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Hello, my name is Jane O’Rourke. I’m a Child, Adolescent and Family Psychotherapist, and I’m a yoga and mindfulness teacher. Today we are going to be practicing soothing rhythm breathing.

How we feel effects how we breathe and how we breathe effects how we feel. So by slowing the breath down to a soothing regular rhythm, we can start to slow the mind down, and slow the body down, and feel less anxious and stressed. It’s also a really good way to give ourselves self-compassion, looking after ourselves, supporting ourselves. Soothing rhythm breathing also helps us to self-regulate by stimulating the vagus nerve and it increases our heartrate variability which is a really good marker of our body’s ability to respond effectively to stress. It will also activate your brain’s soothing system.

So starting to find a comfortable seated posture, somewhere where you can feel comfortable and your spine can rise tall, and your chest is open, your heart is open, your jaw soft, your shoulders are sliding down the back and you feel yourself rooted to the ground, and supported by the earth below. You can rest your hands in your lap.

We are going to be really slowing the breath down to about five breaths a minute. We are going to be aiming for a really smooth in breath and a really smooth out breath, so that the length of time you breathe in matches the length of time that you breathe out, and as we breathe we will be focussing on slowing the body down, so the mind can slow down too.

And before we start just checking our facial expression, and softening and relaxing the face so that you have a friendly expression on your face, reinforcing a friendly intent to ourselves. So I am going to be counting you in and out and then you can rest for a while afterwards, just breathing at your own rhythm.

So breathing in for a count of 1, 2, breathing out 1, 2, breathing in 1, 2, 3, breathing out 1, 2, 3, breathing in 1, 2, 3, 4, breathing out 1, 2, 3, 4, breathing in 1, 2, 3, 4, breathing out 1, 2, 3, 4, breathing in 1, 2, 3, 4, breathing out 1, 2, 3, 4, breathing in 1, 2, 3, 4, breathing out 1, 2, 3, 4, breathing in 1, 2, 3, 4, breathing out 1, 2, 3, 4, breathing in 1, 2, 3, 4, breathing out 1, 2, 3, 4, breathing in 1, 2, 3, 4, breathing out 1, 2, 3, 4, breathing in 1, 2, 3, 4, breathing out 1, 2, 3, 4, breathing in 1, 2, 3, 4, breathing out 1, 2, 3, 4. Last time, breathing in 1, 2, 3, 4, breathing out 1, 2, 3, 4. 

For now just let your breath just go at its own rhythm, breathing in and out in your own time and noticing as the breath has slowed down, with your mind has managed to slow down a little too. And all the while feeling connected to the ground and the earth below. Feeling a steadiness and rootedness, just focusing on the flow of the in breath and the steady flow of the out breath. And you can stay here for as long as you like, just watching the breath, feeling a steadiness and a rootedness or in your own time coming back into the room.

This breathing exercise is a good way to experience self-compassion for times when you need more self-care. Soothing Rhythm Breathing relieves stress and anxiety by slowing the body and mind down. Jane is a Yoga and Meditation Teacher, and a Psychodynamic Psychotherapist with Children, Young People and Families. She teaches Yoga4Trauma within the Trauma Service at the Tavistock and Portman NHS Foundation Trust.

Wellbeing Quiz Profile: #MoreFrantic #FeelingHopeless

Hello. My name is Dominic O’Ryan and I am the Lead Psychologist in Substance Misuse and the CBT Training Lead for Camden and Islington NHS Foundation Trust and I’m going to talk to you for a few minutes about sleeping well; in particular about sleeping well during these strange times.

I think it’s best to avoid all the literature that tells you about how bad it is to sleep badly. You don’t need any more information then how you feel. Sleeping well is also by definition good for you. Getting a good night’s sleep helps us feel refreshed and is very important for our physical and mental health.

However, heightened levels of arousal due to constant work and social stress, broken and shifting routines, home working, difficulties switching off and broken boundaries between work space and home space and sleep space, are amongst the kind of pressures that people are under at the moment and they can have an enormous impact on our wellbeing, and our sleep in particular.

We can find ourselves struggling to get off to sleep, we can experience broken sleep and nightmares, and we can experience general fatigue on waking, wondering if we’ve got any sleep at all.

So I’m just going to say a few things about what’s going on during sleep because I think it is helpful to remember that sleep has a natural structure and its own way of managing itself.

Firstly, sleep is driven by the earth’s own day-night cycle. This circadian rhythm is as in-built and important as any other biological or physical process. If we are working shifts, or not getting natural light in the day or we’re exposed to high levels of light at night, sleep will be broken. So the first step is to check on our own day-night cycle and to take steps as far as possible to retain or reset that soon and often.

Secondly, and paradoxically, sleep is designed to be broken. Sleep has distinct phases of light sleep, deep sleep and rapid eye movement or REM sleep. Dreaming happens in all phases but is mostly associated with REM sleep. These phases together last for an hour and a half or maybe 2 hours at a time. Even though we might think we should be sleeping for longer, we naturally come back to the surface of wakefulness after this time, then generally speaking we drift back to sleep without paying much attention.

But something that happens to all of us sometimes, and to more and more of us at these times, is we noticed that we’re awake and then we can become quite agitated about this, which in itself gets in the way of the natural process of falling back to sleep. And so accepting that waking up in the night is actually a part of sleeping well is a key step in returning to sleep.

Thirdly, humans are natural problem solvers. And we can easily fall into the trap of trying to use day-time active, conscious problem solving at night. We try to solve the problems of the day and we try to solve the problem of why we’re not asleep by actively thinking about them. This kind of problem solving is for day time only.

Instead, that’s something that’s sleep is designed to do on its own. The phases of sleep all have problem-solving components built in. They are there to help us consolidate memories, make sense of things, practice our emotional responses, and anything that we do that interferes with the natural process of sleep just makes the natural process unworkable.

If sleep is proving to be elusive just let sleep look after itself. If you’re not getting to sleep then look for a tendency to problem-solve and just allow yourself to gently stretch and let your mind wander off and do something else. The more we try and bring it back to problem solving of getting back to sleep, the more we’re getting trapped in active problem-solving mode when the problem really is something that can solve itself.

Paul Gilbert’s model of threat mind, drive mind and compassionate mind is very helpful here. We can experience poor sleep as a threat, so we get more aroused. We respond by using our drive systems to try to fix it. In reality the best thing to do is just to be gentle, kind, open and let the compassionate mind look after itself.

This part of ourselves can sometimes be tricky to activate and a simple soothing rhythm breathing practice for a few minutes, a few times during the day, can make it easier to bring on line at night.

And so, if you’re lying still in bed with your eyes closed in the dark, breathing gently, who is to say that you aren’t actually already asleep and you just think you’re awake.

Overall, allow your mind and body to look after you, by being kind to yourself during day and particularly at night.

Dominic O’Ryan qualified as a Clinical Psychologist from UCL in 2000. He is the Lead Psychologist in Substance Misuse Services and the CBT Training Lead for Camden and Islington NHS Foundation Trust. He talks about three simple approaches to sleeping well.

Wellbeing Quiz Profile: #MoreFrantic

The past few months have been a whirlwind; a time that has flown by whilst feeling protracted, life changing and leaving us struggling to remember what “pre-COVID-19” life looked like. You may have worked longer, harder hours than you ever thought possible. You may have been redeployed to a new role, moving even further away from “normal” life. You may have been told to “watch and wait”, bouncing between feelings of guilt that you “should be doing more” and anxiety as you anticipated the threat of redeployment.

Whilst our individual experiences may look different, we are united by two common themes: 1.We have all, for an uncertain period of time, had to say goodbye to our “normal” professional roles and 2. We have all been living in a high threat environment.  

So, as talk turns to establishing a “new normal” and re-opening services, I wanted to spend time thinking about what it’s like to “come home” from the experiences we have had.

Whilst our understanding of the psychological impact of COVID-19 on NHS staff is still emerging, we can begin to anticipate some of the likely psychological responses (and possible avenues for psychological support) from other areas of literature.

For example, research into the experience of humanitarian aid workers highlights how difficult it can be for them to return home from the experiences that they have had.

Humanitarian aid workers will often return home feeling emotionally and physically exhausted (following a prolonged period of time in a “high threat” state). Research highlights the experience of “vicarious traumatisation”, or the belief that one’s self (i.e. an individual’s hope or meaning) has inherently changed following exposure to a trauma environment. They have seen things that they can’t unsee, and are now acutely aware of how cruel Mother Nature and mankind can be.

Adjusting back to an old but now unfamiliar environment can contribute to a complex mixture of emotions including guilt, anxiety, anger and loneliness. It may also leave an individual longing for what they left behind, wanting to return to those that understood the challenges they faced.

Importantly, research further documents how difficult it can be for aid workers to seek support on their return either viewing this as “weak” or neglecting their own distress because “other people have it worse”.

Whilst the experience of NHS staff working in the COVID-19 pandemic and humanitarian aid workers cannot be directly compared, there are a number of similarities that may be able to inform psychological support moving forward. Importantly, research highlights the value of preparing staff for returning home (including debriefing and reintegration sessions), psychological assessment and psychoeducation.

Preparing to Come Home: Key Questions

With that in mind, I invite you to consider the following questions as you navigate this next period of uncertainty (it might help to get a pen and paper and write your answers down):

  • What am I coming home from?

Take a moment of gentle reflection, gently breathing as you do this. What impact did COVID-19 have upon your job role? What other challenges did COVID-19 bring? What difficult emotions have you had to navigate over the past few months? Try to offer yourself a sense of kindness and compassion as you reflect back upon some of the challenges you have faced.

Now turn reflection to your strengths, again gently breathing as you do this. How did you manage to navigate this time of difficulty? What helped you to cope? What did you say to yourself? Who else helped to support you?

  • What am I coming home to?

This may include reflection on what your new working role or environment looks like. Acknowledge that this may have changed, and that this may create new anxieties.

If you notice yourself getting overwhelmed by difficult thoughts or feelings, it may help to practice a grounding technique such as ACE.

  • What am I bringing home with me?

Continuing with your gentle breathing, try to think about what you are bringing home with you. This could be difficult emotions such as stress or anxiety about the future.  This could be feelings of guilt if you think you “have not done enough” , or a sense of sadness for a team that you are no longer working with.

You could also be returning home with positive emotions. What adventures did you have? How did you help and feel worthwhile?

Take a moment to notice what emotions are showing up for you. Gently acknowledge these, without judgement. As you gently explore these emotions, try to offer yourself the same kindness and compassion that you would to someone that you care deeply about.

  • What do I need to help me move forward?

Whilst this can sometimes be a difficult question to answer, try to focus on labelling the main emotion that you are struggling with. What might help you to best navigate this? What has helped you to manage this emotional response in the past? This might include seeking support from those around you, prioritising self-care, or problem solving areas of difficulty.

For additional ideas on how to best manage difficult emotions please visit the resources page on this website.

Dr Sarah Appleton is a Clinical Psychologist working in Employee Health for Central London Community Healthcare NHS Foundation Trust. Sarah explores the experience of returning to ‘business as usual’ following participation in a crisis response such as COVID-19, and helps us prepare to navigate this next period of uncertainty.

Wellbeing Quiz Profile: #LessInterested

Hello, my name is Jane O’Rourke. I’m a Child, Adolescent and Family Psychotherapist, and a yoga and meditation teacher. Today we’re going to be doing a compassion exercise.

Showing compassion for others often comes a lot more easier than showing for ourselves. But research has shown that if we can show compassion for ourselves, our mental wellbeing can be really improved and we can also sustain higher levels of stress and anxiety if we’re showing ourselves compassion through times of difficulty.

So, finding a comfortable position to either sit in, perhaps feeling supported by a cushion or maybe you’d like to lie down. So whatever feels more comfortable for you, and just allowing yourself to feel more settled here, so just allowing your breath to move freely ant noticing any tension in your body, relaxing your shoulders, relaxing the face, softening the eyes. So you can either close your eyes of just lower them, whatever feels good, and allowing the earth to support you. Giving yourself permission to do nothing for the next few minutes.

So as the body settles, allow your mind to as well. And then bringing to mind somebody you know who is going through some difficulty at the moment, and visualising them and perhaps you’re standing near them and looking at them and taking them in and saying to them “may you be happy, may you be healthy, and may you live with ease and grace”.

And notice them looking back at you with gratitude and feeling your sincerity and your warmest wishes to them. And then visualising them, sending their compassionate wishes to you too, and them saying to you “may you be happy, may you be healthy and may you live with ease and grace”.

And then bringing to mind any other people that might have really been compassionate to you in your lifetime, or somebody that you consider to be a compassionate figure. It might be a religious figure; perhaps Gandhi, Jesus, Mohammed or Martin Luther King, perhaps Mandela, or it might be a pet, an animal who you know has been a trusted and kind animal in your life. So there might be one or two people now standing next to the person who you know you’ve given compassion to, so there’s a circle around you all wishing you well. And they’re saying to you and looking into your eyes, and saying to you “may you be healthy, may you be happy, and may you live with ease and grace”.

And taking in their good wishes and noticing how that feels. Sometime sit can be quite hard to accept compassion from other but noticing if there is a little bit of resistance there, and then sending out compassion to everyone else who you know needs it and perhaps everyone else in the world might need you compassion and good wishes, and saying to them “may you be happy, may you be healthy and may you live with ease and grace”.

And just allowing the breath to settle again, feeling the support of the ground around you, feeling the support of good wishes and compassion from so many others in the world, and your compassion and good wishes resonating throughout the world to anyone who needs it. And if you like it, you can remain here for as long as you like, allowing the breath to be steady and feeling some of the support from the ground, or whenever you’re ready, opening your eyes and coming back into the room in your own time.

 

Jane O’Rourke guides us through a compassion exercise for wellbeing and ease at times of difficulty. Jane is a Yoga and Meditation Teacher, and a Psychodynamic Psychotherapist with Children, Young People and Families. She teaches Yoga4Trauma within the Trauma Service at the Tavistock and Portman NHS Foundation Trust.

Wellbeing Quiz Profile: #MoreFrantic #LessInterested #FeelingHopeless

Hello my name is Jane O’Rourke, I am a child, adolescent and family psychotherapist and a yoga and mindfulness teacher and today we are going to do a simple technique to help to embody the qualities of strength and courage.

So start by finding a sitting posture that feels comfortable for you, so it might be sitting on a chair, or you might find sitting on a cushion comfortable. The idea is that we start to embody the qualities of strength and courage. So first of all start by finding your sit bones, so you might need to take some of the flesh of the buttocks away a little bit, in order to find the bony bits to make contact with whatever you are sitting on. You might find that by finding that contact, it will start to help you give a really steady foundation to your posture.

So find your sitting bones on your cushion or on your chair and then start to rise out of that posture. So, you might find a little tilting forwards of the pelvis and so then your heart and chest can rise, and your shoulders can slide down the back and your neck is nice and long. So you’ve got a strong back and a soft open heart.

And then allow the eyes to close or just keeping them open a little, whatever feels most comfortable and start to do our internal weather check. So just noticing how you are feeling at this moment. So not pushing anything away, just allowing anything to arise, any feelings that you might be feeling, and just noticing these feelings perhaps as you would clouds passing by on a windy day, just coming and going.

And then start to give some attention to the breath and all the while allowing our spine to feel nice and strong, your neck nice and long.

And noting the breath now, and it might help you to focus the breath at the tip of the nose or perhaps in the chest or in the belly, so having a focus point. Noticing the rise of each breath and the fall of each breath, the texture of the breath at the tip of the nose, perhaps the warming of the breath on the out breath as it leaves the body.

And by embodying this strong posture and cultivating the qualities of strength and courage in your posture, it allows that feeling to become part of who you are in this moment. It’s not pushing anything away in terms of any difficulties or anxieties or worries, but allowing them to sit alongside the strength of the posture and the steadiness of the breath.

And every time your mind gets diverted as minds do, just gently bringing back the focus to the breath at the tip of your nose. Your spine rising tall, the chest is open and soft.

And you can stay here longer if you like or when you are ready very slowly coming back into the room in your own time and knowing this is a resource that you can come back to at any moment, sitting tall in your chair or on your cushion or in your seat when you want to embody the qualities of strength and courage.

 

Jane O’Rourke guides us through a simple technique to help to embody the qualities of strength and courage. Jane is a Yoga and Meditation Teacher, and a Psychodynamic Psychotherapist with Children, Young People and Families. She teaches Yoga4Trauma within the Trauma Service at the Tavistock and Portman NHS Foundation Trust.

Wellbeing Quiz Profile: #MoreFrantic #LessInterested #FeelingHopeless #RelivingTrauma

My name is Jo Williams and I am the Delivery Lead for the Practice Supervisor Development Programme and a Senior Lecturer at the Tavistock and Portman NHS Foundation Trust.

This podcast draws on some recent reflections from conversations with co-facilitators on the Practice Supervisor Development Programme, about the impact for supervisors in social work during the COVID-19 pandemic.

If the emotional landscape of social work practice wasn’t hard enough… the coronavirus onset has certainly increased the probability of fear, anxiety, tears, frustration and emotional meltdowns for practitioners in recent weeks…

What we have noticed, is that thinking is much harder to do, perhaps because the realities of our situation are sometimes too unbearable to think about…it is difficult for many of us to compute what is happening…this is a new experience for which there is no internal working model – yet…

We have found that our regular conversations on Zoom…in spite of the paradoxical feelings of ‘disconnected connection’…have provided valuable ‘thinking space’ where perhaps the familiarity of our relationship has provided containment… sufficiently enough to ignite new thought.

We are hearing from practice supervisors across the country, that during the recent onset of lock-down in the UK, many are adopting the practice of ‘checking in’ with their teams at the beginning of the day and ‘checking out’ at the end of the day

…this emerging practice will no doubt be serving as an essential ‘thinking space’ for them too…where stories can be shared…feelings can be expressed…made sense of and attended to…perhaps modelling a process for social workers to emulate with the people they support…

…the notion of uncertainty can seduce us into feeling that we must ‘do’ something…a theme of our conversations was to notice in ourselves and others sense of urgency to do something…a sense of ‘panic working’…and maintaining the status quo…

…we wonder if these reactive and instinctive ‘doing’ responses are perhaps a desire to mitigate our unprecedented experiences …and navigate adapted professional working practices…

…what is required first though…is for us to attend to our feelings…or our ‘being,’…there is a need to ‘pause’…to take a moment…to stand still and notice what arises for us within the intensity of the unfamiliar circumstances being encountered by everyone

…by doing this,  we can start to think more effectively about the sort of actions that might be most useful… …‘Being’ before ‘doing’ enables social workers and supervisors to more holistically understand the lived experiences of the people we support…

At the moment, the uncertainty and disruption that everyone is living with is extreme and ongoing and most people find high levels of anxiety hard to manage….we are all faced with the challenge of navigating how to look after ourselves and others in the face of something which is far too big for us to make sense of…

… for all of us in the sector, if there was ever a time to put our relational skills, experience and knowledge into practice, it is now…

…when the world becomes unfamiliar, it is all the more important to remember what is familiar…this situation requires us to hold on to the ordinary, everyday practices and ways of relating that we can rely on…this is the consistency that the people we support need…and what we can provide…

It is important to remember…that…when we are perhaps experiencing hopelessness ourselves…small acts of kindness and thoughtfulness…which are all within our agency…offer some comfort amidst the vast unchartered territory we find ourselves in.

So whilst we seek ways to process our feelings…and ways to think…we can a find new ways of being and doing…we all have the beginnings of a story within us, yet to evolve…and these unlived stories can take form through learning new ways of becoming and creating new ways to live…and new ways to practice.

Jo Williams is a Practice Supervisor Development Programme, Delivery Lead and Senior Lecturer, Social Care Leadership and Management Portfolio at the Tavistock and Portman NHS Foundation Trust. She discusses the impact for supervisors in social work during the COVID-19 pandemic. To accompany this podcast we share Jo’s blog on the Chief Social Workers for Adults, Guidance for the Support and Wellbeing of the Adult Social Care Workforce by the Tavistock, and a blog by Jo, Jerri Damman and Gillian Ruch entitled ‘Feeling, thinking, being: A call to mindfulness in times of crisis.

Wellbeing Quiz Profile: #LessInterested

Hello, my name is Jane O’Rourke, I’m a child and adolescent psychotherapist and I am a yoga and mindfulness teacher and today we are going to do the Butterfly Calming Technique. It is really good for when you are feeling stressed or anxious, and very easy to do.

So first of all, start by finding a comfortable posture, so just noticing where you might need to release some tension, perhaps the shoulders, or maybe the area around the jaw, or maybe even the root of your tongue.

And then notice how you are feeling today, I call it an internal check-in. So just noticing what thoughts are arising…

And then we are going to start to allow the breath to steady us. I like to say that the breath is like our life long companion because it is with us from the moment we are born. So imagine now that the breath is tenderly breathing through you, each breath giving us new life and helping us to steady.

And then cross one arm over your chest and then the other arm, so that your palms are resting over your heart and the fingertips are rising up towards the collarbones and it is like you are caressing yourself as if you would a really good friend.

And then start to create the shape of a butterfly by interlocking your thumbs, so that the thumbs become like the body of a butterfly and the fingers are like butterfly’s wings and you can choose whether you keep your eyes open or gently start to rest them down.

And then very steadily start to move the hands one by one like the wings of a moving butterfly, so that the right hand taps down and then the left in a nice steady rhythm. Left hand, right hand, left hand, right hand, left hand, right hand.

Find your own rhythm that feels steadying and comforting and just keep rhythmically tapping in this way, almost like the pat of a hand on a new-born’s back. Nice, steady, comforting tapping. Like the gentle rhythm of a butterfly.

And continue to do this as if comforting and soothing a loved one, gently feeling the vibration on your heart… Each breath is slowly moving into your abdomen as it rises with each in breath and gently falls with each out breath. And then when you are ready just start to slow down the tapping so it just becomes a very very slow rhythmic motion.

And then gently placing your hands wherever they feel comfortable, maybe on your knees or thighs or just resting in your lap. Notice how you are feeling now.

If there are still feelings of anxiety or stressfulness then repeat this exercise again and know that it is something you can always resource back to, your breath is always your constant companion and just placing your hands over your heart is like a loving self-gesture of compassion and self-care.

Take a few more breaths here, feeling a steadiness in your posture, a rootedness, a groundedness. Allowing the breath to just breathe through you.

And then whenever you are ready gently opening the eyes and coming into the room in your own time.

Jane guides us through the Butterfly Calming Technique which is an easy and helpful technique to use when feeling stressed or anxious. Jane O’Rourke is a Yoga and Meditation Teacher, and a Psychodynamic Psychotherapist with Children, Young People and Families. She teaches Yoga4Trauma within the Trauma Service at the Tavistock and Portman NHS Foundation Trust.

Wellbeing Quiz Profile: #MoreFrantic #LessInterested #FeelingHopeless

I have been hearing a lot about professionals in the public sector who are being redeployed and having to work in areas they do not normally deal with. With many people being exposed to things they had never been exposed to in their career before, like deprivation, death and like children at risk of harm. Even those who have not been redeployed are finding they are having to work in very different conditions, working outside of our normally tight guidance and governance rules. The phrase ‘We’re making it up as we go along’, comes up a lot, I’ve used it myself. 

Many of us are working outside of our comfort zone. Delivering services without the right equipment, without the benefit of face to face contact, with fewer resources and less contact with the colleagues who usually brighten our day. Some of us perhaps do not have much choice about being on the frontline, about being exposed to risks that make us anxious. Many are doing this whilst worrying about colleagues, friends or family who may be at risk or unwell and bearing the financial pressures and other losses that lockdown has brought. Some are doing this without the benefit of someone to meet up with at the end of the day, without that reassuring hug, that offer of a cup of tea. 

I wanted to talk a bit about what happens when we are pushed out of our comfort zone. In particular about what happens when we are exposed to distressing situations and pressures at work. I work in the Family Courts, and people often ask me how I cope with all of the upsetting things I see. To be honest how I respond usually depends on the day I’ve had. And this got me to thinking that the danger of giving messages to people about how to cope with difficult issues, is that it might give the idea that there is a right way to cope, that if you’re doing it right you should be coping, that coping means feeling fine and that somehow not feeling fine is not OK. What do we really mean by ‘coping’ anyway?  How do I know if I am ‘coping well’ with something?     

When I was thinking about this issue, I was reminded of a job interview, for my first job in safeguarding.  I remembering being the waiting room, and the interviewer handed me a case study and left me to prepare.  It was about an infant who had been severely injured.  There was detailed description. I felt like someone had punched me in the stomach, my heart rate shot out of control, I thought I was going to be sick.  Panic set in, the words on the page started to swim and I had the overwhelming impulse to leave. The over-riding thought in my mind was ‘I can’t do this’. In retrospect I think the only reason I stayed was that I couldn’t face that embarrassment of backing out at that point.

Ten years, and many, many sad and horrific stories later, whilst the stomach-punch panic response is not as strong, I have to be honest that the work still gets to me. In fact, I truly believe that to become immune to hearing about children being harmed, would be to lose my humanity. If I got to the point where I had no emotional response to such things, surely that would be a sign that I needed to leave. So how do I stay emotionally connected enough to stay compassionate without becoming overwhelmed by my emotions? As I say this, I notice, I’m back to this idea of a ‘right’ way of doing things. 

I still think that we collectively carry a notion that we somehow can become ‘OK’ with pain, abuse, death and loss. And we do as human beings have a tremendous natural ability to heal from both physical and psychological wounds. But often part of that healing process is about recognising the wounds, and feeling the pain. Often our natural healing processes are disrupted by being in too big a hurry to ‘be OK’, or at least, look ‘OK’. I think it’s also important to remember that healing doesn’t necessarily equate to feeling no pain. Rather it often means learning to carry on living, alongside the pain. 

The pressure to be ‘stronger’, to ‘cope better’ often triggers us into feeling even worse. I often hear people in therapy talking about how they feel others ‘cope better’, mistaking people’s outward calm as ‘better coping’.  Very often these are the very same people who are hiding their emotions from others for fear they will be seen as being weak. Enter our old friends, the inner critic and, it’s close cousin, the guilt monster. 

Many people have an inner critic, for some it’s just a nagging voice pointing out that the tablecloth isn’t straight enough, or that you really should have eaten that extra biscuit. For others, it is a relentless slave driver, beating the drum, constantly propelling you to work longer and harder, whilst always moving the finish line further and further away. 

The inner critic generally feasts on our fear that we not good enough, and our guilt monster believes that our entitlement on this earth is really only measured in what we do for others. Doing things for others is a great thing, but feeding the endlessly hungry guilt monster is a one-way road to exhaustion. And, here’s the snag, because the inner critic and the guilt monster are driven by fundamental fears about our self-worth, the more we feed them, the hungrier they get.    

When our self-critical inner voices take over, they often over-ride what your body is screaming out at you. These unforgiving voice will often tell you to carry on, be strong, don’t make excuses and never, never call in sick.  And then you find that, despite feeling exhausted, when someone asks you to do that one more thing, you mouth is saying ‘yes’, even if your body is screaming ‘no’.  In these moments we over-ride hunger, tiredness, pain and distress to our detriment. And that’s when we risk doing the real harm to ourselves.  The paradox is that our belief that it’s better to be ‘strong’, is actually what risks making us sick.     

However, the inner critic and the guilt monsters are wily creatures. Sometimes, I have actually found myself criticising myself for criticising myself. The issue is that when we try and battle with, or push these voices away, a bit like a wasp at a picnic, they kind of get more insistent. In reality, what we really need to do is let them be, but not take too much notice of them. Like a slightly irritating and judgemental relative at the dinner table.  Hear what they have to say, perhaps even give a polite response, but then let it go.   

Often, in the context of managing work stress, we hear a lot about self-care.  Taking breaks, talking to colleagues, engaging in mindfulness, eating well and sleeping well.  All of these things are immensely helpful in refuelling our tank. We know that working under stressful conditions has a cumulative impact on our bodies and we know these things are proven to be helpful.  We are literally bombarded with advice on social media about being mindful, eating well and focusing on ourselves.  

However, many people, me included, often find themselves ignoring that advice. Again, the self-critical and self-sacrificial parts of our minds tell us that that advice is for other people. That we are made of steel and we can, and therefore should, just keep going. Or, we really feel that we should follow the advice, but somehow don’t manage it, giving us another reason to beat ourselves with the criticism stick for not ‘taking care of ourselves better’. 

I’m not knocking good advice. It’s really helpful. But at the same time, it’s important to recognise why we don’t always follow that advice, and how that then makes us feel. 

An example of this is when people tell you ‘don’t take it home with you’.  Now I absolutely believe we should try and keep good boundaries between work and home. But this instruction suggests that we have some kind of water tight airlock in our minds that we can activate at the end of the working day. Now some people are great at that, but not everyone, not always. And sometimes, no matter how hard you try to detach from work, an image, a feeling, a painful detail, will follow you home. This is another moment to go easy on yourself and recognise that this happens sometimes.  That we shouldn’t feel bad about it. We should just feel human. 

Often the feeling that follows us home, is a feeling that we didn’t do enough, a worry that the person we tried to help, is still in pain or at risk.  It is really important to recognise that, however brilliant you are, there is a limit to what you can control. There is also a limit to how much you can do with the resources you have. The outcome of any situation is the result of many factors, not just how good a job we did. 

When we work in high risk or high need situations, we can feel terribly responsible for things that simply aren’t our doing. And this can be more acute when we are faced with vulnerable and distressed people. I always to say to my teams, imagine you are in A&E responding to a train crash, absolutely try your best to help people, but always remember, you didn’t cause the crash and you cannot save everybody.

Strong emotion, particularly anxiety, triggers powerful impulses to act.  When we see something terrible happen to someone else, a part of us says ‘that could you be you’, ‘that could be your child’, and activates our threat system. Our mind, detects the alarm and screams ‘do something’! The more frightening and shocking the situation, the more the force of our emotions can pull us into feeling we must act. But action is not always what is needed. Sometimes our compassion, our calm presence is more important than anything.   

So when we get home, whether the stresses of the day have followed us home or not, it’s helpful to allow ourselves the space to feel what we feel.  To let our inner critic chatter on like a radio in the background, without getting too involved. Whether we find ourselves using mindfulness, or crying, or binge watching box sets, or reorganising the fridge. To be aware that we all cope in our own ways, and the most unhelpful thing we can do is beat ourselves up for how we are coping.   

Some days are awful, and leave us feeling terrible. But if we can accept that and be kind to ourselves about it, more often than not the feelings pass. Like a plane bumping through turbulence, it can be uncomfortable and scary, but rarely dangerous. You can’t control the turbulence, all you can do is keep flying through it. And know that it’s not necessarily about flying the plane better.  You are already doing the best you can. And that is good enough.   

And if the turbulence doesn’t pass.  If you find that the awful feelings are still there the next morning, and the next and the next, if they are keeping you awake night after night, if your inner critic won’t leave you alone, if you feel numb and cannot connect with people and you feel like you are losing sight of the good in the world. Then yes, that is that time to seek more help.  And again, another time to be kind to yourself, because if you feel this way it is not your fault or failing, what you’re dealing with is just too much. As professionals we are not immune to depression and anxiety but we can often expect ourselves to be. Again, accepting how you feel without judgement, frees you up to seek the help you need. Berating yourself for not coping better, will make things much, much harder.

I hope you find some of these thoughts helpful, but if you didn’t, or if you find you can’t sit with your feelings, or you can’t ignore your inner critic, or you do agree to that extra shift, please remember, that’s OK too. 

Sheena Webb is a Consultant Clinical Psychologist, Service Manager and Joint Clinical Lead for the Family Drug and Alcohol Court Team, at the Tavistock and Portman NHS Foundation Trust. She speaks about what happens when we are pushed out of our comfort zone in response to distressing situations and pressures at work, and how to manage our inner critic.

Wellbeing Quiz Profile: #FeelingHopeless

I’m Robyn Vesey, Organisational Consultant at Tavistock Consulting, talking in this podcast about leadership and management in health and social care during the COVID-19 crisis.

Building on much of what has already been said in this series of excellent podcasts I want to highlight a few of the areas particularly relevant for leaders and managers, and for each area offer practical pointers for leaders and managers in their role.

First of all, we know this is an unprecedented, intense period of time, with a range – a kaleidoscope – of different feelings, particularly feelings of anxiety, grief, and helplessness. All of us are managing our personal feelings about our own family, friends and living situations, and many people’s work in health and social care has been hugely impacted.  Redeployment into new roles or having new staff join a team, usual routines and expected career plans disrupted, not being able to support people in the usual way when working remotely, and – most painfully – witnessing the distress and suffering of people, whether in intensive care with pneumonia, grieving for a lost family member, or someone struggling with their mental health now that face to face services are on hold.

At a time of such real crisis, the role leaders and managers play in practically supporting their teams is paramount, and in this communication is key.  Leaders need to be able to listen to staff concerns, especially where there are inevitable difficulties in the system and failures to provide what is needed, such as, in some trusts, PPE.  Leaders need to be transparent about what is happening, why, what is being done to address the situation, and tell staff when they will next be updated.  Responding to concerns, even when leaders are not able to provide the response they, and their staff wish, is crucial, so that staff can see what it is leaders and managers are doing to support them, and make some sense of the wider systems in place, as challenging as these may be.

Secondly, in this context of a global health crisis, the function of leaders and managers as emotional containers cannot be underestimated.  Many leaders and managers know and understand this, and that it will be managing and holding a particularly intense emotional load at this time. Leaders and managers need to continue to be aware of this crucial role and keep in touch with whatever they need to enable them to feel contained and supported themselves.

In particular leaders and managers need to be present and responsive to staff’s emotions, model empathy and kindness, validate what staff communicate and listen to difficult things without becoming defensive or retaliatory.  In doing so leaders and managers can create an environment where others feel safe to talk about the challenges and worries they are facing, so that staff teams feel more supported and connected to each other.

Leaders and managers need to give staff a message that their work – whatever it is – is valued, and to support staff in what they need in order to maintain relationships and feel connected. For example helping a member of staff to take part in a team meeting with their usual team, even if redeployed

And leaders and managers need to resist the urge to do, to rush, or to fix things out of anxiety, and instead seek the support that the time that is needed. For example, taking the time to think, talking something through with a colleague. Recognising one’s own limits in this way models self-care and means that better decisions are made.

Finally, leaders, like staff can recognise that they are operating in an imperfect system, and resist the pressure to be a heroic leader.  One helpful idea, especially in the time of a global pandemic – is that of tolerating the contradictions, and dissonance that are thrown up in this situation.

Just because there is anxiety, loss and even overwhelming feelings, does not mean there isn’t effective and productive work.  Every day people are carrying out important and valuable work across health and social care.

Just because there is conflict or anger doesn’t mean there isn’t collaboration and solidarity, with staff able to support and follow leaders and managers.

Just because there is helplessness and guilt about what cannot be achieved doesn’t mean there are no spaces where decisions and actions can helpfully be taken.

And just because leaders do not know what the next steps are, does not mean there cannot be trustworthy and competent leadership, responsive to the reality of the current context.

The more leaders and managers are able to bear the uncertainty and tolerate the contradictions, the better they and their teams will be able to work within the uncertainty and challenges of this crisis, with less need to take up unhelpful ways of functioning and so being able to continue to do their work effectively.

Robyn Vesey is an Organisational Consultant at Tavistock Consulting. In this podcast Robyn offers practical pointers for leaders and managers in their role during this challenging time, and how they can support their teams as well as themselves. To accompany this podcast we have added three resources; Managing Anxiety, Keeping a Gratitude Journal, and Coping With Nightmares And Sleep During Covid-19, we hope you find them useful.

Wellbeing Quiz Profile: #LessInterested

Hello my name is Jo O’Reilly. These are extraordinary times and our health services are under great strain. The wellbeing of an organisation is fundamental to the staff that work within it and to their ability to carry out their work. I’m going to be talking in this podcast about how all staff can contribute to supporting the mental health trust in a simpler way as possible during the coronavirus pandemic. In ordinary times, anxiety is managed and dilemmas are thought about in discussions with colleagues, supervision, meetings from clinical teams to trust board level. In a well-functioning organisation there is a hierarchical framework of activities, proving containment for anxiety in a multi layered way, which enables staff to perform their specific roles within their team. Support for the process of thinking is embedded within the fabric of the organisation, through these activities. These are extraordinary times however; COVID-19 brings a unique fear and level of threat related to survival. There is no blueprint to draw from; we are learning as we go along; there are few certainties.

The place of work and contact with our patients has become a potential source of danger. The ability of the mental health trust to manage anxiety has never been more important. So what can help the mental health trust to function in a healthier way as possible during the current crisis? I have 10 points to suggest.

  1. Anxiety and emotional distress at this time permeates every level of the organisation and challenges the ability to think. This affects all staff. It’s important to establish a culture and activities such as buddy schemes within which all teams and all staff check in with themselves and others about how they are doing. These can normalise anxiety and distress as entirely understandable responses, affecting us all. Identify particular vulnerabilitors and stressors within yourself and colleagues and have a low threshold for seeking further support. Increased uses of defences against anxiety may become problematics. Omnipotence is a common defence in healthcare professionals, in which we carry on as if we are invincible. This can place us at unnecessary risk of infection or emotional strain. All staff need to be realistic about their vulnerability. Look after your own health, follow precautions, use the protective equipment as advised and point out to colleagues when they are not doing so. Projection and splitting also increase when anxiety increases, which may mean uncomfortable feelings of helplessness or inadequacies may become located in others. This creates divisions between teams when we need unity. Avoid terms such as “non-essential services” or other urges to behave in such ways which may exacerbate such splits. Excessive projection in to managers to “do something” can also leave other staff losing their own agency and ability to contribute to the crisis. We are all in this together and we have something to contribute.
  2. Avoid the urge to “do” as a response to anxiety. Immediate and precipitative actions can create further anxiety in the long term. A degree of anxiety is inevitable and understand and we need to find ways to stay with this. Check that your decisions and behaviours are coming from a place of thought, rather than as an overreaction to anxiety or are based on panic. Running decisions by a colleague to think through usually helps. A word about emails; because of their rapidity and their wide reach, emails can be powerful vehicles to discharge anxiety into others. Take care when you write to people and watch out especially at times of peak anxiety, when writing a quick email may be an attempt to release anxiety within yourself and can create anxiety in others.
  3. Maintain, attend and support usually activities as much as possible. The organisation functions in some ways like a living organism, in which a change in one part of the system affects the whole. Closure or suspension of services causes further destabilisation and strain elsewhere and can make staff and patients more anxious. Education activities should continue in adapted forms where possible. There are opportunities for new learning and this also demonstrates that the senior staff and supervisors are not overwhelmed, which contains trainees and other staff.
  4. Maintain and increase opportunities for thinking and emotional containment. Excessive anxiety paralyses thought and leads to fight-flight modes of behaviour and decisions becoming led by anxiety, anxiety becomes the tail that wags the dog as it were. Increased anxiety in staff needs increased opportunities in the organisation to address it, reflective practice and opportunities to think about the emotional impact of the work and the dilemmas which arise should be continued and increased throughout all levels of the organisation, using remote platforms. These support staff to tolerate the discomfort of anxiety without becoming overwhelmed and enable them to perform their roles, whilst limiting contamination with anxiety from other parts of the organisation.
  5. Maintain differentiation of staff roles as much as possible, staff are not equally exposed to risk within the organisation and this needs explicit acknowledgement. It may be unfair, it is role dependent, and is a reality which cannot be avoided if staff more exposed to the virus are to have their specific needs attended to. Guilt in staff not working in the hot-spots of the organisation is increasingly and understandably being expressed. All staff can be helpfully reminded that they have skills to offer which will be needed at different stages of the crisis and they can best contribute from their areas of expertise. Unless acknowledged, guilt may lead to staff taking unnecessary and unrealistic risks, or putting themselves forward for roles they are not equipped to do.
  6. Leadership. The leadership of the organisation is crucial in setting the emotional tone and supporting staff to do their work. It is also having to make some very difficult decisions at the current time and needs the support of the staff. Establish regular, open and consistent channels of communication from the senior managers and use this to show that the leadership really wants to know where the areas of difficult lie. It’s really important that staff feed back to the leadership team and that they see how their feedback is contributing to decision making. It is also really important that the senior managers recognise helplessness and loss of control in the workforce as contributing to anxiety and to try to mitigate this as much as possible. Avoid overly positive messages which turn a blind eye to difficulties and which can undermine trust and increase anxiety within staff. The leadership team also model an attitude of curiosity and learning from experience when things go wrong. A hallmark of healthy functioning is not that the organisation and its staff make mistakes, we all do, it’s how the organisation responds when it gets things wrong.
  7. Team and colleague relationships are key to how we perform our tasks. Redeployment leads to loss of usual peer relationships and new teams are being rapidly created in which staff are carrying out new tasks. Don’t give up activities such as supervision and team meetings because the teams have changed. They are of even more importance in new teams where staff may be carrying out unfamiliar tasks and need peer support more than ever.
  8. Triggers and blind spots. Encourage all staff to be mindful of their internal states. Fear and threat trigger reactions based on previous experiences of trauma and loss, and teams will have their triggers and blind spots reactivated by anxiety. A team recently traumatised by patient suicide for example may have particular anxieties about further deaths in their patient group and may need additional support. Making these links helps to unpick anxiety and to process it, relieving some of its effects.
  9. The need for unity. Be kind to one another. Functioning during a crisis calls for unity. Increased stress will hit upon pre-existing tensions in the organisation. Expect this, it can be addressed later, and is best not done so in the heat of a crisis.
  10. Start preparing for recovery. This will not last forever; recovery will require opportunities for staff to process their experiences at work and should be negotiated with teams. If not addressed, challenging and traumatic experiences are likely to continue to exert their influences within the organisation. Loss and mourning for the workplace as being able to protect and adequately care for its staff will need to be openly worked through, to prevent ongoing grievance which can prevent psychological recovery. New ways of working, creative solutions, increased working across teams and cutting back of unnecessary tasks will also have emerged from this. The organisation will also have had an opportunity to learn about itself, its strengths and limitations, which can be taken forward as the basis for its continued development.

Dr Jo O’Reilly is a Consultant Psychiatrist in Medical Psychotherapy at the Camden and Islington Psychodynamic Psychotherapy Service. She is also a member of the British Psychoanalytic Society. Jo talks here about the kinds of familiar and potentially unhelpful processes that get going in organisations at highly challenging  times like these, with some suggestions about how we can try and respond from wherever we sit in the organisation. Her starting point is a mental health trust, but the difficulties are shared across working settings and being better prepared to manage them can make a big difference. To accompany this podcast we have added three resources; Using Controlled Breathing During Covid-19, Using Grounding Techniques During Covid-19 and Coping With Anger And Irritability During Covid-19, which we hope you will find useful.

Wellbeing Quiz Profile: #MoreFrantic #MoreIrritable

What are podcasts?

Podcasts are regular, short messages from wellbeing and mental health practitioners within this network. They will be directly responding to what we are hearing from you through both the Wellbeing Quiz and the ‘How Are You Today’ survey, as well as offering more specific presentations for targeted staff groups, for example social workers.

Once you have completed the Wellbeing Quiz, keep an eye on the hashtags underneath each of podcasts to help identify those which might be most helpful for you.