For this blog I would like to share a poem written by a wonderful lady who has PTSD. The symptoms from this condition can be distressing and at this time of year can be made worse by certain triggers. Don't forget to be kind to others as we hit the Xmas period and everyone is rushing about shopping. More importantly, take some time out to be gentle with yourself.
At Nature Therapy CIC we are always interested in finding out the outcomes from what we deliver. Not only does it ensure we know if we are making a difference, it also helps us evolve and shape our programmes for the future so we can make a better impact.
Research doesn't always have to be boring surveys and questionnaires, although they do help contribute to the pot of knowledge. We like to use really creative ingredients in our evaluation soup that engages our clients as much as possible. We like to ensure their voices comes through loud and clear. Just like a tasty consume soup.
We also focus on engaging children we work with in any evaluation, whatever their capacity. This is so they are able to shape what we do and how we do it. We do this by using creative techniques such as the wonderful draw and write technique. This was developed by the awe inspiring Noreen Whetton at the University of Southampton in the 1980's. It has since been used in thousands of projects world wide to ensure the voices of children are able to make an impact.
Sadly more and more funders are wanting to see techniques such as randomised controlled trials to prove outcomes. There is a real lack of understanding that we might be able to prove if a pill is effective or not, but ultimately this method proves nothing but impossible to determine social outcomes from the human condition. Just far too many variables to account for.
One method we do like to use is Discourse Analysis. Often psychosocial programmes such as the ones we deliver are intrinsically linked to the power and control exerted by institutions on an individual. These are things they (and we) are often not even aware of. So, we like to use a research method called Discourse Analysis to really surface insights into the impact of our programmes and how they might effect outcomes for our clients. This helps us understand far more about how to develop our work than a survey alone. It makes sure that clients voices are not only heard - but acted on.
Here is a link to a short video I prepared for any of our funders or clients explaining what discourse analysis is about.
The ethos of Nature Therapy CIC is to nourish minds through contact with nature. It is about reconnecting once again with all the incredible senses we have been gifted with.
When we live too much in the mind we never get a straight answer that can be relied on. But when we ask our senses a question, we receive an answer to be trusted. Our senses provide us with intuition, or a gut feeling, about situations and people. Listen to them with awe and respect because our senses have been shaped over millions of years to help us thrive as a species.
Nature Therapy helps people understand and learn to trust their senses. Through guided and creative work with nature, insights can be gained into how senses try to help us in every situation. Wise choices can then be made about the people we want to be around and how we move forward with our lives.
Each one of us is unique in how we sense the world around us and create our own reality. No two people use their senses in the same way, but if you Think Sense first and foremost, you will nurture and nourish your embodied wisdom. You will feel happy in your own skin and content with your life.
(Extract from Wolf Medicine by Dr Kim Brown. Available in 2016)
One of the key factors for delivery of the nature therapy and dementia programme is about increasing resilience amongst the carers older people. But the question arises of how can we measure if taking part in our programme actually builds resilience to burn out. One of the challenges is that there are many different ways of understanding the concept of resilience but there is no consensus on what it actually is. In addition, we have no idea if resilience is a dynamic process or a fixed character trait. There is little point in measuring fixed character trait before and after a programme because it is - fixed.
Demakakos et al (2012) define resilience as the ability of people to resist adversity and flourish under it. They noted that resilient older people are more satisfied with their lives and had a better quality of life than non-resilient people. We are keen to ascertain if nature therapy enhances resilience in carers so they can cope with future adversity or if, as some believe, measuring resilience actually requires the existence of adversity to see if people effectively overcome it. This latter concept raises challenges as we would only know if there was any increase in resilience after they reached a crisis situation, which of course might be years away, or indeed never.
Then again, if resilience is resisting adversity, we have to be clear what we mean by adversity. Financial crisis, bereavement, and ill health are all considered to be situations that could be classified as adverse, or it could be anything that might significantly impact on an individual. Measuring changes in mood levels has been thought of as one way of measuring resilience.
The research evidence is not clear if socio demographic factors such as gender, age, marital status, education, and income impact on resilience and of course these are factors that projects such as ours have no control over. Feelings of loss of control have been implicated in individuals experiencing depressive symptoms.
One further issue we need to take into consideration when measuring resilience is that adversity can be compound. That is one event such as illness can trigger other adversities such as loss of income thereby compounding the effect of loss of choice and control.
So, having set out some of the challenges in measuring resilience, we set out to look at what was the best possible tool we could use to measure any change in our nature therapy and dementia care work. Consultation with older carers suggested the best possible tool for them as one that was easily completed, visual, did not involve a great deal of writing, did not make them feel depressed completing it, was quick, and was in a format they could easily understand without having to think too much. So we reviewed the available scales against this criteria.
Windle (2011) of Bangor University reviewed 19 resilience scales. She noted that some of the scales are relatively new and concluded none identify any specific scale as more reliable. However five measures (the RSA, the CD-RISC, the Brief Resilience Scale, the ER-89 and the Dispositional Resilience Scale provided test-retest information, and the Resilience Scale for Adults (RSA) scored the maximum for this criteria. This provides some indication of the measure's stability, and an early indication of the potential for it to be able to detect important change, as opposed to measurement error.
The RSA scale was validated in Norwegian samples raising concerns about cultural significance. In addition, there is a significant cost associated with the licence for this scale. This equate to 150 US dollars for every 50 people. As the intention is to use this scale with every single person who downloads an online planner pre and post completion, the use of the scale was outside of our financial resources.
Our review into measuring resilience is on going, meanwhile we are using a self assessed likert scale to determine any change for the person with dementia based on observable factors such as less agitation and aggression, better sleep and sign of enjoyment in life. We are asking carers to scale this factos both before and after the carers pop up dementia theatre experience to see if they change anything they do as a result of the Think Sense campaign that ultimately impacts on the person they are caring for.
In addition we use the much simpler Compassion Fatigue Scale for carers as that can be applied both before their involvement in our nature therapy and dementia care work and again after.
Early results are showing a significant improvement in Compassion Fatigue plus less agitation and aggression being expressed by older people with dementia.
I am in the process of developing an on line self help journal for those with experience of Post Traumatic Stress Syndrome. Journaling has been therapeutic source since humans could put pen to paper. So, in order to create this resource I have tried out several different methods to see what works well in an on line format. I thought for this blog I would share one of my own personal experiences of using image work in a self help journal.
The first step being to sit quietly and peacefully and let your mind float. Ask for an image to come into your mind that is important for you to try and understand at that point in time.
There is no right or wrong image. It could be a cartoon character, an inanimate object, a person, situation or a fantasy. However, the image that came to my mind on this occasion was a moment in time, many years ago, when I was working with children and young people. I had been working with a young man who was expressing suicidal ideation and was so concerned I arranged for him to see a psychiatrist. I agreed to accompany him to the appointment because he was afraid.
Over weeks of working alongside this young man, let’s call him Billy, I had begun to understand he experienced an overarching sense of rejection. First by his parents, and then later by his peers because of his sexuality.
My image was of Billy sitting in the psychiatrist's room feeling scared and so alone, rejected and desolate trying to answer questions about his life and finally breaking down into heaving sobs as a way of expressing his heartache.
Now I have to reveal a bit about myself to help you understand more about this personal image I am trying to share and I hope none of you are psychiatric nurses or psychiatrists! I have two characters inside me. One is Ms Correct who first appeared in my adolescence. She is the one that installed in me a sense of right and wrong, importance of academic study, working hard, professionalism and always doing what is ‘right’. The second character was with me throughout my childhood but later in life was continually admonished by Ms Correct to the point she would disappear for long periods. This character is Gypsy Lee Free. She is the part of me that treads her own path despite the rules of convention, that runs barefoot through the grass to feel the dew on her toes and kisses frogs. Gypsy is my inner child that is constantly begging to be let out to play but she doesn’t always behave herself according to the rules set down by Ms Correct.
Now back to Billy. My Gypsy Lee Free heart hurt for him whilst my Ms Correct head was saying ‘better out than in’. At which point Billy flung his arms around me, buried his head into my shoulder and covered me with tears, dribble and snot.
Ms Correct was horrified as the whole thing about boundaries and touch, transference and therapeutic relationship was flashed up on her always present blackboard and pointed at fiercely with her pointy stick. This pointy stick moment happened at about the same time I became aware of the psychiatrist shouting at Billy to take his hands off me and telling him I was not his friend or mother. Almost simultaneously Gypsy Lee Free made a random guest appearance and simply hugged him back whilst passing him a tissue. She was arguing that he already felt rejected and Ms Correct would only reinforce that belief.
I knew I was in trouble, and I was. There was very little point explaining to a psychiatrist of all people about the wild wonderful carefree spontaneous woman that lived inside me and inspired me to random crazy acts. Acts like hugging a child when they hurt.
This was the image I drew into my journal using little stick figures to depict Billy, the Psychiatrist, Gypsy Lee Free and Ms Correct. I then reflected on compassion and how hard it is for us as nurses , therapists and professional carers to know where boundaries start and end and what compassion actually looks and feels like.
Was it that Gypsy Lee Free herself could not deal with his overt expression of pain so was being self-compassionate? What might have outwardly appeared as an act of compassion in comforting a distressed child could have been in reality self-soothing.
I realised the importance of this image to me at that point in time was about letting things go. Everything has a time and place in this universe - there is a time for Ms Correct and a time to let your inner wild child roam free to relish new experiences.
This is the point of a self help journal; it becomes what you want it to be. To safely record your innermost thoughts, disentangle feelings, or as a cathartic way of letting go of experiences. It can help you reflect, analyse and self supervise. It can also help you let out your inner child in a safe and boundaried way.
Have a go – you never know how it might help unless you try. I hope by revealing some of my inner world it will help you take the plunge.
Since I wrote the first blog about potential links between Post Traumatic Stress Disorder (PTSD) and dementia I have been contacted by several concerned people. I wrote about what was happening to my rather wonderful neighbour, John, who is just shy of one hundred years old and was a prisoner of war in Burma where he witnessed atrocities he barely spoke about on his return and in later years.
John was reliving some of his distressing past experiences through seeing visions of Japanese soldiers. After writing the blog I was later contacted by several people who had a diagnosis of PTSD who were anxious that their eventual fate might be to develop dementia and be forced to relive their worst nightmares over and over again. I certainly needed to do some desk top research on any potential links before I could offer insight as once case history like John's might raise questions but it was by no means certain there was a definitive link between PTSD and dementia.
I knew there was some evidence to suggest links between stress and dementia but then again dementia is not just one condition and PTSD is a manifestation of extreme trauma and not necessarily a culmination of on going day to day stresses.
So I will start with dementia. It seems John in all likelihood has quite a rare form of dementia called dementia with Lewy Body which accounts for only 4 per cent of all dementia diagnosis and how it presents very much depends on where the Lewy Bodies are in the brain. It tends to present in part as visual hallucinations but is more prevalent in people who already have visual problem (such as John who is almost blind).
Whilst exploring the role of wolf assisted therapy I am often asked two questions. The first is why wolves? And the second is how can you do wolf therapy in the UK as we have no wolves. The two questions are actually quite inter-related so I will start with answering why wolves?
The wolf has been very much part of our heritage for at least 20,000 years and perhaps even longer. Different cultures have enshrined the wolf in ancient folklore such as the myth of Romulus and Remus being rescued and nourished by a she wolf and going on to found a great civilisation and in Norse mythology Odin riding to victory on the back of a wolf.
Across many parts of the world the wolf has walked alongside humans throughout the centuries creating fables, mysticism and stereotypes. A brief look at this history shows a human belief in the duality of wolves across the globe and throughout time. They can be feared and revered in equal measures as much as they are considered protectors on the one hand or destroyers on the other. What is interesting is this is the same duality that can be applied to the human psyche. Wolves are social creatures remaining loyal and protective of their packs yet seen to be guilty of an assumed carnage in seeking an existence in line with their nature as a wild animal. As Rudyard Kipling rightly pointed out, the strength of the pack is the wolf and the wolf is the strength of the pack, and so it is with humans.
In psychotherapeutic terms, any animal is merely a symbol of what lies within. Many indigenous populations used animals as totems for good reasons, either to help people take on the characteristics of a particular animal to help them deal with a specific situation, or to help explain the many multi-faceted aspects of our own way of being. We all have the capacity to show different characteristics in any given situation and the wolf is no different.
The involvement of wolves in a therapeutic style intervention is particular valuable for those that have been in the armed forces where they have had to be highly attuned to their senses to protect their pack, walk alone and suffer horror and deprivations that only other pack members may understand in relation to survival. They have also been part of a rigid hierarchy in which they have a role. Here, the duality of the wolf nature becomes a metaphor for life. It is also applicable to gang work where the gang is a protective pack within which the individual seeks strength and status.
So, having answered a little on the question of why wolves, this follows on to how this type of therapeutic approach could be applied in the UK.
Dogs and wolves are closely related in as much as there are breeds of dogs that have a wolf like appearance. This includes the Tamaskan and the Northern Inuit as well as the Eskimo dog. The picture accompanying this blog is the stunningly beautiful Cody who is an Utonagan dog which translates into Wolf Spirit. This breed is a mixture of Malamute, Siberian Husky and German Shepherd and they have exceptionally kind temperaments.
If the wolf is a symbolic representation of an inner world we inhabit then a ‘wolf dog’ can have the same impact. Walking with a dog that resembles a wolf still connects us with our wild self, a self that walks alone, that loves and protects and yet holds no fear. Many of us walk this world with a disconnection that we cannot place, feeling slightly adrift from others of our kind and perhaps out of step. Holding that powerful symbol mindfully can help us find a place to be at peace, where, like a wolf we can wrap our tails around our paws and nose to stay warm when life freezes. The wolf symbol can help us learn heightened awareness and to trust our senses and intuition as we learn to associate with those around us or to simply walk away.
When I met Cody I felt an immediate connection with him as he sat beside me and wrapped one paw protectively around me. There was no fear of this big dog even though my mind made words relating to savage, my senses told me to trust my intuition and to respond to the warmth and friendship he was offering. This is the gift these amazing creatures offer us – to trust and believe in ourselves.
Picture courtesy of Windy and Michael - Cody is pictured here with Bill who he had just met.
I am really excited to be involved in a new piece of research into a form of nature therapy that is currently quite limited - and probably for good reasons you might think. However, evaluation of our work with ex members of the armed forces clearly demonstrated high adrenaline activities were more attractive to some. Walking alongside a wolf and feeling an intimate connection with this wild animal could be counted as inducing an adrenaline rush.
From the range of Nature Quests we deliver, it seems the more unusual or demanding ones were the most well received by some. Partly this could be because high adrenaline activities can help ground you if you experience symptoms of detachment with post traumatic stress disorder - and partly because of the need for higher and higher thrill seeking to help release the feel good neurotransmitter - dopamine.
Promises, a recovery centre in the US, currently deliver Wolf Assisted Therapy using rescued and specially trained wolves and wolf dogs who would have otherwise been destroyed under US legislation. Interestingly Equine Assisted Therapy also first started as a formal therapeutic intervention in the recovery world and has expanded to become a global intervention despite major concerns for safety. The expansion involves the use of many different clinically accepted models of application, from neurolinguistic Programming to Gestalt and from psychotherapeutic to solution focused - all have a part to play as a underpinning theory of practice somewhere in the world alongside a range of other more metaphysical models of application.
Having studied the involvement of horses in the development of human well being over many years and across the world, I have looked at so many different ways of involving horses. At Nature Therapy CIC, we use a model of equine assisted learning and therapy that involves interacting with horses using all the senses and the horse as a metaphor for life.
The qualities we apply to an animal are an important part of the approach - our vision of the horse has been crafted over centuries - generally it is seen as free, beautiful athletic, kind and spiritual although the shadow to this is unpredictable and fearsome. All these qualities we give to the horse are only really aspects of ourselves. A lot of equine assisted work involves working with our fears.
What qualities do you see in a wolf? Do you see it as a strong, independent animal with a fierce sense of protection for its pack or do you see it as a threat to your safety, a indiscriminate killer that walks alone?
Over the coming months I will be contacting various people and hopefully may even visit a woldfcentre to try and learn more about how Wolf Assisted Therapy may be applied - to the benefit of the human - and the wolf.
I am never sure who reads these blogs or if they are sometimes more for my benefit through a process of catharsis. However something very personal happened recently that I feel a need to share with all of you who are interested in PTSD, especially with those who are ex armed forces. It is very relevant to the work we do around sensory perception, PTSD and dementia.
One of my dear friends was a prisoner of war many years ago. He has recently been diagnosed with a dementia and has virtually lost his vision. He turned up at my house very early one morning quite distressed as he believed there were Japanese soldiers coming to get him and he had to protect us. He could see them, smell them, hear them and felt the terror of their presence. He knew what they were capable of as he had seen his friends beheaded by them in the past. He stayed on guard at the door requesting absolute silence as the soldiers were moving around outside the front gate.
My heart ached for him and for what he had experienced as such a young man - the beatings, threats and starvation. It also hurt for him as an older man re-living these experiences. It made me wonder if help had been available when he returned from war all those years ago - would it be different for him now? I was unsure if it was the PTSD or perhaps something like Lewy Body dementia causing his reality to be slightly askew. It could even be something as simple as an untreated infection as this can cause hallucinations in an older person. Whatever it was causing it, the common link was the changes that had taken place for him in how he sensed the world around him to create a reality.
He responded well to some grounding techniques and challenging his current reality. For me - I need to research this in far more depth to see what studies have been done on links between PTSD, dementia and sensory perception. Watch this space.
I sometimes think setting up and running an organisation is just so full of highs and lows that it is hard to know where you are at times. This past months have certainly been like being on an unsteady sea - one minute up, the next minute down. and a lot of queasiness in between.
It was an amazing yet humbling experience to win the Venus Inspirational Women awards under the National Professional of the Year category sponsored by Checkaprofessional.com. I genuinely was surprised. I had not prepared a speech or even made sure I could get up from the table if my name was announced. I mumbled something into the microphone and stumbled back to the table in a blaze of flashlights and a slight daze.
Our two new projects, Women as a Force for Nature and the POP UP dementia theatre were proving to be a delight, stimulating, heart warming and gob smacking in equal measures. To create something that hits you with such a force of making a measurable difference in peoples lives made me thankful to the universe. The whole team were riding high on the waves of success and then, as was inevitable, we had to hit the lowest point of the wave.
This came in the form of many evenings spent writing a bit of a complex bid to try and get funding for my salary. Hour upon hour at the computer instead of doing what I really love. So far I had been working at the University as a Research Fellow whilst trying to build up Nature Therapy CIC at the same time - I knew this was not sustainable so was really holding on to the hope I might be successful with this bid. I even had a mentor from the organisation helping me with the grant bid and telling me what a success the enterprise had been over the past year.
Fingers crossed and well versed I went to London for a Dragons Den style interview. It was just dreadful from the outset. I had 20 minutes to place my pitch but 2 minutes in one of the panel started having a coughing fit - and the poor woman continued on gasping for air for the next 15 minutes. The other panel member had to leave the room and in the few minutes I had left I completely lost my way due to a bit of panic setting in. Unsurprisingly I did not get the grant and the feedback was Nature Therapy CIC was not focused enough. Surprisingly they also told me to get in touch with another charity which I had explained to them during the very brief interview that I had already done.
It was a great lesson, if not an expensive and time consuming one, but a lesson nevertheless. So many charities and enterprises are now bidding for the same grants that competition is intense and being in a Dragons Den (which strangely enough is exactly what it felt like) is definitely not my forte. I needed to acknowledge I felt aggrieved by the process, withdraw, lick my wounds, wipe off mouth, and come up with Plan B. Even with an equitable interview I might not have got the funding.
Moral of the story is: the mark of a great entrepreneur is they get knocked down but they get up again cos nothing is going to keep them down (although I will avoid the whisky drink and the vodka drink).
Dr Kim Brown