Supporting practice: Living and working during COVID-19 and beyond

[Introduction] 

This is a Research in Practice podcast, supporting evidence-informed practice with children and families, young people and adults.  

Katy: Hello everyone. Welcome to this Research in Practice podcast. My name is Katy Shorten. I'm really glad today to be talking to Dr Danny Taggart, principle psychologist of the Independent Inquiry into Child Sexual Abuse, and the academic director for the doctorate in clinical psychology at the University of Essex. During this podcast, we're going to cover why it is important to be thinking about the experience and impacts of the pandemic through a trauma range, especially as we start to think about the possibility of them merging from multiple, national lockdowns. We'll also talk through ideas for supporting people who have been affected in this way by the pandemic, and finally thinking about practitioner themselves, and how to recognised and respond to their own experiences of trauma, grief and loss. So, first of all, would you like to introduce yourself, Danny?  

Danny: Thanks, Katy. Thanks again for inviting me to talk with you about this today, so as you said, I'm a clinical psychologist. My permanent position is as a university academic at the University of Essex, where I have a particular interest in trauma, as a field of study. For the last eighteen months, two years, I have been working at the Independent Inquiry into Child Sexual Abuse, where I'm the clinical lead for the Truth Project. The Truth Project was an initiative that was established to give any adult survivors of child sexual abuse and opportunity to share their experience with the Inquiry in a private setting, and so far, we've had over 5,500 people who have come forward, making it the largest example of public participation in a British Inquiry in UK history. I should just say at this stage that today, I'm speaking with you as a, sort of, independent practitioner. I'm not on behalf of the Independent Inquiry, although I would encourage people if they're interested in the field of child sexual abuse and particularly around the impacts that it has upon adult functioning, that they go along and check out the website because there's an amazing amount of research resource, and inquiry reports that are available there.  

[Seeing people's experiences of the Covid-19 pandemic through the lens of grief, loss and trauma] 

Katy: Brilliant, thanks Danny. So, to start off with then why do you think it's important that we talk about people's experiences of the Covid-19 pandemic through the lens of grief, loss and trauma?  

Danny: So, first of all, I want to talk about one of the two main paradoxes with regards to this work, so whenever your colleague approached me about delivering some workshops about the cover pandemic that we're in, my initial response was, 'But what would I know about it? I'm just another person like everyone else, trying my best to adapt and survive, and to get through this.' In many ways, I have a lot of privileges, being able to work from home, I have my family around me, I have a job that I can do from home, but in some sense, I'm also in the midst of this thing. I think for the people who are listening, for anybody who comes to the workshops, it will be the same really, so they will be… the paradox is that they're being asked to look after people for something that they are also in the midst of themselves. I think that often, as health and social care practitioners, one of the ways we manage to do the job and to survive in the job is by distancing ourselves from the subject that we're dealing with.  

So, sometimes we may have mental health problems and be working with people with mental health problems, but often we're able to go into work in the morning and put our feelings and what's gone on for us to one side in the service of the patient. That's the right thing to do from a patient care perspective, but it also protects us in some ways from feeling like we are going to be drowning alongside the people we're trying to help. It gives us a sense of attachment. I think it's harder for us to do that at the minute, but it's not impossible. So, I was pleased to be given an opportunity to think about the pandemic as a psychologist and as a researcher, and as a practitioner, because up until that point, mostly I'd been thinking about it as a person.  

So, that's one of the tasks that we have, to think about ourselves in the work, which is why I think it needs to be thought about. I mean, one particular reason why I think it's important to think about it from a traumatic perspective is that for some members of the public, they will have experienced trauma over this last year. I think that one of the things I've been trying to do and develop in the workshop is to begin to discriminate between different groups of people who are impacted in different ways. So, if I say a little bit about where I've got to with that, so there is adversity that everyone has suffered in the sense of social isolation, the disconnected mess that we have from friends and loved ones, the impact that it's had upon our physical health. There's an adversity that is universal and is general. Then, there are people who have been much more directly impacted by Covid, where they have become sick themselves, and they may have needed to have invasive treatment. There is some evidence that suggests that if people have to have invasive treatment because of breathing problems, for example, that that can act as a primary trauma on people, and that they can have post-traumatic stress as a consequence of that. Then, there's another group of people who may be connected to the first two, who have got a family member or a loved one who they've lost through bereavement, as a consequence of Covid. They will be dealing with a separate set of issues.  

Complicated grief as a consequence of not being able to be with people to hold their hand and to be close to them, not being able to have a healthy mourning process whereby they're able to attend funerals and to commune with loved ones and to be close to people, that actually there's a really problem. Another paradox of the pandemic is that the thing that we do when we're distressed, as social animals, is we seek out the comfort and care of loved ones and we seek out social proximity, most of us seek out social proximity. That's the opposite of what we've had to do, so there's been a real disruption to mourning and grieving processes for people who have lost loved ones. I think there are another group of people who may also be part of the other groups as well, who have underlying conditions that predate the Covid pandemic, so people who have pre-existing mental health problems. One of the groups that I am particularly interested in is people who have suffered childhood trauma. We know that whenever we suffer childhood trauma, that there's an increased likelihood we're going to struggle with our physical health, with our mental health, and with our ability to be socially integrated. All of those areas are at increased risk during a pandemic, so childhood trauma survivors are more likely to be negatively impacted if they catch Covid because of underlying health conditions. They're more likely to have mental health problems re-emerge or become exacerbated as a consequence of the pandemic, and given that they're already a group of people who are socially marginalised, they're also likely to have that exacerbated by what's going on.  

The final group who I was thinking about is people who are economically and socially marginalised, who live in a state of economic precarity, anyway that has been exacerbated by the pandemic, who come from particular backgrounds that we know have been more negatively impacted by the pandemic as well. So, the, sort of, structural social inequalities have been exacerbated by the pandemic, and put certain groups of people at increased risk. So, I think that there are five groups there that I've identified. They're not discrete, so lots of people may exist in more than one of them, but it begins to give us a sense of how we can begin the differentiate, the different ways or clients that we work with, or perhaps groups of clients that we work with, may be impacted in different ways to different degrees. So, there's a cumulative impact of being affected in more than one way, of belonging in more than one of these groups, which is why we're not all on the same boat. We're all living through this pandemic but it's not impacting us in the same way.  

Katy: Thanks, Danny. Yes, I've heard a great quote that was on Twitter recently around, we might all be on the same sea or in the same storm, but absolutely people have got different experiences and are in different boats at different stages, kind of, in their response to the pandemic, in terms of their experiences. So, yes, building on the, we're not in the same boat but we might be in the same storm, kind of, analogy there. Yes, so what you've described is a really, kind of, complex set of potential interactions of different experiences, current experiences or born out of previous experiences, and also the paradox between that which is going on for the people that we serve and the people that we're supporting and working with, and also what is going on for ourselves as practitioners. The practitioners that are listening to this podcast will be working in person-centred and strength-based ways. That's, kind of, the backdrop, the human rights, person-centred, strength-based ways of social care practice, but I'm wondering whether there are any general pointers you can give to practitioners in terms of supporting them, if they feel that this might be something that's affecting them or happening to them?  

[How can we best support practitioners during the pandemic] 

Danny: So, if we think about the impact upon staff and staff wellbeing in the midst of this pandemic, interestingly, as a psychologist, one of the research findings that came out of Wuhan early on. Whenever they assessed the needs of front-line healthcare practitioners dealing with people coming into intensive care units is, and this fits with other post-disaster trauma research, that actually debriefing and psychological treatment in the midst of the disaster is not necessarily very helpful. That it's contraindicated, that people should, if left alone, can often recover and heal in, sort of, fairly natural ways through using peer support, you know, through being practically assisted by their employers to have the right kind of PPE equipment, for example. To be given some latitude with regards to work pattern, to be able to manage their own diaries in a way that they don't feel overwhelmed or overburdened, but it tended to be more practical solutions rather than debrief and reflect to practice clinical supervision in the midst of things. The evidence seemed to suggest that that's both what people want, and based upon other post-disaster trauma research. For the majority of practitioners and majority of people affected, actually that's the best outcome. In saying all of that, reflective practice and ongoing reflective supervision are very good forms of, sort of, psychological hygiene generally, so if that was part of someone's routine, I certainly wouldn't want them to stop doing it. It's more to be cautious about implementing lots of staff wellbeing that requires high levels of staff reflection, when they're in the midst of having to deal with a crisis situation.  

That isn't always helpful, and certainly in social care, my work with social work colleagues over many years in child protection services, really helped me understand that if they're dealing with an incredibly traumatic, difficult case with a high level of violence in a family home, for example, or with real concerns about the children being sexually abused, or with the potential for child removal, there's a real risk in asking them to slow down and tell you about how they feel, because they need to get through it. They need to do the job. There may be time after things have calmed down, after the crisis is over, where you can help them process and think through what they've been through, but it isn't always a good idea to force them to do that in the moment.  

[Applying trauma-informed approaches] 

Katy: That's super interesting in terms of, kind of, what we might have just been experiencing and just been through, but I'm wondering just building on what you're saying then, at this point in time when we're recording this podcast, there's a roadmap to out of lockdown, which is, kind of, getting closer. So, thinking about as we move out of that crisis moment and start to think about transitioning back into a society of interaction and social contact, and maybe a bit of release and relief. Is there anything that you think from a trauma perspective that we could be thinking ahead or planning for in terms of what the impact of mental health in the long-term might feel like, and what might be able to be put in place or planned for now?  

Danny: So, one of the really interesting findings that has come out of the emerging research during the pandemic that has actually been… it was started really at the beginning of the lockdown. Sir Richard Bentall, a British clinical psychologist and a number of colleagues from England, Wales and Ireland, they got together very quickly and put together a research consortium. They conducted some large scale, questionnaire-based research with the general population, and they have followed those people up. I think the last data was published in December 2020, but it's right from the beginning of March, which is an extraordinary achievement and they've got a huge amount of really interesting data. What they found was that depression, anxiety and traumatic stress increased in the month of the first lockdown, but not by as much as they predicted. So, there was an increase from the figures that they had from the UK Psychiatric Morbidity Survey, for example, where we have a picture of the general population. There was an increase in the first month after lockdown but not by much. There was about 25% of people who were struggling. There was subsequently a reduction in the number of people who were struggling with… this is clinical levels of anxiety, depression and traumatic stress, which is different from the, sort of, normative feelings of anxiety and worry, and a sense of despair and hopelessness that lots of people feel all of the time, and during this pandemic, and as part of the fluctuation of daily life. We're talking about clinical level, but actually, the number of clinical level came down slightly and has stayed fairly constant since then, so it seems to be about 25% of people have struggled.  

Some groups have actually improved, their mental health has improved, so for older people, mental health has improved. For people who have older children, perhaps who have come to live at home again, they've got to spend more time with their families, and actually mental health for those groups of people has got better. 

 Where there has been a reduction in social isolation because people who were living away from their family members, perhaps their family members have come back and they've actually had more contact. For the 25% who have either deteriorated further from quite a low point to begin with, or have gone from being okay enough to in the clinical range. The risk factors for those people are, and this is in relation to depression and anxiety as well as traumatic stress. The risk factors is having younger children in the home, so having a lot of pressure to home school, being a woman. It's been a more difficult time for women than men, even though paradoxically, from a Covid perspective, men are much more at risk of serious illness and death. Something of the social burden that women have had to carry has meant that it's had a bigger impact upon their mental health, particularly younger women. People who live in urban areas are more at risk, because there's less space for them to move around. Then, people who have other forms of marginalisation, so people who come from already quite disadvantaged and impoverished backgrounds. Their mental health has deteriorated more than people who are at higher socio-economic groups.  

Once again, what's interesting is that this pandemic has shown the importance of understanding health inequalities, the, sort of, social gradient of health, that being at a certain point in the economic gradient will be very protective against all sorts of mental and physical health problems, and then the further you are down that scale, the more you're exposed to things like pandemics. Then, also the upcoming recession as well. So, from a social care point of view, it's telling social workers a lot of what they know, which is that the people that are most disadvantaged are at the greatest risk during the pandemic, and then also in the aftermath of the pandemic.  

 Katy: Thanks, Danny, absolutely, so we recently had a partnership conference around mental health and wellbeing which you were a part of. Thank you for your contribution, but certainly that first session we did was around the impact of Covid-19 on mental health, and we had Lena Dominelli from Stirling University talking about learning from international disasters and the importance of community, and resilience in its broadest sense. Then, Sarah Hughes from the Centre for Mental Health talked about the impact from a UK focus and exactly what you were just talking about, disadvantage, kind of, is exacerbated by the experiences during the pandemic, and that was really brought to life by Ursula Myrie from a charity called Adira in Sheffield that works to support the black community. She really was very powerful in bringing to life what that might mean, so yes, thank you for reiterating that as a context within which we're working, so I guess we know this stuff already. It's exacerbated now with and in terms of the people that we work with, and so being conscious and mindful, I guess, of that in our work. So, in terms of practitioners or strategic leaders indeed, what can we be putting in place as we look forward to coming out of this pandemic?  

Danny: So, I think it's a really interesting question because we don't know, so what we predicted was that there may have been a, the word was a tsunami of mental health problems. That hasn't emerged yet. People who are already in precarious positions with regards to their mental health, there definitely seems to have been a deterioration. That isn't to say that we won't see an increase once the pandemic begins to ease.  

One of the features of collective trauma, so there's a difference… the research is very consistent that individual trauma, being sexually assaulted, physically assaulted, being abused in childhood, the outcomes in terms of mental health for individual trauma are much more serious than they are for collective trauma. Again, it's to do with what you described, which is the sense of social cohesion, that people have collectively, where there's a sense of bonding and connectedness to one another. There's something awfully isolating about individual trauma, where people feel like they're on their own with it. That, up to a point, is reason for a degree of optimism, but if this sense of connectiveness and social cohesion continues, that it may bring a large proportion of the population out relatively unscathed or even with some degree of post-traumatic growth, where perhaps an optimistic viewpoint is that actually it will help make us a better society. We've seen elements of increased social solidarity. We've certainly seen an increase in investment, at least in a, sort of, non-financial way. We've seen an increase in endorsement of our health and social care professionals during this period.  

I mean, the cynic in me who's worked in the field of mental health for a very long time is curious about how well that will be translated into ongoing increased investment and policy change, and certainly for colleagues in social care. I mean, just the enormous cuts that have happened to that system over the past ten years, it's very difficult to imagine social care being able to carry the population out of this pandemic into the next stage, which is really what we're going to need help with in the absence of investment. So, I think that there's a broader macro-level, political and economical issue that has to be addressed. For those of us who work within organisations that are directly impacted by that, there is no way for us to do more than we are actually resourced to do. So, that feels like that's an important thing to say, that sometimes in the midst of austerity and now in the midst of this pandemic, and the increased need of the social care services and similar organisations have seen. There can be this sense that we should do more, and that we should be working harder, and we should be meeting the needs, an increased level of need that I don't think is sustainable in terms of an organisation or staff wellbeing perspective. That's the sort of point that has to be acknowledged and thought about before you get into what we could do differently. Within that, I think in terms of individual clinical practice, with people who have been affected by the pandemic in some of the ways that we've already discussed, there are things that we can do.  

Traumatic stress tends to emphasise deficit and emphasises the way that things are taken away from us, and it inhibits our ability to relate to other people. It has an impact upon our levels of trust. It causes us a huge amount of psychological disturbance in different ways. It leads to an increase in anxiety, and I think that it's very important that we're honest and transparent about that as being one potential outcome for people. I think what has been really helpful in the field of trauma research over the past 20 years or so is the emergence of ideas around post-traumatic growth. Not in order to negate or dismiss the very really impact that post-traumatic stress disorder has upon people's lives, or to pretend that that's not a real thing, but rather to, sort of, offer a counteracting narrative that offers some clinical hope to people, and that also is grounded in some empirical evidence. One of the things that I've noticed at the Inquiry is when people come forward to the Truth Project to tell their story about the abuse that they suffered, that is something that can lead to a reawakening of traumatic symptoms. It's something that can lead to them experiencing things, maybe that they've been able to block out for a long period of time. It leads to the becoming destabilised because they fell back in that child-like vulnerable place.  

Then, we have a lot of support built around that period because we've seen it so many times, that we know that people have to be quite carefully supported.  

When they get to their session, the experience that… the feedback I get consistently from the facilitators who run those sessions is that people find being able to tell their story, being able to make meaning of what has happened to them, and being able to feel like they've made a contribution to their Inquiry, that that is deeply empowering, a powerful transformational experience for lots of people who we see. Now, how much that is sustained post the session, it's hard for me to judge, because we have some data about follow-up, about how people have fared after their truth session, and we have reason to be encouraged by what the feedback has been that we get, but I don't have a huge amount of data to guarantee that this is a long-term sustained change. I hope for some people it is. So, why I think this is relevant to working this, sort of, post-pandemic or moving out of the pandemic into a different stage is that if we can allow people to tell their story of how it's been for them, and if we can allow them space to try and make sense of what it all means. Particularly how they can use what they've been through in order to help them develop or grow in other ways, and part of that will be about what contribution can they make. Those are lessons that I've taken away from the thousands of people that have come to the Truth Project, and I wonder if there may be some transferable ideas that could be used in the post-pandemic.  

[Reflective practice and reflective supervision] 

Katy: Absolutely. Earlier on in the podcast you talked about, when people are in it and in the crisis reflection, and encouraging people to talk about feelings and what might be going on for them might not be as helpful. I think maybe collectively as practitioners or collectively in conversation with people that we're supporting, I wonder whether the time for reflective supervision and reflective practice might be able to draw out some of that learning just described, into what we might be able to do now. So, I guess what I'm saying is, how important is reflective practice and reflective supervision in the next stages and the recovery from the pandemic together?  

Danny: Yes. I mean, I think that's an excellent question, and I think it's incredibly important, and really for these reasons. So, what we've done in order to survive this from a psychoanalytic point of view, we have regressed to a more primitive state, to an earlier state, where we have focused on things like having enough to eat, basic aspects of survival. We've, sort of, shrunken down in order to get through something very difficult, and that's been important, but we have to come out of that and begin to change. Otherwise, we may stay in quite a rigid, regressed state. That has been helpful in a disaster but it's not helpful in terms of living more generally, and it's not going to be helpful particularly for those of us who work in this field. One of the things that I have seen in myself as much as anything, is I've been much quicker to make decisions. I've been much more certain about what I think. I've been much quicker to use a piece of evidence or a model, or sort of, cling to it and say, and be highly predictable about other people's minds, which for me as a psychologist is always a warning sign. If I start to think I know what's going on inside somebody's head, I am in big trouble, because we don't even know what's going on in our own heads half the time, and so it's the curiosity and the flexibility, and the openness that makes me able to do my job.  

Once that begins to get shut down because of my own anxiety and need for control, uncertainty, that's understandable and okay in the midst of what we've just been in, but if I can't find a way back out of that again, then I'm not going to be serving people I work with in the way that I need to do.  

So, in a sense, I think it is now, as the immediate threat diminishes hopefully and will continue to diminish, this is the time where we need to process what has been going on and what impact that has had upon our practice, and to begin to think about what type of practice we want to see in a post-pandemic work environment. Then, to begin to think more carefully about what are the needs we're seeing in our client group and we can look at the research that is emerging. We may see lots of problems around adaptation, so we may see lots of difficulties with, for some people, going back to a, sort of, non-socially distanced world. We were talking before the podcast started about what it would be like to be in a very busy train station in central London, for example, compared to the relative distance and space that we've had between one another over the past year. That's going to cause a normative amount of anxiety for all of us, and some people I think will really struggle with that, so that's something that we have to think about, thinking about the social and economic context in which we're going to be working soon. There is going to be an economic retraction, there already is. There's likely to be a recession. We know from previous experience that the way the British state copes with and manages economic recessions is to cut public services and to cut support service for people, so welfare and social security have been very badly affected since 2008, as has social care provision. So, we're already living and working in quite a reduced, shrunken size of the state compared to what we needed, and that's pre-pandemic.  

That optimistic part of me is that that will be politically more difficult to do, given what we've just been through and given what health and social care professionals have carried on behalf of the population. I'm not naïve enough to think that that's going to be straightforward or inevitable, and so for me, reflective practice supervision, discussion with colleagues, it's really important to think about what's possible in the context that we're in and it's almost like we have to look at it through two different perspectives. We have to look at, what is the social and economic context that our client group are managing right now, and how is that impacting our ability to move on from the pandemic and to engage in forms of post-traumatic growth? Are they at risk of getting stuck in some way, because of the lack of choice or a lack of control, or a lack of access to decent services. We may not be able to do anything about that reality for them, but at least we can use it as part of our formulation in terms of how we think, why we think that they're struggling in the way that they are. Then, we also need to look at it from the perspective of the services that we work in and the limits that are within that. So, one of the big things that I have been thinking a lot about in the years leading up to working at the Inquiry and then since working at the Inquiry is the, sort of, explosion of interest in trauma-informed care. I've done some research and written quite a bit about the area really, and overall, I'm someone who is very much in favour of it, because I can see, you know, up to two thirds of people in the mental health system have got a childhood trauma history.  

So, the idea that we wouldn't be trauma-informed, to me, seems non-nonsensical, but actually it's taken us a long time to get to the stage where trauma survivors and academics have been able to, you know, campaign really for a greater recognition of the impact that childhood and adult trauma has upon health and social functioning.  

So, I want to celebrate and herald, and encourage that change, but I also think that there are risks in thinking that trauma-informed care can be applied in the context of retraction of sport services generally. One of the things that causes me some concern is that I'm seeing the brand or the slogan of trauma-informed care being used without any real substance being built into who that is going to be done organisationally, how the organisation is going to take responsibility for that, and how it's going to be supported with staff. So, I think I have some question around trauma-informed care being used as a panache or a solution to the pandemic and the impact that it's had upon client groups, even though I think that working through a trauma lens and understanding the impact of the pandemic, but also the, sort of, precursor of vulnerabilities that lots of our clients have had. A traumatic lens can be quite a good one to understand it. I think that, as I said at the beginning, lots of people have suffered adversity and loss which are not the same as trauma, but of course there is some overlap with them, and I think it's useful to not call everything trauma.  

When we talk about trauma, we're talking about specific life-threatening or ongoing life-threatening situations that people find themselves in, so chronic trauma is within the context of ongoing intimate partner violence or abuse, or a sexually abusive relationship. Developmental trauma is those types of abusive relationships that happen in the context of childhood, or very, very severe neglect. Then, we're thinking about individual traumatic events such as accidents, but in the context of the pandemic, invasive medical treatment or the traumatic loss of a loved one, so I think it's helpful to be clear conceptually about the difference between those things. While I would want to see an increase in use of trauma-informed care, I wouldn't want to see an increase of use of the language and the absence of a real, systemic and organisational change around that. Lots of the constructs, such as collaboration, the development of trust, the recognition of the importance of a social relational approach, these are all ways of working that are embedded within social care practice already at its best. There are also ones that will be useful in the post-pandemic word irrespective of whether that individual client is traumatised or not. One of the advantages of trauma-informed care approaches, it's good for working with people irrespective of their background and irrespective of their history.  

It's particularly important whenever you're dealing with people who have been given good reason to not trust and to have a complex relationship to help, and have had lots of times in their life where they've had control taken away from them, and where they've been coerced or forced to behave in ways that they didn't want to do. So, that's a very long-winded way of saying it's a good idea but let's not oversell it. 

Katy: Thank you, Danny. I think also what you've articulated there is just the complexity within which we're working individually and systemically, and that there are principles that run throughout all of that that if we hold in our minds, can drive our behaviour and drive our interactions. One of the things that came to mind when I was listening to you speak was, sometimes there's nothing new under the sun. It's about relationships. It's about seeking to understand where people might be coming from, and where behaviours may be coming from, or where our own behaviours may be coming from, and working with those trauma-informed principles in our minds and in our behaviours in order to make the best sense that we can out of situations, and think about the best way to be with people.  

Danny: Yes, you're absolutely right, Katy. I mean, I suspect that there will need to be Covid-specific psychological treatments that will develop in response to what we see over the next couple of years, but even they will be adaptations of pre-existing ways of the treatment of mental health problems. So, I imagine there will be an increased need for people to be helped with obsessional worries and concerns, and compulsive behaviours. That may have a particular complexion that is different from what we saw before, because we've all been forced into behaving in a slightly obsessive, compulsive way, in a moderate way. It may be that for some of us, that's a struggle to get away from, and that actually, that becomes more of a clinical level problem, but that will be an adaptation of what we already have. Actually, I think that adjustment problems are going to be a big issue. I think issues around complex grief are going to be a big issue, but as you say, we have ways of understanding and thinking about those, and why they will develop in response to the way that they're expressed within the particular context of the pandemic. I think it's important that clinicians and practitioners feel empowered to know the core components of social work relationship-based practice, is going to be the foundation on which any of these other things are built upon.  

Katy: Wow, what an amazing point to be ending with, a sense that what we do and have done will see us through with some adaptation and change, and consciousness around what our current situation is, but we do this, we've got this as a set of practitioners. There is a backdrop and a foundation to which we can grow and develop as we move out and beyond the pandemic. So, thank you, Danny. I always love hearing you speak and hearing your reflections, and your clear articulation around so many different angles within social care practice, and how the transference across from your psychologist experience can be used to support us in adult social care, so thank you so much for your time today. Before we finish, is there anything that you wanted to say that you haven't had a chance to say?  

Danny: Well, thank you for asking such well-articulated and pointed questions, because I think one of the things with this whole area is that it can feel quite overwhelming. So, maybe another way forward for us as practitioners that can be supervisory relationships but can just be in dialogue more generally, is that through talking about these things, we can make sense of our own experience, and that can help us to then think about the work that we do. That can only really happen through dialogue, because in the context of this conversation, my thinking has become clearer than it was at the beginning because there's something about, sort of, totalising the impact of the pandemic that can make it very difficult for us to think at all. It almost feels like an attack on thinking, and so thank you for helping me to think as well.  

Katy: Thank you, Danny. Thank you for helping me to think, and I'm sure, thank you for helping the listeners to think as well.  

[Outro] 

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