Let's break down dual diagnosis

What is dual diagnosis?

Now, bear with me for a moment here.

Dual Diagnosis — image by

The Recovery Village Columbus, for our friends in the USA, explains that “a person with a co-occurring disorder has been diagnosed with a substance abuse disorder and another mental health disorder.”

The World Health Organization defines it as “the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder”.

Confused? I would be too, if I hadn’t already come across the different terminology while studying and in my work as a mental health nurse.

I think the UK National Institute for Health and Care Excellence (NICE) offers a clear explanation, referring to dual diagnosis as “young people and adults with severe mental illness who misuse substances.”

The dilemmas and challenges of dual diagnosis

With a huge proportion of their patients experiencing mental health problems, knowing how to respond or who should respond is a huge worry for both the UK’s drug and alcohol services and mental health services. So who is responsible for coordinating these patients’ care? Should it be mental health services or the substance abuse teams? And who should pay?

Nurse management of Dual Diagnosis — Sam Abraham at Researchgate.net

I know from personal experience both psychiatrists and nurses found that working with mental health patients, who also had a dual diagnosis, was a significant problem. Most nurses neither had the skills and knowledge or the patience to work with this group of patients. Many saw it as a patient’s choice (they could just stop using drugs or alcohol). Some lacked the empathy and compassion needed to support our more challenging patients. Others just saw them as a bloody nuisance or a waste of space.

As much as I found working with patients with a dual diagnosis trying at times, my heart went out to them. They were tired of being pushed from one service to another, they were confused and frustrated by the system. As were nurses because these patients needs were complex, which created a lot of work for nurses i.e. contacting and interacting with the various services required to support patients with dual diagnosis.

So what came first, the chicken or the egg?

It’s well documented that chronic use of alcohol and/or certain drugs can cause both short and long-term changes in the brain, which can in fact lead to depression, anxiety, sleeplessness, anger or aggression, paranoia and other mental health disorders.

Research also shows that many mental health patients use alcohol or drugs, sometimes as a way of self-medicating. Patients often said that the drink or drugs (or both) helped to calm them down, helped them ‘get out of it‘, to get away from it all, to blot things out, to relieve the anxiety, their voices or the stigma of mental illness.

More than this, I’ve read and believe that some youngsters who experience mental illness use alcohol/drugs perhaps to fit in with their peers or to assume an identity as drunk or drugged rather than mad because this is more socially acceptable.

Dual diagnosis in UK prisons —
Getty Images

Studies have shown that dual diagnosis sufferers come into contact with the criminal justice system more often than people with a mental health disorder only. It is estimated that a large proportion of prisoners have both mental health and substance misuse problems (Brooker et al., 2002).

Moreover, in the UK, a large percentage of people with dual diagnosis are also homeless which adds to their already very complex needs.

There appears to be great concern about the UK’s fragmented mental health service delivery. Particularly for those who are dually diagnosed homeless people, and consternation that such a fragmented service will adversely affect access to services.

With all these issues in mind, Public Health England wrote A guide for commissioners and service providers (2017) which states:

Dual diagnosis and homelessness- Darren Listicle SovCal.com

“Reaching these populations may require local and innovative strategies and service models. Services should be built around the specific needs, and work to overcome potential issues of stigma, mistrust based on poor past experiences or other barriers preventing access.”

The Guide goes on to say “They need to be able to respond to a range of presenting needs, including: alcohol and drug use, mental and physical health issues, and other vulnerabilities such as homelessness and domestic violence. This will require collaboration with a wide range of other services, and close working with local safeguarding for children and vulnerable adults.”

It’s a huge ask.

I’d say good luck with that and I’ll be interested to read their results after the alloted five year time span.

What’s your thoughts on people who have a dual diagnosis? How best do you think they can be supported? Do you know what services are available in your area?

If you or someone you know has a dual diagnosis and needs support, you may find this ‘Useful Mental Health Contacts’ list helpful. However, in the first instance (and where possible), please seek support from your GP.

Other posts you might find interesting:


  • Brooker, C., Repper, J., Beverley, C., Ferriter, M. & Brewer, N.l. (2002) Mental Health Services and Prisoners: A Review. Commissioned by Prison Healthcare Taskforce, Department of Health / Home Office. Sheffield: ScHARR, University of Sheffield.
  • Public Health England (2017) Better care for people with co-occurring mental health and alcohol/drug use conditions: A guide for commissioners and service providers
  • The Recovery Village Columbus (2020) What are co-occurring disorders. https://www.columbusrecoverycenter.com/treatment-programs/co-occurring-disorders/

Interventions used to promote relaxation at our Day Hospital

In a recent post I wrote that I’d had the most amazing job as senior nurse in our Day Hospital (DH) and wrote of the visualisation techniques we used with our patients. If you’re a nurse or student nurse, the following activities and interventions might interest you in particular. However, if you’d just like a short relaxation exercise, scroll down to relaxation tips.

Evidence based therapeutic groups that promote relaxation

Well-attended art therapy — Creativelywildartstudio.com
  • Art — you don’t have to be Picasso – just paint what you feel. This group was well attended and any patient topics that arose here would later be picked up and discussed during a patient’s therapeutic time with their named nurse.
  • We had a celebrated local artist who worked alongside one of our nurses and patients each week. This artist had the patients’ artwork framed and organised two exhibitions in well know banks in the City of London. Yes, there was one or two celebs in attendance and most of the patient’s artwork sold. One elderly lady was delighted, of course, with the £350 she got for one of her paintings.
  • Weekly swimming at the local pool; it’s well documented that exercise can boost your mood.
  • We had our own gym with two instructors. Even the staff joined in — four of us (two staff, two patients) did a charity run for cancer and we each romped home in less than 40 minutes.
  • Groups would often visit a local garden centre that grew seedlings and plants with people who have mental health problems – many patients found it relaxing and best of all, they really enjoyed seeing their seedlings grow
  • We’d play charades and other board games to keep patients occupied when they didn’t have another of their activities going on — Chris Mounsher says playing games, especially as you get older is beneficial as an active brain is at lower risk of cognitive decline. A study in the New England Journal of Medicine showed that playing board games was associated with a reduced risk of dementia and Alzheimer’s disease. The old adage ‘use it or lose it’ seems to have some truth after all.

Evidence based therapeutic interventions used to promote relaxation

Seated massage — Anon
  • Visualisation (previous post)
  • Indian head massage (you can do this without patients’ having to remove any clothing)
  • Seated massage — a well populated intervention which patients had to queue for unfortunately
  • We had a yoga teacher come in twice a week
  • Basic Cognitive Behavioural Therapy (CBT) skills for patients who experienced depression, anxiety, panic attacks, OCD and phobias in small groups or for individuals
  • We had therapeutic one to one’s with patients on a weekly basis using mainly CBT techniques but I often popped into my virtual mental health toolbox to find other evidence based techniques I could use
  • Guided Relaxation was carried out each day by one or two nurses who had attended evidence-based training in relaxation techniques.

There are various relaxation techniques such as breathing, body scan, guided imagery and mindfulness and depending on the various mood of the attendees, we’d pick an appropriate method for that session. Outcomes were monitored using Beck’s Anxiety Inventory (BAI) and/or Beck’s Depression Inventory (BDI).

This group was always very well-attended and patients both enjoyed and benefited from the relaxation group.

You’ll note that our activities and interventions were designed to promote, amongst other benefits, relaxation.

Let’s talk about relaxation

Effects of stress on your body — Medindia.net

It’s impossible to avoid all the various stresses that life throws at us; those small irritations like late trains, traffic jams or babysitter not turning up to more troublesome worries like losing your job, facing unemployment or the imminent death of a loved one.

Stress impacts on both the body and the mind. It doesn’t matter what causes it – stress floods your body with hormones — your breathing gets quicker, your heart thuds, your muscles tense and you might find you need to use the bathroom – now. However, while we can’t stop the stressors, we can develop healthier ways of responding to them.

One way is to invoke the “relaxation response,” through a technique first developed in the 1970s at Harvard Medical School by cardiologist Dr. Herbert Benson, editor of the Harvard Medical School Special Health Report Stress Management: Approaches for preventing and reducing stress.

The relaxation response is the opposite of the stress response. It’s a state of profound rest that can be reached in many ways. With regular practice, you’ll be able to elicit the relaxation response quickly, as and when the need arises.

I’ve previously mentioned, as with any new skills, you must practice, practice, practice. Imagine trying to drive down a motorway if you’ve only ever practiced driving once.

There are various relaxation techniques such as breathing, body scan, guided imagery and mindfulness and depending on the various mood of the attendees, we’d pick an appropriate method for that session. Outcomes were monitored using Beck’s Anxiety Inventory (BAI) and/or Beck’s Depression Inventory (BDI).

This group was always very well-attended and patients both enjoyed and benefited from the relaxation group.

Relaxation tips

I’m aware of the difficulty of trying to relax, I know it’s not an easy skill to pick up on your own. But there are a few thing you can start to do immediately:

Relax quickly —Stop, think & breath
  • Stop what you’re doing – now and just for a moment
  • Exhale — puff outwards lightly for 3-5 seconds and let your breathing slow naturally, don’t think about it too much
  • Let your shoulders down from your ears — do this now
  • Unclench your teeth and wiggle your jaw a couple of times — ensure you now have a gap between your teeth
  • Let your body slouch naturally into your seat — let your stomach muscles droop and sag (don’t worry that anyone can see you)
  • Uncross your legs and place your feet flat on the floor
  • Unclench your fists and let them rest naturally on your thighs

Just doing these things can immediately start the relaxation response because, and remember this, your body cannot be relaxed and tense at the same time. So if your body is relaxed, it’s telling your brain that you’re relaxed. If you’re tense your brain presume danger and it gets you ready for the fight or flight response.

— Image by Hot yogini

You could try to practice the above exercise regularly; at home, at work, on the bus or train (don’t worry, nobody would even notice and guess what, you don’t even have to sit cross legged).

Once you’ve been able to master this technique you might want to go to youtube to find short relaxation videos (I’m showing my age here), with visuals and sound, to start with.

Don’t beat yourself up if you think you couldn’t do it. Stop and try again another time. Don’t give up if you think it didn’t work. Stop and try again another time. Keep going and don’t stop — try to find a relaxation video or cd that works for you.

But do keep the short exercise above in mind and practice this whenever possible. I used to do this 10-20 times a day, honestly — in bed, at work, at uni or in my car before I switched the engine on. And now I can do it whenever I need it.

Now I know I’m going to get the relaxation haters but I’d still like to know about your experiences.

My journey through psychotic depression VIII

Don’t look back — Eric Johansson

For those of you who don’t already know, I started writing about my journey some months ago and only intended to write it in four posts. However, it’s become clear that my journey was a lot longer and more painful than I remembered, making it difficult to get the words down on paper at times. I’ve taken breaks and written other posts in between, giving me time to reflect and bounce back a bit stronger each time.

Please click here for Parts I, II, III, IV, V , VI and VII if you wish to read the backstory (It might make more sense).

My poor angry son

………….. I held onto Nic tightly and let him sob into my shoulder — until his howling became a whimper.

Finally, he looked up at me angrily and backed onto his bed “I’ll kill him. If I knew all that, I’d have kicked him out myself mama. Aarrgghhh!” he screamed. “I’ll bloody well kill him,” he cried as he jumped down from his bed and paced the tight space between me and his bunk bed.

“Do you know what he told us Mama?” — “He’s had me and Dan in tears nearly every weekend for over six months….. Aarrgghhh! He told us that you were cheating, seeing other men!”

“Sunshine, that not true,” I blubbered, “You know I’d never do that. You know how I feel about cheating.” They knew what their Nana had gone through in her life with my dad. They’d always been taught never to raise their hands to partners and if they’re unhappy with someone then leave, before meeting someone else.

“I know mama, but he was so convincing, crying and everything.”

“He’s hurt Sunsh……”

“So. the b*stard — sorry Mama. He should be flippin’ sorry. And he’s with Bel now anyway. Was that who was cheating with? What’s his flipping problem? I hate him mama.”

“No Sunshine, you’re angry and upset. Come on, let’s get some sleep and we’ll talk more in the morning if you want.”

“Okay. But I still hate him and I don’t want to see him any more.”

Can’t get to sleep — Getty Images

“Please don’t tell Dan yet, let me talk to him first,” and off we both went, to our beds. But sleep wouldn’t come. All this was going through my head and I thought, no wonder Nic’s behaviour had changed towards me. Not that I’m making excuses for him drinking, his moodiness or his sometimes foul language. I’m not. Each of these issues will be addressed openly and sensitively at some point because I’m a great believer in being allowed to express your self, but in an appropriate manner.

My angry ex

Tony was coming to take the boys the next day so I was up early because I thought it best to give him some warning. I called him “Tony listen, I’m sorry but Nic knows about you hitting me. I had to……….”

“You f*cking stupid bitch,” he screamed, “What did you do that for? F*ck sake.”

“Look, I’m sorry. I had to tell him — you’d told them I was cheating; seeing other men.” I’d later remember I’d apologised to him — twice — doh!

“I’m coming round – now.”

“No don’t, Nic doesn’t want to see you. Leave it today.”

Teenager on sofa with smartphone —
image by Canva

“B*llocks,” he yelled and down went the phone. As he lived across the road, he wouldn’t be long. Fortunately, the boys were up anyway, Dan was dressed and waiting on the sofa. Nic, I knew, was going nowhere and he turned to go up the stairs. At that the front door burst open and in thundered Tony, “What’s going on? Nic, get ready, we’re off mate.”

Crikey, Nic was now thundering down the stairs so I stood at the bottom with my back to him, trying to stop him getting to his dad. I really didn’t want to see them fight. As I’ve mentioned before, Nic and Dan are black belts at karate and I wasn’t sure how a fight would end but what I was sure of, is that Tony wouldn’t ever give in!

My angry ex is a pig

Then he started, “I bet she ain’t told you about all her crap, has she?”

“Leave it Tony,” I begged. I didn’t want the boys to find out about my childhood abuse — and certainly not in this way. However, he just wouldn’t stop.

“Ask your mother why I cheated…. go on, ask.”

Angry man — Simplerecovery.com

I could feel the tension in Nic behind me and I kept my arms stretched out to hold him off. “Go on ask her, ask her why she let some dirty old c*nt do ……….. and she f*cking did all that but she won’t f*cking give me ………. Go on. Ask her,” he goaded. And — ask her why I hit her, the f*cking frigid cow. But she’d give it away to anyone else.”

“Aaarrgghhh! You b*stard. Move mama. Please, get out of the way,” Nic begged.

“No Sunshine. Tony – go,” I pleaded. I could see Dan on the sofa, wide eyed pale skinned and white lipped, in panic. “Just go. You’re upsetting everyone,” I hissed.

“Nah mate. Dan come on, we’re going cinema…….” he smiled and tried to drag Dan off the sofa. But Dan wasn’t having any of it.

“No, I’m not going anywhere with you. Go dada, I don’t want to see you. I hate you.” Dan fumed and I watched my poor boy’s fear and anger pumping through his young body, his fists clenched.

“Tony just go,” I insisted.

Anger, upset and tears

However, now it was Tony’s turn to pale as he realised how upset both boys were with him and it would have been like a kick in the stomach for him to hear them say “I hate you!” Ouch! So Tony gave up and slouched out. We could see from the kitchen window how he was kicking at loose stone, angrily. Nic went up to his room, I went to mine, to breathe and calm down. But Dan followed me and was on his knees staring up at me, “Mama, did dada ever rape you?”

“No Sweetheart, never.”

Boy talking with mum —

“Well why was he saying all that stuff? Why was he talking about an old man? Who was he? Did he rape you mama?” and my heart was breaking for him, this young innocent boy having to hear Tony’s pathetic tale, all just to get back at me. He’s such an ignorant pig, the boys knew it too, but this — this was something else.

True to their word, the boys refused to see him for about six months despite my protestations i.e. “Look Daddy’s angry at mama, not you two. He loves you both.”

“Yeah, well he’s got a funny way of showing it,” Nic tutted,”and he’s hurt you mama. All that crap he fed us. No, I still hate him.”

“Me too mama. I hate him and I don’t care if I never see him again. He shouldn’t have hurt you mama, I don’t want you to be upset any more” Dan said tearfully.

Telling the boys I’m okay

Boys at breakfast with mum — niddk.nih.gov/

“He’s gone now Sweetheart. Shall we go out for breakfast?” I trilled in my happy voice, trying to minimise their pain. So we did; we talked things over and I gave the boys only the very briefest details of the childhood sexual abuse because they’d asked me and because they wanted to know, saying “mam, we’ve always been honest and open. so I replied “It’s happened boys and it hurts but it’s all over now -and I’ve got a good therapist to talk to when I’m feeling overwhelmed. I’ve also got nana and Liz so please try to stop worrying about me.

They also asked how long he was hitting me but I didn’t want to tell them. “Mama, now we know, he did hit you, how often?” And I’d told them a very short version; as any mum would. I don’t believe they were old enough or emotionally mature at the time and said that perhaps they could speak to their dad about it. I got an emphatic no!

So, eventually, the boys settled once more…….

I’ve only got one more episode of this particular journey and I hope you’ll bear with me. I hadn’t realise how exhausting this process would be and I’m pleased it’s coming to and end — almost there.

This my story and Tony might argue or deny, which he’s always done. Do you think I could have handled the above situation differently?

If you’ve been affected by anything in this post, please seek support from your GP.

Sunshine Blogger Award


Yay, Ceridwen from Illuminating the fools mirror nominated me for a Sunshine Blogger Award! So thank you, thank you, thank you. I’m thrilled to receive Ceridwen’s nomination and if you’re not already familiar with her blog, fairy tales and mythology galore, pop on over there now. Ceridwen loves all things spiritual, astronomy, paleontology and anything paranormal — just don’t mention UFOs.

The Rules

  • Thank the person who nominated you and provide a link back to their blog so others can find them.
  • Answer the 11 questions asked by the blogger who nominated you.
  • Nominate 11 other bloggers and ask them 11 new questions.
  • Notify the nominees about it by commenting on one of their blog posts.
  • List the rules and display a Sunshine Blogger Award logo on your post and/or your blog site.

Questions from Ceridwen

Legends of Reggae Album— Cover my Tune
  1. What kinds of music do you like? Oh wow, that’s a biggie cos I love all things 60’s 70’s, 80’s and 90’s but I have a thing for the old Country & Western – Tammy Wynette, Patsy Cline, Johnny Cash…. still love reggae and would go again to see Tom Jones, Rod Stewart and Van the man Morrison, David Bowie, Madness, Adele… I could go on…….
  2. What’s one thing you would absolutely never eat? Yew… tripe, brains and hearts, things like that. I’ve eaten lots of food from around the world but the thought of chewing on lump white stuff, grey matter, atria, veins and ventricles 🤢🤢🤢
  3. What is a language you don’t currently speak but wish you could? Mmm, fluent Spanish would be good but I have to admit, I’m not that motivated.
  4. Would you rather live in a city, a small town, or alone in the woods? Alone in the woods? Nah! The thought’s great but in reality I would be terrified. I’ve loved the City of London for so long and “When a man is tired of London, he is tired of life; for there is in London all that life can afford.” — said Samuel Johnson. So for now, it’s the city.
  5. Is there anything you cannot currently change about your blog that you wish you could? Arrgghhh! — don’t start me off. The technical side drives me nuts i.e. analytics, SEO. I have no idea.
  6. If you had shape-shifting powers, would you rather be able to change into any specific human being or any type of animal? I suppose I’d like to sit in the Queens chair — but only or a day, just to see if it suits me 😉 so it’s a human being.
  7. Which would you rather watch, a sunrise or a sunset? I love ’em both but the best ever sunrise I saw was when we stayed at Mount Masada in Israel – with a gorgeous Danish boy – it was so romantic. I was on a Kibbutz for a year when I was a teenager.
  8. If you could name a star, what would you call it? It would have to be Hannah, our stepdad’s surname that I took when mum remarried. I have two boys and they’re the only ones who’ll carry on his name.
  9. Where does the line between adventure and danger lie for you? Ooh, I’m getting older now and what I used to love as adventure, I might now see as danger i.e. hitch-hiking through Israel and Egypt, being picked up by army trucks — it felt so safe then.
  10. Would you ever go to Mars? Mmm, adventure or danger? If I could go for a few days and come back safely 🙂
  11. What fairy tale/mythological role do you see yourself in? If none, make up a new one! Maybe Cinderella at the ball and I’d make sure I got that damn prince! 🤴👑👸

My Nominees

There are so many blogs that I love and bloggers who I believe deserve this award and I couldn’t possibly pick out eleven favourites. So — I’d love everyone who wants to participate, to answer my questions, particularly new bloggers — I think it’s a really great way of getting to know a bit more about our fellow-bloggers.

My questions

Tattoos when pregnant – Safety and Precautions — American Pregnancy Association
  1. Who would be your hero, dead or alive, real or fictional?
  2. Tell us about your blog?
  3. What’s your favourite film and why?
  4. Do you have a funny family tale that gets retold every celebration, Christmas?
  5. Tattoos or not?
  6. Flip flops or sandals
  7. Over or under? Think toilet paper.
  8. Where in the world is your favourite place and why?
  9. What and where was your favourite concert or gig?
  10. What’s currently in the news or trending where you live?
  11. How do you (try to) relax? Do you have any tips?

I never get bored of this type of Award cos I find other bloggers questions and and answer so interesting. It’s a bit of fun too. What’s your thoughts on Awards? Love ’em or leave ’em?

What are good listening skills?

Yesterday was #TimeToTalk Day. Sorry I’m a day late with this post.

Let’s end mental health discrimination — Timetochange.org.uk

Mental health problems affect one in four of us, yet too many people are made to feel isolated, ashamed and worthless because of this. Time to Talk Day encourages everyone to be more open about mental health – to talk, to listen, to change lives.

Oh, most of us know how to talk, yes? But how many people know how to listen? Actively listen? Well, from my personal and professional experiences — very few, so that’s our topic for today — Listening Skills.

Hands up — as you’ve been telling your ‘story’, who’s had someone butting in with “Oh, my gran’s neighbour’s youngest granddaughter is…………. “?

Ffs — I don’t know their gran, I don’t know their neighbour and I neither know nor care what the heck granny’s neighbours youngest granddaughter is, does or bloody well thinks.

Boring conversations —
B2M Productions/Getty Images

My mum’s great at that one, “Oh remember wee Grettel doon the road from thirty years ago? Oh, maybe thirty three or four. Well…….” she puffs in response to me just telling her I’ve had a cough and a sore throat.

Me, eyes rolling, “No mum. I don’t.”

“Och you do. Her mum was …………. Well, anyway, her wee boy’s best pal’s mum went into hospital with a cough she couldnae get rid of and bless her, she passed away. She was only in there for three days. Poor wee boy, eh?”

“Aha (means yes in Scotland) mum.” Moving on quickly —

See, when I’m telling my ‘story‘, particularly when I’ve been asked to tell it i.e. mum says “How are you?”, I want to tell it, without interruption and be heard and properly listened to. Mum might get the hint when I show her this next bit:

Common mistakes we make while ‘listening

While it’s good to talk and be open about mental health, you might agree that not everyone listens effectively. Common mistakes we make while we’re supposed to be ‘listening’:

Not listening — Istock.com
  • We’re distracted i.e watching or answering our phones, texting etc or perhaps we’re chasing small children around or we’re eying up the candy at the next table 😉
  • We daydream — we’re gazing out of the window or around the room/cafe/bar and not looking interested in the other person’s ‘story’.
  • We’re rehearsing our response — thinking of how to answer, thinking about what we’re going to say next, “maybe I’ll say something funny?” to take away the tension.
  • We mind read — we make assumptions about what the other person’s thinking and feeling or what they’re going to say next and we interrupt – “Oh, I know what you’re gonna say.”
  • We filter —we zone in on the points that diminish someone’s argument, so we can say they’re wrong and make our own arguments right.
  • Placating — telling the other person “Yes, I agree. He is a pig.”without putting in an effort to hear the whole ‘story‘ and understand. And remember, while it’s okay for someone to miscall their mum/boyfriend/partner, it’s not okay for you to do it.
  • Judging — we’re making up our own opinion of a friend/person, their ‘story‘, their argument i.e if you think of the person as a know-it-all, it might stop you from listening.
  • Debating — you can’t listen if you’re interrupting, arguing, and disputing everything.
  • Derailing — interrupting and bringing the focus back to what you want to discuss or because you don’t want to tackle a tough conversation.
  • Advising — jumping in and offering solutions before they’ve got to the end of their ‘story’ – they might have solved it already and just want you to listen.

People often tell me I’m a good listener and sometimes I really wish I wasn’t.

A friend in Spain starts off with “Ello darlin’. How are you?” and without stopping to breathe, he starts “I’ve had such a busy day……..” then goes on to explain everything in minute detail. He tells me where he’s been, whether he was driving or walking and what he’s done, which could take him twenty minutes plus. And I sit there nodding, smiling and doing the “uh huh” thing and “Ahh” while maintaining good eye contact — until he stops!

You might have gathered by now that I see listening as so much more than just hearing. Listening is what happens when we not only open our ears, but also open our minds – and sometimes our hearts – to another person. Listening is not a passive skill. Listening is an active skills that not everyone has — true but, trust me, it’s easily learned. We’ve already looked at poor and passive listening.

So, what is active listening?

The 7 key active listen skills according to the Centre for Creative Leadership:

  1. Be attentive. Look interested and give good eye contact – you don’t need to stare at a person, just look long enough so they see you’re interested – try not to stare into the person’s eyes, just above the nose is a good place.
  2. Ask open-ended questions like “Tell me what’s happening with/for you.” or “Tell me what the matter?” and let them speak, uninterrupted. Don’t ask Yes and No questions like “Are you upset? or “Is there a problem?” because you’ll probably get a sharp yes or no in response.
  3. Ask probing questions like “I’m interested to hear, tell me more.” or “How did that make you feel?”
  4. Request clarification like “I’m not sure I understand, can you explain a bit more?” or “I’m not quite sure I get that last bit, do you want to repeat it?”
  5. Paraphrase – perhaps say “What I heard was ………….., did I get that right?” repeat back to them in your own words.
  6. Be attuned to reflect feelings – determine the feelings and emotions in a person’s verbal and body language and state those feelings back to the person.
  7. Summarise – you might say something like “Okay, so what you’ve said is this, this and this. Am I right so far?”


Being an active listener is important
— Thomas Barwick/Iconica/Getty Images

Effective listening is something you can do with everyone you come across i.e. family, friends, partners, children, colleagues etc. Good listening encourages the speaker to feel considered and valued and hopefully you’ll gain something from the conversation.

Apart from the practical benefits, being an active listener is important for aspects of your social life. Relationships where someone talks all the time and never listens to you aren’t well balanced at all. Reciprocation is necessary for any good relationship – a mutual exchange during the conversation. If someone’s talking at you without listening in return, you’re unable to develop a meaningful, healthy and mutually beneficial relationship. Ditto if you’re doing all the talking.

What might you take away from this post? Do you recognise yourself in the common mistakes section or do you see yourself as an active listener?

“I remind myself every morning: Nothing I say this day will teach me anything. So if I’m going to learn, I must do it by listening.” — Larry King

Visualisation can improve your mood

Mental Health Day Hospital


I was a nurse at an amazing Mental Health Day Hospital (DH) where patients were actively involved in planning a timetable of evidence-based therapeutic activities to support them in their recovery before being discharged as an in-patient.

It wasn’t a drop-in centre. Ward patients were referred by their Consultant and attended the DH normally for a period of 12 weeks. Part of the programme was that patients had to agree to attend their chosen groups. Once admitted, they would spend time with their named nurse (who oversaw their care at the DH) and together choose therapies and activities that would best suit their needs.

Their named nurse would attend their weekly multidisciplinary ward round to hand over documented patient progress. The multidisciplinary team (which includes the patient) would at some point decide the patient was well enough to be discharged from the ward as an in-patient. However, if that happened after only 6 weeks at the DH, the patient could stay with us to complete their programme.

Therapeutic groups and activities

We had many therapeutic groups and activities which were all run by our qualified and skilled nurses who demonstrated empathy, compassion and an abundance of energy. We created a safe, therapeutic space where patients could relax, learn new coping skills or hobbies and benefit from the evidence based therapies available.

Dreamcatcher – Legomenon.com

There’s far too many groups and activities to mention here but when reading my friend Kacha’s (from Food for thought) recent post Mythical Monday on Visualisation — I was transported way back to the fun we all shared during this particular therapy. So I think I’ll start with that.


Visualisation was carried out in either small groups or for individuals twice a week. With individuals, we did what’s called virtual ‘in vitro‘ exposure to sources of threat for anxiety, phobias and panic disorders and later went on to ‘in vivo’ real-life practice. We were able to monitor their progress using the Beck Anxiety Inventory, which is a self-report measure of anxiety and more often than not, we saw a great reduction.

Virtual ‘in vitro‘ exposure is where you’ll support the patient in visualising their perceived threat, for example, let me tell you a shortened version of one young lady’s experience. Kerry was so anxious she found it difficult to go into shops on her own, particularly large stores like Tesco or Aldi. Once, while shopping with her two young children, she got distracted and knocked over a whole display of wines. She said she was absolutely mortified and is now terrified of shopping on her own.

In visualisation we took her back to the shop and she was actually panicking in the first session so we stopped. I engaged her in light conversation and, unbeknown to her, I started fishing. I asked about the last time she felt relaxed, which led to her telling me about a surprise birthday she’d been given a few years ago. I watched as she smiled at the memory then as she puffed wistfully ‘Ah, but that feels like so long ago,’ and the frown reappeared as she sagged into her chair.

Surprise – Shutterfly.com

I half whispered “Close your eyes Kerry…… that’s it, let your shoulders down from your ears, (and she giggled) stretch your jaw and let it fall, relaxed.” she did. “Now, let’s go back to that party — “Tell me, what did you see when you walked in?” She’s smiling now and telling me of all the family and friends greeting her, the decorated venue, the flowers and gifts……….

“Tell me what was it you heard?” She spoke of everyone cheering, singing happy birthday, all the greetings, the music…… her smile got wider.

“Were there any smells that you remember?” She babbled on about the overwhelming perfumes and aftershaves as everyone hugged her…….. When asked about any tastes, she raved on about the cake and laughed at how bad the ‘cheap’ champagne was.

“What were you feeling Kerry, can you remember?” She was grinning like the cat that got the cream, giggling, smiling and — totally relaxed. “Okay Kerry,” I’m smiling now, I asked her to open her eyes. She gasped, wide eyed, then huffed and puffed, “Oh, my word, that was amazing, I didn’t want it to stop,” she beamed, still totally relaxed.

The next sessions were never going to be as fulfilling but after the next virtual ‘in vitro’ exposure to her shopping anxiety, we ended with a happy ten-minute visualisation. We then went out together a few times for the ‘in vivo’ real-life shopping trips, which she eventually conquered, alone.

Free from panic – offset.com

Throughout the 12 weeks Kerry had been given visualisation exercises she could carry out at home and she practised them religiously, using all the five senses as much as she could. She was discharged from the DH, not cured of her anxiety, but free from the panic of shopping and confident in her new coping techniques. She said she would continue to practice visualisation at home to help with other situations that made her anxious. She visited many months later to tell us of her new part-time job as a children’s dance teacher, something she’d done before becoming mentally unwell and never thought she’d achieve again.

All our patients, regardless of their diagnosis, were welcome to attend visualisation and while it wasn’t easy if someone was experiencing hallucinations or were in a manic phase, we found that all patients benefited in one way or another.

So, can visualisation help reduce anxiety, panic attacks and phobias? Can visualisation help improve your mood? Does visualisation work? There’s much research to prove it does and yes, I certainly think so.

Visualisation – the right kind — Spring.org.uk

Now some might disagree. If it hasn’t worked or benefitted you in some way, I could suggest that perhaps the therapist wasn’t as qualified or skilled as is necessary to carry out effective visualisation techniques. I would also say that it’s really not an easy activity to carry out alone, without any therapeutic input. But, okay. I agree it’s not for everyone.

What do you think? Have you tried it? With or without a therapist’s support?

Disclaimer. Whilst I am a qualified practitioner, I do not suggest you try this at home. If you think this therapy might benefit you, speak to your GP.