 Hello and welcome to Pookie Ponders, the podcast where I explore big questions with brilliant people. Today's question is, how do things change when we define a child by their strengths rather than their diagnoses or challenges? And I'm in conversation with Dr Amber Sadiq. Hi, so my name is Dr Amber Sadiq. I am a consultant psychiatrist, I'm a medical doctor working with children, young people and families in London. I work in the NHS and I also have a small private practice as well. So the episode question for today is, how do things change when we define a child by their strengths rather than by their diagnoses or challenges? Do you want to just make a start on that very gnarly question Amber? Yes, huge isn't it? And I'm really kind of excited to come on here and talk to you about this. I think very traditionally, you know, as a psychiatrist, children and families will come to me and my services looking for answers and looking to kind of maybe even a diagnosis for why they might be experiencing different issues, challenges and behavioral problems, low mood. I've seen the full range of issues. And I think often families are really surprised when I ask them right at the start, what are your hopes and expectations from coming here? How would you describe your child? Can you tell me what their strengths are? And it's really interesting because I get such variable responses and I've really been curious about why that might be. I do believe that, you know, a lot of the work that we do as child and adolescent specialists works best if we get to know the child from a position of strength. When we know what areas they're good at, when we find out the areas that they maybe need to develop a bit more, and we use positive language around their situation. And I think that is not a dominant narrative. I mean, maybe over the past five, 10 years in my career, I've seen it changing and shifting where we're trying to understand children's challenges as being more around what's the function of the symptoms? You know, why might this child be acting in this particular way? Why might they be aggressive? How can we really shine the light on their strengths and the things that they can do? We're all human, so we all have strengths and weaknesses. You know, I'm first person to say that I've got many weaknesses in lots of areas that, you know, I've not been good at. I wasn't particularly sporty at school, for example. But I've tried really hard to improve my hockey skills and my running skills. And I think that, you know, if we limit children to the problems that they present with, then we're really not going to be helping them as much as we can. And is that not a bit counterintuitive though? Because presumably when a child or family end up in a consultation with you, that's because there's a problem. Yeah. So great question. Really good question. It is counterintuitive because I think in a way, you know, people come to me looking for answers and often the position is you're the expert, so you tell me what's wrong with me or what the disorder is or I've been reading up on depression and, you know, do I have a depression doctor? And I think it's really important as a specialist and it's something that I talked to a lot when I'm training people up is we look at the both and what I mean by that is, of course, if the family are coming with challenges and difficulties and they want an explanation and a diagnosis as part of that, of course, it is our duty to explore that to complete an assessment to maybe speak to the school and other professionals involved to really understand from the family's perspective and the child's perspective to hear their voice as to what that problem is so that we can make sense of it together. And therefore, absolutely the diagnosis isn't something that we don't do. It's an important part of the work, but it's also about recognizing what are the protective factors, what are the strengths, and really not just looking at the child by themselves, really kind of widening it out, really looking at what are the strengths of the family. How have they managed to get this far up to this stage? Now, what kind of resources do they have that they are able to tap into? Because often the way that our brains work when we're very much kind of looking at the negatives and we're kind of, I think we're inclined to look at negatives because of survival instinct and managing threats and difficulties. I think if we can get families and children to actually look at, actually we've got some resources here, we've got some tools or we might not have tools in this area. We're not quite sure how to talk to our child when they're struggling with a tantrum or a behavioral outburst or our child's at risk of exclusion and actually that's really hard and we don't know how to manage it. So then we think together about, okay, well these are your strengths and protective factors, but actually there are some areas that we need to work on and this is what we're going to do about it. And how do we empower families in that situation? Because I'm assuming, and you'll correct me if I'm wrong, that as a consultant psychiatrist by the time that they're in the room with you, this has probably been going on quite a long time and things might be quite broken and they're probably quite emotionally and physically exhausted. Absolutely, absolutely. I think the, you know, the only way that we can really do it is by being really human and compassionate and creating a space. So what I call it is warming the context and it's something that I learned when I was training in family therapy because we have to create a specialist, we have to create a safe space for children and families to, you know, they're going to come with lots of anxieties and worries about even how the session is going to be. You know, they might feel broken, you know, the parents might feel broken, they might have lots of social issues or financial issues, there might be other things going on in their lives. And therefore it's really important for specialists like me to actually create a space where we can have conversations, we can be honest with one another. It might not just take one session, it might take a series of sessions. So again, it's about kind of managing expectations. You know, if there's a sense of we want an answer now doctor, I'll sometimes say, look, I can, I can kind of share this information with you just now. This is what I'm thinking right now. What do you think about this, so that we come up with a shared understanding of what the problems are. And then I might say, but I'd like to kind of get to know you a bit more, I'd like to get to know your child a bit more as well. And then we will meet over a series of sessions or maybe one of my colleagues will join alongside as well. And really what we're kind of doing through that process is developing something called a formulation. So it's not just looking at the diagnosis, you have depression, and that's that it's really looking at the factors that contribute towards the depression or the low mood symptoms. So why is it at this particular point of time that you're experiencing low mood and you're struggling with your self esteem and your self confidence. What kind of things have happened to you that might have contributed towards us being in this place. What kind of factors are happening in the family that we might want to be curious about when we're working with children and families, you know, rather than just look at a diagnosis. We also want to be looking at, you know, the formulation. This is where I would work with families that might work with professionals, you know, could be and school teachers, for example, who are concerned about the child and really look at the factors that might be contributing to why that child is struggling at that point of time. So rather than this is a depressive disorder. And that's it. It's really about looking at the different components of the different kind of ingredients that are contributing towards that. Now that isn't just kind of looking at everything's, you know, wonderful and it's all strengths based and it's all, you know, protective factors. It's really kind of unpacking what the different facets are. So for example, looking at what the I use the five piece model and the five piece model. I'll just explain to anyone who hasn't heard of it is really looking at predisposing factors. So things that might lead to some vulnerabilities for mental health challenges. It could be, for example, that the child has been born premature. It might be that they have some maybe underlying learning difficulties, for example. So these are kind of predisposing factors that we would want to just really think about in our shared understanding of the child. We want to be looking at precipitating factors. So those would be any significant events that have happened in the child's life that might have led to why the child and family are coming to see us right now. For example, it might be a child who has just moved country, for example, and they're finding it really difficult to adjust to life. Maybe parents aren't speaking the same language and aren't speaking English. So it's really looking at what are those specific trigger points. Then we look at perpetuating factors, which are more kind of those factors that would maintain the difficulties. So if we were to put some interventions in place, or put some treatments in place. What are those kind of areas that we need to be mindful of that might keep the problem going? So for example, if the child isn't receiving the correct reasonable adjustments at school, for example, if the child needs medication, but they're not able to swallow the tablets, for example, you know, it's really looking at those factors that might be affecting that. And then finally, and really importantly, I'm going to come back to kind of the protective factors. So what is it about this child or family? And it's really opening it out to the family. I always call myself a child and family psychiatrist because I can never think of the child in isolation. Often the child's bringing their families to the sessions. And really to look at what is it that this child has that's really positive, shining light on those strengths, those strengths that are often hidden away, tucked away somewhere. And it's very hard for children and families to sometimes identify those. So I might ask questions like, how would your best friend describe you, or how would your auntie describe you? You know, really trying to kind of tease out what those different things could be. And it's amazing, often we end up with a list of things that the child can do. So all of that then contributes towards what the presenting complaint is. And that's why we call it the five piece model. We kind of bring that together. And that then becomes a little bit of a shared explanation for why the child struggling with particular problems right now. And it's really important to be respectful in the way that we use our language. It's shared so that it's often using the child and the family's words as well. Often including things that the family might not have thought about before, you know, and they think, ah, okay, that could have made sense. You know, we've moved around a lot or actually there is this stress in the family that could be impacting on our child, or actually maybe your child could have some neurodevelopmental difficulties. You know, maybe there could be something there that we hadn't thought about before because we have some difficulties in the family. And, you know, I think it's just about reaching those kind of aha moments. And I think that that's why I love the work that I do, because we do that together with families. Absolutely. And it feels hearing you talk about the approach that you're taking and I love the five piece. And it feels like you're taking a really compassionate approach, which I love to hear. So why is in the face of perhaps what we might expect because you're essentially in clinical practice and our very perception of the word clinical is almost the opposite of compassionate. So I just wondered if you were happy to talk about that. Is this how you were trained? Is this the way you found your way? Is it at odds with maybe what other colleagues might be doing? I think that that's a really interesting question. And I suppose we all come with our own personal stories and experiences. And I think for myself, you know, I'm a Scottish Asian at female psychiatrist, and I've been very open to really understanding kind of the complexities of the human experience. And I think a lot of that has come from my own background. My dad is a scientist, but originally we are from a family of farmers back home in the Indian subcontinent. And I think, you know, growing up, I was very aware of the resources that I had, but also about stories of adversity, you know, people who have been able to break some of the cycles, you know, of deprivation, poverty. Obviously, my dad is an example of that. And I think that was just really inspiring to me because I really thought, you know, often we become the stories that we tell ourselves. And how can we tell different stories about ourselves? How can we kind of break free from even the stories that other people tell us about ourselves. And I think as a kind of, you know, South Asian woman, I'm very aware of those stories that get told the kind of dominant narratives in society. And I'm very cognizant of the stories that we tell our children as well. And when I say we, I don't mean that as parents we necessarily are saying you're like this and you're like that, but really thinking about society and what the narratives are around appreciation of difference, diversity. What is inclusion? What does that actually mean? And what does that mean in practice? We can talk about it, but what does it mean when we're actually having to kind of walk the talk, I suppose. And, you know, I think all those experiences in my life have really impacted on me. I've also experienced family members and friends with mental illness. So therefore that idea that mental illness does not exist. For me, I've seen people really struggle with depression, anxiety, neurodiversity is something that I'm very familiar with as well. And, and I can see how important some of those treatments that we use as psychiatrists can be really helpful. I think it has to be done within a context of curiosity and openness, that there's not just one size fits all. And I've been very lucky in my life. And I think it's because I've kind of, I don't mean to say I've made life more difficult for myself, but I have moved around quite a lot. And I've been really passionate about opening up my mind to different models, different ways of thinking about the same problem. I trained at the Tavistock Clinic in London, which over five years really allowed me to look at different kind of the more, I suppose, traditional prescribing medical model and looking at kind of systemic approaches, thinking about kind of how psychologists work and the different approaches they might use, and really looking at the new waves of therapeutic interventions, which are really exciting for me, which kind of plays a little bit less emphasis on the expert, which can be, like I've said before, can be a very uncomfortable position, because I think we all, at some level, want certainty. We all want to know what's wrong with us or what the problem is and how we can fix it. And I suppose I bring a slightly different approach through my experiences and I'm just being a human, I'm just being very human in my way of working, but sometimes we don't know all the answers. And sometimes, you know, we might call this depression, and we might try a treatment, you know, for example, a talking therapy, and that might not work. It might work, it might not work. The evidence says it should work, but it might not work. And then we have to kind of go back to the drawing board and think about, well, what else is going on? Shall we try something else? And I think it's really about not being fixed in the way that we look at things. So, for example, if I was to say a child has a eating disorder or a child has a, you know, an experience of what we call psychosis or hearing voices or, you know, it's really about them being able to take a step back and look at reviewing that. So does this still hold? Does this diagnosis still hold? Now that is a bit of a different way of working, isn't it? Because that involves us having to be constantly engaged in thinking, is there a different explanation? Or is children grow up? Their brains are developing, you know, adolescent brains are fascinating, aren't they? Because they're constantly developing and growing. And we know that it doesn't just stop at 18, it continues until you're kind of in your mid-20s or even later. And so, therefore, our formulations and our understanding has to develop as well. Because children and families grow up and they develop and they change. The things change. It feels like I've got so many different questions to shoot off from there, but one of the ones that I'm interested to talk to you about, I know that you like to talk about is the one around kind of vulnerability. Because it feels to me that you really care and you come with your own experiences and a very human approach. And I just wonder there, does that make you as a clinician vulnerable? And is that okay? And what role does vulnerability have to play here, both in terms of, you know, in your role as clinician, but then also for families coming in? That's a massive and very, yeah, nebulous question, but talk about vulnerability. I think, you know, as human beings, if we're not open to the fact that we can be vulnerable in our lives. You know, right now, especially, you know, I think in the space of this interview, I've been kind of juggling about two or three different tasks. And we are human. And, you know, although I believe that we can reach the stars in many ways and we can find our superpowers, we also have to recognize that as humans, we're not robots. And we all have, you know, there will be points in our lives for all of us where we struggle or where our mood changes or we feel more anxious. Because, you know, that's part of the human experience. And that's not something to be medicalized or pathologized necessarily. It's okay to have different types of emotions. It's okay to have a bit of a wobble. I'll have moments where I notice that I've become more vulnerable. Maybe I'll become quieter. Maybe I'll need to have a bit more sleep. Maybe I'll feel tired. Maybe my parents will look at me when we're kind of zooming each other and they'll be like, are you okay? And I'll say, actually, it's been, I've had a really hard time or, you know, it's been a tough week. And I think if I can be open to my vulnerability, then actually it helps me in my work, because I'm in touch with it. I'm not pushing it away. I'm not saying I don't have bad days, you know, or, you know, I'm perfect or I know everything. And I think by being able to model that as a doctor, for me personally, everyone's different, but for me personally, that works. And I think, I think it's actually allowed me to remain curious about other people's experiences. But I also recognize that in all of us we have blind spots, which is why, you know, as Ambers, Dr. Amber, I do like to work with other people who bring in their own vulnerabilities, who bring in their own strengths, who bring in their own experiences. And it's really interesting because, you know, as a doctor before I became a doctor, I was actually working as an agency nurse, or kind of nursing auxiliary. And I think these different experiences where I've kind of looked at kind of the patient experience, the patient journey from different perspectives, and the kind of vulnerability that I've seen in, and I'm calling them patients. I know that some people prefer clients or service users, but for me thinking about patients and how vulnerable children and families can feel, how vulnerable older adults can feel, how vulnerable I can feel when I go to the doctor saying, I've got this problem, I've got headache or, you know, I've got a stomachache. I think actually does really help me to be more compassionate. Now, the flip side of that is, and there's always, I think a side effect to most things in life is about that level of awareness and that level of thinking about things and feeling things also means that we have to be, I have to be quite tight about my boundaries. So for example, I have to be very tight about kind of things like my sleep, things like making sure that I, I can't go like when I was a junior doctor days where I would eat properly and have a chocolate bar and, you know, really work on making sure I have my breakfast, lunch and dinner, that I work on boundaries if I am able to do something, I'm able to say no. I also want to role model that with my trainees. So I train doctors in not the amber approach but kind of you thinking about how we become compassionate specialists kind of mental health specialists. And to recognize that vulnerabilities are strength. Being soft can be a strength, but it can also mean that it can open up increase pressure and it can increase the risk of burnout. And there are things which we call compassion fatigue. And I think there's something called zoom burnout, you know, so I think there's like lots and lots of factors that we need to just be mindful of in order to then put a plan in place. I'm very much for putting a plan in place. What can I do right now to look after my, my own mental health. What can I do to look after my physical health. And, you know, so I'm not seeing vulnerabilities. It's a positive thing. And actually what I've noticed more and more, especially in the Twitter sphere is clinicians talk about their lived experiences, talk about being human, talk about their bad days, talk about the things that, you know, are going really well for them. And I think that's amazing. I think that really is amazing. I think that's, for me, that's a shift that I, as a 20 years ago, when I was training, I could not even have imagined that we could that I could say that I've had a difficult night shift, or that, you know, to even imagine that as a junior doctor, I would often get asked by consultants, why do you smile so much? Or I remember I cried once in A&E because I'd had a really difficult night shift. What's wrong with you? You know, I remember being taken aside and being asked kind of what's wrong with you, why are you crying? And I thought, that's not the type of doctor that I want to be. It's okay to cry. It's okay to smile. If you want to smile, that's who you are. That's okay. We accept that. And I think it's these experiences just in the way that our brains are just plastic and they evolve and they change. These experiences have really shaped the type of person I am, the doctor that I am. But also, I want to continue improving that. You know, I want to continue opening up my eyes to the patient experience and what I'm particularly interested in at the moment is kind of patient leadership. I'm really looking at how we, and not just talking about it, because I think we're talking about it a lot, kind of service user participation. We're looking at kind of having, you know, patients in recruitment panels, for example. So when I was interviewed, I was interviewed by a patient and or somebody who had been through services and actually she asked me the best questions and actually probably felt most nervous when she was asking me because I really thought, actually, this is somebody who has been on the other side who actually wants the best for patients who wants to recruit the best person for the job, actually. And actually I was really pleased that that was happening. But I think we have to go one step ahead. And I think this is about kind of bringing up in more patients into leadership positions but kind of high level leadership positions, which is going to be a whole, this is a game changer, if we can get to that stage. Definitely. It's a conversation that's often in the forefront of my mind. I had a really good chat with on my podcast recently with someone who talked about having been in those roles and how there is a real lid on where you can get to. And she was keen that whilst as the, you know, service user, the person bringing that experience, you got trained on how to work with a clinician but it didn't happen the other way around and that clinicians often treated her like a patient rather than as a colleague. There were lots and lots of things there. But that idea that you can be more human and be more vulnerable in your role is one that fascinates me and strikes a really personal chord because, yeah, I made a really kind of clear decision at one point in my career that I was going to just be me. And that was hard and it's limited what I can do. But actually ultimately I think it's meant that I'm able to do more and have more impact and, yeah, and it changes the conversation for the people as well. It's hard though and I think that, you know, coming back to the then around the sort of self care around, around that you talked about kind of your physical and emotional well being and really needing to put that first and that's something we come back to often here thinking about as the adults. We must first look after ourselves before we can do what we need to for our children and their families. But I think if we're going to be more vulnerable there's a particular sort of bit there isn't there about knowing what our limits are how much of ourselves do we bring and where are the boundaries and how do we safeguard ourselves because sometimes I think we end up thinking oh we've got to share everything or we're not doing that well enough and we hold, I don't know it's complicated isn't it. Definitely, definitely. And I think that does require a little bit of space to be able to think about that to reflect on it and unfortunately a lot of the families that I work with don't have that mental space to think about these things. In a way that's possibly why they're coming to see me because we create that kind of holding space of actually how can we think about things differently how can we flip the narrative. You know how can we change the perspective as well, which is also why I talk about the strengths based model because sometimes families need to hear things from it's kind of witnessed from a different position. So for example I'll come in with my ideas and they'll think I haven't thought about that, and they're receptive to it we have to be receptive to these ideas. And sometimes when we're under stress. You know I think the pandemic is a good example of that when we're juggling lots of different plates. It is hard to create that space it is hard to kind of think, actually, how do I fill my vessel, because actually filling my cup is really important right now. You know, and actually, as adults we're role modeling for our children as well. And this isn't about guilt. It really is not about guilt because we all this about being good enough. We never aim for perfection when it comes to parenting ever, but we're just looking at how can we be good enough, how can we feel safe, where we are, recognizing that there's uncertainty. So for example, someone that influenced me a lot in my training was Barry Mason, who sadly passed away, a family therapist and he talked about a model of kind of safe uncertainty, safe certainty, unsafe certainty. It's like a quadrant model. And, and I think what what really kind of sticks out for me is how do we create a space for ourselves as clinicians as teachers, for example, working in schools as parents, where we can tolerate uncertainty but feel safe with it as well. And what is it that we need to do what do we need to have in place in order to do that, because sometimes we just can't we can't do everything by ourselves. You know, sometimes we need that friend who's going to hold a space and we can have a cry with sometimes we need our partners to understand what's going on for us. Sometimes, you know, we need to take a break sometimes maybe we need to say to our kids. I'm really sorry that, you know, Mummy flipped her lead, but you know, it's okay this is all kind of, you know, we can repair things, you know, it's, you know, nothing, nothing is so broken that it can't be kind of improved in some way. And I suppose that's kind of why I call myself a child and family psychiatrist because I really feel that if we can look at the perspective of the family, look at the perspective of or the system supporting the child, create some space so that we can allow some of the hidden stories to emerge to look at the strengths and resources of the family of the parents or the carers whoever's looking after that child. I think that's, that's really that that can be very helpful, and it's more sustainable as well, because actually, it helps to put the power away for me, and into the kind of life, so that the family think actually I can take a bit of control here in doing things differently. When my child is getting really upset, and I try and kind of tell them not to do something a certain way and they're not listening to me. Maybe it's because they're not their brains aren't receptive to it, maybe they're just so stressed out that what they need is a cuddle, or they need me to connect with them differently, so that then we can have that conversation about what didn't go so well. And I suppose also appreciating that children and families want to do their best. So we come from a position of actually kids who are struggling, who are maybe doing things that society doesn't want them to be doing. Or that schools don't want them to be doing or even me, you know, and kids that will maybe present with quite destructive behaviors, for example, you know, self harming behaviors that actually these kids and families they really want things not to be like this. So how can we help to stick things they've kind of got themselves a bit stuck so how can we create some space again it's about creating that what I call a third space to really look at what else could be going on. What about when things do go wrong so just like I mean on a not not not over time but that idea of parent flips their lids because perhaps they've been trying and trying and trying and being able to do the calm thing. And then just that final time they lose it and they get really angry with their child. That might have happened to me yesterday, perhaps. What's the best way of kind of repairing that rupture I'm always teaching people that it's okay to have those moments, it's how you repair it that really matters but what's your advice on that. I'm sure everyone listening wants to know too but please help. I think it's this is this is my perspective isn't it and I'm sure there'll be lots of other kind of ways of approaching the situation but I'm really kind of a lot of my work has been influenced by people like Seagal who talks about kind of the whole brain child, talking about kind of kids and parents kind of flipping their lids and the disconnect between the more developed kind of the upper brain and the lower brain so kind of thinking about the logical brain and the emotional brain. And you know sometimes I will actually just talk it depends on the family and what they're open and receptive to. Sometimes I will talk about the brain and how it works and what it looks like and talk about things like the amygdala I'll even teach children these things and kind of explain that when things go wrong, you know, when there's a crisis that actually that's okay this is an opportunity to actually reflect and once things have calmed down so not when you're in the heat at the moment, that's never a good time to have these discussions actually then reflecting on things and maybe going back to your child and having depending on the age of the child and where they are mentally, you know, having a conversation to say look, you know, things were really difficult, you know, I'm really sorry that that happened or, you know, I think apologies go a long way don't they because what we're doing is we're all modelling that actually it's okay to have these emotions there's not kind of good or bad emotions. It's human to experience a range of these and actually it's okay to sometimes get upset as well and getting upset has consequences though doesn't it. So, I think it's being able to talk about that not in our emotional kind of guilt fueled kind of way but being able to say like this is what happened. You know, what what could we do differently next time you know what could we learn from this experience. And maybe mommy next time will you know, if you're not able to kind of listen to the instructions maybe maybe we can take take a break from one another. Maybe you can try something else maybe you could try your breathing, you know when you're getting really upset or angry so I think it's about giving some strategies and tools but also to recognize that it's okay to apologize and it's okay to I think sometimes as parents, we might try and be really calm when actually it's okay to say I know this is actually really difficult and you know to almost like join the emotions so actually this is really difficult this is hard. I can see that you're really upset I can see that this is frustrating for you. I can see that you want to play computer games all day and you know it's it's tough, but actually this is what I think we should maybe do what do you think about this and I think it's about being able to have a conversation with your child, and not to shy away from it either because I think often as parents we, we might think actually it happened yesterday so we don't need to think about it, you know it's fine we'll just move on, and then it happens again. So how can we use it as an opportunity just to really think and learn. Thank you that's really helpful. Go and apologize to my daughter. And I think I do think that is a really important thing to note actually, and while we're talking about this is, you know we talked about being human and I do lots of teaching around how to be the adult that children need and being that calm and caring person theory around it. And I think it's important to acknowledge that it's really hard isn't it, but as a parent. I get it wrong all the time, and I'm trying always to learn and I do try to be curious and I do try to apologize but there are moments that I'm really ashamed of myself as a parent and you know we can beat ourselves up about it or we can try and learn from it and and move on but we all get it wrong and I mean, I don't know. People often seem to find it deeply reassuring to know that yeah my house has shouting in it sometimes too. Yeah, I mean look, this is this is not about just one way of parenting right but we're always kind of these calm parents that kind of we get it right all the time of course we don't get it right all the time. Of course we're always learning, and you know I've got I've got two children so I've got two boys, and they're very very different. They're very different in the way that they think in the way that they look at situations in the way that they problem solve, and therefore as a parent I forget about being Dr Amber as a parent. I need to really look at those, you know, like my two boys and think, actually what approach do they need, because actually it's going to be quite different. And, you know, what are their strengths, and sometimes their strengths might be things that I've never done before so my son's musical I'm not very musical but that's okay that's alright you know. But actually, by developing those strengths, I can see that he's so much happier, because he's then able to apply some of that learning into other areas of his life. And, you know, and I think kind of, you know, if we can accept that parenting is tough that maternal anger paternal anger, you know these emotions these are real, you know, we feel these things, but they don't define us. We can have a flip out moment, you know we can all have those, but that doesn't make us into bad parents or bad carers or, you know, terrible but you know everything's just going to our child's going to be kind of damaged as a result of this. And actually, these are all opportunities and actually this research that's been done, it hasn't there like you'll be able to maybe say more than me where if you're too tuned in, almost kind of like to mirroring your child, that can actually not be helpful either that kind of idea of being a perfect parent actually doesn't offer any I mean it's first of all not even realistic but second of all aspiring to be that perfect parent doesn't allow any space for the reflection for the space to think. How can I do this differently? How can I think about my child differently? Maybe what I was wanting for my child actually isn't the best thing for them. Maybe we have to try something else. And I think that's actually really healthy. That's a really healthy place to be in but like I said before, I recognize that it's not always easy. That's why families welcome you know often the child will bring the family into the room or into the clinic, but actually often will open up a conversation like this, where we're curious, we'll try and unpack things and just try and figure out the best way forward. Yeah, and always hanging on to being human seems to be the key thread here doesn't it let's be human and curious. And before we wrap up, I just wanted to ask you about something completely different, which was that I know your Twitter profile so Twitter is my happy place. And but you know Twitter profiles are short but you have mentioned women Ed in yours so I'm assuming that's something that you care about or involved in. Would you mind just saying a word or two about it for people who might not know what it is or who it's for. Yeah, just women Ed. It's really about kind of promoting women in kind of having a voice creating a space for women in education. And for me, it's about kind of being a woman who has her own differences, who kind of brings a different voice, you know, maybe a more diverse voice, a different education voice, a Scottish voice into kind of the kind of education sphere. And when I'm thinking about women Ed it's more around looking at medical education so looking at kind of public mental health. So really offering a different voice because often, you know, for me growing up, I didn't see many women that were like me. When I was younger talking about things or advocating for health issues. And it tend, it tended to be when I was younger, older white males. And that's just the way that things were set up then it's not you know I'm not not blaming it or wasn't a problem. I am where I am today for those reasons but, you know, I just think it's really important to kind of have diversity in how we make sure that we promote voices that are not heard subjugated voices voices that are less dominant. And I suppose that's kind of what I want to push for. And I think obviously being a woman it's, it's kind of really important because I think often women's voices haven't been given that space but I think there definitely has been a shift over like I'm really looking at the past few years where I love Twitter for that you know I think social media is a platform for us to find a space. And there's many spaces. Okay, there's lots of lots of room for different views and different perspectives. And that's that's what I would say women's ed is. Thank you for that just I think some people listening might be interested to know more and yeah and it's and I and I love that idea as well of, you didn't have role models like you and so now you're the role model for the next generation which is such a lovely lovely What sort would you like to close with. I think you know it's it's really thinking about that that child who is presenting with all the problems and presenting with all those issues and all those challenges and things feel really really stuck. As the adults as the professionals as the parents as the carers as the teachers to really ask the question, you know, how can we understand this situation differently. How can we formulate how can we help this child shine their light to us and really kind of show us their strengths show us what they're capable of. And if we can kind of hold that position that children and families actually really want to do their best in life, but they might not have the strategies or the tools to be able to do so, or they might not have the story. They're really telling the right story about themselves that actually I would just like people to hold these questions in mind so that we can really work towards helping children and