Leaves Leaving

This Autumn, looking at the leaves, I was reminded of my post of 2018 Pebbles and People and struck by a contrast in my thinking. It is not new – in fact it is practically habitual – for me to reply to my own ideas with some sort of a challenge. On this occasion it was not so much that I challenged my earlier thoughts about pebbles, but rather it seemed that leaves, by their nature, encouraged a different analogy or line of thinking. Or was it a shift in my attention and meaning-making?

Where I had found myself drawn to individual pebbles taken from the mass, enjoying my conviction of their separate and inherent adequacy (a perfection that allows, even requires, imperfection; a good-enough-ness), here I found myself appreciative of the mass effect. Taking any leaf individually did not satisfy. I would find a blemish or a lack of lustre that was irrelevant when part of the grand show. I tossed them back quickly to rejoin their fellows and resume whatever process I had interrupted.

It struck me that leaves are not pebbles. They are organic and relatively transient. They were born individual and seem almost to relish merging when the opportunity arises. Pebbles, by contrast, were hewn from a mass existence to which they seem in no rush to return.

And what change in my own circumstances might be responsible for this different appreciation – this appreciation of the transience and communal beauty, over stubborn and proud individuality?

Autumn and Parting

@occidens pointed out to me a while ago whilst walking through a wood that if a branch of a tree breaks during the summer when the leaves are fully out and green, the leaves do not fall but wither on the branch and stay there. When it comes to autumn and all the other deciduous leaves change colour and fall, these dried up dead leaves stay on the dead branch.

What this says to me is that when trees lose their leaves in the autumn it is an active process, not a passive one. It is part of living, and the letting go of the leaves is a living act. The tree clearly has to take steps to prepare – and release the leaves.

It is worth remembering this. when it comes to loss.

It recalls the film Truly Madly Deeply in which the bereaved protagonist has to actively let her husband go – almost drive him away – in order to be freed from the ghost of his presence lingering on like those dried up leaves.

Autumn reminds us that loss can be a beautiful thing. It is part of life and it enables new growth.

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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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.

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Narrative Matters

We have kept a lot of our children’s books. They represent such good value in terms of revisit rate, and they remind us of happy times.

I just had another look at Creation Stories retold by Ann Pilling and illustrated by Michael foreman (Walker, 1997). The first story tells how, before there was anything else, there was an egg. A giant popped out and grew (over the next eighteen thousand years) pushing the land and sky apart until he could rely on them to stay in their place, at which point he went on to other tasks like carving valleys and mountains. When he died, all of his body parts were used in some way; his hair for forests, bones for rocks, and his tears formed the rivers.

I am impressed by the multiple layers of wisdom in this tale. At the level of content (and with a nod to the likely purchaser) it acknowledges the tiring job of the parent in creating and maintaining the space in which offspring can grow. It also introduces us to the importance of sustainability.

But at the level of process we realise that those who developed and treasured this story chose, for their progenitor, not an immortal but a flesh-and-blood being very much like us. Someone who can get tired and weep; Someone who dies and decays, and for whom it is possible to grieve.

Also, we are not invited to believe this story as a literal representation of fact, or required to believe the improbable; Dogma, immortality, and unreachable qualities, are not held up as objects of devotion or aspiration.

In this way generations are taught the importance of symbolic truth and the ordinariness of cosmic events, as well as the crucial role that narrative has in making sense of our existence and contextualising our experience.

We can take reassurance from the fact that stories will do this important job for us, particularly if they are obviously located in the symbolic realm, rather than the concrete. It is better if these stories don’t take themselves too seriously. Stories that are too eager to convince us of their truth and too bullying in their insistence upon compliance are harder to make friends with; are less adaptable; are more likely to drive us from our neighbour over issues of difference.

A parent reading this story to their child might stand to learn at least as much as the child, if not more. And I generally think that that is the mark of a proper children’s story.

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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:

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

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A new home in free musical improvisation

I do have concerns, though, about those children who have been taught to play a sport, a musical instrument, or a complex board game, to the exclusion of playing which is the freer, more creative, and developmental activity. = Being With and Saying Goodbye, Ch 5 Thinking

I joined Oxford Improvisers in 2018 because I am a musician as well as a clinician and was in need of stimulation and a new direction. This turned out to be a brilliant move, and further explanation is perfectly relevant to Therapeutic Attitude.

In Oxford Improvisers I found myself immediately welcomed, and at home. Home, of course, is a secure place from which one can venture.

“Exploration requires a secure base, as attachment theory has taught us, but there is no certainty* in terms of the anticipated outcome. The confidence shown by the clinician, then, must be a confidence in process coupled with an optimistic acknowledgement of the uncertain future” (BWSG Ch 4).

In that chapter, which is on Uncertainty, I consider “an appropriate analogy [for the practising clinician] to be that of the improvising musician who uses landmarks and artistry, and is confident that the result will be music whilst not being at all sure what will actually come next”. I was already describing clinical work in child and adolescent mental health as improvisation, though I had little experience of musical improvisation at the time.

The picture above, taken by Gabriele Pani and tweeted for @OX_Improvisers , shows overlaid objects; a piano (barely visible in this version), toy piano, guitar, watch, plastic spoon, drum sticks and mallets. What moves me about this picture is that each of these objects is taken seriously and lightly at the same time. The same is true of participation.

The difference between participants is respected; indeed this difference is essential to the activity. At the same time participants are valued equally; valued to the same extent, but for different reasons or qualities.

Uncertainty is not only accepted; nor even simply embraced; it is encouraged and nurtured. Any “rules” introduced are not to constrain movement, but to provide something to bounce off.

From the conclusion of Chapter 3, The Nature of evidence, I have selected the following points:

For the development of an individual existence there must be freedom of movement.
If statistics and “facts” are to be used in relation to human growth, they must be understood such that the individual’s room for manoeuvre can be demonstrated.
This amounts to an attitude of irreverence towards the apparently immovable.
Humour in the clinical setting reveals the creative space between how things are and how they might be.
Despite humanity’s constant search for certainty, possibility and hope can only exist where there is uncertainty.

This all contributes to the attitude of clinical practice that evolved through my own working mid-life and that I have come to call Therapeutic Attitude. Small wonder that I found myself a new home with a group of free musical improvisers on retirement from my NHS job. Therapy has to be creative and for therapeutic creativity one requires freedom of movement within a safe space.

♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪

*PS in the lines quoted above I actually wrote “security” but “certainty” gets us closer to what I was thinking.

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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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Nature of Evidence – After the day

Nearly two months after the Nature of Evidence seminar, the buzz of the day has passed and I periodically return to the sound-file. Such richness and diversity of material!

Thirteen people assembled for the day. Each had prepared a brief presentation, and these were delivered in groups throughout the day, separated by open discussion.

I am listening to the sound-file in order to extract themes, but what I am reflecting on right now is the way that people are affected by each other’s positions. There is a quality of respect and attention that contrasts so starkly with what I see so often on Twitter.

Of course this was a group of people who were likely to be respectful of one another’s opinions and sensitivities, but what I particularly notice today is what is said by someone AFTER they have listened to and taken on board other opinions. There is often a softness or slight circumspection that marks these utterances. For example, “This may not apply so much in some of the areas you are working in, but I think that…”

So this day was informative through process as well as content. People took care of one another, which is heartening. But I find myself wondering if the validation that opinion can receive from agreement may be less that that which it receives from its ability to demonstrate that it emerges from a process of reflection. For agreement, the message is often simplified, rather as the outcome measures of a quantitative study are simplified. The devil remains hidden in the detail, and the detail has been effaced by the process. Perhaps we are agreeing over that-which-can-be-agreed-upon instead of that-which-needs-to-be-debated.

In this discussion about evidence, there is a difference between the statement “this is about power” and the statement “context is important” (both of which, incidentally, I agree with). It is not that one is convergent and the other divergent, but more that they invite differing qualities of convergence-divergence.

It calls to mind Leonard Cohen’s lyric “There is a war between the ones who say there is a war and the ones who say there isn’t“. If those two groups can work together, then we are really getting somewhere!

When presented with “evidence”, I inspect it for evidence of some reflective process that has been able to listen to contradictory positions and that continues to take them seriously.

Therapeutic Attitude

This site explores "being with and saying goodbye", the attitude that sustains professional practice, and that itself now needs sustenance

Tag: Attitude