Podcasts

In Mindcast

Jo O’Reilly – Organisational Wellbeing

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

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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.
In Mindcast

Jane O’Rourke – Box Breathing Exercise for Sweet Dreams or Relaxation

Box breathing is a practice that has been taught all around the world to people working in frontline jobs. Jane O’Rourke takes us through this practice as a way of helping the body and mind to calm at times of stress or to help us sleep. Jane is a yoga and mindfulness teacher and a psychodynamic psychotherapist with children young people and families. She teaches yoga for trauma within the trauma service at the Tavistock and Portman NHS Foundation Trust.

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Hello, my name is Jane O’Rourke. I’m a Child, Adolescent and Family Psychotherapist, and a yoga and mindfulness teacher. This exercise called the Box Exercise is really good for helping you steady and ground, and also to do before you go to sleep.

So I’m inviting you to either lie down if you’re preparing to go to sleep, or you really need to rest, or to find a comfortable seated posture. If you’re lying down, get yourself nice and comfortable, perhaps by putting a cushion underneath your head and allowing the body to settle. And if you’re sitting up, then finding a posture where you can let your spine rise nice and tall.

And then I’m inviting you next to put a hand on your heart and a hand on your belly. And just start to engage with the steady rhythm of your breath. Perhaps notice in your hands rise on the in breath, as your belly rises and your chest rises. And then on the outbreath, the belly releasing and the chest releasing, so tuning into the rhythm of your breath. Feeling the steadiness of the floor, if you’re sitting up, that’s beneath your feet, or if you’re laying down feeling the whole body underneath you, being supported by the earth, feeling the steadiness of the earth, connecting with that, so that you can feel your whole body starting to relax. The breath starting to deepen and soften.

So in your mind’s eye we’re going to imagine the breath going around like a box shape. So, breathing in for a count of four and then we’re going to be holding it for a count of four, breathing out for a count of four and then pausing for a count of four before we begin again. So on your next in breath, breathing in for a count of 4, 3, 2, 1, holding the breath for 4, 3, 2, 1. And then breathing out 4, 3, 2, 1, and holding the breath for 4, 3, 2, 1. Breathing in 4, 3, 2, 1, holding 4, 3, 2, 1, breathing out 4, 3, 2, 1, holding 4, 3, 2, 1.

Breathing in… Holding… Breathing out… Breathing in… Holding… Breathing out… Holding… Breathing in 4, 3, 2, 1. Holding… Breathing out… And holding… Breathing in… Holding… Breathing out… Holding… Breathing in… Holding… Breathing out… Holding…

Last round, breathing in… Holding… Breathing out… Holding… And then just allowing the breath to move in and out at its own pace, not controlling it in any way. Feeling the steady rhythm of your own breath…

And you can stay here longer if you’re now going to sleep. Or in your own time allowing yourself to gently come back into the room in your own time.

Perhaps taking some time to look around, to centre yourself, taking in the room around you and gently coming back. Perhaps stretching, giving yourself perhaps a little shake if you need to re-energise before you can go on with the rest of your day.

In Mindcast

Jane O’Rourke – Breath As An Anchor 4 Minutes Short Practice

Being able to use the breath is a good way of finding an anchor when storms arise in our lives or if we just need some steadying. Jane O’Rourke leads us through a short practice to help us find a resource that is always with us, our breath. Jane is a Child, Adolescent and Family Psychotherapist, and Yoga and Mindfulness teacher. She teaches Yoga4Trauma in the Trauma Service at the Tavistock Clinic.

Wellbeing Quiz Profile: #MoreFrantic #RelivingTrauma

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Hello, my name is Jane O’Rourke. I’m a Child, Adolescent and Family Psychotherapist, and I’m a yoga mindfulness teacher.

This is an opportunity to find the resources that are always there for us within side ourselves. The breath is an incredibly helpful way to find space and steadiness, to find a connection to our true selves.

So finding a comfortable seated posture, or you can remain standing if that feels better. And allow yourself to feel the contact with the floor if you’re standing, perhaps with your contact with your feet on the floor, or if you’re sitting then finding your sit bones so you can rise nice and tall.

Allow the shoulders to drop. Allow the face to soften, so the jaw to unlock, the root of the tongue to soften, the space between your brows to soften and just starting to notice where you feel the breath most prominently. It might be at the tip of your nose, perhaps feeling the soft breath touching your nostrils, or it could be in the chest gently rising or maybe in your belly.

And just for the next couple of minutes, we’re going to be focusing on that, just where you feel the breath most prominently. And of course your mind will wander off as minds do, it is their job to be curious about what’s going on around you. But the practice is just to gently, when you notice your mind has wandered off, to bring it back. Gently bring it back to this focus of your breath. Giving yourself permission to not be distracted by anything else just to do this for the next couple of minutes. I’m gonna be mostly quiet I might just give a little reminder or two. But for the next minute or two, just leaving you in quietness with your breath.

Gently bringing your mind back. If it’s wandered off, back to your breath.

And then becoming aware again of my voice. Feeling how your breath is now, perhaps it’s steadied a little… and staying here for longer if you need more time to study. Otherwise, whenever you’re ready, gently coming back into the room in your own time.

In Mindcast

James Ollerenshaw – Keeping Hope Alive During A Global Pandemic

James Ollerenshaw is a Mental Health Nurse working in acute inpatient care. Here he discusses how life on the ward has changed during the Covid crisis, and how staff maintain hope for their patients, and for themselves.

Wellbeing Quiz Profile: #FeelingHopeless

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Hi, my name is James and I’m a registered mental health nurse. For the past year I’ve been working across three wards in an acute mental health setting just outside of London. Initially I was working on an all female ward, but the strain that Covid put on the NHS caused on resources and staff, forced us to reduce our capacity. As such we’ve now condensed to have two mixed gender wards.

In mental health nursing, one of the first concepts that we learn about is unconditional positive regard. Put simply, this is the belief that anyone is capable of positive change. Our patients frequently don’t see any light at the end of the tunnel, any hope that things could change for the better. Which is why it is so essential for Nursing Staff to keep this glimmer of hope alive for them when they aren’t capable of seeing or believing it for themselves.

Recent global events have made staying true to this value so much harder, for staff and patients alike. We’ve all faced disruption in some form or another, as staff we’ve been separated from the ward and teams that we know and trust. Our patients have endured further constriction in a setting that is already fraught with restriction. Visits by family’s and loved ones have only just begun to return for those unable to leave the ward due to their status under the mental health act. Even these visits are few and far between and heavily regulated. Any capacity for leniency or making exceptions has disappeared.

Life on the ward is very different now. Many workers deemed unessential, like activity staff, chaplains or even advocates are unable to come and visit, to break the monotony of life within a small ward. New patient are confined to their bedrooms for the first few days of their admission while staff wait for Covid results to come back. Most importantly, the staff members who are interacting with them in their time of crisis are often wearing face masks, losing the most important form of communication, facial expression.

Further to this, patients who are recovered to the point of being ready for discharge are faced with impossible choices to make. Housing associations and step down placements are at capacity, community services are severely limiting face to face visitations and family homes they could have returned to have become unviable due to loved ones shielding.

Our patients who experience psychosis or delusions of another nature have been influenced by the events unfolding on the television each day. Many tearful individuals have told me that they believe that they are to blame for the pandemic, and that the guilt is killing them. Similarly, patients with religious, conspiratorial or outright racist tendencies have openly expressed their support for the virus in the communal areas of the ward, claiming that it will purge the world of sin, or that this is the first step in an apocalyptic plan

So how do overstretched and under resourced staff members hold hope that their working conditions, and more importantly, their patients can improve now? It is entirely unclear when we will be able to get back to “business as usual” or whether what we considered to be normal will ever be a state we can return to. I wish there were easy answers to these questions. For their part, hospital management have attempted to be as transparent as possible about ongoing plans for the unit, and what support staff can expect to receive, but we are all aware that there is no magic wand to fix these problems. As would be expected, the already high turnover of staff has increased further, and long-time staff have elected to take an early retirement.

For my part, I have been truly inspired by the students who continue to come and work diligently on the ward in these difficult times, who continue to care and develop their skills despite not being paid to be here. Their courage and commitment gives me hope the next generation of nurses.  As for the permanent members of nursing staff, it’s undeniable that a tole is being taken on us. The policies we work with change on what feels like a weekly basis, each time we enter the ward it feels as if we’re walking into the unknown and the inevitability of staff burnout feels close at hand. But through all of this, we have rallied together to take care of each other. No matter how overwhelmed we feel, we still turn up on time and leave our personal baggage at the door. We take the time to look after each other, whether that be a debrief after a bad shift, covering duties for each other to make time for our breaks or bringing in a coffee round and treats to share in the morning. No amount of pressure will stop us from trying to bring laughter, smiles and love onto our ward each day.

As hard as it gets I still hold on to my fundamental principle, my belief that all my patients are capable of making meaningful recoveries and improving their lot in life. This past year has made an already difficult job feel impossible to achieve, and while I’m still hopeful, achieving a good standard of care in services as they’re currently structured becomes harder and harder each day.

In Mindcast

Lydia Hartland-Rowe – On Grumpiness

Lydia Hartland-Rowe is a Consultant Child and Adolescent Psychotherapist and Portfolio Manager for Psychological Therapies for the Tavistock and Portman NHS Foundation Trust. Here Lydia discusses something we are recognising about where we are in relation to the pandemic and in the face of what is coming, an increased tendency towards irritation and anger, or as the podcast say, grumpiness. Feeling that way at times, at the moment, makes sense and while it might at moments make things difficult, grumpiness is known to be something that shifts and lifts and that we may need to make space for in ourselves and others at the moment.

Wellbeing Quiz Profile: #MoreIrritable

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One of the complicated things about the current and ongoing situation created by the global pandemic, and maybe especially at the moment,  is that it both creates new strains and challenges for us, but also may subtly magnify strains and challenges that were there already. And equally, while some of our responses to what has been and is happening may be new, for the most part they will connect to   who we are already and  our particular ways of processing and responding to things. Some responses to a potentially traumatising experience may seem more obvious and understandable; sadness, shock, tiredness. But what do we do if we are someone, or work closely with someone, whose particular way of responding to the challenges posed by the pandemic is to be more irritable, grumpier, more prone to anger? It’s hard enough at the best of times to remember that when somebody is angry or bad-tempered it may be that there is an underlying anxiety, fear or sadness, but just at the moment it may be even more difficult when there is so much strain around for so many, and where, if remote working is part of the mix, it’s harder to read some cues that might help.

As with so much that can happen to us at a time when there is so much stimulus to take in, and much of it potentially very unsettling, one of the most important things to be able to do is to notice what you are feeling. Just that. It is easy to settle into being fed up and grumpy, and in a modern NHS or social care setting to find lots of reasons to explain it that are outside yourself, but it may be very helpful just to pause, and notice if you are more short-fused than usual, or that anger is harder to step away from. And at that moment to ask yourself whether it’s possible that your state of mind might be in some way related to the extreme situation that is unfolding, even if you are not aware of being specifically angry about that. This isn’t a pass to behaving unkindly to colleagues, or to allowing yourself to get really filled up with anger, but it is a way of just reminding yourself of the context, and of the need for compassion.  There can sometimes be a bit of a luxury in getting filled with righteous irritation, but the cost to working relationships can be high, so taking that moment to see whether there might be something happening beyond the immediate apparent cause of your anger can be an important break in the cycle.

There are of course practical things you can do. Taking a few minutes out, a walk, a conversation with a colleague, or if you need something more focussed, a breathing exercise or calming technique. But of course, sometimes when we feel filled up with something, it’s hard to do what we know would be helpful or good for us, and so it might also be that one of the most helpful things we can do is after the fact; some recognition of the strain we are under, and some leeway in the expectations we have of ourselves – so basically, it won’t help to beat yourself up if your usual calm manner  isn’t sustainable, and the important thing is to pause and go forward.

Of course, the thing about grumpiness rather than more obvious distress, is that it can have an impact on how we feel about each other; the email that gets sent too quickly, the impatient tone that we wouldn’t normally have. So while it is still reasonable   and important to expect basic standards of courtesy between colleagues, it may also be helpful to use a little imagination if someone is less patient than usual, more prickly. Ideally, this won’t just mean suffering in silence and   sympathy but might mean an opportunity to check in with each other, but sometimes that won’t be possible or the right space, and then it might be enough just to pause before getting too stuck in a view about someone to think about where their irritation is coming from, and whether some of it, even if it doesn’t feel justified, is just coming from the wider situation.

 I think it can be particularly hard, if you are the person feeling angry, if you aren’t aware of having had an experience over the past 6 months that has been obviously a source of upheaval, so you haven’t been ill, haven’t been working in an acute context, haven’t lost anyone close or had your livelihood threatened – and yet you are still stirred up in this way. But you are also a member of a society that has and is going through experiences collectively that are a source of sadness, powerlessness and fear. So it may well be that at moments, some of this gets into you, in an ordinary way but still in a way that can feel really uncomfortable unless you find a way to understand and forgive it, in yourself and others.

That isn’t to say that there aren’t things to  be angry about, to claim justice for, and to raise with your organisations if they need challenging – and we have seen that in relation to the inequities highlighted by Covid-19 as well as by the issues re-exposed through Black Lives Matter. But taking the time to sift through anger that can be useful and creative in making change where it’s needed, and anger that might get in the way of good working relationships and your own ease of mind is really important at the moment, and is likely to continue to be for the foreseeable future.

In Mindcast

Jane O’Rourke – Grounding Breathing Practice To Cultivate Relaxation And Gratitude

Jane O’Rourke offers a breathing practice to help relaxation and gratitude. Research shows that cultivating gratitude is helpful for stress and anxiety and for appreciating the good things we have in our lives, whatever the difficulties. 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 #RelivingTrauma

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Hello, my name is Jane O’Rourke, I’m a Child, Adolescent and Family Psychotherapist and a yoga and mindfulness teacher.

So let’s begin by getting a nice, comfortable posture, so where you can find your sit bones, so maybe putting a cushion underneath what you are sitting on, whether you are sitting on the floor, and sitting nice and tall if you are in a chair. So allowing the shoulders to slide down the back and keeping your neck nice and long. And then begin to soften the face, releasing any tension in the jaw, allowing the route of your tongue to relax, and allowing your hands to soften in your lap. And then begin to notice your contact with the floor, feeling the steadiness that is there for whenever we need it, and if you like on the next in breath drawing up that steadiness all the way through your body, and then on the out breath a releasing and letting go back down to the earth. So breathing in steadiness and breathing out and letting go, releasing any tension. Doing this a couple more times, filling the belly on the in breath and then a slow releasing and letting go on the out breath.

And now start to connect your attention to the breath where you are most feeling it in your body, so that could be in your belly, in your chest, or maybe at the tip of your nose. And your attention might wander off lots of times, our minds often keep us very busy and distracted, so just gently bring back the attention whenever this happens. And just focussing your attention on the physical sensations around the breath, so the rising and falling of the belly over the soft texture of the breath at the tip of your nose and all the while keeping a steady connection to the earth, keeping us anchored…

Keeping your attention on each flow of the breath, on the in breath and then on the out breath, noticing the little pause before you draw the breath and the little pause before you breath out. And noticing the cycle of the breath, perhaps give us a little extra gratitude for our life force, for the life we have been given. Our breath is our constant companion from the day we are born until the day we die, and just cultivating appreciation for this very simple thing, this very essential thing, our breath. It can be a wonderful practice to help us be in the moment and to give gratitude for our lives, and so before we leave this practice it might be that you want to draw attention to anything else that you are grateful for in your life alongside this breath. And just noticing how you feel as you bring attention to maybe some very small things in your life, or maybe some big things, some special people, or any aspect of your life that you are grateful for…

And just taking a few breaths here in this practice before we finish, a few extra moments to ground and settle… And stay here for as long as you wish, or gently opening your eyes and coming back into the room in your own time.

In Mindcast

Neelam Solanki – Junior staff experiences during a global pandemic

Neelam Solanki is an Assistant Psychologist working within the National i-THRIVE Programme Team at the Tavistock and Portman NHS Foundation Trust, and has also been working on Together in Mind. Neelam shares her experiences of being a relatively junior member of staff through periods of great change and uncertainty, and its impact on her wellbeing and future.

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Hello, my name is Neelam Solanki and I’m an Assistant Psychologist working at the Tavistock and Portman NHS Foundation Trust. I work primarily within the National i-THRIVE Programme Team, however, I was redeployed at the beginning of lockdown to work on a few different projects within the Trust, one of which was here at Together in Mind.

I started at the Trust in February 2020 and was working in my role for about four weeks before we went into lockdown, and my experience from there on has been a little bit “all over the place” to say the least. I found that I was only working for about two sessions (a day) per week in terms of my actual job role, and otherwise I found that I was being asked to help whoever needed it for whichever project, whenever they needed it. Initially this was really exciting and it meant that I got to know a lot of people within the Trust who otherwise I may not have met, but after a while it became exhausting and anxiety inducing as I felt more and more that I did not really have a place, a purpose, or a defined role.

Over the last 6 months, I have been reflecting on what it means for me and others in a similar position as a relatively junior member of staff, and the unique tasks and asks we’ve had which we may unlikely have the experience, the training or the foundation of knowledge to prepare us for. But then, there’s the catch-22, because the fact that we’re not particularly tied to a job role and don’t have a particular job to do that no one else can do, we can be more flexible about supporting other teams and projects. COVID has enabled me and so many others to become sort of a ‘jack of all trades’ but of course the other half of that phrase is ‘master of none’. I am so grateful and genuinely excited about the new experiences that have been presented to me, but it has been difficult to feel settled or like I fully know what I’m doing. And I’m certain that this isn’t just the case for more junior members of staff, COVID has meant that everyone has felt unsettled and lost at some point.

Another consideration is that as an Assistant Psychologist who intends on applying for clinical training later this year, everything that I do in my job is for the purpose of giving me the relevant experience and skills and knowledge and confidence to be an attractive candidate. Although there is some safety in the knowledge that all of the other hopeful assistants in the country are likely feeling the same way, there is still that feeling of dread that we don’t have a safety net. Developing my psychological skills hasn’t been a focus over the last period, so then what do I talk about in my application? What does this mean for my future?

It’s hard not to think about the 5,500 final year medical students who had to graduate early to join the workforce, as the need to manage COVID was, and still is, so high. I cannot begin to imagine what the impact of suddenly transitioning from student to doctor would be, particularly on their confidence and feelings of preparation, and what a hit their mental health and wellbeing could have taken.

During these times, things like inductions, training, support, and supervision have understandably taken a backseat because there are more pressing issues, however the impact of this is that the more junior workforce lack the confidence in themselves and the feeling of ability to do the tasks we are being asked to. For me, and in particular after taking the wellbeing quiz on Together in Mind, my profile came out as ‘More Frantic’ which made complete sense. The panic of feeling displaced, not particularly useful but also feeling as though I’m giving 110% to multiple teams all day every day took its toll.

But it is not all doom and gloom. The opportunities have been amazing and truly insightful, and although it might have taken a few months, the relationships that I’ve been able to build with such a huge range of people from different teams, divisions, disciplines and organisations feel positive and strong. I do not think that I’m particularly qualified to advise anyone who may be feeling this way at all, but to keep to the trends of the last 6 months I’m going to do it anyway: always ask for feedback. Talk to your line manager when it feels like too much. Say no if it’s not manageable. Resist the urge to want to prove yourself at every opportunity – it’s exhausting. Take breaks! Take that FULL lunch break away from your screen.

The point of being a junior member of staff if that eventually we hope to be senior members of staff. It’s hard to forget our goals when everything is so unsettled but the one main take away I’ve learnt is to use every experience to my advantage and learn, learn, learn. And to have frequent pet breaks. And to never run out of milk for tea. And have a really well-stocked snack cupboard.

Good luck to everyone and well done for coping as well as you have. Thank you for listening.

In Mindcast

Dominic O’Ryan – Dropping Anchor

Dominic O’Ryan, Lead Psychologist with Substance Misuse Services at Camden and Islington NHS Foundation Trust. Dominic contributes some thoughts and practical guidance about how to find ways to pay the necessary attention to how we are in the context of a global storm that has in some ways come to feel like just the way things are.

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My name is Dominic O’Ryan and I am Lead Psychologist with Substance Misuse Services at Camden and Islington NHS Foundation Trust.

There are times when we might feel that everything is running away with us …

We feel lost and distressed.

At these times it’s helpful to pause for a moment, to drop anchor…

Dropping anchor won’t make any storms go away, but it may allow us to notice what is happening, gather our inner resources and make steps towards self-care and action.

Our mind might tell us that it is not worth pausing because the risks are too great. If we stop even for a minute, we might become even more lost. We might discover something that we couldn’t bear, or we couldn’t manage.

Notice these thoughts and be kind to them. They are there to try and protect us from harm.

And then we can sit up or stand, plant our feet firmly on the ground, adopting a posture of someone being attentive. And alert. And kind.

Acknowledge what other thoughts are here? Are there thoughts about being overwhelmed? About not being able to cope. Maybe thoughts about never being good enough.

Maybe there are no thoughts in particular.

And rather than trying to change the thoughts or push them away or chase after more worthy thoughts, just notice what is here now.

And notice the feelings that are present alongside them. Maybe give these feelings and emotions words that describe them for you. Notice worry. Notice fear. Notice sadness. Notice anger with ourself or others. 

And just connect with and notice what is here in the body. Become aware of what’s happening in the body.

Perhaps notice a heaviness. Or the breath being short or shallow.

Notice the heart racing. Notice tension or holding or bracing.  Or stillness.

And be aware of immediate behaviours, perhaps avoidance, procrastination, perhaps too many biscuits, being snappy with colleagues or giving too much of ourself to others without attending to our own needs.

And then at that moment, allow the thought that maybe, just for now things are okay.

Bring to mind purpose, intention, values.

And then bring to mind just one or two behaviours that map onto those intentions and values. Behaviours that can be started and embodied straight away.

Perhaps taking a break, going for a short walk, sitting quietly for a little while longer. Or maybe there’s an email or a brief report that could actually be finished in a relatively short period of time, if only it could actually be started.

Perhaps something about turning towards a colleague. Asking them for something or offering them some kindness.

Whatever it is, whilst it may only be a small action it can still be a valuable action.

And maybe it is important to drop anchor a few times each day. And that’s alright. It’s okay to pause. And it’s certainly alright to check in on our intentions and values and sense of purpose.

And it’s always alright to turn to friends, family and colleagues to make connections, offer help and ask for help.

To be human. 

In Mindcast

Jane O’Rourke – 4 Minute Triangle Breathing Exercise To Feel Refreshed And Rested

This four-minute triangular breathing exercise is for when you want to feel more rested and rejuvenated. 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

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Hello, my name is Jane O’Rourke, I’m a Child, Adolescent and Family Psychotherapist and a yoga and mindfulness teacher. Today we are going to be practicing triangular breathing. It’s a way of helping us to slowdown in our day, just finding a few minutes for ourselves to slow the breath so that we can slow our minds, a feel a little bit of steadiness and calm.

So finding a comfortable posture so you can be standing if you like, or maybe if you would like to sit in a chair, find a cushion and sitting on the floor, making yourself comfortable. Softening the jaw, relaxing the shoulders, softening the space between your eyebrows so there is no tension being held in your face. And then just noticing how you are feeling in this moment, I like to call it an internal weather check. So noticing how you are feeling physically, any tension being held in the body and noticing how you are feeling too. It can be really helpful to name what those feelings are.

And then, begin to imagine a triangle in your mind. So let’s start at the bottom corner of the triangle and breathing in for 1, 2, 3, hold the breath as you imagine in your mind’s eye coming up to the top of the triangle for 1, 2, 3 and then breathing out for 1, 2, 3 as you come back down to the bottom of the triangle. Breathing in, 1, 2, 3, holding the breath for 1, 2, 3 as you come up to the top of the triangle, then breathing out for 1, 2, 3 as you go back down to the bottom of the triangle. Breathing in 1, 2, 3, hold the breath for 1, 2, 3, as you come up to the top of the triangle and then breathing out 1, 2, 3. Breathing in 1, 2, 3 holding the breath for 1, 2, 3, and then breathing out 1, 2, 3. Breathing in 1, 2, 3 holding the breath 1, 2, 3, then breathing out for 1, 2, 3. Last time, breathing in for 1, 2, 3, hold the breath for 1, 2, 3 and then breathing out for 1, 2, 3.

And then just allow the breath to go at its own pace, so not forcing anything, giving yourself a few moments now just to ground a little more, feel the steadiness of the earth beneath you… and lets finish by doing this internal check-in once more, just noticing how you are feeling in this moment physically, what emotions are arising for you, everything included, nothing excluded. Just noticing how the breath is now, just taking the last few final breaths here doing this exercise and you can stay a little longer if you need or whenever you are ready coming back into the room in your own time.

In Mindcast

Lydia Hartland-Rowe – Wellbeing Quiz

Lydia Hartland-Rowe introduces the Wellbeing Quiz, explaining why we have created this new resource, what we hope it will do and how we are thinking about the current situation. You can access the quiz on the Together in Mind website home page and we hope you find it interesting.

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Hello, my name is Lydia Hartland-Rowe. And I just want to say a bit about the quiz that we’re adding to the website today to explain what we hope it will do and how we’re thinking about it.

The aim of this website, part of a project across North Central and Northeast London to provide resources for staff support in the context of the pandemic, has always been to respond to what we’re hearing about how people are and what they feel they need in the NHS and social care sectors. Some of that was a bit easier earlier on in the unfolding of what COVID-19 has brought us when such stark events were taking place and it was, on the whole, not difficult for people to know what was having an impact on them, what might help and where the strain and stress were located.

For some people, of course, those who are working face to face with people who are ill and dying of the coronavirus, and those working with people whose lives have been changed by contact with the virus may still be working in very similar ways to the ways they have been since March or April and that’s even while in London anyway, the official guidance since lockdown has changed and keeps changing. But for many of us as we get used to new ways of working and relating to each other, it can seem as if the most acute times are over and that we ought to be able to get on as we were before without being slowed down or affected too much by the events of the past few months.

But what we know from those with expertise in the field is that the most important time to be alert and ready to notice and think about the impact of having been exposed to potentially traumatising events is after they’re over. And this is of course quite complicated with COVID-19 for a number of reasons; one quite simply is that trauma is felt differently by different people for different reasons. The same event can be experienced by one person as deeply unsettling, shaking their core in a way that can feel profound and hard to recover from and by another, as something undeniably difficult but recoverable from.

Sometimes within a team of people, these different responses will also reflect something about the team as a whole. So one person’s vulnerability is important because it recognises the vulnerability within the team, and someone else’s resilience shows that this is also part of what the team has to offer, and both are important. We don’t always know what it is in our experience and in our own individual and personal way of processing our experiences from very early in life that will make the difference between being at any moment, someone who remains fairly steady in the face of events while noticing their severity and someone who feels more fundamentally shaken up. And the cue that causes the shake up can be something very particular and not apparently obvious, either to the person that happens to or to colleagues and friends.

Well into that highly personal situation that is the different ways that each of us responds to the same events that we live through comes the other really complicated ingredient that with COVID-19 we just don’t know what’s coming next. We know more than we did six months ago but there’s still so much uncertainty, not just in relation to the behaviour of the virus itself, but in terms of its impact on global society and on family life all at once.

That’s the context. And it means that this is a time when it’s really important to be keeping a thoughtful eye on how we are and on how those around us seem to be managing.

In the early stages of the pandemic, trauma experts talked about the importance in the immediate aftermath following a traumatic event of watchful waiting. Well, clearly, we’re not quite in that place anymore now that COVID-19 and its impacts has been with us for some time. But just because we’re no longer at that acute point, it doesn’t mean that it isn’t still important in ordinary ways to be aware of how people are and alert to what different experiences people are having on an emotional level. So being ready to support and enjoy the resilience and capacity of those who are feeling well and healthy, while at the same time being open to noticing where people may be struggling and what the signs might be.

We also know from trauma experts that there are some typical ways in which responses to trauma show themselves in really ordinary ways that don’t necessarily become problematic, but might be worth recognising and being aware of.

So this quiz is aimed at giving you a chance to pause and get a sense, broadly, about where your current ways of responding to what’s happening now might show themselves. It’s not a diagnostic test, but just a chance to stop and notice how you’re managing, what direction your responses to experiences seem to take you in, and where you might turn for resources if you were to feel that would be helpful.

We worked with our trauma lead here at the Tavistock and Portman NHS Trust to develop the quiz and some broad profiles describing typical ways that we might be responding to things at the moment. We’ve added the Wellbeing Quiz Profiles to the podcasts and resources they align with using a hashtag and the profile title in a similar way to how hashtags are used on Twitter. This will enable you to search for podcasts and resources that align with the profiles that are produced once you’ve completed the quiz.

We’re also asking you if you want to let us know what role you’re in and where you work, so that this anonymous information can help us to understand more about patterns of response, and need for staff support in our different organisations. I hope that you find the quiz of interest and of use and as always, we welcome feedback and suggestions.

In Mindcast

Jane O’Rourke – Self-compassion and Self-care 5 Minute Breathing Exercise

Needing more self-care? Jane O’Rourke leads us through a self-compassion breathing exercise to help nurture and steady ourselves. Jane is a Yoga and Mindfulness teacher and a Psychodynamic Child, Adolescent and Family Psychotherapist. She teaches Yoga4Trauma at the Tavistock Clinic.

Wellbeing Quiz Profile: #MoreFrantic

View transcript

Hello, my name is Jane O’Rourke. I’m a Child, Adolescent and Family Psychotherapist and a yoga and mindfulness teacher.

So start by finding a comfortable posture. It might be that you want to sit on a cushion or in a chair or perhaps lying down, whatever you feel you most need in this moment.

And start to take a few slow, easy deep breaths, just to let go of whatever you’re carrying around with you today, any emotional baggage. And then either closing your eyes or, just gently lowering the eyelids and then start to bring your attention to your breath. The intention here is to bring a friendly attention. So noticing where you’re breathing most easily. It might be that you can feel the breath most at the tip of your nose, perhaps as a cool breeze on your upper lip. Maybe you’re most aware of your chest, or your belly rising and falling. So bringing a gentle curiosity to the sensations of the breath. Just feeling your breath here for a while. And then when you notice that your mind has wandered as minds do, just come back to feeling your breath again…

Just let your body breathe you. So no holding of the breath or trying to change it in any way. And now put your hand on your heart reminding yourself that you’re bringing a kind attention to your breathing. Our breath is with us from the moment we are born until the moment we die. So our lifelong companion. So allowing yourself to appreciate this breath that sustains us. Wherever we go, whatever we’re doing, it’s always there, it’s there to help us when times are difficult, if we need to slow down, if we need to ground and steady ourselves.

So bringing curiosity and enormous gratitude for this, this breath that gives us life and then exploring how it feels by perhaps putting the other hand on top of the hand that’s already there, on top of your heart. And feeling this as a compassionate gesture for yourself, looking after yourself. Bringing a tender awareness to your breath, be really present to how you are in this moment, looking after yourself.

Not worrying about how many times your mind might wander, just gently returning it back to the feeling of your of the breath underneath your hands. And then gently resting your hands on your lap, just noticing how your breath is now.

Give yourself a few moments to experience the sensations in the whole of your body. A curious observer of what’s happening in your body in this moment. And staying here for as long as you like and then whenever you’re ready, coming back into the room in your own time.