What I learned about healing trauma at the Cat’s Home.

Do you ever get sick of ideas and thinking and just want to hang out in experiences and doing?

I’ve been immersed in a rich tapestry of experiences fostering cats for a local animal shelter. I had become interested in the power of communities to heal, particularly in relation to the small group of people who don’t do well with psychotherapy. At the cats home I found a community healing orphaned, damaged, abandoned cats and kittens and there were so many parallels with my work and what I was exploring that I got immersed, while also enjoying some kitten company.

I recall a conversation with Rob on Christmas Eve when I had a homeless mother cat and her kittens upstairs in our bathroom but downstairs I had a one hour session with a homeless teenager and then she left through the front door into the big harsh world.

I reflected on her life in foster care and beyond, and the parallels between the cats home and the human system wondering why one seemed to work well and the other didn’t. Bad behavior in the cats was more likely to be understood as the result of cruelty or neglect and not some intrinsic badness.

The confronting difference was that antisocial cats were euthanaised…. but not always. There are definitely a handful of people braving the teeth and claws and having success at rebuilding trust in antisocial cats.

The feline family moved on and were adopted and we ended up with a motley crew of 6 teenagers who had ringworm and were thrown together by circumstance. Now ringworm, which is just a glorified form of tinea has some serious prejudices and baggage attached in the cat world, and cats are commonly euthanaised in shelters to prevent the spread of this highly contagious fungus. Take a moment to imagine if children were euthanaised for having ringworm. The parallel in therapy for this mob was probably in the Axis 2 realm. Not many people wanted to touch them.

This mob became a tight knit group, united by the trauma of twice weekly antifungal baths. Two of them must have grown up with a dog and taught the others that dogs are fun. The leader of the group, a big black panther named Sambucca was a beautiful goofy loving felllow but when he was cured and went back to the Cat’s Home he suddenly behaved as if he hated cats. He was relegated to a single cage in the boarding section and we went in to bat for his good character. In the end it was his love of dogs that got him adopted by a German Shepherd who had recently lost his pet cat.

IMG_6506

I wondered how many clients I see in the nasty bitter stage, and how different it would be if I got to glimpse before and after to see what is possible.

The next foster was Snowflake, a 2 1/2 week old innocent who apart from being abandoned for a day and a half had known no trauma. Food, warmth and a tender touch and she was putty in our hands.

IMG_6557

Then, as she grew and started to play she was missing the learning that comes from siblings about not playing too roughly. So after we put the word out, Louis arrived.

IMG_6652

Now Louis had a very different beginning. He was found abandoned in a barn at the age of 4 weeks, but it was clear his innocence had been rocked. The story was that he liked other cats and played hard, but if a human approached he froze, flattened himself to the ground and became paralyzed. My guess is that something had toyed with him. Maybe a dog that chased if he ran, taunted harder if he moved, so he had leaned to play possum.

The first night my son spent holding him and when I walked in to check he said “I don’t know what you are saying about this kitten being scared, he is just sitting here in my arms snuggled up.” I took a closer look. He wasn’t happy, he was paralyzed. So we upped the gentleness and reassurance. I remember the day about a week later when I walked into the kitten room and he ran away! Yay, progress. The progression was then from running, to starting to run and then slowing down. Then starting to run and changing direction to approach. Then catching himself before he ran. Then approaching. And then that magical day when I walked into the room and he immediately started to purr.

Now I didn’t do any therapy. All we did was provide a safe and loving environment… and he worked it out for himself. And that, for me, is the most powerful distillation of the rich tapestry of this whole experience that also aligns with what we know about therapy.

 

Why Barefoot Therapists?

Barefoot Doctors began in China nearly a century ago, to address the inequity between health care in urban and rural regions. Farmers were taught basic health care and first aid in an attempt to close this gap.

Barefoot Therapists are tackling a different gap.

The medicalisation of human suffering began after the Second World War, when soldiers were returning with shell shock into a community that had no experience or understanding of what they had been through.  Psychiatry and Psychology were called to arms, and complex political and socioeconomic forces shaped the emergence of what we know as modern Mental Health Care. We saw from the 1960’s, both the explosion of both therapeutic and pharmaceutical approaches to treating human suffering, and yet, as neatly summed up  by the title of a book: “We’ve had 100 years of psychotherapy and the world is getting worse” and pharmaceuticals have likewise not delivered on their promise.

In the wake of this bubble bursting, scientific inquiry has uncovered two interesting phenomenon. The first is that both psychological and pharmacological interventions carry with them an unusually large dose of the power of placebo. The second is a term called allegiance. The therapist/doctor’s belief that their treatment will work contributes enormously to the effective therapy, be it pill or therapy model.

Simply put, if the patient believes in the treatment they are getting, they will get better, and if the therapist believes in the treatment they are delivering,  then they will be effective, and the patient will get better.

So what is the gap?

Could it be that the medicalisation of human suffering, as described by “mental illness” has made it hard to believe?

Consider our cultural attitude to a cancer patient who doesn’t respond to treatment. Not you personally, but what our culture thinks. You see it in the headlines of newspapers. Family and community fight for their chance to try experimental new treatments. If only we had better treatment, we could cure this disease. The general message is that medicine should do better. There is no patient blaming.

Now consider our cultural attitude to a person with a mental illness who does not respond to treatment. Not you personally, but what our culture thinks. You see it in the headlines of newspapers. How often is crime and mental illness linked, to give just one example.

When our first instinct is to blame the patient if they do not respond or  are non compliant with treatment, then we have a cultural compassion gap.

In the last 70 years or so, people who are suffering have been diagnosed and sent for professional help. Inadvertently, the art of emotional healing that has historically lived in the community since the beginning of time is being lost.

No one meant for this to happen. Doctors, Pschologists and Mental Health practitioners are now faced with treating very isolated patients, who they know would benefit from community connection, but none is available.

Add to that, the fear of anyone who is different that is being fostered in our global community, and we have created a cultural inequity.

The Barefoot Therapy Project, aims to return the dying art of emotional healing, back to the community.

Barefoot Therapists Resolving Grief

My husband told me that when one of his boys was just 6y.o, they were walking hand in hand along a beach and the boy looked up at the father and said: “Dad, what would I ever do if you died?” Rob looked down and warmly and simply said: “Well, you’d be sad for a while, and then you would just get on with things.”

When I heard this story my own children were young, and I was touched by the simplicity, trust and beautiful lack of emotional tangle, and so I determined that if my children ever asked this question, I would say just that.

Some years later when my own son was maybe 12, we pulled up in the car in front of our house, and he said; “Mum, what would you ever do if I died?” The sirens that blew in my head from his nut allergy and previous brushes with death, as well as the realisation that he had asked this question backwards, were quelled by the mood of Rob’s story, and I found myself saying: “Well, I’d be sad for a while, and then I would get on with things.”

I turned to the back of the car and was met with his great grin, and then he said; “Bitch” and we both laughed out loud.

I told this story to a young, single mother who was having cancer treatment, and her biggest concern was for her small child if she were to die. Some years later I saw this woman, who was now cured, for something unrelated. She reminded me of the story and said that some time after, she knew things would be fine, because she was at a relatives house and her child was in the next room playing with their new puppy. The child piped up and said; “Hey, Mum! If you die I think I’ll live here because I love this puppy.”

Loss can be painful, but I have never met someone who has not lost something smaller in their past and got through it. A child grieving after the death of a parent, can be easily engaged by asking:

“I know it’s not the same, but have you ever lost someone or something you loved in the past? A grandparent? A beloved pet? Or had a friend move away, or change school? How did you get through it? What was the first thing you did? How did it go from so painful you couldn’t stand it, to just really sad? When you think about it now and just feel peacefully sad, how did you do that?”

“Most children use distraction at first, or they may even pretend that it hasn’t happened, that she just went down the street to the shops. This serves to protect them while the hurt is too painful. It works like an anaesthetic on an open wound. They do this until the wound is bearable. Until some healing has occurred.

Just like a broken leg, if you put a plaster on, it will heal. You don’t always need to pay attention. And like all wounds, it is best not to pick at it. Then, as families talk, and rituals happen, and stories are shared, the healing process can settle in. Paying attention to what helps, for this individual, and staying away from things that make the pain worse, as with all wounds, healing is promoted.

A Barefoot Therapist who knows this, and trusts this, will be a welcome comfort to a grieving soul.

Emotions and the Barefoot Therapist

If you look at a small baby in their natural habitat, they breathe, they eat, they sleep, they pee and poop, they cry and smile and laugh and get spooked. They get frustrated, they show delight and contentment. Pretty much like any mammal, as I am reminded daily by our foster kittens.

How have we managed to pathologise all these things that bodies know how to do? As a culture there are so many obsessions about food and diets, about gut health and enemas and high colonics. People read self help books and start thinking they are not breathing correctly, and don’t get me started on sleep!

But emotions! Surely emotions are just part of the rich tapestry of human experience. Milton Erickson said, when you learn the letters of the alphabet, you need to learn all of the letters, not just the ones you like, and not just the ones you are good at, because it’s all of the letters that make up an adults literacy. And when you learn the emotions, you have to learn all of them, not just the ones you like, not just the ones you are good at, because it’s all of the emotions that make up an adults emotional world.

So many people get worried about the intensity of their anger, their sadness or their fear. Yet no one ever comes to a therapist worrried about the intensity of their happiness, delight or contentment… though it may bug others!

Erickson also said that when you feel something, you should feel it thoroughly, all the way to the tips of your fingers and all the way to the tips of your toes and let it go. Yet so often we get caught trying to stop an emotion. Trying not to have it. We get caught in a kind of emotional stutter.

When I was a kid I remember a day trip we took to a beach where the waves seemed enormous and yet there were people having a ball body surfing. Now this was Bellerive beach in Hobart, Tasmania, so the waves can’t have been very big, but to my young eyes they were enormous. Eventually I couldn’t contain my wanting to experience the body surfing I was watching, so I ventured out with a bit of an idea about what to do from my time sitting and observing.

The  first wave dumped me and I thought I was going to drown. It was like someone had thrown me in a washing machine and there was no way out. So I fought and struggled and was washed up, breathless on the shore. Sitting in the shallows, I still couldn’t get over the enjoyment on the faces of the body surfers, so I ventured out again. Small hints of successes and further dumplings, and slowly I realized that I always got washed up in the shallows. The next time a wave dumped me I decided to relax into it, and sure enough I was washed up in the shallows, but this time I was less out of breath.

I think emotions are like the waves at Bellerieve beach. If you’re not used to them, they will look like the waves in Hawaii, or Chile, but if you look, there will actually be a lot of people enjoying them. Just look at the queues at the movies for films like The Boy In The Striped Pyjamas, or The endless B grade horror movies. Look at the films that won Acadmy awards or People’s Choice at Cannes. People don’t like bland. They like to be touched and moved and stirred and scared.

Barefoot Therapists know this about people.

 

Barefoot Therapists healing trauma

“All wounds heal…. if we allow them” Theresa Robles

If we look for culturally accepted examples of healing from frightening or painful experiences, a pretty universal one is childbirth. Ask a woman how she got over her experience if it was other than sublime and there are some common themes. The first time she tells the story it is still pretty intense, and she relives the emotions….. but then life is busy, possibly filled with other children, commitments, time frames…. in other words, distractions.

The next time she tells the story, from her distractedness, she is less in it, and the emotions are less intense. This continues with each new visitor, until she is a bit over it, so that by six weeks post-partum she thinks having another baby is a really good idea!

Everyone has some small trauma in their past that they successfully got over. A frightening crash off their tricycle. Getting picked up late after school. A family argument that was upsetting. Asking what helped these upsets to heal gives a blueprint, however small, that can serve as a guide to traverse a current, more overwhelming emotional trauma.

“Running a country, is just like cooking a small fish” Lao Tsu

Keeping it simple, and using many past experiences, reminds a person that all wounds can and do heal.

With thanks to Theresa Robles for opening my eyes to this universal wisdom.

Barefoot Therapist Beginning

When you ask someone about something that they like to do, you are not simply making small talk. This area of a person’s life is a vast storehouse of skills and resources, and abilities, even in the face of problems.

To begin with you are taking a person who has come to you in a defeated space, with a problem they cannot surmount, and transporting them into an area of their life that works. In doing this you shift their mood from resignation to possibility, and their sense of incompetence to a lived experience of competence and confidence. Like the alchemist, you turn lead into gold.

The second thing you discover as you explore more, is something about the person in front of you. What makes them tick. What they care about. What is important to them, and perhaps even something that they are passionate about. You get a glimpse of their soul.

Once you have thoroughly explored with them you will see an engaged and interested person in front of you. You have generated a relationship by your sincere interest in this thing that they like,  and you can then move on to ask them the next pearl:

“Tell me about something that went pear shaped in what you like to do. Some problem that happened that you got through, and is now, no longer a problem” and then ask “how did you do that?” Then, hey presto and abracadabra, a blue print appears in front of you both. The blue print for how this person gets through difficulties.

But wait, there’s more! You can then ask how they learned to do this thing they like to do. How they went from ‘I can’t do this’ to ‘I can do this’ and this magically reveals another blueprint. A ‘how this person learns’ blueprint.

Give it a go and see what you discover. Ask:

What do you like to do?

What is it about that, that you like?

Notice the parts that seem really important to this person and mention them.

Now ask about something that went pear shaped but that they got through and is no longer a problem.

Try to articulate what you hear is their process or blueprint.

Now ask them, when they very first learned this thing, how did they do it? How did they go from ‘I can’t do this’ to ‘I can do this’?

Notice how these blueprints can be applied to getting over any problem, or to learning anything new.

Barefoot Therapist Update

Our Barefoot Therapist project aims to support community mental health care by consolidating the skills of lay people who offer support to people in their communities, be it friends, family or via community groups.

The rationale came from both the obvious need, and the overwhelming evidence that complex training does not make effective therapists,  nor does length of training, or tertiary level training. While specialist services are overwhelmed with people who are suffering, it makes sense to resource the community to make a difference for people with milder levels of distress, as well as building confidence to include the more severely unwell people who are receiving specialist care in the community where healing and connection can be enhanced.

The qualities the person of the therapist brings to effective therapy are usually present before they embark on therapy training, and the overwhelming majority of programs do not focus on building those skills. In fact, it is not until recently that we had any evidence describing what those qualities are, and we merely relied on an intuitive sense that a warm and empathic person was likely to be better than a cold sociopath. Common sense, rather than evidence, drove conversations about therapist qualities.

That is beginning to change with more clinical researchers being interested in the question, and the lonely voices of clarity being joined by a crowd.

In contributing to members of our community who might want to become Barefoot Therapists we are putting the emphasis on the relationship that they build with their client, the expectancy or hope that they generate for improvement and their belief that the client can get through their difficulty. These three things continue to rise to the top of the pea soup that is outcome research.

I plan to blog about what we are producing as it happens and would welcome feedback. Our intention is that this will be online training with video talks, slides and demonstrations, and supported by video conference calls where there will be an opportunity to practice skills in virtual breakout rooms. We feel strongly that the training be free of charge, and would like to support therapists around the globe to provide it locally in their communities. We would expect therapists delivering training would increase their referral base as Barefoot Therapists are likely to refer more complex issues on. The supervision community that grows would also provide a wonderful opportunity to develop your edge.

If you are interested, or have any ideas or suggestions, please leave a comment.

 

Believe it or not…..

img_0818

Rob and I have been part of a conversation on Facebook with someone who still believes that specific factors are responsible for effectiveness in psychotherapy. Facebook is usually just a place to hang out with people who think like you do, and I’m not sure if I’m just lucky but I really enjoy waking to the expansive musings of my friends and the mostly nourishing and sustaining things that they share. (American politics aside).

This last conversation reminded me of when I was 9 and in a Catholic private hospital after having my appendix out deep in conversation with a creationist of similar age who could not hear the Darwinian dogma on which I was raised. It was finally the cleaning lady who put end to the debate by declaring that God made the world. And that was that.

So I’ve been musing about beliefs, and rather than sermonising on what I think, I thought I’d share a funny story.

I don’t believe the moon landing happened. Sure, if you show me the evidence, and I judge you have the authority to know, I can get to a place where I accept it probably happened, but in my core I have the quirky experience of not believing. Don’t get me wrong, I love that JFK made it happen, and “The Dish” is one of my favourite movies, but when I look into my soul I just don’t believe.

I was just a toddler in 1969 and language was not my strong suit. Only my brother who was 2 years older could understand what I said, so I doubt I was very focused on the hoopla of the day. I was busy drawing cats and wondering why my parents couldn’t see the importance of me having one, and socializing with lizards and sugar ants in our back yard. My world was comfortably small and fascinating. It wasn’t until years later that my parents gave me a box set of Gerald Durrel books that I found someone who understood my world.

As the years passed I heard of this moon landing thing that was televised live, but we couldn’t even watch a football game live, and my Dad, who was a sports teacher, would have to wait for the recordings to be televised. I’m not sure when we got a telephone, but it had to be more than 4 years after the moon landing, and it had wires. There were no wires hanging from the moon.

I think that my lived experience was one where the moon landing could not have happened.

It’s such a quirky thing, and my husband and family who were all older think it’s funny. In fact it’s become a party trick… “Ask Gabrielle if she believes in the moon landing” and then the snickers happen, including from my own children. My brother said he would get me a telescope so I could see the flag and all the stuff left behind. I said it would be enough for me to hear that he had seen… but he hadn’t.

When I’m with a client who has a rigid belief that is keeping them stuck in their problem, I am trying to sit with it, as I do my own quirky beliefs, and notice how we can actually get to acceptance of an alternate view, without really letting go. I think that is preferable to head butting, or making wrong.

Learning Barefoot Therapy

One of my deep appreciations of my husband Rob McNeilly’s work is his ability to create simplicity. He gets to the essence of a client’s stuckness and shows them an easy way out, and, it is their way out, never his clever idea. As tantalizing as the many complex theories about the human condition are, they more often make a problem harder to surmount. A student was telling Jay Haley about a problem case where she surmised that there was an overly enmeshed relationship between the mother and daughter, and Haley said “I’d never let that be the problem!” I think our conceptualisation of mental illness actually makes the problem harder to solve..

I got some clarity watching Rob’s grandson learn to ride on a balance bike. He could ride before he knew how. He also had some of the sophistications that came quite late for people of my generation who learned with training wheels, such as leaning into turns, and controlling the bike down hills, and he was only 3 years old.

It looked a bit like this….

I think learning therapy can be a bit the same and I think the therapeutic relationship is the balance bike, and learning the client is like learning to ride. I suspect that learning the model is like training wheels, and you end up having to unlearn your interaction with training wheels if you want to ride a bike.

A hallmark of the work we do is to explore with a client something that they like to do.  We have turned this conversation into an art form over the years and we claim that everything the client needs to get over their problem is right there if you know how to look. When they are doing what they like to do, with effortless transparency, they have mastered their proverbial balance bike, and when we help them to translate those skills, we are merely showing them how to find the gears and propulsion to get out of the mud.

A man came to see me troubled by tinnitus. He had seen an ENT specialist and got quite worried during the process of investigation, so to be told there was nothing sinister wrong but also nothing they could do was a mixed bag. When he pushed that he wanted relief he was told that sometimes acupuncture helps. He dutifully went along, all the while wondering, how on earth could acupuncture help, so of course it didn’t and he returned to the specialist, who said that if acupuncture didn’t help then hypnosis might.

He arrived to his appointment with me just as sceptical. I asked what he liked to do, and he loved fly fishing. I almost said, give me a break! You stand in waders in freezing Tasmanian lakes and rivers for hours on end and are trying to tell me you’re having trouble not noticing a bit of tinnitus. But, by immersing him in the experience of fly fishing, it was easy to point out to him how talented he was at not noticing. At the end of the session he said “I thought you were going to hypnotize me.” I validated his skepticism and suggested he just see what was different about his experience after our conversation, and if anything interested him he should ring for another appointment.

About a month later he phoned saying he was discovering there where patches where he was unaware of the tinnitus and wanted another conversation.

This time I discovered that his working life was spent as a dental prosthetist. This time I did say, give me a break. He made bits of plastic that people had uto stick in their mouths and learn to become unaware of. Confronted with his lived experience that people are good at not noticing he said “There are some people who never get used to dentures” so I asked if he had a denture and he sheepishly admitted that he did and that he had had no trouble getting used to it.” Needless to say tinnitus was not a problem for him after that conversation.

In the last 2 years prompted by a student pushing him to be clearer, Rob has distilled things even further, and I find, more and more, I am using that distillation and little else. So now if I saw this man, I would simply say:

Not noticing your tinnitus is just like not noticing your cold feet in waders, or the denture in your mouth.

If he didn’t get that, I would ask: How is not noticing your tinnitus just like not noticing your cold feet in waders or the denture in your mouth? (The question creates a search that uncovers more than we can think up, often in really surprising ways)

If he still didn’t connect it I would then ask: when you learned to fly fish, how was the way you began to not notice your feet, like the way you are beginning to not notice your tinnitus.

Brief therapy eh! Try it out, it is remarkable what you uncover.

I also think that this simplicity has given birth to the idea of teaching Barefoot Therapists. It’s not intrusive, the client is the expert and there are no ethical dilemmas. We have found the balance bike.

There are people who never asked for the job, but find that people come to them with their problems and upsets. They never meant to be good at helping, but somehow they are. There are also people who become leaders in clubs, community groups and the like, who similarly find people come to them with their troubles and they feel ill-equipped to help. Yet psychotherapy research tells us that these people could be just as effective as tertiary trained professionals, with a little guidance.

The medicalisation of human emotional suffering has, I think, had a detrimental effect on the normal human conversations that heal, and even on the fundamental belief that healing can happen. Erickson used to say that a baby doesn’t know that they will be able to walk at some point, but we know. We underestimate the power of our knowing. A baby walks into that knowing. That is the gift we give…

If you are interested in teaching Barefoot Therapists in your community, we are having a video call with interested therapists next Saturday Hobart time. Leave a comment or message me if you are interested to be part of this conversation for possibilities.

Barefoot Therapists

We are cooking up a new project and I’m interested in your thoughts.

We are interested in teaching for free, anyone who’s interested to learn the foundational basics that psychotherapy research has taught us about how to be effective in a healing conversation with another human being.

The foundations of relationship, expectancy, and allegiance are not rocket science. They are there in our loving human relationships in our friends, family and community, but they are missing in our ordinary human relationships whenever someone is pathologised.

The label of mental illness puts a wedge in the way we would normally relate, it puts doubt in our ability to be part of their belief that they will get better, and it puts doubt in our own ability to believe that we can help.

Modern medicine has done some great things, but in the way it handles mental illness it has inadvertently damaged the ordinary human relationships that heal.

So, inspired by The Barefoot Investor, and originally by Barefoot Doctors in China, we want to start a movement, that will give back to our community their human ability to be useful to another human who is in a bad spot.

Its not about doing therapy, it’s not about creating a surge of do-gooders, or missionaries, it’s just about rekindling the dying art of human healing.

Please share your response to this as we know we will be blind to many potential hurdles, and your thoughts will help.

And, if this project speaks to you, let’s collaborate.