Moulding Health

Moulding Health

Blog

Understanding Healthcare Private Practice Management from a Physiotherapists Perspective

My mind is always blown away when we speak to healthcare professionals about their private practices and how they manage them. In a recent episode of our Moulding Health Show, we spoke to Samantha Harding, a physiotherapist based in Empangeni, South Africa. Managing a private practice is no small feat, but Samantha explains her approach to getting to grips with this complex topic. 

Samantha mentioned that she originally wanted to be a cook as she loves to cook and bake. It was her mother that guided her toward a career as a physiotherapist after her brother had fallen ill with pneumonia and needed therapy. Samatha admitted that her mom used to take her to a physiotherapist that worked from home and believed that it was a lovely job for a lady as she got to work from home and could have her kids around her. 

Samatha did confess that getting her qualification as a physiotherapist was not easy, and in fact, she was not accepted to the program the first time she applied. She went on to do BSC and used those marks to reapply for the physiotherapy program, again she was not accepted. But fate intervened shortly after that when one of the students quit the program and Samantha was given their slot. Despite being accepted a year later Samatha said it was a blessing in disguise as she was a year older and slightly more mature so she could handle the intense course better. 

This again reminded me that becoming a healthcare provider is a blessing and a true calling. You won’t always get in the first or even the second time that you apply, but as its your calling when you are given the opportunity to study what you are passionate about, you appreciate the opportunity so much more. 

Once you have completed your degree, there is still work to do before you can practice independently and set up a private practice. Most allied healthcare practitioners have to do a year of community service before they are allowed to practice. For Samantha that year was served in rural Empangeni at the Ngwelezana State Hospital. She told us that it was one of the toughest but most fulfilling years of her career so far. The comradery between the interns was amazing and working in a hospital environment gave her a holistic view of what physiotherapy is. Treating patients in a hospital is very different to in private practice but in that community service year, you learn so much and are able to give back to the community. 

Unlike many physiotherapists that have completed their community service, Samantha went straight into private practice. She admitted that although she had loved working in a hospital environment that her passion was directed more towards working with outpatients. For about four years she worked for another physiotherapist where she could gain experience before finally opening her own practice. 

Advice for someone thinking of opening a private practice. 

We asked Samatha if there was something she wished she had been told before opening a private practice and her answer was something that we have heard so many times before. 

She said she wished that there had been more courses or access to talks on how ICD-10 coding works or billing works. Because these things were never covered in a single module while she was studying. She also advised that when starting a private practice it would be a good idea to take a short course on business management and labour law because after all running a private practice is essentially running a business. 

One of the best decisions Samantha says she made was that when she started out she immediately hired a receptionist. She is more of a clinician and was glad she chose to have someone to assist her rather than having to man the phone, do the admin and treat patients.  By having a receptionist she is able to maintain a therapeutic relationship with her patients while her receptionist is able to handle the admin work as well as have conversations with late payers etc. This keeps the healthcare side and the business side of her practice running smoothly and allows her to concentrate on what she does best which is treating patients. 

The other big thing that Samantha recommended when going into private practice was to invest in billing software. Her reasoning was that it saved both herself and her receptionist time when it comes to the day-to-day running of the practice. 

Advice for someone thinking of becoming a physiotherapist? 

Samantha had this tidbit of information for students getting physiotherapy. It can sometimes be hard because you have to do everything. She admitted that she struggled with paediatrics as it was so far from her special interest. But that she loved neuro physiotherapy because she sees it as a gift to see a patient’s recovery. While studying you’ve got to be able to do everything. All areas of physiotherapy are in your final exam so you need to have a good understanding of each in order to pass. 

Once you’ve got the qualification you can choose, to specialise further and create a practice that caters to your specific area of interest. 

Final thoughts 

In closing, Samantha left us with this lovely piece of advice. If you are going to be in private practice or just practice as a healthcare provider or physio just to not stop learning. I think the scariest or most dangerous type of practitioner, is someone who thinks that they know it all.  The more that you learn, the more you realise you don’t know. And I think, there’s a lot of value in that continued learning and with the virtual world being what it is, it’s actually so much easier than it was before as well. So there’s really no excuse not to continue learning and to be the best that you can be for your patients.

It was an enlightening experience discussing private practice management with a physiotherapist such as Samantha Harding, and understanding how her career has evolved to the current level. 

If you would like to hear more about medical private practice management and uncover other stories like Samantha’s, you can go to https://kitrin.com/medical-practice-management. Many of our clients also prefer to concentrate solely on the medical billing solutions rather than the more comprehensive practice management aspects. In this case, we created a useful resource to guide them through this process – which can be found here https://kitrin.com/medical-billing-solutions. 

If you’re a healthcare practitioner or you know of a colleague or loved one that would like to share their knowledge and experiences of being a healthcare practitioner and a special area of interest of theirs, we would love to give them the opportunity to be on our Moulding Health and Moulding Private Practice podcasts. This will not only help the healthcare practitioner with additional referrals to their private practice, but it also helps us as a society learn more from amazing healthcare practitioners. You can contact us by sending an email to info@kitrin.com

Hypnotherapy – Pseudoscience or not?

How does hypnotherapy fit into the therapeutic space.

Okay, so hypnotherapy is a modality of psychotherapy that uses the natural neurocognitive, the phenomenon of trance, or hypnosis, to alleviate presenting complaints and reach therapeutic goals. So in hypnosis, we take advantage of the fact that a person’s brain is programmed. And inclined to go into this natural state we call hypnosis or trance in order to help them alleviate their presenting complaints and reach the therapeutic goals.

What are the conditions for hypnosis.

I’m sure we’re going to get there exactly how it works technically. We all actually hypnotize ourselves all the time. For example, driving somewhere very familiar and you forget the route you took, and suddenly you’re home. That’s actually a state of hypnosis called highway hypnosis or planning to go to the shops after work. And suddenly you’re at home, you’re like, Oh, I forgot, or walking into a room and forgetting what you walked into the room for, or watching a movie and experiencing emotions based on what’s going on for the characters in the movie. Those are all kinds of hypnosis.

And we are naturally programmed to hypnosis because it’s very therapeutic for the survival centre of our brain for our amygdala. The pattern of brainwaves is very regulatory. So everybody has got the potential to be hypnotized. And we hypnotize ourselves all the time. But in order for hypnosis to take place in an interpersonal context, whether it’s therapy or stage hypnosis, or whatever the context for hypnosis is there have to be three conditions.

The first condition is that there has to be communication. So I have to share some kind of communication with the person that I’m going to be inviting to hypnotize themselves at that moment. Because I can’t hypnotize anybody, however, I can show you how to hypnotize yourself. Secondly, there has to be consent. So you cannot hypnotize somebody that doesn’t want to be hypnotized. And then finally, there has to be freedom from fear. So if a person doesn’t understand hypnosis and is still under the misconceptions and myths about hypnosis. That it is allowing somebody to take over, or it’s mind control, it is giving control over to the other person, they will be fearful.

And hypnosis does not have to be fearful. Hypnosis is actually incredibly safe. It can be incredibly effective, but it’s also incredibly safe. And I always explain to my clients exactly how hypnosis works, so that they understand how safe it is. Now sometimes, I get a lot of people asking me specifically for hypnosis, but it’s actually that is not the norm. The norm is usually that time presents for therapy. And I will see that this particular client would benefit from hypnosis. Then I will introduce the concept of hypnosis. And explain to the client exactly how it works, then invite them to experience hypnosis.

How does hypnotherapy work.

All hypnosis is self-hypnosis, but it’s not always true. As the hypnotherapist, I am the car or the GPS and the client is the driver. The client tells me where they want to go, and what they want to work on. They want to work on the belief that they can’t be loved in a relationship. Or they want to work on smoking, they want to work on their fear of public speaking, they want to work on this belief that romantic relationships are going to be traumatic for them. Basically, anything that is happening outside of the conscious awareness in a subconscious that is informing the range in their role repertoire.

So they want to work on something like that. They tell me where they want to go. They put the destination into the GPS. And I know the route to go there, but I’m not driving the car. So I will say turn right yeah, I will say in 200 meters go left or whatever it is that the GPS says. And in that, the client will get into a state of trance, which is actually just a pattern of brainwaves. This is a naturally occurring pattern of brainwaves that we all experience throughout the day. And the client will then be able to deliberately manufacture, this pattern of brainwaves. In order for us to reach the therapeutic goals but I’m not the one driving the client is the one inducing their own trance.

How does a stage hypnotist like Andre the great get people to act like a chicken on stage.

I’m so glad you brought that up. Because on stage hypnotism is real hypnotism. In fact, the model of rapid induction hypnosis that my colleagues and I trained in was developed by Dave Ullman who himself was a stage hypnotist. He wasn’t a psychologist or psychiatrist. He was a rival at the time of Milton Erickson who was also seen as the father of hypnosis. We just have different principles from the Milton Erickson Institute on how to induce that trance. But Dave Ullman and Milton Erickson were rivals at around the same time in the 1950s and 1960s. And Ullman’s father was a stage hypnotist along with Dave Ullman himself.

Now Dave Ullman worked very closely with the Mayo brothers from the Mayo clinic. Because one of the phenomena of a state of hypnosis called the Esdaile state is named after James Esdaile who was a British physician. He worked alongside Dave Elman at the Mayo Clinic using hypnosis as a part of anaesthesia which lowered the rates of anaesthesia related mortality. Because they were having to use less anaesthetic per patient. And back in the 1950s and 60s, the medication wasn’t as effective as it is now and there was a high risk of anaesthesia. And in the head of anaesthetics wanted to publish an article about the use of hypnosis in anaesthetics. The Mayo brothers prevented her from doing so because they didn’t want to discredit the clinic because hypnosis was seen as fringe science.

Dave Ullman himself was actually a stage hypnotist. Now how people like Andre the amazing hypnotist work is that the person that is participating with them wants to have a good time. They want to be the centre of attention, they want to have a different experience, they want to bite into an onion and have it taste like an apple. They want to do that. So they volunteer. So how it works is that Andre the hypnotist will say who would like to come up.

There are two kinds of people that go up those that want to have a good time and prove that hypnosis works. And those that want to go up and prove that it doesn’t work. Then they do a screening and of course, those who want to prove that it doesn’t work that don’t get selected. Because they don’t go into trance because they haven’t consented to it. So then they go off and on ones that want to participate, will stay behind.

I saw a stage hypnotist and on the show was an Ex-Miss South Africa. And she said to the hypnotist, I just don’t want to look foolish. I’ll do anything but don’t make a fool out of me. He smiled and nodded then winked at the audience. When she was deeply in trance, we can see when a person’s deeply in trance certain physiological things that happen that a person can’t do on purpose that are are spontaneous things.

So you can see she was deeply in trance. Then he said to her “Right, you are world famous opera singer. And everybody here is here to hear you sing your best aria now go ahead and sing it”. She simply shook her head slowly from side to side and said, “No”. So she didn’t want to do that. She didn’t want to be made to look foolish. And so she said, Nope.

So you cannot make a person do something under hypnosis that they don’t want to do. And you cannot make somebody believe something under hypnosis that they don’t want to believe. Or that their subconscious does not believe is in the best interest of the system. Because the subconscious is always looking after you to protect you. That’s why if you’re sleeping and you smell smoke, you will wake up or you hear a loud sound when you’re sleeping, you wake up because your subconscious is always looking after you. And it’s the very same in hypnosis.

So to answer your question, stage hypnotism is real. But it relies on those same things, communication concerns, and freedom from fear. And the people that cluck like a chicken to bite into the onion, want to have that experience. They want to bypass the critical faculty and have a selected experience that is something different and have a good laugh.

How did hypnotherapy become a part of health care.

Freud himself, he was actually very bad at hypnosis. So he and his friends went down to the hypnosis school in the south of France against their supervisors’ wishes. And he tried to learn hypnosis and he was very bad at it. Freud couldn’t do it, it would take him almost an hour and a half to induce even a light trance. And so that was when psychology once again said no to hypnosis because Freud was bad at it.

So he developed his free association technique as compensation for not being able to do hypnosis. This is actually a kind of hypnosis but he didn’t do the rapid induction. And hypnosis then fell by the wayside again. It was brought up again in the 1950s and 60s and yes, exactly like you say new and fringe and because it wasn’t well understood, it was seen as almost quackery.

What is the difference between a hypnotist and a mentalist.

So mentalists typically use a branch of hypnosis called neurolinguistic programming. I’m not an expert on. But it is all down to the language that you use, in our frame of reference, we call it your semantics. So it is all down to the language that you use. And we see very good mentalists like Darren Brown, who do absolutely incredible things. But the thing is for a mentalist and sometimes coaches use neurolinguistic programming. And it would, it would be the difference would be what would be the purpose.

So for a coach using NLP, or a psychologist using hypnotherapy, the agenda would be to alleviate presenting complaints and reach therapeutic goals. Whereas for a mentalist it might be more for entertainment, research, neuroscience or evidence purposes. So I’d say that the difference really is actually only down to the agenda and the purpose. Whereas actually, the neurophysiological, and the neurocognitive processes might be very, very similar to one another, just different ways. My GPS might say, go on the highway, whereas the mentalist’s GPS might say, take the back routes, because the highway is congested, for whatever reason. It’s just different routes for different objectives, but also going into the same pattern of brainwaves. Bypassing the critical faculty for selective thinking.

So Hypnotherapy makes the subconscious changes that the conscious mind cannot.

Absolutely and my mentor who trained me in hypnosis is doctor Warrick Fipps, who is an incredible hypnotherapist. Warrick actually says that all therapy is hypnotherapy. You might be using rapid induction, or you might be using CBT. Maybe you are using brain spotting or narrative therapy. But the definition of hypnosis is that it’s a frame of mind, in which you bypass the critical faculty for selective thinking. And we see that in absolutely every single form of therapy.

Let’s say, there’s something that I want to change. And if it was something that the person could consciously change, they would have changed it. They wouldn’t need to come to therapy. So it’s something sitting in the subconscious. And we work insurrectionary. So we say what happens in the subconscious is the result of events in the interactional field, and gets perpetuated by events in the interactional field. So that’s our punctuation, that it all sits in a subconscious. And if the person could change it consciously they would.

So you have to bypass the conscious mind, you have to go past the conscious mind and talk directly to the subconscious. Now, in psychodynamics that might be through analysis, in person-centred therapy, that is when the person becomes emotional, and brain spotting that is when the person gets into the particular pattern of brainwaves by looking at the pointer. At those times, there is a bypass of the critical faculty where the subconscious is now open to suggestions and suggestions for selective thinking. A new way of programming and updates of the schemas that lead to more effective functioning. and that’s applicable to all forms of therapy.

Now it can be through hypnosis. As I said, it can also be through using metaphor. So when you tell your clients a story or use a metaphor. It is also when your clients is emotional. It’s also when you use experiential therapies like animals in psychotherapy, or when you play. I like to use sometimes games in my sessions with my client, to demonstrate a metaphor that I’m wanting to put across as an option for selective thinking to the subconscious. So in all kinds of therapy, there is this state of mind, there’s something that that I need to change. I can’t do it consciously. Bypass of the conscious mind for selective thinking and rapid induction hypnosis is just a very acute and direct version of that.

Your subconscious is like a computer in sleep mode.

Exactly the subconscious and the unconscious are always working to keep you safe. So the unconscious being for physical well being, the subconscious being for emotional well being relational well being and emotional safety they are always on, it’s only the conscious mind that switches off. And in hypnosis, we do not switch the conscious mind off, it is not sleep. It is easier to access a pattern of brainwaves with your eyes closed and your body still, but it is not sleep.

And back in the day of the 1950s and 60s, when stage hypnotism was a very popular form of entertainment, people looked like they got stuck in hypnosis or fell asleep. But they actually didn’t actually instance a very deep state of trance. Which is just so lovely, so blissful and so therapeutic, that they kept pressing the snooze button. Every time a therapist or hypnotist wanted to bring them out. They said no thanks because it was just so nice.

So in hypnosis, we don’t switch off the conscious mind. Not like when you sleep, the conscious mind switches off, to decompress and get rid of what it doesn’t need to rest, recharge, restore. But the subconscious and the unconscious are always working. That’s why you keep breathing when you’re sleeping. Your endocrine system keeps working when you’re sleeping. And your subconscious is also constantly keeping you safe, which is why you dream when you’re sleeping. Because your subconscious is working to process information, the relational field processes the emotional world in order to integrate these rules about how to keep yourself safe in your relationships, which we call schemas.

What risks are there to hypnotherapy.

So the risks of hypnosis would be that it doesn’t work and you waste your time and your money. And then also, you know, doing something like self-hypnosis by yourself if it’s uncontained. Or going to a hypnotherapist that doesn’t understand the oversaturation of the central nervous system. And in trying to put a person into hypnosis, they can have an adverse reaction. I usually only see this in other kinds of brain-based therapy. I’ve never had this in hypnosis.

I like to think of hypnosis as like the hand beater that beats the cream by hand and it never over beats it. Whereas sometimes the brain-based therapies are like an electric beater and the neurofeedback is like the cement mixer. And those you actually have to first make sure that there’s enough space, if you think about, if you beat something with an electric beater, you have to make sure there’s enough space so it doesn’t spill over. But those would be the only real risks of hypnosis that you waste your time and money.

And then obviously, things like false memories, so to go to somebody that knows what they’re doing in terms of their posthypnotic suggestions or working with regression analysis. And also if you’ve got a very overstimulated or over-saturated central nervous system that the therapist knows firsthand to ground and contain a central nervous system before trying to do any work with it. But I think that would go for any kind of brain-based therapy and hypnotherapy is a brain-based therapy.

Posthypnotic suggestions.

So the first one is that it has to be as if it is happening now. So I eat less exercise more I lose weight easily. Okay, you can hear which is my favorite one to do when the Christmas pants feeling a little bit tight. Is that exercise more I lose weight easily. Okay, so it has to be realistic. Not wake up in the morning. 10 kilograms lighter, okay, so it has to be realistic. It has to be something that your subconscious will buy. Okay?

Not I don’t want to smoke any more. It can be I am confident and confideny in social settings and enjoy engaging with people. Okay, smoking is something that helps you with social anxiety. So it’d be something like that. And it has to be said at least 15 times, it has to be at certain times. Like when you are running on a treadmill, not when you’re running on the road so much were you paying attention to other things or just before you go to sleep at night. Or when you are listening to bilateral music, or when you’ve done a self hypnosis trance at times like that.

The technical criteria is that it has to be happening now. It has to be something that is going to happen, that is positive, so happening rather than not happening. So not stop feeling self conscious in public more, I feel confident and relaxed when I’m with people. And it has to be plausible for the subconscious. Okay, the subconscious not not stupid, it has to be plausible.

Not so much a technical aspect, but it also has to be a little bit rhythmic. There has to be a little bit of rhythm to it, that you lose exercise more, I lose weight easily. I create healing within myself, in every day in every way I am better and better. If we look at that every day, and everywhere, I am better and better. What was that guy’s name, Emil KU, who said that every day and everywhere, he said, I am getting better and better.

But we understand in hypnosis, you have to say in every day in every way I am better and better, I create safety within myself, I love and accept myself. So there’s a little bit of a rhythm to it. And then it actually helps your subconscious get into that pattern of brainwaves as you are giving that suggestion, because the suggestion creates bypass of the critical faculty, as much as the critical faculty creates opportunity for selected thinking. And so having a little bit of a rhythm to it actually helps it go deeper and even quicker.

To listen to the podcast with Jeanie Cave on hypnotherapy click here

Mental Health and Mental Illness in The Workplace

How People confuse mental heath and mental illness

I run a series of workshops, and they all relate to the subject of mental health in the workplace. And I’ve tried to explain this to so many people, but if you can think of it as an umbrella. I refer to my workshops as mental health matters in the workplace . Matters serving a dual purpose in terms of the word matters could mean issues, but it also means that mental health matters, it should be a concern. So it’s got a dual meaning. So I’ve got the umbrella of mental health matters in the workplace.

But my flagship workshop has the title Understanding and Managing Mental Illness in the Workplace. And that comes up under my umbrella of being a mental health matter. Now, the reason as I said these terms of being confused. And I had a previous marketing partner, who, in their wisdom sent out the topic of that workshop, as Understanding and Managing Mental Health in the Workplace instead of illness.

And it made such a huge difference. I was actually extremely annoyed. I said to them, “Why did you change the word?”. And they said they weren’t paying attention. But it changed everything. Because that workshop is about understanding mental illness. Mental illness is a topic all on its own. And in that workshop, I talk about the mental illnesses that you can expect to see in the workplace, like your depressive disorders, anxiety disorders, bipolar disorder, post-traumatic stress disorder. And I’ll also include a little bit about schizophrenia, which is not a common mental illness in the workplace, because it is one of the more severe illnesses, people with schizophrenia can work. But often, they don’t, especially as they get older, it’s kind of a degenerative disease, if I can call it that.

That whole workshop is talking about illnesses and how to manage them in the workplace, whereas mental health covers a much broader spectrum. All my other workshops fall under that like Building Resilience, The power of Being Assertive ect, that’s a mental health concern. It’s not actually a mental illness. So mental illness is just one part of mental health. And if you want to manage mental health in your workplace, what you’re going to be doing is very different to what I’m talking about in my, in my workshop about mental illness.

So we’ve got to understand that mental health is a big global term, and everyone’s talking about it. We need to be more aware of our mental health. And yes, we do healthy living and managing the organizational strategies to limit the risk of burnout. These are all mental health concerns, but mental illness is another topic. And it’s, I think it’s an extremely important topic. I see it all the time in the workplace. People, just don’t get it. Everyone knows what it means to be a paraplegic. They can see, the persons in a wheelchair, they can’t walk, they’ve got no function from the waist down, you know, these things, we can see them. When it comes to mental illness. People just don’t. A lot of people just don’t get it. So yeah, if there’s an important difference between health and illness.

Analogy to physical illness.

When I do my workshops, I use a lot of analogies to physical illness to try and help people understand. You just said that thing about if they go to their boss and say, they’re really struggling to get going in the morning. That’s a classic problem and people with depressive disorders and there are lots of reasons for that. It’s a symptom and it’s also a side effect of the medication that they take.

The analogy I often make and people’s eyes just light up when I say this. But asking someone with severe depression to get out of bed in the morning. is like asking a paraplegic to stand up. That is how difficult it can be for someone with depression. And I’d see people’s eyes going big and people nodding their heads and saying, Oh, really? Is it? Can it be that hard?

And to try and get this message across to the managers. Someone with depression is coming late for work every day they get disciplined. Whereas someone who’s paralyzed, he’s coming late for work, because they’ve had catheter problems or bowel management problems, get all the sympathy in the world. Again, it’s about understanding, and that’s what the workshop on understanding mental illness is all about. About trying to help HR managers, and any kind of managers, supervisors, team leaders understand that this thing called mental illness is a very real thing. And, the responses are amazing, they really do just start to get it. And those analogies that are used between physical illness can help quite a bit.

Do employers really care about the mental well being of their employees?

But you know, one of the things I was thinking about is. Do employers really care about the mental well being of their employees? And, the straightforward answer to that is some do and some don’t. I think what I’m experiencing at the moment, in my own marketing efforts. Is that a lot of companies do have the service of ICAS. This is a service, that’s available to all their employees, and even their families, if they’re struggling with issues, they can go to ICAS.

But I fear that a lot of people don’t make use of that. And there’s a lot of fear about being found out at work, that you have a mental health issue. And this all comes back to stigma, which, unfortunately, prevails still, very, very strongly. People are saying that it’s getting better, but it’s definitely still there. And although COVID has helped people, in a way talk about the importance of mental health at work. I don’t think that it’s really done much to reduce the stigma. And if anything, people are being even quieter about their struggles now, because jobs are on the line. I don’t know how many hundreds of millions of people in the world have lost their jobs in the last few years. So obviously people are going to be wanting to protect their job as much as they can.

And if they think that they’re going to be frowned upon. Because they go to their HR manager or their line manager. And they say, Look, I’ve been struggling with depression. If they think that there’s any chance that that’s going to put their heads first onto that chopping block, they’re not going to do it. What I’ve also experienced in organizations, and I hope I’m sticking to the point here, because, I do have so many thoughts that come into my head. And I’ve also got a bit of ADHD actually think I always have, but I’ve never been treated for it.

I think it needs to start at the top. I don’t think it can just start at middle management. So I’m, trying to encourage organizations to go right to the very top. And get them, to start working on the stigma from the CEO of the organization. Because when everybody else realizes that the CEO is on board, that’s when people are going to start talking about it. That’s when the stigma is going to go down, that’s when awareness is going to increase, there’s going to be more empathy in the workplace. And we can make a big difference.

I’m not sure if you’ve ever heard of a guy called Chuck Robbins, I don’t expect you have but he’s the CEO of a company called Cisco Systems. Which is an information technology organization that’s based in the US and a couple of years ago, it had a total of approximately 75,000 employees worldwide. Chuck Robbins, who’s a fairly young CEO. He was in a conversation with someone, I don’t know if it was a colleague or a family member. But he heard about someone who’d committed suicide, and it really touched him.

And what he did was he sent an email to all 75,000 employees of Cisco, simply saying that we need to start prioritizing our mental well being. And within I think, 24 hours, he had about 100 responses, which is not a lot out of 75,000. But it’s 100, more than would ever have happened without his email of employees actually talking about issues that they were having. And since then he’s had many more. And I think he’s a standard example of what top people in organizations need to be doing.

Unfortunately, the argument that I’m always faced with when it comes to the CEOs don’t have time for this. It’s not that they need to attend the workshops and go and talk to everybody. They just need to have their face on the issue. The employees need to just know that whoever their person is, is on board. And it will filter down and, and people will start talking about it. And employees won’t be suffering in silence, they will feel that they can go and talk to whoever their reporting line requires them to talk to.

Therapy Appointments do your managers know or should they know.

Saying that you’ve got a therapy appointment with your psychologist on Thursday and you can’t go to the meeting. Should be as easy as saying that you’ve got a therapy appointment with your physio therapist, because you broke your leg five weeks ago. No one worries about saying that and I can’t wait for the day that we do get there.

I guess it does get back to the manager, I’ve seen a lot of disability claimants who have been referred to ICAS. And their managers are always aware of that. You know, they’re their line managers, their team, leaders, supervisors, everybody generally does know. The colleagues in their team don’t necessarily know about it, but their managers do know about it. So yeah, that fear is, is it’s big, so just don’t do it. I suspect that people might even be more prone to finding their own therapist out of work. So that they don’t have to have their managers be aware of this.

How do you find the balance between work and managing your mental heath and mental illness.

So it’s about getting the balance, right, isn’t it? I mean, obviously for any organization doesn’t matter how small you are. You can be a one-person show like like I am, but the return on investment is why you’re doing it because you need it. You need to produce because you need to make money to survive. I mean, that’s the point of business and I think, you know, what I’m about is not not not ignoring that at all. Not for a second.

I mean, we start talking about special accommodation of people with job accommodation of people with mental illness. That’s quite a big topic all on its own. And I always emphasize that the very first and most important consideration is whatever that special accommodation is. It must not place the employer under any undue hardship, because there is a job that needs to be done. So for example, I hear people saying that someone who suffers from let’s just take an example of someone who suffers from a debilitating anxiety disorder. Now, they can only work half days, they can’t work full days. And that’s not reasonable. We talk about special reasonable accommodations. Because what’s the employer then supposed to do with the other half of the day, if that person’s only working a half-day.

So, you know, there’s got to be a lot of consideration from both sides. And, I’m all about just making workplaces more, aware, more inclusive, more understanding, more empathetic, when it comes to having people there with mental illness. And again, to understand that, if you’ve got a mental illness, it doesn’t mean that you can’t do your job. These illnesses are usually relapsing-remitting types of illnesses. So people can be absolutely 100% for a long time. We just need to look at these celebrities that continue to perform and excel in sport and in music, and acting. All these people I mentioned earlier, just have moments when they’re not functioning.

And it’s then when employers need to be empathetic and supportive and understand what’s going on. It doesn’t mean that they’re going to be like that forever, and they must get rid of them as quickly as possible on the grounds of incapacity. That’s possibly one of the biggest myths of all. And when it comes to mental illnesses of these people, they can’t work they must go.

It’s a bit like being epileptic, you’re not epileptic, all the time. You’re not having a seizure all the time, you’re having a seizure, maybe once a month, maybe less frequently than that, and in between your seizures, you’re absolutely fine. You’re just as good as the person sitting at the desk next to you. But you do have a condition that comes along from time to time and, affects your ability to work when it does.

How would someone with a mental health or mental illness issues approach their manager maturely.

Well, again, in an ideal world, they would approach their boss just as they would if they had any kind of illness. And they would, they’d explain what their symptoms are. The symptoms of if we talk about depression, the symptoms are physical, psychological and cognitive. So they’d go there and say, from a physical point of view, they’re constantly tired. They often get aches and pains and all of that, psychologically, they’re just feeling done. They’re feeling emotional. They’re feeling irritable. From a cognitive point of view, they’re feeling that they can’t concentrate, they’re forgetful. They can’t make decisions anymore, can’t solve problems, just can’t focus their attention. And they’ve explained it all to the manager. The problem is, and again, this is where the education comes in, as the manager is going to be listening to this and thinking, Well, really, I also feel like that sometimes.

So what makes you different? And this is why they don’t go and tell them. If I can make the analogy again, if you go in, you’ve been off work for four for six months. Because you had a catastrophic motor vehicle accident and you lost an arm and a leg. You don’t need to explain all of that. Your employer, your manager you can see it, that obviously, it’s going to take you longer to get going in the morning. You’re going to have to go to your therapy appointments, and there’s lots of sympathy. There’s lots of accommodation, don’t worry, there’s almost too much sometimes that it gets taken advantage of, you know, just come to work when you can. And, you know, if there’s anything you need come and ask us,

But for the person with the mental illness, that’s where the challenge starts, right there. Is that they’re going to try and explain something to a person. Who’s going to be listening to them and thinking, I don’t know, is this person putting it on? There is a responsibility on people with mental illness, to help other people understand as well. There is a responsibility on them, but there’s, there’s so much fear about it. At work, they can be very good at explaining it to their family, and, and even their friends. But when it comes to work, there’s, more at risk there.

It’s such a difficult one, and in terms of what the HR person should be saying back. And how they or the manager, what they should be saying to the person, there’s all sorts of things that they should be saying. And they should not be saying, for example, don’t say that chamomile tea is going to solve all your problems, and everything’s going to be fine. But they’ve got to understand that. So, it’s really the, the approach should be just like it is for anything else. If you’re at work and you’re not feeling well, you need to go to whoever is up the line from you and explain it to them. And you’ve got to hope that they understand it and are supportive and empathetic. And sometimes they are and sometimes they’re not.

Loadshedding mental heath or mental illness.

And I’m working my way through companies trying to give them some more of those skills that help to accommodate a person with mental health or mental illness. I’ve listed eight items, and it’s according it’s called load shed.

  • L :: line of reporting, who do you need to report to.
  • O :: Time off, do you need to take time off.
  • A :: Assistive devices, do you need a device to assist you to do your job.
  • D :: Duties, can you do your duties.

And I’ve done it all according to loadshedding, because that’s a little bit what special job accommodation is, it’s about shedding the load from the person who’s not well, to allow them to continue to perform their role in the organization with that organization suffering.

Click the picture to listen to our interview with Lesley Burns about mental health or illness in the workplace.

Mental Illness and Health with an Occupational Therapist Lesley Burns

Anxiety in Children and Teenagers

What made you specialize in anxiety in children and teenagers

I love to obviously help children. I think something that makes me really excited about it is anxiety can be really treatable. And it’s so nice to see the difference in the child when I see them for a first session, versus when we kind of towards the end of the process. Or even if we don’t ever overcome the anxiety. The fact that anxiety can be so much more manageable in children. So yeah, that’s probably why I like to work with it. Childhood anxiety specifically because I only do work with children and adolescents in my practice. So I wouldn’t be the best person to give you a lot of anxiety tip for adults, but for children, adolescents, I’ve got that down.

In terms of the signs of anxiety, I think this is where it can be really tricky. I think anxiety especially in a child, and more so in a young child can be very unnoticed. It’s not like one of our behavioral disorders where a child is going to always be acting out or maybe the child throwing a tantrum or poking someone at school, often anxiety is very silent. In that respect, a lot of your teens will often speak up and say like, I can feel something. This isn’t right, but with our little children, this can go very unnoticed. I think another big reason for that is there’s a thing called normal anxiety. We’re supposed to have some level of anxiety in our lives.

Normal Anxiety vs Anxiety Disorder

We’re supposed to have certain fears, especially as we grow up as that’s what we would call normal fears for children. And when they have them in that age group. It’s not something unless it’s excessive, it’s not something we would really be concerned about.

So when I talk about normal anxiety, a classic example is if I’m standing at an edge of a cliff. And I’m feeling zero anxiety about being there, I could potentially maybe make a mistake or joke around to the friend I’m going to fall off and I’m going to die. So the reason I have that anxiety there is so that I keep myself alive. Our bodies are ultimately designed to protect themselves at the end of the day. Another reason why it can be really normal is it motivates us to get things done.

As a childhood example, if I have a test coming up. Having a little bit of anxiety is totally fine, because that’s going to motivate me to study harder. Or if I don’t know my work, I might go ask a friend or a teacher. The problem is when that goes from a normal level of anxiety to a more abnormal level. Where we could potentially be looking at like an anxiety disorder would be, if it’s something that starts becoming very excessive.

I’m going to go back to my child studying for a test example if now I sit down and study for my test. But am worrying about the test so much that now I can’t study. Or have a feeling the whole time I’m going to be a failure. I’m definitely going to fail and have lots of very negative thoughts. To the point that I probably don’t even study for the test. Or I don’t sleep well, I will then get in write the test and I’ll probably do really badly because I haven’t studied. That then just makes anxiety stronger, because now I’ve confirmed I can’t do it.

What signs would a parent look out for regarding anxiety in children and teenagers

So children and adolescents, even adults, we get stuck in these anxiety cycles. But looking at the parents asking What Sign Am I going to see in my child. There are a whole lot that they could see. And you got to remember when I list some of them now that just because a child does this one thing doesn’t mean the child has anxiety. There could be other reasons, obviously, to explain this.

Something we see a lot in young children is that my tummy sore, and you’ll see it, especially if it’s coming up to an event. So I know schools just started for many kids. And I’ve actually had a few moms phoned me and say, for the last three, four days, this sore tummy has come back. Or the child’s been vomiting for no reason, for example. And that is a classic sign, especially in your younger kids, they don’t really understand what the anxiety feeling is. And they definitely don’t know how to articulate it. So it’s very, very common. But it doesn’t mean if your child has a sore tummy, they definitely anxious.

Sepertation Anxiety

And something that you would also see very commonly in young kids is lots of clinginess. So separation anxiety is probably the biggest thing I see seeing kids. Want to be with the caregiver, or near them. You also see, feeling just generally overwhelmed, a bit sad. Some parents will report that their child’s been a little bit tearier, for example. But then we can also see it in terms of bad behaviour if you want to call it that. So a child is being quite difficult, quite oppositional, and always wanting to know what’s going on. Mom’s answer is not good enough, I need to know exactly, or, they push back.

Avoidance and concerntration difficulties

Another big one would be avoidance, I don’t want to do it, I don’t want to go to school, I can’t do school, it’s scary for them. Then we’ll see obviously, things like sleep issues, not being able to sleep. Or things like not eating, whether it’s eating more, or eating less. I always say a change in the eating pattern is something that I should look at.

Other things like difficulty concentrating, especially with both age groups, a lot of my teens will be like, I just can’t focus at school. And I don’t know why I don’t have something like ADD or ADHD just can’t concentrate. And other signs would be kids that are very eager to please, can often be quite anxious children. Obviously shy children can also be anxious doesn’t mean every shy child is anxious. There are a lot of shy children that are actually very confident kids.

Anxiety in teenagers

And in a lot of situations, looking more now as our teen, they will often withdraw. So your teenagers sitting in the bedroom all day never wanting to come out. However, that is also a normal thing for teens to do sometimes. So I wouldn’t necessarily panic about that all the time.

But a big one would be I’m not doing extra-murals anymore. Or I don’t want to go to that party or not wanting to go to school, so withdrawing from things that they would normally enjoy doing. Looking a lot for things like reassurance. So kids who say they’re worried about safety, for example, “Mom, have you locked the door”. “Mom are you sure you locked the door” or they go check the door. Those kinds of things that we see, that’s definitely your major anxiety, also looking at things like just general fears. So again, excessive fears. So like, for routine things like getting in the car. Now they are scared they might die. That’s not a normal fear that a teen should normally have those kinds of things would all definitely be warning signs to me.

When would you recommend that a child or teenager is brought in for therapy for their anxiety.

I think it really depends on your child and is this a problem that they’ve had before. So if they have been prone to anxiety before. But this is a new one coming up, then I would probably say, the sooner the better. Because it’s a long-lasting issue.

However, if it’s a new anxiety, and your child’s never really been like an anxious child. But there’s a big event coming up. So maybe it’s your first time ever going overseas, your child has never been on an aeroplane before. And they’re feeling a bit anxious about that. I wouldn’t be too concerned, I wouldn’t rush straight to a psychologist. There are still things that you can do to help them manage and assist.

Does anxiety in children and teenagers have a certain age group where it manifests.

I would say, it can really appear at any age, like if you say, what’s the onset, I wouldn’t give you an exact age. There are also some times that we see if more often. One of those times would be, say around 5 to 7-year-olds. And the reason for that is the child is at school-going age. Some children do go to school a little bit younger but say you’re going to school for like the first time. It’s really the first time I’ve got to separate from mom and dad for such a long time. And at that age, obviously, we do see heightened separation anxiety.

But it’s also the first time I ever have to kind of perform outside of my family. So an example would be, often kids will do things at home. And parents always say it’s great. And even sometimes it isn’t great, that’s what we do as parents. Now what happens is I go to school, and the kid looks at me and goes, What’s that drawing of that’s terrible. Or your teacher doesn’t give you a good mark on a test, for example, or you’re not the fastest swimmer. So it’s the first time you’re getting this communication that actually maybe you aren’t good enough in certain aspects. Even though mom and dad have always told you, you are. And that can bring on a lot of anxiety for a child. So we see them quite a bit.

And then also in like our adolescent phase, and that is obviously just because in adolescence, there’s a lot going on, our bodies are changing, there’s a lot of peer pressure, trying to fit in where I am, so it can come up quite a lot in that age group as well.

How do you treat anxiety in children and teenagers.

Firstly we would have to get the kid in would get a whole lot of information from parents first. How I work in my practice is I always meet the parent’s first. We discuss the whole background history, just so by the time I’m working with your child, I already have a good idea of what I want to do with them. I know their whole backstory, and I think about play therapy, if they little or talk therapy, if it’s an adolescent.

Cognitive

It can really really ease anxiety we were used like our cognitive behavioral therapy quite a lot. Also, especially with my littlies, I do a lot of externalization but it’s almost like anxiety is separate from us. In this room, we talk a lot about Mr Worry. And Mr Worry, he told us the bad things he told us I’m not good enough or he tells me that I’m going to fail my test but I know that’s not true.

So I equip them in kind of in a fun way of you know. How do we push back at anxiety and how do we fight back and also prove anxiety wrong? I always tell my kids you know, Mr. Worry, he’s a big liar. And the best way we can beat him is by telling him the truth. What we really know what we can prove. And then obviously, I also have a whole bunch of tips that I will then help parents with to equip them with stuff that they can use at home, as well, just to help ease anxiety.

Does anxiety in children and teenagers go away after a while.

Definitely, I think, you know, a lot of the coping skills you teach for one area can filter out everywhere? I think going back to your question, can this go away? It’s a very difficult question to answer because every child is going to be so different.

You know, if you had to do just some basic research, it will some places say it’s very curable, some places it will tell you that it’s not curable. I think for me, it’s very normal anxiety when I speak about normal, you know, very normal in terms of this is the kind of fears or anxieties a child have at this age, maybe it’s slightly excessive. And we could look at that, you know, definitely going away, definitely something that can be cured. I’ve worked with kids before, where we’ve gone through like a kind of a patch. And because we’ve dealt with it quickly and early, and we’ve equipped them with tools, we haven’t seen it ever come back.

But then you do obviously have, childhood anxiety, which is diagnosable anxiety as well. And it is just something that the person is going to have with them for their entire life. It doesn’t mean it’s going to be this terrible anxiety all the time. It’s all about getting that anxiety to a very manageable level. And a lot of people in their lives or teens or kids, that anxiety is so manageable that they don’t even notice the habits if that makes sense.

Only if maybe there’s something traumatic or another trigger does come up, and I maybe need to go see Dave for a few sessions, or, you know, I need to go speak to mom and mom’s going to help me also looking at does it go into adulthood. Your anxious kids do often become anxious adults, it is something that does stay with us. But again, it can be so manageable, I don’t want to say that sometimes it can’t be cured. I don’t want this to be like a negative thing, it doesn’t mean that we’re doom and gloom, there’s so much we can do. And, so many people who live with anxiety every day, that you would never know, because of how well they are able to manage it, and how well they’re able to look after themselves.

What things would be a trigger for children and teenagers with anxiety

I think your most obvious ones would be any kind of trauma that a child goes through any time they’re under stress. Because obviously when we are under threat, we are supposed to have anxiety. But then obviously if I’m more prone to an anxiety disorder, it’s going to just continue and I’m not going to be able to stop thinking about it.

But a normal day to day stressor can really trigger anxiety as well. So something that might not be stressful for you might not be stressful for me, but it’s stressful for that person that can definitely trigger. So I think also where as adults we forget with kids is something that are really stressful for children but they not for us.

I know once I was trying to motivate for a medical aid that I needed sessions for a child because he had a really stressful hospital admission. Where he’d gone through a lot of stressful testing and he was exhibiting, all these kinds of stress response symptoms. And the medical aid response was “going to the hospital isn’t stressful”. I said “it is for a four-year-old not for me but it’s definitely for a four-year-old”.

So we do need to also think of that in their shoes going to school is stressful. Standing up and giving an oral if that’s not something I’m into that is very stressed provoking. And those kinds of things as small as they can be, can bring on anxiety. Something I have been seeing a lot lately, and I think it’s just a world we living in at the moment with COVID we living in a very anxious world.

You know, it’s there’s all this uncertainty with COVID, I do think we’re getting a lot better. I practice Durban as well. So we had those riots really badly. So that was also very anxiety triggering, and even a lot of my teens, can’t tell me why they’re feeling anxious or sad. There’s like a certain trigger. But I think it’s just this whole climate. We are living in this constant state of maybe like fear or uncertainty, and then something that I do every day, like go to school, and it’s never been a problem. But because I’m carrying all these extra things it is now.

Do you teach anxious children and teenagers stress management tools.

Definitely, and it will be different from case to case. But it’s definitely a case of some children are a lot more stressed out than others. And then when we’re looking at the long term treatment.

It’s not just giving tools for the immediate anxiety right now, it’s also looking long term. Your stress is not manageable, especially for a lot of the teens, the ones who push themselves in school. It’s like, you can’t keep up that way, because you’re going to keep ending up in the cycle. So it’s also looking at how do we manage that long term? How do we, do something for ourselves as well, self-care. A lot of your very anxious people feel especially your teens, they feel like they have to do everything. And it’s also telling them, you don’t have to, you need to take time for yourself, as well.

How do we expain what is happening in the world now to children or teenages with anxiety

I definitely think so. And I think just because the world is so weird right now, I think that’s the only way I can actually explain it. You know, I think we need to be very honest with children. And I think parenting has changed quite a lot over the years. When I was raised, for example, it was kids aren’t supposed to know certain things and it’s just slot in and go with it.

And if a child is prone to anxiety as an example again, that is going to make the anxiety so much worse. So sit down with them and be very honest. Let’s use the masks as an example. This is why we are wearing masks it’s to keep us safe. Because the government says so, obviously keeping it extremely age-appropriate. You never ever want to actually make your kids fearful of that.

But also I think being vulnerable with your children sometimes. Not obviously letting them take on your own emotions. But kind of being like, mom also does feel a little bit nervous sometimes. Or I also don’t like wearing a mask I also actually worry about COVID. Showing them that it’s normal to have these feelings, but then also modelling how you deal with it, I’m not allowing it to let me get so overwhelmed that I can’t do the things that I enjoy doing.

And even if it does, that’s okay. But try to not show that to your child, because in these moments, you don’t want to make, their anxieties bigger. For them you want to be the stable person, you want to be the rock for so that they can come and talk to you. So I think honestly, with kids, goes a long way. Because they figure it out anyway, they pick it up, they go to school, and their friends tell them. Why not rather hear from your parents in a very controlled safe environment to start?

Can devices help with anxiety in children and teenagers

Definitely, I think devices is a tricky one, I think devices can be so great, in somethings. And also there’s a whole negative sighs too. So using it as a coping tool, and my space to just kind of, sit by myself and go through some stuff, I don’t think that’s necessarily a bad thing. I’m definitely not a psychologist that is like ban all devices, I think they definitely have a place in our lives.

And if the child or the adolescent is sitting on their device, maybe they’re talking to friends, or they’re looking at very appropriate content. I mean, a lot of these platforms like Tik Tok, and your Instagram that have had a lot of motivational great stuff as well. So for you seen in that sense, I think it’s totally fine.

Obviously, not sitting on it all day, but you know, sitting on it for an appropriate amount of time. But I think as a parent, you also have to be very careful, because that can trip over very quickly, to getting you know, into a more negative space. I’ve also seen you know, when I speak to my teens, they will tell me stuff about depression or anxiety and I’m like, How do you know that? And they say, “No, I saw it on Tik Tok”, and I’m happy to be like, “you know, tick tock not reliable, that’s not true.” That’s not what actually happens. So it can also be there’s that whole sense to it.

Then there’s also the cyberbullying that can come out and it can also be quite anxiety-provoking. In the sense that, you know, thinking, of the stereotypical example of a teenage girl looking at all these perfect people on Instagram and Tiktok and feeling like. Well, I’m not comfortable in my body. Why? Why is everyone else beautiful? And I’m not?

I think it’s kind of a bit of both and I think that’s where parents need to fit in to monitor what purpose is the device serving for my child. And if it’s that healthy purpose that little bit of a like downtime appropriate escape thing, great, but if it’s serving that other kind of purpose where it’s, you know, self-defeating the kind of behavior. Then that’s when I would step in and say, Okay, we need to be changed something so yeah, I have a love-hate relationship with devices.

Can the home environment be a cause of anxiety in children and teenagers

I’m gonna say yes, it can. And I’m not going to say definitely yes, some kids are resilient, they can grow up and fight adverse environments, and you don’t see any anxieties coming out. But we do also see trends. But then also in saying that, you know, anxiety is quite hereditary, first of all. So your environment might be perfect, but if it’s kind of in your genes you’re really going to be predisposed to it.

And, some children, just due to their temperament, are more prone to anxiety. They could have the perfect home and life perfect parents. But obviously, also we can’t control things like school and the outside world. So we will still see it. But generally, if we’re looking at what kind of environment could maybe give us a worse outcome in terms of like a child having anxiety. Definitely your parents that are very, harsh or overly critical. So the “Why are you wearing that or why did you do that?” “Why didn’t you do as well as your friend?” a lot of that kind of talk to kids can really trigger anxiety.

A lot of the teens I work with, whether it’s real pressure from mom or dad, or they perceive mom and dad put that pressure on. Especially with teens they often perceive something that’s not there. It said major pressure to perform at school, that is a big one a lot of time next, that can definitely come from the home environment.

And then obviously, things like growing up with very anxious parents. That anxiety can also be put onto a child and I know parents who’ve got anxiety ever would choose to do that to their child. But it’s something that can happen as well. And then obviously, an environment if I’m living an environment, that’s very stressful, a very traumatic environment. And again, parents can’t always control for that, like, I can’t control if we’re going to be robbed. For example, those kinds of things will definitely also bring about it. So yeah, definitely doesn’t mean it always will, though.

What tips can you give a parent of an anxious child or teenager

So I’m going to use the plane example as I go through it, but you could apply to anything that’s new, something that the child has never done that they’re feeling anxious about. And I would say you know, prepping a child for any situation is amazing. We know what a plane is like because we went on one for the first time sometime when we were young. We also have to think of anxiety, anxiety, likes to be in control anxiety likes to know what’s going on.

So we can often ease a lot of anxiety by doing that in the appropriate way. As adults, sometimes we wonder why kids are worried about this. I always say to parents is because as adults we make the plan, I make the plan. I know what time I’m going on the aeroplane because I booked the ticket I know what I need. And we just expect kids to follow along with us and wonder why they worried about this.

So sitting a child down and saying okay this is the plan. This is what we’re going to do we’re going to pack our suitcases and we’re going to go in the car for quite a long trip to the airport. When we get there, the next step is, we will get our boarding passes, we’re going to go through the gates where we put all our bags through the machine. So really step by step, what can they expect to happen? And obviously, I know how tricky is because we can’t always control everything. But the best we can do is to explain what we expect to happen. But then also trying to make it fun and exciting.

So kids I know I prepped recently them for an overseas trip. I spoke to them a lot about how the overseas planes have the TVs and so you’re going to be watching movies. And did you know you can watch movies on those that aren’t even in the cinema at the moment just to get them really excited. If you’re going on a normal plane can be stuff like, prepping them that their ears might pop, but for that we bought you this really awesome sucker. But to try and make it as exciting. As well as telling them step by step, this is what you are going to expect.

And also if it’s a safety thing, I always tell kids, it’s okay to be worried about safety. If they are worried the plane going to crash or anything like that. I’ve always give them all the facts like statistically, a plane is not going to crash but always say that is mom and dad’s worry it’s their job. If something has to go wrong, if there was a car accident, it’s their job to jump out and make sure you’re okay. So that’s not a child’s worry. That’s mom and dad. And mom and dad are always going to have a plan.

Because I think also we often talk it on it’s never gonna happen. And it backfires. One of the psychologists I know she, told the child that they’ll never get robbed he was robbed the next day. So we got also you know, kind of control for that in like situations that can technically happen. But that’s yeah, it’s an adults worry. It’s not a child worry, mom and dad have it sorted.

Do you think medicication can help with anxiety in children and teenagers

So your medication can always be really great. You know, it doesn’t mean every child that got anxiety needs medication, definitely not. And working with children, definitely cautious when it comes to sending them for medication.

So obviously, as a psychologist, I can’t actually prescribe but I would then refer parents to a psychiatrist. And the times I would maybe suggest medication is when you know, it’s very severe. This child is not able to go to school, they feel like they drowning, and they’re not coping at all. And the reason for that is to take that edge off so they can get to a point of where it is going to be more manageable. You know, your, your general anxiety that kids come in with, and they struggle with now and again, I would never rush to medicate that that can be dealt with very effectively with, you know, Parent Training and parents doing tips of home and just therapy.

But in your most severe cases, it is proven that the best course of treatment is when we have therapy and we have the medication hand in hand. I think it just takes that edge off so that I can sit in a therapy session and I can understand the stuff. And I can work through it and I can apply these skills. Whereas if I’m just feeling so overwhelmed, I’m giving coping skills, and then we work into this but that feeling of, it’s never going to help. It’s never going to work. And so medication and therapy can align really nicely.

You know, my goal was kids as well is if we can wean off the medicine. That is always going to be our goal, obviously, again, the psychiatrist would be the one that would have to dictate that. But for me, it would be the absolute win. If it is just a short term medication where we can get it to a manageable limit. And then hopefully, use the therapy use the tools to keep it kind of at that manageable space. And hopefully not go on medication again though obviously, every child is so different.

But also about if your child responds really well to the medication, I’m totally aware that medications can also have, side effects. And for me, it’s all meeting in the middle, what is going to be the best fit for my specific child at the time. Where maybe we’re not going to get the perfect quality of life. Maybe we have a side effect that we don’t like so much. But am I getting to a better quality of life where my child is happier? That’s definitely a win for me.

To listen to the podcast please click here

Contact Details for Jayde Green

Mobile Number :: 081 385 4431
Email Address :: jayde@greenpsych.co.za

How Occupational Therapists Assist with Mental Health Issues

Helen Gatley discusses the relationship between occupational therapy and mental health and wellness with the Moulding Health Team.

How does an Occupational Therapist find themself in the mental health and wellness setting.

Essentially, as occupational therapists, our big concern is, how are people managing to function in the day to day lives. And I don’t think there’s anyone in the world who would deny that mental health has an impact on our ability to function, to do our jobs, learn if we’re at school, manage our household, enjoy our hobbies, all these things. And so it is something that a lot of people don’t necessarily realize.

But once you understand the connection to function, which is really the home of occupational therapy. Then it makes perfect sense that mental health and OT would have a crossover and a big crossover. Yeah, so we work in many, many settings, and hospital-based, community-based, private practice, obviously. And, yeah, we, work with other people, we work within the team. So it’s not, that we work individually necessarily, but we often work with psychologists with the psychiatrists and bring our little perspective into helping people really re-engage with the sort of self-selected activities, the things that they want to do with their lives. That’s our focus, largely.

Are there certain mental health and wellness issues that you treat as an occupational therapist.

So it’s a deceptively complex question that you have asked. But there isn’t a specific set of disorders that we say these are the domain of OT and anything else isn’t. Because at the end of the day function is the name of the game. We will work in the perfect world, we would always work with psychologists and psychiatrists to make sure that we get as holistic care as possible for the clients.

I’ve worked with people with many disorders, from mood disorders to psychotic disorders to substance use disorders. But then we also might work with people who maybe don’t have as, as clearly defined mental health concerns, but are looking for, for building up of greater health-promoting practices within their lives. Or just struggling with conflict resolution, maybe within particular situations. We might even work with people who, within the mental health space don’t have a clear diagnosis.

Crossover

There’s also a huge crossover because humans are not made up of a mind in a jar and a body in a jar. Our minds and bodies are integrated. And so even working with a person, that was in a car accident and has some sort of broken bone or a tendon injury that needs to be rehabbed. But they’re also probably dealing with some sort of traumatic response to the injury. As well as dealing with the changes to their body and the changes to what they can and can’t do. And so there are elements of mental health, that affect every person, we see. I don’t think there’s an occupational therapist on the planet, that can avoid mental health.

But on the other hand, how, does someone know they need to come to us? It is tricky, because, a lot of people don’t know, don’t necessarily know what an occupational therapist can do to help them. So self-referral is relatively rare. Most referrals will come from other therapists or doctors. As well as psychologists and psychiatrists, who understand where we can add to what they’re already doing. So that is largely, what happens.

Therapeutic Relationship

There are a lot of elements to what constitutes a good therapeutic relationship. And so it’s like with a psychologist, obviously. It’s not just about the skill set as I’m an OT, therefore I can help this person. Because we work with very personal, difficult and deep parts of their lives. They need to feel safe with the individual who’s their therapist as well. So there’s complexity in that referral system. We have to be quiet, sensitive to the people who come into our space and make sure that we’re looking for the people who can best serve them.

It’s possible for someone to be referred to me and I have the skill set to help them. But I might not be the best individual because we don’t relate to each other well. And it’s not that I’m saying, I can’t work with people who, are different to me, that’s not it at all. But you do need to feel comfortable and safe in that space with your therapist. So, that is similar to how psychologists also have to look at how they work with people. Because we’re often dealing with very deeply personal things.

What would you do as an Occupational therapist to help a person improve their function.

As OTs, we look at function from multiple different levels. One of the things we would do is assess some of the core components of functions. Perhaps, there’s an issue in concentration, or there’s an issue in mood specifically. So specifically depressed mood, and then we would add elements into our therapeutic package that address those individual client factors. Which may include the specific activities we choose as part of our sessions or may include home program elements.

We know that exercise has a massive beneficial effect on mood. But a depressed person is probably really struggling with motivation to get up and go for a run. Part of what we will do is try and find ways to facilitate the movement from the theory of this is quite good for you. Which most doctors who deal with mental health will say to their patients, you should really try and exercise and preferably outdoors, because the natural light helps better. But the OT will try and help transition them from the recommendation to the action.

And, and that’s sort of the little space that we interact with. So perhaps we’ll use strategies, like habit-building strategies, goal setting strategies, planning strategies. Perhaps we will add in other elements that we know can elevate mood to try and get that motivation up. We also do a lot of patient education, a lot of working with family groups.

Support systems for mental health and wellness

If there’s one individual in the family who is struggling, the support system is a hugely important part of their function and their well being. So having, having connection and helping them build that connection, but also working with their support system. So that because we can’t be there all the time, they have to have more than us. And so that might be part of what we help with. And we could also then look instead of like these tiny little individual factors, like specific mood or specific concentration, we might zoom out of it and look at slightly bigger parts to the whole functional complexity, which could be overall activity schedules.

So maybe we look at if a person has a pattern in thier engagement that’s potentially problematic. How do we try and shift that? One of the challenges of OT, but also the thing that I love is that it really works best when the client is the leader of the change. So we are there as a facilitator and a helper and a therapeutic presence. But everything has to come from a person-centred perspective. Because what works for me will not work for you or someone else necessarily. And so it’s very difficult. I think this is one of the reasons why OT is often misunderstood and hard to explain. Because it’s so individualized, there’s a lot that doesn’t necessarily explain here is the protocol we would follow. Even though there are elements of that there’s a lot that individually.

As an OT do you find giving the patient accountability for their mental health and wellness works with people.

So sometimes just the act of coming to therapy is part of that, because there’s an external person who’s in the process with you. And so, you’ve got to go and see the therapist in a week’s time, and they’re gonna ask how did it go? And you’re going to have to say. Now, that’s not enough for everyone. But for some people, that in itself is enough. There’s some people who work brilliantly with a checklist or if I can tick it off at the end of the day and say, Yes, and sort of almost like reward systems and people that really works for them. But other people, it really doesn’t just feels like admin.

Goal Setting

So there are a number of different strategies like that. One of the big things I find is really important is to actually reexamine the goal-setting process itself. And just because often we set goals, and I can’t claim credit for this because I learned it from a very wise person who’s actually not an OT, but a coach. But she often talks about goal setting and how we often and I think this is true for New Year’s resolutions, too, we often set these lofty goals. Which are great goals and, things that we should be working for and beneficial and all these things. But we don’t have the first step yet. Thus we just never get going. So that’s one thing.

Pacing

And another huge factor that I definitely do use in my practice, is pacing. W all have the capacity for change. But it’s not unlimited. I can’t change everything today. When I try to, I’ll probably fail and become demotivated. So I do find that I often end up with patients who are just those very driven, motivated people. And so they get very frustrated when they can’t fix the problem that they have. Therfore teaching them to slow down and do one step at a time is really important. Because, there’s often I work with people who just, they’re used to succeeding, and when it doesn’t work, they get extremely frustrated, which is frustrating, to be honest.

How as an Occupational Therapist do you find the mental health or wellness barrier to help a client.

One of the things that occupational therapist’s are taught is to examine things, from multiple angles and on multiple layers. So when we look at function, we’re taught to find the barrier. And it takes years of practice to get really skilled at this. I often say to students, that it will feel natural and logical to you, but you’ve trained to do it. So it isn’t necessarily common sense to your client. So I think it’s it’s something that we often think but isn’t it obvious?

And it’s not necessarily because that’s what we trained ourselves to learn to do. So when you have a goal and you’re working for it, and you’re not succeeding, part of as an OT that I would want to do is to go and sit with the client and help them examine where the barrier is, and maybe there’s something that we missed there. Originally, that we need to go back and look at that, okay, this thing is still in the way.

And I think another big part of that is, is sort of finding effective measurements for your success. Because when it takes a long time to get where you’re aiming at, you can become demotivated, but, and I’ve had this with clients before, we sort of feel like they’re getting nowhere. And then I can go back to my files there. But now look at these measurements we did on your first session. Now, can you see how far you’ve come? And that’s incredibly useful.

Can occupational therapy help with burnout and stress management

Yes, absolutely. So I mean, burnout and, and just general stress is just so prolific. And it has been, but even more, so now. I just this weekend was running a workshop on this and talking about how, we’re all just exhausted, our systems are exhausted, our nervous systems are tired because we’ve had to maintain this level of alertness constantly.

And besides all the other problems that existed before COVID, you know, we’ve, we’ve now maintained an added layer of alertness and, you know, probably there were other life things happening in everyone’s lives as well as well. So managing that is enormous. And as OTS we do have a few unique tools, particularly looking at the nervous system, and the process of stress and one of those is our understanding of sensory systems and the nervous system, and how that affects mental health.

There’s a lot of body-brain Confluence around stress, we all know, you’re nervous for a meeting, and so your tummy starts googling. I mean, we know that our body carries stress. So, we ignore it often. As OTs, I think we’ve got a huge role in helping work some of those really practical solutions around somatic or body-based approaches to some of the stresses as well. And we obviously also trained in some of the cognitive strategies, but psychologists also do that, in that area. So we have a slightly more crossover, not okay, I have to qualify myself, psychologists also do somatic therapy, but we just approach it slightly differently. And I think as OTS we have, we have a bit of a unique space there.

To listen to the Podcast with Helen Gatley please click here