The Practice | MK

Mental health issues can be a real battle, particularly without support and processes in place. According to Mind, approximately 1 in 4 people will experience mental illness in the UK, making mental health issues more common that you might think.

One of the most effective ways of dealing with, improving and even overcoming mental health problems is through talking therapy. For some this might mean reaching out to their GP to tell someone that they are struggling, for others it might mean talking to a counsellor or psychiatrist to work through their thoughts, feelings and any possible traumas.

Taking that first step

Reaching out and speaking to a doctor or mental health professional about any mental health issues or emotional difficulties is a positive step towards recovery. Often this is the hardest part, and it may take desperation or reaching your limit to ask for help. While this is a step in the right direction, it’s important to avoid getting stuck in a downwards spiral before you do ask for help, as the sooner you can get help the better.

You don’t need to be officially diagnosed with a mental health issue to ask for help. While a diagnosis can be helpful, help from your GP and talking therapies are available to all sorts of people dealing with different problems and in different situations.

How talking therapies can help

Talking therapy is used for a number of reasons, most commonly to help with anxiety, depression, eating disorders, addiction and phobias, as well as PTSD. They can also be used for serious mental health conditions such as schizophrenia or bipolar disorder. Talking therapy can also be used after experiencing a traumatic life event, such as the death of a loved one, or for help with the mental difficulties that often surround serious physical illnesses, such as diabetes. 

Many people find it far easier to talk openly and honestly with a stranger rather than with a family member, partner or friend. Talking therapies offer a safe environment and complete confidentiality to explore thoughts and feelings, as well as past experiences and concerns about the future.

What to expect from talking therapy

Talking therapies are carried out by trained counsellors and therapists. During your sessions, your therapist will listen to you, and allow you time to talk, cry or even shout should you need. It’s an opportunity to work through everything you’ve been feeling, and learn new and more positive ways to look at things, as well as learning new coping mechanisms.

Generally talking therapy is carried out one-on-one, but can sometimes be in groups or perhaps over the phone or online if you have problems with mobility. There are lots of different types of talking therapies, your GP might be able to recommend what might work best for you, and your therapist will be able to accommodate your own unique needs to use a unique programme to help you. All talking therapies have the same end goal - to help you get to the root of the problem and eventually feel better.

Talking things through with someone impartial can help you better understand yourself, your feelings and to generally make sense of everything going on in your life and how that makes you feel. It can help you resolve complicated feelings or find ways to live with them.

Who talking therapies can help

If you are struggling with any of the following, talk therapy may help:

Difficult life events, such as loss including bereavement or losing your job

Upsetting or traumatic experiences, recent or in the past

Relationship issues

Depression and anxiety

Difficult emotions including guilt, unhappiness, anger and low self-esteem

Long-term physical health problems

Other mental illnesses

Some people consider talking therapy to be a last resort, but in some places around the world it’s considered a normal part of life to see a therapist to work through your thoughts and feelings. Considering talking to a therapist before things get to crisis point is just common sense, although of course it’s possible to see improvement at any stage, no matter what you’re struggling with.

Mental Health Support | The Practice

Regardless of whether you have suffered mental health issues in the past, have ongoing issues or haven’t had much experience with mental health before, now is a difficult time for everyone. During these times of uncertainty, many people may find they start to struggle with their mental health. From having ‘down’ days, or days of persistent worry, to ongoing anxiety and depression, now more than ever before, we need a little extra help to take care of our mental health.

Whether you find yourself struggling at this point or not, it’s a good idea to make yourself aware of how you can support your mental health while self isolating.

Putting Daily Measures In Place

First and foremost, it’s important to put a few measures in place to actively support your mental health. Within days, all of our lives changed dramatically, and we are now spending more time at home than ever before, some of us with loved ones, some of us alone. This in itself is difficult, for many different people in many different ways. Added to that the uncertainty of our futures and the inability to plan ahead makes this a big challenge for our mental health.

We need to respond to this, and acknowledge the fact that this might negatively affect us, by being aware of what can be damaging, and what we can do to help ourselves. Here are a few tips.

Limit News Consumption

It’s important to stay up to date and aware of what is happening, but looking at the news too much can cause upset, internal battles, worry and confusion. If you’ve been checking the news regularly, you might have noticed some conflicting opinions, which can cause a rollercoaster of emotions, feeling positive one moment and upset and angry the next. Limit your news consumption to once a day, such as watching the daily briefing, and avoid checking it throughout the day. Also choose your source wisely - we recommend getting your updates from the BBC and the BBC only.

Try to Avoid Becoming Obsessive About Cleanliness

We know that it’s important to keep on top of hand washing and general cleanliness, but try to avoid becoming obsessive, like washing your hands everytime you touch something in the house. Obsessive hand washing could lead to issues with health anxiety and OCD. Just wash your hands when necessary - when you return home from being outside, before you eat and after you have been to the toilet, and avoid touching your face in between. Follow the BBC’s guidelines on staying safe and hygiene in your home, but don’t take this to the extreme.

Stay Well Connected

Don’t suffer in silence - when you are going through periods of worry or feeling low, it’s easy to try and shut yourself away and hope that your problems will resolve themselves in a few days time. Talking is a well known method of therapy, so don’t let yourself stew over your worries as often they will only get worse and become bigger in your mind.

Stay well connected to friends and family during isolation, by arranging regular phone calls or Skype sessions. This will help you feel connected to the wider world, as well as offering an opportunity to talk through your worries, or simply put things into perspective when you realise everyone is going through the same thing. If something is really getting you down, you’ll often feel better once you’ve had the chance to talk it through with someone you trust.

Be Kind to Yourself

It can be all too easy to feel like you need to make the most of the extra time you have, putting even more pressure on yourself than you might usually. The truth is that things are very difficult for all of us at the moment, which means you need to take even more time than usual to be kind to yourself.

Make sure you’re getting plenty of rest and downtime. If you’re struggling to settle your mind, try daily meditation, take your mind off your worries with a craft or read a book. Try to include a weekly bath or at least half an hour of ‘me time’ and make self care a priority.

Accessing Online Support

While the measures above will really help you stay on top of your mental health, you may find there are times when you need additional support. Mental health problems can quickly spiral out of control into months of depression and/or anxiety, so don’t leave it too late to get professional help if you find yourself struggling.

Traditionally, talking therapy would be carried out in person, but because of the current measures this isn’t always possible. During this time, consider using online services to access the support that you need. While we believe that talking therapy is best done in person, using Microsoft TEAMS we can deliver the same service to you at home, allowing you to get the help that you need during this difficult time in all of our lives.

To find out more about our online therapy options, click here: https://www.thepracticemk.co.uk/appointments-online

The Practice MK has considered the UK Governments guidance provided to businesses on safely reopening during the Covid-19 pandemic. The Practice has two key responsibilities.

Ensure the environment is safe for its employees, associates and clients

Continue to deliver services to our usual high standard.

Employers have a duty to reduce workplace risk to the lowest practicable level. Following a comprehensive risk assessment, the directors have concluded that it would not be in the best interests of its employees, associates or clients to offer face to face appointments for all the services we usually provide. To do so would be putting people at risk.

From the 1st June 2020 the practice will begin to offer clients face to face appointments for:

Trauma Therapy (EMDR)

Autism Diagnostic Assessments

Further Information and instructions for clients attending the practice for appointments can be found here.

The practice will be restricting the number of face to face appointments initially and will only be operating between the hours of 9.30am and 6pm. As the situation with Covid-19 develops more face to face services may be offered.

Our Risk Assessment

The Government have asked businesses to consider 4 key points when formulating their Covid-19 Risk Assessment.

Promote and increase the frequency of handwashing

Enable staff to work from home where possible

Social Distancing - Consider if all business activities should operate, if so, take all possible steps to mitigate actions that could possibly risk transmission of the virus

If social distancing cannot be implemented, consider if the activity can safely go ahead.

Also, to have particular regard to whether individuals are especially vulnerable to Covid-19.

Our risk assessment has been produced in consultation with our employees, associates and some existing clients.

Point 1

We have provided hand sanitiser around the practice for clients and our clinical team to use.  All clients who attend the practice must either use the hand sanitiser provided or the anti-bacterial soap in the washrooms as they enter and leave the practice.

Point 2

Our Case Management Team and Business Support Assistants are currently furloughed.  Clinical employees who are not furloughed and our Associate Clinical Team have been advised to work from home where possible and will only attend the practice to see clients who are receiving trauma therapy or undergoing assessment for Autism.

The Governments guidelines are not specifically designed with our practice in mind and so we have needed to consider a number of different industry guidelines to cover the services we intend to provide.

Prior to Covid-19 all our consultation and therapy services were delivered face to face.  Although most clients have found the switch to online acceptable, a few have not found it useful and would prefer if given a choice to have sessions face to face. 

There is also a number of clients who have found accessing support online from home difficult due to the very nature of what they are seeking support for.  For example, those experiencing domestic violence.

A key consideration for the directors of the practice is the guidance that states staff should work from home if at all possible.  Of course, we can deliver nearly all our services online and it is instead our preference and that of most of our clients that we provide face to face appointments.   It is for this reason we are not currently able to offer face to face appointments for all the services we currently deliver. 

In deciding which services clients could be offered face to face appointments for, we have created the following criteria:

Are clients able to receive the service near to, or to the exact same clinical standards and experience online?

If no, is there a likelihood the client will experience further mental health difficulties or be negatively impacted in other ways by not receiving the service face to face.    

Can the risk of transmission between individuals be safely managed?

Is the client considered clinically vulnerable?

In applying the above criteria to our current services, we have concluded that clients requiring trauma therapy (EMDR) and those requiring assessment for Autism cannot reasonably expect to receive an online service that meets our usual clinical standards and client experience. Furthermore, we have concluded that clients seeking these two services are more likely to experience further mental health difficulties if not provided with the service.

In consultation with our clinical team it has been agreed that face to face appointments for clients receiving these two services can be safely managed as long as the service and client meet our criteria.

Point 3

Government guidance emphasises the need to maintain social distancing (2 metres) for employees and clients.

Those who have previously attended the practice will understand how difficult this will be.  We currently have 5 consulting rooms and 1 meeting room.

To operate safely, only 4 rooms (including our meeting room) can be utilised for face to face appointments.

In the past, room allocation has been based on client/practitioner preference.  Going forward, practitioners will be allocated a room and must remain in that room to see clients for the duration of the working day.

Each of the 3 consulting rooms and our meeting room will be configured to ensure practitioner and client can remain more than 2 metres apart at all times.

Appointment times will be based on the consulting room so that no two clients arrive or leave at the same time.

Clients will no longer be greeted in reception and will instead be notified of the consultation room via a notice board in reception and will instead make their own way to and from the room.

Detailed information and instructions for clients attending the practice have been published on our website here

Point 4

For services where social distancing is not possible, we have taken the decision to temporary suspend such services until we understand the local risk of Covid-19 better.  These services include:

Educational Assessments

Child Focused Therapy

To finish with

Ultimately it would be our wish to get things back to normal as quickly as possible, however, myself and Katherine are not prepared to expose any of our clients, employees or associates to a level of risk that cannot be effectively managed.

We expect to see around 30% of clients attending the practice compared to what we would ordinarily operate at and monitor closely how things go before we reintroduce further face to face services.

Our team really appreciate and thank you for your continued patience.  For new and current clients if you need to speak to a member of the team you will need to either leave a voice message on our telephone system or send an email to [email protected] as we are unable to take calls currently.

We have some availability to schedule call backs for clients, but this will need to be arranged on email in the first instance.  Clients with disabilities or those who have difficulty with email please indicate this on your voice message and we will do our best to return your call as soon as possible.

Due to the significant financial impact Covid-19 has had on most individuals and businesses, the practice continues to furlough its business support assistants and case management team so that we can continue to meet our financial obligations.

It is our hope as things start to return to normal and more services resume, we will be able to bring back key staff to improve our client service levels.

For many, working from home is a completely new experience, and one that’s a little tricky to navigate. WFH can cause difficulties concentrating and with productivity, but it can also take its toll on your mental health, in extreme cases leaving you feeling anxious or suffering from depression.

Currently, life is challenging for all of us, but there are things that you can do to ensure you’re taking care of your mental wellbeing. Read on to discover our guide to wellbeing and working from home, to help you feel as positive and settled as possible

Create a Routine

The first area in which many people struggle when it comes to working from home is creating and following a routine. A routine can help you stay focused, feeling like you have a purpose and that you are achieving something, despite being at home 24/7. Without a routine, you may find yourself feeling a little lost, unsure of how to use your home, or possibly even working too much and forgetting to look after yourself.

From the offset, create a daily routine for your work day. You can relax your routine on the weekend, which will help you differentiate between the work days and the rest days. On work days, get up at the same time everyday, take time to enjoy a nourishing breakfast, set aside the time you need to work, the time you need to get on top of chores, and factor in breaks and rest time too.

Set Aside a Dedicated Work Space

A dedicated work space within the home is a must. Just like the office at work, it’s somewhere that you can leave at the end of the working day, helping to communicate that work is over, and it’s time to relax. For some this may be a spare bedroom, for others a nook under the stairs or a bay window in the living room. Wherever it is, make a point of shutting down your laptop, walking away, and not sitting down at this space again until the next day, when it’s time to start working again.

Where possible make this a calming and clutter free environment, with lots of natural light. Move house plants from other areas of the house, to help you feel connected to the outside world while you work.

Be strict with your work/life balance

It can be all too easy to slip into damaging habits quickly while working from home, such as working on the sofa in front of the TV, working more hours than you usually would, or getting distracted by house work and not working enough. Be strict with both your working hours and your ‘off’ hours.

When you’re working, try your best to be focused on your work, breaking down work time into manageable chunks. Once an hour stretch your legs with a stroll around the garden, or make a cup of tea. Take a proper lunch break, and aim to finish by a set time everyday too. Getting the work done that you need to complete efficiently will allow you plenty of time to get on top of things around the house, relax, and spend time with your family.

In being strict with yourself, giving yourself plenty of time off and making sure you’re productive while you work, you will be able to stay focused and positive, feeling like you are achieving something, yet also allowing time off to relax.

Be Kind to Yourself

Now more than ever before is not the time to beat yourself up if you’re feeling a little low or finding it hard to focus. Life is difficult for everyone right now, and the uncertainty can leave us feeling really unsettled and in some cases a little afraid. If you’re having a difficult day, take a step back. Look at your schedule and see if you can allow yourself the day off, or take an hour to sit in the garden quietly or with a book to reset and start over.

Meditation can be a brilliant tool, especially during difficult times. Being at home a lot is difficult for many of us, and so pausing to bring calm and clarity back to the mind is a must to keep on top of our mental health. If you find yourself getting lost in worrying thoughts, or simply cannot quieten your mind, sit in a chair for 5 minutes and take in your surroundings, focusing on touch, smell, sight and sound. This is a grounding technique and will bring you back into your body, rather than being in your head too much. 

Talk through your thoughts and feelings

Nobody is in this alone, and you should never feel like you have to face this without the support of others. Thousands of us across the country are going through self-isolation by ourselves, and thousands more find it difficult opening up to their friends and family.

Talking therapy can be greatly effective during times of uncertainty, and allows us to work through our thoughts and feelings in a safe environment. If you feel like you need additional support during this difficult time, we are offering online talking therapy to help you improve and manage your mental wellbeing: https://www.thepracticemk.co.uk/appointments-online

Milton Keynes Autism Online Drop in Sesson

The Practice MK will be hosting an online drop in session for adults who have autism in Milton Keynes between 2pm and 4pm on Monday, March 30th 2020.

Participating in the online session will be the therapists and psychologists of The Practice MK who will be happy to answer any questions or help address any concerns our adult autism community have during this particularly challenging time.

Katherine Goodsell, Consultant Forensic Psychologist and Clinical Director of The Practice MK will be online to talk to you about anything that may be causing you to feel anxious or worried. Katherine specialises in autism and has provided diagnostic assessments and support for over 1000 clients both for the NHS and privately.

We hope the event will provide some useful information on how you can try to stay mentally fit and positive.

The event will be informal and attendees can drop in and out of the session at any time between 2pm and 4pm.

All our participants will be live on video and a chat facility will be available for you to ask questions.

To attend the event please email [email protected] where you will be provided with a link to the online event.

See you there

Coronavirus

The Directors of The Practice MK have been monitoring the worldwide situation with regards to the coronavirus and wish to reassure all clients with the following information.

We must consider a proportionate response to the current situation and whilst we do not wish to ‘over react’ to current or new media reports we do want to ensure that at all times we consider what is in the best interests of our clients and staff.

At the end of the day, we have always enjoyed a close relationship with our clients and the practice doesn’t really work without both clients and staff together. So, from today we will be changing a couple of things at the practice to ensure we do our bit with preventing the spread of nasty germs and bugs and that includes the coronavirus.

These are the little changes we ask clients to help us with:

We will not be using glasses for water - and request everyone uses the disposable cups by the water dispenser. The dispenser actually has a built in anti bacteria system which is designed to prevent the spread of contamination.

We already have hand sanitisers located on the way into the practice and outside of the practice rooms. We kindly ask that staff and clients use them on the way and way out of the practice. For those who prefer not to use these, in the client bathroom is an antibacterial soap.

Paper towels are provided in the bathrooms and we kindly remind clients to use the bins provided and to ensure hands are washed for the recommended time of at least 20 seconds

Each day, staff will be performing additional cleaning in high traffic areas and disinfecting surfaces and door handles.

Tissues are located in every room of the practice and in our reception area and we kindly ask that clients use them where needed.

If clients are unwell and showing symptoms of the coronavirus, please do not attend the practice. We do ask that 24 hours notice is provided wherever possible but for clients who suddenly feel unwell and unable to attend their appointment a more flexible approach will be considered by the practice. We will need to consider postponing appointments for 14 days.

For clients who may need to self isolate we are able to offer consultations and therapy by virtual means (skype etc). Please try to provide as much notice as possible so the IT can be setup in time for your appointment.

If you are a student and have a learning difficulty, health problem or disability you can apply for support from the DSA.  I'm not a fan of what DSA is short for, 'Disabled Student Allowance' as I think in 2018 we all recognise most conditions as just that, a condition., or more to the point, just part of who someone is!  To lump everything under "disability" is quite old fashioned if you ask me but anyway, the government backed fund is not going to change its name anytime soon and why should it, the government have more important things to be getting right. 

It does raise an interesting discussion however, and that is Autism Spectrum Disorder (ASD) or how we prefer, Autism Spectrum Condition (ASC).  More specifically what does the fund offer students with ASC.  

I have spoken to numerous students and parents who are preparing for university over the years considering applying for DSA.  My practice has often been asked to evidence a students already diagnosed ASC or deliver a full diagnostic assessment for those where any previous assessment was either unclear or did not meet assessment guidelines.  This has often led to unnecessary costs for students and parents and confusion over what evidence they need to submit. 

To begin lets start by explaining what the DSA fund actually is.

DSA enables those with long term illness, mental health problems or other forms of disability to access additional funding to support their studies. Autism as we all should know is not a mental health problem nor is it a long term illness so it is considered for the purposes of DSA to be a disability.  Now, the overwhelming majority of individuals with ASC and certainly nearly all of our clients would not appreciate being referred to as disabled but this is a fund that students don't have to repay and can be used to directly support their studies so we may have to park the moral question over a name for now.

Who is eligible?

You can apply for Disabled Students’ Allowances (DSAs) if you live in England and have a disability that affects your ability to study, such as a:

learning difficulty, for example dyslexia, dyspraxia or ADHD

mental health condition like anxiety or depression

physical disability, for example if you’re partially sighted or have to use crutches

long-term health condition such as cancer, chronic heart disease or HIV

You must also:

be an undergraduate or postgraduate student (including Open University or distance learning)

qualify for student finance from Student Finance England be studying on a course that lasts at least a year

So what can it be used for?

Specialist equipment, for example a computer if you need one because of your disability

Non-medical helpers

Extra travel because of your disability

Other disability-related costs of studying

Proving your eligible

Disabilities / Long Term Health

You will need to submit a disabilities Evidence Form and have this signed by your GP or an appropriate health care practitioner.  

Those with a diagnosis of ASC will need to do this and can download the form here.

Our clients can download the form and have this completed by our team free of charge. 

For clients who have not been assessed by us and would like us to complete the form please speak to a member of the team.

Mental Health

A letter from your GP or Consultant treating you. 

Alternatively, you may use the Disabilites Evidence Form which can be downloaded here

   Learning Difficulty

A ‘diagnostic assessment’ from a psychologist or suitably qualified specialist teacher - you’ll need to get reassessed if you had this done when you were under 16.  Our Psychologists are able to provide students with a full diagnostic assessment, just ask us for more details.

Applying for DSA

The application process for DSAs can take four or five months so it is important that you apply as soon as possible.  You may be invited to attend a needs assessment centre.  A Study Needs Assessment is an informal meeting between the student and an experienced study needs assessor. It helps identify what support the student needs based on their individual needs.

Understanding the SEN Process - Free Seminar

We are giving parents the opportunity to access free legal advice from the UK’s leading education law department.

If you are considering applying for a statutory assessment, you are in the process of having your child’s Statement of Special Educational Needs transferred to an Education, Health and Care Plan or if you want your specialist school placement funded by your Local Authority then this seminar is aimed at you.

The seminar aims to bring parents of children with special educational needs, including autism and specific learning difficulties, up-to-speed on the legislation issued in 2014 which saw the introduction of Education, Health and Care Plans (EHCPs).

Solicitors from the Education Law Department from HCB Solicitors will be hosting a dedicated free SEN seminar in partnership with The Practice MK on Wednesday 15th November 2017 at 6.15pm at Double Tree, Stadium Way, West Bletchley, Milton Keynes, MK1 1ST.

The Children and Families Act 2014 has created many grey areas and could see existing children’s statements altered or removed. The team from HCB will help worried or confused parents get to grips with the process in a jargon free presentation.

The Practice MK is a multi-disciplinary practice in Milton Keynes that specialises in a number of services including autism and educational testing and assessment.  We are a leading provider of counselling and therapy services which includes a specialised trauma clinic. 

The HCB education team have years of experience representing parents with children with special educational needs and have assisted in securing over 1000 places at independent specialist schools through special educational needs tribunals. It is so important for parents of children with learning difficulties to know their legal rights.

A free individual consultation will be available immediately after the seminar.

To reserve a place at this seminar please register your interest early to avoid disappointment.

Talent Unlimited MK (Promoting Autistic Expertise) would really like you to drop in to our Welcome event Friday 20th October between 2 and 4 pm, to be held at The Play Association, Kiln Farm to find out about our project which is supported by MK Community Foundation.

 It will be a great opportunity to learn more about us and what we are doing and can offer.  Our current projects include an exciting on line magazine "Showcase", design and photographic services, a wide range of craft items to buy and or commission and lots more.  As new members join us we aim to promote their individual talents so we are always developing ideas and projects.

 We will be providing drinks and cake and an opportunity to buy / commission items.

 See below for a flyerfor the event.

 Jane Lynds

Steering group chair

Talent Unlimited MK

email:  [email protected]  

For people with Autism aged 18+ to meet up and discuss any issues they like and exchange information about social opportunities etc.

Venue and Dates: Every third Wednesday in the month upstairs at the Secklow 100, 316 Midsummer Blvd, Central Milton Keynes MK9 1EB from 7.30 pm – 9.30 pm

Adoption Support Fund

I have case managed a number of clients recently whose therapy was funded by the Adoption Support Fund (ASF).  Working with these clients afforded me the experience of understanding the challenges faced and sometimes heartache felt by parents who months after adopting a child are still struggling to manage behavioural challenges and emotional needs.  Some discovering that their child has mental health problems or developmental difficulties.

What has been described to me as pure frustration by parents, I am informed by my team that these mental health difficulties could and in some cases, should have been identified during the adoption process.  Nearly all the parents I asked the question, “Would you have still adopted them, if you had known?” all but one of them answered “yes”, but some support would be nice.

So with other parents considering adoption in mind, or those engaged already in the process, maybe those who are working within children’s services, I thought I would share my own experiences from the management/practitioner perspective of working with families funded by the Adoption Support Fund.

I am not, I would like to make clear a healthcare professional and so my opinions, and my experiences are purely taken from the case management perspective of my practice and those opinions generally shared amongst my team.

Firstly, let me introduce myself.  I am the Practice Manager for The Practice MK, a multi-disciplinary psychological practice in Milton Keynes. We currently have 16 highly trained and experienced practitioners providing their services through us.

Our Associates include:

Clinical, Educational, Forensic and Occupational Psychologists

Psychiatrists

Counsellors and Therapists

We provide a range of psychology based services and specialise in autism diagnostics and trauma.

Over the years we have established ourselves as a ‘go to place’ or as one Local Authority recently put it, “a one stop shop” to deliver comprehensive psychological assessments, provide treatment plans and deliver ongoing short or long term therapy whilst reporting back to instructing clients and keeping them informed on the progress of such therapy.

In 2016 we provided a number of services to parents seeking support for their adoptive children and by case managing these clients I was able to understand from the parents perspective the challenges families who adopt sometimes experience.

Some of the challenges I was made aware of included:

Not being prepared adequately for supporting children with potential mental health problems

Lack of pre-adoption assessment information.

Emotional support for parents themselves struggling to manage their children’s behavioural and emotional difficulties.

I tried to break down into boxes the conversations I have had with over 25 sets of parents who have adopted children and come to us from all over the UK to access our services.  To be honest, the majority shared the same experience.  They had adopted a child, there were some behavioural difficulties observed which was initially described as ‘settling in problems’ or they were told “just give them time”.  Managing the behavioural and emotional challenges became harder as time went by.  Problems started being noticed at school.  Parents were becoming tired and drained, and well, you can probably already identify the cycle forming.

Before I go further into my own experiences I thought it best to set out what the Adoption Support Fund is and to put some context to this article.

Some interesting facts

As of the 31st March 2016 the number of children being ‘looked after’ hit 70,440.  This includes all children within foster placements or placed for adoption or residing in secure or residential accommodation (Department for Education, 2016).

A child is considered to be ‘looked after’ if they are in the care of the local authority for more than 24 hours.

According to UK Government statistics the majority of looked after children are placed with foster carers.  In 2016 the number of looked after children in foster placements was recorded as 51,850 (74%) (Department for Education, 2016).

Children who were taken into care by the Local Authority during 2016, 4,690 of them were adopted.  The only year that numbers actually fell, down from 5,360 in 2015.

Children who are looked after are more likely to have mental health problems compared to children who are not.

45% of children aged between 5 and 17 years in England, looked after by the Local Authority were assessed as having a mental disorder.  37% had clinically significant conduct disorders and 12% were assessed with emotional disorders, anxiety and depression. Only 4% were assessed with pervasive developmental disorders, tics and eating disorders (Meltzer H, et all, 2003).

Meltzer found that 5 to 10 years olds, looked after by the Local Authority were five times more likely to have mental disorders than those children in private households. (Meltzer H et al, 2000).

"11 to 15 year olds, looked after by the Local Authority were four to five times more likely to have a mental disorder compared to private household children."  -- Meltzer H, et all, 2003

This is probably not surprising given that the Department of Health estimated in 2001 that 62% of children taken into care were subjected to abuse or neglect.  This was the same between 2013 and 2014 according to the Department for Education in their report, ‘Children in care’ (Department for Education, 2014).

Reviewing the past 5 years of data it becomes clear that year on year more children are taking into care.  This means more adoptive parents or carers are sought by the Local Authority to help look after children and provide for their needs. 

Sadly, this also means more children will require short and long term therapy which asks the question, who will pay for it?

Adoption Support Fund

In 2013 the Government via the Department for Education published a report setting out proposals to attract more parents to adopt children.  This led to the launch of the Adoption Support Fund in 2015 which allowed Local Authorities in England to apply for funding to provide post adoption therapeutic support.

The Adoption Support Fund (ASF) is available to assist families who have legally adopted children, up to and including the age of 21 from a local authority in England, or adopted from overseas.

Families looking for support require an assessment by the Local Authority.  This is a legal obligation of all Local Authorities who have responsibility for assessing adoption needs for three years after the adoption order.

Due to the success of the ASF, on the 25th January 2017, Edward Timpson, MP and Minister of State for Vulnerable Children and Families wrote a letter to the Director of Children’s Services detailing the ‘fair access limit’ which places a limit of £5000 per child under the ASF.  For those requiring more specialist services an additional £2,500 may be made available.  If additional funding is required, provided the Local Authority can meet the criteria, a funding match will be agreed between the ASF and the Local Authority.  The current spend on average per child, Mr Timpson says is approximately £4000 (Adoption Support Fund [ASF], 2016).

He also confirmed that an increase in the ASF budget to £28m (20% increase) would allow more families to access the fund.  Since its England wide launch in May 2015 over 12,500 families have accessed the fund.

Who provides the therapeutic support?

Who provides such therapy under the fund varies between Local Authorities. Some have interdepartmental agreements with their local NHS trust, some will rely on private organisations to provide specialist services that are either unavailable locally or have excessive waiting lists.

What support options are available under the funding?

Under the ASF current rules a number of therapy or assessment options are available.  Whilst not feasible to list all of them the following is a summary of what can be used (ASF, 2016).

Psychotherapy

Creative Therapies

MDT assessments including neurodevelopmental

Parenting support courses

Filial Therapy

Life Story Work

Some notable exclusions do apply, most of which are therapy based options with care givers and certain types of assessment, for example speech and language therapy.

Even with some questionable exclusions, to be fair, the fund has embraced a wide range of therapy options for practitioners to consider when working with clients under the ASF.  I like that systemic family therapy is included as for children with attachment disorder, this type of therapy delivered over time can help build attachments and trust with their new family.

One option ‘out of scope’ is educational and cognitive assessments (unless part of an MDT assessment).  Parents seeking educational support for children they have adopted tell me this is one area they would like to see included in the options.

It is reported that between 25 and 40% of people with learning disabilities also experience mental health problems (Mental Health Foundation, n.d).

The prevalence of psychiatric disorders among children with learning disabilities is 36% compared to 8% among children without learning disabilities (Emerson E et al, 2012).

Parents trying to evidence the need for an Educational Health and Care Plan (EHCP) are often left to privately fund the assessments required as learning difficulties alone would seem to exclude them from accessing funding under the ASF.

The Process of obtaining funding

The process below is how a parent or caregiver can access funding for their adoptive child.

Approach your local authority for an assessment of adoption support needs.

The local authority that places the child with you is responsible for assessing your adoption support needs for three years after the adoption. After that, it becomes the responsibility of the local authority where you live.

Local authorities will be able to submit applications for funding before an Adoption Order, so adopters can receive a continuous package of support from the time of placement.

The local authority considers if therapeutic support is needed, the type required and if it is eligible for payments from the fund.

The adopter and the local authority will look at the support that is available.

The local authority applies directly to the Adoption Support Fund on behalf of the adopter.

The Adoption Support Fund approves the funding and the funds are transferred to the local authority who then purchases the support.

Our experiences and thoughts

Initially we were frustrated by the process and let me explain why.  It should be made clear that the assessment made by the Local Authority is not the same as having an assessment with, for example, a Clinical Psychologist who specialises in looked after children. 

The assessment in point 1 above is to look at the needs of the adoptive family and to ensure those needs meet the ASF eligibility as described in point 2.  The Local Authority require confirmation from the ASF that funding will be approved before contracting with a provider of such services.  At some stage they may request an estimate of fees from the provider to support an application to the ASF.

If you are thinking about an egg and a chicken at this point you know what I’m about to say next.  If the child / family has not yet been assessed by a suitably qualified practitioner to determine clinically, the most appropriate therapy or support options, how do Local Authorities know how much funding to apply for and what services they are seeking.

I will admit this stirred some frustration with my psychologists, however, we eventually developed a model which provided flexibility to the issue.  This essentially involves providing the Local Authority with a generic estimate or service provision which enables flexibility to tailor the support and therapy options following the completion of the clinical assessment.

What I would like to see is a more structured approach taken by the ASF.  Why not allow Local Authorities to apply for an assessment of needs (clinically not eligibility) and permit suitably qualified healthcare practitioners to provide a treatment plan evidenced by standardised assessments and observations with the family.  This would most likely be Psychologists who specialise in working with looked after children.

Fees for this stage I propose should be standard, capped by the ASF to include consultations, initial assessments and treatment plans.  Once in possession of the treatment plan Local Authorities could source approved practitioners to deliver the therapy recommended in the treatment plan or if in any disagreement, request a second opinion or order a review of the case by another psychologist, again with capped fees.

Practitioners who are contacted to provide the therapy should then be asked for an estimate of fees which clearly match the treatment plan.  A second application to the ASF should then be submitted with the treatment plan and estimated of fees by the therapist or healthcare practitioner delivering on the plan.

This may on one hand sound like additional work is being created but on the other, a standardised and consistent framework would be created in determining how short and long term therapy is funded.

This may have avoided once such problem a client of ours experienced when their Local Authority sent them to a highly specialised systemic therapist who in their assessment of the family determined that 18 sessions of family therapy should be considered (no coincidence I promise). 

Now, the therapist was not wrong in her formulation of what the family required.  Our Psychologist agreed completely that up to 18 sessions of systemic therapy should be considered.

What the therapist didn’t assess for and what they didn’t identify was the trauma experienced by the child including significant domestic violence they experienced between the ages of 5 and 10.

After 12 sessions and no sign of improvement the parents withdrew from therapy and instead investigated online other possible solutions.  That led them to us and following a lengthy consultation and assessment, it was determined that the child, now 13, would undergo trauma based therapy before attempting any systemic family therapy. 

I am pleased to say that after several months of working with the family we are told things at home are improving.  We also delivered a full educational assessment but only because our Clinical Director was so angry that this part would not be funded she did it for free! 

My point is, that its crucial the ASF consider two stages to funding.  Assessment and Therapy and consider standardising the process for consistency and to help manage the budget.

Future Funding

Talking about money, with more families believed to be seeking access to the fund in 2017, even with the increased budget of £28m for 2017/2018, will the fund be able to support all those who need it?

I am not a statistician and if I’m being honest I was not that good at maths either, so this next thought of mine may light the end to a few people’s fireworks.  If you look at the statistics involving children who are adopted over the past 5 years I estimate at least 5,500 will be adopted during 2017.  Consider 45% of children looked after between the age of 5 and 17 are assessed as having a mental disorder (Meltzer. H et al, 2003) and although I do not have exact figures for those older, let’s say for arguments sake is similar. 

I estimate at least 2,475 additional children may require access to the fund up to March 2018.  To support the additional children likely to require support, a minimum of £10m would be needed to fund the ASF during this period.   But am I missing something?  Mr Timpson himself wrote “but demand for support is over twice the level forecast” in his open letter to the Director of Children’s Services in October 2016. Maybe he tried using my formula at first and discovered what I am now discovering.

My estimate does not seem accurate or even close when you consider over 9,000 families received agreement for funding over £30m of therapeutic support in less than 18 months, up until October 2016 (ASF, 2016).  This equates to an average spend of £3,333 per child. 

Between October 2016 and January 2017 a further 1500 families are reported to have accessed £8m of funding which brings the average up to £3619 per child. 

If this trend continues it is more feasible that at least 6000 families will require access to the fund during 2017.  I hope this bit doesn’t embarrass me but take 10,500 families and divide by 21 (18 months + 3 for October to January) and you get 500 (times by 12) equals 6000.  I did this several times before posting!

Based on this estimate which looks at the current trend and taking Mr Timpson’s average reported spend per child under the ASF is £4,000, you would need £24m to fund the ASF.

A budget of £28m therefore looks attractive and rather generous considering the times we live in.  Will it be enough though?  I would like to see some figures published on individual Local Authorities spending under the ASF and what services were purchased.

There will of course always be complex cases which require additional funding for assessment and diagnostic work but these should be the exception not the norm.

Given that many Local Authorities are having to save money in all other areas of business it would be sensible to consider that if they can assess the ASF they will which will result in more families being funded through the ASF going forward.

I believe a standardised assessment process with capped fees could easily be achieved and would provide greater control over budgeting going forward to ensure every child requires access to the fund is supported.

I welcome thoughts on the subject, in particular my maths but please be polite, it was never my strongest subject at school!

Notes for the Editor

The Practice MK is a private multi-disciplinary psychological practice in Milton Keynes that specialises in Autism Spectrum Conditions

The article was written by Dominic Goodsell, Director and Practice Manager. 

The Practice MK has 16 Associates working in the field of psychology and delivers counselling, therapy, educational and psychological assessments.  It also delivers a specialist trauma clinic and therapeutic adoption and fostering service.

www.thepracticemk.co.uk 

References

Department for Education. (2016). Children Looked after in England including adoption:2015 to 2016. Retrieved on 01/03/17 from https://www.gov.uk/government/statistics/children-looked-after-in-england-including-adoption-2015-to-2016

Main Text:SFR41/2016, Retrieved on 01/03/17 from,  https://www.gov.uk/government/statistics/children-looked-after-in-england-including-adoption-2015-to-2016#history

Meltzer, H et al (2003), The Mental Health of young people by local authorities in England, London: The Stationery Office (TSO)

Department for Education. (2014). Children in Care. Retrieved on 01/03/17 from, https://www.nao.org.uk/wp-content/uploads/2014/11/Children-in-care1.pdf

Letter to Children’s Services, 01/03/17, http://www.adoptionsupportfund.co.uk/Portals/0/ET%2025-01.pdf?ver=2017-02-03-121235-803

Adoption Support Fund, Service Categorisation Guidance, 22/04/16, http://www.adoptionsupportfund.co.uk/Portals/0/Service%20Categorisation%20Guidance_22%20April%202016_V2.pdf

Experiences from private clients of The Practice MK

Mental Health Foundation, https://www.mentalhealth.org.uk/learning-disabilities/help-information/learning-disability-statistics-/187699

Emerson E, Hatton C, Robertson J,Roberts H, Baines S, Glover G (2012). People with Learning Disabilities in England 2011. Improving Health and Lives: Learning Disability Observatory.

Pathological Demand Avoidance, PDA

Recently we have been asked by a number of parents if we can assess and diagnose Pathological Demand Avoidance or PDA as its easier to know.  We thought, given the clear rise in the attention it is receiving we should explain what it is and how, or if, it can be assessed and diagnosed.

History and Profile

Dr Elizabeth Newson, a developmental psychologist, focused her work with autism during the 1970’s.  In 1994 she was made a professor of developmental psychology in Nottingham where she used her inaugural lecture to discuss PDA, as a sub type of autism.

PDA can be thought of as a behavioural profile that is sometimes identified with individuals who are being assessed for autism spectrum disorder (ASD).   PDA is not universally accepted, however, which we will explain further on in this post.

PDA is best understood as an anxiety driven need to be in control and avoid other people’s demands and expectations.

Although not everyone will display the same traits, the distinctive features of PDA in children show them to:

Resist and avoid the ordinary demands of life

Use social strategies as part of avoidance, eg distracting, giving excuses

Appear sociable, but lack understanding

Experience excessive mood swings and impulsivity

Appear comfortable in role play and pretence

Display obsessive behaviour that is often focused on other people.   

People with this profile can appear controlling and dominating, especially when they feel anxious. However, when in control they can be charming, relaxed and engage positively with others around them. 

Recently, more children having been assessed for either ASD or ADHD are walking away with labels of PDA, but not all.   It would appear only some experienced clinicians involved in neurodevelopmental are happy to identify and apply the behavioural profile.

Why is PDA not listed in either ICD 10 or DSM V and does it have to be in order for it to be diagnosed?

Answering both these questions will inevitably divide opinion amongst health care professionals, clinicians and readers.

"In 2014 a petition to the UK parliament was created asking for PDA to become a diagnosable condition.  It received only 2,248 votes.  "  -- https://petition.parliament.uk/archived/petitions/57807

Firstly, it is useful for us to explain that PDA is not a clinical condition or disorder that appears in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition or The ICD-10 Classification of Mental and Behavioural Disorders and so cannot be ‘diagnosed’.  

For those who are unaware of either of these concepts:

DSM is what the Americans use to diagnose mental conditions or disorders, its publication is currently in its fifth revision, hence DSM V is commonly heard.

ICD 10, a publication produced by the World Health Organisation (WHO), contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.  It is used throughout the international community including the UK and most of Europe.  It is different to DSM V in that it covers health as a whole compared to just mental disorders classified by the US.

A study involving Psychiatrists from 66 different countries found that ICD was used more often for Clinical Diagnosis while DSM was used more for research.

To avoid becoming distracted on a completely different topic we shall move on to discussing more about PDA, however please read our post on ICD 10 and DSM V if you would like to know more.

Assessment for PDA

There is no specific PDA assessment process and it is unlikely the NHS in the UK will develop such a specific pathway, instead, opting to refer individuals for an autism diagnostic assessment.  It is usually during this assessment process that PDA can be accurately identified.

Diagnosing children with ASD with PDA as a behavioural profile has been a recent development and not all autism diagnostic teams will be happy to provide parents with both labels. The National Autistic Society has recently made clear their thoughts on PDA becoming a recognised behavioural profile under the autism spectrum and explains the benefits of doing so.

It has been shown to:

Help people with PDA and their families to understand why they experience certain difficulties and what they can do about them

Allow people to access services, support and appropriate advice about strategies

Avoid incorrect assumptions and diagnoses, such as Personality Disorder, Oppositional Defiance Disorder, ADHD, dyslexia or dyspraxia (although a person might have these as well)

Inform local authorities and schools about the importance of providing support and using appropriate PDA strategies and interventions, which differ to those that benefit others on the autism spectrum. This helps to avoid school exclusion. 

As PDA is not officially recognised in either ICD 10 or DSM V it is unlikely to be ‘diagnosed’ as a mental health condition, illness, or anything else.

There has been some movement in developing PDA specific screening tools, namely the ‘Extreme Demand Avoidance Questionnaire’ (EDA-Q).  This questionnaire containing 26 questions is a measure designed to quantify traits of extreme ‘pathological’ demand avoidance (PDA) in children aged 5-17, on the basis of parent or teacher-report.

The validity study of the screening tool involved data from 326 parents and showed potential for its development, however we would recommend that it should not be relied upon as a strong indicator without direct observation of the child and the use of more widely accepted assessment tools more commonly used in autism diagnostics.

NHS Position

Each NHS trust may differ slightly with their position on PDA.  A freedom of information request to NHS Grampion in September 2016 asked several questions relating to PDA, including:

Does NHS Grampian have any specific policy regarding the diagnosis of PDA?

Does NHS Grampian have any policy that would discourage or restrict clinicians from diagnosing conditions not currently described in lCD I0?

Its response:

NHS Grampian can advise that we do not have a specific policy regarding the diagnosis of Pathological Demand Avoidance (PDA). NHS Grampian can advise that we do not have a policy that would discourage or restrict clinicians from diagnosing conditions not currently described in lCD I DSM guidance or other similar documents.

Another FOI request to South Essex NHS in November 2014 asked:

Does your trust have any specific policy regarding the diagnosis of Pathological demand avoidance syndrome? If so, please enclose a relevant copy.

Response:

No

Does your trust have any policy that would discourage or restrict clinicians from diagnosing conditions not described in the ICD, DSM, NICE guidanceor other similar documents? If so please enclose a copy of the relevant policy.

Response:

No

How many children have been diagnosed as having Pathological demand avoidance syndrome by child and adolescent psychiatrists based in Bedfordshire?

Response:

None

Please list all child and adolescent psychiatrists who have diagnosed Pathological demand avoidance syndrome.

Response:

None

Autism and PDA

People with a PDA behaviour profile share difficulties with others on the autism spectrum in social communication, social interaction and restricted and repetitive patterns of behaviours, activities or interests.

It likely that clinicians and healthcare professionals will continue to refer individuals suspected of PDA for an autism diagnostic assessment.  This is the current practice for nearly all NHS trusts that we know of and we would recommend the same for any clinicians practising privately in this field.  It is during this process that PDA is most likely to be identified and if appropriate, provided as a behavioural profile only.

Case Study

Recently within our own practice we diagnosed an adolescent with ASD.  This was following a multi-disciplinary assessment involving a clinical psychologist, forensic psychologist who specialises in autism diagnostics and an educational Psychologist over four, two hour appointments.  Aside from the full clinical interview with the individual and parents, standardised assessments used included:

Autism Diagnostic Interview, revised

Autism Diagnostic Observation Schedule 2

Social Responsiveness Scale 2

Gilliam Autism Rating Scale 3

Full cognitive based assessment using the Wechsler Individual Achievement Test, 2nd addition and the Wechsler Intelligence Scale for Children, 4th addition.

Additional assessment tools which included personality disorder screening.

A diagnosis of ASD was given along with attachment disorder.  It is worth pointing out that the individual had been adopted following abuse within their early childhood.  Detailed recommendations were provided which included the management of ‘melt downs’ and violent outbursts.  Of course this is just a tiny extract of the conclusion in this case following a lengthy assessment process.

What is interesting is that 6 months later we were informed that a further "clear diagnosis" of PDA had been given by another clinician, the result of which had led to a reported improvement with managing the individuals behaviour at home.

Did we miss something?  Speaking with our team they believe not.  In this case based on the time spent with the individual, the detailed clinical interviews and the number of standardised evidenced based assessments (widely used and respected globally) a diagnosis of ASD was correct (and not disputed by the clinician).

Whilst PDA may have been provided by the clinician as a behavioural profile, it was clearly not explained correctly (or the parents misunderstood) as they now believe PDA to be the primary diagnosis and not ASD.

On one hand it could be said that it is not the diagnosis that is important in this case but the management of the individual’s aggressive and disruptive behaviour within the family. If by having a label of PDA this improves the ability to manage the behaviours then maybe we need to engage in further research of PDA and explore how our recommendations may be influenced by applying this label with future clients.

What was clear from the case is that the clinician did not fully explain PDA to the parents and left them confused by thinking they were completely separate disorders.  It may have helped if the clinician had contacted us and asked us to contribute to the additional work being undertaken with the family, we would have been more than happy to provide the detailed notes and raw assessment data that the team recorded.

Conclusion

It would seem, to receive a 'diagnosis' or behavioural profile of PDA, very much depends on the individual clinician on whether they choose to apply a specific label of PDA to an individual or not.

Note I am using the word ‘label’ not ‘diagnosis’

This highlights the risk that in the absence of specific training, evidence based and reliable assessments and a universally accepted condition, individuals could be mislabelled, and even with a label of PDA, many other health care professionals or in the case of children, Local Authority’s, can reject the condition.  This can result in a lack of funded support for those who may, for example require an Education Health and Care Plan (EHCP).

It can also lead to confusion for parents when trying to seek additional support from healthcare providers as there is no clear guidance issued by NICE, the NHS or any other public body on what the recommended support for PDA is.

PDA is not currently recognised as a mental health disorder or illness in the UK and so by having the profile applied, it is unlikely to help individuals apply for additional financial or health care based support. 

It is however, becoming increasingly recognised as a behavioural profile within the neurodevelopmental community and in certain cases may benefit clients by understanding the profile and how to manage it.  While the PDA profile has been found to be relatively uncommon, we would agree that it’s important to recognise and understand the distinct behaviour profile as it may have implications for the way a person is best supported.

Notes for the Editor

The Practice MK is a private multi-disciplinary psychological practice in Milton Keynes that specialises in Autism Spectrum Conditions

The article was produced by Dominic Goodsell, Director and Practice Manager but in collaboration with its Clinical Director, Katherine Goodsell who specialises in Autism. 

The Practice MK has 16 Associates working in the fields of psychology and delivers counselling, therapy, educational and psychological assessments.  It also delivers a specialist trauma clinic and therapetuic adoption and fostering service.

References

Understanding Pathological Demand Avoidance syndrome in children. Christie, Duncan, Fidler & Healey (2011).

Mezzich, Juan E. (2002). "International Surveys on the Use of ICD-10 and Related Diagnostic Systems"

http://www.autism.org.uk/about/what-is/pda.aspx

O’Nions, E., Christie, P., Gould, J., Viding, E. & Happé, F. (2013)

There may be a particular issue you wish to sort outor you may just want to communicate better and fight less. Relationship counselling builds on what first attracted you to each other and what can be done to reduce hurt and conflict. You may be in a pattern where one of you wants more and your partner withdraws.

Most couples come for relationship counselling because they want to be able to talk about things without arguing. They want to be closer and have more fun.  

Relationship Counselling at The Practice MK

"Almost one in five (18%) couples in the UK argue regularly or consider separating, a study suggests. The report, carried out by charity Relate and based on a survey of 20,980 people in relationships from 2013-15, suggested 2.87 million people were in "distressed" relationships."  -- http://www.bbc.co.uk/news/uk-36373299

Our closest relationships can provide us with some of life’s greatest happiness and satisfaction.

Here at The Practice MK, Milton Keynes, we see many couples who have turned to counselling and therapy as a means of improving or rescuing their relationships. Our experienced relationship therapists work with you together to help you rebuild your relationship or, if you wish to separate or divorce, to do so as amicably as possible.

Your therapist’s aim is not to resolve the issues for you, but to develop your skills so you can resolve the issues yourselves. They will encourage you to talk openly about difficult topics and explore your childhood and family history. By analysing your behavioural patterns and the ways in which you communicate with each other, they will also help you see discrepancies in your and your partner’s behaviour and teach you techniques to improve your communication. 

Ultimately, we work to support you as a couple to identify patterns and modes of communication and behaviours so you can both take responsibility for your own choices and actions and work out the best way for you to resolve your complications.

Relationship counselling can help you come to the decision of what you should do with your relationship. Once you have made that decision, we can help you either to work out your problems and stick together, or help you to split up from each other with the minimum of fuss. You can speak to our counsellors face to face, by phone or online. We also have a range of other services for people who want help with their relationship. 

Find out more about our counselling and therapy services

January 2016 sees the launch of our specialised EMDR service for PTSD and Trauma, so we thought we would share with you how it all works!

For further information about EMDR and our fees please see our EMDR Therapy page

What is PTSD?

Post-Traumatic Stress Disorder (known as PTSD), is often associated in people’s minds with soldiers who have seen active duty in war zones. The truth is that it can effect anyone of any age, sex, ethnicity or religion and is more widespread than people know.

What is common to anyone suffering the effects of PTSD are individual intense experiences of or repeated exposure to traumatic events.  So for example, children who are continually bullied can become traumatised, women suffering domestic violence, anyone who has gone through sexual abuse, exposure to public tragedies, such as natural disasters, bombings, the list goes on.

Dealing with PTSD means identifying the symptoms of the disorder and these can vary from person to person, ranging from overt physical symptoms or behaviours, to internalised mental or emotional difficulties, that even close relatives or friends may not always detect. The next step in overcoming PTSD is seeking PTSD treatment.

More often than not, people choose counselling for PTSD because of comments or advice from loved ones who can see that a client is having problems that are not ‘normal’ for that person and it is effecting relationships, or the person suffering can end up in trouble with the law, or coming to the attention of the psychiatric profession, at which time PTSD may be diagnosed.  Sometimes, clients are not aware that they may be suffering from PTSD, but disclose other problems to a counsellor.

For instance, someone who is suffering from post- traumatic stress disorder may be suffering a range symptoms, such as:

Depression

Anxiety or stress – specific or free floating

Panic Attacks

Nervous breakdown

Uncontrolled anger

Nightmares and flashbacks

Dissociation and ‘acting out’

Hypervigilance or OCD

Shakes and tremors

Nightsweats

If you have had symptoms of PTSD for more than a few weeks, then talking to your G.P. is recommended.  They may then refer you to a specialist after their initial assessment.  If you have had symptoms of PTSD for more than four weeks, or have severe symptoms, you will be referred to a mental health specialist for further assessment and treatment, which may include medication and ‘talking therapy’. 

How Can EMDR For PTSD Help?

"In a controlled component analysis study of 17 chronic outpatient veterans, using a crossover design, subjects were randomly divided into two EMDR groups, one using eye movement and a control group that used a combination of forced eye fixation, hand taps, and hand waving. Six sessions were administered for a single memory in each condition. Both groups showed significant decreases in self-reported distress, intrusion, and avoidance symptoms."  -- Pitman et al. 1996

Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories.

It enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences.  Repeated studies show that by using EMDR people can experience the benefits of psychotherapy that once took years to make a difference.

During EMDR therapy a specially trained member of the team will support a client to attend to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus. Directed lateral eye movements are the most commonly used external stimulus but hand-tapping and audio stimulation are often used.

EMDR facilitates the accessing of the traumatic memory network, so that information processing is enhanced, with new associations forged between the traumatic memory and more adaptive memories or information. These new associations are thought to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights.

EMDR therapy uses a three pronged protocol:

The past events that have laid the groundwork for dysfunction are processed, forging new associative links with adaptive information

The current circumstances that elicit distress are targeted, and internal and external triggers are desensitised

Imaginal templates of future events are incorporated, to assist the client in acquiring the skills needed for adaptive functioning.

The brain’s information processing system naturally moves toward mental health.  If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering.  Once the block is removed, healing resumes.  Using the detailed protocols and procedures learned in EMDR training sessions, clinicians help clients activate their natural healing processes.

"Some studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions."  -- http://www.emdr.com/what-is-emdr/

The Practice MK Can Help

If you think you or someone you are close to is suffering from post-traumatic stress disorder or has experienced trauma and would like some advice on how to deal with it, or need help, everything you tell our psychologists or counsellors will be in the strictest confidence.  

What is PECS?

PECS stands for Picture Exchange Communication System and was developed specifically as a communication tool for non verbal children with Autism Spectrum Conditions. Although this system was designed for use with ASC’s it has been successful in supporting individuals with a wide range of learning and physically disabilities.

  One of the major benefits of the PECS system is that it is a picture based communication system, which utilises everyday images. These images are unambiguous and universally known which means that this communication method is easily transferable between the home and education settings. This ensures that there is inherently a high level of consistency in this communication method.

 Where PECS differs from other communication methods, is that it supports the individual to initiate the interaction, as opposed to being asked questions. This allows the individual to develop spontaneous communication.

 How does PECS work?

The PECS system of communication is 6 phase process and is works as follows;

Phase 1 - How to Communicate

This initial stage requires the individual to begin to initiate communication by using a single image of a desired item. The individual is supported to present a single image to the trainer sitting close. Support is gradually withdrawn until the individual manages independently.

 Phase 2 - Distance and Persistence

The image is now placed on a board away from the individual and the distance between the individual and the trainer is gradually increased.

 Phase 3 - Discrimination Between Symbols

More images are incrementally placed on the board requiring the individual to select a desired item. It is again presented to the trainer and positive reinforcement is provided.

Phase 4 - Using Phrases

During this phase simple sentence structure is introduced. The individual initially uses the image “I want” followed by an image of the desired item.

Phase 5 - Answering a Direct Question

The individual uses the images they have learned to answer the question “What do you want?” 

Phase 6 - Commenting

The cumultive effect of these phases, in conjunction with an ever increasing number of known images, means that an individual can comment on things around them rather than just requesting items. This creates the foundation for more complicated communication, such as “What do you see?”, “What do you hear?”.

Eventually this method of communication can help to communicate abstract issues like, “What do you like?” and “How do you feel?”.

Does PECS work?

PECS is a very positive and rewarding process and research suggests that it is a very useful tool in helping individuals with communication issue express themselves. Parents and carers are fundamental in the successful of this process, enjoying the involvement it gives them in helping their child communicate more effectively.

How can we help?

The Practice MK has a specialist Speech and Language Therapy Department, trained and experienced in implementing and using the PECS system. Following the successful implementation of the process our therapists can provide ongoing advice and support to ensure the best possible outcomes for each child.

Mental Health in 2015

Recently Ed Milliband called for measures to cut the suicide rate in the UK. At The Practice Milton Keynes we are very pleased to hear abut this move towards tackling the problems of people who feel so desperate that they take their own lives. Speaking at a conference on mental health Mr Clegg said, "Suicide is, and always has been, a massive taboo in our society. People are genuinely scared to talk about it, never mind intervene when they believe a loved one is at risk. That's why I'm issuing a call to every part of the NHS to commit to a new ambition for zero suicides. This isn't about blame. It is doing more in every area of our society to ensure that people don't get to that point where they believe taking their own life is their only option."

Suicide Rates Up

The fact is that more than 5,900 people took their own lives in the UK in 2012, according to the Samaritans and most of those people were men. In some age groups, according to National Statistics Office figures, suicide is the leading cause of death.

When Friends and Family Are Not Enough

There is no doubt that friends and family can be a great source of comfort to us when we are down, depressed or anxious, if we have lost a job or perhaps suffered a relationship break up.  These are usually transient episodes that pass.   But what happens if they don’t?  What happens if the situation begins to spiral out of control and make an impact on everyday life?   Some people feel nervous about seeing their doctor - there is still a stigma attached to admitting that you have mental health problems.   But like physical illnesses, that can affect anyone, mental illness is just the same. 

Even if you do pluck up the courage to visit your GP, if he or she decides that you need to go for counselling or any other kind of psychological support it an be six or twelve months before you can see anyone.  The pressures on the NHS are well known and mental health services are stretched to the limit.

Talking Therapies

At The Practice Milton Keynes we have a team of very experienced counsellors and psychologists and we are proud to be one of the only psychology family practices in the UK to provide a wide range of mental health services under one roof. We aim to offer treatment without the wait so that you can start getting better as soon as possible. In The Practice, trained practitioners who work with people to get over a temporary bump in the road or to tackle longer-term problems, deliver counselling and psychotherapy.  Our aim is always to help our patients to achieve an improvement in their symptoms and to enhance their wellbeing.

Working Through It Together

Together with your therapist you will be able to examine what has brought you to therapy, looking back on life events, as well as at the current situation.  With your therapists guidance you will be able to gain real insight into the way that you think and through that gain a better understanding of your own patterns of behaviour.

Your therapist at the Practice will work with you to examine the issues you have and help you to understand what has caused the problem.  Then they will help you to find the right way forward, for you.  Through the careful and expert care that we offer at The Practice we aim to help our patients resolve their problems and concerns or to help them identify coping mechanisms that they can use.

Why Wait when You Need Help? 

When we diagnose a child or adult with autism spectrum disorder (although we prefer the term autism spectrum condition) it can be both a relief and a shock to them and their family.  Clients often tell us that they "feel different" or that they are "not like everyone else".  Receiving a formal diagnosis can explain behaviours and give reason to what can be an extremely distressing period in someone's life. 

We try to focus on the positive and talk with clients about moving forward giving them options to choose from.  There is 'no cure' for ASD, and the reason we prefer to think of it as a condition rather than a disorder is because in most cases autism does not prevent a person from being successful in life.

Stephen Wiltshire MBE

One of the best examples of someone with autism harnessing their strengths is Stephen Wiltshire MBE.  

Stephen is an artist who draws and paints detailed cityscapes. He has a particular talent for drawing lifelike, accurate representations of cities, sometimes after having only observed them briefly. He was awarded an MBE for services to the art world in 2006. He studied Fine Art at City & Guilds Art College. His work is popular all over the world, and is held in a number of important collections.  Stephen was born in London to West Indian parents on 24th April, 1974. As a child he was mute, and did not relate to other people. Aged three, he was diagnosed as autistic. He had no language and lived entirely in his own world. 

At the age of five, Stephen was sent to Queensmill School in London, where it was noticed that the only pastime he enjoyed was drawing. It soon became apparent he communicated with the world through the language of drawing; first animals, then London buses, and finally buildings. These drawings show a masterful perspective, a whimsical line, and reveal a natural innate artistry.

To read more about Stephen and his life and how he harnessed his autism into his art read his biography on his website.

Companies employing people with autism