In the UK we are emerging out of lockdown and there are concerns about the impact on the mental health of people at all ages and stages of life. This is a good time to reflect on the wide variety of blogs that have signposted how useful Talking Mats can be in helping people to think, structure coherent responses, and express their views. If this is an area of interest to you then take a look at these blogs to find out more:
- Edith Barrowcliffe from The Action Group demonstrates how Talking Mats has allowed individuals with intellectual disabilities access talking therapies and counselling. https://www.talkingmats.com/counselling-communication-1/
- Edith expands on this work in her second blog, describing how she adapted this approach to use during remote support during lockdown. https://www.talkingmats.com/counselling-learning-in-lockdown/
- Jo Brackley, NHS Clinical Lead for SLT Secure Services (Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust) describes how Talking Mats helps people with mental health open up and have richer conversations, with increased novel information gained. https://www.talkingmats.com/covid19_securehospitalsetting/
- Susan Gowland, SLT at NHS Fife Forensic Learning Disability Service, describes how Talking Mats support patients to express what they think in forensic learning disability setting. https://www.talkingmats.com/forensic_ld_setting/
- Dr Carla Innes, Clinical Psychologist for Learning Disabilities at Stockport Healthy Young Minds (CAMHS) describes how Talking Mats helps the team to gain more insight to the children and young people they are working with, and how it has helped intervention focus on the child’s potential, and zone of proximal development. https://www.talkingmats.com/talking-mats-and-mental-health/. This work in Stockport is further expanded on in a presentation by Dr Rosie Noyce, Clinical Psychologist, given at the Talking Mats 21st Birthday Event in August 2019. https://www.talkingmats.com/wp-content/uploads/2019/08/Talking-Mats-and-Young-Peoples-Mental-Health.pdf
- Georgia Bowker-Brady, Advanced Specialist SLT (Berkshire Healthcare Foundation Trust) describes how using Talking Mats in dementia care and acute health patient inpatient services helps patients organise their thoughts and express what is going well for them, as well as what isn’t. https://www.talkingmats.com/acute-mental-health/
- Rachel Woolcomb, Talking Mats OT Associate, explains why Talking Mats supports thinking, and why it can be particularly useful in helping people to structure and express their thoughts. https://www.talkingmats.com/talking-mats-as-a-thinking-tool/
We would love someone to carry out some research in this field, so if this sparks a research, or blog idea, please get in touch with us at firstname.lastname@example.org.
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!
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:
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!
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 email@example.com for more information.
Our first Talking Mats advanced online module has launched. We are pleased we had developed our online foundation training well before lockdown. There has been such great feedback from people who have completed our online foundation course and they have been asking for more. They like the bite size chunks, being able to pace their own learning and the reflective practice approach. Now we are adding to our online course with an advanced Talking Mats module focusing on Talking Mats use in safeguarding. This course is structured around the Talking Mats Keeping Safe resource and how to use it.
The Keeping Safe Talking Mats resource was developed to check in with people and find out how their lives are going. It uses a holistic framework to do this and the conversation it supports is structured around three topics: 1) well-being; 2) relationships; 3) thoughts and feelings. The resource was trialled and tested in projects involving over 700 practitioners. Originally, it was designed for people with learning disabilities but feedback has been that it has been helpful with a wide range of people including, those with stroke, head injury, dementia and mental health issues.
The advanced online module involves 2 to 3 hours of learning that you do at your own time and pace. It involves short talks, reading, videos and reflective practice activities. You will develop confidence in using the resource as well as an understanding of relevant issues, such as diagnostic overshadowing, developing the capacity of individuals to raise concerns, the impact of trauma. You will be encouraged to reflect on how you can apply the Talking Mats Keeping Safe resource to your own area of practice
To apply for the course, you must have completed your foundation Talking Mats training. If you haven’t completed this training book now – there is still the reduced price training offer if you book your place before the end of August 2020. Access to this advanced course will begin on the first of every month and you will have the full month to complete it.
Book your place now. The cost is £85 for the course and the Keeping Safe resource and £35 if you already have your Keeping Safe resource and just want to do the training.
I stole the lyrics and altered them slightly, but this is the song line that has kept popping into my head over the past few weeks as we find ourselves hurtling through the different phases of lockdown easing. The rules and recommendations that have guided our lives for the past 3 months or so are changing rapidly and change can be difficult. Communicating how we feel about change and life in general can be difficult.
We have seen creative uses of our resources and have really enjoyed learning how they have helped young people and adults express how they coped throughout lockdown and beyond. Kirsten Lamb’s guest blog about Returning to School After Lockdown is just one example of how the TM framework was invaluable in gaining the opinions of young people as they adapted to ongoing changes over which they had little or no control.
Another Talking Mats practitioner recently tweeted this mat that she did with a college student, showing how Talking Mats helped structure thinking about how life was going.
We felt a single resource was needed to help kick start a conversation around Life (but not as we know it; I am sure that’s a song too) looking at the following themes:
- Family / Friends / Bubbles / Social Distancing
- Mood / Emotion
- School / College
As with every Talking Mat you can change the top scale to be more or less concrete, you can use blanks to add in things that we haven’t included, you can leave things out that aren’t relevant. Download your free printable pdf here: LOCKDOWN SET
We look forward to hearing stories from our Talking Mats Community on how you helped others express themselves (definitely another song!)
Since the start of the restrictions placed on us by Covid-19 there have been lots of questions to us about how you can use Talking Mats remotely. We have all been forced to learn quickly what we can and cannot do in a virtual world when we need to be physically distanced from each other.
We have tried various ways to do Talking Mats virtually, but the easiest way we have found is to log into your digital Talking Mats through our website and use the Talking Mat in this mode. Then open your virtual meeting app, e.g. Microsoft Teams or Zoom, and share your screen. For both you can share the control of your screen so your thinker can move the options as you talk them through using the standard Talking Mats principles.
Sometimes people run into problems with the Talking Mats digital log in because they get a message about Adobe Flash. If you get that, our advice would be to try a different browser or if you are using Chrome do the following:
- Click on the 3 little dots at the top-right of chrome
- Click on “settings”
- “Privacy and security”
- “Site settings”
- Change from “Blocked” to “Ask first”
EXTENDED OFFER to increase digital access during the Covid-19 Emergency
We realise that many of you don’t have the digital Talking Mats so we are making it available for a charge of £30.00 including VAT from now until the END OF 2020. Fill in this form DISCOUNTED DIGITAL TALKING MATS REQUEST FORM. (We hope you will understand that we will not release your digital logon until payment is received.) We always recommend the Talking Mats foundation training to get the full benefit from this communication framework so watch out for our online training offer which will be released next week.
On a personal level we have been testing remote use of Digital Talking Mats amongst the Talking Mats team. We used the coping set from our Health and Wellbeing resource and it has helped our own reflections on how we are feeling about the current restrictions on our lives and the impact it is having on us.
We are aware it is still early days and we do not have a lot of experience of using the digital Talking Mats remotely with people with communication difficulties. It would be good to have a forum for sharing those experiences. We held a virtual meeting on Thursday 23rd April at 10.00 a.m. to do that here is the report of that meeting including a link to a video demonstrating how to set up your digital Talking Mat 20200429 post zoom meeting notes_ no link
Many thanks to Georgia Bowker-Brady, Advanced Specialist SLT (Berkshire Healthcare Foundation Trust) for this latest guest blog.
I attended the Talking Mats training in June and I work in both dementia care and acute mental health in-patient services.
I had initially imagined that I would primarily be using the Talking Mats to support the dementia patients.
However I’ve been surprised to find that I have been increasingly using Talking Mats with functional patients and it has been a really positive tool when discussing with patients about their self-care, the care they are receiving in the hospital and opinions on discharge.
Due to their mental state, many of the patients may find it hard to organise and express their thoughts, and if patients are hypomanic it can be difficult for professionals to guide the topic to get meaningful information, but Talking Mats has really helped with this! It has also been pertinent in establishing patients’ insight levels and gaining better understanding of their impression of the current situation.
Here is a photo of one my mats from the psychiatric adult acute wards. This was for a patient who is severely low in mood and has relatively recently gone through a traumatic incident. The ward staff and OTs have had difficulty gathering any information about what she ordinarily enjoys doing in order find some activities to try and engage her with.
The staff stated that the patient would simply report she doesn’t enjoy anything and questions about what she used to enjoy received no answer. I went and did a joint session with the OT where I asked about what she enjoyed doing before this incident and we did the mat (see picture below) in a matter of minutes.
This can now provide a starting point for considering areas for trying to encourage some behavioural activation.
We then extended it by using an emotions wheel to ask how she felt about certain activities available in the hospital. We were able to establish that she felt fearful about trying new things and sad about carrying out certain activities she used to do prior to the incident.
It is wonderful to hear such a great example of Talking Mats in action – if you have any stories you would like to share, please get in touch with us at firstname.lastname@example.org
Many thanks to Claire Wiseman & Ann Lafferty from The Advocacy Project (Scotland) for this guest blog, including a great example of how Talking Mats helped a young woman with learning disabilities and psychosis share her views about being in hospital, receiving medical treatment and her preferences in respect of future post discharge welfare decisions:
For some time, The Advocacy Project have been thinking about how we could use the Talking Mats Framework to support people going through legislative processes such as the Mental Health (Care and Treatment) (Scotland) Act 2000, Adults with Incapacity (Scotland) Act 2000 and the Adult Support and Protection (Scotland) Act 2007.
Recently the Mental Welfare Commission published a best practice guidance on Supported Decision Making – https://www.mwcscot.org.uk/good-practice/guidance-advice, which we referred to as part of our presentation for the recent Talking Mats is 21 celebrations (click here to see the presentation Talking Mats and Supported Decision Making PP 2 (1)). The feedback from this session was that ‘yes’ there is a need for symbols to support legislation. As accredited trainers, we’ve also been asked when we’re delivering training to lawyers, Mental Health Officers, Social Workers, support workers and other advocacy organisations if there are specific symbols related to Supported Decision Making, particularly with regard to legislative issues.
Here is one of the Supported Decision Making and Talking Mats examples shared in our presentation:
One of our staff supported a young woman with a learning disability who was thought to be experiencing a psychotic episode. She had been detained in an in-patient learning disability unit under the Mental Health (Care and Treatment) (Scotland) Act 2003 on a Short Term Detention Certificate. The clinical team then made an application for a Compulsory Treatment Order, which was granted. Later, when discharge planning was in progress, an application for Welfare Guardianship was made under the Adults with Incapacity (Scotland) Act 2000.
Although the young woman was able to communicate verbally, the effects of the psychosis combined with her learning disability meant that her conversation was discursive and she was very easily distracted. Using a combination of Talking Mats and our additional symbols over a number of sessions, the advocacy worker managed to ascertain her views about being in hospital, receiving medical treatment and her preferences in respect of future post discharge welfare decisions.
The Talking Mats reports were submitted as evidence at two mental health tribunal hearings and the Welfare Guardianship hearing at the sheriff court. We received positive feedback from the Curator Ad Litem, Mental Health Officer and Sherriff regarding the reports as they had never had Talking Mats reports submitted before during these proceedings.
The use of Talking Mats had been instrumental in supporting the young woman to put forward her views and ensuring an outcome she was happy with.
Going forward, Talking Mats and The Advocacy Project will be exploring the possibility of a symbols set for Supported Decision Making and legislation. We are currently looking at funding possibilities.
A fantastic example of the power of Talking Mats – if you have any Talking Mats stories you would like to share, please get in touch! Just send me an email at email@example.com
Many thanks to Susan Gowland, SLT at NHS Fife Forensic Learning Disability Service, for this guest blog summarising the fantastic presentation she delivered at our TM is 21 event in August 2019.
As a speech and language therapist within NHS Fife’s forensic learning disability service, I work across two low secure wards. In my presentation for the “Talking Mats is 21 event” I talked about the way in which Talking Mats is used within these wards and the positive impact this has had for staff and patients.
Regular Check In: “it’s the same questions, but it’s easier to talk with the pictures”
Some of the people I work with use Talking Mats as a regular check in tool. Conversations are often based around the Wellbeing, Relationships and Thoughts and Feelings cards of the Keeping Safe resource, with personalised adaptations agreed with the thinker. Some people who find it difficult to express how they are feeling and irritations can either build up to a serious incident or the person can get weighted down by unexpressed needs and concerns. For these people a regular check in can address the small things before they become big things. This can help the thinker feel listened and responded to, build experiences of communicating effectively, as well as trust and therapeutic relationships, all of which are assets which will support the person to move on.
Self Reporting: “It helps me understand how I’m feeling about things”
For some people, the check in can have a specific focus. In a hospital based forensic service, unexpected and unrecognised changes in mental health can lead to serious incidents. To address this we have used Talking Mats to talk about mental health. SLT have worked with individuals, psychiatry & nursing to identify personal symptoms of mental health changes. These symptoms become options in the Talking Mat & can be used to support person to self report at the times their mental health changes. Being able to do this enables people to discuss the support they need & reduce the risk of out of the blue incidents. The Talking Mat itself can be a support. As one thinker said, “Talking Mats relaxes you, it calms you down”.
As and when required:
The regular use of Talking Mats on the ward has led to other patients asking for Talking Mats sessions. As a licensed trainer I offer training to all professionals within our multi-disciplinary team and there is often at least one Talking Mats trained nurse on shift. This means ad hoc requests can be facilitated and some thinkers have started using Talking Mats in weekly meetings; as a tool to talk through emotional events and as a way of exploring the mixed emotions around discharge. In the words of one of the charge nurses:
“Talking Mats has enabled me to communicate with people in a way that is meaningful. To support someone to express and understand their thoughts and feelings regarding both joyous and distressing events is a privilege. The format may be simple, but the outcome is often comprehensive and insightful.”
(Picture drawn by Fiona Glanville, staff nurse, NHS Fife)
If you would like to find out more about accessing Talking Mats training, check out this link:
If you are interested in our Keeping Safe resource mentioned here (available to those who have accessed our Foundation Training / Online Training Course) please see these links for more details:
Talking Mats have been part of an exciting research project which looked at whether the Digital Talking Mat App could improve health and housing outcomes for social housing tenants.
Working together with tenants and staff from Loretto Housing and Care, Stirling University, Napier University and Age Scotland we have developed and piloted a new Talking Health and Housing set for the Talking Mats App!
The aim of the project was to:
- Develop an App that would support social housing tenants with communication difficulties to say what they thought about their Housing and Health.
- To improve communication between social housing tenants and health professionals.
Researchers were also keen to see whether the App would help to demonstrate the link between tenants’ housing and health solutions.
What we did
The Talking mats team facilitated two focus group sessions with all the partners to decide what topics were needed.
Once the mats had been completed the researchers from Stirling University and Napier University conducted interviews and focus groups with staff from Loretto and related Health professionals and then analysed the data from the mats.
The Talking Health and Housing set
The set has three topics: Home, Wellbeing, Support people
The Top scale for this set is Going well…Going well sometimes…Not going well
- A broken stair door
- Uneven pavement outside the house,
- Poor eyesight
- Poor mobility
This was having a negative impact on tenants’ wellbeing and by doing the mats, actions were identified to address all these concerns and anxieties were reduced.
It was a great partnership and we hope to work together again to further explore how the App can support the Service Integration agenda by facilitating communication between Health, Social and Care and Housing with the tenant at the centre.
Read the summary report 201908 Talking Health and Housing Summary Report
If you are interested in finding out more about the Talking Health and Housing App please email firstname.lastname@example.org
The Symbols are designed and © to Adam Murphy 2015 and assigned to Talking Mats Ltd. in perpetuity. They may not be reproduced without permission