Category Archives: Ptsd/cptsd Articles

Right Brain Therapy : Is It More Appropriate For Trauma Survivors?

Right Brain Therapy : Is It More Appropriate For Trauma Survivors?

 

 

 

Why is it that right brain therapy may be more appropriate for trauma survivors as opposed to therapies that concentrate largely upon the left brain?

Right Brain And How We Relate To Others :

One of the main symptoms of complex posttraumatic stress disorder (from which we may suffer if we experienced significant and protracted childhood trauma) is having problems relating to others.

The brain is made up of two halves, called hemispheres : the left hemisphere (or, left brain) and the right hemisphere (or, right brain). It is the right brain that plays a vital role in how we relate to others because it is intimately involved with many functions that affect how we get along, or, don’t get along, with other people. These functions include :

– our ability to empathize with other people

– our ability to trust others

– our ability to identify with others

– our ability to read the emotions of other people from their facial expressions

– our ability to form healthy attachments with others

– non-conscious communication

Because these functions can be impaired if we have complex PTSD, and because they are controlled largely by the right brain, it follows logically that therapy to restore these functions to their optimum levels should, too, concentrate on the right brain.

Why Do These Functions Reside In The Right Brain?

This is because, in the first two years of life, according to psychodynamic theory, our interactions with our primary caregiver very significantly lay the foundations of our emotional life, including our expectations regarding relationships with others ; these expectations are encoded, on an unconscious level, in the right brain.

Right Brain Therapy And Self-Esteem :

Those with complex PTSD also frequently have significant problems in relation to their sense of self-esteem and therapy for this, too, is also likely to be especially effective when it concentrates upon the right brain. Again, according to psychodynamic theory, this is because the foundations of our self-esteem are (and it is worth repeating) acquired in our first two years of life and are encoded, on an unconscious level, in the right brain.

It follows, therefore, that if our interactions with our primary caregiver in the first two years of our lives are dysfunctional in a way that leads us to believe others do not regard us as of value and worth, we are at high risk of developing into adults who have an ingrained, deeply embedded, unconscious set of negative expectations with regard our relationships with others and our self-esteem.

In other words, such poor expectations regarding our relationships with others and low self-esteem have their foundations in a set of unconscious beliefs, stored in the right brain, that were laid down during the first two years of our lives.

Right Brain And Our Sense Of Safety :

Another feature of complex PTSD is that of a constant feeling of being unsafe and under threat. Research conducted by Schorre (2003) suggests that the sense of how safe, or unsafe, we feel is largely dictated by the right brain.

How Does Right Brain Therapy Work?

Right brain therapy can work by modifying behavior patterns encoded on an unconscious level in the right brain.

Right Brain And Implicit Memory :

Memories stored in the right brain before the age of about two years are known as IMPLICIT memories. This means we are unable to articulate them in words as they are not stored at a linguistic level. Therefore, such memories can only make themselves known to us in ways that are non-verbal (e.g. via our feelings, body sensations and mental imagery).

However, when these memories are triggered and give rise to these feelings, body sensations and mental images we are unaware of their origin for the very reason that they derive from these unconscious/implicit memories in the right brain.

Only right brain therapy then, that can modify these implicit memories on an unconscious level, may be truly effective as left brain therapy, relying on language, is unable to effectively connect with such non – linguistically stored memories.

Examples Of Right Brain Therapy :

These include :

– Art therapy

– Play therapy

– Hypnosis

– Mental imagery
Right Brain Therapy : Is It More Appropriate For Trauma Survivors?

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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Copyright 2017 Child Abuse, Trauma and Recovery

Complex PTSD Treatment

Complex PTSD Treatment

What is the best complex PTSD treatment?

The NHS (UK) recommend that those suffering from complex PTSD undergo three stages of treatment. These are as follows :

1) STABILISATION

2) TRAUMA-FOCUSED THERAPY

3) REINTEGRATION

Let’s look at each of these a little more closely :

REINTEGRATION

NHS guidelines suggest that during the first stage, stabilsation, the individual being treated for complex PTSD may wish to focus on:

– redeveloping an ability to trust others

– reestablishing an emotional connection with friends and family

– learning to live in the present again (as opposed to staying trapped in the past ). This normally involves learning to feel safe again and reducing the level of fear that traumatic memories have hitherto provoked (often manifested in the disturbing form of nightmares and flashbacks).

The aim of this first stage of treatment is to improve the individual’s level of functioning to the point whereby s/he is able to start functioning again on a daily basis, no longer paralysed by anxiety.

TRAUMA-FOCUSED THERAPY

These include :

(The importance of engaging with an appropriately trained and experienced professional if considering these treatments is emphasized.)

REINTEGRATION

  • i.e. reintegration into society and the development of improved, more trusting relationships with others (one of the hallmarks of complex PTSD is to avoid others and self-isolate, leading to a vicious cycle driven by operant conditioning and loss of confidence).

What About Medication?

In cases whereby psychotherapy is not helpful or appropriate, the NHS (UK) suggest that antidepressants may be of benefit to some individuals.

Links :

For those who would like extremely detailed information relating to ISTSS ‘s guidelines for the treatment of complex PTSD, it is possible to download the relevant PDF from this here.

The main NHS (UK) website can be found by clicking here.

eBook :

Complex PTSD Treatment

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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Copyright 2017 Child Abuse, Trauma and Recovery

Ego State Therapy For Treatment Of CPTSD

Ego State Therapy For Treatment Of CPTSD

EGO STATE THERAPY is an approach to treating complex posttraumatic stress disorder (cPTSD) and is sometimes referred to as ‘parts work.’

In particular, this therapy is designed to help treat symptoms of CPTSD which come under the headings of :

  • avoidance symptoms
  • intrusive symptoms
  • depressive symptoms

Let’s briefly look at each of these three types of symptoms :

AVOIDANCE SYMPTOMS :

These include avoiding places, people, events and situations which remind one of one’s past trauma. However, individuals often employ psychological defenses (usually unconsciously) as a way of avoiding accepting the reality of their childhood traumatic experiences; these psychological defenses include :

Finally, people who have suffered traumatic childhoods may use dysfunctional coping strategies to avoid their emotional pain which, in turn, can lead to addictions such as :

  • addiction to alcohol
  • addiction to drugs (both illegal and prescribed such as sleeping tablets and tranquilizers)
  • addiction to gambling
  • sex addiction
  • comfort food / carbohydrate addiction
  • excessive exercise
  • addiction to self-cutting / self-harm with short-term effect of relieving unbearable stress/anxiety

INTRUSIVE SYMPTOMS :

These include nightmares, flashbacks, hypervigilance, anxiety, feelings of aggression and irritablity ; such symptoms can also be categorized as high-arousal symptoms.

DEPRESSIVE SYMPTOMS :

These include despair, shame, inadequacy, unworthiness, hopelessness, helplessness and a sense of being trapped in a tormenting frame of mind, with no escape route (this is sometimes referred to as ‘learned helplessness.’
Feeling one has no hope is a particularly invidious symptom as it is known that feelings of hope, even when highly distressed over long periods, lowers the probability of suicide attempts; logically, therefore, the opposite holds true.

Depressive symptoms can also be categorized as low-arousal symptoms.

‘PARTS’ WORK :

Ego states theory involves a technique known as parts work.

Parts work is based upon the theory that as a psychological defense we unconsciously ‘compartmentalize’ different aspects of our personalities to enable us to ‘mentally partition-off’ the ‘parts’ of ourselves that we find unacceptable, and/or that contain intolerable memories, from the more acceptable ‘parts’ of ourselves that allow (at least a semblance of) day-to-day functioning.

These ‘parts’, or ego states, that hold we find unacceptable and/or hold distressing memories frequently reflect earlier developmental phases in our lives that occurred during our traumatic childhood and that are therefore related to traumatic memories.

How Can These Parts That Reflect Earlier Developmental Phases Manifest Themselves Now We Are Adults?

These parts may manifest themselves when we are under stress in the form of regressive behaviors.

For example, under extreme stress we may display child-like tantrums or behave in an aggressive, rebellious manner like that of a young teenager. Or, when upset, we may curl up on our beds clutching a soft toy.

Internalized Parts :

We may, too, possess ‘parts’ of ourselves that we have internalized from emotionally significant others (usually parents or primary-carers) during our childhood.

For example, if we had a parent who was highly critical of us when we were children, we may find we are prone to judging ourselves with a very unforgiving and self-lacerating attitude, constantly feeling that we failed to meet the exacting standards that we’ve set ourselves.

Or, if we had a parent / primary-carer who was highly religious and regarded us as fundamentally flawed and sinful, we may, as adults, find ourselves tormented by fears of ‘eternal damnation’.

INTERNAL FAMILY SYSTEMS (IFS) THERAPY:

IFS therapy is perhaps the most well known therapy to incorporate ‘parts work.’ It is based on the idea that the individual has three types of parts; these are as follows :

  • Exile parts
  • Manager parts
  • Firefighter parts

Ego State Therapy For Treatment Of CPTSD

Let’s briefly look at each of these in turn :

EXILE PARTS :

As the name suggests, these are the parts of ourselves that developed as a result of the damage done to our personalities by our childhood trauma and which we largely keep banished and cut off from conscious awareness / repressed / suppressed.

The exile parts are kept closed off from conscious awareness as a means of psychological self-protection as these parts contain distressing memories and painful emotions such as neediness/dependency, intense anger, grief, fear, shame, loneliness and vulnerability.

MANAGER PARTS :

These are the parts of ourselves that try to keep us in control and allow us to function on a day-to-day basis and keep extreme/distressing/counterproductive emotions at bay. Frequently, too, these parts are extremely self-critical.

FIREFIGHTER PARTS :

These parts attempt to protect us from the emotional pain the comes upon us when our exile parts start to break through and impinge upon our consciousness and behavior (as may happen,for instance, during periods of intense stress and/or when we are reminded – either consciously or unconsciously – of our childhood trauma).

However, they do this by causing us to behave in impulsive, and, in the long-term, self-destructive ways such as excessive drinking, abuse of narcotics, workaholism, risky, promiscuous sex, gambling and overeating.

Link :

To learn more about IFS therapy and how it works, click here.

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Ego State Therapy For Treatment Of CPTSD

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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What Is Psychic Numbing?

 

What Is Psychic Numbing?

Severe emotional distress and trauma can lead to a psychological defense known as psychic numbing.

Psychic numbing occurs when our conscious experience becomes so overwhelmingly, mentally painful that our feelings, in effect, ‘switch themselves off;’ the result is a kind of psychological ‘escape from reality’ – a reality which has become too terrible to tolerate.

Those who experience psychic numbing may use metaphors in an attempt to describe their condition such as : ‘It’s as if I’ve turned to stone,’ or, ‘it’s like my heart’s become made of stone.’ Sadly, in this state, the person may feel s/he no longer cares about him/herself or others – even close family members / previously close friends.

This may sound a distressing state to be in in itself, but part of the condition of psychic numbing means, too, that the person may also not care that s/he doesn’t care.

How Long Does Psychic Numbing Last?

The condition may be a relatively transient response following a severely traumatic incident or it may become a long-term in response to protracted exposure to traumatic conditions especially, for example, if one has developed complex posttraumatic stress disorder as a result of a traumatic childhood. In such cases, the sense of psychic numbing may persist (in the absence of effective therapy) for years or even decades.

What Is Psychic Numbing?

Are Both Good And Bad Feelings Affected?

Generally, yes. Whilst the condition may arise as a defense against bad feelings, the ability to feel anything good tends also to greatly diminish, including the loss of the ability to gain pleasure from food and sex (for more about the inability to experience feelings of pleasure, see my article about anhedonia).

The Sense Of ‘Anesthesia.’

When one is in the grip of psychic numbing, it can feel not only as if one has been given an ’emotional anesthetic’, but, sometimes, too, as if one has also been physically anesthetized as the body itself can become relatively numb to the sense of pain.

Research Into Posttraumatic Stress Disorder (PTSD) And Psychic Numbing :

Some researchers have suggested that the symptom of psychic numbing is intrinsically bound up in the biological responses which form the foundation of PTSD.

Psychic numbing is also closely related to depersonalization and a sense of loss of identity.

eBook:

What Is Psychic Numbing?

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Structural Dissociation Theory

Structural Dissociation Theory

Structural dissociation theory was developed by Van der Hart, Nijenhuis and Steele (2006).

Essentially, this theory relates to the idea that many of the behaviors that you may feel uncomfortable about, ashamed of, guilty about, or hate are likely to be the behaviors you unconsciously learned as a child to survive in an environment which was hostile, unpredictable, threatening and unsafe. In the present, these behaviors are likely to be triggered by any occurrences or events which, even remotely, resemble the events which once threatened your safety (psychological or physical) as a child.

In other words, the vulnerable, frightened child continues to live within you, trapped in the past, and responding to events now as if they (or, rather, what these events symbolize) were happening then (during your traumatic childhood).

These behaviors, then, can be seen as adaptations : behaviors that allowed you, as a child, to survive; I repeat : they are the legacy of the child within you that, under extreme circumstances, managed to survive and, as such, should cause neither guilt nor shame. THE BEHAVIORS WERE ESSENTIAL AS A MEANS OF PSYCHOLOGICAL SELF-PROTECTION.

 

Structural Dissociation Theory In Terms Of Neurobiology :

In terms of neurobiology (the physical/biological workings of the brain) the theory states that when events occur that we find threatening (on either a conscious or unconscious level) because they trigger implicit memories of our traumatic childhood :

the right half (hemisphere) of the brain and the left half (hemisphere) of the brain become disconnected to a degree that they no longer communicate with one another in an effective manner.

What Are The Functions Of The Left And Right Hemispheres Of The Brain ?

For the sake of simplicity,we can confine ourselves to the functions most pertinent to the theory :

  • The brain’s left hemisphere is involved with day-to-day functioning and is relatively logical, permitting us to struggle on despite internal, mental conflict.
  • The brain’s right hemisphere ‘contains’ the responses that you were forced, by extreme and hostile circumstance, to learn as a child in order to ensure psychological survival, including hypervigilance for imminent danger and perpetual readiness for fight/flight/freezing/fawning – whatever was necessary to avert danger (real or perceived).

Structural Dissociation Theory

Splitting / Fragmentation :

The personality of the individual who has experienced severe childhood trauma can become split / fragmented so that when events occur that cause stress / fear / make the individual feel threatened / remind the individual, however tenuously (on a conscious or unconscious level), of their childhood trauma the responses stored in the brain’s right hemisphere are triggered (fight/flight/freeze/fawn responses) whereas the brain’s left hemisphere guides ‘normal’ everyday behavior, allowing the person, to some degree at least, to function. To simplify :

  • Stress, threat, fear etc / implicit reminders of childhood trauma = right hemisphere dominant
  • Everyday functioning = left hemisphere dominant

Compartmentalization and Self-Alienation :

Whilst such compartmentalization may allow our day-to-day functioning to continue under one guise or another, there is, however, a price to be paid : the individual can suffer from intense feelings of self-alienation, self-loathing, shame (that s/he is ‘concealing’ a ‘bad,’ ‘secret’ self) and a sense of being a ‘fake’ and ‘fraudulent’ person.

My next article (Part Two) will look at how we might best overcome this problem.

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Structural Dissociation Theory.  Structural Dissociation Theory

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

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Effects Of Trauma Should Be Addressed Rather Than Its Events

Effects Of Trauma Should Be Addressed Rather Than Its Events

According to J Fisher, PhD, Assistant Educational Director of The Sensorimotor Psychotherapy Institute and author of the book Healing The Fragmented Selves Of Trauma Survivors, it is of greater importance to address the effects of a person’s traumatic past rather than its specific events. Why should this be?

Sigmund Freud, often referred to as the ‘father of psychoanalysis’, originally treated his patients by helping them to remember, and piece together, their childhood traumatic experiences, the memory of which had been largely repressed.

The idea was that by talking about what had happened to them during childhood, and bringing their traumatic memories into conscious awareness, they would be able to develop a coherent narrative relating to their adverse experiences which would, in turn, alleviate their psychological distress and the symptoms pertaining to their early life trauma.

This kind of therapy is usually referred to as talk therapy or psychodynamic psychotherapy.

Effects Of Trauma Should Be Addressed Rather Than Its Events

Above : Possible long-term effects of childhood trauma

However, various researchers (e.g. Herman, 1992) have highlighted the fact that many therapists who have adopted this approach to treating their traumatized patients / clients have found that these same patients / clients are made worse rather than better by this ‘talking cure’ strategy.

Specifically, it had been found that patients / clients, when treated in such a way, can become flooded and overwhelmed by the myriad implicit memories this form of therapy is prone, inadvertently, to trigger. To read my article about trauma and implicit (also referred to as non-declarative) memories, click here.

In her book, Fisher takes the view that, rather than bringing into conscious awareness the ‘full narrative’ of our childhood trauma and replaying it in its raw form until we can ‘face-up’ to it, it is more important to learn how to deal with the effects /symptoms of the trauma, such as learning to feel safe,  secure and relaxed in the here and now and to ameliorate present feelings of fear and panic.

Fisher recommends the following cutting-edge therapies for addressing the effects of trauma : mindfulness a based therapies, internal family systems therapy, sensorimotor psychotherapy and clinical hypnotherapy.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Childhood Trauma And Non-Declarative Memory

Childhood Trauma And Non-Declarative Memory

Our long-term memory can be divided into :

1. Declarative Memory (sometimes called explicit memory or narrative memory) – it is the part of our memory that we use for the conscious recall of facts or events.

Declarative memory depends upon language in order to organize, store and retrieve the information that it holds.

2. Non- Declarative Memory (sometimes called implicit memory, procedural memory or sensorimotor memory) – it is this part of our memory that allows us to automatically retrieve information connected to something we have learned without conscious deliberation.

Childhood Trauma And Non-Declarative Memory

For example, we can get on a bike and ride it without having to concentrate on exactly how we’re doing it or go over in our minds the steps involved in how we learned to do it; indeed, we need not even remember when or how when learned to do it (I certainly don’t) – nevertheless, the necessary ‘know-how’ has been unconsciously, permanently retained.

Non-declarative memory, unlike declarative memory, does not depend upon language for the organization, storage and retrieval of information. Because of this, non-declarative memories are frequently very hard indeed to describe in words (try explaining all the tiny body and muscle adjustments necessary to maintain balance whilst riding a bicycle – yet the memory of exactly how to do this has been faithfully, unconsciously stored, courtesy of your non-declarative memory!).

TRAUMATIC EXPERIENCES ARE FREQUENTLY STORED AS NON-DECLARATIVE MEMORIES :

Due to their their utterly overwhelming nature, we often can’t completely and linguistically, mentally process our traumatic experiences which prevents them from being stored in declarative memory ; when this happens, the traumatic experiences are instead stored in our non-declarative memory.

THE FRAGMENTARY NATURE OF INCOMPLETELY PROCESSED TRAUMATIC MEMORIES :

The incompletely processed traumatic memories stored in non-declarative memory tend to be very fragmentary in nature. As we have seen, too, they are not stored in linguistic form but, instead, often in the form of :

bodily sensations (e.g. muscular tension, increased heart rate, hyperventilation)

images (e.g. these might come to us in nightmares or intrusively and unheralded during our waking hours as a result, often, of unconscious triggers – see below)

emotions (e.g. extreme anger or fear)

Also, our unconscious, non-declarative memories may express themselves through chronic, seemingly inexplicable symptoms and behaviours.

WHY WE FIND IT HARD TO ARTICULATE OUR TRAUMATIC EXPERIENCES :

Because the memory of our trauma has not been properly processed at the linguistic level we are likely to find ourselves unable to articulate our traumatic experiences in any coherent manner. (Click here to read my article on how we find it difficult to talk about our trauma).

TRIGGERS :

Bodily sensations, images, emotions, symptoms and behaviours linked to our non-declarative memories of our original, childhood trauma may be triggered whenever anything even remotely reminds us of this trauma.

In this way, we may find ourselves re-enacting aspects of our original trauma in our everyday lives months, years or, even (in the absence of effective therapy), decades after the actual experience of our childhood trauma is over.

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2017 Child Abuse, Trauma and Recovery

Childhood Trauma and PTSD – Facts and Fiction

 

Childhood Trauma and PTSD - Facts and Fiction

I have written extensively elsewhere on this site about how severe childhood trauma can lead to, amongst many other psychological conditions, PTSD (post traumatic stress disorder). For example, click here to read one of my articles on the topic.

Table of signs and symptoms of PTSD :

Childhood Trauma and PTSD - Facts and Fiction

However, amongst the general public, certain myths have developed in connection with what PTSD is, how the condition manifests itself and who it affects.

It is these I want to look at in this article :

PTSD – FACTS AND FICTION :

MYTH 1 – PTSD can only be caused by traumatic war experiences.

In fact, nearly three quarters of people in USA will experience a severe trauma at some point in their lives. Of these, about one fifth will go on to develop symptoms which are severe enough and long-lasting enough to be clinically classified as PTSD.

Taking the two above statistics above, it clearly follows that about 15% of people in the USA will suffer from PTSD at some point during their lives.

Whilst traumatic war experiences are indeed one cause of PTSD (what used to be called ‘shell shock’) many other life experiences also lead to the condition; these include natural disasters, being the victim of a serious physical attack and SEVERE CHILDHOOD TRAUMA.

Statistics also show that women are about twice as likely to suffer from PTSD as men are at any given time (this is thought to be connected to the fact that women are more likely to suffer from sexual abuse).

A further breakdown of statistics is shown on the table below:

Childhood Trauma and PTSD - Facts and Fiction

MYTH 2 – Those who develop a psychological condition after a trauma are weak – they should be able to move on with their lives and put it behind them.

Developing PTSD has nothing to do with weakness. Everybody is potentially at risk of developing PTSD given particular experiences, it is just that different experiences affect people in different ways.

Indeed, research now shows that severe and prolonged trauma, particularly in CHILDHOOD, can adversely affect the physical development of the brain (click here to read my article on this) which can in turn make the individual vulnerable to developing not only PTSD but, also BPD (borderline personality disorder), severe anxiety and depression. THIS CAN IN NO WAY BE CONSTRUED AS THE INDIVIDUAL’S FAULT.

In such a situation, however, intensive therapy can help to reverse any harm that was done to the developing brain due to a brain quality known as neuroplasticity (click here to read one of my articles on this).

MYTH 3 – People develop PTSD immediately after the traumatic event that triggered it.

This is not always the case. It is true that if the severely traumatic experience is a one-off event, such as being violently mugged, symptoms of PTSD do tend to occur soon afterwards.

However, in the case of childhood abuse, which may have extended over a period of years, full blown PTSD may not develop for many years after the abuse has ended (click here to read my article explaining why this is).

It is for this reason that, in many cases, people do not realize that they have PTSD and therefore erroneously blame themselves for how they feel and behave (eg they may be prone to outbursts of extreme anger and rage).

And even if they realize they seem to have a condition similar to PTSD, they do not link it to their traumatic childhood experiences.

Unfortunately, this means many PTSD sufferers who could benefit from therapies such as CBT (cognitive behavioural therapy) and DBT (dialectical behaviour therapy) are not getting the help which could, potentially, dramatically improve their lives.

Childhood Trauma and PTSD - Facts and Fiction

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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