Reaching Across The Divide

Here is a sort of précis / romp through this piece I wrote a year ago for Thresholds – a BACP quarterly that addresses spiritual issues in counselling and psychotherapy. The article sprang from our efforts, early in the Coronavirus pandemic, to manage therapeutic contact across video-conferencing platforms. I was struck by my and others’ experience of finding the process particularly effortful and was led to reflect on the difference between this medium and the “real life” analogue situation, and to explore how it might shed light on what goes on in the latter (hitherto much commoner) setting.

I contend that the digital medium favours content over process whilst psychotherapy relies on content in the process which may therefore be lost, or at least harder to apprehend. The issue of timing, in particular, is important in communication; minute hesitations can say so much in the real world, but may be put down to latency when on-line. The platform algorithm, selecting which video of moving mouth parts to patch onto which bit of compressed speech, and often arbitrarily promoting one speaker over another, I liken to an enthusiastic and naïve co-worker in the therapy room.

This technological solution to the problem of being together during a pandemic brings obstacles to communication which I liken to the concrete obstacles that had to be overcome by adherents of non-conformist churches meeting together in Britain in the 17th century. This comparison, in turn, leads me to reflect on the common ground between psychotherapy and religion; a conviction of reality and benefit on the inside, struggling with an external demand for sufficient “evidence” to satisfy a sceptical audience.

I conclude (via yet another analogy drawn this time from marine biology) that when humans communicate, factual content has to be accompanied by some animating essence that I decide to call animus.

Bit of a stretch? Nah! But sorry; if this has whetted your appetite, you will have to get through the paywall.

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Keeping Intelligence in the Clinical Encounter

Keeping Intelligence in the Clinical Encounter

You may wonder why it has taken me this long to get around to reading Gödel, Escher, Bach by Douglas R. Hofstadter. I blame the conditions at the coal-face. It is brilliant stuff. On page 26 of the 20th Anniversary edition by Penguin (2000), after an introduction to strange loops in music, art, and mathematics, the author turns to intelligence and the abilities that are essential for it to pertain. I précis the section slightly:

Essential for intelligence are the ability to:

  • respond to situations very flexibly
  • take advantage of fortuitous circumstances
  • make sense of ambiguous or contradictory messages
  • recognize the relative importance of different elements of a situation
  • find similarities between situations despite differences which may separate them
  • draw distinctions between situations despite similarities which may link them
  • synthesize new concepts by taking old ones and putting them together in new ways
  • come up with ideas which are novel

Of interest to me here are not the limits of artificial intelligence, but how much these abilities are utterly intrinsic to the job of a therapist. Hardly surprising, one might say, since therapists are human.

But let’s look again, and reflect on the extent to which mental health work is being encouraged to follow practices that blunt or neglect these abilities.

Above is a list of things that questionnaires, categories, proformas, and protocols are bad at.

Therapeutic Attitude, therefore, is the attitude that insists on retaining intelligence in the clinical encounter.

Home page: https://afwest.com/

Vortex Management

Vortex Management

I have often thought about the vortex. It has been a vivid metaphor for that mood state that exerts a powerful pull and encompasses fatal peril, nameless dread, the unspoken, and unimaginable hopelessness.

The capital V provides the graphic.

Much of my life I have been blessed with a grandiosity and/or ignorance that has meant that skating across the edge of the vortex seemed more of a thrill than a danger. It has been possible for me to look in as I skirt the lip, my own velocity enough to ensure safety. I could even lend my confidence to others and act as a guide on those treacherous slopes.

But that energy wanes. Experience chips away at the assumption of safety. My sense of balance admits a hint of wobble…

So my awareness of vortex management has come to include more conscientious thinking and practice.

We differ in our relationship with the vortex, no doubt depending on our temperaments, experience, and circumstances:

  1. Some look the other way. This often works. Perhaps, by not seeing the possibility, the risk of vertigo is reduced. Unconscious awareness and a subtle lure my nevertheless remain. Whether one stumbles backwards into an abyss of which one had no knowledge, or one flings oneself backwards into something that has been kept in suppressed consciousness; either way, it comes as a total shock to the conscious mind.
  2. Others are all too aware and spend much of their time and energy marching or scrambling away from it – for the most part successfully, but sometimes not, and perhaps always only partially so.
  3. My approach for many years was, as I put it above, to skate across the lip. This brings to mind the “slingshot” used by spacecraft. If I have understood this correctly, the gravitational pull of a celestial body may be exploited to develop acceleration and turn directional into angular momentum. The vortex can actually be used as a means of changing direction. This requires considerable confidence and panache. Surely, there must remain a risk of miscalculation and a plummet into the core.
  4. Finally (though do, please, add to this list) there is the skill of staying still.

I have been developing this skill. The current pandemic, with its erasing of the horizon and its repeated and protracted limbo states of lockdown can be held largely responsible, but my recent emergence from the institutionalisation of public sector employment must also figure. I suppose that, as I slow down, I can no longer rely on my ability to maintain an escape velocity. So I have learned some new tricks. I have learned not to lean away from the abyss, thereby keeping my centre of gravity over my feet with closer attention to the friction between feet and funnel.

(You can tell when a metaphor is getting desperate, because it starts to thrash around.)

I acknowledge the existence of the vortex and its pull, but I weigh against it my own resources, and most importantly this includes an ability to separate what is happening from what I fear might happen.

At that point I pause and reflect. If I can separate the actual from the feared, surely I can notice that this is not a vortex at all. That was a vivid metaphor, and useful up to a point, but the truth of the matter is that I am not falling; I am afraid.

Not falling; simply afraid. This helps because I have been afraid before, and I have learned that, if I can prevent myself from running away, the fear passes.

I have retained the term, though: vortex management. It seems a suitable label for what is going on at those times, and it reminds me that there is something I can do about it.

Home Page: Therapeutic Attitude

The Pain of the Wronged World

The Pain of the Wronged World

Here are two fragments of text. Each is there to comfort you if you are put off by the language of the other.

Elio Vittorini

Elio Vittorini was an Italian Communist, born in Sicily in 1908. The translator Alane Salierno Mason points to Vittorini’s conception of the novel as an art form akin to music – specifically opera. Music is a medium capable of taking us past words and into a non-partisan realm. In his posthumously published novel Conversations in Sicily his protagonist starts,

“…in the grip of abstract furies….not heroic, not living…furies for all doomed humanity.

On the spur of the moment he sets out for his home village to see his mother, whose birthday it is. This proves to be something of an Odyssey during which he is welcomed by a group of men who bemoan the fact that,

“The world is big and it is beautiful, but it has been badly wronged. Everyone suffers each for himself, but not for the world that has been wronged and so it continues to be wronged.”

These men applaud our protagonist’s suffering with a phrase that becomes a sort of chorus:

He suffers the pain of the wronged world.”

Lighting a cigarette as he leaves his mother’s house, he remembers, and starts to weep. He walks through the village weeping and, gradually, the villagers follow him:

‘Why are you crying?’ They asked. But I had no response to give them. I wasn’t crying for any reason. Deep down I wasn’t even crying; I was remembering.  

〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰

L. Violet Holdsworth

L. Violet Holdsworth, née Hodgkin, (1869-1954) was an English Quaker. Amongst her many writings is the following passage from Seas of the Moon (1940) quoted in the 1960 “Blue” version of Quaker Faith and Practice (©1969 London Yearly Meeting of the Religious Society of Friends):

Perhaps [in ageing] our other powers are being taken away from us to teach us to trust more to our prayer-wings, and to pray, pray for the needs of the whole world with an urgency unknown in earlier days, when our longings were more circumscribed by our immediate horizon. We can pray now, or rather we can try to let prayer stream through us, knowing that our prayer is not ours alone…”

〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰

In Being With and Saying Goodbye I describe myself as a “moderately aggressive agnostic”. I am not someone who uses the word “prayer” – one has to somehow avoid alienating either side of the religious coin – but I am taken by the ground shared by these texts, and by the hope of a redemptive power in collective grief, compassion, expression, and the virtue of being open to the pain of the wronged world.

Here I am, then, with youthful powers gradually reducing, hoping that in some way I can contribute to a healing so much vaster than myself. I wonder if this is what Therapeutic Attitude might look like, applied beyond the individual, to a collective suffering.

In the middle of your life

In the middle of your life

The future can easily look bleak and, when it does, motivation to move forwards can be noticeably lacking. There is no end of self-help stuff around and I am not about to rehearse or list self-help strategies now. Here I am interested in attitude, rather than strategy or instruction. And one aspect of attitude is perspective. When feeling a bit stuck, it can help to consider my position and my present perspective.

One perspective caught my ear in a short spoken piece on sitting meditation and has stayed with me since. Ed Brown is a Zen priest whose delivery is simple and clear. On the CD that accompanies a small introduction to meditation Quiet Mind he describes a sitting posture for Zen meditation. I can’t lay my hands on the CD at the moment, so what follows is from my recollection.

When he has concluded his description of posture he says, “This is a really good position in which to sit, right in the middle of your life”.

This is the bit that caught me. I have listened to it many times since and thought about it many times more.

Up until then the metaphor for my life had me stationed at the prow of ship as it cleaved the waves. This is fine when everything is going well, but when the ship has shrunk to a coracle and is not forging ahead, it is not such an inspiring image.

Perhaps we are at a disadvantage with our eyes at the front of our heads. I wonder if raptors get anxious or depressed when they are not on the chase. Alternatively, perhaps it is to do with the dominance of vision in our lives. With my eyes shut I realise that space is equally distributed around me. Sound, smell, and general sense of being are all around, not only in front.

And when I come to think of it, my life is all around me. There are cultures, I believe, where the dominant idea is that people travel through time facing backwards, as it were, watching their increasingly rich and diverse past fanning out behind. I can’t say that I would particularly want to swap my cultural perspective for that one, but when I am inclined to an idea of the future as a sharply focussed cone in front of my face, what do I do when it is poorly focussed or empty?

So here I am, right in the middle of my life. Not nearing the end. Not with a past forever buried or dwindling to an invisible and unreachable speck. Not in a dinghy drifting to a standstill with a fading wake the only thing to show for my progress. There is change, but no linearity. Am I growing like an onion from the inside, adding layers? Or am I a benign black hole, drawing experience into me from all directions, so that I gather in density at my core?

And I need not develop the image at all, but it repeatedly feels to me that this shift of perspective offers the attitudinal change I need.

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Therapeutic Chess… or… When the engineering analogy breaks down

Therapeutic Chess… or… When the engineering analogy breaks down

This Christmas a three-player chess-set was given as a present and we had a game. It was a fascinating experience. I am not a great chess-player. As someone said to me recently, I always have the sense that my opponent has some far-reaching grand scheme that I unequivocally lack. This hexagonal chess board reduced the three of us to very similar levels of ineptitude as we reminded and re-reminded ourselves and each other which squares the pawn could take, how many bent diagonals were currently open to the queen, and the oddly straight knight’s move.

But that was not all. We found how hard it was to build any strategy when the person you took to be your opponent for the last two moves turns out to be an ally. The rules (one version, at least) spell out that, if you fail to take available steps to prevent a checkmate, you lose. And yet no checkmate that we encountered in two days of playing was achieved without the effective, if inadvertent, collusion of the other player.

We have been raised with a firm understanding that the triangle is the most stable structure. And yet, with this game, we found ourselves unseated from a stable, albeit viciously confrontational, dyadic structure into a disorienting dream world in which familiar shapes abounded but relationships flickered constantly and with bewildering rapidity. Chess had changed.

It seems that however important the triangle may be in the creation of stability and rigidity in the physical world in the world of interpersonal dynamics they represent a massive step into instability.

Our first relationships are with one Other (even if based on a misunderstanding about the identity and composition of that other) and I suggest that we would happily have it stay that way provided the Other remains committed and continues to come up with what we need. We often use a metaphorical third party to stabilize the dyad (you and me against the world) but the truth of the matter is that the world inexorably introduces genuine third parties with agency and their own urges to combine forces. What is more, the Other we have got used to fails, from time to time, to come up with the goods, we develop our own roving eye and the world, for evermore, is a place of unstable triads.

Or, if you prefer, the world is for evermore a stable-ish scenario of constant flickering transitions as triads configure and reconfigure. This is the world we found ourselves in with three-sided chess. It was initially disconcerting but, once the unfamiliarity was overcome, a new relief settled in. We found that the bitter paranoia of being in the lonely position was always momentary and was replaced by a higher-level sense of everyone being equally and temporarily both in a dyad, and in relationship with a dyad. Rigidity had actually been the problem; This idea that I am rubbish at chess, for example, or the constant search for a chess partner exactly like me.

This set could be sold as Therapeutic Chess …. and triangles rock.

Reaching Across and Introducing Animus

Reaching Across and Introducing Animus

The last nine Covid months have been weird. They have felt relatively unproductive, and yet I think something intangible or indefinite has happened. I think a great deal has been processing in the background. In the foreground, so to speak, one of the things I did was to write a piece for the British Association for Counselling and Psychotherapy in which I try, rather ambitiously, to set out what remote working has taught me about therapeutic process – or “being with”.

I attach a link to the pdf below and invite you to read it whilst respecting copyright. Here, though, are two essential points:

  1. I talk about content and process and assert that video conferencing platforms favour content at the expense of process. I give examples of how timing is messed with and non verbal material is sacrificed so that verbal content can be transmitted as intact as possible. But I acknowledge that the distinction between the two is not absolute or clear. “Which is the content and which the process, for example, when a mother and a baby look at one another?” The therapist looks for the content in the process. I believe this is one important reason for the increased effort needed to carry out certain categories of conversation when the participants are “remote”: How to be with someone when you can’t actually be with them.
  2. I invite the reader to an exploratory use of the idea of animus. I use this word, not in the gendered sense that Jung used it, nor in the sense of aggressive urge, but to denote that which gives life to or animates our utterance. If what I have to say to you is to reach you, and if you are to appreciate it in a holistic sense – ie not simply the overt content but also the content embedded in process – then it must reach you with its animus intact. Human contact is a living process. This, I believe, is something that the video conferencing platform with its binary coding, simplistic algorithms, and bias in favour of verbal content, cannot yet achieve.
The article provided here in pdf form appears in the October 2020 issue of Thresholds, published by the British Association for Counselling and Psychotherapy. www.bacp.co.uk/bacp-journals/thresholds/ BACP 2020©.

Two Stories About Jade

Two Stories About Jade

I was told these stories as a child. Looking back now I think they nearly summarise my approach to teaching.

The first tale was given to a group of us at junior school by the Bishop of Hereford.
A man wanted to become a connoisseur and collector of jade. One particular teacher came very highly recommended by his friend, so the man went to see him. He was welcomed, shown to a room and sat in front of a small piece of jade. The teacher left him there, returning an hour later to collect the piece of jade and his fee, and to bid our protagonist goodbye. This happened the next day and the next. Several weeks later the man bumped into his friend who asked how the lessons were going. “Appalling!” he replied, “He just leaves me alone in the room in front of a piece of jade for an hour. Doesn’t even say a word. And to add insult to injury, this morning it wasn’t even good quality jade!”

The other story my father liked to re-tell from the diaries of the diplomat Harold Nicholson. Nicholson was sat next to a Chinese official at a meal and was told, “In my country we have a proverb – Better a tile, intact, than a broken piece of jade.” “That is an excellent proverb” said Nicholson, writing it in his notebook. When he had done so he found his interlocutor frowning, “Or, maybe I have the proverb wrong. I think perhaps it is – Better a broken piece of jade than a tile intact.” “That, too, is an excellent proverb.” said the diplomat, “I shall write that down as well”.

I thought I should follow the example of the Bishop who, I can see now, was practising and preaching the same thing – at least on that occasion, but ending the blog at that point would no doubt results in a bemused reader, so here is my translation:

The Bishop’s point is that teaching is more effective if it is implicit. The man became an expert – he became something he had not been before. Had he been instructed by an explicit, content-based approach, he would have remained the same as before, just with some extra information. I did think I might do the same, and leave these stories suspended, but the required repetition and exposure (and in psychoanalytic terms the frustration tension) would have been missing; You would have had to sit with my blog for a few weeks.

The second story is, for me, about the nature of knowledge. Certainty is attractive but illusory, but the fact that the certainty is illusory does not make the information any less useful. In fact it makes it more useful by virtue of being more flexible. Secondly, apparently mutually exclusive opposites, far from being a problem, are what makes the world go around. The story is explicitly about whether it is substance or form that determines quality. That would be the explicit, content-based message – the substance, but it is the process, or form, that interests me more. Either that, or the flickering ambiguity that oscillates my attention between the two and leaves me suspended in a sort of pleasurable trance of unknowing.

Home Page: Therapeutic Attitude

Self-care and remote-working

Self-care and remote-working

Remote-working is here to stay. This post on behalf of Developmental Conversations offers tips for maintaining self-care drawn from experience, conversation, and published sources. Key sources are listed below.

Most will apply generally to working from home. Some refer particularly to video-conferencing. Not all suggestions will apply or be useful to everyone. Have a look and see what you think.

Curating the context:

General wellbeing:

  • Eat, Exercise, Sleep
  • Protect boundaries (see below)
  • Practice self-compassion
  • Build morale (see below)

Transition

Pay attention to the transition from normal into remote working. A major problem with the Coronavirus pandemic has been that it bumped huge numbers into remote working without any preparation or training, and without much in the way of choice. It is not too late to remedy that:

  • Acknowledge it as a major transition. Go easy on yourself. Don’t give yourself a hard time if you get some things wrong or are slow to pick up speed.
  • Don’t assume that you can work at the same pace as you did before. Communication by video link requires more effort. We have become communication novices overnight and there are lots of techniques still to learn.
  • Schedule a lighter diary to start with – that is, one that looks lighter. You may well find that you are more tired after it than you expect.
  • Learn and plan more explicitly than you normally do. So much of face-to-face communication and time management we learned by implicit means and over years, so now we need to read up and network to gather tips and strategies. Write them down. Adapt them to suit your work and temperament and build them into your practice.

Space

  • Dedicated space

If possible establish a space devoted entirely to work, remote linking or otherwise. If you do not have the luxury of space that can be devoted only to this, then have a place that you can reliably use – and you do use – for the remote linking, so that camera angles, background etc are already settled. Some people walk.

  • Good lighting

This is important for your comfort (eye strain), productivity (energy and focus) and, when it comes to video calling it is important that your face is clearly, but not harshly, illuminated for the person you are meeting.

  • Noise control
    • ambient noise needs to be minimised for you to be clearly audible, and for you and others to be undistracted.
    • volume control covered also below. This will be affected by equipment, distance from the microphone etc.
    • com suggest a white noise machine to shut out distracting sounds. I have no idea if this works and I am not going to try it, but it is a thought. I doubt if this is for the video call, though.
  • Comfortable seating
  • Plenty of surface area. You need to be able to take notes without rustling, reach for references without leaving the frame etc.
  • Personal joyful stuff. Traject recommend this, and I am not sure. The comfort and uplift that this provides needs to be weighed against distraction and boundary diffusion.

Time

  • Protect your time.
  • Set a daily schedule:
    • Make sure you know what is work time and when you are off work.
    • Make sure you know what project you are engaged in at any one time.
  • Include casual connections with colleagues (as you would do in the workplace), not just formal meetings.
  • Schedule fresh air and exercise.

Communication

Broadly speaking, channels of communication and communication skill have both been reduced drastically, all round, so more effort will be needed:

  • Be positive and supportive.
  • Overcommunicate rather than undercommunicate.
  • Clarify:
    • how others can reach you
    • when others can catch you
    • expectations
    • and clear up issues quickly with a phone call.
  • Interpret problems as miscommunication rather than malice.
  • Ask for feedback
  • Reply promptly
  • Establish how to share documents

The Work

Your working style

  • Identify your “productivity weaknesses” and address them:
    • Procrastination
    • Distraction
    • Fatigue
    • Boredom
  • Maintain your brand or culture and, if in a team, the team culture.
  • Maintain morale:
    • Dress and groom
    • Chart project progress

The meeting

  • Not everything requires a meeting.
  • On the other hand, the human face humanises.
  • Ground yourself before you start.
  • Volume
    • Can you be heard?
    • Can you hear without strain?
    • Consider confidentiality – being overheard
    • Earphones?
  • Decide on Chair, facilitator, use of mute, hand signals, and chat.
  • Decide on speaker view or (eg for chair) gallery view.
  • Decide on chat before, after, or not at all.
  • Establish alternative routes of communication
    • For documents
    • In event of interruption
    • Chat function
  • Ask for feedback
    • Can you be heard?
    • Were you understood?
    • Did you understand?
  • Avoid multitasking
  • Avoid rudeness in the room (like looking at your phone)

Here are some sites to which I am indebted for ideas:

A good description of the need: https://twitter.com/LeapersCo/status/1257941168182243328?s=20

Traject:                                                                                                          https://bytraject.com/blog/tips-for-working-remotely/?utm_medium=social&utm_source=twitter.com&utm_content=&utm_campaign=&utm_term= https://twitter.com/ByTraject/status/1244814375485083648?s=20

Inc.com                                                                                                           https://www.inc.com/lindsey-pollak-eileen-coombes/remote-work-home-productivity-communication-self-care-morale-team.html?utm_content=122166550&utm_medium=social&utm_source=twitter&hss_channel=tw-893547756282822656

MyCareAcademy https://twitter.com/MyCareAcademy/status/1242015839433474048/photo/2

Realbusiness.co.uk                                                                         https://realbusiness.co.uk/mental-health-covid-19/

@Leapers (eg on video calls, Matthew Knight) https://www.leapers.co/articles/2020-04-17/i-think-youre-on-mute-seven-ways-of-making-video-calls-less-stressful

And back to Home Page: Therapeutic Attitude

Staff Wellbeing in Crisis

Staff Wellbeing in Crisis

Protecting Staff Mental Health Through Covid-19

There are still plenty of things that individuals, teams, and services can do to minimise the traumatic impact on individual staff in the impending pandemic “peak”.

The following are action points extrapolated from two key review papers. Links to those papers are provided below. Emphasis is on current staff mental and emotional well-being and reducing the risk of future sequelae of trauma.

All members have a role in the health of the team, but some individuals, on behalf of the organisation, hold explicit responsibility for the health and efficacy of teams. To highlight this I have created separate lists for individuals and those with specific leadership responsibilities.

Individuals:

  • Competence and efficacy. Feeling competent and prepared helps to protect you from negative outcomes. Practice procedures. Satisfy yourself that you are ready. If there is an area you feel less confident of, seek support and develop a plan.
  • Motivation. Motivation is protective. Remind yourself how important your work is.
  • Fitness improves your resistance to emotional strain. Use proactive, strategies to stay mentally and physically well. Don’t deny. Use action to distract. Exercise, relax, fix something, meditate – whatever is familiar and suits you. Make relaxation a skill. Use planned problem-solving. Hold back on alcohol. Avoid drugs.
  • Being integral to a team is protective. Plan together. Rehearse the plan for the day. Practice skills. Share successes as well as fears and other reactions. Do not stigmatise feelings, either in yourself or others.
  • Secure your secure base. Satisfy yourself you have done what you can to protect yourself and your family. Practical steps; insurance, wills.
  • Social connection is protective. Connect with friends and family. Don’t expect them to understand what work is like, exactly. Spend quality time with them, even briefly. They will want to help you but may not know how. Make clear requests.
  • It helps to feel effective. If you need quarantine, use this time away from maximum exposure to recharge your emotional batteries. If it frustrates you to be prevented from work, find something you can do to support the team – revise protocols etc.

Leadership

  • The wellbeing of team members depends on being and feeling Safe, Skilled, Connected, and Prepared. Make every effort to ensure all team members have the skills and the equipment to do their work safely and well.
  • Team spirit and morale protect. Make yourself accessible to team members. Encourage supportive relationships within teams.
  • Preparation protects. Train team members, and rehears roles, skills, and communication. Establish key phrases for difficult moral decisions, such as “your own oxygen mask first.”
  • Belonging, and team morale are protective. Meet and share. Normalise (do not mandate) grief, doubt, frustration, fear. Celebrate positives, like cohesion, team spirit, tenacity. Identify learning if it can be operationalised. Divert from stigma and blame, including self-blame. Include all, including reception and support staff.
  • Communication is key. Establish regular times for sharing information and updates.
  • Appreciated voluntary contribution protects. Take seriously, and find a way to act on, any suggestions from individuals. As much as possible enable individuals to feel in control of their work.
  • Vulnerability to trauma varies between individuals and between roles. Know your team members and be aware of early signs – fatigue, poor sleep, health worries, avoidance, increased alcohol use. Act early to support.
  • Sharing protects. Try to avoid individuals having sole responsibility for areas or individual patients.
  • Traumatic harm is cumulative Consider rotating a team member through roles to reduce overall exposure.
  • Competent contributing protects. If rotating team members into less exposed situations ensure they understand they are recharging their batteries, and still have a skilled contribution to make. Train them in that skill if they are not confident.
  • Individuals differ in what they need from down time and support. Have a flexible approach to support and down time and agree this with individuals. Establish a stepped approach to support in the organisation. Support the supporters.

Source material can be found on the website for the Association of Anaesthetists. These are review papers summarising findings from research carried out during and following the SARS pandemic:

A Systematic, Thematic Review of Social and Occupational Factors Associated With Psychological Outcomes in Healthcare Employees During an Infectious Disease Outbreak (PDF) Brooks et al JOEM Volume 60, Number 3, March 2018,

Traumatic stress within disaster-exposed occupations: overview of the literature and suggestions for the management of traumatic stress in the workplace (PDF) Brooks Rubin and Greenberg 2018 British Medical Bulletin, 2018, 1–10 doi: 10.1093/bmb/ldy04

Andrew West April 2020 2/2

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