personal

Bedtime routine: The gift that keeps on giving

Of all the things I’ve done as a psychologist who is also a parent, the one I am probably most proud of is my bedtime routine. As I watch other people struggle to get their kids to sleep, or hear about the struggles of kids that keep getting out of bed or will only sleep with a parent present, I feel very grateful of the fact that mine always go down like magic.

The secret recipe started in infancy. After a difficult start with premature twins born before they had a suckle reflex, and six months of having to spend an hour feeding each of them every four hours (meaning we got a maximum of 2 hours sleep at a time), we turned a corner. At six months, we were told by our health visitor that they no longer needed milk in the night and could manage without a feed from the time we went to bed to 7am. So after a late feed at 11pm or midnight we got back our night. There were a few nights with some crying before the new routine was established. The first night pulled on all my emotional hooks, so I went to check and found they were fine and soon settled with me there, so the next night I was able to resist going for the ten minutes it took for the crying to peter out. Two nights later and it was quiet from midnight to seven am and we got back our unbroken sleep and our sanity. Soon after we saw that they were not taking much, if any, milk at the last feed and we were able to withdraw any room service from 7pm to 7am. By then, my night time routine was already in place.

Once baths are done, pyjamas are on and teeth are brushed, the kids get into bed and we make the room darker by closing the blackout curtains. I used to wish them goodnight using the same little rhyme every night, and then move straight to singing. Now they are older, when there is time, we normally have a little chat about the day and read a story – this is one of my favourite Mummy times, as we talk about all kinds of interesting things. Our conversations range from why some children are mean, to where petrol comes from, to why there is war in Gaza, to whether religious beliefs are true or just stories that some people believe and some people don’t, to how families have different configurations, why their second cousin had a brain tumour, or how flowers come back after the winter, or why some people are homeless. I’ve got a strong belief that if they are old enough to ask a question they are old enough to have an honest answer, no matter how difficult that answer is to articulate in simple terms for me as an adult. They have this insatiable thirst for knowledge, and often bring up what they have learnt at other times.

Whenever we have these discussions, my kids amaze me with their compassion and desire for fairness in the world. I still remember being told by a serious-faced four year old that we needed to “send a load of postcards to people in Israel and Palestine to tell them to look after and re-build schools, so that everybody can learn about how to be kind to others, no matter whether they believe in the Hanukkah God or the Eid God”. They were even younger when they explained how they want us to buy things that create employment in less developed countries, because most people have food and houses in England, but the people in other countries would want jobs that let them feed their families. And I remember how nonplussed they were to hear about gay marriage and how they couldn’t understand the examples of prejudice that kept coming up on the news because “its not right to be mean to people because of the colour of their skin or who they love”.

Then after our serious discussions and perhaps a bit of reading (Harry Potter and Rebel Girls seem to be favourites at the moment) it is time to wind down to sleep. Then quiet time begins. That signals that it is no longer the time to have a conversation and anything except the most urgent questions need to wait for the next day. I sing a few songs that they have chosen and a few old favourites, and within 15 minutes they are asleep. If we’ve had a busy day and we are out late, I can skip right to quiet time and go from active to asleep in the same time-frame. Friends and family members are often amazed, but I say its the best example of behavioural conditioning ever. I can even make the kids yawn by singing the same song in the middle of the day!

Of course it isn’t always perfect. If one of them is poorly, or I have been away too much in the week for work, they might stir and say “don’t go Mummy, sing an extra song” or they might wake in the night and come down for a cuddle or some medicine. But we always meet that need as quietly as possible and then return them to bed. Because when they sleep well, and we get quiet time as adults to wind down and catch up as a couple, the whole household is happier. We can flex the routine enough to stay up late for a special occasion or to give a little extra time on weekends or holidays, but we also flex the other way and start winding down earlier if they are tired and irritable. The kids even say “Mummy can we have an early night tonight as I’m feeling a bit tired and I want to have enough energy for swimming tomorrow?”

I know there is a lot of debate about ‘controlled crying’ but the few nights in which we ignored some crying at six months have reaped rewards ever since, and we have a happier family as a result. Of course, it won’t work for everyone. There are plenty of children who are more difficult to get to sleep than ours, but my advice would be to have a very clear routine, to start as young as possible, to be very calm as a parent throughout, and to persist through the difficult bit as quietly and calmly and consistently as possible. Because sleeping well helps all members of the family to regulate their emotional state better and have more positive experiences throughout the day as well as at night. I know I’m happier and more able to focus when I’ve had enough sleep, and the same is true for all members of the family.

Some thoughts on causing offence: 2 Trigger Warnings

The idea of cultural appropriation being offensive (which I discussed in part one of this blog entry) seems to go hand in hand with other recent social movements towards being more aware of the emotional well-being of others. This includes the use of social media to document the pervasiveness of small everyday actions that are a cumulative indication of how pervasive some prejudices are in society. The everyday sexism project has highlighted examples of how women’s daily experiences differ from men’s because of their gender, and there are similar projects to highlight the pervasiveness of racism. These small and often individually minor experiences, particularly in the context of race, are being termed “microaggressions” to denote the harm they cause when considered across a lifetime. I think these projects are helpful because, like the short films ‘Homoworld‘  and ‘Oppressed Majority‘, they humanise concepts that might otherwise be hard to explain, and show the massive quantity of incidents that might each in isolation seem too petty to raise. Without such examples or dramatisations it can be very hard to put ourselves into the perspective of another and to realise that their everyday experience is different to your own. And awareness is the first step towards behaviour change.

This change is happening at both the individual and organisational level. There is an increasing perception that organisations such as businesses, universities, public services and broadcasters having some responsibility for the impact of their content on customers, employees, students or their audience. This means being more aware of how the meaning of various content can impact differently on different people according to their experiences. This includes the use of ‘trigger warnings’ to orient readers/viewers/listeners about the aspects of the content that will follow that may resonate for them in negative ways. This could include mention of rape/sexual assault, violence, trauma, child abuse, racism, hate crimes or other forms of prejudice. The intent is to ensure that any person in the audience who has had traumatic experiences in their past is not re-traumatised by unintended exposure similar material without the option to prepare or opt out of that experience.

Although widely mocked, I think trigger warnings are quite sensible in principle. They aren’t there to molly coddle the delicate sensibilities of a whole generation of students (or social justice warriors) that don’t like being challenged, they are there to protect the small percentage of the population that have had traumatic experiences from post-traumatic symptoms. When I hear people on social media bragging about how they intend to trigger others, it seems like they lack either insight into what this means, basic human empathy, or both.

A trigger is a very specific word for what happens in the brain of people who have experienced serious trauma – normally experiences they have perceived as life-threatening – where the brain becomes sensitised to threat. When similar sensory stimuli to those associated with the event are detected, the amygdala goes into overdrive, and will put the person into a state of high physiological arousal (readiness for fight or flight) and make it harder for them to use brain functions apart from those associated with survival. Because the brain does not encode memories in narrative form very effectively during survival situations (due to much reduced activity in the prefrontal cortex) these sensory links often activate sensory memory fragments from the trauma, causing flashbacks and high levels of distress. This means that certain triggers can cause them to re-experience their trauma later on in their lives. Just as a war veteran might get flashbacks or nightmares about their war experiences, so people who have been seriously abused, raped or tortured experience unwanted intrusive images and memories of what they have been through when they see, hear or feel something similar to something they experienced during the trauma.

This isn’t something that has been made up, or reflects certain people being “sensitive flowers” either innately or by choice. It is a scientifically evidenced change to the brain after trauma. Intrusive images or thoughts, including re-experiencing of trauma is one of the diagnostic features of PTSD, and it is well established that certain experiences trigger these flashbacks. MRI scanners show the limbic brain (eg the amygdala) lighting up faster and brighter to threat signals that would not be perceived as threatening by others without the trauma, and the resulting decreased activity in the prefrontal cortex. Neurochemical analysis (eg from swab tests) have shown that this has a significant effect on the person’s neurochemistry and chemical messengers (like adrenalin and cortisol) are released that prepare the body for fight or flight. In short, this is a serious and well-documented physical response to serious trauma that I have blogged about previously. I’ve worked with lots of traumatised and/or abused children and adults and it is a really horrible thing to go though. It seems like a double dose of adversity for those whose abuse/trauma continues to echo through their life months or years later. It is not something to make light of or mock, and only a truly repugnant person would do so.

But being thoughtful about the impact of content on others, and orienting the audience about what is going to be covered, does not have to equal censorship. We should still talk about the tough stuff, study it, make art about it and even sometimes joke about it. It often makes for the most interesting debates, and it is through engagement with these complex and challenging issues that people learn to analyse the motivation of the writer/speaker and to appraise the context as well as the content of what is said.

As uncomfortable as it can be when people use it to say annoying, idiotic and offensive things, I am a believer in free speech. I don’t think being offended is a reason to silence someone. It is a reason to reply so that others are not persuaded by them, to ignore them, or to deny them their audience (because free speech doesn’t entitle you to a platform, and any website, venue or business can decide not to welcome/endorse somebody). But it isn’t a reason to stop them saying their piece, unless it incites violence or racial hatred and is therefore against the law. As hateful and bigoted as Donald Trump is, for example, the answer to the awful things he says is not to ban him from the UK, it is ignore him and deny him the oxygen of publicity, or simply to laugh at him. Mock his ignorance. Share your disgust. Highlight how hateful and harmful his ideas are, and how he has not earned the right to lead by showing any personal qualities that are admirable. Ensure that he faces legal consequences if he oversteps and breaks the law by inciting racial hatred whilst in the UK. But don’t censor him and allow him to take the role of being oppressed, as it would be counter-productive.

Even President Obama has weighed in to say “Anybody who comes to speak to you and you disagree with, you should have an argument with them. But you shouldn’t silence them by saying, ‘You can’t come because I’m too sensitive to hear what you have to say.’ That’s not the way we learn.” I’m inclined to agree. We are all responsible for this conversation, and in the therapy professions, genuine empathy has to include acknowledging the difference between the client’s perspective (or a colleague’s) and your own.

 

Happily ever after: Some thoughts on trauma in the movies

I watched a romantic drama this evening in which a man and a woman who has a child from her past relationship fall in love. The ex-boyfriend is controlling, threatening and manipulative and tries to sabotage the relationship. He is shown getting drunk and grabbing the woman’s arm tightly to stop her leaving twice, and at another point he threatens the man with a weapon. Towards the end of the film the ex-boyfriend is drunk and upset. He threatens to take the child, who runs away and falls into a river. The ex-boyfriend rescues the child at the cost of his own life, and the mother and child witness him meeting a sudden grizzly death. Then the couple get together, become a family with the child and the film ends, leaving them to live happily ever after.

Having watched a set of characters for an hour and a half that were portrayed sympathetically and realistically enough to feel invested in, this seemed like a weird ending. I was left with this really disconcerting feeling that the writers, producers and large numbers of reviewers of this film (who gave it respectable scores on Amazon and IMDB) thought that this climactic scene tied up the ends neatly and left us with the uplifting moral righteousness of the baddie getting his just deserts, the couple unimpeded in their romance and a perfect nuclear family.

But how could a child who just witnessed his father’s death (and probably felt responsible for it) not have any emotional reaction to that? Would it not be yet another loss of a close male relationship for this young child, who had already lost others as part of the back-story? How could the mother not have complex feelings about the death of a guy who has been emotionally and potentially physically abusing her for five years? Would her relief perhaps be tinged with guilt that her new romance triggered these events, or at being relieved to see the back of him? Would a mother not feel sadness in empathy for her child’s experience of trauma and loss? Would she not feel echoes of the loss of her own father in childhood, or her brother the previous year? Perhaps their different ways of dealing with grief and loss would challenge the romantic relationship? How about our leading man, who was mourning lost friends and showing signs of PTSD at the beginning of the film. Would it not re-awaken all the unresolved grief he is repressing? And what of the ex-boyfriend’s parents and their stoical thanks to those that tried to rescue him? Does nobody cry for this man, who gave his life up to save his child? Was his inept handling of the relationship that resulted from an unplanned pregnancy in his teens so bad that he deserved to die?

Why couldn’t the film have been one that illustrated the reality and complexity of modern family relationships? Surely the alternative was for the father to have shown his priority was the wellbeing of the child, during the rescue scene, but to have survived and been part of a renegotiated family configuration in which the child was able to have both a positive experience of contact with him and to live in the new family unit with Mum and step-Dad? As I often tell children who feel that any affection to foster or adoptive carers is disloyal to their birth family, love is not like a cake where you have a finite amount to share out between all your relationships, love is like candles where using your fire to light others just creates more brightness for everyone. But if the father had to die, then they needed to show the emotional fallout of that. They can’t have one without the other, any more than they could show a person standing in sunshine without showing their shadow.

As it stood, the film profoundly failed to acknowledge the impact of trauma on the different characters. And this film was far from alone in that. So many traumas occur in films and TV shows that it seems they are very much part of the expectation nowadays. In every vampire franchise I’ve seen the head counts of characters close to the main protagonists who die are extraordinary, and yet they briefly mourn and then move on. In Vampire Diaries, an average of 19 characters shown on screen die per episode, and the main character, Elena, has lost almost every living relative and most of her friends, as well as dying herself, twice! Many other shows track medical emergencies, murderers, serious crimes, drug dealing and power battles, yet they are dealt with in an entirely sanitised, emotion-free way. Sure, a pathologist would be well-used to the physical nature of human corpses, but even in the most hardened professionals some cases creep through the cracks into your psyche. The person that looks a little like someone you know, or reminds you of something in your past. The tragic story that becomes apparent from the cause of death, or the untimely demise of a child. We are not robots analysing data, surely we recognise that people are like us and the people we care about?

The latest Star Wars film showed planet-scale genocide without that even being acknowledged by the cast. It’s a really good film otherwise, and I really enjoyed it, but the scriptwriters chose to show genocide as shorthand to make the baddies bad. It could equally have done so through less wide-scale slaughter, or by showing the snatching of children to indoctrinate as stormtroopers or many other plot devices. Including the slaughter of millions of people was a plot choice, and given that the film is part of a historical franchise that is pitched to the whole family and used to market toys to children, that is a pretty weird choice of plot. To then skim over making light of it makes that more disturbing, rather than less, once you think about it. I’m not saying the main characters should have processed the emotional impact there and then; I’m sure if you are busy fighting for your life or have 20 minutes to save the world and see some planets blow up, that isn’t the moment you down tools, lie down and cry. But even an extra second of footage showing sad faces, one person humanising the loss by mention of having lost individuals there, or an additional comment about how awful that loss was, would have given some hint of the emotional connections of all the people whose lives were extinguished in an instant. In the original trilogy when Alderaan was destroyed they used the change in the force to acknowledge how monstrous it was. I still remember the scale and momentousness given by the line “I felt a great disturbance in the Force, as if millions of voices suddenly cried out in terror, and were suddenly silenced. I fear something terrible has happened.” And this is what was missing in The Force Awakens.

But I think this lack of acknowledgement of millions of deaths was also illustrating something very poignant about human processing of events; we identify much more emotionally with death or distress at the individual scale than we do at a population level. Think of how the discovery of the body of young Aylan Kurdi humanised the treatment of Syrian refugees in the news narratives, for example. Prior to that point, they were treated like an invading army of ants, but in the weeks immediately afterwards some individual stories were told and people felt more sympathetic and we were shown footage of refugees being welcomed into various European countries. I think that change in response according to the scale of deaths is part of human nature, as is our ability to shut off from suffering and get on with life, if that is necessary to our survival. At the extreme end, people living through wars or in areas of high risk or conflict are probably coping by living in “survival mode” and using more primitive parts of the brain in favour of the prefrontal cortex, which has reduced activity under threat. It makes sense, logically, as we do have to compartmentalise awful stuff to just keep on going sometimes. I think back to all the life events that happened whilst I was pregnant (including a car accident, my granddad dying, a close colleague dying unexpectedly, my job being placed at risk, my babies being born very prematurely) and think I only coped with everything I couldn’t avoid by going into a psychological bubble and putting all that bad news aside to deal with later.

Maybe these fictional narratives of unacknowledged loss that have become so prevalent in TV and film are using this tendency – our ability to put emotional distance between ourselves and tragedy through various forms of displacement. If something awful happens far away, or it happened in the past, or in a different cultural context, or in fiction, then we are able to distance ourselves from it and deal with it at a purely cognitive level. We think about it but don’t feel it. The shame is that this seems to be how many politicians and decision makers deal with the problems affecting people in our day to day lives. Although it is ‘psychologically expensive’ to allow emotions in, it is only with empathy that we can really make informed decisions. So in real life as well as in fiction, I think a bit more feeling would be a good thing.

If you build it they will come: The impact of making space in my professional life

When my personal development coach told me that the first steps towards having a happier working life and better work life balance were to a) figure out what I wanted to do most and b) clear out some space in my life for it to fit into, that seemed a bit back to front and almost too obvious.

Although I’ve always known that I want to apply clinical psychology to helping the most complex children and families, I felt a real lack of clarity about what I wanted to do. I think in retrospect this was because I’d originally envisaged nothing more creative than a career in CAMHS in the NHS. But even once I was outside the NHS I still felt this lack of vision for my ideal future, perhaps because I wanted to choose it from the options available to me, and I hadn’t explored what those might be very far beyond returning to the NHS or continuing what I was doing already (court expert witness work, with a side helping of trying to influence policy and practise by being involved with national committees, standards groups and supporting the next generation of CPs).

I had also internalised the idea that the right process was to build up my investment of time in what I wanted to do more, until that took off and allowed me to do less of the other stuff. I felt like clearing out space from my established work streams was of no value (or even a potential risk to my income) unless I had figured out what I wanted to do, or ideally created the alternative channels already. But slowly I realised that if all my time and energy was being consumed by my current workload, then there was no capacity to imagine anything better, to seek out any opportunities or plan any change, and I’d still be overloading myself and worrying about my work life balance in a year from now, or five, or ten.

So I decided to take a gamble and cut down my work commitments for a while and give myself thinking space to figure it out. Of course, being me, I took on the new part-time consulting role that was going to pay the bills whilst giving me time to think before I had managed to reduce my existing workload. So I had six months in which I had to overlap this new role with my all my ongoing court and committee work, before I was able to wind them down very much at all, and then a minor RTA to contend with (see previous blog). So I sure didn’t take the easy route to cutting down.

But the physical jolt was the final straw to help me to realise that I needed to change my work patterns and I have been able to spend more time with my family, and have now stepped down from almost all of my committee roles. This is an enormous change after 4 or 5 years on the BPS CYPF committee, nearly double that of being involved with CPLAAC, and more recently being part of the BPS/FJC standards group for psychology experts to the family court and the NICE guidance development group for attachment interventions, and a rep from the BPS to BAAF. I am now at the very tail end of the court work, with just three small pieces of work to complete (each an addendum to prior work or work that was delayed after I agreed to complete it) and a couple of single days in court.

Although my time is still very fraught for another couple of weeks and we will then segue into Christmas (meaning my winding down schedule will have taken me almost a year to achieve), I’ve managed to get onto some tasks I have been avoiding for a long time. I’ve started to work my way through the financial tangles that constantly stop things running smoothly – this is mainly the enormous pile of unpaid invoices where parties to court work have disputed their share, gone bust, or just not paid for years and years, but also includes the un-invoiced work that we have completed, expenses I have not claimed back from the company, and the administrative task of reconciling our records with the bank statements. My team have stepped up to help me and as I have made sense of it bit by bit it feels like that tangle is turning into a single logical thread I can follow and wind up as I go.

As I sort and put away the clutter that consumes my time and energy step by step, I am starting to feel less overwhelmed by running the business. As the volume of court work I undertake reduces, so does the emotional weight of the work. And as the burden I am carrying gets lighter, psychologically at least, some small gaps between the demands on my time and energy are already starting to appear. Into those gaps has come the beginnings of the vision I lacked of where I want to take my career in the future, and what kind of life I want.

I’m sure I’ll talk more about that next time. But for now I just wanted to share that it feels great to put down some of the load I have been carrying, to untangle the frustrating little issues that have been tying me up, and to create space for the stuff that I care about the most. With the help of a new business mentor I’ve been able to connect with the motivation that started me on this journey, and to finally work out where I want to go both personally and professionally. And that makes all the steps I have to take to get there much clearer.

I made the space, and sure enough, the goals of how I want to fill it have come to me.

Talking about depression and seeking help

Someone I know emailed me this week, saying he was feeling depressed. He was very self-critical about it because objectively his life was the best it had ever been (after a lot of difficult experiences in his childhood and early adult life he is now employed, in a relationship, with a nice home) and therefore it felt ungrateful to complain about anything (like social anxiety, work stress, sleep disturbance, niggles in the relationship, having to care for a dependent parent) as he should be happy. He felt perpetually exhausted and like therapy and medication was for people with ‘real problems’ and talked about wishing he didn’t exist. This was my answer:

There is no ‘should’ with feelings. They just are what they are. We can learn to challenge our thoughts or change our behaviours, which can have a positive knock on effect, but feelings we have little control over. So just be mindful of them, and try to deal with the stuff that underlies them when you are feeling well-resourced and supported.

I read a rather naff explanation on facebook today, but it has a germ of wisdom in it:

I held up an orange and asked a boy in the audience “If I were to squeeze this orange as hard as I could, what would come out?”

He looked at me like I was a little crazy and said, “Juice, of course.”

“Do you think apple juice could come out of it?”

“No!” he laughed.

“What about grapefruit juice?”

“No!”

“What would come out of it?”

“Orange juice, of course.”

“Why? Why when you squeeze an orange does orange juice come out?”

He may have been getting a little exasperated with me at this point.

“Well, it’s an orange and that’s what’s inside.”

I nodded. “Let’s assume that this orange isn’t an orange, but it’s you. And someone squeezes you, puts pressure on you, says something you don’t like, offends you. And out of you comes anger, hatred, bitterness, fear. Why? The answer, as our young friend has told us, is because that’s what’s inside.”

It’s one of the great lessons of life. What comes out when life squeezes you? When someone hurts or offends you? If anger, pain and fear come out of you, it’s because that’s what’s inside. It doesn’t matter who does the squeezing—your mother, your brother, your children, your boss, the government. If someone says something about you that you don’t like, what comes out of you is what’s inside. And what’s inside is up to you, it’s your choice.

When someone puts the pressure on you and out of you comes anything other than love, it’s because that’s what you’ve allowed to be inside. Once you take away all those negative things you don’t want in your life and replace them with love, you’ll find yourself living a highly functioning life.

Now, I’m not totally on board with filling yourself exclusively with love and light (because I think negative feelings are pretty normal and have their value too), and I’m not sure that anyone can ever respond only positively to life’s pressures, but he is right with one thing – your response under stress reflects what you have learnt and experienced in your life up to that point. If you are filled with the poison of being bullied at school or denigrated by your parents, with the wounds of failed relationships, with traumas and losses, then that becomes your norm. It will tarnish your view of yourself, the world and others, and it has the potential to leak out in unhelpful ways. When you carry that baggage and aren’t buoyed up by positive experiences and relationships it becomes much harder to be resilient to the day to day stressors of life. It becomes harder to feel you deserve a better life and to seek out positive experiences for yourself, and you can instead end up avoiding or sabotaging them.

Therapy is there to help you recognise that skew, and to separate the result of negative experiences from your innate worth as an individual. It can help you to challenge your thinking, to change your behaviour, to give yourself opportunities to test and refine your beliefs about yourself, the world and others. It can help you reflect on the patterns in your relationships, why you keep replaying the ones that are not helpful and how you can begin to change this. And sometimes when you are feeling so hopeless and worn out that even the idea of therapy is too much to manage, medication can help to give you the energy and optimism back to allow change to be possible.

The biggest problem of depression is that people can see it compassionately in others, but we are very critical of ourselves for feeling that way, and unable to recognise that the stuckness and self criticism is part of the depression and – importantly – eminently treatable. If you read back your email to me and imagine someone else made it, I think you’d be a lot more compassionate to that person than you are being to yourself. The problem is that you are trying to measure the objective situation with a subjective (and in fact distorted) tool – yourself. And that distortion increases when you are depressed. So be kind to yourself, and allow others to help you. You don’t have to be stuck with feeling sad just because you can’t pin a reason for it on something specific or because there are other people who have bigger problems in their lives.

You said that you sometimes wish you didn’t exist, but I am very glad you do, and I am sure that there are lots of other people who value you and would miss you if you weren’t around. When you are depressed it is hard (if not impossible) to imagine that life can get better. But it can get better. Not only that, but it does get better for most people with depression. Most people who are depressed or even suicidal go on to happier times and to be glad they didn’t act on those thoughts. So please, seek help and don’t give up. Call the Samaritans if you feel like you might harm yourself, and speak to your GP about medication and/or a referral for psychological therapy. After all, 90% of people who turn up to therapy start to feel better, and you can too.

Bump!

Its been a while since I wrote a blog entry, so this is a catch-up to the little chain of events that took up my summer.

On 24th June I was driving from work to do an assessment in the community, when I gave way at a roundabout. Unfortunately the lorry behind me didn’t stop, and went into the back of me. I got jolted forward in my seatbelt, but walked out physically unscathed to find that you could hardly see the impact on the car either. Thankfully the lorry driver was lovely about it; concerned and apologetic and we exchanged details. I was right near the VW dealership where I bought the car, so I got them to check it was roadworthy and went on to my appointment about an hour late. The garage explained that cars are very well protected against straight on collisions, and the bumper would have absorbed most of the impact by crumpling inside, so it was later replaced by my insurance. Likewise I was fine on the outside, but things on the inside started to show the impact in unexpected ways, both physically and psychologically.

Physically I got a typical pattern of whiplash injury – pain in my neck and left shoulder, tightness in my left arm and a restricted range of movement, stiffness in my back, headaches and disrupted sleep. I also got dental pain, along with bruxism, the tendency to clench or grind your teeth, particularly during sleep. I’ve had similar physical symptoms from previous road traffic accidents (I’ve been hit several times before, 3 of which caused whiplash, but I’ve never had an at fault accident in 200,000+ miles since I bought my first car at age 20). But the psychological symptoms were new.

The first thing I noticed was that my concentration was completely shot. I couldn’t sequence tasks into the right order, sustain my attention or gather my thoughts enough to write coherently. I became more anxious, had an increased startle reaction to loud noises and weird scary dreams. I had to work hard to keep my mind on mundane tasks like driving, so I didn’t wander out of my lane on a quiet motorway and was attentive to the speed limit (although driving was limited anyway due to the pain in my shoulder and arm). I couldn’t draw together and reflect on the different information in my court reports, feel confident about my conclusions and present them effectively in a report, so I had to be signed off sick for a month – something I have never done before. However the weighty nature of doing expert witness work for the family court means that I had no other option, it wouldn’t have been ethical to have submitted poor work to inform the court’s decisions on such life-changing matters.

To compound things I started getting severe pain in my teeth and jaw. The dentist was initially unable to identify the source, but eventually found a crack in my wisdom tooth. He tried to fill this, but it caused me levels of pain that I have never experienced before (even in childbirth). A few days later they tried to remove the tooth but had to abort the attempt midway, due to an infection in my jaw. I spent the following week on antibiotics and analgesics, wavering between debilitating pain and a pleasant but unproductive codeine-induced haze. I was reminded how debilitating chronic pain can be, especially as I became more tolerant to codeine and had to alternate with ibuprofen to gain relief. I also found out that dental pain falls in the gaps between the out of hours services (the emergency dentist said “see your dentist on Monday, nothing we can do except let the antibiotics do their stuff, but see your GP if over the counter painkillers are not enough” whilst the walk in clinic said they couldn’t prescribe for dental pain). And to add insult to injury I got a speeding ticket for doing 36 mph on my way to the clinic. The tooth was removed the day before we flew to Scotland for our good friends’ wedding, and once there, I immediately started to feel somewhat better. On my return I was able to complete the delayed court reports and start to catch up with my email, albeit with limited intervals on the computer.

Now I feel like I’m getting back to normal. I’ve still got dental pain, and some physical restrictions (I can’t go weightlifting at the gym, my sleep isn’t 100% and I’m still very stiff on waking or if I do anything physical like playing with the kids or trying to pull a few weeds in the garden), but I feel like myself again psychologically. I can concentrate and plan to levels typical for me, and it has been an interesting experience to reflect upon. Taking time out of work was difficult for me, because it challenges both my expectations of myself as a perfectionist and workaholic, the level of input/control I’ve been able to have over my business, and my reputation as a reliable provider of services. The up side has been spending more time at home with the kids over the summer holidays, taking time to relax and being forced to think about self-care a bit more than usual. I am very lucky that my husband had just left his job and was able to postpone his freelance work and take on a lot of the domestic tasks, otherwise I don’t think that I’d have managed nearly as well.

As a self employed person, taking time off work also lost me a lot of money, but it was difficult to see this as a loss I had no control over (even though this is the case) rather than me being self-indulgent. Even though I was told that I could claim from the lorry driver’s insurance for lost earnings I was still loathe to make a claim. Plus it is hard to quantify losses when you don’t have a steady salary and payments come in months after I complete work. Of course I had to contact my insurer, as the car bumper was structurally compromised and needed replacement, and my insurance company in turn set other wheels in motion.

I genuinely loathe the personal injury claim industry from the speculative cold-calls and TV marketing to drum up trade to the impact on premiums and the motivation to malinger. I hate to be part of it. Yet I watch helplessly from the sidelines as the leaches of the insurance industry cream off maximum profit to take forward my claim, from the hire car whilst mine was in for repair (for more than twice the price of just walking into the local hire shop), to the paralegals at the ambulance-chasing law firm charging an obscene hourly rate for their cut-and-paste letters and calls. Yesterday I had my medical interview/examination with a very nice doctor who took 16 minutes to complete his assessment. Certainly an interesting contrast to the detailed day of interviews and assessments of each person I do for the family court!

So, its been an interesting summer. Despite the hiatus there is a lot I want to write about.

To the parent in the changing rooms this morning

It made me sad to hear you repeatedly criticise your child for minor things, and then conclude “you’ll go straight to bed when we get home”. When I came out the shower to see the child concerned was 12-18 months of age, and having to sit patiently on the counter whilst you did your hair and makeup, I wondered whether I should have said something. But being British, I bit my lip.

Here is what I’d have liked to have said:

Firstly: A child of that age won’t be able to sit still without making a noise for 20 minutes. It isn’t a realistic expectation, so you as a parent should bring along things to do or a snack for times like that. If the issue is that being up on the counter means they need supervision, use the playpen provided, or leave the child in the creche until you have got dressed. If you took the child swimming then make the whole outing fun, and recognise that after an energy-consuming activity a child might be more frazzled than usual, so prepare for this.

Second: A child of any age needs lots of praise and encouragement to learn how to behave, and to feel that they are a worthwhile person. You teach children best by showing them what you want them to do, not telling them what not to do, and praising any approximation of it whilst giving encouraging feedback until they get it right. Can you imagine teaching an adult to drive by saying what not to do? “Don’t hit the pedestrians… no, don’t mount the kerb… don’t hit that other car… don’t go so fast… don’t use that gear”. Would it work? Then why do you think a child can learn much more complex and subtle social and life skills based on what you don’t want them to do? Like a learner driver, they need to be told what to think about and prepare for, then given guidance how to do it, and feedback about how to improve their attempt next time, whilst making them feel okay about the fact that they are still learning and things are pretty hard until they become intuitive.

At this age, you also need to ensure your expectations are realistic – instructions for a child with a limited vocabulary are like trying to follow directions given a foreign language, whilst you are still learning how to use your body and interact with the world. Set simple clear rules and then be consistent in how you react to them. Hurting others or yourself, or breaking things on purpose are not okay, but the way you manage these has to be age appropriate. With a toddler, being told what they have done wrong and/or removed from the situation is the simplest response.

Third: Using sending to bed as a consequence for undesirable behaviour is a really bad choice for several reasons. Most obviously, it isn’t an immediate consequence. The child will not link the behaviour with the punishment if there is a gap of more than a few minutes until they are much older (even at 4-7 children will normally need an immediate consequence like a sticker to help them understand the longer term gain or loss is related to the behaviour). But it is also really silly to link going to bed with being punished. It sets up a negative reaction to being put to bed, which will increase arousal at exactly the time you should be helping a child to feel soothed and start winding down to sleep, and set up expectations of resisting going to bed or staying awake and active/noisy which are likely to lead to more negative feelings. If it is normally nap time just after lunch, make that a pleasant time, not a punishment. If it isn’t a nap time, then don’t use it at all.

Being put in isolation feels like being rejected and neglected and is a very serious consequence, even if only for a minute or two (which is why it works so powerfully in time out with older children). A preschool child being shut in their room for longer than a few minutes is abuse, and with an older child I’d still advocate for the shortest possible length of time. Consequences should last no more than the child’s age worth of minutes and be proportionate. Never deprive a child of food just because they have done something irritating – for most things your displeased facial expression and tone of voice are enough. With little ones you may have to physically intervene to make them safe or to take away something being used inappropriately (eg a crayon that is being drawn onto the table) but make sure to repair the relationship after you’ve given that consequence, and to praise the behaviours you want to see instead. Choose your battles wisely. Ignore the little stuff, it doesn’t matter compared to your child having a positive experience of themselves, others and the world. A positive relationship with their primary caregiver is the biggest gift you can give them and makes them resilient for the rest of their lives.

Finally, if you are stressed or unhappy, or lack parenting skills or support, do something about that. Your child sees you as the centre of their universe, and deserves to experience warmth, safety and love rather than recurrent criticism. If other stuff in your life or your mental health or experiences of being parented are a barrier to providing the kind of care you want to provide for your child, get some help. Ask your GP or speak to your health visitor. Lots of good parenting services exist, and it really is a sign of strength not of weakness to seek them out when it might benefit your child.

I hope I observed an unrepresentative sample of the relationship today, and that there was something the child did that merited the negative feedback, like trying to touch the hot hairdryer or the plug sockets. We all have bad hair days and moments when we aren’t the kind of parent we would like to be. But it made me realise how much of the maltreatment I see in the histories of people through work is the chronic, insidious, low-level kind, and how we all turn a blind eye to that every day. Maybe I should have spoken up to ask whether I could help, rather than being caught up in my own discomfort and feeling it would be difficult/inappropriate to criticise.

Sadly, I am sure there will be another time in another situation with another parent, so hopefully I can give that a try.

Siblings, friends and vampire bats: a story of reciprocity

I don’t remember that much of my undergraduate psychology degree. This may be because I wasn’t paying enough attention at the time, or because it was two decades ago, or because I have built so much later knowledge on top of it that the foundations are no longer visible, or some combination of the three. But I do recall that for the most part it didn’t feel that relevant to what I was most interested in – how I could help to alleviate human distress. I didn’t really care much for the mechanics, chemistry or geography of the brain. The seminal experiments that built our knowledge of human behaviour felt more about history than something I could apply in my daily life or future clinical practise. However, one course surprisingly caught my interest: behavioural ecology.

In this class, the text by Krebs and Davies, was a joy to read and full of fascinating insights into how human behaviour is very much just an extension of animal behaviour. Altruism in particular may feel like a sophisticated moral drive, but is in fact just a sensible survival strategy within a community of related individuals. I wrote essays that argued that religion and law were ways to formalise the reciprocity of altruistic behaviour. I particularly remember about vampire bats, and how donating blood to a peer who has not fed is a mutually beneficial strategy within the community. Such apparently selfless acts become a worthwhile investment when there is reciprocity, as one day you may need to be the recipient rather than the donor.

This came into my mind recently when I asked my brother if I could borrow some money. I was surprised that he hardly seemed to think about it before saying yes, until my parents pointed out that I had loaned him money and otherwise put myself out for him many times in the past. Similarly I asked old friends whether I could stay over with them when visiting a different part of the UK, and they were super accommodating to me. Both times it was interesting to have the experience of being the recipient of selfless kindness, as I very rarely make demands on others, despite constantly expecting myself to be a giver (perhaps because I feel that I am lucky enough to have plentiful resources myself both physically and emotionally most of the time). However, it felt very good to be the receiver for a change, and reminded me of the fact that there is pleasure on both sides of the relationship, and that reciprocity is the marker of the best relationships. Being helped is obviously a positive experience, but the act of helping a loved one is also rewarding in and of itself, and makes it more possible to ask for their help in the future.

In the bigger picture, my tendency to be a donor rather than a recipient is also one that I have been thinking about in a work context. I’ve clearly chosen a line of work in which I am acting to support those in need, and where I put some of my own emotional resources into my job. I’ve blogged in the past about times of feeling quite burnt out by my work (particularly my expert witness work for the family courts, as it contains so much grim content about child abuse) and the lack of nourishing and supportive experiences provided by certain employers or employment experiences (where good work doesn’t seem to be valued, and people are expected to live up to unrealistic expectations despite being sabotaged rather than supported to achieve them). I find myself wondering: where is the reciprocity? What do we get back when the positive feedback loops are absent? I read an excellent article about sick systems, and I found parts of it eerily familiar when I think back to my NHS days. I’m not in a sick system now, as I run my own company. Most of the time I can do work I enjoy and be rewarded for it (in terms of positive feedback, thanks and payment), but I do sometimes still feel somewhat exploited. I end up doing lots of committee work, policy documents, best practise papers and making contributions to the work of others (mostly unpaid and in my own time), and often those who promise input to these things, or to my work, don’t deliver. So why do I keep doing it? I wonder whether it is echoes of that culture that I carry with me, or my own unrelenting high standards and expectation I can always be a donor, or some combination of the two…

If the bigger picture is too depressing, look at the little picture

Today we learned that we will have a Conservative government for another five years, and I woke up feeling very pessimistic about the world. Clearly there are a lot of people who were swayed by the propaganda churned out by the billionaire owned newspapers, and the scaremongering about whether Scotland would steal English money. This is a sad day for the NHS, which will continue to be fragmented and put out to tender. It is a sad day for anyone dependent on benefits or health and social care services, who will continue to be blamed, stigmatised and treated like second class citizens. It is another five years in which wealth will be leached from the poorest and most vulnerable members of our society and given to the wealthiest and least deserving. So I could have stayed in bed and despaired for the state of the world. But I didn’t.

Today I made a difference person by person through my work. I also gave blood, and hopefully helped a stranger in their time of need. I was friendly to my neighbours and colleagues so that they could be a little happier as they went about their day. I donated to the DEC appeal for Nepal to help a displaced family have clean water. I gave advice to a person I don’t know on the internet to help them get their landlord to repair the hot water in their home. I spent time explaining things to my children and helped them to understand that the decisions that benefit us personally the most are not always the right ones to make when weighed up against the greater good. In other words, I made several small positive ripples go outwards into the world.

I’ve learnt that when problems on a global or political scale seem beyond my reach to influence I have two choices, to let despair immobilise me or to take it as an incentive to action. Today I was able to take the latter path, and I hope that many of you can too.

Getting organised

If you haven’t realised it by now, I’m the kind of person that keeps a lot of plates spinning in my professional life. I end up getting excited about things and find it hard to say no, even when I don’t have the capacity to give things the time they deserve. Perhaps because of this overload, and my avoidance of putting a financial value on my work, I have always struggling to get on top of the finances of the business, keep up with invoicing, respond to queries and book things in with enough time to complete everything before the deadline. However, I have relentless standards for my own work, so I try to do everything to the best of my ability, even if it eats into my time out of work (or even my sleep).

Having so much on the go requires a lot of organisational skills, and I know that I sometimes fall short in this regard, so I am very reliant on having a good team around me and particularly a good PA. Thus it was a disaster for me (although fab news for her) when my admin decided to leave Lifepsychol earlier this year and go and bake cakes instead. Worse still, it came at a time that I had two new Assistant Psychologists without prior experience starting in post, and a whole lot of deadlines. I had also concluded that delegating the book keeping to the accountants was not cost effective, as they did not understand the ins and outs of the business, or have access to our files or close enough communication with me to resolve queries. I was starting to panic that I wouldn’t be able to keep up with the demands and everything would fall apart.

Thus it is great news that I have recruited a new admin/operational manager, who is helping me to get everything organised, and has taken on the finances of the company, along with some of the personnel functions. This has been a lifeline as it has really taken the pressure off me, and allowed me to start chipping away at a to-do-list that has been growing much faster than I have been able to check items off it. It is helpful that there is a central point of contact for the company who is there on a full-time basis, and that is making all our lines of communication easier, especially as I seem to be all over the country at the moment!

Today we signed up for Google Apps for Work to set up shared cloud storage for the company, and a more professional company email, calendar and task-list system. We are gradually working through the state of the finances, and catching up with invoicing. We even sorted out the materials in the cupboards, and re-homed the five boxes of left over questionnaires from the diabetes study, some materials that were ordered in error, and a massive collection of used lever-arch files.

This really pleases my inner OCD, as I really dislike the feeling of disorganisation and clutter in my physical or psychological space. I have high hopes that once we are organised things can tick over in a much more satisfying way.

I’ve also been offered one of 10 UK places to be supported by ImpactHub to scale up one aspect of my business over the next year, so I’ll write more about that in my next blog!