Oh, why didn't you TELL me! (when telling doesn't work)

One of my favourite young people to work with is a young girl with autism who, although able to say many things, usually gets by through non-verbal means. She has taught me a lot over the past few years. Although at times challenging, the rewards have been plentiful.
One thing that has struck me on more than one occasion is how she learns what to do - and what not to do. Let me tell you two short stories:
One day we were at home and the kitchen was locked. She really wanted to go into that kitchen, but no-one else was around and we both didn't know the code for the door. It started off as just a little irritating, but in time things escalated. My hand was taken to the lock and I entered numerous combinations of numbers - none of which worked. The tension mounted, feet stamped, vocalisations got louder and more intense. Having exhausted all other strategies - distraction, ignoring, reducing sensory input - I decided to join in. I stamped my feet, screamed and jabbed at the numbers, shouting 'I want to go in the kitchen!!!' .... there was a pause, and with a small smile, she looked at me. Then, clear as day 'I want a drink'. Wow!
The second occasion was a day when the slightest thing seemed to be the cause of major upset. It's possible that she was unwell but not able to say, so there were frequent unhappy faces and noises and unconvincing cries. I tried saying things like, 'It's ok', or 'what's the matter?' but nothing helped. However, when I was face to face I tried copying the facial expression and sounds. Again, this did the trick. She stopped, looking very intently and then grinned.
When we know the auditory channel so easily gets blocked, let's try to use the visual channel instead. Mirroring back someone's feelings tells them that we understand and gives them a glimmer of insight into another person's perspective. It might not work for everyone, but it worth a try. Visit my website to find out more about my work.

To prepare or not to prepare: that is the question!

This is a debate that has aired in a number of places recently and it has inspired to me share it with you, as I think it is something that comes up quite a lot in the world of autism. So often we are told that we need to prepare people who are on the spectrum for what is going to happen; particularly if there is going to be a change to the usual routine or a big event looming. We can go to town (in a manner of speaking) preparing social stories, putting together photo albums, using role play and good old chat about the change, giving opportunities for questions and discussing feelings.

But for some people on the spectrum this seems to make them more anxious. They have far too many questions for us to possibly answer. So what at first seems like a kind and indeed the right thing to do ends up being an opened can of worms. In fact they may then do all they can to avoid the new event. Perhaps 'surprise' might be a better option and, hey, they may even enjoy it. You could provide a social script at the time of the event just in case.

What are your experiences? Get in touch via Twitter @KarenMTherapies or send me an email to admin@karenmasseytherapies.com and let's discuss this further. I do believe, like anything else, each individual is different and careful consideration of past experiences is really important so that life is as smooth and happy as it can be.

The Importance of Visuals

I have just come back from a relaxing swim. Have you been to a swimming pool recently? If you have, you may have noticed just how many visuals are available to help. How normal it is to use visuals. How essential they are for us all to function successfully. I hadn't been to this particular pool before, so I was especially grateful. The first 2 doors were clearly labelled as either Male or Female changing rooms. Then, a sign on the toilet door as opposed to the shower door. Next up, a sign pointing the way to the pool. At the pool, a clock on the wall so you could tell the time, signs to show the depth of the water. Visuals to show the pool rules - no dive bombing, no pushing, no dunking etc. Also, a warning visual to weaker swimmers, showing them which end of the pool to stay in. Then there were 5 lanes labelled with numbers 1-5. Often you then see diagrams showing you to either swim clockwise or ant-clockwise. This last visual was missing, so I had to rely on contextual cues, ie the person swimming towards me!

The next time you question how important it is to put visuals in place for a young, or not so young, person with autism, take a look around you, and take note how much you yourself use visuals throughout the day. You might be surprised at just how many you find!

If you have any questions about visuals or any other aspect of speech and language therapy, visit my website www.karenmasseytherapies.com or send me an email to admin@karenmasseytherapies.com and I will be in touch.

Child using PODD activity board lights up the whole classroom :-)

I love my job anyway. Each day brings something new, even if it is small, or just the fact that a child grins or runs up to give me a hug.

But today I witnessed something extra special. And it wasn't just me that saw it; it was a whole class that got inspired and amazed and awed.

So I happened to be in our therapy room catching up on some quick note writing when the phone rang. It was the nursery teacher asking for my colleague. "She's out doing a visit," I replied. She nearly ended the call, but then changed her mind and asked me if I wanted to come in and see something wonderful, maybe as it was one of my classes before the summer.

I am so glad I said yes. I went straight to the classroom and walked in to see everyone crowded round near the water tray. The teacher filled me in on how things had happened up to that point. Child had gone to the water tray and seen it empty of water with just a few blocks in. He took the blocks out then looked round the room until he found the PODD activity board for the water tray. He took it to a nursery nurse and led her to the water tray. He pointed to 'pour' then 'water' so she poured water in the tray. He then pointed to 'boats' so she got out the boats. When I joined the scene they were having a two-way conversation about splashing and getting wet!

The child looked so happy. He has very unclear speech. I was told how, without the board, he would have remained very frustrated, had some unsuccessful attempts at communication then settled for play in a different area.

It was definitely a 'wow!' moment. What a privilege.

If you would like to know more about PODD activity boards and how you can use them to support your child's communication, get in touch.

PDA: anxiety based demand avoidance or 'oppositional' and 'stubborn'?

Pathological Demand Avoidance is often met with mixed emotions by professionals. Some believe it doesn't exist. Others explain it as part of the autistic spectrum. Yet others argue it deserves a separate diagnosis that should be recognised in diagnostic criteria such as the DSM or ICD manuals.

Whatever you believe, I want to share my thoughts. Thoughts based on real life experiences of meeting young children in mainstream and special school settings; based on my trialling different approaches - and of course the responses I have had.

One young boy, probably 6 or 7, was in a mainstream school. He struggled so much in class that his school employed a teaching assistant to work 1 to 1 with him in a separate classroom. I went in to carry out a series of assessments. I was advised in advance it was difficult to instruct or direct him. So I went in the room and joined in with what was already going on. I gently and gradually unpacked my first assessment materials and went back to play. I then invited the adult to come over an have a look. After a while I started to 'test' the adult but we ensured she got things wrong. We then wondered out loud "I wonder if anyone else can help..." He came over immediately and before we knew it he was willingly completing the assessments. Eureka! I went back to the office and looked up advice and strategies but was disappointed to find only descriptions of this condition, not practical tips. I then typed up some ideas and sent them off with my report.

Roll on a couple of years and I am in a special school. I have worked with 2 or 3 young people who, although with more significant learning needs, also appear to have the same difficulty - coping with demands. Everything is great during relaxed, child-led play. Interaction is rewarding, language flows and there is a great sense of calm. But the minute you decide to take control and suggest going somewhere else or doing something else, it is a trigger for a very unhappy child who absolutely will not do as you say. No amount of bargaining or insistence seems to work. Autism friendly strategies such as countdowns, traffic lights and visual timetables don't seem to help much or at least not consistently.

So what do we do? I firmly believe that these are a group of people with very real anxiety disorders. Their anxiety levels get raised very quickly and very high whenever they feel control disappearing. The more demands placed on them, the worse the anxiety. It can spiral and spiral. So do we all get anxious from time to time. And when WE get anxious, we expect people around us to understand. We need people to be calm, to reassure us, to pamper us, to do things for us, to give us things we like, things that will help us relax. So, I figure, we really need to do the same for these children.

Approaches that are non-directive in nature include Intensive Interaction and Hanen. In my experience they really do work. And, once you have followed the child's lead there is no reason why you can't feed in language and education in a non-threatening way. Get in touch if you would like support with your child who has significant demand avoidance behaviours.

Let's make a deal - getting the job done

Yesterday I had the task of completing 3 assessments with a 6 year old boy. We only had an hour, so I needed to get it right. On a previous classroom visit I noticed him looking at a book about trains (mental note to self - he likes trains). When I walked in to get him, he was just starting quite a large jigsaw.

Uh-oh, I thought. This could take a while. I suggested we go to do some 'special' work, but he said, 'No, I need to do this jigsaw'. Hmmm, I thought, I need to think of something else. 'Why not bring your jigsaw with you? We can do it together. We could even see if we can find a train to play with.' It worked. He put the pieces back in the box and willingly came along the corridor. We chatted about transport on the way and he relaxed. 

First hurdle tackled successfully.... now for the assessments. Unfortunately, on reaching the room, he wanted to get back to the jigsaw straight away. My rather boring looking assessments just couldn't compete. So what next? Give up? Engage in a battle?

No. I used the 'Let's make a deal' strategy. Quite a verbal little boy, all he needed was a verbal approach (but you can make a it visual for children who learn best that way). 'Let's make a deal,' I said, 'Do 3 pages of my book and then we do 3 pieces of jigsaw, 3 more pages of the book then 3 more pieces of jigsaw,' and I held out my hand to shake on it. It worked! He liked the idea, and for the next 30 minutes we stuck religiously to the deal. He even jumped up after every 3rd jigsaw piece, keen to get on with the assessment. 

Why does this strategy work so well? Well, it allows the child an element of control. He doesn't have to give up what he wants to do completely. It is also quite an adult way of dealing with a situation. We do it all the time with other adults, e.g. 'I'll cook and you can wash up'. Children like to be treated like grown-ups. Another child I know will do anything for the chance to carry my fob and lanyard as it makes him feel special and in charge. We don't always have to be the 'teacher' telling them what to do.

Give it a go and see how you get on. I find it works well for most children, especially those on the autistic spectrum who both love being in control and have a special interest you can use as the deal maker.

Understanding Apraxia of Speech or Verbal Dyspraxia

Apraxia of Speech (American terminology) is known in England as Verbal Dyspraxia. It describes a condition in which speech clarity is affected by decreased co-ordination of the oral muscles.

In other words(!) the jaw, lips and tongue don't quite work together and get it right. Children - and adults - can be affected to differing degrees. Some will respond to just a small amount of therapy if their difficulties are very mild. However, for most children with this diagnosis, it is a long road of regular therapy and practice.

So dyspraxia is when co-ordination of the muscles is impaired. Dyspraxia can also occur on top of a muscle weakness (dysarthria). When this happens, it is really important that therapy addresses the muscle weakness first, rather than simply trying to get better co-ordination - as this would only achieve better co-ordination of weak muscles.

I have seen features of dyspraxia in many children who are on the autistic spectrum. This isn't surprising when you consider that motor planning difficulties are common in children with autism.

Traditional therapy for verbal dyspraxia focuses on auditory and visual methods of input followed by lots and lots of practice. If this approach works, then great! That is all that is needed. There are different published programmes such as the Nuffield Dyspraxia Programme (UK) that do the job.

But what traditional therapy does not do is account for those children who learn best through tactile methods. They need auditory, visual AND tactile input in order to learn what to do with their mouth. That is where Talk Tools comes in. It offers an approach that helps this particular group of children transfer their muscle skills (muscle strength) into speech. It also allows us to provide a more holistic therapy environment, considering eating and drinking skills as well as speech (they are all joined up).

Visit my website for details of how to get in touch for an in-depth assessment or treatment.

How Psychological Theory Helps Speech and Language Development

When I was studying to become a Speech and Language Therapist, I also gained a degree in Psychology. One person who stood out during my learning was a man named Lev Vygotsky. I studied his work in relation to child development. To this day I continue to follow his theory known as the Zone of Proximal Development.

This simple, yet powerful, theory makes a lot of sense to me and can be applied to all areas of speech, language and communication. It happens naturally in societies that are not organised into schools, teachers and pupils.

First you need to know where a child is at right now. What can he or she do? What does he or she know? For example, he can complete a 6 piece jigsaw. She can speak in 2 word utterances.

The zone of proximal development refers to what comes next. It contains knowledge and skills just beyond the child's current level, that is just within reach, that will stretch and encourage. Exposure to this zone is what is needed, whether in the form of peers who are a little more able, or in the form of an adult who offers a model of what comes next. This would include showing and helping him to complete a 7 or 8 piece puzzle, adding a word to make up 3 word utterances.

So you know where the child is now. You add the zone of proximal development. Then you add in some scaffolds to help the child cross to the next level. Then you start again.

To learn more about my work, please go to my website.

How to help a child to use his language functionally

Many children I have worked with have had the following problem: they are developing their vocabulary but they don't always use it to communicate. Sometimes they may talk at home but not in school. Sometimes they speak in certain activities, such as when naming in a favourite book, but not in others. It can be frustrating for everyone involved. I have seen it in children who are on the autistic spectrum as well as others who have a language delay and may have a passive personality.

A technique that often (but not always!) works is called 'Sabotage'. This involves creating communication opportunities, ie the child has to say something otherwise the activity doesn't work. Some examples of sabotage include:

1) Ooops! I forgot....    You give your child a bowl of cereal and milk, but no spoon. You wait. You might even encourage him to eat up. If nothing happens, simply model the word you want to hear. It could be 'spoon' or 'help'.

2) Say something silly....  You are counting '1, 2, 3, 4, 27...' Again, you wait and pause. You might say '27? Is that right?' You can model the word 'no!'

3) Do something silly.... You try to put socks on your child's hands

4) Put something in sight but out of reach... You put your child's favourite toy on a shelf he can't reach

5) Be really mean with quantity....  Give your child just a tiny drop of juice in a cup, or just one crisp

Another technique is called 'sentence completion'. This is when you help your child get started but leave out the key word for him to fill in. An example would be when you KNOW he really wants something but he is just pointing or maybe screaming. You help by saying, 'I want....(train)'
Or he is struggling to get going with the zip on his coat. You help by saying, 'I need...(help)'

A new AAC tool to add to the tool kit

I was listening to an audio book last night and discussing how your mindset influences events in your life. So a positive mindset will lead to positive experience, negative to negative - in a simplistic nut shell.

I also knew that today I would be attending a training day on PODD (Pragmatic Organisation of Dynamic Display) - I can see why it is just called PODD! Now my knowledge of PODD was very limited. All of this limited knowledge was via a colleague and I didn't really know whether it was for me, or whether it was for the children I work with. I had also learned that the original 'free' place might have become a 'paid' place. It was hard to wake up with a truly positive mindset. I wanted to be positive but couldn't genuinely do it.

But after 30 minutes that all changed. I had, by the way, made a conscious effort to be at least open-minded. I mean I wasn't negative and set on being a doubter or one of the 'no' camp. The presenters were engaging and they put across the same ethos and principles I believe in - the need for genuine communication (not contrived), the need for communication everywhere, with everyone, all the time (if that is what the child or adult wants), and the need for a two-way process (not just something the child/adult uses but me too). Throughout the day my open-mindedness changed into a definite positive mindset. I like it. There is enough space for PODD alongside all the other techniques I know. It will add another dimension to the environment and to one to one conversations, it is appropriate for children with differing clinical needs,  including autism (it really highlighted what PECS just doesn't do). This positive mindset means that I can and I will be using this successfully with my clients. No questions, no obstacles. Just mindset.

For a small insight into how it works, there are a number of youtube clips. To enquire about my work or to book an appointment, please visit my website. 

What is your goal? Begin with the end in mind

We are obsessed these days with setting goals. Sometimes the goals get in the way of the whole thing, we get stuck on the detail and miss something really great that has happened while we took our eye off the prize, while we were busy with the paperwork or the checklist.

It is a really difficult one. Do we set goals? Do they need to be specific or is it ok to be general? I remember when I was still a student that I assumed that for every child I saw the goal would simply be 'for the child to have age appropriate skills' in whichever area we were working, be it speech clarity, understanding or expressive language. Simple right? Hmm that's ok and is probably in the background of most cases, and that's ok if it means we are looking for progress - we should be looking for progress unless we are aiming to maintain skills. Aim high and you will move higher, but aim low and you will certainly stay low. But goals in reality end up being much more personalised and varied, depending on people's motivation, expectations, standards, hopes and dreams; depending on medical conditions or diagnosed learning difficulties; depending on people's values - is there a trade-off between determined focus on skills and relaxing and being happy?

I have always struggled to fully buy into the goal-setting culture. This is my reason: what if you set amazing specific, relevant goals that are easy to measure etc. etc. but 8 weeks down the road the child doesn't meet them, BUUUT they do make progress in a completely different area? Does that still mean they 'haven't achieved'? or does it just mean we set the wrong goals? Let me explore the technique of Intensive Interaction in this way. I am passionate about Intensive Interaction and its benefits. But if we apply goal setting we end up saying things like, 'my goal is to get more eye contact', or 'my goal is for him or her to copy me when I say "more". For me that limits the approach and misinterprets the philosophy of the approach in one big double-whammy. Do the approach with no strings attached and you will definitely get results. They will be big and they will be general. The child's whole social interactive ability will improve. Not just eye contact or repetition of a word, but enjoyment, joint attention, improved concentration, calm behaviour and many many more skills.

I do agree with the need to know where you are going though, not just aimlessly wandering along. That does help. Know what you want to achieve, not just 'we want lots of therapy', ask the question, 'why? why lots of therapy? what will that achieve?' and you will be much more positive along the way, working towards a meaningful objective.

Tips for Correcting Speech

Unclear pronunciation is very common, particularly among pre-school children. Often, with a few clues and context, although a few sounds may not be clear, you can still understand your child's general message. If you have understood, but you noticed a sound that was missing or different, e.g. he says 'bish' when he means 'fish', there are a few options for what to do. One option is to emphasise the correct sound in your response, 'that's right, it is a fish' - that way he will hear the word in the right way, but you haven't told him off. Another option is what we call 'forced alternative', where you present the word in 2 ways - the way your child said it and the correct way - 'ok, is a bish or a fish?' So your child has the chance to listen to both words and make a judgement. If he is physically able to produce the 'f' sound, he can repeat the word correctly. You might want to vary which technique you use, and try to not to pull him up all the time. These things don't change over night and require a little patience on both your parts.

Choosing an Alternative Communication System

I am currently working with a young group of children who are at the beginning of their communication journey. Some have made excellent progress with their interaction, many have picked up how to use PECS (Picture Exchange Communication System), and can use it to ask for things they really want or need, some have made the leap to using verbal language. So far, PECS has been the only alternative communication system (AAC) that has been trialled. But there are other ways in which communication can be supported. So we are now turning to other strategies. Signalong (similar to Makaton of Mr Tumble fame) can be helpful for children who are visual learners and are also able to copy hand movements. Other options these days tend to involve technology. A lo-tech aid such as PODD will be given a chance. Other aids such as Go Talk and ProLoQuo2Go might feature. The aim is to leave no stone unturned, or no aid un-explored, until each child has his or her system in place. Indeed for some of the children, they show preference for a combination of 2 or 3 different systems (Total Communication). Trial and error will eventually lead to results. Once a child has a sound, robust communication system, there is nothing to stop him or her from achieving full potential. That is a powerful gift. Communication, a human right, not to be taken for granted. Visit my website if you would like more support with PECS or any other aspect of communication.

Bilingualism and Language Development

Young children simultaneously mix languages, separate languages and segment languages according to the situation. All 3 approaches are typical. In terms of development, however, the following sequential stages are usually noted. First, use of the child’s home language. Then, there is often a non verbal period or ‘silent period’ at the time of entering the 2^nd language environment, e.g. nursery. When enough confidence has been built, the child will at first be telegraphic in the 2^nd language before being productive with some errors. The final step in the journey is to be competent or fluent. This is usually achieved 18 months – 2 years after the child first enters nursery or school. It is important that children are supported and encouraged to develop basic interpersonal communication skills in their home language; not to be discouraged from using this language. This will help them to develop their language skills in all languages at a later stage. Remember that Bilingualism is not a disorder. It is an advantage and does not cause communication difficulties. Indeed it should be celebrated! If you are concerned that your chid's communication skills are not developing along the typical lines, get in touch - admin@karenmasseytherapies.com 

What is Intensive Interaction?

Intensive Interaction is the name that has been given to a technique used to help children develop their interaction skills with others. It is also a technique that nearly every new parent uses when interacting with their baby, which makes it one of the easiest techniques to learn and use. It is also, in spite of its simplicity, one of the most powerful and effective tools you can have up your sleeve. One of the reasons why it works so well is that the child leads, doing the things they likes to do. The atmosphere is relaxed. There is no pressure. Results are natural not forced. Skills such as eye contact, social smiles and joint attention are not 'worked on' in 'therapy sessions'; they develop naturally, often when you are least expecting, so that the child experiences REAL feelings, REAL emotions, REAL joy. Initially the technique may involve the adult imitating a sound or an action then pausing to look for a response. This then leads to a 'conversation', where the child has a turn and the adult answers. Turns are not necessarily speech. Sometimes they are a tap on the table, a flick of a light switch or a vocalisation. I LOVE this technique and never tire of its use. To see the technique in action, we recommend a visit to www.intensiveinteraction.co.uk or look up some clips on youtube. We use the technique with children of all abilities, not just those with a severe learning difficulty. Send us an email if you have any questions.

What Are Oral Motor Difficulties?

That's a good question to ask. Oral Motor is, in my opinion, an area of Speech and Language Therapy that gets frequently under-assessed. This leads to children being under-diagnosed with oral-motor difficulties. Therefore, this leads to under-treatment of oral motor difficulties. The worst thing is, just because it's not an area many therapists choose to study further or develop into specialisms, if impaired, oral-motor skills will have a knock-on effect on both feeding AND speech. It is like trying to build a house starting with the walls, adding the roof, windows, doors etc., but ignoring the need to first look at foundations. Oral-motor skills include the muscles of the jaw, lips and tongue. In infant development, the jaw is the first to gain strength, stabilise and allow for chewing to develop. Next come the lips and the speech sounds that go with them - think mama or baba.  Lip skills also help an infant to drink from a cup and then from a straw, or to blow bubbles and give kisses. The lips and jaw should begin to separate their movements, allowing a child to drink without biting down on the cup or the straw. Finally, the finest motor movements are given to the tongue - responsible for many many speech sounds. Oral motor difficulties are common in the following conditions: Down Syndrome, Cerebral Palsy, Verbal Dyspraxia and Autism. To find out more, we recommend a visit to www.talktools.com or look up some clips on youtube. Send us an email if you have any questions or would like an assessment.

How Often Do You Need to Practise?

This is such a difficult to question to answer in a quick sentence, hence the blog rather than a tweet!
But there are some ways of coming up with a frequency that works for you and, more importantly, for your child.
1) What kind of difficulty does s/he have? If it is a social communication or social interaction difficulty, then the answer really has to be, 'practise all the time!' 'Seize the moment'. You can be modelling, using strategies, supporting or encouraging in real-life social situations. If it is a language difficulty, you might want to do short structured activities daily but model and reinforce when the language structures naturally occur. For a speech difficulty, you will need to do structured activities as many days per week as you can, then model and help your child to generalise recently learned sounds throughout the day.
2) How easy does your child find it to sit still and concentrate? If the answer is, not easy at all, then you are probably going to be practising in very short bursts and using play to teach skills rather than follow a structured sit-down-at-a-table programme. If s/he can concentrate for 10 minutes, then practise for 10 minutes; 20 minutes? Guess what, practise for 20 minutes!
3) Is your child motivated to do his/her therapy? If the answer is yes, that's great. You can take advantage of this motivation to practise one or two times per day. However, if motivation is lacking you may need to limit the number of times per week you sit down to practise; you may need to use play or lots of motivators/short breaks/bribes! You might also need to consider offering your child a therapy break so that therapy does not become too much of a chore.
There really is no hard and fast rule, although research evidence does mean there is general guidance for therapists to consider. Try to agree the frequency with your therapist and your child, and be prepared to alter or tweak the arrangements every so often. For more advice, visit my website.

Using Intensive Interaction with Verbal Children

Most people who use Intensive Interaction do so with children who either have severe or profound and multiple learning difficulties and/or autism. It is usually associated with pre-verbal children or adults, or people with a limited amount of verbal communication skills. I want to challenge this viewpoint. I have used the central tenets of Intensive Interaction with children on the autistic spectrum who are described as 'high functioning' or 'Aspergers', with great success. It is a great way to start off with someone new, to build a rapport, or if you know at some point you have an agenda, a task you need to get done. For example, if he or she is tapping the table, join in. If he or she is reciting lines from a film, echo back with a question intonation. Work out the 'theme' and join in on that theme. Now you have a connection.  If your communication partner isn't ready to move themes, that's fine, just weave your agenda in and use their preferred 'theme' to get the job done. For example, if you need the child to get some maths homework done, but all he wants to do is talk about the solar system, do 'solar system maths'. I always think about what we do when we meet anyone for the first time - including people here who are not on the spectrum. We establish common ground after first observing and working out what that common ground might be. Also, don't forget the sensory needs. High functioning individuals have sensory needs just the same as their lower functioning counter-parts. I need my coffee fix just as the child who needs to spin. If you want to chat further on this topic, email me on karen@karenmasseytherapies.com 

The future of speech therapy

We are told that we are now living in a digital economy. So what does that mean for Speech and Language Therapists? The profession has for so long relied on face to face appointments and paper-based materials in order to allow a therapist to help a client. In recent years I have come across one or two websites that have attempted to help therapists engage in a more modern way with clients. Now, too, are a number of apps designed for people to use at home or to enhance face to face therapy sessions. But are we really embracing new technology and taking advantage of what is available? Are we responding to the changing need of the public? There is much that can be done via websites, video and forums. Yes, for a proper assessment, nothing beats face to face, but preventative work, training, and continued support can be done in many other ways that are more convenient and effective.

Lead, don't manage

Here at KarenMasseyTherapies we are not only passionate about the value of the therapy we provide. We are also careful to create an organisation where everyone matters. An important distinction we make in the running of KarenMasseyTherapies is that Karen leads her partners, employees and clients; she does not manage. The word 'lead' to me implies.... 'by example'. Leaders should be inspirational and bring people together, people who are a harmonious whole, working on one and the same philosophy.