We are delighted to share this latest guest blog from Debbie Mole, Clinical Nurse Consultant in Mental Health and Intellectual Disability for DHM Mental Health Care in Melbourne, Australia. This is a great example of the positive impact Talking Mats can have for people who have experienced trauma.
Throughout my 35 year career I have always had a big interest in finding ways to help clients express themselves. My passion is around trauma and working in creative ways to help bring some closure and recovery for the person.
This desire grew when I met a woman who had multiple disabilities. She was blind, deaf, and non-verbal. She was sensitive to touch and had very few ways to express herself. She needed to be admitted to hospital as she was unwell, we had no way to explain to her what was happening. At the time I was working in a new specialised mental health and disability team. This humbling experience of working with her pathed a way for me to find ways to help people communicate and understand.
Working in mental health I am acutely aware of risks and that so many people who struggle to verbalise thoughts, feelings, and past issues. I was always concerned that because a person could not verbalise their thoughts, feelings, and intentions that so much information and potential risks were being missed.
I heard about Talking Mats training in Australia and booked myself on the course. This inspired me and has helped me support clients to find a voice and solutions to issues.
My client was a 30-year man with Down Syndrome, he also has ASD and over the last five years had lost his ability to speak. When I met him, he had poor eye contact and appeared to be locked into his world. It was evident he was also suffering from psychosis as he was responding to auditory and possibly visual hallucinations. He could use some sign language to communicate. He had chronic OCD and anxiety and sleep was a major issue.
I did a Talking Mat exercise and checked his understanding of “like”, “don’t like” and “not sure”. I did a simple exercise to start using the images for his family and carers. There was no real form and the cards appeared to become a collection of images that did not hold any clues.
I decided to use to the personal care cards, this was very different. Showering, bathing, and going to the toilet were placed in the negative area. There was also a change of behaviour and some vocalisation of words that made no sense. Talking to his team and mother, there was a restive quality to his behaviour – he wanted to avoid this area.
I did further assessments and his mom believed that in the past when he was young, he may have experienced some bullying, she also feared that he had suffered some form of abuse. Through the assessment it also transpired that my client was one of five children, all had a significant mental health issue. I organised a specialist to see him and he was diagnosed with Schizophrenia. He was treated with antipsychotic medication.
As the psychosis was being treated his team became aware that my client was starting to talk, it was not clear, but the content had a theme. Tragically themes, names and places started to be spoken about. When he spoke about these events his OCD behaviours of arranging his items on the floor became more chaotic. He spoke of trauma from other boys that took place in bathrooms.
I worked with the client and introduced some basic trauma work, simply allowing him to say what he wanted to and then helping him to realise that he was safe and that was the past. His team did the same. We offered choice about showering, bathing and looked at ways it could be fun or a nice activity to follow. The idea was to change his thinking around baths and showers and for him to realise he was safe and free from threat. We used the talking mats to build upon the things he liked.
I repeated the Talking Mats exercises three, six, nine and twelve months after treatment.
After the psychosis was treated, we became aware that the client looked sad and flat. There was a loss of interest in social activities and there was a lot of talk about the past. We assessed that he was depressed and that it was possible that his recall about the past was becoming clearer. He was commenced on an antidepressant and monitored intensely. We also needed to address the sleep issues. His OCD had led to his bed to being covered in items. We later realised that this helped reduce his anxiety when he was heightened.
My client has regained some speech, I believe he was locked in a world of trauma and psychosis. Now he mentions the names of some of the people who have hurt him. His team reassure him that he is safe, that was the past, and he is ok. He seeks physical attention when he distressed, and he is acknowledged and reassured. We cannot offer typical trauma therapy to him, but just helping him unlock his thoughts, knowing that what was happened was wrong and being heard is healing.
I have since developed my own set of cards, based on the Mental State Examination. I use these to expand on issues and focus on problem areas. These cards talk about perceptual issues, thought problems, beliefs and risks, all areas that are typically private and too often unexplored. The cards have images on them, so clients who struggle to verbalise can use the same system as the talking mats.
Talking Mats allowed me and his team to see things from a different angle. There were many hypotheses used to gain an understanding of his behaviour. This led to effective treatment and partial recovery.
Picture 1 at the assessment stage, images of the clients family were made into an orderly collection with no clear indication of how he felt towards the images:
Picture 2 was also at assessment, showing a clear ability to like, not like and feel unsure about aspects of self care.
Picture 3 was during treatment for Psychosis and therapy – some changes were being noted with his self care and allowing his team to help him:
Picture 4 was towards the end of treatment and intensive therapy. Some aspects of bathing remained unsure, but his behaviour indicated that he was more comfortable with activities around bathing.
Picture 5 was a repeat of the family cards after treatment:
Picture 6 are the cards I have created based on the Mental State Examination – this was six months into therapy and medication. He expressed issues around his mood, thoughts and sleep – these needed more explaining. With the mood pictures, I offered my client different images for mood and he picked the ones that reflected what he was feeling. My mood collection has happy, angry, scared and sad in them as I tend to quote these 4 basic raw emotions daily in my work:
Picture 7 was at the end of treatment the same cards were used with a very different result. As for the previous mat, for the mood pictures, I offered my client different images for mood and he picked the ones that reflected what he was feeling:
Many thanks to Debbie Mole for sharing this powerful example. If you would like to read more about Talking Mats use in Mental Health, take a look at top 10 blogs here: https://www.talkingmats.com/top_10_mental_health/
If you are feeling inspired and have not yet accessed our Talking Mats Foundation Training Course, find out more here:
Many thanks to Karen Mellon, NHS Fife Lead Podiatrist for Learning Disabilities and Care Homes, for this guest blog describing our exciting Fife Health Charity funded project, aimed at supporting patients with a learning disability (LD), or dementia, to be more involved in decisions around their care.
I was initially introduced to Talking Mats by my Learning Disability SLT colleagues who were using the resource to support patient engagement. I could see the real benefits of how it could support our interactions with patients with a LD or dementia and empower people to be more involved with decisions around their care. Our SLT colleagues had undertaken the Talking Mats Train the Trainer program and were then able to train our podiatrists in using the resource. Having used the existing resources we found that we weren’t able to discuss/explore people’s views deeply enough, for example, when they developed a foot ulceration, or were at risk of ulceration. This was the spark that ignited the idea to look at developing a specific podiatry resource to enable these conversations.
The aim was to promote patient engagement in their care – both in preventative care and when specialised input is required. By creating the resource we aimed to explore what really mattered to the person and what for them were acceptable goals and outcomes. By developing a specific Talking Mats resource we were able to explore treatments options and impact of conditions and actively engage the person in expressing their views thus creating a person centred care plan. Evidence shows us when people are involved in decision making they are more satisfied with their care, which in turns improves their quality of life.
Having consulted with Talking Mats we jointly created an initial resource which we piloted within NHS Fife over a 6 week period. People living within care homes and people with a learning disability were the target audience for the pilot. Using the resource, we were able to understand more about the impact that foot ulceration was having on patients, and patient’s views on treatment options.
One example of this positive impact involves a 60 year old patient with learning disabilities and dementia. She lives independently with one hour support each day to assist with personal care. She has been known to podiatry for some time due to repeated ulceration. Specialist footwear has been supplied and regular input is in place to reduce the risk of re-occurrence, however at times the foot does break down.
In May the patient experienced a break down on her foot. She is a very pleasant lady who always comes across as if nothing bothers her and everything is fine; she doesn’t like to “cause a fuss”. It was felt the use of a Talking Mat might give us greater insight into the impact the wound was having.
As a result of completing the Talking Mat we were able to discover the patient was in fact experiencing difficulties with the type of dressing and was experiencing pain. We were able to address this and change the dressing type to an adhesive dressing, which took up less room in her shoe, and started her on Paracetamol 4 times a day to address her pain. Follow up discussions reveal the patient was much more satisfied with the dressing, it was more comfortable and easier to keep dry when showering. She also reported to be experiencing much less pain.
As a result of the mat, we were able to identify concerns she had, but didn’t want to share as she didn’t want to be a burden. We were able to address this and create a plan which was acceptable to the patient and improved her wellbeing.
I hope this resource will go on to benefit other professionals and carers working with people who may be impacted by their foot health. By using this resource, we can help our patients explore their views and wishes, therefore enabling co-production in care. The resource promotes preventative care as well as specialist intervention. Going forward there are many other areas of foot health that could potentially be explored in developing further resources – such as paediatrics, nail surgery, musculoskeletal.
Following the feedback from the pilot the Podiatry Talking Mats are being finalised and we are exploring the best ways to take this to wider Podiatry Services. Please get it touch with us at email@example.com if you are interested.
To find out more about the work and projects supported by the Fife Health Charity follow their Social Media accounts at:
Facebook – @fifehealthcharity
Twitter – @FifeHealth
We are looking forward to our second Talking Mats Twitter chat on Thursday 10/12/20 7.30 – 8.30pm.
Join us to discuss and celebrate our new report ‘Can Scotland Be Brave’, which has a specific focus on children and young people’s participation. Find out more about the report here https://www.talkingmats.com/new-report-to-launch-10th-dec/
The report will be launched by the Scottish Government on the same day, to coincide with Human Rights Day 2020.
Here are the questions we will be asking:
Grab a cuppa – or better still, a mulled wine and mince pie! – and join us to share experiences and ideas.
Remember to use the hashtag #TimeToTalkTM on all your posts!
We are really looking forward to our first ever Talking Mats Twitter Chat on Thursday 01.10.20 from 7.30 – 8.30pm!
It will be a great opportunity to share experiences and ideas – here are the questions we will be asking:
This will be followed by a brief summary of the key learning points from the discussion. Join in and remember to use #TimeToTalkTM in all your comments – we look forward to chatting with you all!
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 firstname.lastname@example.org for more information.
Many thanks to Professor Anna Dunér, Dr Angela Bångsbo and Associate Professor Tina Olsson for this guest blog describing their research project where Talking Mats will be used to enable service users living with dementia to be involved in decisions about their home care services. The project is based on a collaboration between Department of Social Work at the University of Gothenburg, Borås University College and the municipality of Borås, aiming to develop and evaluate the use of Talking Mats.
Associate Prof. Tina Olsson
In Sweden, as in many other developed countries, ideas of consumer choice and personalisation of services have been implemented in social care with the intention of achieving better choice and control as well as increased quality of the services provided for the individual. However, persons living with dementia are at risk of being excluded from the opportunities provided to other groups of service users. Thus, it is important to develop both needs-assessment procedures, and improve the performance of home care services, to enable older people living with dementia continuous choice and control in their everyday living.
We hope that Talking Mats will improve the communication between service users, care managers and staff in eldercare and lead to increased influence of service users over the decisions and planning of their home care services.
During 2020 we have funding for a planning study where we can develop and test the Talking Mats decision aid, identify, translate and test outcome measurements, and refine and test the procedures for a comparative intervention project. In 2021 we hope to attain funding for a three year study.
We have already received valuable advice and information about Talking Mats research from Dr Joan Murphy and hope to keep in contact with her and the Talking Mats team throughout our project.
If you are interested in Talking Mats Research, check out our recent blog with details of how you can get involved with our Virtual Network:
Many thanks to our new Talking Mats Research Associate, Dr Jill Bradshaw (Tizard Centre, University of Kent), for this latest blog focusing on how Talking Mats can help people with communication difficulties to express themselves – to help work out the reasons for behaviour that challenges.
We know that around 10-15% of people with intellectual and developmental disabilities display behaviour that can be challenging. This might include hitting out at other people or injuring themselves. These behaviours can serve very important functions for the individual (e.g. to avoid something unpleasant or to get a need met). When we try to help make things better, we often focus on improving communication, quality of life and health and wellbeing more broadly.
How do we work out why behaviours that are challenging occur?
We often spend time observing the person and talk to carers and staff who work with the person to gain information about what is working well and what might help. This is part of a functional analysis. Here, the aim is to identify the factors that have led to and are maintaining the behaviours displayed. Traditionally, we have not really asked people directly what they think. This is partly people who display behaviour that challenges almost always have complex communication challenges.
How can we better access views of children and adults and would Talking Mats be one way of gaining views?
Together with Nick Gore, we have been working on ways of using Talking Mats to enable children and adults to give their views. We developed a series of mats focusing on:
- Likes and dislikes;
- Difficult behaviours;
- Things that help;
- Things that don’t help;
- General preventative variables.
What happened when we used the Talking Mats?
People were able to use these Talking Mats to tell us about what was important to and important for them. Some information was similar to reports from carers and staff and some information was in addition. For example:
- we gained information about preferred activities, such as riding bikes and preferred snacks. Doing things we like to do is important for all of us!;
- people gave us information about their difficult behaviours and where these took place;
- people were also able to give us at least some information about what made a bad day and what helped on a bad day. This information helped to inform support strategies.
You can read more about this work here: https://kar.kent.ac.uk/67033/1/PDF_Proof%20%283%29.pdf
Using Talking Mats certainly enabled some people to give their views. It was particularly helpful as a way of talking about difficulties, where a focus on the mat rather than on direct questioning was useful.
As expected, more people were able to access the more concrete topics we discussed and the more abstract topics were more difficult. We have also been working with the Challenging Behaviour Foundation to develop a range of methods (including Talking Mats) to help to gain the views of people with communication challenges. You can read more about this work here:
To view Jill’s presentation about this topic from our Talking Mats is 21 event last August, click here: TM and PBS final version for handout
If you are interested in Talking Mats and Research and have completed our Foundation Training Course, you can find out more about our new Talking Mats Research Network Group by emailing Jill at J.Bradshaw@kent.ac.uk, and watch this space for a new blog all about the group – coming soon!
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 email@example.com
The Talking Mats Board is delighted to appoint Dr Jill Bradshaw from the Tizard Centre, University of Kent, to the position of honorary research associate. This is our first appointment of this kind. Talking Mats is an evidence-based framework and research is important to us – but that research needs to be much more diverse, and involve a much wider range of people.
Jill’s role will be to give the Talking Mats team:
- A sounding board for research ideas and proposals
- Advice and support on publishing articles
- Identify research gaps and advise on funding avenues
We are also very aware that a number of people are using Talking Mats as a research tool, and Jill will also help to develop a virtual research network to bring interested researchers together. We are still exploring ways in which this could work, but it could involve an email network, virtual seminars and/or twitter chats. If you are interested in being included, and have completed our Talking Mats Foundation Training course, Jill would love to hear from you. Please email her on J.Bradshaw@kent.ac.uk – or email firstname.lastname@example.org and we will forward your interest to her.
Jill is really excited about this new post. She says ‘We know that the voices of people who have communication challenges can be excluded from research. This is a great opportunity to work with others to think about how we can use Talking Mats creatively in research and to find ways of including views from a wider range of people’.