Man Overboard

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I haven’t written a blog for a while. I came to a standstill in the exploration of excellence in the field of therapy and went on a kind of experiential sabbatical. I think I came to the conclusion that the current paradigm would work if it wasn’t for the people. A bit like the old saying that the operation was a success, but the patient died. People also say that hospitals and schools would run smoothly if you did away with patients and students.

I thought it might be useful to look at the problem of mental illness culturally, since looking at it medically didn’t get us anywhere… and by that I simply mean that there is no evidence that we have improved outcomes for people since the medical profession took on he task of treating emotional suffering after the Second World War.

Returning to the topic of cultural change takes me back to hang out with some splendid explorers. The ones I like are Humberto Maturana, and the others who came out of Chile’s turmoil with a fascination in ontology, Heinz Von Foerster and his connections with the Macey conferences and beyond, and then the greats who have created it without necessarily talking about it intellectually like Nelson Mandela, Mahatma Gandhi and Desmond Tutu. 

Humberto Maturana was interviewed by Bernhard Poerksen to create the lovely book “From Being to Doing” In it he spoke about his time in Chile after the coup where Pinochet assassinated Allende and the country was thrown into tyranny. Everyone who was able, tried to get out while they still could, including Maturana whose friend Heinz Von Foerster scrambled to get him a University post in North America so that he and his family could escape. 

In the ten days or so that it took for a position to be secured Humberto had watched as all the free thinkers and movers and shakers fled the country. As a University lecturer he found himself wondering what would happen to the young people, to his students, and what would happen to democracy if all the democratically minded people left.

He had in the past been fascinated by the stories that his friend Heinz told about cultural change that happened in Nazi Germany, of which Heinz had personal experience. In those phenomena that shocked the free world, including that there were good people who actually didn’t know what was happening and were upholding and supporting the regime that was perpetrating atrocities. How did that blindness get created? 

Maturana was beginning to see how. Curfews were being imposed and people disappeared under cover of night. Plausible stories of cover up and some sense that things must be happening for a greater good because the country was still functioning began breathe life into a bizarre unreality.

He decided to stay.

One of the many things I admire about him was his ability to maintain his dignity in the face of potential oppression. Here is a chilling example:

He and a hundred or more other University academics were invited to dine at the palace with Pinochet. History did not build confidence in situations where large groups of people were rounded up by dictators and many of them feared for their lives. 

Pinochet gave a toast to the fatherland and they sat down to a delicious meal. Before dessert was served Pinochet stood again from his seat where only a few meters away Maturana heard him say “Ladies and gentlemen, the sole purpose of this meeting is to get to know each another. That is all. You may feel quite safe; there will be no demands on you of any kind.” 

He sat down again and Maturana then picked up his glass and stood and said “Ladies and gentlemen, I would also like to toast our fatherland with you. We are gathered here today in the company of the president, and that is a rare occasion under any government. I will therefore seize the opportunity and bring out a toast with you and the president to the effect that we all who are here today contribute to the intellectual freedom and cultural autonomy of our country, Chile”

Now you can imagine the terror in that room as he spoke, but Maturana understood that power only exists where their is obedience. By standing with dignity and preserving his autonomy he helped to restore the dignity of everyone in the room. Pinochet clapped his hands together three times and the room exhaled. Later, in the mingling, Maturana was urged to approach Pinochet who shook his hand and said “I share your good wishes for this country”

Take another moment to share Maturana’s reflection: “It really was a bizarre situation”

Twenty or so years ago, we began seeing a cultural shift in government departments in Australia that had trickled down from some big shifts in leadership. Books were written like “Tampering with the Asylum” and there was enough political commentary for most people to see that something fishy was going on. It wasn’t yet so mainstream that you couldn’t stand up and call out acts of tyranny, and a common analogy of the day was that of the Emperor’s New Clothes. Back then you could be the little boy who stood up and said “But the Emperor is naked”

Not long after this a colleague said “Yes, but the world isn’t kind to the little boy who says that”

That comment has stuck with me as I have watched in government departments as piles of such little boys (and girls) are chewed up and spat out, and we are now seeing this spread from government department to private industry and to schools.

I no longer use the “Emperor’s New Clothes” analogy, as it’s too dangerous, and have moved through the “moving the deck chairs on the Titanic” analogy and am more and more seeing people drowning and flailing in the water in these organizations.

The Fat Man in “The House of God” instructed his hospital Interns: In any emergency, take your own pulse first. Or, said another way, when the oxygen masks fall in the plane, fit your own mask before helping others. If you’ve ever tried to help someone who thinks they are drowning you have likely experienced that the flailing force of their grasp to be saved can be life threatening for you.

I used to think that people higher up in the organisation should know better and have a responsibility to the person under them. It might be true, but it isn’t useful to have that expectation if nothing comes of it. I began to think instead that they were under the influence, like the good people in Germany who fought for Hitlers regime believing that it was right. I often shared stories with people who were damaged by such treatment, of the denazification programs that happened after the war that helped those good people grapple with the terrible things they had done. This reframe helped to make the damage seem more cultural than personal, which sometimes helped the pain. 

More and more, though, I am seeing that those people doing the damage are just drowning too.

Erickson was asked to see a patient in a mental institution around the middle of last century. The man kept saying “I shouldn’t be here” he said this over and over, even in response to attempts to help him. Erickson simply walked up to him and said “But you are here” to which the man replied something like “Oh shit, how do I get out”

I see so many people grappling with injustices in our present day culture, and I do so myself, all the while saying “It shouldn’t be like this”

“But it is like this”

Oh shit….. 

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Darkest before the dawn

“There comes a time when silence is betrayal.” Martin Luther King Jr.

I wasn’t around when women were not allowed to vote, but I was alive when indigenous Australians’ newly granted suffrage was reflected in our constitution. It’s hard for me to imagine what it would be like to experience such discrimination.

In a way I was lucky, because I have a Tasmanian Aboriginal ancestor and I was born during the time of the stolen generation, though I was too white and privileged to be at any risk so that never had any grip.

I remember the shock I felt when I lifted my head from my busy middle class white life to watch Nelson Mandela’s inauguration, and was hit by the realisation that he had just voted for the first time in his life in the election that made him president.

My first child was born during the finals of the 1995 World Cup, so I missed the enormity of South Africa’s win in their first inclusion in the tournament after a decades’ long ban opposing racism and apartheid. This story, portrayed in “Invictus”, is one of my now favourite movies.

I am happy to live in a world where people can have their own opinions, and can hold their political and religious ideas dear. Where they can live whatever doctrine they believe in as it applies to them in their own homes. These opinions could be like what color to paint your lounge room, or what you think constitutes art. They could even share their opinions with their black LGBTI neighbor over tea and scones while their children played happily together in the back yard with the Muslim children from over the back fence.

I don’t know though, how to live in a world where a law of the land can apply to one human being and not another? I can understand why we do not let our children vote, but how do I live in a world where, say, we let children with blue eyes vote and children with brown eyes not vote?

I don’t think there has ever been a time in history where one human being didn’t discriminate against another, and if we are waiting for this eventuation to create world peace, I think we will be silent for a long time. But there have been times in our history where great leaders allowed us to transcend our primitive human tribalism and see a world where there is space for us all.

This poem, Invictus, gave Nelson Mandela strength to stand when all he wanted to do was lie down. Twenty Seven years in prison for being black with an opinion can do that to a fellow. I love this poem and offer it so it may also inspire all oppressed Australians in our darkest hour.

Out of the night that covers me,
Black as the Pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.

In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeonings of chance
My head is bloody, but unbowed.

Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds, and shall find, me unafraid.

It matters not how strait the gate,
How charged with punishments the scroll.
I am the master of my fate:
I am the captain of my soul.
William Ernest Henley

 

And from Winston Churchill

“The mood of Britain is wisely and rightly averse from every form of shallow or premature exultation. This is no time for boasts or glowing prophecies, but there is this—a year ago our position looked forlorn, and well nigh desperate, to all eyes but our own. Today we may say aloud before an awe-struck world, ‘We are still masters of our fate. We still are captain of our souls.’”
—House of Commons, 9 September 1941

 

The mood of Australia is pretty happy with shallow and premature exultation. So I dare to dream of a time for boasts and glowing prophesies where all humans are equal under the law. Who is with me on this? WHO IS WITH ME?

Finally feeling hopeful about Mental Health Research

You might remember, about 5 years ago the National Institute of Mental Health in the U.S. finally said enough! This whole idea of clustering symptoms of mental ill health into diagnostic categories was a great idea, but it just hasn’t got us anywhere.

I remember my heart lifting and a cheer tried to escape but was quickly crushed by what I read next. They were now  going to focus on neural pathways. So instead say of studying PTSD, anxieties and phobias say, as separate entities, they were going to look at fear pathways, with modern laboratory techniques and neuroimaging, and I felt my heart sink. I think because what I read didn’t really sound like a change in paradigm, or how we think about human suffering, just a new thing to look at with old eyes.

Ive checked in now and then since then and have not felt my spirits lifted.

So, this morning, after a week of frustrating conversations with the old old paradigm I thought I’d check in again. Now this is not new, it’s a talk from 2013, and it may have been on the NIH website for some time, but it lifted my spirits. I think there’s still a bit of blindness from looking through the medical model, but in relation to my frustrations about psychotherapy research I think it’s fantastic.

I said to Rob, “you should listen to this” and he said “give me the short version!” So here goes.

In the old paradigm when we make a mental health diagnosis, we are making it with symptom clusters, and that’s like saying “You have a headache disorder, or stomachs ache disorder” without going any further, and then giving that diagnosis the same authority that we might give diabetes. And that really isn’t any more advanced than the ancient Greeks description of melancholia.

The major problem though, is that with all the modern techniques for neuroimaging, for structural and functional analyses of the brain, the findings don’t map on very well to the disorders. I’ve often thought it will turn out to be like diabetes, which was described early on in relation to excessive urination, but when we finally discover some biochemical cause, we have two distinct entities, diabetes mellitus, and diabetes insipidus, which are so dramatically different in their cause and physiology that had they been discovered biochemically  would never have been given the same name.

And that seems to be the problem. That DSM has given a whole lot of heterogeneous symptoms the same name, so no wonder we haven’t come up with a specific diagnostic test or specific treatment. From a paper titled “The drug hunters” the report is that “On average, a marketed psychiatric drug is efficacious in approximately half of the patients who take it.” He presumes that those are the people who have the thing wrong that the drug treats.. (a bit of a stretch but an interesting idea)

(At this point I want to caution myself about this seductive pull to turn the mysterious unfathonableness of the human condition into a simple machine, but for the sake of the short version I will press on.)

So RDoC,  stands for Research Domain Criteria. The statement in RDoC’s strategic plan states, “Develop for research purposes new ways of classifying mental disorders based on dimensions of observable behavior and neurobiological measures.”

There are four components.

The first component Is to identify these fundamental components that may span multiple disorders. So they look at circuits in the brain. Circuits responsible for dealing with threat, looking for food, memory, that kind of thing, and you start to see how lots of these circuits will be at play in different ways in different people who might all say fall under the current umbrella of depression.

The second component is “To determine the full range of variation from normal to abnormal.” This is very cool I think, because they are starting to see all symptoms on the spectrum of normal, and that there has been some adaptive behavior say that has taken a normal behavior to extreme. Watch the video for some useful observations about Schizophrenia and Bipolar. I think clinicians have long seen symptoms on a spectrum of normal, but for researchers to finally get this is a huge step forward I think.

The third component is to integrate genetic, neurobiological, behavioral, environmental, and experiential components, so that the complexity of the human experience is not lost in the science. And they are not just giving lip service to that complexity the way the “biopsychosocial model” did.

And the fourth component is to develop some measure, which might just start with what can be measured and seeing what that lines up with. They seem to be starting from a position of not knowing, and being willing to discover, even if it’s at odds to what they think they know.

The other heartening thing is that they are looking at neurodevelopment. Acknowledging that things that happen to the developing human have an impact at many levels, and understanding more about that impact can inform what to do about it, both with treatment and prevention. They are also looking at the impact of environment, both positive and negative.

So that’s the short version, and I recommend the long version….

 

Loved

How would you describe the experience of being loved? A newborn thrives in its presence. You can see it on their faces. The well loved child. It’s hard to describe. Perhaps a sort of contentment. The faint smile of satiety.  Nothing missing. And in its embrace the experience of being allowed to just be who you are.

Judgements are suspended. Both good and bad. If you are distinguishing beauty, charm or whit, you are not there.

The space where negations delivered under the guise of love are felt for what they are, not heard for what they might be, and are not allowed in.

And in that space, awareness expands. Synergy is created.

Is this the space where healing happens?

Can it be that simple? As simple as….

As you wish…..

 

 

Psychological theories: Too much to bare.

Jay Haley once supervised a therapist who said that the family she was having trouble working with had a mother and daughter who were symbiotically attached to one another. Haley, famously said “I’d never let that be the problem.” (Brief Therapy: Myths, Methods and Metaphors. Zeig and Gilligan)

Pickpockets on a Nudist Colony: The Systemic Revolution in Psychotherapy, a book by Ben Furman and Tapani Ahola sums up beautifully what psychotherapy does. You have to sew a pocket on a nude before you can pick it.

Bill O’Hanlon once said that there is a place in a modern therapist’s room for a couch. Any time they get a theory about their patient they should lie down and wait for it to pass. (In one of his 30 plus books)

Most therapists would know those three tidbits, and we all chortle, genuinely, and yet there we go again, when we find a client difficult, we attribute some theory of maladaption that is impossible to surmount.

It’s sometimes a challenge to remember that all psychological theories are made up. None of them are true or real. They are also made up by human beings. A brain writing a theory about the brain…. there has to be something intrinsically dodgy about that.

As soon as you say that someone has a maladaptive attachment, has trauma stuck in their body, has a disordered personality or disordered thoughts, you are in trouble. You have constructed a problem that has the potential to be difficult to solve. You have also added something that wasn’t there. You have sewn a pocket on.

One of my heroes, Heinz von Foerster describes the way we do this kind of thing as an attempt to turn the amazing unfathomableness of human beings into a trivial machine. Trivial meaning if you input A you can predict output B.

A more universal example is the way schools attempt to turn children into trivial machines. Questions, it is understood, have answers that are already decided, and a good grade on the resultant test is proof of successful trivialisation.

He was the kind of fellow who could get seriously excited by the child who, when asked what is two times three answers green.

Something that hit me hard when reading his work and had a big impact on the way I raised my children was his notion of illegitimate questions. These are questions that when you are asking, you already know the answer to. They generate a yucky experience in the asker and the asked. We all remember that feeling from school that goes with a prayer that it will not be you that will be the chosen one…. even when you know the answer the teacher is thinking of.

I think that working therapeutically with a human being from a position or psychological theory will inevitably be an attempt to turn this person into a trivial machine. I suspect that a good grade from the therapist about the client will be evidence of trivialisation, but a good grade from the client about the therapist will reflect the respect the therapist had for the non-triviality of the client.

I used to think that the questions we ask reveal the client, disclosing who they are and what they care about. Then I realised it is not important for the therapist to see what the questions reveal, but for the client to discover. Now I wonder if the discourse is just a distraction for the thinking mind as the healing happens in the space between two people.

How else can diametrically opposed dogmas result in equal effectiveness?

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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.

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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.

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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.

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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 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…..

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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.