The Neuro Clinic
The Neuro Clinic
Penny Trayner and Pip Calvert on Adult and Child Neuropsychology
Penny, Pip and Ingram discuss the distinctive nature of adult and paediatric work focusing on contextual and legislative difference in addition to professional training and practice boundaries.
So, welcome to the neuro clinic we've had a bit of a break, but this is the 11th podcast yay that's quite exciting that's quite exciting I also. exciting is having two guests hip calvert and penny trainer who have joining us for the second time, so you obviously work off first time round. penny you in podcast to and pip I think podcast I think you were in a relative newcomer to the clinic but i'm delighted to welcome you both back and. I, it will be really helpful, I guess, if you'd introduce yourself just to remind people who who can't remember podcast to and who you are penny, do you want to go first.
Dr Penny Trayner:yeah thanks, and thanks for having us back penny trainer I am a pediatric clinical neuropsychologist and the clinical psychologist so I work in central Manchester I cover most of the north of England actually all of UK well actually a couple of England, Wales, shall we say. Up to the Scottish borders, and I do work in brain injury rehabilitation Community based brain injury rehabilitation and last time I was here, I was talking to you about DJ and for rehabilitation so yeah bit of a different conversation today so thanks again for having a spark and. penny.
Ingram Wright:And pip. Yes.
Pip Calvert:And so i'm pip Calvin i'm a consultant clinical neuropsychologist technically I guess clinical psychologists and i'm a cognitive analytics therapy practitioner and sorry my cat is about to come and join us because he's he's heard us talking so he has to be involved and I work in adult. Well, at all and above and so anybody from 16 and above in my NHS work would also in private practice i've turned it to where it was 16 year old 15 year olds and above. And, and I work on we're all private wise i'm not really done an awful lot recently, but I used to cover the north mainly the Northwest.
Ingram Wright:And you happen to know each other.
Pip Calvert:We do so penny and I were on the Liverpool training course penny with the year above me. And then yeah I think it's more after we both qualified that we started to get to know each other, a bit more, we were in we went to a training course that john Evans, to put to. put on a class guy or just spend the day together that I didn't wait and chatting about things and ever since we've just we've been in each other's lives yeah.
Dr Penny Trayner:Absolutely and we're actually the reflective practice group together, you know the little the peer support groups that Liverpool had, which was fantastic actually and actually. You know i've got some my strongest psychology friendships from those groups so thoroughly recommend them for future courses, but yeah pippin I also. have worked together jointly on cases where it has intersected between the pediatric world and the adult world and so we've done that sort of joint working before. sort of handing over of cases as well when i've handed over from you know child work into the adult world So yes, something we've worked on together before yeah.
Ingram Wright:And we're here today, because one of the topics that's come up and people wanting to hear about was it was about differences between pediatric and adult work so. it's no accident that pip you work predominantly I assume with adults and yet and penny with with children, young people. And I guess, one of the first things, probably to clear up is the color terminologies you you describe yourself penny as a pediatric neuropsychologists. I sometimes described myself as a child neuropsychologist sometimes a developmental neuropsychologist I guess all of those terms of relevant aren't they. And we don't only you can have a specialist title temp you know we didn't have protected title so there's a bit of fluidity isn't are in terms of how those how those terms, get used.
Dr Penny Trayner:Well, there isn't there isn't, I guess, from my perspective, I mean, I have the QA CN so the qualification and clinical neuropsychology which i'm presuming both of you do is also and, within that it's the title is pediatric critical neuropsychologist so that's where that.
Ingram Wright:yeah all right so there's kind of visit kind of split isn't man, I guess, one of the things we can. Talk about is the is is there sort of Gray area in between, and how they might be challenges that sort of maybe make that dichotomy seem less clear in some ways. I mean it'd be helpful, I guess, also just to kind of balance things out thinking about would you describe yourself as an adult you're a psychologist.
Pip Calvert:Know whenever anybody asked me what I do I just say I mean you're a.
Dr Penny Trayner:psychologist having to writing.
Pip Calvert:yeah my my poor system, having to write out, you know, under the supervision or and so no I don't tend to introduce myself as as bad oh it's almost more that's I think that's. often seen as the default so it's there more you guys to distinguish yourself, because I think we need to pull back, and I think you need to introduce yourself ingram about what your profession is then. you're gonna you're gonna contribute a little bit.
Ingram Wright:today.
Pip Calvert:yeah can we get you to introduce yourself.
Ingram Wright:yeah so, is it well it's interesting that I will, so I am I got interested in child work, I suppose. did a PhD in sort of development with children with down syndrome, so I got interested in. In development, I had a great experience as an undergraduate you know starting developmental psychology so they've kind of really interested in developmental themes from starts. And and i've worked with children clinically from the start of my career and I haven't done the kyc, and so I guess, one of the things that I can have them. Maybe you know, sometimes feel a little bit uncomfortable about is that. One of the things that I feel i've been responsible for is is making changes in training and implementing robust system, so our training works and becomes even more fit for purpose and perhaps it was at the start. And I guess, one of the challenges for me, certainly that i've experienced is people who work with. Children and young people or people who work across the lifespan people who work with young people who've had had injuries, who kind of see 1415 1617 year olds. and actually occasionally see someone in their early 20s and they consider themselves neither a child or an adult neuropsychologists most of my. NHS practices, because of their their constraints of the hospital system is you know young people up to the age of 16 but also. and occasionally with conditions like tuberous sclerosis complex, there are some of the pediatricians who will hold on to those young people as they enter their early. adulthood and that's entirely appropriate and clinically reasonable. And we tend not to do the same kind of things in your psychology certainly in hs practice because of those constraints, but I am aware of a number of people, I mean cancers and other specialty where. You know, TV services will often you know span that kind of boundary between child services and adopt services, and I think it's. it's tricky in terms of training penny isn't it to kind of think about when people ask the questions about should I trained as a. pediatric neuro psychologists or an adult neuropsychologist when I worked with young people, I guess, my bias is a property in favor of. The pediatric courses, because if you just kind of start from there, you can kind of. You know, watch someone grow and develop but I mentioned, this is probably a challenge to that pip isn't there or both of you really but pip I wonder what you think about that, when you if you have done any work with. People are sort of under 18 under 16 have you found that difficult challenging.
Pip Calvert:I think I suspect it's probably partly conditions specific I think it's very different if somebody has been born with a neurological condition. And or has developed a lot earlier on in life than it is for somebody to have a brain injury it's a 15 when the bordering on 16 courses still. different things to consider about that developing brain. But then, of course, you know as we know, the brain keeps developing into our early 20s so actually I think adults, need to be aware of that they need to know about that stuff. But probably not in as much depth as if you're then going to specialize in working with with people who are under 18 and below. So I think both of his knee you know, from whichever side you're coming from need that awareness, but the level of expertise is probably slightly different. And certainly I would feel competent going in working with somebody who's 1516 who's had a traumatic brain injury or a stroke. And, but probably not if they were born with some of the really quite complex and ran neurological condition, because I don't have the expertise in that. i'd have to scale up very quickly, and then I probably approaching somebody like penny and going Can you see provides me with this or can we at least joint work with it because I don't have that experience in in. And certainly NHS practice that, as you saying there is that really that real cut off and if somebody had a brain injury even say when the 14. They can't really access the adult services you've got to have had the brain injury, as a young person or adult as in 16 and above, so I think the risa that difference and, but I do think it's a little bit more condition specific.
Dr Penny Trayner:yeah and I guess specific to the issues under consideration so that's all my sort of boundary around this as I. it's difficult it's more complicated, I guess, by the fact we're also clinical psychologist, so we are trained as clinical psychologists across the lifespan. Meaning that we have that knowledge, understanding and skill base that takes us right through to Eldorado heard from from birth. we're working with individuals but in terms of our newer psychology practice what 10 says, I see people from the age of about 00 up to 25 and if they're still in full time education. Yes, because for me, that is where a very big distinction starts to come in, when pit of the discussions we've had been around things like employment issues around benefits about. Adult type issues that are the bread and butter of my daily work, I am aware of these issues and. Actually, you know, having that awareness means having the insight to know when it's it's not for you to be doing to be passing them on. But I think equally I think you'd probably say pip that if it was someone that was involved in education, where you're dealing with lots of educational issues and tribunals and the http plans. And all that sort of stuff then that wouldn't be the work that you typically do day to day either. Looking with a towards a sort pediatric or child.
Pip Calvert:yeah and and I think again depends, where they're at in their education, so I think if they were going back to. Six former going to university feel very competent in in doing that kind of work but that's obviously very different from a developing, as you say there's very specialized educational plans. that are required earlier on in in education, I mean obviously this is arguments they might be needed to zoom. In a levels and degree, but obviously at those levels we're starting to expect people to be a lot more adult learning anyway. And I think that's where I can then bring my skills in in understanding that to then think about Okay, but what difficulties are they having yep absolutely that level, I began that's outside my my knowledge base I just don't have the experience of doing.
Ingram Wright:And so that's an important sort of contextual limitation isn't it. That I would agree penny I feel similarly uncomfortable dealing with technical issues of employment, even just understanding the employment context is a is a challenge, I mean I understand the educational context, I think I can stretch from. You know from secondary school into sort of you know, further education, higher education, but it becomes a real challenge when you're considering. Issues of sort of longer term employment and adult relationships, as well as another area that sort of feels a little bit. difficult for me to kind of understand and appreciate and have competence in terms of asking questions about adult relationships and other concerns. I mean those aren't completely absent, are they in terms of conversations we might have with young people, and I was thinking today about you know there's a lot of focus of attention on. You know, having conversations with adults about sex and sexuality after brain injury, which seems like an important. Part of considering the whole person and being a condition that's prepared to consider the breadth of someone's life. A whole lot more difficult to do that with a young person who might be 14 1516 requires a very different. skill set and understanding of a legislative context professional context and interpersonal context for our practice that feels to me to be very different having a conversation with a 2526 year old.
Dr Penny Trayner:yeah absolutely and also the message that we're giving those individuals, you know it, I see I see people for a long time, so if you've had an acquired brain injury i've got some patients i've seen for eight years, plus. Is you know getting on my career a bit as well, but you know after you've seen someone grow up, if you like. You know, at some point it's really nice to be on stage to match your at this point you're reaching you've reached out or heard or you're you're on the cusp of it. let's hand you over to this service, where they your your truck treated in that way, and the conversations are in that. That arena, and I think that's really important for people's development, particularly if they've had an interruption to their development because of their injury or the things have been. disrupted for them in childhood, you know all the kind of usual gateways and stages that we actually go through have perhaps been disrupted that individual quite nice for them to be honest, they actually reached out now and here. Is an adult service for you don't need to be talking to a child psychologist or developmental psychologists wherever we are yes.
Ingram Wright:you're nodding.
Pip Calvert:yeah there's no left the room yeah no he's he's jumped down who probably be back up in a minute and. I yeah just thinking about one of the cases that that penny and I worked on together that. She brought me in specifically for a specific assessment that some of the discussions we were having touched exactly on what you're saying about. Any you'd worked with him for a very long time haven't you, and that also meant that your lens is probably a bit different from mine, because I would always an approach that. But he's this age, so he isn't he's an adult even if he's an adult who had a brain injury is quite young young person. he's still an adult and he's still got all of that life experience a bit like when we're working in learning disabilities or intellectual disability whatever you want to call it. it's making sure we're equally appreciating that they still have that life experience, even if it's been different from a lot of their peers. And I think that's what penny and I were talking about it was so helpful to talk about that because it then really influence how we went about this particular assessment that we would do in. Because I yeah I think we just brought those different there's different lenses but then equally it's important for me, bringing that adult lens to be talking to penny. About Okay, but then what's his developmental history been like since that since our brain injury, because it just brings all of that, together, so I think. The more we are working at those crossovers, the better we are actually doing for the people that we are, we are working with, and you, you know, I know, one of the questions that we talked about was them. where's that line you know so with penny you saying that you're an adult hood now what you know. And I felt like I technically I suppose i'm an ad or but so.
Ingram Wright:I think you are. you're saying, and so, in some ways, in some ways notice is that.
Pip Calvert:lots of people and I I know because you know I then have assistance coming through the system, and I know they look at me and go. she's a grown up she's the adult in the room, and you know when you get to that stage in your career, where you suddenly look around the room and go, oh no i'm the most senior and therefore responsible here.
Dr Penny Trayner:it's me it's me.
Pip Calvert:I really want somebody above. But yeah there is no I mean I think that's the thing isn't it, there is no crossover line legally there is. But actually developmentally both socially personally, you know, culturally, the reason there is no line is it's a continuing thing. I think that does make it a lot more challenging about how services are set up and why, ideally, it would be if we can have these crossovers and you have a period where you are working together and across.
Ingram Wright:The room what you're saying is that the reliance and yet the Reno lines. And there were some lines that we that we are aware of that are more important, in some cases than others so guess what one of the things you were saying penny is about context so education versus employment. there's also one of the questions we we discussed before and think about this podcast was around legislation, so the maybe aspects of the legislation around safeguarding around capacity. That actually aren't my bread and butter I just don't do often enough to really become skilled and well versed in those legislative constraints I can't deal. With the nuances of that you know I don't have to do it, so it wouldn't be reasonable for me to take on work. That involved an understanding of an area that I don't really not very skilled in or I haven't kept up to date with but that's not so much about adult and child work it's more about the kind of work within that context. I think you'd agree with that.
Dr Penny Trayner:Sorry just smiling because one of the things I always say to pick that I find is quite nice about working the child well. Is that safeguarding children so trumps everything, and so we don't have to make some of the sort of murky Gray area decisions that I can see your face PIC that yeah you the really. kind of those boundaries on the Gray areas where you're not sure Do I need to pass this on where do I go with this. it's much simpler and child work, because actually there's no question about it, if there's child at risk of harm that it gets passed on it, something is but with adults. You know it's much more on the psychologist to be making that making those decisions and having that discussion with the individual, but you know even within the legislation that's kind of murky the mental capacity after prize from age 16. yeah and yeah and we've got this kind of certain things that happened from the age of 16 to 18 now with we're all having competent conversations about good at competence. yeah something we haven't done since undergraduate psychology you know and now suddenly everyone's talking about it in the media as we're talking about you know inoculations of vaccinations. And so they're all these kind of I think the legislation also isn't that clear often. And we have to kind of work together, they are kind of two distinct disciplines in that respect, you know we've got to all be experts in what we do, but come together and kind of, say, well, what do you know about this, what do I knew. about this what's, the best thing we can do for that individual so again it's it's complicated but yeah I think you've got much harder risky risky decisions to make pip so enjoy that.
Pip Calvert:definitely agree with that, but I think also coming back to on the points you made or about. You know you shouldn't take on work and where you're not that skilled up in it, I agree, you shouldn't without supervision. But I think because, again, that one of the situations that penny and I worked on together was that big that exact situation where this this guy needed mental capacity assessment around a specific thing. And penny rightly identified this is beyond my skill set because I don't do it day to day, but then came to me and said. Will you do it with me and then in future supervise me when when I need to do it brilliant yeah absolutely because then I can help scale you up. But you're also recognizing the limitations of your of your competency, just like I would be then saying you know, particularly as penny was saying in those. School settings that's not that's not my bag at all that's not my level of expertise, but it doesn't mean I can't pull on somebody else. To do that, or at least have the discussion about actually in this situation would it be better if you did it. Or would it be okay for me to do with you so supervising or working alongside me, and I think it's about having those conversations about recognizing those potential limitations being honest about about that. But then also having the conversations with somebody go I just bounce this off, you can we just think about this and then sauce it out, and you, you make a plan from there.
Ingram Wright:I think that's right I think it's really helpful isn't it for people listening and kind of feel like. Well, how do I draw these boundaries i'm just starting out in this area, how do I. Act professionally and competently, but also recognize the skill set i've got right, so the breadth of skills that i've got plenty you refer to our training is. Clinical psychologist some people as educational psychologists counselors icon is we've got a quite a broad training, and I suppose, when I started being challenged, particularly in medical, legal practice, it was around areas where. The question was about trauma and brain injury so psychological trauma and brain injury and initially I was thinking well I don't know much about psychological trauma it's not what I do, but I. Thought well i'm working with young people with brain injuries have been injured in road traffic accidents. I kind of want to understand psychological trauma, as well as the biological aspects of the of the brain injury and it would be hard for me to deny any. Expertise or any interest in that area, because otherwise we'd end up you know each person would end up seeing five or six different psychological experts who all had their little niche. and actually what we need to do is to develop indicative formulations that span both the psychological aspects of trauma about growing up with a disability, but also having a brain injury and having cognitive strengths and weaknesses, to go without and I think. Being narrow and protecting yourself by being boundaries is also a risk of not doing good service to our patients and our clients and I guess the room. I also, as you were talking, I was thinking about you know, sometimes it's quite nice to hide behind the NHS frameworks and say I don't do that because. You know our cutoff is this or our service only sees people who live in these postcodes but actually if you have a little bit more liberties, if you work in in independent practice you don't have quite the same.
Dr Penny Trayner:distinctions yourself, you make those boundaries yourself and. That also is you know it's even more Behold non us then to be insightful to look and reflect on our own practice and recognize the limitations of our knowledge and skill and as pip says we are trained to retrain that's what we do in psychology. We have a core set of skills that we can then apply, but the two into another presentation to another client group, but we need to make sure that we're getting the right supervision, and I think. Often, I see more often I get referrals for adults and half to kind of make that that distinction really you're kind of saying actually this isn't for me and explains the person why. And then often can see that other people perhaps do work. You know across the the H band, which I don't think for me would be that helpful I don't think that I think that I do primarily my work is with children and young people, and I think that's where it got real strength and expertise. even down to let's face it, having the right puzzles and games and you covered so that, when the person comes you know you've got the right stuff to be able to engage with them with the right materials in the right tests and, by the way, I still got a test of yours pit that I need to.
Pip Calvert:Take it.
Dr Penny Trayner:So i'll put that back, but it's things like that that actually there are distinctions within the two, there is an adult neuropsychology and there was a child, their psychology. it's just a where the boundaries of that I think are very grain blurred and I think we as a profession haven't perhaps sorted it out yet because we exist within models that already exist for us yeah.
Pip Calvert:But I do know what say probably reflects. socially and culturally what goes on, because where is the boundary between childhood and adulthood, do you have that young person young adult kind of thing so it's that spectrum isn't it and I think. Because we come from those social social and cultural backgrounds, we just reflect back then, and how the NHS gets. Set up. And then we just perpetuates it rather than go yeah Okay, I can stick to that boundary because that's actually may be safer. For me, but that's about our uncomfortableness rather than actually I need to push this and it's not necessary then i'm going to do it, but i'm at least going to have the conversations about how do we actually get this word. because for me it's the same about the boundary between mental health and neurology and brain injury because that's The other thing that I faced an awful lot in in working with adults, so I think it's about how can we have the conversations and start to. push boundaries, but push boundaries in a way that are helpful to think about how can we work together services, rather than just stick to boundaries, and therefore there is no. like this, but it's a wall and the communication between between the two.
Ingram Wright:Yes, it's an awful lot of benefit isn't there and I suppose one of the things was around you know what. ideas we discussing what what, what are the challenges for our profession, I suppose, if we if we don't talk to each other. we're not really aware of what's kind of on the horizon or what's you know currently a concern with an adult neuropsychology because we don't go to any of those events and we're not talking about it, so I. I suppose I really enjoy kind of peering over the wall and looking at what's going on in the adult neuropsychology kind of professional development world because. For me and pediatric neuro psychology it's only a matter of time before we start experiencing fairly similar challenges, and I do see a lot of traffic coming in that direction so whether it's sex and sexuality. or issues around capacity issues around effort testing was kind of you know. be a big issue for adults, I think it's starting to kind of raise some questions around you know, is this an issue for children, young people, of course, it is, it may not be quite as prevalent an issue but it's very much an issue that we need to. Consider, and if we don't think about it, ahead of time we will get challenged on not having thought about those kinds of things so. That, for me, is quite a useful. sort of fluidity around that around that boundary sorry.
Dr Penny Trayner:I was just gonna say in that last example is like the effort testing, I think, is a great example of those differences between the adult and child well. Absolutely, yes, we do have to think about effort testing and young people or potential for some cases, potentially, particularly the medical, legal legal arena adolescence, but actually what we know the research that we have so far tells us that people, children. effort is influenced by different factors to. adulthood they've just had an argument with their dad just before they've got in the car and they've tracked them down this appointment with the psychologists and then knocked off. At dad and they want it, you know, then they're going to the efforts, going to be impacted that's very different to add all that perhaps is aware of the proceedings. could also have the same issues absolutely pit but it's an awareness that they might have different reasons for the behavior and actually when our into it's important to be doing formulation and. I know we're a psychologist we always come back to this that we formulation, but ultimately on each individual basis, we need to be formulating what's happening and what's the most applicable approach for the individual yeah hope you got something to either.
Pip Calvert:Yes or i'm pulling faces, because obviously people can't see and i'm going to disagree with that I think adults are so influenced by those exact things it's how insightful we are. about them, and even if we're insightful about them doesn't mean we don't get caught up in those procedures and that's something.
Dr Penny Trayner:Then.
Pip Calvert:You know cat talks a lot about the concept of analytic therapy. You know and i've had certainly you know at all clients that i've worked with in the medical, legal setting so they've had the the assessment by the elements expert witness and then i'm the treating clinician. And they'll talk about you know the person and lots of swear words, who did the assessment you know this. person is doing it and they couldn't be asked to actually because they didn't want to please this person they wanted to actually you know either. They couldn't then see the consequences of that would then impact on their their claim and how they were being assessed, but in that moment, they did not like that person, so they weren't going to do it. And I think if they have had an adult to say it's a couple coming along and it says the woman who's had the brain injury she's just had an argument with her husband or you know her wife, then. she's gonna come into that, with all of that emotion going on, I don't think that's any different at all. Maybe adults might be a bit more aware of that that's quite a high level of psychological emotional intelligence and understanding and then management.
Ingram Wright:I suppose, these things are qualitatively different. aren't they in terms of the prevalence of these debates in different camps, I suppose, what you know what I was saying. penny where you are picking up on is you know the maybe what you know if quite prevalent debate around effort testing and save the world of adult neuropsychologists which isn't quite as prevalent in that work with children. I guess there's kind of considerations that you talked about penny sort of having an argument with a parent before the assessment. You know those things will play out differently in the context of the work will they will they not pip so they may well be those considerations but there'll be present in a slightly different way, in that context, typically. We don't see many three year olds motivated by maximizing their litigation. potential in terms of how they you know, because if you could take it to extremes of course we would recognize the differences. I guess what we're talking about today is that you know 13 1415 year old is actually not different that different to the 16 1718 year old and maybe someone in their early 20s. Navan someone like me in their early 50s is also influenced by an argument I might have had in the morning is going to influence how I perform. In the afternoon, I know I often talk about you know going to a GP and trying to be taken seriously and being asked if this hurts. And I know if I want to be taken seriously, I have to say out right, even if it doesn't hurt and I think about is that is that behavior really any different to the way someone might behave in an interaction with a neuropsychologist I don't know if i'm alone in that when you go to YouTube.
Pip Calvert:I think.
Ingram Wright:i'm saying symptoms right so i'm I don't do it deliberately to manipulate or to lie or to obfuscate the truth, but I do so because I. i'm really concerned about something and I want to get that across and so there's a there's a message, alongside the interaction, which sometimes this conflated.
Pip Calvert:it's that interpersonal dynamic which, again, you know, one of the conversations that penny, and I have a lot it's about it's for us so i'm speak on your behalf now penny I know you're disagree with me if I say no. And that it's so important to have those clinical psychology skills. To then actually bring that work into your psychology For me, there are people out there who argue, they should be completely separate disciplines. I don't think that's entirely possible I absolutely agree that you need the knowledge and the skills about working in your psychology, but I think you need all of the stuff from clinical psychology. as well to bring into that, because if you don't understand that dynamic in that moment of doing that assessment with somebody you're not actually going to be able to interpret. Their behavior your observations and the results of those normally normative tests in in actually a very effective, where you're going to get quite. skewed and I think that happens, an awful lot in in adult medical, legal settings, in particular where. it's a really difficult situation if you, you know you see somebody maybe for three hours or all day of testing and God forbid, but. And, and you don't have that that background knowledge and understanding of the person and who they are. Then you are you're going to miss something you are you're going to miss a huge portion and I think that's. That it's the same principle for children, even if there are slightly different factors in a different way of thinking about it but it's the same principle. And for me, I think you know what you guys have been talking about it and understanding what the different factors are at different developmental stages. Because again for me, working with somebody who will be classed as an older adult that's really different from working from somebody who's 18. But yeah they're all costs as adults, so I have to have an understanding and awareness of that which, hopefully, I bring to my work which exactly is what you guys were talking about you know, a three year old is very different from a 13 year old.
Ingram Wright:And when we. were talking to Rebecca pause in one of the earlier podcasts about work with older adults, and I think you know she had was throwing kind of similar lines actually you do need to understand the context of older adult hood if you work with older adults it's really important. But also older adults are also adults right, so they shouldn't be disenfranchised from services for adults, without the older prefix and. And I guess we try and entertain ideas that are drawn from all kinds of places don't we depending upon the particular context that we're working. Depending on the particular challenge, I mean, as you say pit where clinical psychologist, we need to understand. I think when working with young people, we need to understand family systems me to understand adult relationships between parents their present all of that needs to be understood, if we're able to give a good service to our named client that the young person in that in that case yeah. I had it was some earlier things that you were talking about paper out of the new development conditions, I suppose it just kind of. Had this a question about you know what about adults who have cerebral palsy and one of my. Senior pediatric colleagues was saying, where all the adults with cerebral palsy and we see we have services for children with cerebral palsy but. Where are the adults with cerebral palsy you know where are the adults, I mean and we sort of know now, but where are the adults with attentional. Deficits where the adults with autism spectrum disorder i'm increasingly there is a desire to make sure the risk parity of provision across the lifespan so these conditions which are recognized and often. identified childhood, but present lifelong challenges for management and I guess, one of the challenges. For you pip that you acknowledge working with adults is if you're seeing people who've had a developmental condition have grown up with that. For whom their life has been influenced by you know, the fact that grown up with cerebral palsy. may well be a predominantly you know motor limitation, it may well have some commentary of accomplishments as as well, but do you are you saying you kind of don't really feel very skilled in in picking up those kinds of cases. Because I wonder if that's true of adult services in general but they're not really equipped for being able to address the needs of of people who've grown up with neuro developmental conditions.
Pip Calvert:yeah I think there's an element of both I think am talking about services, first, I think again it's, by the way in HR services are typically. Set up that particularly in brain injury, you have to have had brain injury as an adult to then access to service that's certainly true true mind. If in widen your psychology and departments again it's how much availability, there is to do things beyond just assessment so you. Certainly might be able to access that department, maybe only through the neurologist or a neurosurgeon and that's quite typical of how their serves the setup you might have an assessment, but then. You know, you might have feedback but you're not actually going to get ongoing work in a lot of those services, I know, some are now doing that, but typically that's not that's not what's happened. So I think they're not D skills people and because they don't then have that ongoing. Development you know to cpd just have access to two people presenting with those difficulties, so you don't develop continue to develop those skills so something, by the way, services, a setup which then limits as as as conditions. me personally, when I was doing a lot more private practice, one of the things I did an awful lot of actually it's working with young people and adults who had a brain injury as a child or were born with cerebral palsy. So it is one of the areas that I actually did end up specializing in quite a lot in my private practice and I benefited from a hugely. Because again I could bring that lens of OK, you are actually now classes and add are legally but you've got all this other stuff and I think. that's where the clinical psychology really helped for me and particularly kept. In thinking about how did it influence how people interact and then I bring all my cognitive stuff to that. But then what our expectations are somebody who hasn't been in that learning environment, who hasn't actually been encouraged to develop as much and. I think that's where my learning disabilities placement, really, really benefited me and I was able to bring all that together. But I only got that through working in private practice, I have never had the opportunity to do that in an HR services and absolutely I agree with what you're saying about where do these people go who have cerebral palsy but our classes learning disabilities. So you know okay if they then our classes being on the autistic spectrum we're starting to get more services, so they can they can access that support what about the people who don't. You know uh where did they go and, again, I think. If they've had a medical, legal time they'll often have access through that ongoing process and the money that's been put in that provision that's been put in, but what if they don't. And you know if what if it was very limited because it was so long ago, you know what about the people in the 50s 60s, who then still presenting. A. challenge.
Dr Penny Trayner:or even if they can't access some of the services, sometimes their holy inappropriate just because of the nature which. A lot of adults, perhaps have acquired their injuries compared to how they have so i've got a young person at the moment that's looking to transition. To probably residential setting for a period of intensive rehab who has had the injury very young, so you know they've grown up with it. They present very differently to the typical population that we're finding in the Inpatient rehabilitation centers which are a lot of people. Unfortunately who've had problems with being assaulted or alcohol and drug problems, you know that these are really quite heavy units, you know and the we're sending these young people who. have just been sort of quite causative they've had 128 perhaps their holes edgy and off you go into that setting it, you know it's very, very challenging to find. The right place to send individuals Where do they go well, some of them go off to specialist colleges halfway around the country. very far away from your home environment very far away from your social content context from everything, and then they get a couple of years, maybe if you're lucky. And then they're back home, and there is a massive gap between you know what do we do have individuals in that. In that situation, where do they go yeah it's it's really, really difficult, and I think that point of transition is a point that we just haven't really addressed properly and there's there's you know it is a problem there's a problem.
Ingram Wright:yeah similarly penny, I was thinking about you, when you were talking about your DJ work earlier on in rehabilitation I seen a young person who. You know, had an injury at 14 they never been in the kitchen, I mean he had been in the kitchen but he'd never. Never cooked a meal before, but one of the first things he did in his Inpatient rehab setting was kind of do some meal preparation with the occupational therapists and he said i'm just not at all. interested in this it's just not on my radar now most you know many 14 year olds, including some not far from from me here. You know, we would probably expect a similar ambivalence about you know that being a big feature of their life but it's something that really needs to be accommodated within the way we deliver rehabilitation, the way we structure services. Which is a point I think you made very eloquently in the earlier conversation we had to penny but it's. it's important that we that we recognize fluidity across these boundaries, but also do recognize that the. Different life stages that we go through, although there'll be variable in terms of when they started finished come with. Qualitative challenges and associations and a need for rehabilitation a particular form of rehabilitation that's that's that's radically different as we move along that pathway.
Pip Calvert:yeah and I think if anything that speaks to you know the suppose of gender, about being person centered if we're going to be truly person centered across the lifespan, we need to understand. What a typical lifespan would look like and then think about what will be the difference before this person if that trajectory has been interrupted. And then also actually just the changing social and cultural differences, you know expectations on teenagers are very different this these days, and they are 50 years ago. And unless we are adjusting that understanding and thinking early thinking about it we're not going to adjust what we do.
Dr Penny Trayner:yeah the number of children sorry, the number of young people are still living at home well into their sort of 20 sometimes 30 know even in comparison to when I grew up is so different you know when. I was like i'm off to uni i've got whereas it's very usual down to be in your mid 20s and still got you know returned home from uni. And we suddenly taken will be 16 year old 17 years ago let's teach them life skills, so you can live on your own, you can have to do, ran an iron and do this and that and it's actually how realistic is that for what their trajectory would have been otherwise so yeah. yeah absolutely.
Ingram Wright:I had a question.
Pip Calvert:People they want to do that great. Right, are we forcing them to do something, because we think that's what they should be doing, yes, yes.
Ingram Wright:I had I had various points, I mean we've talked a little bit about sort of professional boundaries, the way our profession is structured. i've heard you both saying you know, for me, this is where the boundary is i'm wondering how much do you think it's for you. To define those boundaries and how much do you think we should like as a professional body, the bps or whoever. To define where the limits of your competencies should be I think that's pip you sounded like you were saying actually. is for us to have conversations about those limitations and to define for ourselves where those boundaries are I did wonder whether, in terms of the. I guess we all do a little bit of independent practice, I think your practice is substantially independent is that is that right penny yeah I wonder if sometimes a bit more of a challenge in that environment where you are. You know, having to draw those boundaries for yourself other challenges out there, you know would people say. I think you're taking on too much I think you're extending too far, I think you ought to rein it in I think you ought not to be seeing people in their 30s is that adjustment for you to make is it a judgment other people are making about you.
Dr Penny Trayner:and your practice yeah against me those things that really come up because my I. i'm a big believer in the qualification and clinical neuropsychology and people being registered on the specialist register. And, by virtue of being in that that reader in that context, on a specialist register those boundaries and lay down for us, so you know, we need to if this adult work at this adult neuropsychology work. I likely won't be doing it, I would be passing it on to someone unless there was a not reason, and I really need to think about what that reason might be. It might be that actually they just they actually don't need a whole neuropsychology services someone i've seen when they're younger. giving them some treatment, maybe for anxiety, or whatever it may have been, or they just need a bit of a top up. That seems totally appropriate to me it's about kind of talking to them and but also recognizing in that discussion, whether they do that needs to be passed on to an adult or psychologists. So I think I have to say that I think that is one of the strengths of qualification and having. Some structure and some around these things, because it helps us understand those things a little bit more, but. You know, also as pip said repeatedly and you're absolutely right it's a Gray area and even within the kyc when you study at I still submitted cases that are 1617 year olds which.
Ingram Wright:here.
Dr Penny Trayner:And the adult services, so you know it, I think, to some extent that we have to define those things I think it's actually more free. When you're in the independent sector because you're not defined by the NHS and the structures that are there, but I, you know I also know a lot of you guys are still working here just quite rebellious anyway intend to do what you think is right for your patience sure it shouldn't yeah. don't do what we think is right, rather than what's being you know really directed to us we've got you know that's what we're here we're here to be psychologist we're not here to be directed by arbitrary rules that are going to be.
Ingram Wright:An increasingly there's a mandate you know whether it's within the NHS or certainly within the independent sector where that is absolutely paramount consideration, you know what's in the best interest of the patient, you know not what's in the best interest of me on my business or. You know my hospital my NHS trust, but actually what's the best interest of this patient and sometimes that's to stay with a pediatric practitioner for a little bit longer because that reflects the nature of those concerns and the expertise of the. system around the person for some an early transition to adult services may be the best thing for them, and I suppose, as long as we can justify that decision. In terms of our role, but also in terms of the wider system, support for that person then not seems to me to be reasonable that we maintain this as a Gray area rather than trying to find a boundary which artificially disenfranchises some people.
Pip Calvert:will easily because the boundary for penny might be different to the boundary for me because of my experiences and my qualifications. So we to put in a very solid boundary actually potentially will be very helpful in some ways, it could be helpful, because it makes things very supposedly very clear. But then actually is that not repeating what's happening in NHS services about so what's between an adult and an older adult. You know what's between that I mean one of the phrases a lot that got us when I was in mental health was you know the steps. Who step two step three and then you actually find out this this Gray area between the steps, even though we define the steps. I don't think we're very, very good at doing that and I think, by encouraging that. We actually we we magnify those problems I think it's harder to have the conversations about the Gray areas. But actually that's exactly why we should be having those conversations, because they are more difficult, but by having continuing conversations were a developing it I guess it's a bit like case law. You continuing to develop your understanding, but actually also you, continuing to develop relationships and working together and encouraging that collaboration. Which is always going to be in somebody's best interest because then there should always be someone who will challenge within the system. and go great Okay, you have always done that, and you get the new be coming along again when you're always done it like that, and that should be welcomed and invited rather than batted down.
Dr Penny Trayner:we're talking about disrupting services disrupting unhelpful systems, this is great we've been having that conversation, for many, many years so yeah and. yeah formulation is key really formulation reflecting and good supervision and always comes back down to that you know if you're you've got to kind of think what am I reasons for staying with this individual. And you say ingram sometimes just keeping them in pediatrics just a little bit longer you can actually finish off and complete a piece of work that individual means that they can then go out and live their life without needing to come back into services if you. push them out the door too soon and i'm often sometimes into a black hole of stuff between services, I can't actually see anyone and that's definitely can't be right for anyone so yeah.
Ingram Wright:yeah I I had them it's interesting pepe you've not not use the single reference source in this in this conversation so far, unlike the, unlike the cat podcast we all grew up the box of what you've got there to interface of the quiz. we've all got books i've got a bookshelf next to me who knows what i'm going to grab from the bookshelf or what have you what have you got for us today penny.
Dr Penny Trayner:zach and pips pixels got but but actually ingram um. We have things we just wanted to yeah we had to pivot a little bit of a discussion and ahead of time and we just thought a couple of things we thought might be fun to just.
Ingram Wright:turn the tables. You can.
Dr Penny Trayner:Just.
Ingram Wright:We can we can edit this out.
Dr Penny Trayner:yeah just for fun.
Pip Calvert:Just really well if you do i'll be commenting on Twitter, that it was edited out.
Ingram Wright:For us, thanks i'm consider myself. well and truly trapped no.
Pip Calvert:No invited to participate so.
Ingram Wright:that's what it is.
Pip Calvert:You can say no, you don't have to do it as penny, and I was saying we just.
Ingram Wright:wouldn't Anderson creasing Lee anxious now. What have you got.
Pip Calvert:To get so we've got some questions about whales, because I understand you are a wealth.
Ingram Wright:Well, I know I wasn't born in Wales, I do live in Wales, I live in the most English part of Wales, I live in Malaysia, but. If you asked me to say yeah okay well I don't think we've got many Welsh listeners.
Dr Penny Trayner:This is the time to change that so.
Pip Calvert:Did you know that Everest is named after a Welshman.
Ingram Wright:I didn't know that.
Pip Calvert:Interesting so you're not going to know what his first name is. Which is going to be one of my questions.
Ingram Wright:No, I don't know why his first name is.
Pip Calvert:George just so.
Ingram Wright:George Everest.
Dr Penny Trayner:Welshman named George or send an interesting.
Pip Calvert:Maybe lived in the most English version of. Okay, what is the largest castle in Wales.
Dr Penny Trayner:You look out your window to a car, so in.
Ingram Wright:Looking at the castle. on the fringes of the state. This might be it. I hope that is a castle caerphilly Castle it's not very far from me. And I do have my aunt and uncle living caerphilly they will be ashamed of me, if this is.
Pip Calvert:Now a.
Ingram Wright:meal plan so far.
Dr Penny Trayner:More we've got a killer one for. never be invited back again after this, but you know.
Pip Calvert:We had all sorts of okay actually knows, and you can decide between two things so so what gower this is Anglesey.
Ingram Wright:or gower definitely. Sorry.
Pip Calvert:are the first ones, he.
Ingram Wright:it's a tough one, because it's got to be Cardiff i'm afraid.
Pip Calvert:And I can't think of any other ones off the top of my head because we've thrown me now rugby football.
Ingram Wright:football.
Pip Calvert:Well, I think we need to answer on that.
Ingram Wright:I don't think. I have i've. I don't think i've earned very many well she this this. This liquid. So I will be i'll be monitoring the podcast stats carefully and seeing if we've gone up in Wales or town in Wales. There was a brief, there was a brief period round about the time penny jointed podcast three where we were the most popular health related podcast in South Korea.
Dr Penny Trayner:wow that's when back that crown.
Ingram Wright:So I am very grateful to penny for that and we may well be continuing this very successful theme of sort of regional quiz related questions. With some South Korean.
Pip Calvert:Following in South Korea that's why.
Dr Penny Trayner:i'm loving this.
Ingram Wright:Well, I am grateful to you both for being so gentle when that obviously that opportunity. could have. could have been experiencing.
Pip Calvert:Right now.
Ingram Wright:Yes, I had suggested to both of you, as you know, because you were part of the conversation that we have a Brockman Bingo. session. yeah which I think you quite rightly asserted yourselves being. Being podcast returnees that that it that it wasn't floating your boats.
Dr Penny Trayner:just say no people.
Ingram Wright:Who knows, they might be.
Pip Calvert:A massive step.
Ingram Wright:was in the band was in the. Positive. Or the functional neuroanatomy that was off. Putting.
Dr Penny Trayner:It was the Bingo action was.
Pip Calvert:Also, oh my God i've got professor of psychology is going to start quizzing me. to kick it.
Dr Penny Trayner:And why we are crushing neuropsychology textbooks, as we speak pippin I we've come loaded so going back to your original very sensible question about their psychology I have this APP which I know is. That the you know the go to everyone must have this on their shelf surely its various iterations I think we're up to version, six, seven, at the moment, six, seven. they're very expensive excellent books highly recommended will be got.
Pip Calvert:i've got various just clinical psychology ones, because I was trying to find a book that, as you have the problem is Eric eeg. Saving I could look it up on the Internet it's about actually and then I was looking at my am because I have done the queue it in in in your psychology, but I am not on the specialist register of near psychologists so that's my board. So I was looking at my PG module on your signs is. Quite a few years ago I.
Dr Penny Trayner:thought it was covered at one point angry supposed to be randomly grabbing a book.
Ingram Wright:I know I know tell you what what what i'm really interested in and I started I started off life with i'm holding up. Louise Hayes his book thriving adolescent, which is the DNA the model of act and sort of rather late in my career not you know not too late. i'm getting increasingly interested in act and getting trained in act and being. A therapist as well as a diagnostic assessment neuropsychologist and that's feeling that's enlivening me in this stage of my career so i'm less interested in broadening Bingo and much more interested in enact and maintaining.
Pip Calvert:A whole lot of questions back.
Ingram Wright:yeah I wouldn't be I wouldn't have been able to answer them because I haven't read this book. Yet, but i'm you know i'm working i'm working my way through it, but one of the questions I was going to ask you, both because some of the. When I must why I went into child psychology I do think about the the work the aspects of what I really enjoy so I really enjoy working with children and when i've been more heavily involved in assessment work. i've really enjoyed the fact that work feels like a playful environment sometimes like I can play with the kids. And my kids are sort of growing up now, and my eldest is just going off to university they don't want to get down on the floor and play with me anymore, but every now and again at work. I get to kneel down on the floor hard to get up these days I get to kneel down on the floor and just play right and and but the play is part of my work and I wondered, I suppose I didn't want to draw any sort of false distinctions here but. For me that's always been a really enjoyable part of being a PDF in your psychology is the fact that i'm talking to young people. That, I feel I can relate to them, I can get them interested in what it is that we're doing. And i've not seen that as being absent from interactions with adults, but I think you know interactions with adults feel to me a little bit more buttoned up. Maybe a little bit less about being playful little bit more about being professional. And I wondered when you were saying earlier, you know you kind of we never really feel like we proper grown ups. If you still play in your work if there's still something playful about aspects of your work or whether something else fails your work with adults, that you do that's a very long winded. question.
Pip Calvert:Just reflecting as you were talking about that enjoyment, for you about having those moments of being able to play with children, you know as part of your job and. When I when I was training, I actually found that really difficult, not because I. loads of my friends have children, I really enjoy mucking about with them and playing with them. What I didn't like as doing it as part of my job was I knew there was always some serious edge to it. There was a real reason that this person was here with their parents or without their parents and I didn't really didn't like that I, because I just wanted to be able to play. I wanted to just have fun with that young person and, and so I really struggled to actually separate that there was something about the work that I knew I wouldn't be able to do every day, and you would bring up. Too much for me emotionally to then be able to be effective in my job. So for me with adults, I can have fun with them, I mean lots of my counterparts and I wind up giggling and offline. or i'll never forget on the the training course I can't remember which one of our professors, it was. saying you know if you come out of a session and you've enjoyed it there's something wrong and sometimes I come out settings go go really enjoy. And then go Oh, but and and I think that's important to reflect on you know is that because we were actually not doing work sure actually as part of that enjoyment of just having some lightness in that moment. was so therapeutic and it was something that we just we made a connection on a really human level, but it was still within that professional remits. So I have a lot of laughs with with with the clients that I that I work with because I think, particularly for a lot of the clients that I work with who've been through such a serious. You know, events in their life with something huge has changed, even if they can just laugh at themselves or someone else is massive do about getting down, you know and playing twister.
Ingram Wright:say I don't play twister.
Pip Calvert:See, this is also when i'm out of the loop because it's just not.
Ingram Wright:it's not in the cupboard.
Pip Calvert:Where you know I will pay jenga with some of my clients, I will play connect for because that tells me about a whole load of motor and cognitive. yeah, but we can have fun with it, too, and I really like it when they can take the Mickey out of me when I. i've made a mess, because I think that also shows i'm human and it's okay to make mistakes that i'm then not unsettle by that, so I think you can have a lot of fun with that, but yeah just for me, on a personal level. Doing that work with with the with the children that I was working with in my child placement was really hard. Because I knew there was really horrible reasons that they were there and they were children, and they should be looked after and cared for and nurtured I find it a bit easier with adults to to be a bit more boundaries, I guess, with with that then.
Ingram Wright:there's a. deeper level to some of this stuff isn't there, and so I think sometimes when I found myself away enjoy the playfulness. If the answer is actually much richer than that, as you as you're pointing out it's actually a sort of. There are several levels beneath that means something about being inspired in terms of understanding development really enjoying the connection that you can make with. Young people with with with children that very early stages in their development penny, I wonder if you have some sort of in terms of your day to day experience of the work that you do. I imagine it's fun, I imagine it's playful at times.
Dr Penny Trayner:It is at times, but actually you know, the thing that probably most attracted me to neuropsychology particularly with child neuropsychology. Is the variety, so you know one day I might be, you know, a tribunal for a kid who can't get placement in a special educational needs school, the next day I might be. Having you know well, actually this week I played perfection Do you remember that from back in the day, with a little joke most stressful game ever with the timer great. yeah the speed of information processing motor skill, but you know might be doing that one week might be the next day talking to a parent about their child's trajectory and like pips it doesn't very difficult. very, very difficult conversation for. Another day might be trading support workers another day I might be training school stuff. No, I can honestly say that there is no one day in my my week or or my life that is ever the same, and that is why I absolutely love about it, I mean. pit knows me very well, England, probably from what you've known about me and so far, you know i'm not great Apps sitting still not doing a lot so i'm where I really thrive is getting out there and doing stuff. And I think there's work there's a lot to do and there's a lot of variety and and I think that for me is what really inspires me about this work, and I was thinking about your question about how did we end up I end up here. And I was very lucky that my very first ever assistant psychologist job was in Cannes, but before that my first job ever in clinic. Clinical arena was with a young man when I was still at university, who are autistic spectrum condition. Quite sort of severe autistic spectrum conditionality support worker. And we spend our days on the were all rollerblading up and down the Brighton part problem and going to the pub to learn how to exchange money and. You know, going to the fair on new Brighton and doing things like that and from there, I went into comes from there, I ended up in. The primary and high banking very working in child rehab and so somehow your solo career kind of ends up going, you know it down that path, and before you know you suddenly like Well, this is the work I know and I love. And I kind of think did I choose out or do you just kind of self select as you go on it's really interesting looking backwards and trying to reflect on that. But yeah if you want a very job and you want a job, where you know every day is different, this is definitely the role for you, you know so yeah.
Pip Calvert:I feel like I need to make an equivalent pitch now for working with more.
Ingram Wright:Sales every day, the same for you.
Pip Calvert:I think it's more varied in independent practice and it is within my practice. But yeah I mean, I still go into work every day and go i've got this list that i'm going to do, and the end of every day i'm like. i've done nothing on that list i've done lots of other stuff and now the list is bigger and and there are lots of things and I think actually the the challenge in adult because I think. psychodynamic stuff talks a lot about it is that we lose the ability to play as adults. and actually that keeps us young it keeps it happy, it keeps us having variety in life and more satisfied with life if we can play. So one of my I think one of the challenges for people working in services with. People who are classed as adults and particularly older adults is how you can introduce that element of play again that it's all right not to be so serious. Because actually that can contribute to a whole load of the difficulties and I think that's where my personality to couldn't come in, because I am a really playful person. But I am an incredibly serious person at times as well, and I, I would like to say that i'm very variable with that in it in an appropriate way that I can bring all of that that in you know I mean. You to know I have bright blue hair I have piercings I have tattoos and I can bring all of that too, but I can also be very serious and people will hopefully respect me for the knowledge and. And what I bring into those situations don't judge me on on how I look, I think I can bring all of that as well i'll never forget. One lady I was working within the impatient Ward and it was summer so I have my ankles and i've got a lot of tattoos or America she's like are you over this phase, yet. Phase i'm still in it. And it was fine, because then we could have that conversation about what it meant meant for her. And how it was working with people who are younger than her who looked different who she would never done that she was on it opened up a whole different conversation than when I connected with her on a whole nother level. But, yet we were able to do a whole lot of work together, and I think that is the challenge now is how you can bring in that playfulness but still be serious and responsible.
Dr Penny Trayner:I think that's trying to pick I think that's a very, very important point I think we've talked about playing a part of this, but actually there's a real seriousness to a job. That you know, is an inescapable we're dealing with people with highly complex neurological conditions that are not going to go away. And they have to you know face some enormous challenges, and we need to be with them on that journey. And it's about being able to pitch it right for that for that moment, sometimes it is about laughing with families, sometimes about crying with them, sometimes it's about just being there with them, whatever bearing witness to whatever they're going through. It is about that appropriate balance, and I think. And like you say I wouldn't be able to do this job as effectively as I think I do if I didn't enjoy it, and so there has to be that an element of pleasure and enjoyment and bringing yourself into the work. But you're right that it is it's a very serious job, and I think we have to you have to be mindful and respectful of that to.
Ingram Wright:Thank you, both for your time today I know. we've all got to go and go off and do different things and but thank you very much for your time and it's a real pleasure talking to both of you and thank you for for engaging so effectively this conversation so engaging so effectively what's that was.
Dr Penny Trayner:Saying.
Pip Calvert:Had a really joyful conversation about.
Ingram Wright:We have about some really serious things.
Dr Penny Trayner:yeah i've really enjoyed talking to and it's been a real pleasure to share this sort of space in this conversation with you both, and I hope people find it helpful. And from my point of view I just hope people take away that, whilst there are distinctions, there is also a lot that unites us and we just need to be talking together and working together for the greater good of everyone.