Observation in Health and Social Care – extract

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Helen Hingley-Jones is Associate Professor of Social Work at Middlesex University. Clare Parkinson is Clinical Lecturer and Senior Social Worker at the Tavistock and Portman NHS Foundation Trust. Lucille Allain is Associate Professor and Director of Social Work Programmes at Middlesex University. They have worked together to edit Observation in Health & Social Care

Examining and exploring new approaches to therapeutic observation in health and social care, this multidisciplinary guide discusses and analyses its uses in a range of practical contexts with children, families and adults.

Developing good observation skills is paramount to sustaining relationships in the challenging settings that health and social care professionals find themselves in. This guide shows how observation is taught, applied in practice, and how it will be returned to throughout professionals’ careers.

Drawing on psychoanalytic ideas and theories of human development as a base for professional learning, the experienced editors and authors offer theoretically informed models to teach observation skills in professional programmes, helping their readers prepare for successful intervention in any setting.

Below is the foreword, introduction and list of contents for the book.

Click here to read the extract

Brexit on the Brain – the implications of the interbrain for the Brexit debate

Are you a Brexiteer or a Remainer? In this exclusive blog piece, author Digby Tantam examines the implications of the interbrain connection for the Brexit debate. 

Two years ago, the UK had only just held together following the Scottish referendum, and then came the unexpected, catastrophic result of the second referendum on the UK’s continuing membership of the European Union. There was a feeling of doom for many of us (the majority of UK residents if the calculations of the numbers of 16-18-year olds, non-UK Europeans resident in the UK, and UK nationals abroad if the estimates are correct.)

We face the potential secession of Scotland, the loss of our major financial institutions to Paris, Frankfurt or Luxembourg, a dramatic loss of trade, many inconveniences not least to overseas travel, but even more importantly, the loss of our European cultural identity.

Although many will share my sense of doom about the UK’s future, others appear to feel the opposite – a sense of triumph.

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What exactly is anxiety and why do we need it?

managing anxietyClinical psychologists Sue Knowles and Bridie Gallagher discuss what anxiety is and how, although it can sometimes feel unbearable for many people, we actually need our anxiety to make our lives work.  Their article has been adapted from their new book, My Anxiety Handbook: Getting Back on Track, which provides young people with guidance on how to recognise and manage anxiety’s difficulties.

Anxiety is what happens when our bodies think we are under threat.  It’s a feeling that most people describe as unpleasant, but the physical sensations can actually be very similar to feelings of excitement.  The difference when we’re anxious is that we also have anxious thoughts or interpret the feeling as “bad”.  Other words that are commonly used to describe feeling anxious are “nervous”, “fearful” or “worried”.

Everyone responds a little differently when they are anxious.  Some people feel anxiety mostly in their body with sensations in their stomach, chest and even sometimes their arms and legs.  Other people might say that anxiety is “in their head” because the main thing they notice is that their thoughts go very fast.  These things happen in our body and our mind because when our body notices a “threat”, it responds in the way that it has since we were living in caves.  Back then, we were threatened by predators and worried about being clubbed to death by other cavemen.  Now, we might be more worried about exams and feel threatened by new groups of people.  So, in the way that is has for eons, your brain uses the information collected by your eyes and ears to detect threats in your environment and, without consulting you, releases a number of chemicals that have immediate effects on both your body and the way you think.

These chemicals affect your breathing, your digestion, heart rate, blood flow and muscle tension.  The aim is to make you ready to get very far away from the threat quickly (flight), kick the hell out of that caveman (fight) or pretend you are dead so he goes away and leaves you alone (freeze).  So, your heart rate and breathing speed up, your blood flows away from you internal organs and towards your arms and legs so they are ready for action.  The unintended consequences can be that you feel tense and a bit sick, or get butterflies in your stomach.  You could start to sweat and feel light-headed or a bit dizzy, even though you might be sitting still.  All these reactions are clever ways ways of your brain helping you to be ready and prepared to manage threat.  However, as threats have changed significantly since this threat system evolved, these reactions are not as useful as they once were.  If we don’t understand what our body is doing, then these reactions themselves can cause even more anxiety.

Some people feel anxious every day; other people only feel anxious occasionally.  Some people’s brains will kick off the chemical reactions much more easily than others.  We think, from looking at the research, that this can be because they were either born with a sensitive threat system or because they have had more difficult and stressful experiences, or both.  There are lots of individual differences, but what we know is that everyone experiences anxiety.

When we are anxious, several things happen to the way we think.  It becomes easier to think of negative rather than positive outcomes, we get stuck on “what if” questions, and our thinking brain shuts down and our threat brain (focused solely on survival) takes over.  This means that we struggle to use the bits of our brains that usually would help us to solve problems and see the wider context, because these bits are offline whilst we manage the threat.  This is a really effective way of dealing with physical threats that were common for cavemen, but it does not serve us so well in complex social situations that we find ourselves in now.

That said, we wouldn’t want to be entirely without anxiety.  This may sound silly, especially if anxiety is making your life miserable, however it is important to remember that anxiety is useful and we wouldn’t want to be without it.  We developed flight, fight and freeze for a very good reason and although we now have more complex worries and things to be scared of, we still need our anxiety to make our lives work.

Imagine if parents didn’t feel anxious about their new baby?  Dads might not bother to baby-proof the house, mums might not bother to check that the car seats are attached properly.  None of these things work out very well for the baby.

Worrying about exams might be stressful, but is it worse than not worrying about exams?  If we didn’t have any anxiety about the future, then we would probably just sit and eat ice-cream rather than revising.  After all, which is more fun and pleasant?

In our new book, we do not aim to rid you of your anxiety.  This might sound like a blissful idea, but we really think that your anxiety is an important and useful part of your life.  It might just need some understanding, and maybe some taming, to make sure it is helping more than it is causing you problems.  We aim to provide you with information and young people’s stories that will help you to better understand your anxiety and where it might come from, and to explain a number of different approaches and strategies to help you to feel more in control of your anxiety.  The ideas that we have included come from research studies, our experiences of working with young people, and the experiences of young people and what they have found helpful.

Use code MAH for a 10% discount when you order this book from our website before the 10th February.

If you would like to read more articles like Joy’s and hear the latest news and offers on our Mental Health books, why not join our mailing list? We can send information by email or post as you prefer. You can unsubscribe at any time.

Autism and Enablement

Described as ‘an excellent read providing visionary insight’ by Jane Miller (County Manager Occupational Therapy and Reablement, Kent County Council), Autism and Enablement shows how to help adults with autism achieve greater independence and become more self-sufficient.

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We are very pleased to receive so much positive feedback after the launch of our book Autism and Enablement. The Kent specialist ASC Enablement approach is the first of its kind provided by a UK Local Authority and we are honoured to publish a book on the approach. We hope that the approach is taken up nationally; this is only equitable because enablement is provided across the county to older people and people with physical needs, and increasingly to people with mental health issues and learning disability. We would argue that people on the spectrum are prime candidate for enablement because it is not inevitable that just because you have autism you should be destined to rely on others throughout the lifespan. People we have met have been found to have significant potential for personal growth, increased self-worth and self-esteem, for an increased sense of wellbeing and internal resilience; many just haven’t been offered the right support and neither have their supporters.

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‘Eat your peas or you won’t get your ice cream!’: Five reasons why withholding dessert will backfire

Article by Jo Cormack, author of Helping Children Develop a Positive Relationship with Food.

When people ask me which question I get asked the most by parents of picky eaters, they are often surprised at the answer. It isn’t: ‘how can I get my child to eat more veggies?’ or even: ‘how can I get my child to try new foods?’ It is: ‘how should I handle dessert?’

For the last few decades – at least in the UK where I live – it has been standard practice in many families, for parents to tell children that they need to eat all or most of their main course before they ‘earn’ their dessert .

When you are already concerned about the lack of variety in your child’s diet, making dessert conditional can feel like good parenting because it is a way (in the short term) of potentially increasing children’s food intake.

It can work, for sure. If your goal is getting your child to eat three more peas than they might otherwise have done,  holding the ice cream hostage could possibly make that happen.

Instead of going for short term gain,  I want to argue that withholding dessert can actually be harmful to your child’s long term relationship with food.  Here are five reasons why: Continue reading

What real progress has been made in dementia training?

In this blog post, author Dr Shibley Rahman addresses the urge to recognise the needs of the workforce in dementia education and training by asking a simple, yet poignant, question: what real progress has been made in this direction over the past few years?

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The current Prime Minister’s Dementia Challenge 2020 has successfully improved the awareness of dementia (and quality in other areas), but it also did produce a lot of other industrious contributions, such as courses and conferences, not always with a primary aim of educating the workforce.

But – “Knowledge is power.”

A lot has been made of the finding that people living with dementia are “core users” of the NHS and social care. And it has been said “dementia is everybody’s business”. But these tropes are too easy to trot out. Rather, the needs of people with dementia and their care partners often go unaddressed, despite much effort being publicly pumped into ‘dementia awareness’.

Just before Christmas last year, as a full time carer of a family relative with dementia, I had reason to experience at close quarters an English hospital admission. Although I am loath to extrapolate from what was essentially an anecdotal experience, I found the mismatch between reality and political rhetoric quite revealing.  Continue reading

How do we relate to “old age” and aged care?

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Felicity Chapman, author of Counselling and Psychotherapy with Older People in Care,  is an accredited mental health social worker who has extensive training and experience in psychotherapy and specialises in work with seniors both in the community and facility settings. Here, she talks about the importance of senior-friendly practices and redefining our relationship with “old age” and aged care.

We know about our ageing population. We know that, soon, it won’t be a skateboarding teenager that we’ll have to look out for while taking a stroll outside but a speeding mobility scooter – but what about our relationship with “old age” and all those who represent it?

Is it a passionate love affair or something we just do? Or maybe it is something that we can’t even fudge an interest in. Too “urgh” to even think about. If that’s you – I hear ya’. What’s a person to do when all that is blaring in their ears is to “fight the signs of ageing”? Beat that “old age” monster back (only with a certain product of course).

And what about our throw-away society? Much as we might not want to replace and dispose, many of us have little choice. Your eight-year-old washing machine stops working. What to do? Shell out a lot of money to try and fix it or spend not much more on a brand new one? Yep, planned obsolesce is certainly in-built in our life.

You see, even if we have the best of intentions, “old” can become synonymous with “urgh” or “obsolete”. What does this mean for how we view other things when they are old? People when they are old?

I’m not wanting you to hug every grandma you meet or guilt you in to acts of service for older adult populations. I am just appreciating the social milieu that surrounds our Western world when it comes to how we view this thing called “old age” and how much we value, or not, our elders.

My question to you is this – is it time to “bring sexy back” to how we view aged care?

It seems like a good time to me. We know the clock is ticking and our cohort of seniors is growing day by day, and living longer. I don’t like being affected by dire warnings of a “grey tsunami” but I do think that now is the time to see our ageing population as an opportunity to celebrate age and all those who represent “old age”.

So, what does it mean to “bring sexy back” to how we view aged care or older adults?

I’m sure Justin Timberlake did not have older adults in mind when he sung “I’m bringing sexy back…” Sexy is often everything that aged care is not. But by using the word “sexy” I am not referring to the high octane experience of being intimate with someone. Who knows though, older adults may well want to talk about such things! How senior friendly to encourage this?

What I mean when I talk about “bringing sexy back” is bringing a sense of spice or pizzazz associated with respect back to our Western society that appears to have lost its way in valuing seniors. I am a social worker before I am a psychotherapist. It seems perfectly natural to me to examine systems at all levels and not accept the status quo if it is at odds with a senior-friendly practice.

Nothing, I believe, should be exempt. From community attitudes, to what governments will fund, to social policy, our learning institutions, organisational mandates and the field of geropsychology – all should be fodder for our discerning eye as we look through the lens of valuing seniors. Bringing sexy back for me means to ensure that, as a society, we are senior friendly and celebrate age in all that we do.

This is not limited to healthy ageing campaigns or practices, as good as they are. As a social worker and a gerontological psychotherapist I am interested in models that extend the good that already exists and challenges what has not yet been challenged. From the way that older adults are engaged with psychotherapeutically through to how our governments and industry prioritise senior health and emotional wellbeing. All systems need to be scrutinized for how senior friendly they are.

For the sake of the current group of advanced seniors – and all of those who will surely follow – it is in humanity’s best interest to develop senior-friendly practices and be excited about the opportunities that await us when we turn our personal and professional energies toward redefining our relationship with “old age” and aged care. In the field of psychology, experts are lamenting a lack of interest in aged care, worldwide.

I hope that my book Counselling and Psychotherapy with Older People in Care: A Support Guide can go some way toward exciting and equipping workers – not just psychologists – who are either thinking of “dipping their toe in” to the aged care sector or who are fully immersed already. I also hope that it offers new horizons of thought in how we, as a society, relate to this thing called “old age” and aged care. Whether you are in to aged care or not, I’m sure you’ll agree that everyone on this planet deserves respect and dignity – especially when we are at our most vulnerable.

And if you think that psychotherapeutic work with older adults or aged care is staid and boring. Think again! What a rich mix of things to navigate. It’s seriously interesting!
It is – I think – a little bit sexy.

Morality, Demons and Beasts

In this extract from ‘The Interbrain,’ Digby Tantam considers the implications of the interbrain for religion, morality and our ability to demonize other humans. 

For a very long time, human beings have explained harm coming to one person or to groups by attributing this to demons. Demonic possession is possibly the oldest explanation of psychopathology and is still widely held in Africa and other parts of the world.

Demonization of offenders increases the public’s desire to punish them retributively is most likely because of common knowledge, which seems to be widespread, that demons exist, that they are evil, and that evil is contagious. So humans cannot, and indeed should not without imperilling their own morals, consort or connect with demons. Demons must be cast out of individuals, as the Bible has Jesus casting out the demons, and of society. Psychiatrists and psychologists have updated this demonology by postulating that types of people exist who cannot empathize and consequently act in a deranged or demonic fashion. There is also the presumption,
as there often is when a person is said to lack empathy, that it is equally impossible to empathize with them.

Demonization is, for obvious reasons, a strategy that is particularly attractive to religious groups…

Follow this link to continue reading this exclusive extract.

For more information on The Interbrain, or to buy a copy of the book, click here. 

All About Me

All About Me is an in-depth guide describing the practicalities of telling a child or young person about their autism diagnosis. It discusses when to tell, who should do it, and what they need to know beforehand. In this blog, author Andrew Miller explains his reasons for creating the book, and who can benefit from it.

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What motivated you to write All About Me?

Telling children and young people that they have autism and trying to explain what it means to them is difficult. The abstract nature of autism, its associated differences in cognition and its lifelong implications make it hard for children to understand, and finding out that they have autism could potentially cause some individuals emotional and psychological upset. Therefore, in some cases it could create more problems for an individual than it might intend to solve.

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A Crash Course in Widowed Single Parenting – Top Tips for Keeping It Together

Things Jon Didn’t Know About: Our Life After My Husband’s Suicide is an honest and moving account of the day-to-day practicalities of raising a family as a single parent survivor of suicide with advice on how to talk to children about death and how to support them as they grow up. Author Sue Henderson draws on her experience as a social worker to discusses theories of grief and men’s mental health. Here are her ‘top tips for keeping it together’, taken from chapter 2, ‘A Crash Course in Widowed Single Parenting’:  Continue reading