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 It’s a Monday morning and a new week is promised.

I start my day with a gentle run (yes, quite!) as I find this sets me up for the rest of the day.  For me, time on my own supports my own mental health and I can selfishly revel in the sunrise all on my own.

At SPFT We employ a hybrid approach to working which is a combination of clinic-based practice as well as working from home. Today starts at home and then I travel a few minutes to the clinic.  I smile and feel like I'm winning already as I make a cup of tea and a flask.  Working from home has increased my tea consumption 10 fold.

At the start of the working day I read through my emails and see if there have been any hospital admissions for my service users over the weekend.  I breathe a small sigh of relief to find that I have no urgent emails notifying me of such and I can get on with what I had planned for the day.

At 10am I attend our MDT- Multi Disciplinary Team Meeting.  These occur every day in my Team and this is the arena in which all cases that have been assessed are brought for a clinical discussion and plans made as to how to progress with the referral.  Today we explored a very complex case where a young woman was mute- her voice was not heard at all throughout the Initial Assessment.  Her Mam spoke for her and about her and was adamant in her request for medication and psychiatry review for her daughter.  We explored this and decided that we did not have a clear formulation of her needs at this stage and we really need to hear her voice, in which ever way possible and this could not be communicated during the assessment.  There are risks that need further exploration around potential low mood, trauma and anxiety.  The team are wanting to know if art therapy can support in any way.  We think creatively and after much discussion I suggest that I will write to the young person, initially introducing myself and the reason for my writing to her.  Then I will signpost in the letter that I will write to her again in a couple of weeks, and this time include an SAE in case she wants to reply to me.  The reason for this two-pronged correspondence approach is to acknowledge her anxiety in the first instance, and to allay any fears she may have, and to then send another letter in the hope that it may encourage a response.  She can trust us, after all, I did what I said I would in that initial letter.  This simple suggestion is grounded on sound attachment theory that it helps for a young person to know that they are being 'held in mind' and being thought about and that we are curious and keen to engage with them.

The team are really pleased with this suggestion:- I, on the other hand think that it is number 57 on my To Do list for the week and I have not even discussed this with the admin team who are ever so supportive to us.  But we are a team, we stand shoulder to shoulder with each other in our support of our service users.

The team is incredibly supportive of the Arts Therapists and I genuinely feel a warmth of respect from them all. They support me without judgement as I decorate the halls for different occasions.

Together as a team we bask in the praise that the service users give us as they see the decorations and a sense of 'wowness' is created.  CAMHS is suddenly cool.  They do not need to know the sound clinical reasons behind this, that I want to foster in them the notion that change can be good, they deserve good things to happen to them and as a clinician, I am prepared and ready for them, no matter what uncomfortable, dark shadow things they want to share with me.  They are safe with me and I trust them. They are used to using blades against their skin and here I am, supporting them to use knives and carving tools and they feel safe. Change really can be exciting.

I arrive at the clinic and supervise an Art Therapist who works in the community. I feel so humbled when I hear about how she engages the young people who really struggle to express themselves.  I wonder if she knows that my supervision of her practice is actually a two- way process where I learn so much from her.

I then prepare for my three sessions of art therapy that afternoon.  I have already done the thinking time around these sessions as I get out their previous work and any other materials that may be pertinent for them.  Each session is almost staged for them individually; certain pens are brought out, images that have been created and revisited are placed in the same spot and I check quickly to see if there is anything out that should be there, such as bits of rubbish left from previous room users.  I sit for a few moments and breathe;  I am composed, in a neutral gear and I can now go and collect my young patient.

What I haven’t shared is that with me is Hettie, my qualified therapy dog whom joins us in our sessions. We leave the clinic room together and walk to pick up our patient who is patiently waiting for us. As soon as she sees Hettie she is up, exclaiming 'Hettie, oh Hettie!' Hettie matches this excitement and eagerly wags her tail in anticipation of the hugs and fuss she is about to receive.

 I see my patient beam, literally as she is engaged and has a purpose, even if just for that moment, to bend down, call out for Hettie and respond to her hugs.  It does not surprise me that in the evaluation card that my patients complete after each session, Hettie features heavily as the thing that makes my patients feel better.

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 Hettie gallops towards her with abandonment and I see the foster carer smile too.  I was once taught that if I concentrated really, really hard in the first few moments of a session, I would have done the hard bit, so by the time we arrive in the clinic room I am aware of any new clothes being worn, any slight body movements such as a slight rise in shoulders and also any changes in their breathing, intonation and presentation.  My session has already started.

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