Tag Archives: Practice

My Journey with Talking Mats

Talking Mats (TMs) I hear you say, is that a mat that talks?! And so begins my story of Talking Mats. Talking mats is an evidence-based pictorial tool developed by Dr Joan Murphy in 1989. Since its creation, it is used in the UK and worldwide.

What does Talking Mats do? It gives individuals with thinking and talking difficulties a voice. This means that it gives those with difficulties expressing themselves a medium to communicate: for example, to express thoughts, make choices, have a chat. Research has shown its effectiveness with individuals who have sustained a stroke, dementia or MND as well as adults and children with learning difficulties. It is also used with individuals who stutter and asylum seekers where English is a second language.

How do you use it? Firstly, I suggest to anyone new to Talking Mats that they enrol on the day’s Foundation Training to understand the theory of Talking Mats whilst gaining the practical experience on the training. A topic is selected from a core of topics and the individual is asked how they feel about aspects of this topic, placing the picture on the mat where they feel this applies to them. There is a top scale with a range of headings depending on the question asked. For example, see the picture below – the topic is ‘hobbies’ and the top scale is ‘like – so so- dislike’:

Talking mats can be used to explore a variety of elements including the individual’s insight and awareness, their goals, exploring their views, management of activities of daily living, facilitating capacity, and facilitating conversation. The complexity arises in the use of Talking Mats and the skill in asking the relevant questions. Initial mats, can often, lead to a ‘sub-mat’. More to follow on this with case examples in my blog next month!

I initially did my foundation training in London, run by Talking Mats, in 2013. Since that initial day’s training I have not stopped using Talking Mats! In November 2015, I travelled to Talking Mats HQ to train as an accredited trainer in Stirling, Scotland. The 2-day course was inspiring and reflective. Joan, Lois and Rhona brought out the best in us and gave us constructive feedback to continue our learning. Their hospitality and the beauty of Scotland left me feeling inspired and confident to deliver their foundation training. The course participants were teachers, SLTs, OTs and a social worker. In sharing each other’s videos, we exchanged views and ideas. I came away with ideas of using TMs as an outcome tool; and to explore using TMs in our groups – I had not considered this before. It encouraged course participants to reflect on their own communication skills in their videos carrying out Talking Mats, as well as how to teach the core principles of Talking Mats to others. I am now qualified to teach Talking Mats at foundation level (beginners). So far, I have run one course in the NHS and one independently. I have enjoyed teaching Talking Mats and incorporating my own experiences of using Talking Mats. The reflective process is also transformative for the participants who have attended my foundation courses. The use of video and reflective feedback enables changes in SLT practise. Feedback from participants included their use of TMs: using TMs symbols they were able to reflect on what went well and what didn’t. The ideas and the variety of videos shared by the group participants was just as inspiring for me as a facilitator, as it was for them. Ideas such as using TMs with carers to compare their views with their relatives and using a child’s TMs picture on the front of their SLT report or school report, for example.

I highly recommend the accredited training for those that have completed their foundation Talking Mats training and have experience of using Talking Mats in practice.

 

Leila Paxton

For more information about Talking Mats, please visit: www.talkingmats.com
For more information about this blog and foundation training (TMs beginners) please contact me via:
Email: leilapaxton@hotmail.com
Twitter: @leilapaxton

 

Finding meaning in therapy

As a speech and language therapist and researcher, Mark Ylvisaker inspires my work. Mark was both a speech and language therapist and philosopher, and someone who passionately devoted his life to working with people with brain injury. Back in 2007, he said “in the absence of meaningful engagement in chosen life activities, all interventions ultimately fail”. A phrase like this really resonated with me as a therapist. Therapy needs to be meaningful. However, it wasn’t until a few years ago when a Professor asked me “but what is meaning?” that I started to consider the importance of this term.

In our interactions involving people with brain injury the term “meaningful” is regularly used; meaningful goals, meaningful activities, meaningful roles, meaningful participation and meaningful engagement. But what I found particularly interesting to learn was that philosophers couldn’t agree on the definition of meaning owing to its complex, fluid and multifaceted nature. In fact, philosophers argue that meaning does not surrender itself to a definition. They do agree however, that meaning is comprised of three features: connectedness, coherence, and subjectivity. Connectedness refers to the linking of experiences so that they can be understood and interpreted. Coherence refers to a person making an evaluation of their life or experiences as making sense or being coherent. This is usually done within a bigger context that may include a goal, motivation or life at large. Both connectedness and coherence relate to meaningfulness, as a disconnected and fragmented (incoherent) life is considered meaningless. Subjectivity refers to the subjective experience of connectedness and coherence, as the experiences in a person’s life have no meaning unless they are meaningful to someone.

This started me thinking about how we as therapists create meaning for people with brain injury. Some people may have a notion of what is meaningful to them but need our help to connect and make sense of their experiences. Others have lost meaning in their lives so we need to help them find it again. Meaning can be derived in many ways, from multiple contexts (or sources). An activity or action alone cannot create meaning. It is the emotional response to those activities or actions and the link to a higher purpose, motivation or goal, which is important to the creation of meaning. As a therapist, I’m often left wondering how to do that for people with brain injury. A few years ago, I came across some research by Levasseur and colleagues (2010) who described contexts according to a person’s involvement in an activity (alone through to interaction with others) and the goals of that activity (to satisfy basic needs through to helping others and contributing to society).

Taxonomy

 

 

 

 

 

Proposed taxonomy of social activities

This “taxonomy” made me realise that much of the therapy I was offering was at some of the lower levels (individual or small group activities focused on fulfilling basic needs e.g. buying a coffee, ordering lunch, having a conversation). Little therapy was focused on helping others or contributing to society in interaction with others. That is not to say we should do that, but rather, doing therapy in multiple contexts (or sources), which includes Levels 4-6, may serve to increase opportunities in which a person with brain injury can derive meaning.

The creation of meaning during the therapy process is considered essential for a person with brain injury to engage with the rehabilitation process. People with brain injury just want to take part in something, give something back to others and be someone important, in spite of their injury. If we can help people with brain injury take part in meaningful activities reflective of their desires, they may also report a better quality of life, which some would consider the ultimate goal of therapy. Some ways in which we could achieve this include: individual and group therapy; therapy in real-life contexts chosen by the person with brain injury; video-taping interactions involving people with brain injury and family members, friends and/or significant others; completion of projects designed to help others learn more about brain injury or help brain injury survivors cope with the experience of sustaining a brain injury; setting goals that relate directly to something bigger (e.g. getting a girlfriend, getting a job). These are just some examples of the contexts that may help people with brain injury find meaning in their lives.

Ultimately, I wrote this blog to convey a simple message: how important it is to help a person with brain injury find meaning in their lives. This message attests to Mark’s legacy who was dedicated to making lives for people with brain injury both meaningful and satisfying. Not losing sight of what is meaningful to our patients and clients is what we can do as therapists to take his life’s work forward.

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Dr Nicholas Behn
Speech and Language Therapist
City University London

 

 

Stammering activism and speech and language therapy: an inside view

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This month Sam is guest blogger for the Did I Stutter? Project – you may read her blog here

Putting the Relationship in Supervision

images-9Supervision. The word invokes many different thoughts for me. The many supervisors I have had, and the many people I have supervised. And the formality of the word. I got a bit stuck when trying to move past this, so I read through multiple blog posts about having one’s communication shaped, ‘therapyed’ or embraced. These posts brought to my mind the way that we as Speech and Language Therapists (SLTs) advocate for all of this communication, in whatever form is successful or possible for each individual, yet when it comes to shaping my own supervision, the same rules just don’t apply. I turn up to therapy sessions with clients. But at times, have found it hard to access my own unique communication space (which will help in those therapy sessions I turn up to), why is that? We want our accountants to be au fait with current tax law, our mechanics to put the right parts in our car, yet for some reason there are times when we turn up to sessions not having invested in our knowledge space, which is essential to providing therapy. Why do we not seek it out if we don’t have what we need or want?

Reasons I have not accessed supervision include that I have worked outside of the NHS and just haven’t got round to getting any, I have had managers who haven’t seen its benefits (I have also had managers who have ‘over-supervised’!), and I have had supervisors where their style of supervision is just not my cup of tea. There have also been times when I’ve not been linked into a neat network of Speech and Language Therapists. At times I have craved this ‘simple’ structure of one senior SLT supervises me, and then I supervise an SLT below me. But currently that isn’t an option available to me. I am an overseas trained SLT, who has spent some time as a permanent staff member in the NHS, a wee stint working privately and am currently working as a locum in the NHS. My life is soon changing as I am looking to return home.

Right now, I am lucky, especially as a locum. I have regular supervision. I also give regular supervision. I have a clinical team leader (CTL) who is not an SLT, but who always has an open ear, and filing cabinet full of ideas, especially around complex issues such as safeguarding and setting up a service. But, we have both wondered on occasion, if she was an SLT, would we come up with the answer to a curly clinical quandary more quickly?

I also have, until recently, received private supervision from an SLT. On writing this I reflected about what brought me to private supervision, and it struck me that I was looking for that ‘simple’ hierarchical structure that I mentioned above. However, what came out was something different. I had the freedom to discuss anything as my supervisor was able to look at my thoughts and issues through a different lens, removed from the need to be managerial. Someone who was intrigued to help me find the balance in relationships, who did not have a stake in the outcome and, therefore, was able to challenge me in order to help me create boundaries within my work. In her removed position, she was able to help me understand what areas to drive forward clinically. However, this separation from my day-to-day work existence, meant at times I would need to go back to my CTL to float the ideas discussed.

It took me a while to access private clinical supervision. I would often go to my sessions with the anxiety that one has when the ‘to do’ list takes up three sides of paper. But when I would leave it was like a weight had been lifted off my shoulders – the exact same feeling that I have when I meet with my CTL. Although both of my supervisors are interested in serving the same purpose – making sure I don’t burn out – they come at it from differing perspectives.

The biggest thing I will be taking from my recent supervision experience is that it is all about relationships. The relationship with the supervisor and myself, but mostly the content of discussion is how I am relating to others. I have sated my need for the neat little SLT supervision structure. It is not a necessity to be supervised by your own discipline or receive clinical support from your own workplace. A perfectly excellent job can be achieved outside of these arrangements, as long as your supervisor knows what kinds of questions to ask, and is humble enough to say “Hmmm, is this what that looks like? If not, tell me more…” I can feel myself now asking similar-structured questions to the Occupational Therapists and Physiotherapists, who ask me how they should manage a particular situation. I pride myself on my ability to relate to my colleagues, clients and wider community as an SLT, but I need to leave my guilt at the supervision door because if I am not showing up to my own unique communication space then the relationships in my work just won’t work.

Anna Childs (nee Wivell)

Insider accounts: Living with communication disability

As a student Speech and Language Therapist (SLT) nearing the end of your training, you begin to feel a bit like you might know a few things. After four years of placements and the range of experiences you have amassed through interaction with a variety of clients and their families, you start to think ‘Ok, I’m beginning to get the hang of this.’ Your tentative steps become surer as you get to grips with assessments and hypotheses and management plans and the wonderful array of devices in the SLT toolkit. But, as a fledgling clinician it is also important to sometimes silence the internal noise of ‘What does this test result mean?’, ‘Which therapy approach do I think is best?’, ‘How many intervention sessions should I give this client?’ And just listen.

In a lecture called ‘Insider accounts: Living with communication disability’, Cathy Sparkes and Sam Simpson provided us with this opportunity. They invited a group of their clients with a range of communication disabilities to come in and talk to all the final year student SLTs at UCL. With our assessor’s hats firmly off, we were able to sit back and listen to people’s lived experiences. All the speakers were very generous with their stories, sharing the painful, puzzling and even playful moments of coming to terms with their respective communication disabilities, both acquired and lifelong, and moving forward with their lives. Many accounts were the result of a number of years of experience and reflection, and it was partly this that made the session so unique for us.

As an SLT, you are generally involved for a very small snapshot of a client’s journey – a few months, maybe a year if you’re lucky. To borrow an analogy, you are ‘a stripe in the scarf of their story’ [1]. But this experience enabled us to more fully appreciate the stripes that come later on, when our input may have finished and our clients have had to renegotiate what it means to live in the world. Furthermore, the speakers were able to give us access to what some of our clients might be feeling now, as we’re meeting them in the early stages after a stroke or brain injury. For example, it may be easy for us to categorise our clients in the light of what they can outwardly communicate. However, the Comprehensive Aphasia Test does not allow us to measure the presence or otherwise of someone’s inner voice – you know, the one that narrates your thoughts and feelings – I had never before considered that loss of spoken language might also lead to inner silence, as so articulately described by one of our speakers.

It was a thought-provoking and at times, moving morning, and overwhelming feedback from the students was that we felt our practice would be changed as a result. The session reminded us to always dig deeper than what we might be presented with on the surface, step outside of our therapeutic comfort zones to provide flexible and individualised support to our clients, and of course, to listen.

Kat UCL Student - 1

 

Katherine Newton
Student Speech and Language Therapist, UCL

[1] McIntosh J., Charles N., Lyon B. & James K. (2011). The Strands of Speech and Language Therapy: Weaving a Therapy Plan for Neurorehabilitation. Milton Keynes: Speechmark

News group: ‘being part of something’ (1/2)

10.30am and this week’s News Group is about to start on the neuro-rehabilitation unit where I work as a speech and language therapist. As I arrange chairs and sort through the newspapers, John arrives without any prompting, having remembered to consult his diary for his programme for the day. John is working on strategies to compensate for memory impairment.

Steve is next to walk in. He has come prepared with a couple of news stories to present to the rest of the group. Steve has had a long hospital stay and is close to getting home now. He wants to fine-tune his speech intelligibility strategies as he hopes to make moves to a gradual return to his job where speaking to small groups is a significant component. The plan is that next week he will co-facilitate the group with me as he has enjoyed re-exploring the nurturing side of his nature; discovering that he can be supportive of others here in hospital just as he has done in his work role in the past.

Jan arrives on time having consulted her diary too. She announces that she has ‘done her homework’. She spent a session with the speech and language therapy assistant yesterday selecting and preparing a news item to present to the group. Jan has used the group to rebuild her communicative confidence. This was low when she first came to us due to difficulties with verbal explanation as a result of generally slowed processing. Like Steve, Jan has now become a supportive member of the group, using sessions both to challenge herself to convey information and her own opinions concisely, as well as to encourage other group members to contribute to the discussion:

‘Other people share topics and I’m learning more. It’s like educating. I’m learning about more and different things. I’m speaking loudly. Preventing other people from butting in because before I just whispered. Now I don’t shut up talking. Definitely more confident. I can tell people ‘shut up, I’m talking!. I won’t cope with rudeness. I liked having the chance to prepare the day before.’

‘I was worried at first about coming but then I actually really enjoyed it.’

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As Steve and Jan organise their notes, Hashim comes in, with my occupational therapy colleague and co-facilitator. Hashim finds it difficult to inhibit voicing his every thought, which as well as impacting on conversation, is affecting his ability to engage and benefit fully from his other therapy sessions. We will agree as a group before we start that we will endeavour to let everyone have a turn at getting their point across, and that we will supportively highlight when any group member may be returning to a theme they have already clearly expressed in whatever way they can. This provides a structure for giving direct feedback to Hashim as necessary. He also has the opportunity to interact with positive role models such as Steve and Jan throughout the session’s discussion on world news, sports news, celebrity gossip, local news or perhaps even a bit of light-hearted ‘ward gossip’. More serious ward issues may arise at times. The group is a safe place to express any frustrations and to problem-solve with others possible courses of action. As staff members, we may be able to take an opportunity here to provide information, or to offer to take on an advocacy role for a given issue if needed.

Now Val walks in with a student nurse who wants to learn more about the role of the SLT on the ward, and who will join our group today. Val has marked expressive aphasia. In a group setting, she has been able to show that her functional communication skills far outweigh her abilities in more specific word-finding tasks and in the limited, often practitioner-led, task-focused conversation opportunities which she is most frequently exposed to on the ward.

Vladan too has aphasia. Previously a keen daily newspaper reader, he has said he enjoys the group as it allows him the extra time he needs to absorb information about what is going on in the world. Participating in the group also provides Vladan with unpressured space to try out compensatory strategies, such as drawing or circumlocution, when word finding difficulties arise. 1:1 support from one of the two co-facilitators is available. Any encouragement to verbal output from Vladan is in response to whatever course the group discussion is taking. There are no test questions or situations where Vladan is expected to attempt to convey information already known by others in the group. Some weeks, with his strong auditory comprehension abilities, Vladan may choose to participate primarily by listening and commenting with facial expression (often cynical!), a laugh or a nod.

Josie completes the group for this week’s session. It is not easy for Josie to remain orientated to time and place. The group provides an opportunity for her to receive gentle orientation as we will generally begin by checking the date on the newspapers, again avoiding any direct testing. The daily news then provides ready-made, genuine material for orientation to the times we are living in as the group as a whole attempts to piece together the facts on any given news story before moving on to opportunities for discussion and debate.

‘It’s lively and thorough and makes me feel as though I am part of something.’

Although definitely a place for rehabilitation, our ward does feel very much like a medical ward with people spending large amounts of time at their bed-space on a bay when they are not engaged in therapy sessions or activities. Group members have frequently reported that they enjoy the opportunity to socialise with other people they may otherwise not meet; people from so many different backgrounds and ways of life:

‘Works as a social mechanism – that’s important for people with communication problems. It helped me to work on volume and voice but it was more about confidence.’

Group members consistently express how they enjoy the group sessions and will talk about the news group during their other therapy sessions that day. The group membership can change from week to week according to the admission and discharge patterns on the ward. However, the format of the group is such that as long as we have news to discuss, there will be people on our ward who can benefit from and simultaneously contribute to what the news group has to offer.

 Nic Martin

Please note all names have been changed to protect identities.

 

Living with a communication disability: insider accounts

image001 ‘Nothing ever becomes real till it is experienced’
John Keats
One of the greatest challenges in acquiring any new skill is taking the knowledge you have gained and applying it to the real world in a meaningful and positive way. Bridging the gap between theory and experience is something I, as a student speech and language therapist, have had to contend with. Speech and language therapists work with a wide range of clients at various stages of their lives and recovery, and whilst training there are limits on the range of clients you are able to work with due to various factors, such as timing and placement provision. The reality of being a newly qualified speech and language therapist is being faced with client groups that you have no previous experience of working with. Although you have the theoretical knowledge and transferable skills this prospect can feel daunting.

Sam Simpson and Cathy Sparkes have recognised the importance of learning through experience and how talking to people with a communication disability can enhance the developing skills of student speech and language therapists. ‘Living with a communication disability: insider accounts’ was one of a series of lectures Sam and Cathy gave to speech and language therapy students at University College London this year. It provided an open forum for students to meet clients with a range of communication disabilities, to hear their stories and ask them questions. This experience differed from meeting clients in a placement setting as our role was not to assess, provide therapy or to advise them, but to listen to their personal narrative and use their experience to reflect on our practice as speech and language therapists in training.

Clients sharing their stories in an open and honest way made me reflect on the extent to which communication disability impacts a person’s life. What stood out to me were how the clients’ communication difficulties impacted their identity and role within society. Examples included difficulties returning to their previous occupation and maintaining social networks and relationships. Viewing the client holistically has been embedded into our training, but I believe meeting clients and hearing their first-hand accounts has made me reflect on my perception of what speech and language therapy can offer. As a student I am guilty often of getting overwhelmed with theory and the process of therapy, which can narrow my view of the client. This experience has taught me to view every client I meet holistically and to consider the wide-ranging and varied impact a communication disability can have on an individual. I hope to carry this experience with me beyond my training into my clinical work as a constant reminder of the importance of the person at the centre of the communication disability.

Lindsey Beer

Living well with stuttering

To celebrate International Stuttering Awareness Day on Tuesday 22 October 2013, Selena Donaldson, speech and language therapist for The Fluency Network at The University of Auckland hosted an informative breakfast seminar. This seminar featured a pre-recorded question and answer session with Sam Simpson and Rachel Everard, two of the co-authors of ‘Stammering Therapy From the Inside’. This event marked the opening of The Fluency Network at The University of Auckland, New Zealand’s newest service for people who
stammer.

Sam and Rachel introduced the concept of ‘living well with stuttering’. They discussed the idea of therapy supporting living with stuttering in a more comfortable way and deconstructed the common misconception that stuttering is something that has to be ‘fixed’. Sam and Rachel acknowledged that there is a range of approaches to stuttering therapy, and that the therapy process parallels a journey, in which a person may try different things at different points in life. They emphasised the importance of being transparent with clients about the type of approach taken, and the theoretical base behind it. Rachel stated from her own personal experience of stammering that although there are useful fluency shaping techniques available, those techniques can be difficult to apply in practice, unless the person becomes more open and accepting of their stuttering.

During this seminar, Sam and Rachel also spoke of self-disclosure. They emphasised the importance of not viewing stuttering as something that needs to be hidden, and promoted the value of stuttering being acknowledged by family and friends. They also emphasised the speech and language therapists’ role in offering clients a flexible model of therapy to help clients on their journey towards self-acceptance. These were concepts I have recently explored with a client at the University of Auckland Fluency Network Clinic. My client was interested in fluency shaping and the freedom approach to stuttering as well. Self-disclosure proved to be a highly powerful tool for this client, who was initially apprehensive about self-advertising and voluntary stuttering due to his past negative experiences. Having independently decided to self-disclose in a group situation outside of the therapy environment, he reported the experience to have been positive, stating, “the stutter doesn’t define me”.

It was wonderful to hear from Sam and Rachel, across the world, on International Stuttering Awareness Day, and to open the University’s new service with their astute and holistic clinical reflections.

Irene Yap
Master of Speech Language Therapy (Practice), final year student
The University of Auckland

Book launch

Launching ‘Stammering Therapy from the Inside’
9th May 2013 at City Lit and the House of Commons

Over 120 people who stammer and speech and language therapists gathered at City Lit for a day of talks relating to some of the key themes from the book. Trudy Stewart kicked off with an inspiring personal analysis of the therapeutic relationship using the metaphor of a bridge to depict key variables that influence the unique structure and form of each alliance as well as the qualities that both architects (the client and therapist) bring to the construction process. St John Harris followed with a thought-provoking and eloquent exploration of the social model of disability using the film ‘The King’s Speech’ and his own experience of stammering and therapy to illustrate (click here to read). Finally, Carolyn Desforges and Richard Seals concluded the morning with a passionate demonstration of the value of therapist/client collaboration in maintaining a specialist stammering service within the current NHS.

After lunch, Carolyn Cheasman briefly spoke about the genesis of the book and some of her own personal highs and lows during the editorial process; and I was able to pay tribute to the many therapists and clients, both present and absent, who have influenced my professional development, fuelled my interest in stammering and inspired my philosophy of therapy. Next, the Right Honourable Ed Balls, who contributed to a chapter in the book, gave a candid and humorous account of his experience of therapy and the process of ‘coming out’ as a person who stammers in the public eye. A personal reflection by Willie Botterill followed, highlighting the key influences that have shaped her approach to therapy and career. Finally Katy Bailey brought the talks to a close with a frank exploration of some of the challenges and intrinsic contradictions of stammering therapy that aims to promote fluency and acceptance of stammering (click here to read). Following Walt Manning’s summing up, this inspiring day ended with a reception at the House of Commons to launch both the book and the Employers Stammering Network.

Here are some photographic highlights:

Book launch
Myself, Dan Durling, Ed Balls and Jan Logan celebrating our co-authorship of the chapter on 1:1 therapy at City Lit
Co-editors Carolyn Cheasman, Rachel Everard and myself with City Lit Principal and Chief Executive, Mark Malcomson at the House of Commons
dusk

What a truly momentous day!

Sam

The House of Commons at dusk

The Stammering Open Space

I’d been to see Sam a few times before she introduced the idea of a group session. At first I was sceptical, after all I’d been trying to hide my stammer from everyone: family, friends, colleagues etc. so why would I want to be in a situation with people I didn’t know and be open about having a speech problem? Well that turned out to be exactly the point: the opportunity to be in a safe & non-judging environment, where I didn’t have to try to hide it!

The moment I arrived I was happy that I’d had the courage to attend – the session completely exceeded expectations and was actually good fun and a lot of laughs. The other guys were a lot like me, which was the biggest surprise of all. Everyone was open, honest and going through the same things, which made me realise that I wasn’t actually alone in any of this – and that’s really encouraging. We all have varying degrees of stammering and each of us different aspects we struggle with. Listening to everyone’s experiences and how they deal with their speech has definitely helped me overcome some of my obstacles and has made the whole process of speaking that much easier. Being able to share, push the boundaries and experience something new in a group environment is incredibly beneficial and I’d encourage everyone to try it at least once. And of course, did I mention the superb tea, coffee and biscuits that are on offer as well…?

See you at the next Open Space, cheers.

Joe