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 shall try to follow the example of the Bishop who, I can see now, was practising and preaching the same thing – at least on that occasion.

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Self-care and remote-working

Self-care and remote-working

Here are some self-care tips for remote-working. They should really be posted on my other site Developmental Conversations but I can’t get the blog to publish properly, so here they are.

Most of these ideas will apply generally to working from home whether or not this involves meeting with others via video link. Some apply particularly to video-linking.

I am not great at this myself. If you were to tell me to practice what I preach you would be half right. Not all suggestions will apply or be useful to everyone, though. Have a look and see what you think.

These ideas are partly drawn from experience and conversation but also through consulting multiple sources. Key sources are listed at the bottom.

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. This advice may seem a bit too late. A major problem with the Coronavirus pandemic is that it bumped huge numbers into remote working without any preparation or training, and without much in the way of choice. Nevertheless, there is still a lot you can do:

  • 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

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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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Music Again

Music Again

This post is a sort of dialogue with a podcast interview about music therapy. I provide the link here and encourage anyone who reads this blog with any interest, to listen to the podcast. The interview is really more about the creation of therapeutic space, but it also economically exemplifies what I have called “Therapeutic Attitude” and has added to my own conception of it.

Philippa Derrington is a Senior Lecturer within the Division of Occupational Therapy and Arts Therapies at Queen Margaret University in Edinburgh and leads the MSc Music Therapy course there. Here she is interviewed by Luke Annesley, a jazz musician and music therapist who produces the British Association for Music Therapy podcast series Music Therapy Conversations.

Music Therapy Conversations. Episode 25. Philippa Derrington

In this interview, Philippa describes setting up a music therapy space in a school, in the corner of a garage, and using large instruments (to occupy and therefore command space) and anything she could salvage from the school skip. In doing this she demonstrates beautifully one aspect of therapeutic attitude, which is taking responsibility for the space.

Therapy is exploration and, as such, requires a secure base (1,2). The therapist is as responsible for this aspect of therapy as any other. If a therapist is lucky enough to be able to totally control the physical environment, then they can (and should) do so creatively. But it may be that significant aspects of the environment are fixed and out of the physical control of the therapist. When this is the case the therapist can make sure that, when in the room, they “extend themselves to its boundaries” (3).

When I have managed to put an idea into words and another practitioner from a different discipline expresses something similar, I find it hugely affirming. As I listened to this podcast I found myself thinking over and over again, “this is Therapeutic Attitude!”

Take, for example:

PD: “Respect takes first place for me in work with any adolescent” (16m00s)

– and compare with –

AW “A crucial aspect of therapeutic work with children is the forming of a respectful relationship with them: discussing, offering genuine choices, and relating to them as valid, motivated humans with a right to, and the potential for, a life of their own, rather than simply existing as a product and part of the lives of others.” (BWSG p 151)

Or:

PD “A most important element is being able to get alongside the young person” (18m40s)

compare…

AW “…my position is alongside the child, looking at the conundrum, as though to say, “Is this what you would like us to think about?” (p12)

And:

PD “…the importance of not-knowing, and staying with that.” (20m09s)

compare…

AW Chapter Four on Uncertainty which leans heavily on D. W. Winnicott’s “..contain conflicts…. instead of anxiously looking around for a cure” (4) and John Keats’ concept of Negative Capability (5).

I am excited enough by the similarities, but here is a point of divergence or extension which gives me pause for thought. Luke and Philippa have a conversation (14m08s) about how in the school she is “always a music therapist, but not always doing music therapy”. This is really interesting. I wrote a section (p11) “Being a Psychiatrist” in which I contrasted being a psychiatrist with doing psychiatry, but I wanted to make a different point and distinguish between (in the frame of virtue ethics) being a psychiatrist as opposed to performing a set of tasks which constituted psychiatry but which might as well be alien (being versus doing). I still think that my point is an important one, but Phillipa and Luke’s point is also, and they complement one another . A therapist must have therapeutic attitude when “doing therapy” but the attitude is also important when in one’s professional role – being a therapist – but not actually in session. Philippa clearly protects the sessions in betweenwhiles, but only to the extent that each client requires. This is a form of “holding in mind”. The attitude extends beyond the session and becomes part of the professional person; Perhaps even the person.

Have a listen!

refs:

  1. Bowlby, J. (1988). A Secure Base: Clinical Applications of Attachment Theory.
    London: Routledge.
  2. Byng-Hall, J. (1995). Creating a secure family base: Some implications of
    attachment theory for family therapy. Family Process, 34: 45–58.
  3. Being With and Saying Goodbye. Cultivating Therapeutic Attitude in Professional Practice p89.
  4. Winnicott, D. W. (1971b). Therapeutic Consultations in Child Psychiatry. London: Hogarth & The Institute of Psycho-Analysis. p2.
  5. Gittings, R. (1966). Selected Poems and Letters of John Keats. Oxford:
    Heinemann Educational. p40-41.

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Therapeutic Alliteration

Therapeutic Alliteration

Every argument worth making, it seems, can be summarised in a limited number of words all beginning with the same letter. So here are the Four Ps of Therapeutic Attitude. The last one is A, so I made the middle two either P/A to balance it out.

By the way, the “you” addressed here may be a therapist, but not necessarily. Everyone can bring some therapeutic attitude to the table in whatever relationship they are in. If you are in a position of professional responsibility, then I believe you have a duty to do so. Oh, and first check out Attitude

So here are the four Ps: Position, Posture, Purpose, and Appreciation. That’s P for ‘preciation.

Position

Are you visible? Accessible? Are you in a place in your own life that enables you to park your issues and engage fully in the therapeutic relationship for the allotted time? There is little point in having all the other attributes of a therapist if you are hidden away or beset constantly by other demands. Position can also refer to your “position on issues”. Where are your red lines? I suggest, very simply, “Support the other if you can do so without harming anyone”. If you have read much else of what I have written you will know that I have other red lines; I will not serve the machine, for example. Red lines are relatively static and provide the channels through which Purpose (see below) is directed.

Posture/Appearance

Body posture is both a useful metaphor, and a way to evidence and influence a more internal posture. You need to be upright without being rigid; relaxed without being slumped; alert without being rapacious; responsive without jumping to conclusions or into action. Some aspects of your posture will become evident from your responses. To maintain therapeutic attitude, you need to be located in the real world, but not too subservient to it. Stable, yet poised for movement. How you appear will hopefully inform others as to your position and likely style.

Purpose/ Approach

The purpose of therapy is to enable positive developmental change; enable and encourage, but never force or demand. The agenda arises in – is set and owned by – the other person. Any other would-be influences can be considered part of the environment. If the client has been sent or brought by a third party – then the agenda of that third party is something that you and your patient or client can look at with interest. Someone may come to you with an agenda and that is fine, but you will be curious towards it, and ready for it to change.

Appreciation

Appreciation of the other includes warmth, greeting, acknowledgement (that they are real and valid), acclaim, and humour. There are two keys to appreciation. One is Sensitivity. There is no merit to acclaim, for example, if it is insensitive. Some people are not rewarded by a fanfare, but rather a shy nod. Others will only notice a fanfare and will experience a shy nod as a brush-off or will not notice it at all. The other key to appreciation is genuineness, and it is at the point of appreciation that genuineness is most crucial. It is possible to manufacture Position, Posture, and Purpose and act them out – possibly against the grain, though this will require a good deal of effort – but genuineness must be genuine. Fake genuineness, when detected, simply results in disengagement; if undetected, fake genuineness can be toxic. Therapeutic work, therefore, is a vocation. You do it because you really want to, and because it really matters to you.

TA = P + P(A) + P(A) + A(P)SG . What could be simpler?

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Conscience is Our Safeguard

This piece was written in response to an article in the BMJ by the Oxford philosopher Julian Savulescu. I really didn’t like what he had to say at all. I thought his argument to be poorly constructed, and the position he reached (or perhaps started out from) to be repellent and dangerous. Here is a link to my rapid response to the BMJ, published on the 2nd of February 2006: Conscience is our Safeguard I don’t know why the formatting is so shoddy when you get there. It doesn’t make it any easier to read, so I have pasted it here for ease of reading. If it was due to my error in the original submission, then my apologies to the BMJ:

Conscience is our safeguard

Julian Savulescu’s piece on conscientious objection demands, and will no doubt receive, critical discussion. My initial reaction was to respond ironically, presuming that he wrote the piece tongue-in-cheek. However, I am not practised at irony. Saying one thing and meaning another has always seemed too much like lying, and my conscience (sic) has tended to prevent me from being ironic with the conviction that is needed to bring it off. The other problem, which a colleague raised, was that Savulescu may have been writing with sincerity, and that to respond with irony might be disrespectful. I have therefore decided to respond as though he meant what he said.

He is right that individual values can get in the way of ethical health care. He is catastrophically wrong in jumping to the conclusion that doctors should eliminate their own values from their practice. He might just as well argue that, as there can sometimes be problems with policies, we should ignore them all. It was this startling lack of philosophical and ethical sophistication in his writing that caused me to presume that he was being ironic.

The paper opens with a quote from Shakespeare’s Richard III. Savulescu chooses to cite the values of a king who was known for his ruthless dishonesty (arguably almost devoid of conscience) , who put the Princes in the Tower, and whose subjects were ultimately too ashamed to fight for him at the Battle of Bosworth. In doing so, Savulescu has inadvertently put the case for the importance of conscience as an essential element of respectful and trusting relationships. He attributes the words to Shakespeare rather than his character, thus giving them greater weight. The Bard was probably himself writing ironically. Conscience, for Shakespeare’s Richard III was, after all, mostly guilt in the shape of the ghosts of his past victims. He could not go to war with a good conscience, so he had to ignore it. Finally, Savulescu, in what may be a Freudian slip, directs us in error to Scene iv, in which Richard, the “bloody dog” , gets the gruesome end that he deserves. This is an admonition and warning to those who would eschew the importance of conscience. Savulescu appears to take it as the opposite.

Next we are introduced to the concept of conscience invoked to avoid duty. I would call this idea oxymoronic: One cannot knowingly, by definition, use conscience for an ulterior end, although one could pretend to, in which case avoidance of duty is the value to which one’s conscience is urging adherence. I hope that Savulescu is not suggesting that avoidance of duty is an important value for doctors.

It is impossible to be impressed with the moral or philosophical weight of Savulescu’s argument when he uses absolutes ( “always” appears in two consecutive sentences) and value-laden phrases ( “Their values crept in…”, and “..has been squarely overturned…”) with reckless abandon. He refers to duty without saying to whom the duty is owed, and introduces “true” and “grave” duties without definition. He speaks of action in the public interest without alluding to the inevitable conflict between individual and public interest that pervades any debate about state provision of health services. Even his use of the word “paternalism” implies that it is a negative, when in ethical discourse it is a value of
central importance to be weighed against autonomy – each having their role to play in differing proportions. He reduces complexity to a series of right / wrong dichotomies, and claims that a position that is morally defensible when adopted by a few becomes indefensible when adopted by a larger number. He conflates distinct concepts (for example conscience with values with religious belief with adherence to a school of religious thought). He seems to believe that acting according to one’s conscience is the same as “making moral decisions on behalf of patients”. This is not a good example of reasoned argument!

By his exclusive use of the termination of pregnancy as the medical paradigm, he exposes his starting point, but he doesn’t begin to discuss even this narrow area with balance. I would agree that a doctor who objects to abortion might choose to work in another area of medicine, but he fails to acknowledge that a woman who has a conscientious objection to abortion may have a right to treatment by a gynaecologist who does not perform the operation. He totally ignores other branches of medicine, such as general practice, geriatrics, psychiatry.

Savulescu suggests that doctors should simply carry out instructions and that the full range of a doctor’s duties can be set out at medical school for the student to take or leave. I can only infer that he left clinical medicine at a relatively junior stage. Medicine must, by its nature, be an evolving profession, responding to an evolving world The doctor’s commitment must therefore be constantly renewed.

It seems that, in Savulescu’s utopian vision of the world, medicine is neither an art, nor has it anything to do with a relationship between individuals; our scientific and moral knowledge is comprehensive and incontrovertible; last year’s scientific theories were held in good faith but were wrong, whilst this year’s are correct, and so faith doesn’t come into the equation. He seems to be advocating blind adherence to the current dominant values and he does not consider the risk of institutionalised abuse of medicine. He implies that though this happened in Hitler’s Germany and in the USSR, we have learned that lesson once and for all. He seems to have forgotten that the values of individual clinicians may be the only real safeguard against that horror.

There is a place for the maverick and the iconoclast in ethical discourse and I welcome the provocation of this debate, but Savulescu has given us no clue, other than the outrageous nature of his argument, that he may be acting as “devil’s advocate”. He appears. therefore, to bring the weight of philosophy, Oxford University, and medical ethics with him. What worries me more than Savulescu’s views, therefore, is the fact that the BMJ has published them without qualification, disclaimer, or balancing argument. The danger of publishing this extreme view on its own and provoking uncontrolled debate is that the (hopefully) inevitable howl of protest may be read by some as the squealing of doctors as we are brought further to heel.

I must conclude, therefore, by readily accepting that individual values can result in unethical practice. The risk, though, is best minimised by teamwork, continuous professional development, appraisal, and supervision. Personal integrity underpins the doctor-patient relationship. The values of the individual doctor are our safeguard against the institutionalised abuse of medicine.

Competing interests:
None declared

cite as BMJ 2006;332:294

Compass Bearings

Compass Bearings

A compass needle will point towards magnetic north, as long as there is not too much metal around, but typically when travelling we want to get to a geographic location, so it is geographic north that is the more useful reference in deciding our direction.

We often use the compass as a metaphor to evoke those bearings we use (or ignore) to varying degrees when deciding our values and actions. Individual politicians or business-people, for example, are occasionally criticised for their lack of “moral compass”.

Retiring from a post I have worked in for seventeen years has given me a new perspective on what I was doing and some of my strengths and weaknesses. This reflection is in its very early stages. I am two weeks retired and still disorientated by my sudden de-institutionalisation. I have decided to dig out that old compass.

And so it was, in conversation with a friend, that I found myself owning up to a relative lack of attention to what he and I came to call the “pragmatic compass”.

I have spent a fair bit of my time kicking against the pricks (a brilliant phrase that offers in its archaic imagery scope for serious irreverence). This has not achieved as much as I always hoped at the time. Early on, my optimism could have been put down to naivete but later, with greyer hair, one has to wonder at my lack of pragmatism. If I had a pragmatic compass I was not following it very closely.

Needless to say, I had some colleagues who were following theirs and, whilst they were doing so, I accumulated accolades for “standing up for people”. I am proud of that, of course, but I have wondered if I had the balance right and if I might have been able to achieve more if I had adjusted things a little.

My friend and I agreed that in the world – and perhaps especially in the workplace – we need to set our course somewhere between two bearings; those of the moral compass, on the one hand, and those of the pragmatic compass, on the other. If they coincide, then we are truly lucky. If on the other hand they point in opposite directions which, sometimes, they do – we have a particularly thorny problem to resolve. Sometimes, the pragmatic action is in the opposite direction to the moral one.

Anyway, this has got me musing on various situations in which “pragmatic north” and “moral north” diverge by differing angles and, in each case, which course I have chosen – or might in the future choose. I am not a great one for regret, but I think it is worth learning from experience.

Transference: A reflection on not being the Other

Transference happens. We could argue about how much, exactly how, and whether the name is right, but that would be pointless. The point is that we can, at times, react towards another person as though they were not who they actually are (friend, boss, shop assistant etc), but an important other from our own past or distant lives.

Some of us do it more than others. Some people seem almost to do nothing else. It can be trivial, but it can also seriously hamper relationships and personal development. People who enter therapy are likely to be doing so exactly because they do have problems with their relationships and their personal development. They may be expected to be particularly prone to this type of relating. For this reason, therapists need to be adept at managing the situation.
                                                                                                                                                          Therapy encourages transference by 1) establishing a particular kind of relationship which has inherent in it a degree of asymmetry, and then 2) having as its remit the exploration of areas in which the patient or client is unconfident or unskilled and which evoke earlier relationships. Some styles of therapy may further encourage this by their use of silence and by developing what has been called the “frustration tension”.
                                                                                                                                                                  The therapist cannot simply dismiss the confusion by saying, for example, “Stop it. Don’t be ridiculous! I’m not you mother!” They have to keep it going enough for it to be seen, understood, and worked with. It would be unforgivable, though, if the therapist were to encourage or consolidate the confusion, by continuing to play the part and recapitulate the original trauma.
                                                                                                                                                                      In other words – and here I am getting to the crux of it – the therapist has to be able to be enough of all these others (these fathers, mothers, lovers, siblings etc) to be plausible to the client’s unconscious whilst manifestly NOT being these people. In a sense, they need to be able to be any number of people whilst emphatically not being them.
                                                                                                                                                                           Not being should perhaps have a hyphen, because this activity of not-being is different to a simple absence. As in the mind-experiment of trying to not think of a pink giraffe, not-being to a large extent draws attention towards being. Not-being subsumes a degree of being. In a sense, it flirts with being. Think, for example, of the counsellor whose skill set should include knowing how one might take the session deeper, in order to not-do so. Or the doctor who is required to be able to prescribe a medication before their decision to not-do so can take on significance. The mountain guide must know what would be a reckless action in order to be saved from carrying it out.
                                                                                                                                                            Adding to this, the therapist must also be genuinely themselves and 100% present whilst in a way leaving much of themselves outside the room: bringing their skills, attention, and beneficial intent into the room – giving them a voice – yet leaving their own factual lives outside. They have to remember the right things. They have to remember who they are without the constant rehearsal of self-revelation and, whilst stripped in this way, they have to not-accept the roles and characteristics transferred within the therapeutic relationship.
                                                                                                                                                            Therapists, then, if they are to be therapists rather than functionaries, have to be sufficiently capable and supported to perform this balancing act; a balancing that includes things repeatedly touched upon in Being With and Saying Goodbye such as equipoise, believing whilst suspending belief, uncertainty, and paradox. The space between being and not being (which I have here called not-being) is what Winnicott might have termed a “potential space”. It is there yet not-there; the essential ambiguity needed for the play that is therapy.
                                                                                                                                                                    Do think, reply, discuss. Here, or @afwesty via Twitter