We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to the next episode of The Therapy Show, behind closed doors with me Jackie Jones and the wonderful Bob Cook. And we're going to follow on from what we did in the last podcast and look at The Paranoid Client. Correct, often called, well in the personality adaptations book by Van Joins called The Brilliant Skeptic. I'm very well aware of this one, Bob. Good. Yes, why? Okay, so with all these, well, I'm guessing, you want me to guess why? That's because you have some affinity with the paranoid traits or personality. Yes. Okay. Oh, you'll like this then. I do. I love it. The more information I can get about this. When you know this yourself, so you'll be a very good person to speak on this podcast. But with all these different styles of personalities that we're dealing with. I'd like just to talk about a way of thinking about this in general. And that's around a continuum of health. In other words, on one side you've got what some people might call mild symptoms and something might be called in the world of the neurotic well, or you might want just to call it traits if you wanted to. If you go up to more intense traits, working all the way up to the other end of the continuum, which is personality disorders, where the world is more black and white and fixed, and there's less flexibility or spontaneity. If you go to the other side, where you've got the neurotic well or the worried well, which is often called on that side of it, there's more flexibility than there may be traits of the style. We're going to talk about paranoia. So on the worried well, or the neurotic side, we're talking about traits. And on the other side, we're talking about much more fixed personality disorders, where there's far less flexibility, there's lacking of spontaneity, and it's very black and white. And then in the middle of that, you've got more intense traits if you like. It's like a continuum from left to right, from mild to the other end, a more of a personality disorder, or even psychosis. So whatever style we're talking about, think about and continue with health, because when you said you identified with the paranoid personality if you like, I think you're talking about traits, or what I would call in the area on the left-hand side of the continuum, which is more like the worried well, or the neurotic well, there's different names for it, but it's more in the arena of traits, rather than the other end, which is very black and white, fixed personality, lack of spontaneity. I think you're talking about that you've got quite a reasonable adult, but you have certain traits that you identify perhaps with this particular style of character. Yeah. That's right. 100% yes, I'm not diagnosed as anything. Luckily for me, yeah, I'm sure there are some people who will disagree with that. But no, it's the traits and what you're talking about.  You know, people talk about narcissism an awful lot lately. I don't know whether the pandemic's bringing a lot of narcissism. People like Trump around, haven't you? That's it, yeah. They're puking around where they're real narcissists, I think on the right-hand side of the scale. Yeah. But I kind of associate that with the traits around the antisocial behavior types. You know, I often say that those are the people that I would see in private practice. I don't think a narcissist, you know, somebody that's diagnosed with a disorder would come to see me in private practice. Well, certainly not with the narcissistic side. I know this isn't a podcast on narcissism. But on the narcissistic style, if it was really a personality disorder, they wouldn't even think of coming to see you. Yeah, that's generally what I say to people. You know, I wouldn't see them, yeah. No, and you're quite right with most of the personality disorders. They're so fixed. They're often being, maybe in sections that have been in the psychiatric system, and they're not likely really to reach out for therapy unless they're sometimes sent by the police where part of a court order is that they get therapy. Or maybe by a spouse, or maybe when people maybe even friends of theirs said we'd better go and get therapy. So they might go, but people with personality disorders don't usually reach out for therapy. No. But the traits, you know, I like the traits. I'm quite attached to my personality traits. I've got them very well. That's right. So it's very important that when we're talking about these styles, we're really talking more about traits or adaptations rather than a real disorder. Because once we go on to the disorder level, one, they don't usually come to therapy and be there if they do, they're very fixed.  So when I'm talking about these styles or adaptations, they're more in the worried well section or what we could call traits if you like for the case of the podcast. So if we're going to think of paranoid people or people who come from that paranoid style, one thing I always think about they are very much come from the place they have to control the world. In other words, control is a really important part of their personality. So when they come to see a therapist, they will really attempt to control the therapist. Now, that's from a surviving place because they see the world as out to get them. They see the world as threatening to them. So they need to control the world before they get swallowed up by the world. So when it comes to your therapist, control is a really important process and they will attempt to control consciously if you're not sorry unconsciously even not consciously. They will attempt to call the therapist. So that's a really important one to look out for. Yeah. And I think it, you know what you were saying, I think it's a really valid point that it's all about protection and safety and security. That's, that's where the control comes from. That's right. And in the in, I'm going to talk about a book here. I'll say I'm not particularly into labels, but the book I'm going to talk about is an important book because if you're a psychotherapist, you might turn to this book because it talks about traits, but it also talks about clusters. And it also talks about personality disorders. And that's the diagnostic statistical manual, which actually is a manual for psychiatrists and American psychiatrists in the Britain you've got in Britain or the UK, you've got what's called ICD nine. This is very similar, but you would, or you might turn to this book to just have a some thinking about what clusters or what behaviors or what thinkings might actually make up people who've got traits or even personality disorders. And one of them I was looking at, I've just got a few here, I'm just going to read one of them out to you around this is what I'm talking about. And it says suspects without sufficient bias that other people are exploiting, harming or deceiving him or her. Yeah, so they really are it's important for them to control the therapy room. And also with that, they will not trust the therapist. And they will not trust people easily. So on the traits level. They're not going to trust people very easily. The nicest language will have a don't think message, sorry, don't trust message. And when we talk about tests and other podcasts, this is where this is, this is really quite true for this style of character. They will test the therapist, mainly because they don't trust them. And they come from a place that they could be attacked or harmed quite easily by the other. I see it. Yeah, I know you spoke in previous podcasts that when you were talking about the mayor cat, I kind of see that as kind of paranoid where they're constantly looking the, you know, the on high alert a lot of the time to see if, if there's been caught out by something. Yeah, see the skit so it character or the withdrawn character we talking about when I gave that mayor cat analogy. Yeah. I understand where you go with that as a bit of difference because what you're talking about is hyper vigilance. Yeah. Now, with the skit so it's a it's hyper vigilance about exposure. So in other words, they have a real fear of exposure. And they may pop and pop down very quickly.  They're hyper vision just like you said, because they're afraid of attack or afraid of being harmed or afraid of the world in that that way. So they're very hyper vigilance. And on the straight side, you'll see that exactly the way you just started to talk about they'll start to look around they'll be agitated.  Why is that seat there?  So many different types of questions. Now, I remember I think of a paranoid person that I was working with recently before I stopped working clinically. And he rang the buzzer so I went to the front door, and he was he was a young lad and he had to put you over him. And he said, I've come for the appointment with Bob Cook. And then he said, and by the way, don't look don't look over there because those two people by the bus stop have been following me all the way. Don't look over there. No, no, no. And he just strode straight past me, because, you know, that's quite an acute sense of power now. There weren't people following by the way, but he had that sense of hyper vigilance because he was afraid that the world was out to get Tim was to going to attack him and that it was unpredictable. And he needed to control the world. Yeah, yeah. It's it's that, you know, needing to know everything what you were saying early on about asking lots of questions and why is that cushion there? Why do you sit there? Why do I sit here? Why all those sort of things that's that kind of is what I see a lot of. The first few sessions is just literally answering lots of questions. They do set tests for the therapist to pass, hopefully, or not. And that's all around trust. Now, usually what of course is when you set a test, there's nearly always a failure part to it. So therapists can't really pass the tests. Yeah, they can at least perhaps account for them. But paranoid really, really have a don't trust process. They also don't trust anyone in terms of being loyal to them. You know, they don't expect people to really be there for them or have their back. Yeah, they expect people to let them down. So therefore they're very suspicious people. They're very suspicious of the therapist. So that's interesting when you for their business, set contracts and have boundaries and have stuff with things we're talking about. Because I don't know if you do this, but some therapists may have contracts where they expect the client to sign that certain things, even a treatment contract level. Well, a paranoid client would think, probably it's a trick and why is a person asking me to sign anything. Now, according to their level of disturbance will be how they handle that. So only the person out of disorder wouldn't even sign it. I don't think people at the level of perhaps the worried well or the trait level will ask lots of questions properly before they sign anything. Yes, yeah. What does it mean if I sign it? Am I contracted to being in therapy for the next five years or what am I signing? What does that mean for me? Yeah. Be very specific.  They expect the therapist to let them down. They expect the therapist to disappoint them. They expect the therapist to actually trick them in some way. Because that's the way that's that's really been how their world was. And they've got coping mechanisms linked around survival. Because there's, you know, it's like there's no one else but themselves in the world. Yeah, they can't rely on anybody else. Friendships and people will let them down. Yeah. I the therapist will. Now, the bit is how does the therapist get around that? So you said a moment ago, you work with paranoid clients. How do you, you know, when you're thinking about this, the third the paranoid client is going to, yeah, it's going to have a don't trust message is going to set traps for you is going to be suspicious of you. It's going to expect you to let them down. What do you, how do you see the work with the client? That type of client very, you know, very early on, what do you see as the major emphasis? For me, probably consistency. You know, a few things. I think it's quite important that I remember a lot of the information that they've given me. Right, yeah. I can clarify names of people and places and things like that so that I'm being consistent as in I'm listening to what you're saying I'm taking it in and I'm remembering those things about you. But consistency appointment times turning up on time doing what I say I'm going to do. If I say one week we're going to work on this and then the next week I don't do it. That's, that's going to just fuel the fire for I don't do what I say I'm going to do. Yeah, and you would expect the paranoid client to ask quite a lot of questions. Lots of structure. I've got my whiteboard here. Do you know what I mean? I might draw diagrams and talk through the theory of things. I'm not just pulling it out. I rub it out with a hat sort of thing. There's a point to it the structure to it. Yeah, so you're providing probably a structured boundary consistent reliable framework which the paranoid client probably has never had, or it's been an environment which has let him down. And I'm prepared to let them down to a certain extent because I get a sense sometimes that they will just up the ante to try and prove that the paranoia is there for a reason. Yeah, so you're prepared to sort of go along with that. Yeah, and be prepared to make mistakes.  Yeah, another sort of, you know, taught by characteristics and features of the paranoid is suspicious and they're very suspicious and very jealous, usually usually without any justification. Now, that's really important when you think about in terms of how many clients clinicians have. So, you know, say the average professional therapist has 20 clients, just say an average. The paranoid client will be very, probably if they know that would be very jealous, very suspicious. Wouldn't want to wouldn't want you to have a relation with therapist to shares you with them with other clients and very suspicious about people that any particular justification at all. That's a shame. I was just thinking, you know, we have a waiting room with our institute and, you know, clients sitting there and a paranoid client particularly will be very suspicious of. They often want to sit in the waiting room by the way, but if they did sit in the waiting room, they'd often be very suspicious about the client. So if they were sitting there and say the therapist door that they're going to see is next to that waiting room client comes out the paranoid client to be very suspicious and jealous without any justification of what, you know, of the relationship with the previous client. Because they're in their background. They've been let down, they've been hurt. Life's been unpredictable. They haven't been able to control events. Yeah, it's a it's a it's a very unpredictable, powerless. History they've usually had. Inconsistent parenting is one of the things I think that a lot of people talk about in sessions with me when it's that never knowing 100% that mom or dad is going to be there emotionally available to them or turn up to pick them up from school or you know for whatever reason. That's right. That's correct. And so the coping mechanism is to take control to not believe anything anyone says to not trust people to be suspicious to be jealous, all in order to put to make the world predictable and to attack people before they attack them. To attack without justification before their thoughts are anyway is they get attacked by the other. They will blame others before they get blame themselves. Yeah, which is quite difficult for the the the paranoid client to to be intimate with somebody else to be vulnerable to to be in relationships 100% if they've got that lack of trust and feeling like they're always going to be let down and suspicious and all those sort of things. It's it's a challenge for a lot of clients. Oh, and that's right so it's hard to have relationships with people who are highly paranoid. It's difficult from that framework. And the other thing is of course they're hyper vigilance all the time. So they're cuttles are very high levels and they're very, they're just always on guard. So it's hard to have a relationship with somebody who's actively paranoid. And for them it's also exhausting to be hyper vigilant all the time like you say you're kind of on that upper echelons of anxiety and stress all the time because you need to be on high alert. That's right. So in the transaction analysis world, which we both are. There's a diagram in the ta world called the okay corral and open and he took his ideas from Freud and actually but you can also link into attachment models.  So from the beginning the therapist is in the paranoid eyes, which reflects this history from a coping place of course. Yeah. So how do you prove that as a therapist. Like we said being consistent showing up. Do you think you ever gain 100% trust from somebody that has paranoid traits. Well, I was, well, let's say trades rather than personality disorders or tends to continue because I'm not sure if you do right up there. Yeah. But if we're talking about trains I think we can get to a place where we can offer them a different type of world if they want to step into it. Now, the question is how you do it. Personally, patients, you have to be very, very patient. You have to have to create a world what you were talking about early on I think in terms of consistent boundaries structure reliability all the things you were just talking about so they have a different type of experience. They're not going to easily buy into that because they will in their child think is a trick. Yeah.   Yeah, in there. They're thinking. It's not straightforward work methodologically, but if you hold in your head that you are attempting to reach that vulnerable scared frightened child. I think you've got more of a chance. The problem is, if the therapist takes it all personally. Yeah. If they attack the blame, the lack of trusting the suspicion or personally, then things will go very wrong. Yeah, and I can see how that works because if you're in a situation where you're feeling like you're not trusted and you know that you are a very trustworthy person. I'm going to kind of buy into that constantly trying to prove that you are trustworthy and yeah. Yeah, it's the same if you it's the same for all these things, all these processes in a way harder for I think people are borderline if you're working borderlines or paranoid clients or or my antisocial clients or people that attack. You know, not just attack, but attack without any justification. If the therapist takes any of these processes personally, they're lost. They can go the best thing is that go to their own therapy and go to their supervisor to talk about all their issues they have with these types of clients. So what type of client needs is environment you talked about earlier on and a client who will stay with them and inquire underneath the attacks. Yeah, and inquire gently about what's, what's underneath the process of over control process of suspicion, the process of jealousy, and if it actually helps them in their life. Yeah, I think as a parent and ex foster care and the way that I relate that is, you know, there's always something behind the behavior. Often we focus on the behavior and take that personally, whereas it's a form of communication with a lot of children. You know, I work a lot with kids and it's kind of looking behind the behavior. It's easier to not take it personally if we do that. And like you were saying looking at the skirt child, the child that's trying to protect itself. If we can keep that in our mind's eye, then the distrust and the behavior that's in front of us, it's easier to take it less personal. I think it's another philosophical point, absolutely Jackie, absolutely. And there's another philosophical principle to bear in mind here, that however bizarre the behavior, or the power nor in this case, that if you trace back to the childhood will make perfect sense in that context. It doesn't make sense in the context of the psychotherapy route necessarily in the present day, but if you traced it back this behavior, these thought process to the early childhood, where the client comes from. That bizarre behavior will make a sense. Yeah, 100% sense. Yeah. So it's how you get back there. Yeah. Number one, you don't take it personally. Number two, that you can see the scared child, hopefully. And number three, I think, a lot of search for, you know, or inquiry, if you like, about the coping mechanisms which were set up all those years ago to protect them from what. Now, as we know, it's probably to protect it will be protect to protect them for from trauma, from unpredictable life, from abuse from a place where they've been let down or they've been not understood or they've been misattuned or they've been met. It'll be all those things where the child has felt so scared that the only way they can protect themselves or the only way they can see themselves protect themselves is to attempt to blame to attack to take control to be suspicious to be jealous, etc, etc. And then that way they create a whole barrier or series of barriers around themselves. And hopefully from their perspective will never be hurt. Number one is what you said earlier on, how do they then reach out to the world in an authentic way where they can ever be in a relationship, which is healing or trusting. Yeah. And like you said earlier on patients, it's, it's, it takes a lot of patience. Yeah. But if you can reach beneath those coping mechanism to the different levels of scare within beneath the paranoia and inquire what was happening in their world at that time. You have much more chance of helping heal that scare. Yeah. And again, I'm not sure how you feel about this but with clients that show personality traits such as paranoia, I do my utmost to not get in a tug of war with them. Of trying to prove certain things. I kind of let go of the rope at some points. And, you know, if there's a lot of resistance to what I'm saying, I won't push it. I will just let them stay in that place for a while without encouraging them out with their comfort zone. Let's put it that way. Yeah, because they're already putting up another barrier. They're already distrusting whatever it is. Well, I mean what you're saying is really important that you can leave your own ego outside the room because they're, they're major, major actual defense mechanism is to control. Yeah, and to attack. Yeah, you move into any think which can be perceived as a controlling battle. The only person to lose will be you. Because they're used to that. Yeah, that's the way they survived and that's what they expect the world to be like. And if you move into that, then there's only one way or only one process. You know, you'll end up in a battle and it goes nowhere. In fact, what will happen will be a repeat of history. Yeah, yeah. For the client. Yeah. That's a major point. I told you so. That's the major game. Yeah. Yeah. Major game. I told you so.  Yeah. Very common game in TA, but very common game for paranoid. Yeah. And at some point we need to do the game playing because I find that fascinating. Yeah. So the other side of things I think, you know, touching on it just before we wrap up the paranoid personality trait is that there's there's a lot of strategy and a lot of thinking they're very much in the head. There's not a lot of feeling and emotion stuff goes on with this. It's it's very logical. It's very cognitive. It's all. Well, yes, that's, as you go down the layers, you do need to get to feel this. Of course, but a good way to get to feelings. So that's what they think about what they're feeling. Yeah. You know, sometimes stops and then in the tracks. Yeah, that frame of reference. Yeah. And I think with all the stars we're talking about, you need to go with their frame of reference, whatever that is. Yeah. Whether it's whether it's about withdrawing. So maybe you need to think about initiation, whether it's about in the world of cognition, then for what you've just said there, meeting the thinking level. If you talk about history, hysteronics meeting with the feeling level, we have to meet them where they come in. Yeah. And then we need to go beneath that whole world. And with the paranoia is to gently ask them what they think about what they're feeling or finding a way to go down beneath the cognition is vitally important to reach the, what I believe is vitally critical, which is a huge scare of the world.  They will cross the road, you know, without any justification that the other person on the road is going to hurt them. But because they see the person frown, or so they see the person, I don't know, put their hands in the pockets. They think they think the person is going to attack them or hurt them. They may continue down the road but often might cross the road because they fear conflict. Now, of course, if it's a personality disorder, another story, but they live in a perpetual world of fear. Again, you know, if you're aware of that and see that scare, then being compassionate towards the behavior and understanding in that, that's the way to do it is to see it is all coming from a place of fear and scare. That's right. And, you know, the therapist, I agree with you again, and also to be aware that they may see any attempts of compassion or TA language, nurturing strokes as a trick. It's really not really important not to go and overwhelm them with loads and loads of positive strokes or positive nurturing or positive compassion or whatever you want. So it might be much more compassionate to find a way to think about the timing of positive strokes and compassion rather than just give them a full meal because these people are people have grown up without a full meal. Yeah, yeah. And it can be seen as quite condescending. You know, if they're trying to control their environment and suddenly you're being quite, you know, over the top invalidating and affirming everything that they're doing, they might see that as quite condescending. Again, because they're in that cognitive place, the feelings, the emotions don't mean anything. They don't mean that you might be able to trip them. Yeah. So, so you might I think it's a good point about but you are in the end need to get to their feelings and need the cognition. Yeah. So, to summarise, it's kind of like being in a minefield sometimes being in a therapy room with somebody that has a paranoid personality traits. They want to be in control. Yeah, they have the map. They know where all the mines are and where the traps are and where the tricks are, but it's usually without any justification. So if you can get underneath that, you know, that whole those whole coping mechanisms to get to the scared child who imagines where these maps and traps are and everything else that goes with it. So the perceptions are a very good way to get there, but you need to, I think with timings, everything gets psyched about. Yeah. But we're not rushing it, are we Bob? We're not doing it. No, slow patient work. So that's fantastic. Thank you so much. And the next one, we're going to be looking at passive aggressive. Yes. So, another traits of yours, is it? That one's not one of mine. Is that one of yours, Bob? If you talk about traits, it's really interesting. If we're going to passive aggressive, let's switch to passive aggressive then. Okay. Wait a minute. Let's finish this one and we'll do that in the next episode. Are you going to finish this one? Finish this one first. Draw this one to an end. Oh, let's, let's do this. I want to, I like to say something positive about the power, people have paranoid traits. So, you know, the nickname that was given by Paul Wehr and Van George in a book called personality adaptations. I think it was 2002. They called the paranoid client brilliant skeptic. And they have wonderfully brilliant minds. They work very well. They're very, very good thinkers. And they're very engaging people from that frame of reference. And I think if you can meet them at that level, of that level of thinking, you're going to go a long way. Yeah. And in a lot of work environments, they're really good because they're very detailed focused. Very specific and detailed. And I'll also ask questions. Which in certain jobs is a must. Certainly is go a long way. The devil's in the detail. That's the one. That's the one. Right. See you in the next episode, Bob, where we'll be talking about passive aggressive. Yeah. Yeah. See you soon. Goodbye. Bye. You've been listening to the therapy show behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.


We're teaching this course. We're gonna do what we call the TSL daily maintenance All right, and there are five things that we do to kind of achieve balance These are literally five things that you can do every day.  They're gonna help with things like Direction in life clarity focus, but at the same time, you know what they might tap into a part of you That's kind of confused they might tap into you a part of you that's kind of angry They might tap into a part of you that you may not like, but they are the roadmap to stabilize those things All right, number one. We're gonna get into is daily meditation daily med What kind of do that just because daily meds sound like something else man? but daily meditation number two is giving and I'm just gonna leave these up here and I kind of want these this to revolve around what we're talking about today Number two or number three if only I could count is be social number four Be Sexual oh, yeah. Oh, yeah How do I do that every day? Internet porn is just too That's the cheat and the last one and this one we recently changed Gratitude and purpose. All right, so check this out. I Really wanted to get to a place where I wanted to stabilize the things and there's a lot of work that I do on myself And this is actually a real important thing for guys that I work with they I don't tell them to do anything I haven't done. All right. I Do it myself. I do this with my guys. I probably post well Maybe not more on our forum than anybody about the the TSL five dailies But for me, it's really really really important to do these daily meditation What the hell is that for years years years, man? I've been around so many people who spoke or I've worked with like high-level entrepreneurs I've worked with people that are you know just brilliant people whether they you know some enormously wealthy and intelligent people or people who were just happy, you know There's my buddy Paul who is kind of like one of the wealthier guys I know and he started a search engine like Google years ago sold it. He has a Huge huge businesses and multiple multiple businesses that have like 70 employees a piece It is a real real tycoon type of guy Paul told me he's he's 40 something upper 40s He told me in his early 30s lost all his money and it's actually typical of a lot of entrepreneurs So if you're an entrepreneur and you felt this he lost all his money got divorced He wanted to kill himself and I remember him telling me he's like, you know But I wasn't really serious and I'm like no man. It's totally cool, man I've in the more you hear about my story. It's like no dude. I've totally been there, man I might think about suicide very often at certain times in my life just because of the the stuff that goes on inside me But he said man what I did was I joined the Zen Center in San Francisco And I just dropped everything and started to do that and this was years ago He told me he said every morning I would meditate and I credit that with the most important thing to me becoming a successful Man a successful businessman a successful man. I also know You know my buddy doc man or my buddy Dave These are guys who had crazy crazy lives where literally I remember one of them telling me he said Every morning he used to wake up and just go man I don't want to die.  These are some of the wisest people I know again They would tell me daily meditation You know if you see these guys now, I mean it sounds like kind of an intense thing But you see them now they're like they're like these these southern wise men that I just love talking to you I wish I would have them on my podcast, but they're like They say conflicts with the spiritual message of what they have to say, but daily meditation I don't tell you how to do that. We exchange ideas on how to do that What I do is simply this and actually meditation was very hard for me at different times Because my mind was spinning and spinning and spinning all the time and actually I would only go into state through sexual experiences It's really crazy man. See your true story You know, I would go out and field and try and get laid and do all this Hyper like and sexuality is low energy, man you know, it's malo energy and It's hyper energy is social energy and they kind of conflict with each other But the thing is is I would go out and field and do all this crazy stuff just so I could experience That point of you know some awareness and maybe belief in something that was bigger than me and you know, hey I guess thank God for it But but it took me a long time to be able to do this and I remember my buddy Justin He was actually an attendee who helped me out a lot at one of the 21 conventions in 2008 he said man just try and not think for five minutes a day if a thought comes in You know try and just acknowledge it and it'll pass fuck man. I couldn't do that shit It was too hard for me And so I experimented with different things different breathing things I talked to guys who are a part of our group and they do a whole bunch of different stuff It could be walking your dog. It could be Taking some time to yourself. It could be washing dishes in the sink It could be talking to another human being for years I considered my form of daily meditation and spiritual interaction just talking to one human being because I truly Believe that one human being talking to another is enough to move a man is enough to change somebody to make them feel Something good Yeah, I'm a pretty stubborn guy, maybe not as stubborn as Anthony Johnson But it was human that social dynamic was something that allowed me to calm and change and find the better parts of myself So your morning meditation or daily meditation can be anything but at some point throughout the day reset get back to it in Our minds and how our world work works and whatever it is because it's our culture because it's you know Our consumption because it's our wants or whatever it's because you got you know some abuse growing up or you got like some crazy crazy stuff, who knows You're gonna make every excuse of the world why you don't need to calm down sit down and think calm down sit down and think I'll take you five minutes, and I'll help you reset and It'll put you maybe not in the best place You know, maybe you might lose some money Maybe you might lose some momentum on something something that you're working on a creative project a deadline But it will put you in the place that you need to be where you're gonna actually ultimately function best you need to have faith in that Giving this is an interesting thing There's few people in the seduction industry that I absolutely think are the shit And I try and talk to him as much as possible one is Jason Savage And I remember seeing him speak as he was rehearsing his 2011 21 convention speech which you should all watch. It's it's 2010. That's right. It's the one convention. I missed That I had to cancel out of It's in Sweden. It's an amazing speech, but I remember when he was rehearsing for it He would do it for us all in Austin and talk about I remember emailing Anthony saying it was gonna be the shit And it was it's truly probably the best speech that's ever been given here So so check it out, but he said one of the things that sex and socialization is it's about giving it's about sharing In fact in that speech he said There's two types of personalities that get women there's ones that are Dominant and cold and taking and aggressive and can be manipulative and all this sort of stuff And there's one that's warm and giving and that's also very dominant and confident all that sort of stuff and everybody wants to look at the differences our Program or mindsets for efficiency want to look at the differences and they we can't make it work but one of the things Savage said when he went through his little triangle of social seduction sexual is that He said you got to look at the similarities These guys are dominant these guys are confident when we can work on being dominant confident We can start integrating these other aspects of seduction the exchange the experience between two people where man and woman become equals Where man and woman become one? You know, there's no true dominance in that the man is only dominant so the woman can be dominant the woman's only Dominates of the man can it's an exchange. It's just they speak kind of different languages, you know It's like a plug going into a socket How's that for crude huh, but giving is an amazing thing, you know, and so what I tell people is It's not about donations. I know people who donate a lot of money and they're miserable people I know people that You know give super fish lean all that sort of stuff But what I'm talking about here is intentional human interaction could be opening the door for somebody It could be giving a bunch of money away It could be doing somebody a favor, but it's that one thing that is going to put you in that moment of humanity all right, and That will give you that belief and that ability to have that human interaction and in fact We'll give you that aspect of being social. All right.   I was really scatterbrained There were a lot of changes that I knew I needed to make that's one thing that sex will have you do It'll it'll confront different parts of you that that kind of resonate how you need to evolve and all that sort of stuff but He goes look, why don't you just be honest with people? Why don't you just connect with people it's like you got social skills good enough to make that work So if you're having a bad day if you if you think that you're like Horrible person and stuck in self pity and can never get better you go and find somebody and tell that to them And I literally I mean this is true story man I mean I guess I'm kind of crazy or whatever, but I literally went up to people and did that I'd be in San Diego Or being I'd be teaching workshops You know and you've heard other people people speak today of that like you got to approach and you got to approach and all this stuff When you're teaching which I kind of have a different take on you got to be social all right, and you got to be sexual You don't need to approach if you're defining social dynamics by approaches You're missing the whole point of it, but the thing is I would actually go up to people I'd say look man I'm having a real bad day and like these people just listen to me just listen to me and it was like sheer Desperation but what happened there?


Today, I take $500 and spend it on the best cards I can find on TCGplayer. First is the Power Tool Dragon Ghost Trailer Unlimited for $89.99, we're going to be buying that one. Then a Black Rose Dragon Ultimate Rare for $95.21, a Thessalos the Firestorm Monarch Ultimate Rare for $19.97, an original Magic Rule Blue Eyes Tune Dragon $42, the Millennium Shield McDonald's Promo for only $14.49, an Elemental Hero Flame Wingman for $36.99, Blue Eyes White Dragon for PCK for $30.14, the Brand New Gate Guarding Collector for $48, Elemental Hero Stratos for $17.99, an Underrated Ghost Trailer Divine Dragon Knight Felgrand for $34.99, and the Anniversary Pack Blue Eyes White Dragon for $64.92. Let me know down below what I should or shouldn't have bought.


Hi everybody, Joe for jaspyscasebreaks.com coming at you with a random number block randomizer for that big group of teams right there This knocks out pick your team nine, which will be in a different video Everyone knows how the random number blocks work big. Thanks to Big thanks to Ken and Tim and Steve for buying spots straight up. Appreciate it Kenneth Timothy and Steve the only ones buying spots straight up which I appreciate and congrats to the people who won spots Thanks for buying into that taking a risk on that filler as well. There are the numbers Let's roll it and randomize it three and a six nine times for names and numbers one two three four five six seven eight And ninth and final time. We got Kenneth down to gale Three and a six nine times for the numbers one two three And ninth and final time Seven down to nine After nine All right Kenneth with seven Steve with one gale with zero gale You'll get any and all redemptions for that big group of teams down there including one of one redemption Steve Obviously, you'll still get live one of one Kenneth with eight two and five El Guapo with four Ryan with three Tim with six gale with nine Let's sort by number numerically in order and in the next video. We'll see you for the break Jasper's case breaks calm


Surface-enhanced Raman scattering, SCRS, is a powerful analytical technique used in chemical, material and life sciences due to its intrinsic features such as high sensitivity and fingerprint recognition capabilities. Technological advances have made SCRS more accessible and affordable, leading to increased use of the technique. This review provides an overview of the most important aspects of SCRS, including the phenomena at the basis of the SCRS amplification, the measurement of the enhancement, and the key factors that determine it. Additionally, the excitation wavelength in its CRS experiment is discussed, along with several types of substrates and fabrication methods. Biomedical applications of SCRS are also presented, including direct and indirect protocols. The review is written in a non-technical manner, making it accessible to researchers from various backgrounds. This article was authored by Roberto Pilat, Raffaella Signorini, Christian Duranti, and others.


Hey, what is up? My name is Rubidium. I have something a little special for you today on the crimson engine We're gonna look at a light, but not just any light a very special light this one the Hudson spider eight-limbed Transforming LED array That is incredibly versatile. That's incredibly bright. It has a 400 watt power output It comes with two or three different ways to conform it. I've had it for a couple of weeks now. I met the guys Tim and Sarah at NAB and their Australians here Tim's a DP and he basically created this light out of need He was working on films and commercials and he always needed a big soft source That was light that could be mounted high that was easy to carry But also one that didn't spill So the way you would traditionally get this is use a use a bank of four by four LEDs Or use a bank of four by four Kino flows, but it doesn't give the same effect as a circular source It's not as pretty in the eye. It's not as pretty With the reflections so he threw many prototypes and with his team created this Hudson spider That transforms and adapts to all sorts of wonderful ways I first learned about it on one of Matt workman's podcasts and have really wanted to check it out It's become a kind of go-to high-end LED source for, you know, working cinematographers So i'm going to swap from the Hudson spider over to an LED panel so I can show you exactly how it works So when you pull this light out of the box It looks like this Only weighs a couple of pounds Each one of these eight arms collapses in on itself. So so it's very compact and transportable Then you can mount it to a light stand or a c stand and then you start to open up the different limbs and possibilities and ways to configure this light So by loosening it in the c stand knuckle, um, it can rotate So that lets you open up The first stage of each arm Once you've done that you can open the second stage of each arm So I set it to 10 percent so you can see, uh, basically how it works Um, you just have to now that it's plugged in you have to watch the cable that it doesn't twist up But essentially there's Arrays of LEDs in the arms that are joined by a hinge and it means that uh, you can make the light Smaller or bigger by manipulating the the legs of the spider. So the next thing you do is put on a Softbox like an octobank That drops the you can if you don't have issues with spill you can use it entirely like this The next step in configuring it to be used on set is to add the softbox, which is what I'll do now So you can kind of drape this over And each of the legs fits into a little pocket as you rotate the light Then once you have your softbox on it attaches by a zip at the back So it's pretty easy to configure and this softbox Then serves to hold the diffusion and has the advantage of still revealing a lot of the, um Structure of the spider legs inside the light so that it breaks up the perfect Kind of two perfect circle in the eye of the subject But um, I'll stop I'll turn off this light and I'll stop down the camera and I'll measure the output So at uh full power at about three feet away from the front of the um diffusion I'm getting uh 600 foot candles, which is about 6200 lux the difference between this and other bright leds is This isn't too bright to look at it's not, um, it doesn't burn the eyes of the talent even at full power because the uh the parabolic Formational light is what's giving the throw and not necessarily, um the pure brightness of the leds. So you might be thinking, uh You know three three foot diameter is great, but I want bigger sources I'm shooting full body shots like we are here and this is only going to cover the top half of my talent Well, the spider has you covered and now you have what's probably a four and a half foot source, but You can go bigger again So you start by adding this um initial layer of diffusion and then I'm gonna have to move this back. I'm not even going to fit it on camera.  So now we have a Six foot uh light source and yes, there's diffusion for this So now we have the full six foot version of the Hudson in its diffused light source So I'm going to slide the Panel out the way move this to where it was when we started and I'll show you what that looks like So now I'm being lit by this huge diffused source Like I said, it's still in it 50 power. Um, it can go much brighter. It's by color It all packs up into a tiny little hard case travel case Um, and you can even run it off batteries. So, uh, I mean The Hudson spider as far as configurability as far as Transportability as far as um the way it's designed and the way it's meant to be used is like the future of lighting It is going to be seen a lot more. I think on sets a lot more on um high-end budget feature films tv commercials tv shows It's just a really versatile awesome tool instead of having to bring a whole array of different lights in different colors with different powers different sizes Uh, suddenly you can bring one light and it can do, you know, 90 percent of the things that you would typically want after I met them at nab I went out to their factory Uh, just outside of los angeles here in california, you know, they make everything there They test everything there. That's my look at the Hudson spider. Thanks very much for watching Leave you questions in the comments and I will see you next time


Hello, everyone. We're going to give you a little time to come in. I'm Virginia Robert. I'm the foreign desk editor for Lysico, the French business daily. And we're going to talk about a very incredible electoral year coming ahead. I hear an echo. Is that normal? Yeah, maybe. Yeah, probably normal. Did you hear the echo too? No. The sound is very loud. So to discuss this incredible year we have ahead of us, I have with me Igor Yorgens, from Russia. He's a man of insurance. He's been involved in the insurance industry for many years, several associations, and he's also involved in the Russian International Affairs Council. Next to him is Isabelle Lassin, who is a journalist just like me. She's the diplomatic correspondent for Le Figaro, the French newspaper. Very well known. She's been a defense correspondent, diplomatic correspondent, foreign correspondent, war reporter. So she's done it about all. And she just wrote a book about Poutine and Macron that is going very well. The book is, maybe not the relationship, but the book is doing very well. And next to me is Iroyou Akita, who is a senior writer for Nikkei. He publishes commentaries and columns on foreign affairs and security affairs. And he's worked all over the place in London, in Washington, in Beijing. He's been a foreign correspondent, so he knows foreign affairs very well. And behind us I see Monsieur Gruffin, who joined us, finally through a video link. Welcome. And he's a banker. And I met him in New York when he was working for Citi at the time. And he's involved in many, many different projects. So before we start the panel, I'd like to share with you a study that came out yesterday, actually. And it's a study published by International Idea. And that's an international governmental group that is based in Sweden and that monitors the state of democracy. And the findings are really pretty appalling because it shows that in 2022 the world has entered the longest democratic recession ever observed, which means that for the sixth consecutive year democratic values are losing ground everywhere. And I mean everywhere, I mean in Europe, I mean in the Americas, in India, in Russia. These findings have occurred in the very foundations of democracy, revealing weaknesses in the electoral processes, in the ability of legislators to act as checks on the executive overreach, and also the difficulty for people to access the institutions of justice. You have countries, for instance, like Tunisia, Afghanistan, Belarus, Nicaragua, or Myanmar, that have shown great regressions last year. And this institutional weakness is combated by continuing declines in core democratic rights, including freedom of expression, freedom of association and assembly, and freedom of the press. And Europe, of course, is not immune because according to the report, the rule of law has weakened, and I won't surprise many of you, but in Hungary and Austria, where freedom of expression falters, access to justice is more difficult in the UK as well as in France, where the freedom to assembly is also fading. Poland last year had many factors deteriorating, and the recent elections won by the opposition might pave the way for a betterment. So it is not an overstatement to say that globally, democracy now faces pressure everywhere, with authoritarian regimes tightening their grip and too many elected leaders adopting authoritarian tactics to claim to control. Meanwhile, you have misinformation campaigns, political polarization, and rising inequality that erode people's trust in democracy. So, as you probably agree with me, it is of paramount importance that democracies show their resilience, not all political regions are equal, and next year's elections will show indeed if the democratic process is able to rebound.


Good afternoon. The first item of business today is portfolio questions. Question 1 is from Dean Lockhart. Maîur Tew Whiching Cymru whatnot is taking to lower outpatient wasting time Governor Secretary sooner Robison. We've seen a significant growth in outpatient numbers with over 140,000 extra patients now being seen on an annual basis compared to 2009. I announced last week that £10 million has been made available to health boards to to the ability to reduce long waits for a first outpatient appointment. That funding will provide an additional 40,000 outpatient appointments between now and the end of March. Yesterday, I also announced a consultative document to transform outpatients. The aim is to deliver a major shift in the way outpatient care is delivered. The modern outpatient collaborative approach sets a new strategy for managing the raising demand in outpatient appointments and aims to free-up around 400,000 hospital appointments. iawn i gael ei gweithio i gael y fathau maes ymlaen, yn gweithio i gael oedd yn gweithio i'r rhaglen i gael, a yn gweithio i'r gwymau yn ynnyddol. Dean Lockhart. I thank the cabinet secretary for that response. Further funding is, of course, welcome. However, as we have said on this side of the chamber a number of times, it's not just about the money that's spent, it's about having the necessary staffing resources available to deliver satisfactory outcomes for patients. Across Scotland, there are high vacancy rates in cardiology Cyngorlach han Where the vacancy rate for cardiology consultants is above national average and is currently standing at 16.7 per cent. In any case, that is having a direct effect on patient outcomes. In NHS 4 valley despite the hard work of the local staff, the longest reported rate for cardiologists was 202 days. That is nearly 29 weeks and is more than double the Scottish Government target of 12 weeks. Does the cabinet secretary make sure to urgently resolve high cardiology, consultant vacancy rates across Scotland and NHS Forth Valley and address unacceptable waiting times for patients? Richard Miller-Lefain Whywntooth The Member chatting to the world public health mae'n perthaw safefump mewn pomfail Во을 cael axis i gael ondoeufol ei wneud. Mor diplomatic disputes hefyd, ond mae'n gwneud ahaen eraill ar gyfer CEO i gael eu bap feeli vrij ac wyddwch gan y per 280 village todd nifer gwrs-failain o gael ei wneud effeithiol ei wneud gennym goingf trainings gyda'u holdersunig号 yn fwrdd oedd mae'n ddatuniaf hwnnodd mai mewn mewn darloethau. The number of consultants, medical and dental consultants is up 40 per cent over the last since September 2006 to June 2016. We have seen more consultants, more specialists. There are specialties where there are shortages. Cardiology is one of those challenges. Given that the member has raised specific issues about cardiologists in Forth Valley, i gael i felnau y ping emergency cyfnod y gwahanol wedi wneud o'r edrych o'r resusiau o'i ei ddysgu'i niat. Murray Todd. I welcome the Scottish Government investment in reducing outpatient waiting times. In the winter period, demand for NHS services is expected to increase. What support has been given to NHS boards in the winter to ensure that that acquired capacity is in place to manage the expected increase in demand? I can tell Marie Todd that I announced last week an additional £3 million which is being allocated to local boards to help support their preparations for winter. This £3 million of winter funding is designed to increase each local area's winter resilience. That's in addition to previously announced sums of money, including £9 million to support accident and emergency departments over winter, and £30 million specifically to reduce delayed discharges this year. Patient treatment following GP referrals at NHS Harnarn and now the Washington Scotland has been falling from acceptable levels to unacceptable levels for the last 18 months. I have been aware of that from the growing number of my constituents who have contacted me because they are unable to get hospital appointments with winter pressures still to come. I have raised those matters of unmet demand in different ways with the cabinet secretary over several years, and she has reasonably acknowledged this growing problem and I welcome her promise of extra funding. However, cabinet secretary, hand wringing over the statistics of misery and disappointment, which have a bearing on outcomes, is no longer enough notwithstanding the daily more frantic efforts of front-line staff to get through the work. What instructions or funding are you going to give directly to NHS Harnarn to encourage or force them to up their game? Certainly, we have acknowledged that John Scott has regularly raised local issues regarding NHS Harnarn's performance. I can say to John Scott that, of course, NHS Harnarn will get a share of the £10 million to improve outpatient performance, and that is important in the short term, creating those additional 40,000 outpatient appointments between now and March across Scotland. However, there is a more fundamental issue here, and that is at the moment that our outpatient system works, is that everybody ends up in the same queue to see a specialist, even if they would be better treated by someone else. If you look at orthopedics, for example, a lot of work has been done to make sure that those who were traditionally in the queue to see an orthopedic consultant—many are now seen by physiotherapists—because that is the best health professional to see them. What we need to make sure is that, through the reform of outpatients—whether that is in NHS Harnarn or anywhere else in Scotland—we get people into the right professional, which will mean that those who need to see a specialist will be able to see them far more quickly. Again, I am happy to write to John Scott with more detail about the allocation of the £10 million that will go to NHS Harnarn. I encourage members and the ministers to have shorter questions and answers. We will get through more. Presiding Officer, to ask the Scottish Government how long it will take to make a decision on the future of Lightburn hospital if this was to come to ministers. As the member knows, NHS Greater Glasgow and Clyde's proposals around Lightburn hospital may well change or indeed not be taken forward at all as a result of the public engagement process currently underway. That is part of the well-established process on service change and the NHS and why I cannot and will not prejudge the outcome. The time taken to carefully consider any major service change proposal is largely dependent on the nature, context and complexity of those proposals. If those proposals are designated major and come to me, I will take sufficient time to carefully consider all the available evidence and representations. Former MSP Paul Martin highlighted in January this year that there was a plan to close Lightburn hospital by referring to a health board minute in which it stated that Lightburn hospital was up for closure for what she was called a liar. In April, local MP Anne McLaughlin wrote to constituents saying that she has received an unequivocal assurance that Lightburn will not close. Given that—that is an assurance that I do not think that anyone can give, given what the minister has said—she is deliberating on the matter, so I would like to know where Anne McLaughlin got that assurance from. Is the minister concerned that the service is clearly being run down while that decision is being taken? Will she not accept an appeal from me that the people of Glasgow north-east need a third hospital to serve older people? If she is considering an option to reduce the service by closing Lightburn hospital and transferring beds to Stop Hill and Glasgow royal, it will not be an adequate solution for the people of north-east Glasgow. What I would say to Pauline McNeill on stress is that nothing has come to me. I will have to wait until Greater Glasgow and Clyde have taken through their proper public engagement process. That may or may not result in any formal change proposal, but what I would want to see and to make sure that if anything did come to me—and I was considering that as a major service change proposal—is that I would need to be convinced that it addressed some of those concerns that Pauline McNeill and others have raised, that it would be fully consistent with national policy and would improve the patient experience. I would expect any proposal, if they were to come to me to address all those issues. I would hope that Pauline McNeill and others would certainly fully partake in any consultation around those. Ivan McKee The Scottish Government's national clinical strategy calls for a shift to community-based services and to person-centred care and homeless settings. For example, a local community-based hospital in familiar surroundings and it calls to address health inequalities by moving resources into areas of high deprivation and not away from them. Can the cabinet secretary reiterate her support for those principles and that any proposal for changes to health services in the east end of Glasgow and including local community hospitals, such as Lightburn, would have to be consistent with those principles? Obviously, what I can say is that when Nicola Sturgeon rejected proposals to close Lightburn hospital as self-secretary in 2011, because she had consistently heard from both patients and clinicians that the hospital provided high-quality services and were greatly valued, but, as I said to Pauline McNeill, I would need to be convinced that any final proposals, if they do indeed emerge, effectively address concerns raised by Ivan McKee and others, that any proposals are fully consistent with national policy and, importantly, would improve the patient experience. That is the challenge to Greater Glasgow and Clyde when looking at the future of Lightburn hospital. However, as the stress has come to me at the moment, it is a very early stage of the process and I would expect Greater Glasgow and Clyde to take on board the need for them to address all of those issues. Let's be clear, days before the election, Paul Martin was called a liar for suggesting that there were plans to close Lightburn hospital. An SNP MP used parliamentary resources to write to every constituent to say that she got assurances from this cabinet secretary that there were no plans to close Lightburn hospital. It seems that the cabinet secretary is denying that that was the case. Six months later, those proposals are in black and white and that same MP, as well as the local SNP MSP, is now holding public meetings in the area claiming that they are the ones that will try to save Lightburn hospital. That is a betrayal of people in the east end of Glasgow. The cabinet secretary should be honest with Parliament today and say that those proposals are real and that she will accept the will of this Parliament to call those proposals in. We believe that those proposals should be to reject the closure of Lightburn hospital. I am surprised that Anna Sarwar is criticising MPs or MSPs for listening to their constituents. I would expect any MPs or MSPs to listen to the views of their local constituents, whether it is on the future of Lightburn hospital or any other issue. As I have said in response to two questions, there are no formal proposals. What there is is a consultation public engagement process that is currently under way. That is a very early stage. Proposals may or may not emerge from that. Nothing has come to me in formal service change proposals. However, if they do, I have set out clearly the criteria that would need to be met in those proposals. It would need to improve the patient experience. It would need to be fully consistent with national policy. It would need to address those local concerns that have been raised. I do not think that I could be clearer. I take this opportunity to remind members to be careful about the language that they use in the chamber. I urge all questioners yet again to be brief in their questions. 3. Willie Coffey Thank you to ask the Scottish Government when it last met the NHS Ayrshire and Arran and what matters were discussed. Ministers and Scottish Government officials regularly meet with representatives of all health boards, including NHS Ayrshire and Arran, to discuss the matters of importance to local people. I thank the cabinet secretary for that answer. As part of the independent review that he announced last week into the baby death at Crosshouse hospital, he could ask that the parents of maybe Elijah Kennedy, who died in 2011, and Joseph Campbell, who died in 2012 could ask that both their sets of parents be included in that review so that their story may be heard and that any lessons will be learned and acted upon. I certainly wish to put on record my condolences to any family who lose a baby. I think that we all want to make sure that, in taking forward the review that Healthcare Improvement Scotland has been asked to carry out, that the views of families are very much at the centre of that. I have asked his to look into whether the processes and procedures within Ayrshire and Arran were properly followed in the cases that have been highlighted. I have asked that his meet with the affected families as part of the review, and that his report back to me with their findings at the earliest opportunity. I will certainly ask his to make contact with the families raised here by Willie Coffey, but I would expect Healthcare Improvement Scotland to meet with any families who would wish to discuss their concerns with Healthcare Improvement Scotland, and that is the indication that I have given to them in taking forward this very important review. Jamie Greene NHS Ayrshire and Arran has, unfortunately, been in the news an awful lot recently. We have heard numerous reports of understaffing, lengthy waiting times and unfillable vacancies, a case of a 19-month wait to see a consultant that was only resolved after we brought it up with the First Minister in this chamber, and, of course, the tragic cases of avoidable stillbirth deaths at Crosshouse hospital. Can I ask the cabinet secretary what steps she is planning to take to restore public trust and confidence, not just in NHS Ayrshire and Arran, but across the entire Scottish health service? The member raises a number of issues, but first of all let me deal with the issue of maternity and neonatal care. It is important to stress that, despite some of the serious issues that have been raised about Ayrshire and Arran, Ayrshire and Arran, along with all the other maternity and neonatal units, have seen a marked improvement in the number of stillbirths. Stillbirths are down in 2015, the lowest on record, and neonatal deaths and maternal deaths are also down. It is important that we give that public reassurance that, despite some of those very real issues that Health Care Improvement Scotland has been asked to look into, overall the units are safer now than they were previously. Those figures are something that we should welcome. However, the member raises issues around the general performance of Ayrshire and Arran, issues that were raised previously by John Scott around schedule care performance. I am very clear with Ayrshire and Arran, as I would be with any other board, that we expect, through their share of £10 million, to see marked improvement in outpatient performance and, indeed, in schedule care performance. We also expect improvements in the performance of A and E at Ayr hospital. We have seen significant improvement at Crosshouse hospital in the A and E department performance there. There is improvement in performance in some areas in Ayrshire and Arran, but there is still room for improvement in others. Again, I am happy to write to the member with more details if he would find that help. Christina McKelvie Thank you very much, Presiding Officer, to ask the Scottish Government what discussions it has had with NHS Lanarkshire regarding the implementation of the mental health strategy. Thank you, Presiding Officer. During the implementation of the previous mental health strategy 2012-2015, review visits by Scottish Government officials to NHS Lanarkshire took place in May and November 2012, May and November 2013, May and November 2014 and May 2015. In the engagement process for the forthcoming 10-year mental health strategy, the Scottish Government received a written response to its engagement paper, Mental Health in Scotland, a 10-year vision, from the Lanarkshire planning partnerships north and south. The written response was the result of a collaboration between North and South Lanarkshire health and social care partnerships, NHS Lanarkshire, North and South Lanarkshire councils and the local voluntary sector. The Scottish Government has carefully considered its response, along with the other 597 responses that were received in developing the final strategy. Christina McKelvie I thank the minister for all that information. The minister will know the value of working closely with community-based organisations, along with the NHS and other organisations, and I draw her attention to the work of an organisation in my constituency called FAMS, Families and Friends Affected by Murder and Suicide. I ask the minister if she will ensure that organisations like FAMS will be invited to contribute and work with NHS Lanarkshire to roll out the mental health strategy in my local area. Christina McKelvie I think that organisations like FAMS in the member's constituency absolutely have a key role to play and the prevention and reduction of suicides in Scotland is a key priority area for the Scottish Government and engagement in developing the next suicide prevention strategy will take place in spring 2017. During this period, we would expect input to this important area from a range of agencies, including organisations like FAMS and Friends Affected by Murder and Suicide. It is the role of NHS boards to draw on the knowledge, ability and resources of local groups like those to develop solutions that reflect the needs of their population. Monica Lennon The draft mental health strategy, the 10-year strategy, states that there will be actions to improve perinatal mental health. NHS Lanarkshire perinatal mental health services did not begin until November 2014, and NHS Lanarkshire does not have in-patient specialist perinatal mental health services, instead relies on NHS Greater Glasgow and Clyde. I note from the previous reply that the minister perhaps has not met NHS Lanarkshire recently, but is this something that her officials have discussed or that she might discuss in the near future, and does she find that situation to be acceptable? Of course, it is up to NHS boards to decide how best to provide that services, and co-operation across health boards is absolutely vital in taking forward health in Scotland in the future. In terms of perinatal mental health specifically, the mental health strategy will dovetail with the review that Jane Grant from Forth Fally has been undertaking into neonatal and maternal health services. Emma Harper To ask the Scottish Government what its position is on the establishment of a respiratory task force to help tackle lung disease in Scotland. We are already working closely with the national advisory group to support local improvement in respiratory care through the development of respiratory health quality improvement plan. The plan will aim to support NHS boards and respiratory managed clinical networks in making local improvements in respiratory diagnosis, treatment and care. Emma Harper Thank you for that answer. Does the minister agree that charities such as Chest Heart Stroke Scotland, British Lung Foundation and Asthma UK, are doing important work around lung health in Scotland, and will she maintain regular contact with stakeholders to engage with their recommendations for how to best deal with lung disease? We have absolutely recognised the valuable contribution that our third sector partners play in supporting people living with respiratory conditions. To offer a couple of examples, we have supported the development with £160,000 worth of funding resources such as My Longs My Life, the online resource that was developed by Chest Heart Stroke Scotland, which helps people to understand and self-manage their condition. We have also recently approved funding of £112,000 to CHSS to support the development of an online learning resource to support professionals through e-learning. Colin Smyth Thank you, Presiding Officer. Although we have seen a welcome decrease in the proportion of people smoking, not least as a result of the ban on smoking in public places introduced by Labour in 2006, the rate of declining is much slower in the most deprived areas, and it is not expected to reach the Government's 2034 target, despite the fact that 60 per cent of those access in smoking cessation services live in the most deprived areas. Given that COPD is the only major rising cause of death in Scotland and is much more prevalent in socially deprived areas, does the minister believe that developing an action plan to tackle the slow pace of decline in smoking in the most deprived areas should be a priority for the Government? We absolutely share that, regardless of the party, we understand that inequalities exacerbate some of the public health challenges that we face as a country. That is to be congratulated that the Labour Party took forward that ground-baking piece of legislation. I think that in the spirit of that cross-party co-operation, it should be recognised that we have taken forward other bits of that bit of work to try and stop some of those poor choices around smoking or alcohol or drug dependency impacting most heavily on our most deprived communities. We should work together to try and tackle some of those things. We have a tobacco strategy that sets out some of the areas in which we want to make more progress. Of course, the member will also recognise that I think that next week we will be about to see the legislation come forward around smoking in cars with children. That work goes on across the different political parties to make sure that we can make the differences. However, like the member, sometimes we are always impatient for change to make sure that everybody has a fair chance to flourish and that our most deprived areas get the chance to have better health outcomes. I hope that that spirit of consensus we can probably try and work across the political parties to try and make the differences that I think we all probably want to seek. I note what the minister said in terms of the diagnosis and treatment of lung disease. The minister may be aware of the British Lung Foundation's battle for breath report, which looks at the impact of lung disease across the UK. The report states that more can be done to improve awareness, availability of screening and prevention in particular. What is the Scottish Government doing to improve in those areas? We know that there is a number of recommendations set out by the battle of breath, and we certainly will take on board the recommendations that we met. We will continue to work hard to ensure that diagnosis is better. We have outlined some of the ways in which we have funded our third sector partners in order to try to help and allow people to cope much better with their condition. We will certainly look at all ideas and recommendations to ensure that that can be improved across the piece. 6. Maurice Golden To ask the Scottish Government what analysis it carries out to ascertain which groups are most vulnerable to seasonal health risks. The Scottish Government relies on analysis provided by a range of experts and specialist advisory committees on seasonal risk to health. The sources of those analysis vary depending on the specific issue that is concerned. As seasonal health risks are an issue relevant to a wide range of health matters, for example, the Joint Committee on Vaccination and Immunisation provides advice on which groups should receive the seasonal flu vaccine, and Health Protection Scotland provides the Government with analysis on an on-going basis about threats to health such as infectious diseases that may have a seasonal trend to them. Maurice Golden I thank the cabinet secretary for that response. The Scottish Government's own figures show that last year almost 3,000 of our fellow Scots died during winter, above and beyond the average rate for the rest of the year. That figure is completely unacceptable. World Health Organization research suggests that around one-third of those 3,000 deaths could be attributed to cold homes. In our manifesto, my party commits to improving all properties in Scotland to at least an EPC band C rating. That would improve energy efficiency, tackle fuel poverty and make homes easier to heat. The National Institute of Health and Care Excellence makes the same recommendation. Will the Scottish Government help to tackle those needless deaths by committing to a similar goal and set out a plan of action on how that can be achieved? First of all, there is a lot of analysis done on deaths during winter to look at trends and to look at previous use and whether there is anything emerging from those trends that we should look at in particular. That is an on-going process. The member makes an important point that issues of fuel poverty are very critical in preventing deaths from cold homes. It is not just the health service response that is required here, it is a cross-government response. Of course, we will look at ideas from across the chamber, although I point out that fuel poverty measures have been taken forward by the Government for a number of years now that are important in lifting people out of fuel poverty, but it is very, very challenging. The only point that I would make is that the situation is not helped by some of the welfare reforms that have been introduced by the UK Government, which has put pressure on family budgets, particularly those on low incomes. That does nothing to help to address fuel poverty and, in fact, can make the situation much, much worse. As to the Scottish Government, how many GPs have been recruited in Dumfries and Galloway through the bursary initiative and how many posts remain vacant? Of six GP specialty training posts that are eligible for the bursary in the Dumfries and Galloway region, three posts were initially filled, but one individual has since declined their job offer. That leaves four vacancies that will be advertised in the forthcoming 2017 recruitment rounds. Finlay Carson, I thank the cabinet secretary for her response. Galloway in Western Fries rural GP practices are in crisis. GPs are working longer hours than ever. Practices are being forced to merge and there is a fear in local communities that some practices will close. Will the cabinet secretary meet with me to discuss the possibility of giving the Galloway community hospital in Srinrar training hospital status and exploring the possibility of seconding armed forces doctors to ensure vital GP services can be delivered in rural areas? I am happy to meet with the member to discuss any of those ideas. I am always looking and happy to speak to members about ideas coming from across the chamber. Obviously, we would have to look at whether those ideas were practical and deliverable, but I am certainly willing to meet with the member to discuss them further. I would point out that we have a huge amount of work under way to improve the position within primary care. A £500 million investment over the course of this Parliament, some short-term measures to stabilise the position and address recruitment and retention issues, particularly in rural areas. Again, I am happy to furnish the member with more detail of that, but I would be happy to meet with him to discuss the issues that he raises. To ask the Scottish Government what its assessment is of health services in the Murray area. Health services across the Grampian are assessed at a board level. The NHS Grampian annual review took place on 6 October. The process ensures the rigorous scrutiny of the board's performance whilst encouraging as much direct dialogue and accountability between local communities and NHS Grampian as possible. I have issued a letter to the board that contains my observations on the board's performance in relation to a range of issues. It details a number of initiatives and actions to be taken forward over the coming months. The letter shall be posted on NHS Grampian's website in the near future. I am grateful to the cabinet secretary for that response. I have a constituent from Murray who has been treated for breast cancer at Rhaig Mawr, but because she lives within NHS Grampian she faces significant challenges with her treatment. For example, she cannot have her bloods taken at the Oaks in Elgin, an excellent facility that will save her going into a GP waiting area with her low immune system because the Oaks do not send samples to NHS Highland only to NHS Grampian. She also had an NHS Highland prescription for a wig, but the hairdresser closest to her home in Elgin could not deal with that because she did not have an NHS Grampian prescription. What can the Scottish Government do to improve the service of care for patients within the Murray area who face similar problems because they choose to be treated closer to home at Rhaig Mawr rather than within the NHS Grampian area? I think that the member raises some very important issues here. I would be happy to look into the specifics. It sounds as if there are boundary issues here, potentially getting in the way of some sensible solutions that would make it easier for the patient that you are referring to. What would help me is if you were to write to me with further detail and I can follow that up and respond to the member on the important issues that he raises. The cabinet secretary will be aware that one of the reasons for some of the pressures in Murray health service is attracting health professionals to come and live in our more rural areas. In the case of consultants to work at some of our smaller hospitals in Scotland, would the cabinet secretary be willing to look at the extent to which incentives are available to attract health professionals to work in such areas? As I think this is something that could make a real difference to helping to address some of the pressures. There have already been a number of incentives to encourage those health professionals to go and work particularly in rural communities. We have, for example, bursaries and golden hellows that are available, in particular specialties, to try to attract them to harder-to-fill posts. We also have regional workforce plans that are in the process of being developed, which will again be an opportunity to look at the particular needs of remote and rural Scotland. However, I will ask my office to get in touch with Richard Lochhead to perhaps get more details on the issues that are of concern to him within the Murray area, and I will be happy to respond to him on that basis. To ask the Scottish Government what improvements it considers necessary to the provision of abortion in Scotland. NHS boards are responsible for the provision of abortion services in Scotland. The Scottish Government recognises that there are opportunities to improve that provision, which is why we funded research by Glasgow University on issues surrounding women requiring abortion later in pregnancy and women who have more than one abortion. Both of those pieces of research are now published, and we will be informing how NHS boards deliver abortion services. The 1967 Abortion Act allows abortion up to the time limit of 24 weeks, but as the minister is no doubt aware, research has shown that, in practice, unofficial time limits are operating in Scotland, which range from 15 to 20 weeks, leaving women in Scotland in many circumstances having to travel elsewhere, including the time and the money that it takes to do so and the unnecessary stress that is added to their experience in order to access abortion. Why are women in Scotland facing those unacceptable barriers to exercising their reproductive rights? I thank Patrick Harvie for raising this incredibly important issue. I know that we did have a meeting planned, and we have one in the future to discuss the wider issues that he raised at First Minister's questions. There is one reason for some NHS boards offering other time limits or local limits to abortion is often around delivering a sustainable and safe service for a very small number of patients requiring that specialised procedure. Also, women travel from Scotland to England for later abortions if that is required. Costs for that are met by NHS boards in Scotland. I am happy to look more fully at the issue and to engage with Patrick Harvie when we are scheduled to meet up as well and to also any other member who is interested to look to engage with him as well. There are issues around sustainability and the safety of that service for women, which is one of the reasons why sometimes NHS boards offer different time limits, but there are relationships with other NHS boards and partnership relationships with NHS boards to ensure that women have access, but certainly around travelling in the distance that some women have to embark upon to access the right that they have. We are also looking at that issue because we understand the points that Patrick Harvie makes when he raises. Statistics show that abortion rates are higher among women living in the more deprived areas. What will the Scottish Government do to ensure that all women have equal access to contraception and sexual health advice? That is one of the reasons why we asked Glasgow University to look at some of the issues around abortion, including why women have more than one abortion. We also ensure that women have access to adequate sexual health advice and support should they need it. One of the issues around public health is that sometimes our most deprived communities suffer the greatest and that is something that we need to tackle. Again, I am happy to engage with Brian Whittle on that issue, but those issues are issues that we are certainly making progress on. We have certainly commissioned research from Glasgow University to look at some of the elements of that. However, if he has issues that he thinks require further look, I am happy to engage with him on that issue because it is important that we get it right and we act to prevent issues before having a woman take that very difficult decision to have an abortion should they require. I ask the Scottish Government what its position is on the reported short rise in social care charges for disabled people under 65 in Dumfries and Galloway, and whether it considers that this is a consequence of the cause of the recommending and applicable income allowance of £132 per week. I am disappointed that Dumfries and Galloway Council have chosen to adopt a lower income threshold for people under the age of 65. However, the Scottish Government funding has ensured that the threshold at which they begin to be charged for their social care has not been lowered further still in Dumfries and Galloway. The additional funding of £6 million that we provided to local authorities as part of the £250 million additional funding for social care in 2016-17 was intended to enable all local authorities to increase their charging thresholds to a minimum of 25 per cent in order to take those on the lowest incomes out of social care charges altogether and reduce social care charges for many more service users. Although several local authorities do not begin charging until well above the cause of the minimum, only Dumfries and Galloway Labour Control Council has chosen to immediately and dramatically reduce the threshold for care charges for existing service users and increase the rate of which they pay, despite the money that they have been given by the Scottish Government to reduce charges. That has resulted in vulnerable people with severe disabilities facing charging increases of 500 per cent and bills of £70 a week. Does that come from their already pressured benefits? Does the cabinet secretary agree with me that that is cruel and unjustified? As I said earlier, I am disappointed that Dumfries and Galloway have chosen to reduce the threshold for social care charges. The cosilar charging guidance gives the threshold as a minimum, not a maximum, and other local authorities have higher thresholds. We provided additional funding to local authorities in 2016-17 to tackle poverty. If those people on the lowest incomes are worse off now than they were as a result of those changes to the charging thresholds in Dumfries and Galloway, that will fly in the face of the council being provided with extra money to reduce charges. I would hope that Dumfries and Galloway Council will seriously consider the representations that are made locally and in the chamber on that issue.