Monthly Archives: September 2020

Counselling across Communication Barriers (Part 2): Learning in Lockdown

Action Group Stock Photo 2 crop

Following on from last week’s guest blog, Edith Barrowcliffe from the Action Group describes how she has continued using Talking Mats throughout lockdown.  Please note that the image used in this blog is from a mock session and has been taken for publicity purposes only.

In the second week of March I was running a 9 week old pilot counselling service (HearMe at The Action Group) for adults with cognitive and/or communication difficulties, supported by Talking Mats.

A week later lockdown catapulted me into remote working and demonstrated just how crucial Talking Mats were. Without access to the digital app or a suitably high resolution webcam my first online sessions were conducted without them. One client immediately began struggling to retain the thread of their subject matter.

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I quickly rigged up a secondary webcam, allowing me to shift between my face and a clear view of the physical mat on my desk. Clients direct me how to place the symbols for them.

I’ve recently acquired a Talking Mats digital license and am pleased to find I can add in additional images. My experience with the physical cards is that allowing the client to direct the session often means searching through multiple different sets or hastily drawing new images. We move at a slower pace because of this but it seems to be an important way of giving weight and attention to whatever the client (Thinker) brings. My fantasy version of the digital talking mats app would include an image search function allowing me to rapidly search all the symbols in all the sets, pick one and caption it appropriately mid-session!

The client I mentioned above uses Talking Mats in this very freeform way – when they tell me something I ask if they want to put it on the mat and they will reply yes, or no. Once I’ve located or drawn the image they tell me where to place it. Towards the end of the session we review the mat, photograph it, and I send them the picture.

 Another client uses a more structured approach. I present a choice of symbol sets based on topics that seem to be important to them (eg home environment, relationships, mobility). They select a topic and we begin a more typical talking mat, giving us a framework and focus to explore their feelings around each symbol. After a while the client/Thinker moves on to other emotionally weighted topics unrelated to the symbol set and we transition into something more akin to “regular” counselling – albeit with simplified, concrete, reflections of the kind proposed by Garry Prouty [1] Yet the Talking Mat seems to provide a “way in” to these deeper feelings that we otherwise don’t reach.

Not everyone uses Talking Mats. Lockdown has limited my capacity to offer it – not all clients have a computer/tablet for video calls and some clients actively prefer the phone. I’m continuing to learn, explore and find my way with this very diverse client group, but there is no doubt that Talking Mats opens up emotional exploration for some who might not normally manage it.

 Edith Barrowcliffe, Hear Me, The Action Group

With thanks to our funders and partners for making this work possible – Hospital Saturday Fund, The Action Group Board, Leith Benevolent Society, Port o’Leith Housing Association, and The  Scottish Government.  And to the team at Talking Mats for their support and help!

[1] [PROUTY, G. (2008) Pre-Therapy and the Pre-Expressive Self. In: PROUTY, G. (ed.) Emerging Developments in Pre-Therapy. Monmouth: PCCS Books; also PÖRTNER, M. (2007) Trust and Understanding. Revised Ed. Ross-on-Wye: PCCS Books, pp82-85].

 

A new, updated version of our Digital app, will be available in the New Year.  You can download a free taster version of our app here:

  https://www.talkingmats.com/product/talking-mats-taster/

For more information about using Talking Mats remotely, check out this recent blog:    

https://www.talkingmats.com/using-talking-mats-remotely/

 

 

Counselling across Communication Barriers (Part 1)

Action Group Stock Photo

Many thanks to Edith Barrowcliffe from The Action Group for sharing her experiences of using Talking Mats to support counselling with adults who have cognitive or communication difficulties. Watch this space for Edith’s follow-up blog next week which will describe how she has continued to use Talking Mats during lockdown.  Please note that the image used in this blog is from a mock session and has been taken for publicity purposes only.

Eleven years ago, I began working at The Action Group with adults who have additional support needs and was struck by how many had mental health difficulties that they were getting little help with. Sadly, with services scarce enough for the “mainstream” population, I could see why.

The issue resurfaced for me in 2016 when I began training as a counsellor. I kept returning to whether talking therapy was possible with those who had difficulty communicating – or even thinking about – their feelings.

Then in 2019, I attended Talking Mats training. Immediately excited by the potential for emotional connection, I signed up for the advanced “Keeping Safe” training and approached The Action Group’s CEO with the beginnings of a plan.

I’m fortunate in working for an organisation willing to take new ideas and run with them. Within six months I was embarking on a pilot project, called HearMe, offering counselling to adults with cognitive or communication difficulties, with Talking Mats as a key method to help overcome those barriers. Within a fortnight of opening the service was full to its limited capacity and had a waiting list!

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The work has been experimental, learning as I go and adapting to the particular needs of each client. To conduct initial assessments, I’ve assembled symbols based on “Thoughts and Feelings” from the “Keeping Safe” pack. We return to this to review progress. Most clients have used a top scale of “True”/ ”Not True” with statements “about me” for the assessment. We always begin with a practice mat based on more neutral material, allowing the client (Thinker) to learn what’s involved and me to gauge whether the mat is right for them. This is crucial – one client found a way to frame everything we placed on the mat positively even when they’d been able to tell me the opposite was true a moment before! In this case we simply used each symbol as a focus for exploration.

We’ve kept the number of questions relatively small, but the assessment can take two or three sessions to complete as clients often respond quite deeply to the symbols.

Some more verbally able clients move on to a more “freeform” style of counselling as we progress, relying less on the mat to open up. But even in these cases having symbols on hand can be helpful. One client brought up the topic of sex – then apologised and asked if it was OK to talk about it.

“It’s fine,” I was able to reassure her, producing the relevant symbol. “Look, we even have a picture for it”. She laughed and visibly relaxed, the card giving her tangible evidence that the topic was allowed.

It’s still early days, but from the feedback we’ve received so far, the project really seems to be helping people to open up, express feelings they’ve never given space to before, and explore ways they want to change their lives.  The power of simply being heard.

Edith Barrowcliffe, Hear Me, The Action Group

 With thanks to our funders and partners for making this work possible – Hospital Saturday Fund, The Action Group Board, Leith Benevolent Society, Port o’Leith Housing Association, and The Scottish Government.  And to the team at Talking Mats for their support and help!

Follow the link below to find out more about our Keeping Safe training (now available online) and resource: 

https://www.talkingmats.com/keeping-safe-a-new-talking-mats-resource-available-to-purchase/

 

 

Talking Mats Research Group – Update

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We are delighted that we now have around 20 members of our Talking Mats (TM) research group.  Members come from a variety of countries including the United Kingdom, Denmark, Cyprus, Germany, Sweden, Australia and JapanWe are a mix of academics and practitioners, with many combining both roles.  So far we have spent time getting to know one another via video sessions and thinking about how the group might work. 

Research Gp Zoom Pic

We have decided our initial focus will be thinking about ways of analysing the data that is generated from conversations that are supported by TMs. This idea was suggested by Nikita Hayden.  Nikita is a PhD student at the University of Warwick exploring the outcomes of siblings of children and adults with learning (intellectual) and developmental disabilities. Part of her research has used TMs with children with severe learning disabilities and their siblings to further understand their sibling relationships.  

The types of data generated have been rich, vast and varied, leading to an overhaul of Nikita’s initial plan to analyse her TM data. This has raised questions about how TMs are interpreted and analysed in a research context, and what scope there is for our group to explore and synthesise the analysis potential of TMs. This is a question that the TM team is often asked and so having some information on the different options would be useful.  

TM discussions generate various types of data, including: 

- The photograph of the mat (which symbols are placed under the various columns); 

- The conversation generated during the discussion; 

- The body language and facial expression of the ‘thinker’; 

- The speed of placement of symbols; 

- The symbols that are moved following feedback etc. 

We would like to review existing publications that have used TMs as research data and think about possible methods of analysis. This may include consideration of both within and between group research analysis techniques. It may also involve exploring the potential of both traditionally qualitative and quantitative analysis techniques, such as thematic or conversation analysis, or by drawing on data from the symbol placements to provide pre-post evaluation data.  

We hope to generate a list of guidelines about what you might need to take into account when considering how to analyse these data.  A challenge when analysing TMs data, is how to handle the variation in the types of data collected between participants. For example, some participants may place a large number of symbols, whereas other participants may have placed relatively few. This raises questions about how we deal with ‘missing data’. In small samples, how can we conduct a pre-post evaluation where some symbols are missing for some participants? If some participants use a five-point scale, and some use a two-point scale, what numerical analysis potential is there, if any? How can we appropriately derive qualitative themes from across our sample if some of our participants were minimally verbal? What sorts of non-verbal cues have been analysed in research using TMs?

Please do share any ideas or questions you have with Jill Bradshaw, our Talking Mats Research Associate – J.Bradshaw@kent.ac.uk  

 

Covid 19 Experiences – Using Talking Mats in a Secure Hospital Setting

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As a group of Allied Health Professionals (AHPs) working in a secure hospital we recently embarked on a mini project using Talking Mats to check in with our service users with learning disabilities during Covid-19. We collated the evidence from our respective professional bodies (Royal College of Occupational Therapy, Royal College of Speech and Language Therapy, Chartered Society of Physiotherapists and British Dietetic Association) in terms of changes that people might experience if they’d had Covid-19 and produced a talking mat around these.  

It quickly dawned on us that we might be on to something here, and that creating an opportunity to ‘check in’ more broadly with our service users would serve a useful purpose, so we added some additional categories around changes to routine, psychological wellbeing and feeling safe.  

This was my colleagues’ first experience of using talking mats, and their faces when I turned up clutching my 99p actual doormat were a picture! I introduced them to the theory behind the mat and its presentation and harped on about the benefits in terms of attention, comprehension, non-threatening interaction, initiation and structuring narrative; they nodded supportively.  

We set off across our learning disability wards in multi-disciplinary pairs and all but a few of the service users agreed to have a chat with us. My colleagues commented that they were pleasantly surprised by the engagement and the amount and novelty of the information gained; we  identified things that the service users hadn’t told anyone because they hadn’t been asked that question!  

JB Blog Photo

In talking to others we were asked why weren’t rolling this out in a partner secure hospital for people with mental health conditions? ‘no reason really, we just haven’t got there yet’ we answered. Then came the…. but we can just do it like a questionnaire with them. This question wasn’t, and in my experience isn’t ever ill meant. It comes from a place of naivety in relation to the presence of communication difficulties in people with mental health conditions and because of that, lack of exposure to different professional groups such as Speech and Language Therapy and the skills and approaches we have to offer. Skills in gaining and holding someone’s attention. Skills in decreasing pressure in communication situations. Skills in enabling time, space and ways in which people can initiate their thoughts.  

The Multi-Disciplinary Team (MDT) working around the project has enabled me to show others how talking mats can support their practice. It has enabled them to see how a very simple and non-threatening visual tool can open up conversations and lead to information that the service users hadn’t shared before, in a way that a face to face conversation doesn’t.  

Thanks to Jo Brackley, Clinical Lead, Speech and Language Therapy Secure Services at Cumbria, Northumberland Tyne and Wear NHS Foundation Trust for this inspiring blog – which demonstrates when we shift the way we listen and gather information from patients we get a different result and improve the quality of information and communication . If you or your team want to consider Talking Mats training then we can provide this for organisations . At the moment we can take a cohort through our online course together and then arrange a zoom call to discuss application to your work setting  – email info@talkingmats.com for more information.