BAPAM registered Psychotherapist moves to Bath

December 5th, 2019

BAPAM registered Psychotherapist Alison Penfold who had a successful practice in London for years has moved to the city of Bath. Before retraining and becoming a BACP Accredited Integrative Therapist, Alison worked as a classical singer. She uses perspectives from Psychodynamic, Person Centred, Gestalt, Existential therapy and CBT in her work. 

Alison is able to see people from Bath, Bristol and surrounding areas. In addition to working with those in the performing and creative arts, she has significant experience of supporting survivors of childhood abuse, trauma and addiction related issues.

Alison Penfold was one of a number of psycho social practitioners who contributed to a BAPAM piece a while back and spoke about her expertise and her experience of working with arts clients.




Hearing Conservation Guidance for the Performing Arts: A Consultation

November 26th, 2019

BAPAM has produced new best practice guidance for hearing conservation in the performing arts. You can download the consultation document here.

The guidance is being consulted on until February 2020. All comments are very welcome and respondents are encouraged to discuss with colleagues and use this online survey to provide feedback. The final guidance document will take account of responses.

The document has been authored by:

Rob Shepheard, Consultant Audiologist
Dr. Finola Ryan, Occupational Health Doctor
Paul Checkley, Audiologist
Claire Cordeaux, Director, BAPAM

Summary of key recommendations

Healthy hearing is essential for musicians.

Education providers and industry organisations recognise the potential risk of sound exposure to performers and have a duty to identify hazards to health, and take appropriate steps to minimise the risk of causing harm.

Modification of environment, repertoire and rehearsal schedule all contribute to level of exposure and must be carefully planned in advance.

Hearing tests are vital for health surveillance. Early recognition of changes to musicians’ hearing is best identified with a hearing test called ‘Otoacoustic Emissions’.

Personal protection with custom moulded earplugs must be verified to ensure adequate protection.

Instruction and continuous education for all staff and students must be available and recorded.

Laryngeal Manual Therapy (LMT) and Head and Neck Massage: BAPAM Guidance

November 26th, 2019

In the light of recent press about a death following manipulation ( and the publication of research last year on the dangers of head and neck massage if practised by improperly trained salon employees (“Crick” in Neck Followed by Massage Led to Stroke …), we at the British Association for Performing Arts Medicine, along with our clinical colleagues, thought it would be useful to provide guidance on Laryngeal Manual Therapy (LMT) and Head and Neck Massage, which is often used by professional voice users.

We recommend that manual therapy techniques applied to the head, neck and larynx should only be performed in clinical environments by the following registered professionals:

Physiotherapist – registered with the Chartered Society of Physiotherapists (CSP)

Osteopath – registered with the General Osteopathic Council (GOC)

Speech and Language Therapist – registered with the Royal College of Speech and Language Therapists (RCSLT)

Chiropractor – registered with the General Chiropractic Council (GCC)

Sports Therapist –registered with the Complementary and Natural Healthcare Council (CNHC), Federation of Holistic Therapists (FHT) or British Association of Sports Rehabilitators (BASRAT).

Massage Therapist –registered with the Complementary and Natural Healthcare Council (CNHC) or Federation of Holistic Therapists (FHT). Massage Therapists should be qualified to diploma level and registered with the CNHC or FHT, which are the only Registering bodies for Massage Therapy that are accredited by the UK Professional Standards Authority. While there are many organisations that provide training in massage, only some of them provide training at a level that provides a route to registration with CNHC or FHT.

Membership of a registering body accredited by the Professional Standards Authority is a guarantor of professional standards. It indicates that the practitioner operates within a structure that oversees qualifications, working practices, ethical behaviour etc. and can investigate complaints and impose sanctions on practitioners who fall short.

The BAPAM Directory also lists BAPAM-Registered Vocal Rehabilitation Coaches (VRCs). A VRC is a type of specialist voice coach who works as part of a multidisciplinary team that includes clinicians such as Speech and Language Therapists and Laryngologists. BAPAM-Registered VRCs have undertaken training to carry out palpation assessment. This is to assess tension only, and for onward referral, not to perform manipulations. Training in palpation assessment should be provided by a clinically qualified practitioner such as an Osteopath or Physiotherapist. Like clinical professionals, VRCs require clinical supervision from a Laryngologist, Speech and Language Therapist and sometimes a Psychotherapist.

Crafted talks – peer led discussions for performers

November 22nd, 2019

A singing and vocal coach from Manchester is organising an event aimed at facilitating an open discussion around the challenges performers have faced during their careers.

Kathy Brooke is behind the idea of “Crafted Talks” which was inspired by her personal experience of a voice disorder and its subsequent impact on her quality of life. This episode meant using her voice was painful and singing was also off the cards. This period in her life caused her to become withdrawn and pull back from all areas. She says the self-stigma around her voice issue meant she was unable to open up about it to anyone which affected her confidence levels severely. She was eventually diagnosed with a form of muscle tension induced through stress and emotional trauma. The diagnosis helped her to access the right treatments which led to her recovery and back doing what she loves. This pivotal experience in her life led Kathy to come up with an idea to provide a platform to industry peers where they can share their stories, their highs and lows.

Kathy hopes the event, due to take place in February or March next year will help de-stigmatise the many topics which seem to be off limits due to the fear performers’ have of health issues having a negative impact on their reputation and careers.

For more information about what’s planned, to register your interest or if you’d like to speak at the event email

Free health assessments for performers in Liverpool

November 7th, 2019

If you make a proportion of your living from, or study in the performing arts, and have a physical or psychological health problem related to your work, BAPAM can help you. 

A specialist monthly clinic in Liverpool is available for performers.

The clinic is led by GP Dr Marie McKavanagh who is a Performing Arts Medicine specialist and musician.

Who is it for?

It’s available to Liverpool Philharmonic musicians, other performing arts professionals and students in the city and the North West.

So what exactly is on offer?

BAPAM clinicians can provide an accurate diagnosis and information to help you overcome problems.

The BAPAM team can identify the best sources of ongoing care, both in the NHS and from other specialists, and advise you about sources of financial support for people experiencing health problems affecting their ability to work or study.

Venue: Liverpool Philharmonic Hall

Date: 13th November, 11th December

How to book: The appointments are not drop in and require booking in advance.

Contact details to book: 0207 404 8444

Classical Musicians’ Well-being Survey

October 16th, 2019

Simone Willis, a Performance Science researcher, is conducting an online survey with professional and conservatoire classical musicians about the workplace stressors musicians encounter, coping behaviours and the impact on well-being. The work is part of Simone’s PhD research programme and is intended to inform recommendations for well-being policies in the classical music industry.

The survey should take no longer than 20 minutes to complete and will be open from 21st October. Musicians are asked to complete the questionnaire twice – once now, and again in May/June 2020. The project has received ethical approval from Cardiff Metropolitan University School of Sport and Health Sciences Ethics Committee (SSHSEC).

To take part in the survey, please click here 

Simone is also looking for orchestras to signpost the research to musicians and vocalists by email. No access is required to the organisations records. Promotional materials for the survey are available, including poster/flyer, and a template circular email that you can send to your musicians. Please contact Simone directly to get involved and for further information on

To find out more about the project, please see this blog about the impact of occupational stress on classical musicians. Research from this project has also been published in the peer-reviewed journal, Frontiers in Psychology.

Keeping the Performing Arts Workforce Healthy: Performing Arts Health Champions

October 15th, 2019

Research into poor mental and physical health within the performing arts workforce consistently finds that 70-75% of our population report both mental and physical health problems. That’s much higher than the national average. Over 80% of arts professionals are freelancers, which makes delivering solutions to improve their health more complex. Improving performing arts health relies both on action from the industry and the individuals who work in it. Crucially, organisations and businesses need to provide healthy environments in which creative professionals are empowered to take responsibility for their own health. This can be complicated by the solitary nature of some performance work and the many stakeholders involved in the industry.

November 2018 figures from the Department for Digital, Culture, Media & Sport reveal that the creative industries made a record contribution to the UK economy in 2017, breaking through the £100 billion mark for the first time to hit £101.5bn. In June, the CBI reported in Getting Young People Work Ready that UK jobs in the creative industries are expected to grow by 5.3%, double the rate of average employment, creating approximately 120,000 jobs. It is critical that, to continue the clear growth in this vital sector of the UK’s economy, its performance professionals, many of whom have to take on second jobs to survive, can maintain good health and can access clinicians with experience of working in the performing arts quickly and easily if there is a problem.

To highlight these issues and the fundamental importance of ‘best practice’ in continuing to resolve them, the British Association for Performing Arts and Medicine (BAPAM), Musicians’ Union, Equity, Help Musicians UK (HMUK), PPL , Music Support, One Dance UK  and the Centre for Performance Science are combining their expertise to recognise Health Champions in 2020.

This is the first time so many key players supporting health in the performing arts have collaborated in such an initiative.

Who are our Health Champions?

Health Champions are people or organisations who drive change to improve health in the wider performance environment ecosystem in which they operate. We want to encourage and celebrate Champions from all the performing arts, recognising work done locally or nationally, individually and for venues, companies, orchestras, bands and organisations at all levels and all budgets.

Health Champions will be able to demonstrate what they are doing and how they have achieved it so that best practice can be disseminated and picked up by others. The aim of the campaign is to raise awareness that all organisations and individuals have the capability to improve health throughout our performance environments and that action can be taken.

What happens next?

In the next few months we will be publishing some of the risk factors associated with ill health in the performing arts and we want to start a conversation and hear your stories – what approaches are working? What does a healthy performance environment look like and how has positive change been achieved?

We’ll be reaching out for submissions, and later in 2020 we will share news of our Health Champions awards ceremony and a series of “how to” guides so that good practice can be picked up and implemented more widely in our arts community.

The Awards Working Group Members

Matt Hood: Equity and BAPAM Trustee
Diane Widdison, Musicians’ Union and BAPAM Trustee
Sarah Wall: PPL
Jonathan Morrish: PPL, independent communications consultant and BAPAM Trustee
Claire Gevaux: Help Musicians UK
Eric Mtungwazi: Music Support
Erin Sanchez: One Dance UK
Michael Durrant: Centre for Performance Science
Dan Hayhurst: BAPAM
Claire Cordeaux: BAPAM

A BAPAM patient story

October 15th, 2019

At BAPAM we support a wide range of performers suffering all kinds of health issues. At the various stages of contact with patients we do our best to get a coherent idea of their issue and advise them about a treatment pathway.

22-year-old saxophone player Murphy Robertson is one such patient who came to BAPAM at a particularly low point in May 2019, during her fourth and final year at Guildhall School of Music and Drama.

The final year for most degree students is a busy period, but for Murphy the year has been quite relentless. It was all systems go for her ever since things kicked off in September 2018. On top of university commitments, she was also working as a peripatetic music teacher in schools, while regularly performing in shows outside her degree.

So what specifically brought her to BAPAM?

She says things started to really deteriorate in March 2019 while she was working on an exam piece. She felt severe cheek pain and pain around the mouth, recalling how she thought her mouth would “fall off”. It was then she realised she needed to tell someone. She went to her saxophone teacher and head of music department, who suggested she come to BAPAM for an assessment.

At BAPAM she saw assessing clinician and GP Dr Tamara Karni Cohen. Before the assessment Murphy said the uncertainty about what it could be caused her a lot of nervousness. But once she saw Dr Karni Cohen she felt a huge sense of relief and recalls breaking down at hearing it wasn’t all just “in her head.” She says she had been dismissing the issue and admits having a medical professional listen and understand was very reassuring and validating.

Dr Karni Cohen says: “Here at BAPAM we see a wide range of vocational related issues with a wide range of performers.  Murphy was a very interesting case, demonstrating symptoms of muscle fatigue after a grueling and long recording session.  The facial muscles can also present with a ‘repetitive strain’ type picture.  Muscles being overused can overtire easily and we have factsheets on our website on how to maintain good physical shape as a performer. This includes the importance of strengthening, maintenance and appropriate rest intervals.”

Murphy was recommended a few options like osteopathy or physiotherapy, and Feldenkrais and was told that a consultation with a musculoskeletal or head and neck specialist maybe required if symptoms didn’t improve. As Murphy is a music student and matched the eligibility criteria for charity Help Musicians UK’s Emerging Musicians Health Scheme for financial support towards treatment, Dr Karni Cohen was able to help support her through filling out a funding application.

Looking back on the experience Murphy feels a combination of overplaying and lack of sleep and only one day off between September and March also contributed to the issue. She says juggling life as a final year student, working as a peripatetic teacher 6 days a week and other performing commitments created a lot of stress and exhaustion.

She also likens not being able to play for months to a “purgatory state” and says, “people start treating you differently, you feel like you lose your value.”

Dr Karni Cohen says cases like this show how physical symptoms like this can have an impact on mental health. She says; “When I see patients at BAPAM I like to cover all aspects of symptoms, including how it is affecting their psychological wellbeing. There is a lot of overlap between the mind and body, especially when it comes to a performer’s life. The impact physical symptoms have on people like Murphy, can really take their toll. As she aptly mentioned, people start to address you differently.  We are trying to improve the stigma related to conditions, how they affect performers and how often they are not going to impede them on their overall abilities, especially once addressed and treated. Especially when it comes to mental health related issues – these are still unfortunately stigmatised but there is a wave of change happening.  I always like to encourage performers to be open and connected with their mental and physical health. Prevention is key but recognition early leads to early intervention and prevention of chronic conditions.”

So how is Murphy doing now?

Murphy was successful in receiving funding from Help Musicians UK and has been using the funds to get treatment with a physiotherapist who has experience of treating performers. The treatments she has been receiving includes jaw massage, acupuncture and physiotherapy from the shoulder up. When we spoke to Murphy at the end of September 2019 she had received 5 sessions and said that even though the pain was easing she was still unable to play for very long. She also admitted she had underestimated how long the recovery would take.

What advice does she have for others who maybe in a similar situation?

Despite the challenges she has faced Murphy feels positive about the experience. She says it enabled her to take a step back and realise that she can’t do everything at once. Her advice to others is “don’t push it” and to stop and assess the situation sooner rather than later.

Guest Blog: Getting to know your emojis : )

October 3rd, 2019

In a guest blog for BAPAM, psychotherapist Fiona Macbeth considers the importance of emotional awareness for performers and some simple techniques for managing overwhelming feelings. Fiona ran the counselling service at one of the bigger London colleges for the performing arts, helping many young performers, as well as seeing established artists in her own practice. She helps performers overcome problems including low self-esteem, performance anxiety, perfectionism, confused identity, repressed emotions, distress due to physical injury and eating disorders. She currently sees clients in Brighton and London. Find out more at

Psychotherapist, Fiona Macbeth

Between the ages of 2 and 12 we’re taught lots of useful skills. How to read, write, cross the road safely, eat with a knife and fork and possibly say please and thank you ; )

What we are not taught is a vital skill which can make a huge difference to how we live our lives, and the lives of people around us.

We are not shown how to deal with difficult emotions and calm ourselves when we feel overwhelmed. We are just expected to “pick up” this complex and incredibly difficult skill and develop it unaided. No training, no text books, no user manual – no guide to our emotions and how to manage them : (

To make matters worse, many performers may have “missed out” on real life social opportunities where they might have developed these skills. Maybe they prioritised the dancing competition over the sleepover, were learning lines for an audition when there was a school trip, and their best friend was their dance teacher. So these feelings, which are difficult at the best of times, may be totally overwhelming and terrifying. When we feel so angry we just want to hurt someone. When we feel so jealous of someone getting that part we worked so hard for that we can’t breathe. When we feel so uncomfortable and awkward in new situations that we want to run and hide.

Often young performers overwhelmed in these situations look to someone else to “deal” with it. That person is likely to already be a major influence in their performing life, such as their dance teacher or a parent. Unfortunately they may offer unhelpful advice, along the lines of  raw emotions don’t fit well in a performance personality so it’s better to bury them or repress them. There may be pressure to adopt the “right” personality to do well in Musical Theatre, and exclude these uncomfortable emotions such as anger, jealousy and shame.

In my therapy practice, I see a lot of clients who say “I don’t do conflict and anger.” What they mean is they can’t cope with it or don’t do it well. And believe it or not, there is a good way of doing anger, or even confrontation. By expressing yourself in a calm rational way, and if necessary asserting yourself, you can develop heightened self-awareness. Then you are processing the anger instead of repressing it.

Repressed emotions don’t go away, they just lurk and pop out at inappropriate times. They can come out as a panic attack, as inexplicable and unstoppable crying or hysterical laughter. But they don’t go away unless they are explored, communicated and understood.

Left unattended, they can lead to other unhealthy actions. For example, binge eating as a distraction from emotions you can’t handle. Restricted eating or anorexia giving a false sense of control when emotionally you feel out of control.

Ideally they need exploring in a safe and controlled environment, such as counselling. This will help develop self-awareness, challenge dysfunctional behaviours, tackle underlying issues such as anxiety and increase our chances of being happy! However this can be a lengthy process and in the meantime rather than repression a healthier approach is for everyone, and especially performers, to develop a “toolbox” of techniques to help calm themselves when things are starting to feel out of control.

This can be as simple as a breathing exercise. Either find a quiet corner, or just do it quietly, and breathe in for the count of five and breathe out for the count of five. And whilst you are doing this just concentrate on the breathing. If your mind wanders, bring it back and think only about the breathing in this moment. You can do this for three breaths or three minutes, but practise it and it does work. It works best before things have got really out of control. This is because our emotional brain is triggered almost instantly and our rational brain is slower to kick in. So if you are facing a difficult situation, or something you know from experience might “press your buttons”, do some preparation with the breathing before the event, or entering the room, or seeing that teacher or director.

Free meditation apps work well for some people. Insight Timer and Headspace are very popular. Enter how much time you’ve got, what the issue is e.g. low self-esteem, motivation or anxiety, put your headphones on and zone out.

Visualisation needs practice but can be very effective. Visualise a calm and safe favourite place, such as a beach or wood, and expose all your senses to what that place would be like if you were there now.

Favourite photos of reassuring people or scenes on your phone can help.

Explore, experiment, practise and learn what works for you. Work with your emotions and don’t be taken hostage by them.

Have your say on the government’s occupational health consultation

September 13th, 2019

You may not have heard about the current government consultation: “Health is everyone’s business: proposal to reduce ill-health related job losses”.  The consultation seeks views on different ways in which government and employers can take action to reduce people falling out of work because of ill health.

While much of the document is focused on employers, there is a significant section in chapter 3 which includes proposals to improve access to high quality, cost-effective occupational health services for self-employed people and suggests that a direct subsidy or voucher scheme might be a solution.

Given that about 85% of the performing arts sector is freelance and 75% of artists will experience an occupational health problem, some form of subsidy could transform  the health of performers.

We’d encourage performers, performance professionals, industry organisations and anyone else interested in the health of the performing arts workforce to have a look at this consultation and respond to government to ensure that the needs of our sector are well represented. You only need to complete the bits of the survey that are relevant to you. You have until October 7th.