Bubbles for Joe

This week  I wanted to share with you a story..

A story about loss, and of honouring, of memories and of new beginnings- it formed part of my work previously with loss and hospice care.


Bubbles for Joe.


"This is me, my name is Phillip, and it may seem quite strange to you that I am sharing this photograph with you, especially as I am blowing bubbles.

Why, you may ask?

Well this is my best friends garden, I come here a lot you know, here I can shout, stamp my feet, think, here I can remember.

Molly helped me find this place, I call it my safe place, she lets me call her Molly Moo.

I am 11 years old, my best friend, was, is 10, and I come to this garden to remember him, because he is not here anymore, he has died and it took me a long time to say the D word.

The bubbles you see, are for him, in each one is a message, sometimes I tell him about what I am doing at school, or about the horrible school dinners, or maybe I might just tell him I have a new football, or that I ate loads of popcorn at the Cinema.

Today I am sending him a message about the summer, how hot it has been, that I went to the beach and ate ice cream, and how much I miss him and wish he was here.

I have blown 8 bubbles, but if you look carefully you can see or imagine that there is 2 bubbles together , it looks like an upside down snowman.

That is a special one, that's only meant for me and Joe.



After these bubbles fly towards the sky, I am going to have a water fight in his garden with his brother, we are going to get soaked, so he will be able to see, even though he is not here with me.

I do feel sad sometimes, and cross, very cross, and I miss him.
Molly Moo says it is ok to feel those things, but I still like to laugh sometimes too, just like Joe and I did together.

Sometimes my tummy used to make really strange noises when I was sad, and it felt like a washing machine, with lots of things going round and round, but when I blow the bubbles, and send Joe the messages it helps to make me not so sad, and then things start to calm down.

Soon I am going to be moving house, and I wont be able to come to Joe's garden anymore.

But there are lots of hills where my new house will be, and I will always have the photograph to remind me of my safe place in my head.

My new garden is on top of the highest hill, and you can see for miles and miles across all the tree tops.



So I can go, and blow bubbles.

Bubbles for my best friend Joe, and I can remember all the times we laughed.

On days when I feel sad I can climb to the top of the hill, and a little part of me will always remember Joe's garden and the fantastic summers we had".

The End



Sian Spencer-Little

Little Boxes

      
Over the past few weeks there have been many moments of brightness, contrasting with confusion, unexplained actions and fear.
If we look at impact, and I often talk about this in real time, the consequences to that are, the person effected is left dazed, unable to process and fearful of the future.

Each of us are unique, we carry with us and hold deep within us an ability to behave in a certain way, to re-act to situations, to process and to respond.

Often then, unique people are placed in little boxes- which they cannot seem to find their way out of, this can often result in their character and essence being closed away - rather then being explored, allowed to evolve, celebrated,  and shared.

"Experience growth and the will is far greater than the ability to shut down every time you are scared and want to play it safe"

 I am relating this to a unique group of children and young people I have the honour of sharing there journey with.
                Sometimes they are put in little boxes.

I spend lots of time observing C&YP who are living with long term health conditions, I sit alongside them during treatments and admissions to hospital.
I observe how they are greeted, and the affect it has on them with yet another admission to face.
I spend time with their families, and siblings as they too form part of this journey.

How does this impact on their "non-hospital life", the life away from blood tests, blood pressure checks, treatment, cannulas, more nurses, more doctors.

Do they want to have polite conversations with nurses and doctors who have been with them since they were a baby, when they are now 14!

I have explored this with C&YP this week as I have walked alongside them to support them through there latest stay in hospital, I have been an observer and student.
This has enabled me to really listen to what they need, how they would like to be heard, and what they want from their routine admissions in hospital.

" I like coming here because I get to see some of the nurses and doctors I know, but I wish they wouldn't keep telling the same jokes"

" I just want to get it over and done with, Iv got so much work to do for school"

"Yippee this means I get to go to the hospital school, I love it"

These are just some of the comments shared with me, and so in giving them the opportunity to say how they feel, allows them not to carry so many worries with them, it also says to them, you are unique, and your thoughts and opinions do matter.

"Sian I know I said I don't need you, but if your not busy will you help me with my cannula"
I have known this patient for 8 years, they have a active procedural plan in place and on the last 3 admissions they have said " I'm ok I don't need you"

Each of them is unique and ever evolving- and its ok to ask for help now and then.
Giving C&YP the luxury of time and space, during an admission goes towards non- verbal actions of being present and in the moment.

I may have just been walking past the treatment room, and popped my head round the door " Hi, anything I can do?"

For some of those living with a long term conditions- coming into hospital for even short periods of time is a huge disruption in their lives which they are trying to live as non- clinically as possible.

" Please ask me if I would like to talk,then please ask me how I am today"

Sometimes they don't want to have conversations, sometimes they just want to "get on with it" - can we work towards this which does not involve words and conversations- but by actions.

Can we understand why sometimes they don't want to talk, is it because an opportunity hasn't be offered?

Sometimes they want to have a conversation.
Can we as HCP have those conversations freely, openly and honestly, do we know how to say certain things, are we equipped with the right language

This week I was honoured to attend the official launch of MeFirst.org.uk
this is a brilliant organisation set up to assist and support.
To share skills with HCP who work with and are part of C&YP's lives, it was also thought provoking to hear and gave deep meaning when listening to how C&YP would like to be listened to and supported through their lives within health.
It was also refreshing to meet and see how many of us are doing the most amazing job at supporting C&YP, and how together we can continue the movement forwards.
 
Within my role, I can offer time and space, tools to express, set up discussions with other HCPs to understand C&YP - what are their needs and how can we make being in hospital a more rounded experience.

Effort only fully releases its reward after a person refuses to quit.

"With ordinary talent and extraordinary perseverance, all things are attainable"
Thomas Foxwell Buxton.


Sian Spencer-Little
 








                      

Expression and Story Through Play.

"The Sandtray - tiny grains of sand, like huge diamonds are so powerful, yet it   appears uncomplicated, natural and after all ,its just a tray of sand!"

My thoughts, before I  took part in a Sandtray session many years ago- how wrong was I, and how totally unprepared I was for what followed- it is difficult to even put into words- as its a deep and powerful experience, that cannot be taught- it has to be felt, words do not allow for the impact it has.

Over the last 10 years we have grown to learn more about the expressive tools that can be used and offered to children and young people, experiencing "tough times"


Many professionals within the field of trauma work and neuroscience have shared research and key findings on the impact trauma has on the brain and our ability as human beings to process and cope with that impact.
How it can impact our learning, our processing and for some become a block to growth and development.

Much of this work and research has come from collaborative work alongside children, young people and their families. ( Violet Oaklander, Dr Margot Sunderland, Dr Garry Landreth to name but a few)

I have been fortunate to have been a student with some of these teachers, and have embarked on further training and therapy within the vast area of Therapeutic Play.
As I grow - it is an area of work I am continually learning from as a practitioner.
It is not an area to approach without training, and teaching, supervision or personal therapy opportunity. 

When I think about trauma, and perhaps what a child or young person has experienced, I look at subtle trauma, those short episodes, those things that seem unimportant to others- these are often the beginnings, and then other short episodes arise, little incidents, and they begin to build, much like the "Tower of Jenga" I have spoke about previously.
Then all of a sudden it has grown to enormous height, is so loud that nothing else can be heard.

We all have different ways of dealing with our own episodes- moments in our lives where we have needed an extra hand, an arm to guide us- however for some children and families this is an invisible image- one that is too difficult to locate or see, or accept.

When working with play skills- we open up the dialogue between the two worlds.
Children and young people often reveal things about themselves that they wouldn't normally do, they sometimes use metaphors and objects, as adults we feel the urge to be able to fix them- and within Therapeutic Play sessions its really important to try and resist that urge deep within us.
That is asking a lot of us, and for some playing does not come easy.

If you have not had the opportunity to be free with objects, to explore, to imagine to re-inact with puppets, dance, sing, paint, play with sand- how do you allow yourselves to be free with the medium you wish to invite the child to explore and use.

When delivering a therapeutic session, a space, its important to acknowledge that the simplest of things has the biggest impact.

Allowing children and young people the opportunity to play, take a puppet, share a feeling, the name of the puppet, what is it doing- you are inviting them on a journey of play.
To offer paint, clay ,a drum alongside a child, to listen as the drum becomes a tool an extension of their feelings is a powerful moment.
Here you will both discover individuality, imagination, the role of this character or feeling- how it  plays, its likes and dislikes, the volume of their voice, or instrument, the tone, the language.
Here you begin to do the wonderings for the child or young person.
Symbolising feelings allows children to choose to join in or create conversations about their emotional world.

Working within the metaphor has a feeling of safety, as you speak as an object.

I will be sharing further thoughts and insights in the coming weeks using my blog to explore these, share and grow as a practitioner.




"Trauma makes you fight the last battle, over and over again"
Bessel Van der Kolk 1999.


Further Reading-

Margaret Lowenfeld - Understanding Children's SandPlay
Violet Oaklander- Windows to our children.

Take a moment- see the beauty on a "TwitterBlogVacation"

Time away from computers and blogging is something I thought I would struggle with.
However I feel it has given me some space to really see things through different eyes.

As I sat over looking the ocean- and thought about the last 6 months of work, of the NHS, of pieces of work I have been involved in, new people and peers whom I have worked alongside, I feel really privileged to have had all these opportunities.

I asked my partner the following question.

What allows us to inhale- take a deep breath- look at what is often right in front of our noses?

 

For me- the sea, the waves and the fact that there is nothing on the horizon.

A deep breath- a cleansing sigh to me that says " ok- breath, relax and restore"

The reply from my partner was - "getting into my own bed"

I pose a question- "but what allows you to feel truly relaxed"?

Reply- " I have never really thought about it in that way"

In healthcare and as professionals I wonder if we ever truly have that moment of looking out and seeing nothing on the Horizon- no lists of things to do, projects to complete, patients to spend time with.

I am a bit of a workaholic if that's the right word, I love all the projects I am involved in, and work like crazy in an environment that is highly charged at times- and I love it- wouldn't ever think of anything else, the challenges, the teaching, the patient care- these are all music to my ears.

However - we all need that space in time, that gap, that moment of stillness- in order to do what we do, to recharge our batteries, and see our families, in order to top up our "cup of kindness and compassion"

I then got to thinking about how creative we could be in our workspaces to provide a moment of calm, a breathing space.
We would all have different things, images or ideas about what could make this happen for us.

I have recently shared a blog space with @johnwalsh88 - it was so uplifting, and a learning experience to write alongside him, and we shared our thoughts of creativity, kindness and compassion.

Perhaps we could all do with a place to take a breath.
 A sign on a door " Horizon Space" where you can go for a few moments just to be.........
How effective would it be?

Creativity comes to us in many different ways- over the next few weeks I will be using mine to celebrate and highlight the Power and Passion for Play In Hospitals- with National Play In Hospital Week.
We will be welcoming visitors and working alongside Music In Hospitals to create a space of joy and support for C&YP and their families.

Sian Spencer-Little.



 

The Creativity Flow

The Creativity Flow.

'The most childlike thing about a child is his curiosity and his appetite and his power of wonder at the world' - G K Chesterton


"I can do great things- great things. You can't stop my dreams and ambitions" - NehrurianDoom


We all value and love creativity although there may be creative expressions we don't like. The artists, singers and writers we enjoy are often people of deep creative power. This power is often created deep in their souls by painful and traumatic events. This sense of disjointedness gives birth to desire and design. It leads to attempts to porray and capture. We are allowed to experience and view this in many different forms and platforms.

  If we think of the history of music  - whether it is reggae or rock, opera or oriental metal  - whether we love or hate it we see a constant experimentation and creation of new forms and shapes of music. When we think of those artists who touch our soul what is it that does so? There are probably many things. One answer is creativity. There is something powerful there and it is not like other things. Creativity opens new portals and vistas and communicates itself to others. Mihaly Csikszentmihalyi the psychologist has written extensively on creativity - one of his books is called 'Creativity: Flow and the Psychology of Discovery and Invention.' He notes how 'most of the things that are interesting, important, and human are the results of creativity.' This blog will offer a few thoughts on creativity and how we might start or continue its flow in our lives.


Ken Robinson the educationalist links creativity with imagination. He says 'Creativity is putting your imagination to work, and it's produced the most extraordinary results in human culture'. Imagination is a tremendous resource that humanity has. It allows us to dream and soar. Imagination has birthed all the dramas, books, songs and films that relate to us in potent ways. Imagination links us to another key aspect of creativity - meaning. Creativity is all about meaning. Csikszentmihalyi notes how creativity is 'a central source of meaning in our lives'. This connection with meaning is so important as creativity allows us to make sense of life and the universe. This tells us something about the human mind and spirit. We often see the mind as a  complex computer. While this is a helpful image there is another image to complement it. It is the phrase of the English psychologist Charles Sherrrington who spoke of the mind as an enchanted loom. A loom which was forever making sense of what we were seeing and experiencing. A weaving loom spinning patterns of meaning. Creativity is all about joining up the dots and making seeing meaningful shapes. 



Creativity can be a very demanding activity. Csikszentmihalyi in his work notes how creative people tend to have two things - curiosity and drive. That they take intuition as a serious and key source. That they become authorities in their areas so that they can see their subject from every aspect and angle. Can we then be creative in our lives with all the challenges and pain? Yes we believe we can. It is true that culture and patronage play a big part in big creative expansions and explosions. It is said that if Michelangelo was born 50 years earlier there would not have been the culture of patronage for the arts for him to grow and flourish in. In terms of our everyday life we can think of two ways in which creative activity and actualisation can start to happen or grow. There are many others but we will focus on two. They are pictures and moments. They are all about seeing the picture and seizing the moment.



The first way is all about finding the canvass. One of the authors found this quote many years ago - "You were born to use this life to refine or improve yourself. You were born to use this life as a canvas to paint yourself across." It sums up so well the first way. These beautiful words tell us how our life is a canvass which we paint every moment. Our thoughts, words and actions are the brushes we use. The strokes made and paint used a vehicle for trying to express the journey, the struggle and the hope. The canvas can shimmer with the inner dispositions and emotions freely displayed. In this world we are very fortunate that many decide to paint with kindness, goodness and love. They bring a brightness to dark places. This creative painting impacts what we do in our day to day working and personal lives. It can be found in the smallest of things and the biggest of acts. The second thing is how we can use moments to have that drive and curiosity that true creativity is all about. Of course the heavy demands and pressure of work can take away our moments for reflection and creative action. We may well need to make a conscious decision to have these moments for creative possibility and power. If life or work won't give them we may have to carve them out ourselves. One of the authors recently met someone who shared how each evening he makes ten minutes of writing to reflect on the day, the days lessons and how he can grow. He spoke of it as a key part of his development. This is creative space. This man was and is practising creative inquiry and we are sure much good flows from those moments where he is there in reflection and openness.



There is a famous fresco painting by Michelangelo in the Sistine Chapel called 'The Creation of Adam.' In it there is Adam and God - a chasm separates them. Both are reaching out to connect. This touch will be electric and wondrously creative. To us there is a picture here of our own creativity. Lying deep within us all lies a deep source. If we can make the contact the creativity flow can start or spread. It is part of the 'vast inner resources' that Carl Rogers spoke of. To reach and touch this reservoir of potency and creativity brings magic into our life.



One of the  authors is a Specialised Play and Activities Practitioner within an acute children's ward at a district general hospital. She speaks of how creativity and play are connected within healthcare and symptom control. How it can they can be invaluable in supporting a child or young person share and manage long term conditions and lengthy admissions into hospital. She writes ' 'The use of live music and the the sound and feeling it creates leads to the vibrations that can be felt across the ward. Paint and painting makes you feel free- it allows freedom to make mess, within the sterile boundaries of a clinical setting. How sharing a song, or humming softly whilst soothing a baby is an act of deepest significance. It allows the child, young person and family a creative space  - a special moment in time. How using a drum to allow expression of feelings when words alone are just not enough. As a practitioner hearing that anger/sorrow that comes from the very core of a young person. Being there and with that young person looking for ways forward - ways from within and outside the box.' Creativity is all about imagination and intuition. It is all about using the gifts we have - from intellect to emotions - as paint for the canvass. Creativity whether in a laboratory or a commune often has an element of play about it. Creativity is part of that dance that we as humanity is engaged in -  that work to create, dream and make meaning . We have the tools and resources - its really about being open to find our place in the creativity flow and to let that flow operate in us.

 In finishing we recall the words of that American dreamer and creative artist Maya Angelou - 'You can't use up creativity. The more you use, the more you have.'    

Sian Spencer-Little

John Walsh.

Words and Time.

" Thank you so much, you really put his mind at rest, he now understands"

Time taken and given to C&YP in hospital is a rare commodity, I say this as in an ever changing and fast paced environment such as acute inpatient care- I believe it is, this is not to single out an individual , or team but an observation.

I have heard such conversations, they wished there was a little more time, to explain, adjust, prepare themselves as HCP's as well as their patients and families.
This is not always possible- what if it presents as an emergency?

I feel like I want to turn this on its head a little, so stay with me on this!

As a Specialised Play Practitioner I observe the impact a hospital admission or procedure has on C&YP when it is an acute admission or procedure.
All of a sudden they are informed that a procedure, operation or blood test needs to happen.
At that very moment- everything changes for them, their families and the HCP's caring for them.

As HCP's we don't always know significant history in terms of previous experience or trauma.

However I observe the fear, the apprehension,  I listen to the questions, the slight adjustment in level of voices, pitch, volume- I watch intently to the change in size of their pupil reaction, the flushed colour in their cheeks, the silence that takes over them.
The body language, the breathing rate.

All this occurs immediately after they are told about the procedure- I call this the "golden 5 minutes"- in this time, whilst the HCP's are preparing themselves, as they too experience all or some of the above-the C&YP needs preparing- so how we manage this next episode of care is crucial for us as practitioners, and for the child or young person.

Simple language to explain "what happens next"
Words are so very important at this stage- how we describe things, there are some words that we should not use.

Key words are the only thing parents and C&YP remember, I discussed this during the week with a family, they shared with me  " tube" " mask"  " blood"  " prick" being the most they remember in times of fear.

Tube, Mask, Blood, Prick.

This was a child who will have to come into hospital on a regular basis, for the rest of his life, and these are the words he will remember each time he prepares to visit the hospital.

What if words are not the medium- Photographs, drawings, signs, PECS (picture exchange communication system), Makaton , BSL and so on.

The "golden 5 minutes" should be for the need to know now information.
Why, What, When, How.

These are ideas, and a continual work in progress- because they can and should be adapted to each individual healthcare setting, and individual child or young person.
I should also say that I do observe, HCP's taking the time - and the results speak for themselves.

Change in practise, communication and preparation is always an adventure- it asks us to think differently, use words and language we may not have previously used ,or indeed how we would choose to describe events or actions, at times we might feel silly or self conscious, but we as adults can process that- C&YP cannot when fear and trauma takes over.

Recall what I said about turning this subject on its head........................ what would the outcomes be?

If we have a "golden 5 minutes" just imagine what impact that would have in "time" spent calming a child or young person down, when they refuse to allow HCP's to carry out observations, procedures, examinations?
Time spent encouraging a child to allow that process to happen.



If the "time" was there to prepare as HCP's then it should be there for the C&YP?
Health Play Specialists, Play Specialists, Play workers can be the time keepers.
We are also really good at sharing our skills and knowledge with the wider MDT.

 Trauma in Children is a deep and ever evolving study and research experience, - when we meet C&YP and their families for the first time we do not know what trauma, if any they have experienced, or the family history, but research and studies show us that it impacts on their very being, and ability to cope with new experiences, and how we draw on those, the fight or flight we display.

There are many battles that our patients may have fought and won, there are also many that they are still fighting and living with on a daily and hourly basis when they reach us.

Play4C&YP will be taking a few weeks break, to recharge, to reconnect, and to read!
Recommended read................
Waking the Tiger= Healing Trauma
Peter A. Levine


Sian Spencer-Little

The Parent , The Patient ,The Teacher

I have observed this week creative, thoughtful, moving moments, sorrowful times, sadness and technical skills, experience and medical interventions.

I have witnessed my peers work long hours, with unfaltering  commitment, passion and compassion.

I have watched the bond between a child and their parents- I have been honoured to sit alongside and provide time and space- a moment of relief- of joy.

A smile, an eye movement- a moment of pain free bliss.

Then after- the time to reflect, to process- I look at the junior team of doctors and nurses - the expression on their faces- do they know they have just been part of a moment in time that could enhance to the very core their work- how they develop relationships with patients.

I look at the parents, the patients- and I know they have taught us this week.

I think about the 6C's- each and everyday I walk alongside healthcare and medicine.

I look to my left- to 2 HCP's who stand so still, but breathless, small beads of perspiration fall, the expression on their faces, of concern, of professionalism of care, of passion when an emergency arises.
Sometimes I catch my breath- sometimes I cannot believe that I get to come to work, and be part of this amazing team.

I think about storytelling, sharing experiences, moments in history that all pave the way to learning, and challenging how we react, what are the circumstances, and access to fears and feelings.

 

This week I have read many things- but this section from Dr Tanya Byron's book "The Skeleton Cupboard" stood out for me.

Many paragraphs stand out for me- particularly about hearing patients stories, and providing the platform for them to tell them.

 

I have also spent time sharing my story, with student nurses, junior doctors, they ask me why I work in the way that I do, how does this effect a hospital experience,  impact on the levels of care, what can they do to assist.

We have discussed the difference between changes in careers and how we explain the things that have impacted our lives, events, experiences and how they shape us as HCP's.

So I carry this with me- like a beacon of hope, of understanding and of learning

"When we are no longer able to change a situation- we are challenged to change ourselves"
Viktor E Frankl.


Sian Spencer-Little