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Archive for the ‘Black and White thinking’ Category

negative thoughts and behavioursOften we post lots of information about ‘positive’ signs and skills. After all part of recovery is learning to focus on the positive. But what about the negative, how do you recognise negative coping skills. How do you know that the behaviours you are doing are actually harming you or not promoting recovery. We live inside our heads so much that often negative process are so natural as breathing we think this is normal. Continuing negative behaviours can act as triggers for relapse or harming ourselves even more.

As part of a bigger post, I found a great list of negative behaviours and recognising them as such. Put together by Blake Flannery it is an excellent starting point. You can add your own unique negative behaviours to the list. The full article by Blake ‘List of Coping Skills for Anger, Anxiety and Depression’, also gives a lot of positive skills and how they actually help us by adopting them.

Being aware is the starting point for changing any behaviour.

Negative Coping Skills

Here’s a list of things that will cost you in the long run as coping strategies. These do more harm than good in most cases and can make life more stressful.

Diversions

  1. Procrastination
  2. Abusing drugs or alcohol
  3. Wasting time on unimportant tasks
  4. Shopping (online or malls)

Interpersonal (With Others)

  1. Blaming
  2. Isolating/withdrawing
  3. Mean or hostile joking
  4. Gossiping
  5. Criticizing others
  6. Manipulating others
  7. Refusing help from others
  8. Lying to others
  9. Sabotaging plans
  10. Being late to appointments
  11. Provoking violence from others
  12. Enabling others to take advantage of you

Cognitive (of the Mind)

  1. Denying any problem
  2. Stubbornness/inflexibility
  3. All or nothing/black or white thinking
  4. Catastrophizing
  5. Overgeneralizing

Tension Releasers

  1. Tantrums
  2. Throwing things at people
  3. Hitting people
  4. Yelling at others
  5. Destroying property
  6. Speeding or driving recklessly

Physical

  1. Suicide
  2. Self harm
  3. Developing illnesses

Intrapersonal

  1. Making fun of yourself
  2. Self-sabotaging behaviors
  3. Blaming yourself

Indulging

  1. Spending too much
  2. Gambling
  3. Eating/drinking too much
  4. Setting dangerous fires
  5. Continually crying

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This reprinted here in full, making it easier to read. Thank you to Helen Razer for putting it so well and so correctly about eating disorders and the current ‘DIS’ campaign. To read her original please go to: http://www.crikey.com.au/2015/05/07/were-making-ourselves-sick-with-the-publicity-of-eating-disorders/

I will follow in a while with my own post and thoughts on where Butterfly are and aren’t heading and the damage they do because they heavily mix body image campaigns with eating disorder awareness.

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To survive the current calendar, health advocacy groups must claim a month and shake it. January starts with glaucoma and thyroid conditions, and the year ends with Alzheimer’s and AIDS.  This month is given over to a number of health campaigns with notable new May player The Butterfly Foundation currently raising funds and awareness for eating disorders (ED).

Theirs is a well-regarded organisation providing outpatient services to ED sufferers who, in the case of an anorexia nervosa diagnosis, face what is estimated to be the highest standardised mortality figures of any psychiatric disorder. The help they offer is practical and based in firm research. But, like so many other advocacy groups, the public messages broadcast are entirely theoretical and based on flimsy hope.

With the achievable aim of funding itself and the rather more incredible one of stopping ED at its source, the foundation has launched Don’t DIS My Appearance campaign. Let’s set aside the antique hip-hop language that had passed its best before date before Snoop Dogg had packed his first bowl. Let’s also overlook the decision to ask ambassadors to display a middle finger, which I imagine may seem less like a moment of cheeky defiance than a bleak reminder of the toilet bowl to those who suffer from bulimia. Let’s look instead at how this organisation, and others, can so easily extinguish the very awareness they seek to create with crude messaging.

We spend much of the year in a tangle of awareness ribbons and there are those who reasonably argue that we’re bound to stop noticing the meaning of such decoration at all. But even if a public health campaign is good enough to cut through all this shiny bunting, it may achieve the terrible opposite of its intention.

In a study undertaken to assess the effectiveness of the famous breast cancer pink, researchers unexpectedly found that the women have become both more likely to underestimate their risk of the disease and less likely to donate to charities. The marketing professor who undertook the study concluded that in an effort to make the matter of breast cancer seem less taboo, organisers had also drained the matter of its urgency. After all, it’s pink like Barbie.

In a literature review on gender-based violence awareness, authors found that such campaigns can end up describing a standard of behaviour. If audiences believe that violence is very prevalent, as they reasonably might when viewing such ads, the message can license “violent behavior rather than activating behavior to reduce [it]”. In other words, violence is normalised through its depiction.

The Butterfly Foundation runs a similar risk of normalisation with its campaign. It’s a high-profile, celebrity-studded effort that posits EDs as normal and as prevalent enough to ask us all to change our behaviour in order to prevent them.

The thing is, though, this campaign is really not aimed at anorexia patients.”

Of course, all reasonable people would like to see a reduction in the incidence of anorexia nervosa. This disorder, which has a lifetime prevalence of between 0.3% and 1.5% in females and between 0.1% and 0.5% in males, is horrifying. That treatment, if accessible, promises a very high rate of recovery would seem to make the task of “awareness raising” all the more urgent.

If we can save a few lives by making death and extreme disordered eating seem a lot more common than they are — and the campaign absolutely does this by conflating EDs, a diverse group of mental illnesses, many of which have no extreme physical side effects, with anorexia in stating they collectively “kill more Australians than any other psychiatric illness” — then what of it?

The thing is, though, this campaign is really not aimed at anorexia patients. Professor Susan Rossell, a highly regarded expert in EDs with qualifications and associations too several to cite, sees “awareness” of this type aimed chiefly at people with “super anxious body consciousness” rather than an actual illness.

Rossell says that campaigns that demand an end to bullying might have some benefit for some ED patients. But the at-risk anorexia patients whose mortality statistic is used as a call to action are unlikely to be rescued by the injunction not to “dis”.

While there are accounts of anorexia patients who suffered chiding for overweight in early life, this is just one tiny potential element of a complex range of influences, including biological and genetic ones, which can provoke ED. While some patients may report bullying as a factor in their disease, others may report endorsement. Just as the so-called “Pro Ana” and “thinspiration” online community of extreme dieting normalises anorexia, campaigns of the Butterfly type can do exactly the same. To the potentially anorexic mind, the “everybody’s doing it” nature of this campaign is as much of a catalyst as a “dis” or a size 4 pair of skinny jeans.

Scholars in anorexia and all ED commonly use the biopsychosocial model to explain this disorder range. While it might be nice to end the “dis”, it might be also of great benefit to legitimate patients, as opposed to the simply body conscious, to understand that their disease has more of the “bio” and less of the “social” than most of us suspect.

“All eating disorders have a strong biological component,” said Richard Newton, Austin Health’s medical director of mental health and board member of The Butterfly Foundation.  When I suggest that the foundation’s newest campaign continues to situate ED entirely in the realm of the social, he explains that the illness-shaping or “pathoplastic” effects of the culture can switch the disease on. There are, he says, historical accounts that describe anorexia some 3000 years old. The “Holy Anorexia” of ascetic women who sought to become pure through fasting was, says Newton, “apparently epidemic in the Middle Ages”. The culture can turn this genetic predisposition on and off.

But what this awareness campaign does not give us is any indication that the disease may be genetic. Researcher in risk factors for ED at the University of Melbourne Isabel Krug rattles off a list of studies on potential endophenotypes, heritability, genome wide association and other data that we lay people can trust to mean that these disorders, particularly anorexia, involve a genetic predisposition.

There are even emerging biomarkers for anorexia, and Rossell was lately involved in a study on a particular eye movement called the “square wave jerk”. It is my lay understanding that imaging for anorexia shows more evolved promise than for those in the study of all other psychiatric disorders. It’s odd that common wisdom, and a great deal of general medicine, treats a common mental illness like depression as a case of “chemical imbalance” or genes, and anorexia as purely the result of social factors like bullying or super-skinny ladies in magazines.

Depression, despite its lack of biomarkers and clear prevalence among those poor in social capital, is read as biological. Anorexia, despite great evidence of its biological basis, is read as social and The Butterfly Foundation certainly overplays this by recommending being nice to people as a cure for death.

I asked Rossell about our willingness to see anorexia as an entirely manufactured disorder and she said: “It’s because it occurs so often in young girls”. She is unwilling to elaborate much further but when I asked her if it was due to the assumption that young women are empty vessels whose untainted bodies just wait to be filled by the culture she makes an ambivalent noise.

She is not ambivalent, however, on the enduring refusal to study and describe anorexia as having a biological basis. “There are papers I have tried to publish and these have been refused on the grounds that I am trying to overly medicalise anorexia,” she said. “Of course the biopsychosocial model is one that should be observed. But if you continually refuse to acknowledge the ‘bio’ in that complex, then you will end up with no idea of how the different elements interact.”

With medicine so reluctant to commit itself to an explanation for ED, it’s hardly surprising that groups like The Butterfly Foundation would follow suit. But even if we agree that it’s better to take the potential social catalysts for EDs out of the picture, the “dis” campaign fails miserably on that score.

Let’s even allow that the foundation’s normalisation of extreme ED and selective mortality statistic will do no harm and just think about the phrase “don’t DIS my appearance”. Given that the most at-risk ED sufferers are those who are underweight and gain at least as much momentum from the compliments their tiny silhouettes routinely attract as they may have from an early life “DIS”, perhaps “don’t praise my appearance” might be a more effective tactic.

Approbation is, perhaps, even more hazardous to ED patients than condemnation. As Rossell suggests, many public conversations that purport to address ED patients are really just intended for gals who feel like they might be a bit unattractive. And even if making the super body conscious feel a bit better about their flab is considered a good outcome, the “don’t DIS” edict doesn’t even really work here.

If women, both those who suffer an ED and those who just feel a bit shit about their bodies, want to be liberated from the primacy of the image, then surely an obvious solution is to detonate the power of the image.

Here’s my campaign, free of charge, to The Butterfly Foundation next May. How about you try “completely DISregard my appearance”? And instead of using attractive ambassadors and expensive manicures to underscore the lack of importance of the image, try a picture of me after 24 straight hours of researching EDs in my pyjamas. I’ll show you just how visual perfection has very little currency in one adult human woman’s working life.

 

 

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feelings and anorexiaThere is a blog doing the rounds at the moment of how it is to feel during an eating disorder, particularly anorexia. It is a haunting read. Many of us, either parents/carers or sufferers relate to every feeling. It highlights where we are or have been. We can shout, YES! we agree with all of that.

But we need to balance out what is the need for validation and the need for truth. Every story about living and surviving, or living and still struggling with an eating disorders needs validation. They are your personal journey, your personal thoughts and feelings. Validation is essential, otherwise it takes away your value as a person. It makes your journey a real one. It also helps those of us who don’t suffer with an ED to understand what is going on in the mind of someone who does. It helps those who suffer to know they are not alone nor in some weird, hateful universe of their own making.

The truth of these feelings though is what is needs to be understood. In the depth of the grip of an eating disorder (particularly anorexia), the mind is totally in the control of the ED. It is manipulated, distorted and controlled. Normal perceptions, thoughts and feelings are not happening. What you think and feel is based solely upon the eating disorder and not based in truth or reality. The ED distorts reality, life, decisions and perceptions so badly that your feelings get mixed into this mess as well. It may seem like truth, that this is all there is and it is real. But once you are on the other side, into recovery or recovered, you can see these feelings were not based on truth. Life is not like that, the people around you are not like that, you are not like that.

All mental health illnesses distort our perceptions and govern our thoughts and feelings. When I am severely depressed I know I think all sorts of weird, paranoid, self-inflicting thoughts. I feel many things but none of them based on the reality around me. It’s when I am back in safer lands that I realise that those feelings were not true nor indicative of what was happening to me or around me. My daughter used to think and feel like this current highlighted blog post, but she will tell you now that she knows those feelings to be just about all false. That it was the anorexia that coloured everything and gave her those dreadful feelings.

A good therapist will hear your feelings and validate them. They will allow you to identify and explore your feelings.

A better therapist will THEN point out the ED behaviour and teach you to separate yourself from the negative and distorted feelings.

Our whole team based their care of my daughter on this. They called each anorexic thought, feelings and behaviour into the open and pointed out how false and wrong they were. Without taking away my daughter’s need to be heard or validated.

She never felt she had to apologise for her feelings or she was wrong for feeling them. She did learn that the anorexia had given her thoughts and feelings that were not true about herself and life around her. She learnt to counter each negative feeling with a positive one.

When writing our stories, we need to be mindful that we show that these feelings are only for here and now in the grip of the illness. We need to put forward what happens after therapy and into recovery, that our feelings change and we see things for more differently as the ED loses it’s grips. We need to ensure that our stories are not ‘blanket’ approaches, one size fits all. Above all we need to share that hope lives and that the negative, destructiveness of an eating disorder does not last.

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Finally, have found the time to write this. This is our experience, I can’t talk for everyone who has asperger’s and an eating disorder (usually anorexia). Asperger’s is a spectrum illness so everyone is unique and on different areas of the spectrum. Anorexia is also unique for each person, particularly in their recovery.

By the time most sufferers of anorexia get to medical help, despite whatever other co-morbid illnesses are present or traumas suffered, the immediate concern and treatment is for the anorexia. Everything else is put aside til stability in health is achieved. It is also difficult to tell exactly what the mix of health issues can be too. The anorexia masks so much because it dominates the body and mind totally, and it also mimics so many other illnesses. It’s further into recovery with stable health and a mind more nourished, to get a better picture of what else is happening.

Will’s asperger’s was diagnosed early on but being high functioning and barely over the diagnosis line, it’s easy to think he is fully able to function like others. Whilst he has anxiety/depression the asperger’s affects his treatment plan.

Sophie’s asperger’s didn’t come to light until during her anorexia recovery. The anorexia highlighted the Asperger traits that she had carefully hidden or compensated for. It’s also the same for her, barely over the diagnosis line, it’s easy to forget the asperger’s traits in her recovery treatment.

Rigidness/black and white
Asperger’s is often about rigidity in thought and behaviour. When they get a thought or behaviour it can become a mantra, so tightly held it is very difficult to teach them how to let go and that it is safe when they do. Part of treatment is learning to be flexible. Teaching them that change is part of life, but also helping them negotiate that in a safe way. Change triggers a lot of emotions and rigid behaviours. They also love order and a set routine and knowing well in advance what might happen so they can plan to cope with that. Anorexia is also black/white, rigid thinking, routine or set patterns of behaviour. The two illnesses feed upon each other, and strengthen the thinking and behaviour. Treating the anorexia becomes a struggle of strengths. Both therapist and sufferer can feel blocked and frustrated that they cannot move into more flexible thinking and behaviour patterns. With Sophie, there is so far she can go before she hits the rigidness of the Asperger’s. Then it becomes very difficult to help her understand what is really going on. She also cannot fully understand why she cannot become more flexible, why others recover without the rigidness. An example would be food rules and fears, letting go of the incredible rigidness and fears she had was more to do with the Asperger’s than the anorexia. But the two illnesses together created a very formidable barrier.

Empathy and connection
Asperger’s is often called the ‘mask’. The face doesn’t show the normal display of emotions, nor is there the ability to connect with others on an emotional level. They get (sometimes) the logistics of it, can see other’s doing it, but cannot make the connection themselves. They cannot understand how it feels or is for another person. Anorexia is about cutting all emotions off, becoming numb, checking out so social interaction and normal emotional responses are damped down or non-existent. It helps the anorexia control the person and allow it to destroy the body and mind. Recovery is learning to feel again, connecting with your own buried emotions and reaching out and connecting to others. This is critical to recovery. Couple this though with someone with Asperger’s and again, they can only get so far in identifying emotions and feeling them, or expressing empathy for others. Sophie half gets empathy, and struggles to socially connect. She doesn’t get how to be a friend and often overwhelms her subjects. Will lacks empathy and struggles to connect emotionally. Both want to have full and normal emotional responses and connection. Both will also struggle to do that. In Will’s case he thinks a ‘pill’ will make him happy and be able to connect and feel for others. However that will never happen because of the Aspergers. Only therapy (that he may or may not be able to understand how to do) will help him to learn his version of empathy and connection.

Friendships and Social Awkwardness
Making and keeping significant friendships is a very difficult thing for someone with Asperger’s to do. They can be inappropriate in their responses, not understand social cues and ‘rules’, are unable to communicate at the deeper level that friendships require. Anorexia tries to isolate and destroy friendships for control. Friends of someone with anorexia also can find it all too hard, and just walk away. The majority of sufferers end up having to remake friendships all over again. Meaning, if you have Asperger’s then how do you make those friends again, how do you learn to social and emotionally connect to make friends when you can’t. Nevermind getting past the rejection phase of losing all your friends whilst being ill with anorexia. Sophie perceives her friendships on a different level to what they are. She can take offence when none is given, is very literal and little sense of humour. All Asperger traits. Making new friends in anorexia recovery is difficult – you feel an outstanding, different, still have food or social issues. Add a layer of Asperger’s to this and new friend making becomes a minefield of stops, starts, failures, and if lucky an occassional win.

 

These are the main ones that can create tension, frustration and a block to recovery. Whilst the other traits of Asperger’s can trip things up (little eye contact, perceptions of other’s talk and actions, being literal) they are more to do with relating to the treatment team. Sufferers can think their team is not believing them, blaming them, or is not making an effort. Instead of sticking to the team and pursuing a relationship, too many leave and start a pattern of changing therapists. This doesn’t aid long term recovery and can be behind many relapses.

The need is for a therapist who understands both conditions to help navigate the trickier parts.

The two illnesses requires more patience and understanding from all  – the sufferer, family and friends – that recovery is going to be on very personal terms.

Denying or not treating the asperger side is also harmful. It leaves the sufferer with no full understanding of why they are like this, or how to change or learn to live with it.

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This post is two excerts from Weightless about the inner voice that is part of a lot of mental health illnesses and how to manage them. Worth reposting for my readers. I really like the bit about saying “Oh I’m hearing the critic now”. Sophie was taught to say “Oh it’s that anorexia voice again, it’ boring”. We learnt that pushing or arguing with the voice just adds more fuel to the fire. Taking away it’s power to hurt you by ignoring or downplaying it can be far more effective.

And yes the asperger post is next.

Distinguishing the Inner Critichttp://blogs.psychcentral.com/weightless/2014/10/how-to-distinguish-your-core-self-from-your-inner-critic/

  • It’s harsh and mean. If you’d never say these things to someone you love, it’s your inner critic.
  • It’s black and white. You are either beautiful or ugly. Your dreams are either possible or impossible.
  • It’s the voice of reason. It mentions things that are supposedly in your best interest, such as “If you go forward with the book, you’ll ruin your reputation. Your work isn’t ready for that level of scrutiny. Better hold off for a while.” I’ve realized that, today, my inner critic is largely made up of this voice. It’s the voice that says, Are you sure you should be the one writing this book? Can’t you think of 50 other writers who should be writing this book instead of you? You’re not very good at public speaking. Let’s never do that, OK?
  • It says, “you aren’t ready yet.” “You need more time to prepare,” or “You need more experience.”
  • It spews self-critical thoughts about aging or your weight, shape or size. It says that you look too big or too old. It says you need to lose weight or shouldn’t be wearing this or that.
  • It rehashes negative core narratives.
  • It attacks you with critical thoughts, and then shames you for having those thoughts.
  • It sounds like your parents, siblings or your boss or anyone else who’s been critical.
  • It sounds like your company or culture.

What to do when the Inner Critic is LOUDhttp://blogs.psychcentral.com/weightless/2014/10/what-to-do-when-your-inner-critic-is-roaring/

  • We never win an argument with our inner critics.
  • Instead, when we hear self-doubt,  name the inner critic: “Oh, I’m hearing the critic now.”
  • Explore the inner critic’s motives. We can ask: “What are you trying to do? What are you trying to prevent or protect me from?”
  • Tell the inner critic in a sincere way: “Thanks, but I’ve got this one covered.”
  • Separate yourself from the inner critic. Instead of saying “I’m having a freak-out right now,” say “My inner critic is having a little freak-out right now.” This helps to train our minds to realize that the inner critic is just one voice within us, and “not the primary one.”
  • Seek out humor. Ask yourself, “What is absurd or funny about what my critic is saying right now?”
  • Pretend that you’re putting all the inner critic’s thoughts away into a cup, box or bowl. Then move it into another room. Get back to whatever you are doing knowing that the inner critic is no longer present.
  • Notice where the inner critic’s voice resides in or around your body. Then picture that voice withdrawing, or moving away from you.
  • Picture a volume dial for the inner critic. Simply turn it down.

One thing she does miss in the ‘what to do’ is using your distractions toolbox. Friends, movie, doing something different or active can be like changing the channel on the TV. Removes you from the place where the inner voice was trying to get attention.

The inner critic

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No matter how good our intentions at times, we can find it very hard to stand alone and not become part of the crowd we hang with. It is so easy to take on mannerisms, beliefs, attitudes, habits etc without even realising. It doesn’t matter whether you are online or in a physical social environment. We become, far too easy, what is around us. We may have the best hope and strength for recovery, but the everyday whittling away from those around us, particularly the online environment, can find us falling back into relapse or struggling more than we need to in our recovery.

Where our mind or thoughts are focussed on, that is where our heart resides.

We might have to rethink our lives, clear things out, stay away from social media, make new friends, look at our spiritual self, make our homes a safe and strong environment. Whatever it takes to continue recovery, to continue health.

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If you spend the most time with people who are consumed by calorie-counting and their appearance, you’ll probably start watching your food and nit-picking your body.

If you spend the most time with people who bash their bodies and themselves, you’ll probably start looking at yourself with disappointed, angry eyes.

If you spend the most time with people who consider themselves martyrs, you’ll probably start to feel selfish for practicing any kind of self-care.

If you spend the most time with people who don’t respect your privacy, like to gossip and are very judgmental, you’ll probably feel alone and hesitate to open up to anyone. You may even view humanity with some suspicion and dread.

If you spend the most time with people who have zero boundaries and get upset when you set yours, you might find it hard to have a healthy relationship with both them and yourself.

If you spend the most time with people who have strong boundaries and treat themselves kindly, you’ll probably be inspired to do the same.

If you spend the most time with people who love to laugh, really listen to their loved ones and practice self-care, you’ll probably feel more fulfilled and energised yourself.

If you spend the most time with people who love you for the real you, you might be inspired to turn this love inward and start the process of loving yourself.

It’s the same with the shows we watch, the books we read, the places we go, the things in our homes. We often are our environments. That’s why I suggest recycling diet books and “health” publications and creating a home that nourishes you and helps you feel good about yourself.

 

http:/blogs.psychcentral.com/weightless/2014/08/reflecting-on-the-people-in-your-life/

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The below is a powerful post of what not to say, even if you think you mean well. Even though the study was targetted at anxiety, the results are the same for depression and eating disorders. Throw-away phrases like those below, never help the sufferer, only make the journey back to health harder, lonelier and longer.
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The Priory Group asked anxiety sufferers to share the worst comments people had made about their anxiety. The results, shown in these pictures, revealed a general lack of empathy.

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Natalie Clince / The Priory Group

“Saying ‘snap out of it’ or ‘there’s nothing wrong with you’ is hugely detrimental,” says long-term anxiety sufferer Jonathan. “What that person doesn’t realise is that they are embedding those thoughts into the anxiety sufferer’s mind, which ultimately makes it worse.”

Dr Paul McLaren, a consultant psychiatrist at Hayes Grove Hospital, agrees that people need to have a better grasp of anxiety as an illness.

“It is not easy to switch off,” he said. “We need to work on educating people to help them understand that anxiety is a normal part of human experience and nothing to be ashamed of.”

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Natalie Clince / The Priory Group
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The Priory Group
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Natalie Clince / The Priory Group

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