any given person may have of what ADHD is, how it presents and how to accomodate and support it. A lot of this can be attributed to the different contexts in which any given person has encountered ADHD, such as only being aware of it practically within the scope of special needs accomodations for young boys at primary school, with no frame of reference for how it is experienced and expressed by people in other demographics.

    On of the main challenges that we often run into both in recognising and subsequently acting upon the presence of ADHD is that the symptoms by which it is defined share some significant overlap with several other existing recognised disorders and mental health issues. As a result, it can be possible for misdiagnosis or misunderstanding to occur, where the presence of certain aspects of ADHD are taken as a uniform indication that certain blanket interventions or forms of support are necessary and/or fully sufficient for treatment of that condition, regardless of an individual’s actual needs.

     

    How does ADHD overlap?

    Perhaps the main reason for this is the location of ADHD’s clinical definition within a prescriptive model of diagnostic pathology. When the range of needs we associate with ADHD are conceptualised as a syndrome based in quantifiable symptoms and types of observable behaviour, this limits the scope of clinicians to provide insightful help but also complicates the definitions themselves where those quantifiers are shared by other diagnoses or conflicting diagnostic frameworks.

    In practice, very few of the symptoms used to diagnose ADHD are in isolation, exclusive to ADHD. As a result, where a client of the person performing this diagnosis might actually benefit more from forms of support that are associated with treating ASD, SPD, complex trauma, etc. this is unlikely to be made practically accessible over the established prescribed forms of treatment.

    It doesn’t help matters that many of these symptoms are invisible or poorly understood, and can be deeply impractical for any external assessor to accurately diagnose within the context of a limited assessment, regardless of familiarity or expertise. As such, more so than most care needs, there is a significant risk of important information being missed or misintepreted, to the direct detriment of those who are in need of this support.

    In fact, it’s worth addressing that one area in which people with all these overlapping diagnoses are similar is in ways that they experience reception from others. Across the board, the most significant issue is typically the callousness, dismissal and systemic marginalisation that these people are subjected to.

     

    What is the alternative?

    As raised in previous discussions, there is a way to reframe these issues through a common framework of meeting access needs. There is an argument to be made (one that is being put forward increasingly often at the moment) to make considerations for recognising a person’s indivudual experiences and challenges and approach them accordingly with an aim to meet their unique needs and figure out what tools and techniques are going to provide a meaningful benefit and support to their lived experience.

    I.e. whether a person’s symptoms are likely to be diagnosed as ADHD or not, all of the different techniques used to support it are things that different people tend to find helpful for different reasons. Some of them may genuinely be applicable and deeply necessesary for their quality of life.

     

    What’s next?

    That concludes our October series of posts. Hopefully, it’s given you or those you may have shared this with plenty to reflect on or a fresh perspective on some very important topics.

    If anything you’ve read has left you feeling that you would like to get in touch with us to raise some questions directly about the services we provide, please contact us on 01282 685345 or at office@jsapsychotherapy.com

  3. Adoption week 2022 – What is the relevance of developmental trauma?

    Leave a Comment

    This week, commencing the 17th of October, is national adoption week in the UK. As you may have seen on social media already this week, and likely will over the coming days, conversations are happening all over the country concerning how best to implement and sustain resources and infrastructure to conduct adoption to minimise harm to vulnerable children.

    The article you are reading is the third in this month’s series about the different awareness campaigns happening in October that we’re getting involved with. As mentioned in previous posts, our contributions to the discussions that are happening are tied together by a broader theme of recognising accessibility needs for marginalised groups of the population, as well as actionable steps to address these.

    If you haven’t already, you might want to read our first article, where we outline this in greater depth.

     

    What is necessary?

    The theme that has been chosen for this year’s adoption week is identity and relationships. There are many important reasons to consider the relevance of these factors in a child and family’s wellbeing, many of which are being imparted by other groups and writers at present. Conversely, the scope of the insights that we are able to confidently provide here come specifically from our background of practice and trauma-informed theory.

    If the shared intent with this campaign is to support a person’s sense of identity and the relationships that they exist within, then one of the ways this can be achieved is to have a greater understanding of one’s own history and needs.

    Given many of the circumstances which often lead to a child being assigned for adoption in the UK -to say nothing of the process itself- it’s not uncommon for developmental trauma to occur. Chronic trauma of this kind, if taking place during key early developmental stages of childhood, can cause a person’s identity and past experiences to be deeply fragmented.

    In the typical case where this trauma hasn’t been treated with the care necessary to resolve it, it will remain disintegrated from the brain’s long term memory. Any coherent sense of meaning or association that can be made from these experiences is reliant on that level of integration and without it, it is much more difficult for an individual to arrive at any subsequent position of understanding and acceptance.

     

    How can this cause further harm?

    As was the case in our previous articles on the topics of dyslexia and mental health awareness, this area is one in which unadressed historic harm can manifest as any number of remaining unmet needs which are, by and large, invisible to others. When external adverse circumstances impose these hindrances to cognitive, emotional and relational development, it can be even more arduous and harrowing in turn to continually be denied acceptance and critical support for the individual difficulties that arise as a result.

    This is compounded by the shallow likelihood that a child affected in these ways will have a complete awareness of these personal needs themself, as compared to others who have not endured similar trauma. In the case of adoption, these complex needs that have not otherwise been formally diagnosed as a pathologic developmental or behavioural disorder, will result in an adoptive home environment in which there is inevitable friction and distress that cannot be clearly communicated and isn’t broadly understood.

    The child in this context is typically left to fill in the blanks by believing that they are lesser than others, aren’t trying hard enough and/or have something wrong with them. For the adoptive carers, it can be difficult to understand what the reason can be for them to be experiencing such distress and agitation despite everything that’s been put in place in the hopes of supporting and accomodating them.

     

    What can be done?

    One of the frequent clinical services that we conduct is NMT assessments to identify where developmental trauma has occurred and, further, in which specific areas of development it has caused delay. As a result, it is possible to recognise on a brain map where support can be provided to assist a child in catching up on neglected milestones to achieve a similar level of development as is expected for an average of their same age peers.

    Much like with our educational needs assessments, there is an inherent expectation within the framework that suitable access requires this initial recognition of individual needs. For adoption cases, these assessments can ensure that parents and carers aren’t set up to fail at hidden challenges that nobody involved in the caring process may have been suitably informed of otherwise.

    From here, it’s also possible to take concrete steps in the process of trauma recovery, as well as meeting the present needs on an immediate short-term basis. Having this sort of actionable understanding can be the necessary catalyst for acheiving lasting, integrated healing from the adverse childhood experiences which caused this inhibotory delay, and thus, the delay itself.

     

    What’s next?

    If you found this article informative, be sure to remain on the look out for the rest of October. Our final article in this series will be released before the end of the month, in which we will expand upon many of the points raised here and in previous articles.

    In the meantime, if you have any thoughts or questions of your own, please get involved yourself. If you found this article through social media, be sure to add a comment or send us a message. Alternatively, if you have a more direct query, you can reach us in the office on 01282 685345 or at office@jsapsychotherapy.com

  4. World Mental Health Day – Why it’s important to prioritise proactive support

    Leave a Comment

    Monday the 10th of October is world mental health day for 2022. This year, the central theme is of making mental health a global priority.

    This article is the second in this month’s series about the awareness campaigns we have taken a particular interest in over the month of October. As mentioned in our previous post, we hope to contribute our insights to these discussions within a broader theme of recognising accessibility needs for marginalised groups of the population, as well as actionable steps to address these.

    If you haven’t already, you might wish to read that article first.

     

    How is this relevant?

    The category of mental health is one which is often extended to include learning issues and other disabilites, such as were discussed last week. Since these have already been addressed in some detail, we will instead be focusing here on how other mental health issues, and especially those that result from experiences of trauma, are significant to our own theme of access. This, in turn, can be argued to make them a significant priority for addressing on a global scale.

    We have talked extensively in the past about various specific mental health issues, such as relational issues, personality disorders and men’s mental health. Those linked here are only a handful from the last 12 months and many more can be found in our post archives.

    Of particular relevance in our current discussion, many of these disorders are associated with symptoms which, though debilitating, are rarely recognised and accomodated to a sufficient degree by others, if at all. This is to say nothing of the marginalisation that those affected face as a result of social stigma and exploitation. Most glaring are the degrees to which those with certain mental health issues such as schizophrenia and PTSD are found in many studies to be significantly more likely than other members of the population to be subjected to violence or exclusion from employment, community and social welfare.

     

    How could this be prioritised?

    Again, there is a link that can be connected here to the causal relationship between unresolved experiences of trauma and subsequent disabling effects upon a person in later life. Most relevant in this case are instances of developmental trauma and relational trauma, which is to say, trauma which inhibits a person’s relational development.

    This is a perspective which has been at the core of our practice for years, and which we intend to elaborate upon in detail at some point in the future. For the purposes of this article, it’s only relevant to say that chronic trauma suffered during key stages of development in childhood and adolescence demonstrably inhibit the sequential development of the brain and nervous system. Depending on which areas of development are affected, this can result in a person experiencing greater difficulties with key cognitive and relational skills compared to most people.

    Making the recognition, support and recovery from trauma a priority in this case can, therefore, also prevent greater disparities of this kind in the future. This will be fundamentally necessary for meaningful positive change where the previous neglect of trauma recovery or the persistence of those traumatic circumstances have affected an individual’s development. Even within the field of mental health, this is another area where visibility and recognistion of necessary access needs are obscured or misunderstood.

     

    What’s next?

    If you found this article informative, be sure to pay further attention over the rest of the month. Monday the 17th of October will be the beginning of 2022’s adoption week, and we will expand upon many of the points raised here when commenting on that as well.

    In the meantime, if you have any thoughts or questions of your own, please get involved yourself. If you found this article through social media, be sure to add a comment or send us a message. Alternatively, if you have a more direct query, you can reach us in the office on 01282 685345 or at office@jsapsychotherapy.com

  5. Dyslexia Awareness Week – What are the barriers that need breaking?

    Leave a Comment

    Today is dyslexia awareness day, part of 2022’s dyslexia awareness week. Significantly, this year also coincides with the 50th anniversary of the British Dyslexia Association’s founding.

    This article is the first that we will be releasing this month about several annual awareness campaigns taking place in October. We’ve taken a particular interest in these campaigns and hope to contribute to the discussion with some insights of our own.

    We will also be exploring how each of these topics and causes relates to a broader theme of recognising accessibility needs for marginalised groups of the population, as well as actionable steps to address these.

     

    What is dyslexia?

    For those of you who may not be aware already, dyslexia is commonly defined as a learning difficulty where a person struggles with processing language information, especially in the form of written language. Most often, this refers to issues with reading, writing and spelling as quickly or coherently as other people.

    Statistics vary on how much of the population is believed to be dyslexic, but dyslexia is widely recognised to be by far the most commonly diagnosed learning difficulty. It’s true that diagnosis itself can be challenging to conduct based on an overview of clinical symptomps, many of which fall in a grey area and are shared with other diagnoses such as dyspraxia, dyscalculia, ASD and ADHD.

    There is a significant amount of crossover in the symptoms that these terms are used to refer to, but the most relevant commonality is one of shared lived experience for those affected.

     

    What does this mean for dyslexics?

    The theme of this year’s dyslexia awareness week is breaking barriers, which is an apt way to describe the issues of access and acceptance that people possessing these traits are negatively affected by.  One that is mentioned often is the relative invisibility of learning difficulties. Those with greater needs regarding language processing and similar areas of cognitive function are, for the most part, continually met with a lack or refusal of recognition for these traits.

    As a consequence, they are also subjected to prejudice and material harm following the mistaken attitude that they are obstinate or unmotivated when failing to meet neurotypical expectations of function and productivity. Where there is an expectation to justify these shortcomings that can’t be explained, typically these prejudices become turned inwards as negative self-beliefs as well, especially at formative ages.

    It’s for that reason that there is a point of comparison to be drawn with the work that is done with a trauma-informed approach. As discussed previously, a recognition for the effects of developmental trauma is one that acknowledges similar hidden access needs, many of which can be the result of developmental trauma.

    Despite this, in many applications -especially those within the neurosequential model of education- the objective is to identify extant need for access accomodations. This is as opposed to diagnosing the initial cause of these needs, be they developmental trauma, prenatal developmental conditions, or something else entirely. To a point, these distinctions can be impractical to attempt and are less relevant than identifying necessary support the individual in question.

     

    What’s next?

    If you found this article informative, be sure to pay further attention over the rest of the month. Monday the 10th of October will be world mental health day for 2022, and we will expand upon many of the points raised here when commenting on that as well.

    In the meantime, if you have any thoughts or questions of your own, please get involved yourself. If you found this article through social media, be sure to add a comment or send us a message. Alternatively, if you have a more direct query, you can reach us in the office on 01282 685345 or at office@jsapsychotherapy.com

  6. All in the Mind: Recurring Nightmares and Chronic Trauma

    Leave a Comment

    Recently, BBC’s All in the Mind programme hosted a segment where they discussed a new study being conducted by their guest Bryony Sheaves, a research clinical psychologist at Oxford university. The discussion centred around use of Trauma-focused Cognitive Behavioural Therapy techniques to treat the nightmares of patients with psychosis, in the hopes that their waking symptoms would also subside. 

    Using a control group of 24, the team used a very brief course of targeted TFCBT, specifically the technique of imagery re-scripting. This involved cognitively reframing the most intensely distressing elements of the nightmares in session, and saw some reduction in the frequency and intensity of the nightmares overall, something that is typically only achieved with anti-psychotic medication.  

    The study is still ongoing, but it is likely that this is due to there being two different causes of frequent nightmares that are being treated. Many of the nightmares that remained were those which had no clear theme or reoccurring elements, something that is to be expected of a psychotic episode during sleep.

    These can be compared to the phenomenon of ‘repeating nightmares’ which many non-psychotic people find themselves experiencing to a degree that infringes upon their quality of life. As cited on the programme, as many as 10% of people are believed to experience intense nightmares at least once a week.  

    It’s an interesting distinction to have identified, and we’re hopeful that the study will yield productive results. One of our reasons for having faith in this study is our own experience of having utilised targeted trauma recovery therapies, such as TFCBT and EMDR in treating issues like recurring nightmares, flashbacks and PTSD. In the case of nightmares specifically, we have found that these modalities are effective even for those who have tried talking therapies for their symptoms in the past, and not found it persistently helpful. 

    This is because often, the root cause of the issue is very deep seated. Through a neurological lens, it relates to the formation of fragmented memories within the brain and nervous system which other therapeutic models may not access.  Normally, when a memory is formed about an experience a person has had, the sensory details enter the mind through the lowest, most basic area of the brain, the brain stem, which deals only with the very basest survival needs. Next, it transfers into short term memory, and and gets sorted over time into the long-term memory. 

    This sorting process is a natural function that is always progressing, we have very little influence over it. However, the majority of it occurs during the Rapid Eye Movement (REM) stage of sleep, when we dream. Dreams are essentially a visualisation of our brains taking fragmented chunks of information from the ‘to-sort’ pile, creating meaning from them by creating symbolic images for us to experience by association, and filing them away in the appropriate area of long term memory when they’re done.  

    However, this process is dependent on the received information flowing upwards through the brain unimpeded. If the brain detects an emergency, it will disengage unnecessary sections of the brain to focus on survival. Unfortunately, this means that the resulting memories of the event become fragmented. The fragments that are retained once the distressing event has ended are infused with all of the most intense, overwhelmingly negative feelings that were being experienced in the moment that they were formed. This is because the memories are formed of both sensory and emotional information. 

    However, as mentioned, the brain is always attempting to clean these shards up and sort them away where it finds them. Sometimes this will happen while awake if we are reminded of the event, perhaps smelling or hearing something that triggers the associated memory, and the overwhelming emotions that came with it. Alternatively, the brain may come across the memory on its own during sleep, and construct a nightmare to represent those emotions. E.g. feeling helpless, unprepared, in lethal danger, etc.  

    This may present an opportunity for the brain to finally come to terms with those feelings now that the real emergency is over. However, if it is still too much for a person’s mind to cope with on their own, the fragmented memories will be discarded again as a defence mechanism, only to return again during future nightmares and triggering events, beginning a repeating pattern that reoccurs indefinitely.  

    The treatment that is recommended for this issue is the very targeted trauma recovery modalities mentioned before. These can be utilised to hone in on the fragmented memories that are still circulating in the mind and body. The therapist can then draw them forward and guide the client through the otherwise impossible prospect of overcoming their trauma, supporting them in their vulnerability to come out the other side of the process. After this, the brain is able to fully resolve the memories, sorting them into long term memory and ending the cycle of nightmares.  

    If you are interested in learning more about out trauma-recovery therapy services, or would like to discuss sourcing treatment for yourself or somebody you know who may benefit from it, please contact us on 1282 685345 or send us an email at office@jsapsychotherapy.com

    You can listen to the broadcast of All in the Mind online at: https://www.bbc.co.uk/sounds/play/m000wrlz 

  7. The Surprising Cost of Neglecting the Wellbeing of Your Workforce

    Leave a Comment

    As a business owner, you have probably put a lot of thought in how you can ensure the health and safety of your employees whilst they are in the workplace. But have you put any thought into the impact their mental health has on their productivity at work and on staff retention rates?

    Ensuring the emotional wellbeing of your workforce is not just your ethical responsibility as a business owner, but it also meets your fiscal obligations too. Read on to find out why.

     

    What is the impact on my business?

     

    Stress, depression or anxiety accounted for 55% of working days lost to UK businesses in 2019 and 2020. This means there were were a whopping 17.9m working days lost due to work-related stress, depression or anxiety. More than for any other illness!

    The impact this has on productivity cost UK businesses £15.1bn in 2019 and 2020 and for those employees who left their roles due to mental health issues, this cost UK businesses £3.4bn in recruitment fees.

    Having a productive, reliable and loyal workforce is critical for any employer. There are many reasons why your employees might be feeling pressure or stress and neglecting this rather than resolving it will impact more than just your business.

     

    What is the impact on my employees?

     

     

    Chronic stress has a cumulative impact on the functioning of the human body. Over time it can weaken your natural resilience to disease and contribute to organ failure. This means that many instances of absences from work due to physical illnesses could also be linked to their mental health.

    It’s clear that absence due to both mental and physical health may be avoided entirely if the wellbeing of employees is improved.

    Given that 14.7% of people will experience mental health problems in their workplace, investing in a workplace wellbeing service to provide better mental health support would save UK businesses up to 8bn per year.

     

    How can JSA help future-proof your business?

     

    JSA’s Workplace Wellbeing Service offers access to therapeutic assistance, from counselling to clinical psychotherapy services to help your employees better manage stress or resolve the underlying issues that may contribute to mental illness.

    Get in touch to talk about how we can support you or check out our wellbeing page to find out more.

  8. The challenges of play therapy during a pandemic

    Leave a Comment

    In previous articles we’ve talked about the difficulties of the pandemic broadly, and in the specifics of how it changed how our therapists have had to work when supporting clients and delivering specific clinical models such as EMDR. After discussing the matter with our play therapy team, today we’re going to be addressing the challenges of delivering play therapy during a pandemic, specifically when working with children and young people, how challenging they have been to overcome, and reasons for why that may be the case.  

    At the time of writing, it is also Mental Health Awareness Week in the UK, and the topic of the moment is the mental health of children and young people suffering greater adversity during Covid 19. Consider these statistics provided by Children in Need, which we have been addressing on our social media platforms. As such, we will also take the time in this article to explore what parents, carers and educators of children suffering under lockdown can potentially do to best provide support of their own during this time.   

    What is Play Therapy?

    Play therapy is the primary clinical model that we utilise when providing therapy for children. This is beause it’s much easier for children to engage with than talking therapy such as CBT, which we might provide for an adult. As opposed to other models of therapy, which typically require the client to verbalise their issues, play therapy is a non-talking therapy. Sessions engage the client by providing them with other ways to express their feelings and concerns when it is difficult to do so with words, either because the client is too young to articulate themself, or uncomfortable doing so.  

    What are the Challenges of Delivering This Therapy During a Pandemic?

    When lockdown began in March of 2020, we transitioned the majority of our clinical work to a remote setting using video chat services. However, play therapy inherently involves the child and therapist engaging in play and arts and crafts activities together in an appropriate physical space, and so we had to put it completely on hold. The dilemma was clear. How were we to expect a 5-year-old to reliably sit still in front of a camera for an hour, let alone transition from non-directive play with a sand tray and paints to discussing their feelings verbally over a zoom call? 

    As a result of this, our play therapists were sadly required to suspend the courses of therapy that they were conducting with the children in their care part way through their courses. This was an upsetting disruption for many of the children, particularly those who were drawing a sense of comfort and familiarity from the consistency of the course. Crucially, the therapy that we provide to them takes the form of a quite purposefully set out schedule of intervention. These are difficult to resume after a hiatus of delivery without losing significant pre-established progress. In practice, many of those sessions never continued at all after the disruption occurred. 

    The therapists we spoke to have remarked that it was difficult on a personal, emotional level not being able to have any contact with the children in their care after suddenly being required to terminate the connections they were building. Not being able to know how they were doing, if they were managing to cope in absence of their therapeutic support. Unexpected breaks in communication without a proper ending are a regrettable but ultimately unavoidable occurrence that every therapist must accept will happen every once in a while, but to have all the children’s sessions immediately terminated with most never to be resumed was particularly upsetting, especially given the turmoil of the circumstances that the therapists knew these children would be returning to entirely without their clinical support.

    This persisted until July, when lockdown measures began to ease again. Even now though, necessary safety restrictions on the delivery of play therapy while Covid19 persists make for a clinical experience that remains markedly different from the one we were previously able to provide. Hygiene mandates mean that we’re unable to work with soft toys, dress-up costumes or sand trays at the moment, and the therapists need to be much more strict about keeping sessions to a 45-minute duration to allow time to sanitise the play rooms afterwards.  

    There have been changes that have complicated the specific task of providing clinical support to children as well. It became clear early on that wearing a lower face mask made finding a state of grounded comfort and ease in the play room much more challenging for some children, inhibiting the positive impact that they were able to achieve from the sessions. It was similarly evident that certain children had particular difficulty engaging with their therapists in the same way as they had before. For others, we found that they missed the emotional affect and warmth that they had previously expected to be able to receive from the sessions. This was much more pronounced with the increased physical boundaries that social distancing necessitated.

    Our therapists have picked up on significant reoccurring themes across their client base of children and young people since the pandemic started. By design, lots of play therapy involves imaginative and creative play, including creative activities such as roleplay and storytelling. This is facilitated in a non-directive manner in which the children are the ones who chose which options they want to engage with from a range of prompts.  

    In practice, we noticed a significant increase in the amount of roleplay than children normally went for before, as opposed to painting, sensory stimulation play, music & dance, etc. This was especially true of younger children in the early years bracket. We speculate that this may be the case because current circumstances have deprived them of the opportunity to act out their theories on life the way they used to.

    It is well established in academic study of child psychology that roleplay and imaginative play serves this function for enrichment. For children within that developmental window more so than any other, it is a critically important tool for enabling their cognitive and social development.  

    If roleplay and solitary reverie are the ways in which we conceptualise our understanding of the world, and then test them out, then where children in their early years are unable to experiment with their peers and carers to realise their conceptual understanding of the world around them, they will naturally find themselves condensing it with greater internal speculation. 

    As such, these children are predisposed to seek the chance to compare their daydreams and fantasies with the reality of complex problem solving and human interaction. Despite this, now more than ever they are finding themselves critically under-enriched and there is significant value for children in education provisions to access play therapy as an exercise in being able to achieve this enrichment with the guided support of a skilled professional.

    Concerning the content of the roleplay and creative conceptualisation that our therapists observed during the period since lockdown began, certain recurring themes emerged more than others. A focal point of this observation was exercises in which children are asked to arrange toys and items to create a world of their choosing. Usually, children heavily lean on concepts from their own life, family, school etc. They will typically represent them in abstracted ways, encouraged by the therapist, to explore how to approach the things that intimidate them and better understand the things that confuse them. 

    Presently, we’ve determined that children engaging in this work will far less frequently envision things that interest or excite them. Conversely, most only want to focus on envisioning a world where Covid doesn’t exist, or never happened. In other terms, they are primarily preoccupied with desire for that sense of escape from their overwhelming worry, before they can even consider what else might actually appeal to them outside of it.

    Additionally, we have learned that while children who experienced in-school socialisation with their peers prior to lockdown beginning have taken to online learning and socialisation, they clearly aren’t receiving the same degree of emotional support and catharsis from them as they used to in person. Similarly, the behavioural difference in older children and adolescents accessing therapy online is very stark. Our therapists describe that compared to the time before lockdown began, they have become much lower in mood and affect.  

    Its clear that all of them are struggling for being bereft of the things they relied on before. A topic that concerns us increasingly at the moment is the degree to which children don’t have nearly as much to look forward to. Not only has their ability to interact with the world been severely inhibited, but also their creativity and ability to supplement that through play with each other. It’s only natural that their sense of enthusiasm, optimism and joie de vivre are also going to suffer in turn.

    Lastly, it’s unclear how widespread the impact of the pandemic will prove to be on these children’s cognitive development. In discussions with other professionals around therapy and care planning for the children in our care, learning outcomes have provided one of the biggest topics of discussion. It’s fair to say that across the board we are all feeling great concern for their cognitive and emotional development. 

    One of the most frequent questions that our play therapists have been asked by parents, carers, teachers and social workers who we are involved with is “how can we help?” The answer to this from our play therapists has been a unanimous call to set aside uninterrupted quality time to play with them. Again, the whole reason that this forms a cornerstone of therapeutic interaction with children is that whether they are aware of it or not, they will find it much easier to express how they are feeling, and what they need in this way. 

    Consider the most challenging issues that we are called to provide support for when children are clearly in distress. Are they presenting with behaviours that are impossible to reliably control and de-escalate? Ask yourself what other opportunities they possess to act upon their confusion and frustration. It’s difficult enough for us as adults to regulate our emotions despite this disruption in our lives, but we may take it for granted just how disorienting and overwhelming it must be without having experienced growing up without ever having to worry about them. Whether the children who are dependent upon you for a sense of routine are able to do their schoolwork or not, this can be an incredible method of keeping a routine. 

    Achieving this can, of course, be difficult in and of itself considering the restrictions we must still face upon time and travel, to say nothing of your own ability to lead this sort of play as an adult when you yourself are also struggling with all the stress of lockdown. This is why we continue to be emphatic in our availability to provide these services professionally, whether as part of a more deliberate and directive course of therapeutic intervention, or in support of EBD & SEND needs. 

    If you would like to learn more about our services and the clinicians who work for us on an associate basis, or if you have a question you would like us to answer, please contact us at the office on 01282 685345 or at office@jsapsychotherapy.com

  9. The Challenges of Delivering EMDR During a Pandemic

    Leave a Comment

    Eye Movement Desensitization and Reprocessing Therapy or EMDR is an incredibly effective specialist psychotherapeutic model for resolving trauma and replacing any resulting negative mindsets and behaviours with positive associations. Trauma prevents the left cerebral hemisphere of the brain from self-soothing the right cerebral hemisphere and EMDR works by stimulating both hemispheres of the brain to process the trauma. Using bilateral stimulation in this way bypasses trauma centres that are locked off or unavailable using other therapeutic models.

     

    Can EMDR be delivered remotely?

     

    Zoom call

    The stimulation can take the form of physical sensations such as a rhythmic tapping of the knees or by encouraging the eye to follow a moving finger – delivering this remotely means the guided bilateral stimulation is completely up to the client to achieve and maintain on their own because the therapist can’t be in the room to tap them on the knees or make sure they have something for their eyes to follow!

    There is also an inherent intimacy of face-to-face therapy that is very challenging to replicate remotely – much of the guidance and reassurance that the therapist provides during the session to keep the client safe and stable whilst they access their traumatic memories will be significantly inhibited. This is to say nothing of how much harder it can be to facilitate that healing process once the client has successfully entered the necessary cognitive state for it to begin.

     

    Why do JSA focus on EMDR?

     

    Whilst other therapies such as trauma-focused CBT are effective, EMDR is utilised to resolve the lingering issues surrounding an identified traumatic event in a short timeframe by honing in on it and using intensive, direct therapy work to access the memory at its core, so that the therapist can guide the client to finally processing it.

     

    The brain

     

    Talking therapies like CBT require the client to explore and rationalise their feelings and behaviours with the therapist to decide what is going to work best for them. This process takes place in the highest, most complex parts of the brain in the neo-cortex.

    “The trauma memories, by their nature, have become locked at the brain stem and are unavailable to access without bilateral stimulation.” To be specific, the trauma memories can be triggered without bilateral stimulation (flashbacks, hallucinations and nightmares are an obvious example) or accessed through other therapeutic models like TF-CBT.

    It’s just that the client may find it too overwhelming to access them deliberately in a talking context, which is how they become locked off again as a defence mechanism. EMDR is useful because it can essentially go right past those mental blocks in a way that TF-CBT cannot. The therapist then uses their own grounded higher brain functions to facilitate the client in making sense of this memory and allowing it to find a settled place in their long-term cortical memory.

    This neurological approach to trauma-informed practice is something that we have developed as part of our association with the Child Trauma Academy and their NMT model. Our lead psychotherapist Julie Stirpe is level 2 NMT trained and JSA Psychotherapy operates as the only location in the UK where practitioners can train in this skillset. We are actively looking to synthesise it throughout our practice as we grow.

     

    If you’re interested in joining our team, click here or contact us on 01282 685345 or email office@jsapsychotherapy.com.

     

  10. Supporting the returning workforce post-covid

    Leave a Comment

    As part of our ongoing programme of events and initiatives responding to new forms of adversity presented by the pandemic, today we will be looking at what has come to be known colloquially as ‘long covid’. This phenomenon of post-COVID19  chronic illness is faced by a significant proportion of those who are understood to have otherwise overcome the difficulties of COVID-19, and the numbers only continue to grow as different effects and issues are discovered and reported, some of which can be incredibly enduring and debilitating.

    The result of this can mean a real physical and emotional impact not just for the survivors themselves, but also friends, family and the groups and workforces those survivors are part of. This is especially so for places of work where several employees are suffering these effects. This is most keenly felt by businesses which rely on small-to-medium sized workforces, particularly with regard to the care and support of those for whom ‘long covid’ is a challenging reality.

    Lianne Marie Mease has prepared the following article to detail the necessary steps to ensuring the wellbeing of our workforces. At the end of the article, we will be sharing the details of an event at which we at JSA Psychotherapy can directly help you to achieve this.

     

    It is common knowledge by now that Covid 19 is likely to cause chronic physical health conditions for those who have contracted and survived it. This ‘long covid’ has been the source of necessary discussions among employers and occupational health practitioners about how to appropriately accommodate Covid survivors in their return to work.

    There have been far fewer questions asked about the necessity of accommodating the mental health needs of these employees, as well as those who did not contract Covid, but have nonetheless suffered other issues under quarantine.

    The Health and Safety at work act 1974 states explicitly that employers are responsible for the emotional wellbeing of their employees, mandating a duty of care to ensure they are fit to work both in terms of their physical and mental health. Obviously, the most pressing demand at this time is to support them with the necessary resources to facilitate a smooth, safe transition to business as usual.

    Our experience in the field of mental health assessment for the courts and private sector leads us to believe that part of this transition process for employers should involve considering the ongoing impact of what their employees might have endured during the last 12 months. The tremendous amount of change that has accompanied it has instilled a total reframing of perspective for many people that is difficult to resolve. Disruption to these prior assumptions will have had a significant impact on employees’ mental health.

    When conducting return to work interviews, we would encourage any employers reading this article to consider whether any of your employees have faced the following challenges during lockdown:

    • Shielding and/or caring for elderly relatives
    • Coping with financial instability
    • Having a lack of childcare support or factoring in home learning
    • Feeling over-stimulation from increased use of video conferencing software
    • Experiencing intense periods of social isolation
    • Struggling with a lack of routine
    • Prolonged periods of anxiety and fear
    • Grieving for deceased relatives

    It’s surprisingly common to respond to the hardships of distressing events like prolonged quarantine by experiencing a sort of grief, even if no bereavement has been suffered. The feelings of loss, confusion and alienation inherent in processing the worst parts of the pandemic can be experienced in a similar way to the model of recovery we would typically associate with a grief cycle. Expert knowledge imparts that the this sequence of numbness, shock, denial, anger and acceptance must finally be resolved by accommodating the loss we have experienced as we return to normality.

    It may be the case that employees you have identified as struggling in one way or another may still be feeling numbed or angry, and need some further external support to settle these feelings before they are fully fit for work again. This is especially relevant considering that each of the individual periods of lockdown may have triggered its own separate grief cycle, with distressing events in an earlier lockdown remaining unresolved by the time another began.

     

    How JSA Psychotherapy can help

    We have created a 2-hour seminar designed for those who manage or employ a workforce and are planning for their return to work. It will help you maximise the wellbeing of your workforce to get back to business quickly and effectively, and help your returning workforce to move forward in good health.

    If you believe that this would be beneficial to you or your team, you can book now at the following address: https://www.eventbrite.co.uk/e/issues-for-the-returning-workforce-post-covid-tickets-145223520459

    If you’d like to see more of Marie’s work, or get in touch with her yourself, you can do so at butterflump.com