Tuesday, 8 July 2025

How a bio-psycho-social approach supports people with chronic pain




We evaluated an innovative service in South London to assess impact and replicability







The PEACS Project

The PEACS (Pain: Equality of Care and Support in the Community) service was an innovative approach to chronic pain management that adopted the bio-psycho-social model, delivered by King’s Health Partners Mind & Body Programme in collaboration with the StockWellBeing Primary Care Network in Lambeth.
Context and challenges

Chronic pain affects approximately 34% of UK adults and has profound impacts beyond physical discomfort, influencing employment, mental health, and quality of life. The burden falls disproportionately on certain populations, with women, people from lower socioeconomic backgrounds, and Black communities experiencing higher prevalence rates. Traditional medical approaches often fail to address the complex interplay of physical, psychological, and social factors that influence chronic pain.
Goals of our work

The Tavistock Institute conducted an independent evaluation of PEACS between July 2022 and December 2024, seeking to assess:The development and implementation of the service across five GP practices
The impact on participants’ experience and health outcomes
The impact on the wider healthcare system effects, including healthcare utilisation and costs
The feasibility of replicating the intervention across other Primary Care Networks
What we did

We adopted a developmental and theory-driven mixed-methods approach that combined both quantitative and qualitative elements, includingObservations of intervention workshops
Interviews and focus groups with participants, staff and stakeholders
Analysis of participant surveys and health assessments
Review of healthcare utilisation data, including GP appointments and medication use
Cost-utility analysis to assess value for money
What we found

The PEACS service demonstrated notable success in engaging traditionally underserved populations, with the majority of participants across project cycles and levels of engagement being from Black backgrounds and the proportion of Black participants increasing from Year 1 to Year 2.

Key outcomes included:Improved self-management: Participants showed statistically significant reductions in pain catastrophising scores and improvements in physical health measures.
Reduced healthcare utilisation: Long-term follow-up showed 58% of participants reduced GP visits and 48% reduced medication use over 12 months.
Cost-effectiveness: The programme demonstrated good value for money, with cost per Quality Adjusted Life Year falling within NICE’s acceptable range.
Social connection: Over two-thirds of participants reported feeling less isolated as a result of the programme, with community engagement activities seeing sixfold increase in year 2.
The report

Building on the findings of the year one evaluation report, we published the comprehensive evaluation report in March 2025. The evaluation report provides detailed analysis of PEACS’ development, implementation, outcomes, and potential for replication. It offers insights for healthcare professionals, commissioners, and policymakers interested in addressing health inequalities, particularly for those working with chronic pain management in diverse communities.

Key findings suggest the bio-psycho-social approach adopted by PEACS effectively balanced reducing unnecessary healthcare utilisation while improving access for previously underserved groups. The report highlights both the successes and challenges encountered, providing practical recommendations for future implementations.
Download report



SOURCE:

Πώς να υποστηρίξετε συναισθηματικά το παιδί σας αν δεν τα πήγε όπως ήθελε στις πανελλήνιες



by Αγγελική Λάλου
2 Ιουλίου 2025




Μια δύσκολη περίοδος όπου το παιδί σας χρειάζεται υποστήριξη για να δει ότι δεν είναι το τέλος του κόσμου


Ως μητέρα, υπάρχουν στιγμές που ο πόνος του παιδιού σας μοιάζει με τον δικό σας. Το να βλέπω τον γιο μου να περνάει την πόρτα, με τα μάτια χαμηλωμένα, στεναχωρημένος από τα αποτελέσματα των πανελληνίων ήταν μια από αυτές τις βαθιές στιγμές. Σχεδόν άκουγα την καρδιά του να σπάει βλέποντας την απογοήτευση χαραγμένη στο πρόσωπό του. Είναι ένα πράγμα να αντιμετωπίζεις την αποτυχία ο ίδιος, αλλά το να τη βλέπεις στο παιδί σου είναι μια αγωνία απαράμιλλη.

Κατανοώντας το συναισθηματικό φορτίο

Στο σπίτι, η επιτυχία και η αυτοεκτίμηση είχαν σημαντικό βάρος για τον γιο μου. Είχε αφιερώσει την καρδιά του στο διάβασμα – άυπνες νύχτες, στοίβες από βιβλία, ατελείωτες δοκιμασίες εξάσκησης. Για αυτόν, τα αποτελέσματα ήταν κάτι περισσότερο από βαθμοί. Ήταν επικυρώσεις της προσπάθειας και των ονείρων του. Η συντριβή του ήταν ένας ανεμοστρόβιλος συναισθημάτων: θυμός, θλίψη, αυτοαμφιβολία. Τα είδα όλα να εκτυλίσσονται στα μάτια του, και όσο κι αν ήθελα να το μαλακώσω όλο αυτό με μια αγκαλιά, ήξερα ότι χρειαζόταν περισσότερα.
Μερικές φορές αρκεί το να ακούς

Το πρώτο ένστικτο ως γονέας είναι να διορθώνει τα πράγματα, να λέει κάτι σοφό και παρήγορο που επανασυνδέει όλα τα μικροσκοπικά σπασμένα κομμάτια. Αλλά στην πραγματικότητα, το πιο βαθύ δώρο εκείνη τη στιγμή ήταν η προσφορά σιωπής. Κάθισα με τον γιο μου, αφήνοντας τα συναισθήματά του να ξεχυθούν χωρίς διακοπή. Το να ακούω την απογοήτευση και τον φόβο του να εκφράζονται χωρίς κρίση ή μια διάλεξη «Θα τα πας καλύτερα την επόμενη φορά» ήταν ανακουφιστικό για εκείνον και αποκαλυπτικό για μένα.

Δίνοντας έμφαση στην προσπάθεια έναντι του αποτελέσματος

Όταν ήταν έτοιμος να μιλήσει, συζητήσαμε την προσπάθεια έναντι των αποτελεσμάτων. Οι βαθμολογίες στις εξετάσεις μπορεί να είναι ένα παραπλανητικό μέτρο νοημοσύνης ή δυναμικού. Του υπενθύμισα τη δέσμευσή του, την ανθεκτικότητά του στις δύσκολες μέρες και πόσο περήφανο με έκαναν αυτές οι ιδιότητες. Η ζωή αποτελείται από δοκιμές και λάθη, όπως ακριβώς μαθαίνεις να κάνεις ποδήλατο – η πτώση δεν είναι αποτυχία. είναι εξάσκηση για ισορροπία!
Μοιράζοντας προσωπικές ιστορίες

Σε στιγμές σαν κι αυτές, η ειλικρίνεια γεφυρώνει τα κενά. Διηγήθηκα τη δική μου παρόμοια εμπειρία όταν η ζωή δεν πήγε όπως είχε προγραμματιστεί και το ταρακούνημα της αποτυχίας παρέμεινε περισσότερο από το αναμενόμενο. Αυτή η διαφάνεια του φάνηκε ανακούφιση, καθώς καταλάβαινε ότι η μητέρα του δεν ήταν τέλεια και είχε κάνει τα δικά της λάθη. Ήταν μια υπενθύμιση ότι δεν ήταν μόνος σε αυτόν τον δύσκολο δρόμο.
Δημιουργία ενός υποστηρικτικού περιβάλλοντος

Μαζί, καταστρώσαμε ένα σχέδιο – να μην ασχοληθούμε με το παρελθόν, αλλά να χτίσουμε νέα σκαλοπάτια. Ίσως χρειαζόταν μαθήματα ή μια ομάδα μελέτης. Ίσως ένα χόμπι για να επαναπροσδιορίσει το μυαλό του και να αποκτήσει προοπτική. Μαζί, αναλύσαμε στρατηγικές, ώστε η πορεία προς τα εμπρός να φαίνεται λιγότερο τρομακτική και πιο ελπιδοφόρα. Δεν επρόκειτο απλώς για τη βελτίωση των βαθμολογιών του, αλλά για την ενίσχυση της αυτοπεποίθησής του και της ψυχικής του ευεξίας.
Κατακλύζοντάς τον με αγάπη και ενθάρρυνση

Αν και το ταξίδι ήταν προσωπικό, τον περικυκλώσαμε με αγάπη μέσα στον οικογενειακό μας κύκλο. Γιορτάζοντας τα δυνατά του σημεία που οι εξετάσεις δεν μπορούσαν να ποσοτικοποιήσουν, τον βυθίσαμε σε χόμπι και πάθη που τον τόνωναν εκτός ακαδημαϊκών ορίων. Αυτές οι στιγμές του υπενθύμισαν την πολύπλευρη αξία του πέρα ​​από την ακαμψία των αποτελεσμάτων.

Ενδυνάμωση μέσω σύνδεσης

Ο ρόλος μου δεν ήταν απλώς αυτός της μητέρας, αλλά μιας άγκυρας ακλόνητης υποστήριξης. Το να τον ενθαρρύνω να συνδεθεί με φίλους και μέντορες που τον εκτιμούσαν για τις ιδιορρυθμίες και τον χαρακτήρα του –όχι για τους βαθμούς του–- βοήθησε στην ενίσχυση μιας ευρύτερης προοπτικής. Η κοινότητα έγινε πηγή ενδυνάμωσης, αποκαλύπτοντας την απεραντοσύνη της ζωής πέρα ​​από αυτό το μοναδικό εμπόδιο.
Στοχασμοί ανάπτυξης

Καθώς περνούσαν οι εβδομάδες, παρατήρησα ανεπαίσθητες αλλαγές. Το γέλιο του γιου μου επέστρεψε. Τα βαριά σύννεφα της ήττας άρχισαν να διαλύονται. Συνειδητοποιήσαμε ότι η ζωή είναι πιο ανθεκτική από μερικά αποτελέσματα. Αυτή η εμπειρία ήταν ένα υδατόσημο ωριμότητας, που γινόταν όλο και πιο δυνατή με το ξεθωριασμένο κεντρί της.

Να θυμάστε

Ως γονείς, εύχομαι να μπορούσαμε να προστατεύσουμε τα παιδιά μας από τα χτυπήματα του κόσμου. Ωστόσο, όπως έχω μάθει, η μεγαλύτερη δύναμη έγκειται στην απαλή καθοδήγηση και την άνευ όρων αγάπη κατά τη διάρκεια των δοκιμασιών τους. Το να βλέπω τον γιο μου να συγκεντρώνει το θάρρος του, να αγκαλιάζει την προσαρμοστικότητα και να αναζωπυρώνει τα όνειρά του έγινε η απόλυτη ενδυνάμωση.

Λοιπόν, θυμηθείτε: καλλιεργήστε την ανθεκτικότητα, καλλιεργήστε την αυτοεκτίμηση πέρα ​​από τους βαθμούς και μείνετε ακλόνητοι κατά τη διάρκεια των καταιγίδων. Διδάξτε τα να εμπιστεύονται τη διαδικασία, γνωρίζοντας ότι ενώ το μονοπάτι μπορεί μερικές φορές να ξεμακραίνει, πάντα οδηγεί εκεί που είναι γραφτό να βρίσκονται. Μέσα από αυτό, μαθαίνουν ότι δεν είναι ποτέ μόνα τους, οπλισμένα με τη γνώση ότι η μαμά είναι δίπλα τους, στηρίζοντας σθεναρά, ανεξάρτητα από το αποτέλεσμα.


ΠΗΓΗ:

Wednesday, 2 July 2025

Talking About Sex Too Much With Friends



https://megjohnandjustin.com/sex/talking-sex-much-friends/


This episode we addressed a question sent in by a listener about talking about sex with their friend. Specifically they wanted to know what to do when most of their conversations with their friend revolve around sex, sometimes around other people and in workplace contexts, and they would like to talk about other topics sometimes too.



We started the show with a couple of caveats. First off of course we don’t want to shame people for being interested in sex. Generally speaking, it’s great if sex can be a topic of conversation that friends can talk openly about. It would be wonderful if people did this a lot more in our culture which has so much shame around sex. Second it’s worth thinking about who does and who doesn’t get to talk about sex in our society. Often it’s culturally accepted that more normative people get to mention their sex and relationship lives in a way that less normative people don’t, in the same way that we see far more representations of those kinds of sex and relationships in the media (e.g. heterosexual, monogamous, couple relationships). So, for some people, talking about sex as a non-normative person can be an antidote to the shame of having their sex lives erased.

That said, there are certainly some possible consent issues here.

First, it’s worth attending to where talking about sex strays into actually having sex. Things like talking dirty and sexting count as having sex. Whereas talking about your sex lives with no arousal on the part of either friend doesn’t count as having sex. But there is a grey area between these where one or more person might be getting a frisson out of talking about sex with a friend, either because they want to be sexual with that friend and it’s a kind of flirtation, or they just find it exciting to talk about sex. Like all kinds of sex that’s only okay if both people are consenting to it. It is possible that discomfort on the part of one person might be because they’re picking up that this sex talk is in the grey area and therefore not consensual. That’s definitely worth raising if you feel able, and it should be on the person who is finding it sexy to be checking out the consent of what they’re doing.

Even if the conversation is very clearly in the ‘friends talking about their sex lives’ category, consent is an issue whenever one person is dominating or controlling what gets to happen in a relationship or interaction, for example if all the shared activities are the things they most enjoy, or if all the conversation is on topics they are most interested in. Ideally the person with the most power in the relationship would take responsibility for ongoing consent check-ins that the other person is comfortable, and getting their needs met from the relationship/conversations too, and that this is balanced and mutual. For example, culturally men and people in powerful positions tend to speak more in conversations than women and people in less powerful positions, so it’s important that they take some responsibility for making enough space for people with less power and privilege to be equally involved. There’s more about navigating consent in our video on the topic: you might think about what a second and third handshake approach might look like in relation to conversation topics.

In terms of what you can do if the other person isn’t attending to these imbalances between you, you could open up a meta-conversation about the kinds of things you talk about together, maybe using the Venn diagrams from our relationship user guide to get explicit about what topics you are each interested in and where the overlaps might be – recognising that this can change over time and that’s okay. You could explore why sex is spoken about so much in this relationship. For example it could be that your friend has nobody else they feel safe talking about these things with – in which case they might explore online or offline groups, or consider if it’s possible to bring this into their other friendships to take the pressure off this one. Again it could be good practice in all relationshi​ps to have regular check-ins about the kinds of things you end up talking about and whether everyone’s desires and needs are being met by this.

© Meg-John Barker and Justin Hancock, 2019

SOURCE:

Peace, wisdom and resilience for a changing decade



Our editor Dr Jon Sutton reports from the opening ceremony of the 19th European Congress of Psychology, in Paphos, Cyprus.

01 July 2025

Over many years, and several European Congresses, I've seen a fair few 'Psi' symbols turned into a tree for a conference logo. But, as Conference Chair Dr Eleni Karayianni pointed out in this opening ceremony, there's something particularly fitting about the olive tree. It signifies peace, wisdom, resilience: core values driving psychologists in their mission to support human wellbeing. 'Let this be a space,' she continued, 'to innovate, collaborate and translate' in order to face the challenges of what the European Federation of Psychologists' Associations have termed 'the 2030 agenda'.

Poly Gregora has been advocating for mental health in Cyprus since she was diagnosed with bipolar disorder almost 20 years ago. Here, she deployed the myths and tales of her land – including three beautifully animated short films, directed by Markos Kassinos – to remind us that truth and meaning can be found not only in science, but in story. Oral traditions bring to life forgotten faces from the past, a way to reflect and make meaning in an increasingly chaotic world.

Many of these myths are grounded in fear, confusion, change. And so through the films we heard of hostile forces (very much a psycho-political backdrop to this event), of lost beauty, of passion and love. There are a lot of huge rocks scattered across the island, in strange formations and unusual shapes. Cypriots have woven tales around these rocks and how they ended up where they did (including Petra tou Romiou, shown above). When the rocks splash into the ocean, said Kassinos, the concentric circles spreading out from them serve as messages and emotions from a parallel world, the 'truth of life'. Such stories are also 'tools for reflection', Gregora said, showing that we can – as she has, as an Expert by Lived Experience – turn our greatest fears into assets.
'A clear, rational, evidence-based understanding of reality'

Next up, the incoming President of the Cyprus Psychologists' Association, Dr Evita Katsimicha, urged that 'Psychology can and must be involved to meet the challenge of the decade ahead'. Professor Christoph Steinebach, at his last European Congress as EFPA President, welcomed 'Mrs President', noting that 'Perhaps the world needs more Mrs Presidents'. He insisted that although 'the sheer pace and complexity of global crisis can feel overwhelming… Psychology must, and wants to, step forward to help'.

In this endeavour, Steinebach said, the United Nations Sustainable Development Goals should be our guide. Noting our proximity to the foundations of stoicism, he called for 'a psychological science that is based on a clear, rational, evidence-based understanding of reality'. Practice must be research-informed, and research practice-informed.

Complex times also call for tricky balancing acts, and Steinebach encouraged us to escape the 'ivory tower of pure research', while also ensuring that Psychology doesn't descend into 'mere activism'.

There's sure to be lots to explore over the coming days in this context. I will be chairing discussion panels on digitalisation, climate change, and the European Year of Mental Health; alongside others on policy making, open science and children's mental health; plus countless papers and posters. I'll do my best to update this page as the conference progresses.

SOURCE:


Friday, 27 June 2025

You get to choose your hard thing



Chartered Psychologist Dr Jennifer McClay with a personal and professional take on ‘emotionally-based school non-attendance’, or ‘school refusal’.

20 June 2025



My parents wanted me to be okay and to learn, so they did what they were told was right to get me into school. Things like, 'don't let her watch TV or do nice things', don't make home too comfortable', make her get up and sit in her school uniform each morning'. Typing this, I can still feel the skirt digging tight, collar scratching, cuffs scraping, shoes rubbing – locked in a school uniform cage. Terrified, because it put me one step closer to school.

I limped on only as far as my second year of high school and left with no qualifications. But I'm the first person in my family to go to university, earned my PhD at 25, and later qualified as an Educational Psychologist. I think that shows grit: 'perseverance and passion for achieving long-term goals... maintaining effort and interest over time'. As does the fight my own daughter put up to never walk through that school door again. If there's one thing that girl has in abundance, it's grit.

My mum told me recently that a turning point for her had been when she took me into school for a meeting. She said she couldn't believe the physical change in me. That I curled in like a terrified animal, and she could see the genuine and pure terror. Before that, she didn't get it. She didn't realise that I was experiencing such visceral fear.

Education professionals have moved on in how we conceptualise school refusal, redefining it as school phobia, and landing now on emotionally based school non-attendance/avoidance (EBSNA/EBSA). 'It's can't, not won't' is a phrase used to help people understand. But despite our renaming and reframing, I don't feel that day-to-day practice has moved on all that much. On the ground, parents are still often under immense pressure and intervention can remain heavily within child. When resources are tight and there are often few options or accommodations, there is still an assumption that this child should go back to school. And because of that goal, 'school refuser' can still feel closer to the reality.
The retreat from school

It's quite alien to me when people puzzle over EBSNA: as if it's incomprehensible why children might not want to go to school. With the sensory challenges, the social difficulties and anxieties, the exhaustion of managing the demands and interactions and touch, sounds, smells, talk, response, eyes on you and words coming at you not understanding what the other kids mean, why they're laughing, why the teacher seems so annoyed and everything feels wrong but you don't know why… I'm baffled by people who manage places like school with ease, even pleasure.

There's a family I know who do everything, dance, martial arts, scouts, choir, any and all social events, and somehow I only recently had the epiphany that it's because they like these things and find them enjoyable, restorative, and fun, not stressful, overstimulating, and exhausting. How different folks can be. It makes me think of Boyce's The Orchid and the Dandelion, the beautiful neurodiversity as biodiversity model, and how we're not right or wrong, normal or pathologised, just all different as carrots and apple trees.

Thanks to the internet, we're more informed these days about neurodiversity, school trauma, stress, and burnout. But many parents and professionals still report hearing the same advice as my parents did. The pressure on children and their families is enormous. And it still feels like, rather than accept there may be problems with school – the whole entity – a lot of time can be spent questioning what's wrong with the child and family. Questions of cause rarely seem to centre on school, and even if they do it's assumed without question that this child should go back.

When retreat from school is gradual, change rarely comes quickly enough to help. Or is enough. Adaptations aren't given freely. There are many high and costly hoops to jump through. Often we see a pattern where the child struggles, cracks appear, help is asked for, but the problem isn't bad enough yet, it gets worse, things may change but by then it's too late – the child is traumatised and burnt out. Or sometimes the retreat is sudden – or, more accurately, it seems so on the outside, when the mask of okay-ness suddenly crumbles.
'Touch the gate'

In her wonderful book, Your Child Is Not Broken, Heidi Mavir (founder of EOTAS Matters) describes a meeting where the teacher asks her to drive her son to school to touch the school gate, as a kind of exposure therapy. Her son suffered a fairly sudden burnout early in secondary. Heidi knows that touching the gate won't ever help because the problem is what is on the other side of it. 'I knew that,' Mavir writes, 'and I think Susi also knew that, but her painted smile and expectant look didn't give me any room to say no.'

I've been that kid. Been that parent. Had that meeting. Seen that expression. And, like Heidi, I've jumped through that hoop (or a very similar one) because if you don't it's even more your fault. And when Heidi tells her son he can trust her, he replies, 'I can't though can I Mum? When will you stop trying to trick me?'

This kind of exposure therapy can't work. As Naomi Fisher says, you can't desensitise someone's fear reaction with exposure to a stimulus that is actually terrifying. Using exposure to desensitise a kid like me to school is a bit like taking someone frightened of dogs and trying to cure it by gradual and controlled exposure to a XL bully with rabies.

And isn't that part of the issue? We agree it's emotionally based in fear, but some professionals don't see that the fear is justified? For them there is nothing to fear, whereas for some people, there is. It hurts to be there. And maybe, to quote Keiran Rose, who said about his autistic experience, 'you don't have to understand, you just have to believe me'.

Some people link Covid to an increase in EBSNA, and that may well be true. But many of us see that reason differently. It didn't damage us. During Covid we saw a better way – smaller class sizes, remote education, less mixing and moving around, more personal space. Then all that was whipped away from us.

A child who uses a wheelchair can't go up the stairs - can't, not won't. They use the lift. And if there isn't one, we put in a lift. We don't ask them to build up their arms and drag themselves up the stairs. They can't. Yet with EBSNA (and other mental health conditions), while it may be said, it doesn't feel like the 'can't' is always taken seriously. Messages can remain that these kids just need grit, resilience building, self regulation.
The context

For families, the pressure from all sides is as invisible but present as the air you breathe. Parents and children generally encounter instant demands to return and keep up expectations of attendance, keep links, keep pressure on. And when the child can't, there is such judgment of parents. 'You must be too soft, boundaries aren't clear enough, it's separation anxiety'… and this happens to parents when they're already vulnerable. As a parent, you are exhausted, you are down and doubting yourself, and you are kicked. There is a lack of choice in our education system. For families who have a child that can't attend mainstream, they are often left without choices or options.

And despite our reframing as EBSNA, analysis of the problem and suggested solutions still often remain within child. Contributing factors are analysed. Factors such as screen time, for example, are often interpreted as part of the problem, as causal – a child is staying home to spend time on screens – not considering that this may be the result of school-related trauma and a coping mechanism and means of regulation for a burnout child in crisis (see Naomi Fisher for the role of screens). Interventions can be heavily skewed to within the child – it is for the child to learn to self-regulate, build resilience, and adaptations to the environment receive less focus.

To honestly engage with families, we must address the elephant in the room – it isn't just this child who is struggling in a context that is otherwise fine, well-designed, and fit for purpose. The system is over-stretched, under-resourced, and lacking appropriate training and support from other agencies (see the EIS position statement of November 2024). But while we may at times admit it, it is not officially acknowledged. It may be said in the meeting, but it doesn't make the minute. So in practice, blame – or 'responsibility', if that is less emotionally laden – slides off the system and lands on the child and family.

It's not just the kids who can find school a hard place to be these days. I believe most of us in education now are familiar with the news that another colleague has been signed off with stress and isn't expected to return anytime soon. We all see daily news about teachers struggling in schools, their pain and frustration that there is no help to meet the needs of the children before them. The class teacher cannot do it all.

The difference in the experience of child and adult is in the power imbalance and the twisting of the right to education into an obligation to attend school. Imagine the stressed Class Teacher, Pupil Support Assistant, or Head Teacher at the GP in tears, to be met with the response, 'Well, you have to keep going, it's so important for your future, your career progression. How's it going to look if you're off with stress? Everyone else is managing, why are you any different? Think of everyone you're letting down. What if you lose your job? Think of your bills, your mortgage. If you are off, make sure you call in everyday, make sure you get back as soon as possible, don't forget we expect you back. Get up and dressed for it and try every morning. You just need grit.'

These messages are still being given to some of our vulnerable children. And their families. That needs genuine and serious reflection. How does that feel to hear? What may the ripples be from that message, and how far and how long do they travel?

What should be said instead?

'It will be okay'

'When a child is burnt out, it's alright to take a break. They need to recover.'

'Don't worry, you have options.'

'We can help you.'

Perhaps if nothing else, then at least, 'It's not your fault'.
Grit or compliance?

Angela Duckworth defined the psychological concept of grit as a combination of passion and persistence, with success not a matter of talent or innate intelligence, but of attitude, effort, enthusiasm, and consistency – 'passion and perseverance for long-term goals'. But those goals are the goals of that individual, not somebody else's. The passion they follow is their own, not their parents' passion, not their teachers' passion. Duckworth states this in her Hard Thing Rule – everyone has a hard thing they need to do, you don't get to quit in the middle, and you get to choose your hard thing.

How can you find passion in something you don't want to do? Following someone else's or society's demands? This is not passion. This is not grit. This is compliance – submitting to the demands, wishes, or suggestions of others. Or it's conformity – adjusting behaviour to be more consistent with the opinions of others or the normative standards of a social group. Our education system requires compliance and conformity, not grit.

There is a wide literature on the inefficiency of and damage caused by coercion, and the importance of choice and voluntary action for positive change (e.g. Kurt Lewin's work on managing change). We know that increasing pressure creates conflict, resistance, and resentment (see Sam Harris's interview with Daniel Kahneman for an interesting discussion of this.) And we know it can reduce motivation, a key ingredient of grit. So, all other things aside, the approach many still take to EBSNA is unlikely to work as it is built around applying pressure to children and families.
Now and next

Let's take the refusal out of EBSNA and truly accept can't not won't. Instead of trying to make them go and then trying intervention after intervention aiming to help them tolerate the intolerable, we could be truly child centered – consider what this child needs first to heal, right now. Positive experiences, recovery, screen time, rest, agency, and then what next?

If we're not making changes first, if we're not putting in the lift, how can we ask the child to just try harder? With persuasion, pressures, coercion, with ear defenders, time outs, self-regulation, five-point scales, is this in their long-term best interests? What are they really, deeply learning about life and their place in it from being in school in this manner?

Covid showed us other ways, some in schools and some not. Remote education, for example, is now plentiful in the private sector, with many models from live online full days to 'pick and choose' courses. But often they aren't cheap. In Scotland, I-sgoil is a remote school offering interactive online learning (at home or as a hybrid model) for those unable to attend school.

It's not for everyone, but nothing is. And that's really the point. We need more choices within the current system, and to work towards a system that truly does value grit over compliance.

Dr Jennifer McClay (CPsychol)

Educational and Child Psychologist

Wave Psychology

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