DR ALISON MCCLYMONT: TALKING CHILDREN’S MENTAL HEALTH

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On Private Practice Hub’s monthly podcast, Dr Alison McClymont, leading children’s psychotherapist, discusses the matter of Children’s Mental Health through the lens of the pandemic with Dr. Adam Read, CEO of Private Practice Hub.

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DR. READ: Hi to everyone out there who is going to be listening to this, our practitioners of private practice and potentially some of their clients and consumers as well.  I’m Dr. Adam Read, I’m the host of the PPH podcasts. It would be really good to get your feedback on how you think this is going and there’s any interesting topics you’d like us to cover for you. Today I’m very excited to have Dr. Alison McClymont with us, who has done some amazing work in the children’s mental health space. 

DR. MCCLYMONT: Oh, I try. Thank you very much. I trained originally as a creative arts and play therapist, then I moved more to doing clinical psychology training, so I’m a little bit of both. Sometimes I say I’m a play therapist in disguise, because I do that even sometimes with adult patients, but I don’t necessarily let them know that the activity we’re doing is a play therapy one. I work predominantly with children and young people and their families.

DR. READ: Fantastic. And so how long have you been doing that for?

DR. MCCLYMONT: Over 10 years. Somebody asked me that the other day, and I thought to myself, “Oh, it’s 5” I’m gonna have to live much older than you are. It’s actually over 10. 11 years now.

DR. READ: Yeah, I have the same feeling. I find when you graduate your life is great up until that point, and then it’s just back against the wall, non-stop. It was during the pandemic when we had a bit more time to ourselves, I had time to reflect and think; hang on a second, how did 12, 13 years just pass by? I think that was the kind of the good or the bad side of the pandemic is it gives a bit more headspace in a way. Well, unless you’re a parent, which we’re going to be talking about, because obviously you have to home-school your children. But yes, I can totally relate what you’re saying. I would have thought that it had only been, you know, 3 or 4 years, but turns out I’m actually significantly older than I thought I was. Which is sad. I’m getting quite a few grey hairs and everything… So – What kind of work do you currently do now?

DR. MCCLYMONT: My specialism is trauma, predominantly because – I’m from the UK originally in a trade in the UK, but I was in Southeast Asia for a while and I was working with refugee children and families. Prior to leaving the UK, I was working with rape crisis. I trained in acute trauma in the NHS. So my specialism, as I say, is PTSD and trauma, but over the years, I’ve become a bit more of a generalist. I’m working at the moment in private practice with children, as I say, their families. So I do use some family therapy there, but definitely my clinical specialism is trauma. And it’s not work that all therapists want to do. But I think those of us that do gravitate towards trauma, of course, it’s very much at the coalface. But it can be very rewarding as well. So it’s what I like to do.

DR. READ:  Trauma. Can you define that a little bit in terms of what kinds of trauma?

DR. MCCLYMONT: Technically, my specialism was trauma related to abuse in children, and also adult survivors of child abuse. But over the years, I’ve become more of a, as I say, more of a generalist, so I do trauma related to displacement as a result of being a refugee, which was very much for work in Southeast Asia. Sadly, those individuals and families might also face conflict trauma, but I would say the majority of my work has been adverse childhood experiences that could cover a great manner of things.

DR. READ: And what age do you think that it starts to affect children? Obviously, it depends on when you get to see them, but is there a trigger point in which if the trauma continues there’ll be a specific time in their development where it becomes particularly noticeable?

DR. MCCLYMONT: Here we’re getting into the discussion around complex PTSD versus PTSD. So if we’re talking about something that continues on a systematic, of course, we continue to see that over the lifespan. If we’re talking about a singular event, PTSD, we may see that only around that period of life, hopefully with appropriate treatment with things like EMDR and trauma focused CBT, we may actually not see those symptoms continue over the lifespan. With something like what I specialise in, adverse childhood experiences such as neglect, abuse, etc. I would say you would continue to see that over the lifespan. When it comes to first identifying it, I think, again, it depends on the event. I would say around the ages of four or five, you would start to see that. If the trauma occurred before that.  It also depends on the type of socializing, when people are starting to become verbal. 

DR. READ: And does it depend on the type of parenting as well? Whether at home it is okay for you to talk about your feelings? From my own background, we didn’t really have that kind of open dialog. It was just, “you’re alright, let’s get on with it”.  So when it comes to these children that come to see you, is that because the teachers would have picked it up or the parents would have brought them in? Because if it was a surrounding that I had as a child it would have just been suppressed and we just would know about it.

DR. MCCLYMONT: I think we’re actually getting better as a society around talking about mental health. Of course, we’re not where we need to be, but I think we are getting better, and I think people are beginning to want to open those conversations up much earlier than maybe they did when I was younger and when you were younger? When I was younger, I thought the concept of having a counsellor in school would be non-existent, so now we are looking at a much more structured approach to identifying poor mental health in children. We see teachers, for example, becoming much more aware of how to identify behaviours that might warrant a bit more examination. GPS as well. Your question was more, “does it depend on parents?”  Yes, it does. But I do think that as a society in general, the media has made us much more aware of childhood mental health. So I think,

DR. READ: I’ve seen in your work that you have described as a ‘multimodal approach’. What do you mean by that?

DR. MCCLYMONT: As I say, I trained as an art therapist, so I do still use some of those activities and approaches within my work, while I don’t use a full arts therapy based approach. I think one of the best things about being trained across different disciplines is you can apply a different modality depending on the presentation that comes to you. For example, with something like a phobia or OCD, I would definitely go for a CBT based approach, because that’s evidence based within that sphere.  With young kids, I think it’s really great if you do have any type of background in play therapy or creative therapy approaches, because they just really connect with that. So when I say multimodal it means I’ve been lucky enough to have two cross-disciplines of training and I can pick and choose what is going to be more appropriate for that patient.

DR. READ: And is that quite a unique set of skills that you have? Should more therapists think about having multiple disciplines or are more therapists actually doing that themselves?

DR. MCCLYMONT: I do think that particularly if you’re looking at things like Creative Arts therapies versus a more traditional clinical psychology training, that in some ways you can fall very heavily in one “camp”. Or perhaps if you’re a psychoanalyst or psychodynamic training, you might think, “CBT is my enemy!” – I do and people who practice CBT might feel similarly about psychodynamic work. Human beings are so varied and I think that not all approaches work with all people; not all approaches work with all problems. So, I do think it’s a good thing to not become too heavily entrenched in one modality. It’s good to explore others. For example, because I’m a trauma clinician, I realised what I really needed in my toolkit was EMDR training, because it’s just so valid within that space, so I did some of that as well and found it very helpful. I’m sure lots of people also do online training now with short courses. I’m sure lots of people do this.

DR. READ: I’ve got my subjective understanding of how the pandemic would have affected the field of children’s mental health. But in your experiences, what was it like for you? Is there data and evidence that’s been collected over that pandemic to support the changes that happened over the last 12 months?

DR. MCCLYMONT: There is some data, I read in the British Medical Journal some data that was published in April, where someone was reviewing the data on children’s mental health and it is a varied picture and at the moment, they are only looking at adolescence. From my caseload of young children, currently, we don’t really have a lot of data, but I can tell you from my own anecdotal data that I’m definitely seeing a lot more OCD like behaviours. I think the difficulty has been from where we’ve asked very young children to create a lot of ritualized behaviour around socializing. 

There was a point we were standing two meters back, next it was “masks on”, then it was washing hands and using hand gel. We have also combined this ritual behaviour with some quite frightening messaging; “If you don’t do this, you will get a virus that could harm you. It could harm mum and dad, it could harm granny and grandad” and that in itself is a bit of a package for disaster.

Of course, we’ve had to do this for social distancing but imagine for a six or seven year old, there’s been a long time they’ve been told that they need to stand a certain distance from their friends when they’re playing, they need to wash their hands every time they touch something or else they are going to get a virus. Now, as lockdown restrictions ease they are beginning to be told that they don’t need to do that anymore, and that in itself is a very confusing set of messages, so sadly I have been seeing much more OCD-like behaviours emerging as well as generalized anxiety emerging in that population.

DR. READ: That’s really fascinating… So what is the journey of a child with OCD-like behaviours? If they haven’t found treatment in time?

DR. MCCLYMONT: I think we need to sort of be clear that it’s not necessarily going to develop into full blown OCD that we might see in adolescence or beyond, but do think that if we’re starting to see this combination of a thought that scares us becoming intrusive, we have to do a certain ritual to remove that thought or to remove that fear. Unfortunately, we as clinicians know that is the journey in the development of something that could be later considered a diagnosable obsessive compulsive disorder. So, from a journey perspective, I think we’d be seeing this more – certainly I have – in children who are a little bit more prone to worrying and overthinking. We might be seeing this in children whose houses have absorbed or imbibed a lot more frightening information from the media around Coronavirus, and within families who themselves have quite high structures or anxiety related structures around the Coronavirus. I’m seeing this more in my caseload. 

DR. READ: I’m not surprised. In my mind, we’ve gone through the psychological equivalent of a World War, you know, there’s been so much fear. I was speaking to people that I know, who were alive during the Second World War, and they were saying that they feel this is worse, because at least then you can go out and you’re bit more free, but with Coronavirus there was a fear factor of having to stay at home that was so detrimental. 

I went through a breakup before the pandemic, and then ended up living on my own as a result of that and it was really tough. I was working from home and it was only until the second lockdown that it became really, really challenging. The fact that I was closed off to all of my usual stress relievers. I couldn’t go to the gym, or go out for dinner. And so I imagine if you’re a parent having to look after your child, and then you had what I was going through I would not be surprised that it would then trickle down onto the child.

DR MCCLYMONT:  I’m an obviously trained mental health professional, but my family and I moved countries during the pandemic, and I have two young children. I, even as a mental health professional, was extremely confronted by the experience of going through an empty airport; there was fear all around you. We got on the plane and there were other passengers dressed in what I can only describe as either homemade, or in some cases, bought hazmat suits. I remember sitting there thinking, “How on earth am I going to describe to my two and five year old why people are sitting in the plane in this level of protection?” Thankfully, my two year old wasn’t too bothered, and my five year old was more curious than afraid, but it was a very, very weird set of circumstances. 

Unfortunately as a society, we’ve lived through a lot of these weird circumstances we’ve lived through people telling us, from child’s perspective, “we can’t have a birthday party this year,” or “we can’t go and see granny and grandad” – And it’s hard for them to understand that unless they digest a message that “if we do that something very frightening is going to happen”.

DR. READ: I can imagine that potentially their social skills could be stunted if they weren’t able to go and hang out with their friends or able to go into class since at certain ages that kind of exposure is really important. How do you think that’s going to be combated? Or do you think there’s going to be a proportion of the population that’s going to be behind socially, that we’re going to need to work on when it comes to life going back to normal?

DR. MCCLYMONT: There has been some data, particularly in the kind of speech therapy space around the use of masks and the effects of speech delay, or speech development, for children. That’s not my particular area, but I can imagine that that might be the case. I was having a chat with a colleague recently, they were doing an in-school observation, and they said to me that what was really concerning, disturbing and upsetting was that they were watching five and six year olds returned to what we would describe as “parallel play”, where they are playing on their own as we might see in two year-olds. 

Before, they would have been developing those social skills and the only reason we can think that that kind of trajectory would have gone backwards is because for so long they were playing on their own at home. I hate using the word unprecedented because I think everybody uses it these days, but this is unprecedented. We really don’t know what the effects of that will be. I think 90% of children, once we’ve told them that they can go back and lockdown is easing, I think they’ll jump back into that with abandon. But for some, the sad thing is, or the scary thing is, we really don’t know what the effects of lockdown are going to be. We’re just starting to see them.

DR READ: I imagine that if a child had social issues at home, those are the ones that we would have to worry about since they’re not only being distanced from school and their friends, but for some children going to school is their happy place. Going home might be the issue for them, because they could potentially witness things that would be psychologically harmful to them. Do you think that that group of children would take a shorter amount of time to display symptoms because of the pandemic, it would have just come to the forefront because they’ve just fast forwarded it all? 

DR. MCCLYMONT: That’s a very important point, particularly in relation to some horrifying statistics around domestic violence on the rise during the pandemic. We’ve discussed the effects on the spouse, but maybe we didn’t think enough about the effects on the wider family or children, because as you say, they can’t escape to school. I do think that also that we may have seen a rise in breakups or divorce applications. So again, there are effects from that. Not all siblings get on well, and we have seen situations where they have been forced together during the pandemic. We have also had bereavements within families whereby children and adults haven’t been able to go and say goodbye to other members of the family who’ve been dying, because of COVID restrictions. It has been a tragedy, really, for a lot of people and society as a whole.

DR. READ: I’m interested to know, from your perspective, what kind of signs can parents and teachers pick up on in children? Because that is something that could be shared and could be useful for the people listening to this. What are the early signs and indicators of children that have gone through something and have actually been very negatively affected by the experience or event?

DR. MCCLYMONT: The first thing to know or to say is, if you see any kind of marked change in behaviour – be that withdrawing, which is what I think people might assume, but also if we see a much more irritable or even aggressive behaviour, we have to apply it to the child. So if there is any kind of obvious change in approach to a certain situational personality, that might require a bit more looking at development for phobias, as well. 

Particularly in paediatric anxiety, you often see that the anxiety they have might have its roots in something else, but latches on to a phobia. In the times of the Coronavirus, the most obvious one would be more of a health phobia but we might also see things like a fear of flying and we might also see things like social anxiety. 

Any development of new phobias, any obvious change in personality, more kind of physiological changes also such as changes in eating habits, changes in toilet habits – although changes in toilet habits, particularly in children before the ages of five to six my not necessarily indicate something psychological is going on, because children can go through ups and downs with that and that can be developmentally normal, the same with eating habits. However, if you’ve had a previously very good eater who is no longer eating well, might warrant some more examination. 

I would always say that with anything that feels a bit strange to a parent, it’s good to just get a second opinion and that might be with your GP or a teacher, if you’re seeing this behaviour is crossing different environments.  

I think the danger with giving people a ‘checklist’ is they think that if it’s on the checklist, then it’s definitely a concern. If it’s not on the checklist, it’s definitely not a concern. But as you know, all bodies are different. So you just need to kind of do it on a case by case basis, really. The parent usually knows when it’s time to go and seek professional advice. It’s not something you want to have to do as a parent, so if you’ve gone if you’ve gone that step in the first place, it’s probably something that was worth talking about. 

DR. READ: And what sort of like time would you think it was a good time to get help? When is “the right time” to get therapy? 

DR. MCCLYMONT: In my experience with kids, it is better to go sooner than later. But I do think unfortunately, people end up going later. And I think there’s a reason for that, which is, we pass off a lot of behaviours as all that’s just a phase, or something that they will grow out of later, or “I’ve seen their friend, brother or sister whatever do similar types of things, it’s probably not something to worry about”. I think people are quite frightened to bring their children into therapy, because for a variety of reasons people are worried about coming to therapy in the first place, but a parent could just go and check it out with a therapist, and all the therapist might say is that it is nothing to worry about. I would say go sooner rather than later. Because actually, the longer you leave it depending on the type of behaviour, the more of a, you know, the more entrenched it could become. So it’s always better to just get a second opinion sooner rather than later.

DR. READ:  When I did a six month attachment on psychiatry, I really enjoyed it but I also found it incredibly emotionally draining, because with every consultation I found myself getting sucked into their world. I can imagine that with the pandemic there has been a surge of new clients for therapists who all have their own struggles and own upheavals that they need to balance on top of that. Do you have any tips on how to manage that, and would you say you’ve experienced that yourself in the last 12 months? 

DR. MCCLYMONT:  The obvious advice is to take supervision, that’s what we’re trained to do. We’re trained to compartmentalize what is the patient’s trauma and what is ours, and if it’s ours, we need to go and examine it in supervision. Where that’s not possible, for me myself, I have always found a boost in my mental health through exercise. Again, I know we hear that a lot, but I do think it shouldn’t be underestimated how good it is to get our body moving and get the endorphins flowing. I also really enjoy being outside; I just think there’s something about a change of environment.

Another personal one for me is that I’m not a big news reader or a big social media user, before the pandemic or otherwise. If I was, then I would have stopped being one during the pandemic because I think we get enough messages to our brain throughout the day, and I don’t think we need to be bombarding ourselves quite as much as we do. I’m thinking about things particularly like social media, the quick news feed where they use inflammatory headlines designed to get a response from you. 

DR. READ:  I think that the way that the media went about the pandemic was, in my view, detrimental to society, in reflection it should have been a better mix of positive and negative news. The positive side, as a health doctor, would have been more educational on how to deal with the virus at home, coaching the public on how to get through this rather than focusing so heavily on a death count. I’m not surprised that, as we talk about children’s mental health, that the adults too would be greatly affected – even the ones that are typically solid and stable.

DR MCCLYMONT: I think people are exhausted – mentally exhausted. The spiral of hope followed by disappointment around things like vaccines, we’ve had it recently with the various different lists that countries are on, thinking about booking holidays. Now we know, and it is exhausting. And I think back to your point earlier, that this pandemic is like a psychological world war. It has been because it’s required an extraordinary level of mental resilience and perseverance. To think “when is this going to end?” I was wondering if I myself could sit and receive that report around it was going to be twelve to eighteen months, what would I have felt? I guess some sense of security, probably a little bit of horror, because I was hoping it was going to be two months.

DR READ:  I had that information, so I was mentally just prepared for 12 to 18 months, thinking “life is not going to be normal”. I think that kind of really helped. If it had been framed like that, so that that information would be seeded out to everyone, and then it would  be “Okay, this is Okay, this is what will happen for 12 to 18 months, here’s how to handle it” I think we could have seen less of an impact to people’s mental health. 

As humans, we’re not good at dealing with uncertainty. Everything’s always just been very black and white. If you do X, you get Y. If you do this, you’ll go from zero to one. And suddenly society goes “Hang on a second, I can no longer go from zero to one”. I imagine that life for children would be difficult for adolescence for adults, even university students as well, that would have been really challenging. I think a lot of people would get to the point where they begin to question “What is the point?” Which, I think, would have a huge knock on effect for children witnessing their parents struggling through the uncertainty, and what will end up driving a lot of people to come and speak to therapists.

DR. MCCLYMONT: 100%. I think it really can’t be underestimated how much we need to model an example for our children because that really is what they learn.  To use my example of when I walked on the plane with my children and saw other passengers wearing makeshift hazmat suits, I myself was both horrified and scared, but I did my best to not show that to the kids. I did my best to just try and model a rational but positive approach. Of course, I would be enforcing the necessary medical precautions but no overdramatizing and not catastrophizing it and definitely not sending messages to my children of “if you do this, x and y will happen to you” and I think it’s those kinds of extreme messages that is too difficult for young children to digest, they can’t really assimilate that sort of information.

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Transcription written by Maisie Violet Wicks, BA Hons. For any corrections, questions or responses, please contact newsdesk@privatepracticehub.co.uk.