Magick I have known

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I have been inspired by Scott Millers workshop in San Diego, to tell some stories. I’ve shared these with clients who tentatively bring up such experiences, and the conversations that followed once they could trust I wouldnt judge them, were often so healing and profound, but I have not shared them publically until now.

In a slightly paradoxically tickly presentation, Scott shared research on mystery. That’s right! Just hold that thought for a moment! Something like > 80% of people believe in the spiritual/ supernatural world, and they say it is because they have had direct experience that confirms their belief. Psychotherapy has been so busy trying to give scientific certainty to Itself, that it has hidden the Magick and mystery that was strongly present in its ancestry, under a bushel. Scott Miller shared interviews with people who were NOT helped by therapists but were helped by Clairvoyants or psychic healers. What we heard was a reflection on the field’s inability to hear what a client really wants when it is outside our view of healthy psychology.

I don’t think this is limited to the supernatural. I see many people who’s world view was negated by a supposed mainstream doctor/therapist who thought they had the “truth” only to have their “patient” drop out of treatment. There are also people I know I have done this to, and my great fortune is to be amongst colleagues who I can speak to about such stuff ups so that I can learn and improve.

And so to the stories.

17 years ago, in my first marriage, when my youngest was just 10 months old, my husbands sister killed herself. We knew she had been troubled, so when we got the call that she was missing an emotion set in. An emotion I’m not sure I have felt before or since. There is some texture worth knowing, but skip the next paragraph if you don’t want to know.

We had celebrated her 35th birthday the evening before at her parents house, with her husband and three small children who were 6, 10 and 12. She and I sat on the grass and spoke about some of the shit she was dealing with. The evening wound up and they left with the usual goodbyes. I thought they had gone when she walked back into the house saying “where is she?” And walked up to me and hugged me. It felt warm in the moment, and appreciative, and that was all. I doubt I would have remembered it, if it did not turn out to be our last living contact.

My son, maybe a year before, when he was 3 and he only had one sister, was in his booster seat in the car as I was driving along the narrow country road near our home. Typical of Tasmanian roads, the narrowness and poor construction was reflected in the open speed limit and use by large trucks. So we were driving at highway speed when out of the silence Liam said ” whooo” , in a giggly voice ” I just imagined that we were upside down and I was hanging upside down  in my car seat” He was still giggling but for me it was chilling and I slowed right down. As we came around that corner at slow speed we were stopped by a crash scene. A car had hit a cow, and it was stopping all traffic. Had I come around at speed I realised there would have been nothing I could do to avoid being part of the scene.

So that day, in 1999, when I collected the children from our Pat, after the call at work that my sister in law was missing, we were driving down the highway and Liam said, “whooo, I just saw Aunty Leesa on a cloud” I felt the same chilling feeling.

But that’s not the story. The next paragraph is a bit more background, so don’t read it if you don’t want to know.

We lived on 5 acres of bush. Typical Australian bush, dry, no topsoil, no green, no European plants. So the wildlife and bird life was native and used to the harsh environment. Leesa was found near our home on a vacant block, in her car, with a well researched, successfully orchestrated, efficient device to deliver carbon monoxide into the car. She was found by our local country policeman, strangely on a block owned by a friend of our Pat. She looked beautiful. She had done her makeup, and had just had her nails done. Sitting next to her on the passenger seat were cards she had written to her children.

What happened next, was what happens in families where someone they loved and was loved by dies unecessarily, but from a practical point of view there were things to be done, and her children came to us for the weekend. Enter another huge emotion, but one that I knew.

Saturday morning, one of our cats came towards us as we were out on the back deck looking at the bush, and in its mouth was a white dove. There are no white doves in the Australian bush, but there it was. The contrast of red blood on white feathers… but it was not dead. I rescued it from the jaws of the cat and all 6 children gazed upon it. I explained that birds are very fragile creatures and it had had quite a shock, but we would put it in a box and keep it quiet and see. My experience of trying to save injured birds was that it would be dead in the morning.

The next morning I opened the box and it was alive and well. I carried it outside with 6 little people milling around, helping them to be quiet and hold some care and tenderness towards it. It didn’t seem frightened so I gently put it on the rail of the back deck, where it sat, and allowed her children to stroke it, particularly allowing her 6 year old a lingering touch. I don’t remember what was said, but I will never forget watching that small child and that white dove. And then it flew. But not away. It stayed around for the whole weekend, looking in the windows so boldly that I feared the cats would get it again.

And, at the end of the weekend when the children left, I never saw it again.

I don’t remember if I made it meaningful or comforting to the children, though I hope I did, but I remember powerfully the feeling of meaning and comfort that I felt.

The collateral damage, not only to the people who knew and loved this woman, but to the police and emergency crew who attended has been profound and ongoing. I know she would see the irony if I said I have an urge to “dig her up and beat the shit out of her” for that, but it is much more useful to find a context for healing.

I have heard so many stories like this from clients over the years, and while theirs are too unique and private to share, the conversations about them provide a magical opportunity for healing to happen.

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Being Frank about therapy

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We are off to San Diego for The Brief Therapy Conference next Wednesday. I’m tweaking my presentation and thinking about what other workshops I want to go to.

And here’s the dilemma again. Lots of presentations are about technique when technique is not what is responsible for effectiveness. But how do we talk about what we do without talking about the technical aspects?

And so I came back to Frank and Frank 1991, Persuasion and Healing: A comparative study of psychotherapy.

They think the biggest thing therapy does is tackle what they call the client’s demoralisation about the problem, rather than the problem itself. In our world we call that resignation, and create expectancy as it’s antidote.

They think all therapies have commonalities:

A healing relationship
A healing setting
An explanation, true or mythical, to make sense of the client’s symptoms, that the client accepts as real for them.
A ritual treatment that the client believes, or comes to believe will work, and that both client and therapist participate in.

They also think there are commonalities between all rituals (therapies)

A therapeutic relationship that survives the client sharing their demoralisation thereby combating alienation
The therapist maintains expectancy by linking hope to the process of therapy
The therapist provides new learning experiences
The client’s emotions are aroused
The therapist enhances the client’s sense of mastery or self-efficacy
The therapist provides opportunities for practice

But here’s the thing, and it’s a bit like what happened to me when I first read a theory that dogs domesticated humans, not the other way around. My whole world was tipped on its head, and of course I liked it, because that’s who I am. But the best thing was that it changed the way I am with our dogs. Our communication is more expansive. I am more likely to wonder… “How did they get me to do that”

I think an important part of successful therapy is that the therapist does not get demoralised. So I wonder if we apply the commonalities of the rituals or therapies to the therapist, not the client.

The therapist must first believe that their particular ritual can help the client. But what if the client helps that happen.

So if we turn those 6 points on their head:

The client generates expectancy in the therapist by sharing their demoralisation and letting them think they can help.
The client engages in the therapy that the therapist believes in so that the therapist feels hopeful.
Hope in the therapist is increased by the client sharing that they are learning new things.
The therapists emotions are aroused, as they are connected to their passion for their work.
The Client shares their mastery and self efficacy So the therapist feels validated in what they are doing, thereby improving their own sense of mastery and self efficacy.
The client returns with more scenarios for the therapist to practice their therapy.

What do you think?

Cool study exploring expertise: confessions of a neuroatheist

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Todays obsession with the brain as a pseudoscientific tag line for all things drives me nuts. Yes, we have a brain. Do we really know how it is involved in our conscious, cognitive, behavioural and emotional selves. No.

Insert rant… more eloquently done by Ana Todorovic in her blog “Do psychologists need a brain

Would knowing more about the brain change anything? I’m not convinced. Just like understanding muscles might make some tiny difference to elite athletes but hasn’t helped in muscular dystrophies.

It seems fairly straight forward to me, that if I go to the gym and do arm curls my biceps will get bigger. And so it follows that if we recurrently practice something, the bit of our brain we are working with will get developed.

I went looking for a study I heard about in the ’80’s when I was at medical school. This study found that London taxi drivers had an overdeveloped part of their brain responsible for spatial awareness. As I embarked on this search I tried to recall if we even had CT scans in the 80’s and braced myself for some macabre post mortem study.

What I found was something much more recent, and my confession is that I found it interesting and thought provoking, raising useful questions for doing therapy.

The study:

Talent in the taxi: a model system for exploring expertise. Katherine Woollett et al 2009

They studied London taxi drivers and found that people of average IQ can develop expertise to an exceptional level, and this was associated with developing more grey matter in their posterior hippocampus, an area related to spatial awareness and navigation. The down side, as seen with autism where there can be exceptional abilities at the expense of social cognition and executive functions, and some expert musicians who suffer focal dystonia, the taxi drivers performed poorly on tests of spatial memory and delayed recall, as well as acquiring and retaining other types of new information. They also lost grey matter in their anterior hippocampus associated with worse anterograde associative memory.

Interestingly both the positive and negative grey matter changes began to revert after the drivers retired.

London bus drivers, in comparison, had no hippocampal changes, and this was explained by the different expertise required to follow prescribed bus routes versus being required to learn the layout of all 25,000 streets  and thousands of places of interest in London.

A follow up study in 2011: Acquiring “the Knowledge” of London’s Layout Drives Structural Brain Changes tracked individuals of average IQ over the time of their training and found that those who qualified demonstrated a structural increase in grey matter in their posterior hippocampus and concomitant changes to their memory profile, but there were no changes in those who failed the test, or those in the control group.

Some useful questions for working with clients:

One of the most reproducible findings for structural brain changes in PTSD is reduction in hippocampal volume. This has also been found in major depression, schizophrenia, and in bipolar where a correlation with verbal memory deficit has been shown.

Most people who are stressed or depressed report poor memory. I wonder if you practiced being stressed or depressed you could shrink your hippocampus.

What if reversing those changes were as simple as retiring from taxi driving?

Is it just a matter of use it or lose it?… or better still, lose it or use it…

What we practice we get good at. What are we practicing if we are depressed, anxious, obsessed, paranoid…

What could we practice instead?

What do you think?

Untangling the best treatment of mental ill health… a frayed knot!

 

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Find out why

I started this blog with enthusiasm, as a way of sharing my thoughts as I was exploring what we know about how people diagnosed with mental illness get better. I hoped that by getting clear I would find a focus and direction for developing and improving in my work, and that by sharing a summary, this clarity might also help other practitioners. This blog has been languishing while I have been lost in the metaphoric Amazon, but here’s an update.

Unlike many other areas of medicine, where such a pursuit is a relatively simple journey with well marked sign posts and a road well travelled, this journey has been a murky, muddy, poorly lit path with lots of scrub bashing required.

I have discovered that despite millions of dollars spent on research in the last 50 years, we are no better at treating mental illness now, than we were then.

Gene studies, Neuroscience and exploration about how the brain works has been fascinating, but it has made no difference to patient outcomes.

The promise of medications that work like antibiotics to cure a complaint, is a bubble that has well and truly burst, with placebo being the biggest winner. The strategy of throwing every new drug at every condition to see what happens has been pretty interesting, and probably been driven more by the practitioners desperation and anecdotal observations than any decent science. The result has arguably put the biggest dent in the rationale for diagnostic categories. If you say you can observe benefits of antipsychotics in depressed patients and vice versa… well isn’t that like saying antihypertensives have some effect in Influenza??? You’d have to wonder if we are trying to cobble some therapeutic effect from a side effect, rather than an explainable physiological biochemical intervention. As studies emerge with concerns for long term follow up, particularly of children who were exposed prenatally, we will likely see the pendulum swing in the benefit/risk debate about when to treat.

What has gone wrong? Where is the hard science? The indisputable ground on which to make decisions about patient care.

Well, as Deep Thought famously said: “I think the problem, to be quite honest with you, is that you’ve never actually known what the question is.”

I myself am just sitting with that one, and don’t claim to have had a bolt of lightening about the question. The experience I have in the face of this though, is like working with a family where all the logical attempted solutions to say a child’s behaviour have actually become part of the problem and there’s a big tangly mess of action and reaction, and the best thing to do is to down tools and start again, and a big part of this is to help the individuals give up their certainties about how and why the problem began.

In starting again, there are some things we can say about psychotherapy with certainty:

That the therapeutic alliance is of primary importance, but that the qualities the therapist brings to this alliance are vastly under researched.
That no one model is superior to another when put under scrutiny that controls for quality of study design, therapist allegiance to the model being tested, and comparison to a bona fide treatment.
That therapist allegiance has a robust influence on effective outcome, but is vastly under researched.
That most therapists do not improve with years of experience, implying that their education and continuing professional development, must not be currently focussed on what is responsible for effectiveness.

That feedback is a good starting point, but we need to know more about what to do with that feedback.

The difference between a good therapist and an average therapist is far greater than the perceived difference between models that has been exhaustively investigated, but we know very little about what the good therapist is doing that the average therapist isn’t.

Theres still a lot we don’t know about. We know almost nothing about people who get worse with treatment. The only things I’ve seen written about this phenomenon, generally follows a demeaning, paternalistic bent around the fact that these people are not psychologically minded or sufficiently cognitively sophisticated to be helped by therapy.

We don’t know much about people with severe mental illness who do actually get better. The people who are literally “cured”. It is usually said that they can’t really have had that severe diagnosis in the first place. Then they are dismissed.

I think that we need to think differently about the whole issue, and to start asking different questions…. but what? What do you think?

 

 

Time for the Emperor to buy new clothes from Kmart

I have been preparing my talk for The Brief Therapy Conference in San Diego in December and I’ve just discovered an awfully big problem.

Responding to feedback from my last presentation… People want evidence.

So I looked for evidence for the major points I want to make and I can find it. Some of the studies I could use to support what I am saying are even pretty well designed, but here’s the thing. After my exploration this year, I now know that they are meaningless. You can actually find anything you are looking for in the social sciences and psychology research.

Most of the time researchers are honestly passionate about what they are exploring and don’t see the biases and allegiances they bring, and some of the time affiliations to industry, pharma, or just getting published and keeping your job or earning a crust let the rot creep in.

Even if you find a good study with seemingly none of this, it won’t be reproducible, because none of them are, and for a finding to have any scientific rigor it has to be reproducible.

And there’s another funny thing which I discovered when speaking to my brother who is a scientist. Chemistry is his thing. I could barely understand the title of his PHD, let alone what it was about.. He has embodied the science machine and chemistry has behaved itself appropriately. Being analytical has worked well for him, and I value his clarity and experience.

He is, however, also an athletics coach,  most recently an official Olympic coach. Pretty amazing achievement to manage in his spare time. Inspiring. I have spoken to him about doing the landmark forum, as I think the distinctions and experiential learning would open a whole new world for him in his coaching. He is reluctant, and would expect to walk out not being able to manage the hoopla. But here’s the thing, feedback from 2.5 million participants of the forum show that 95% get a major life altering transformation. This is way better than any therapy or coaching process. Then my brother started telling me how impressed he is with neurofeedback for coaching. Ho hum. We know that Neurofeedback, CBT, or any of the other hundreds of models are all the same. But there’s the thing… Neurofeedback is very palatable for the scientific mind and The Landmark forum is not.

And I think that’s it. We put these studies up on a slide to make what we are saying palatable to our audience. If you really see that, most presentations are like persuasive writing. We are more like journalists than serious contributors to our field.

It’s actually quite funny when you think of all the criticism Erickson got from his Ocean Monarch Lecture, when people discovered he was speaking to generate an experience so that learning could actually happen, and some people felt manipulated. If only people would get offended by the attempted manipulation anytime someone used research to make their point.

Holy toledo! What now?

 

Mental health, toasters and social transition.

Like many Australians, I have been very stirred up by the events of the week. A man asks a question on Q and A that thousands if not millions of Australians have asked themselves. Then a well intended fellow does what many of us thought was a nice thing, without questioning his right to put this man at centre stage. The paternalism and missionary zeal at rescuing the poor savage is so transparently present in our present from our ancestors DNA that many good people forget to question such a pull to action. Indeed they felt it themselves and then found relief in giving to this cause that spoke to them.

I had a moment where I thought we might actually get some real debate, from real Australians not filtered through media self interests. And then the tribalism began. “The he said, she said” The trial by fire. The guilty until proven innocent. Another primal aspect of our humanity fanned into flame. Fanned into flame, in this case by the media self interests. And the tall poppy falls.

All human endeavors through history that fight for human rights have not been without casualties. The suffragettes were blamed and demonized and many saw that only violence was a language that could be understood. The oppressed, violently pushed down, often violently retaliated. And some didn’t. Gandhi grew the power of non-violent non cooperation, but even he couldn’t stop the Civil war that slaughtered innocents even when their victory was at hand.

In Australia, women have had the vote since 1908, though not yet equal pay. Indigenous people did not get the same voting rights as other Australians until 1965, but still have inequality in all Western standards of health and wellbeing. Nelson Mandella got the right to vote for the first time in 1994 in the election that made him president. Imagine that! Yet still, if an indigenous man had asked this same question in Q&A would anyone have wanted to buy him a toaster? What if a woman had asked?

Under all of this lies the last frontier. The child who lives in poverty. Third or fourth generation of poverty and concomitant mental ill health. We all see them. We watch them grow their own mental ill health. From beautiful baby to harried toddler. It’s such a complex story that it’s hard to know how to speak it. For me, as a young GP, more than 2 decades ago, I saw these babies and their young parents as the great Aussie battlers. Against all odds. Blamed more than they were helped. I have worked in General Practices that would refuse to see, even mothers and toddlers because they had missed appointments, with no understanding  that they were punishing them for a symptom of the problem for which they so needed help. After  attending a talk by our human rights commissioner I now have the tools to advocate for such a person, but to have to advocate to doctors for basic human rights is not something I ever envisaged. So often when seeing such patients I found myself thinking that if I had had to endure what they had had to endure I would not have been doing so well.

25 years on and nothing has changed for this minority, and again we see a lonely voice shredded. And where are the Gandhi’s, Mandellas, Martin Luther King Jr’s, who know how to make visible the inconvenient and generate a mood of public debate that grows solutions and change?

“History will have to record that the greatest tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people.” Martin Luther King, Jr.

If you feel moved to speak, please leave a comment.

Rethinking childhood trauma on Anzac Day

I have been attending some monthly meetings held by the Commissioner for Children, and this month Narelle Whatley A PhD Candidate At the School of Social Science UTAS, presented some of her thesis on “Young people’s experience of family violence” The thing I have been left with the most is that  most people who suffered childhood abuse or trauma, didn’t seek counselling, even as adults. I’m sure I’d heard this before, but somehow it hit me differently.

I had been immersed in reading and listening to world experts on trauma treatments over the last while and suddenly I was hit by the image of these experts with all their knowledge, worlds apart from the child who pretty soon works out no one can help so keeps quiet. I got a sense of their world through the voices presented. I hadn’t noticed that part of the reason they don’t find a trusted adult early on is that they moved houses and schools so often. I revisited my own emotional experience of early school life and imagined adding a new house, school, teacher, peers… well no wonder.

Then I thought about the children I am seeing and have seen who’s early life was tumultuous and terrifying, and they have all been brought along by someone else, usually an adult who has some working responsibility for them and needs help. I have routinely asked all these children what had made a difference to them, dealing with all they were dealing with, and the thing that stands out is the rare, infrequent, connection with someone who cared about them and believed in them. It may have been a grandparent or other relative but was commonly a trusted teacher. The thing that helped was not that they intervened in the violence and tried to fix it, but that they somehow allowed the child to believe in themselves.

Neuroscience has given us an amazing understanding of the traumatized brain and the trauma response but has made no difference to the effectiveness of treatment. As Cloe Madanes famously said “Satisfying human relationships can be the most healing “medications” of all. No amount of exercise, meditation, massage, stress reduction or broccoli is an adequate substitute for love and affection for promoting health.

It then occurred to me that if we really want to make a difference to children it might be good to look at things from their perspective. What would be helpful for a child who is suffering, but is protective of their parents and doesn’t want them to get into trouble? What would help the child who stays silent because they perceive that the social interventions in place to help would actually make things worse for them? How do we ask the questions that might actually make life better for such a child and their family?

I think it will take a cultural change. Humberto Maturana, Chilean biologist, gives the best description of how cultural change happens in his talk/writings about the origins of patriarchy. It starts with a change in emotion, which is taken on for some reason or other, not as a manner of living for the adults, but for some greater good. But, when children are born into this new way, they take it on as a manner of living, and it becomes transparent.

What if doctors, nurses, antenatal nurses, obstetricians, child health nurses, pediatricians, social workers, early childhood intervention and family workers, child care workers, Centrelink officers, drug and alcohol workers, psychiatrists, psychiatric nurses, police, ambulance officers, the justice system, family law courts, teachers, teachers aids, sports coaches, gym coaches, bank tellers, shop assistants and tv celebrities, started with love, affection and broccoli anytime they were confronted with a child or family exhibiting what trauma experts would know as the hyper-arousal of trauma symptoms, hitherto thought to be bad behaviours by all of the above.

“Satisfying human relationships can be the most healing “medications” of all. No amount of exercise, meditation, massage, stress reduction or broccoli is an adequate substitute for love and affection for promoting health.” Cloe Madanes

WORKING WITH DISSOCIATION: When reconnecting is not enough

As a medical undergraduate, I found Psychiatry to be such a strange abstraction, that seemed to be about types of people that I’d never met. I was taught that neurosis was something that was within normal human experience, but that psychosis was not. It just didn’t prepare me to deal with patients in General Practice who suffered from extreme forms of dissociation, and I felt ill equipped to help. Somewhere in the next 10 years I discovered how to see the person, not the DSM category, and got to know many interesting individuals, who reminded me of a lot of people I had met in my life. I could see that my part in actively building our relationship helped them. When I then began to learn about Solution Oriented Therapy and then the work of Milton Erickson, I finally discovered that there were ways that I could be more useful.

Now, another 16 years on, I would have some things to say to my younger self. I would tell her that dissociation is in fact a normal human experience. I would remind her of the imaginary games she played as a kid where textured stories unfolded and it was as if these things were really happening.  I would remind her of her daydreams, where quite bizarre realities could feel very real. I would remind her of the time she had a fever and floated around the ceiling looking down on herself, managing not to be afraid because of the soothing voice of her mother. I would remind her of the time when she was sitting in the sun in the family room and saw her old grey tabby cat out of the corner of her eye, and then, when she turned to talk to him, it was just a bundled up jumper, not even the right colour really, and she was so surprised at how real he had seemed that she tried to get that vision again out of the corner of her eye… but couldn’t. I would remind her of the creative spaces she would get into, drawing, building, creating, with ideas that defied logic, as the “real world” disappeared and time sped up, or slowed down. Then there were those optical illusions, and magic eye images. If she could be so easily tricked, couldn’t anyone?

She knew then, that in the moment of perceiving, there was no way of knowing the difference between an illusion and reality, so what was so hard to understand about someone hallucinating, or getting stuck in an unhelpful delusion. By seeing dissociation on a spectrum of normal everyday experiences it is easier to understand, and therefore easier to connect with clients who experience it.

Dissociative skills are helpful when fear and trauma drive someone to want to get out of their own experience. Dissociation becomes a haven, an escape from an unwanted bodily experience, but the mood of this dissociating is sometimes very different to a playful daydream. It is a very useful skill while the danger and damage is still happening, but can be problematic if it is hanging around when the danger has passed. The most remarkable description of the protective nature of dissociation I have heard was from a man who’s childhood was a constant barrage of verbal, emotional, physical and sexual abuse, and yet somehow he managed to really believe that he was lovable. He let himself experience love, sometimes in magical ways. In primary school he pretended that his loving teacher was actually his father, and every morning his teacher greeted him he felt it as a ‘good morning’ from a loving father. He went on to have a successful life, married and had children, and had fulfilling relationships with all of them. He developed enough control of his dissociation that it became psychologically protective in any dangerous situation, and shielded him from pain. If that was possible for him, just imagine what we are able to co-create in a therapeutic relationship.

Most people have daydreamed in class but remain aware enough of “reality” that they hear their name if asked a question, even if they weren’t present for what was said. People rarely wet themselves because they were so absorbed in a daydream that they didn’t attend to a full bladder. You can be absorbed in a book, but still answer the phone when it rings, adjusting quickly to the new reality.

Neuroscience informs us that what the brain practices it gets good at, and people with extreme dissociation have certainly practiced. If there were a competition for dissociative skills, these people would be the Olympic team. Olympians, however, leave their skills on the field. They don’t tend to hurl javelins at the dinner table, and so don’t appear strange to us.

My take on dissociation, when it is a problem, is just that control has been lost. Fear gets in the way of learning, so the more ordinary we can make these experiences, the more connections to everyday examples we make, the easier it is to learn, and to reclaim control.

I have noticed that people who dissociate in a problematic way, very often have learned a few tricks to stay in the room. I had a client who would scratch his palm with the fingernails of the same hand, another who placed a hand on her shoulder under her shirt and kept the awareness of the touch. Others who pick at clothing. I have noticed that complimenting them on finding a way to stay in the room often surprises them as they don’t know they are doing it, but as soon as they realise they are more in control. I then wonder with them what other things they do that they don’t even know they are doing, and often surprising rememberings appear.

The phenomenon of dissociation can be seen in all problems that clients present with, from learning difficulties in school children, through fears and phobias, trauma responses, to the more extreme end of the spectrum of dissociative disorders, and schizophrenia. Most therapy models generate an experience of reconnection, so that a client goes from a disconnected (all over the place like a mad woman’s knitting) experience, to a connected (cooking with gas) experience, where client resources become available again, and learning can happen. However, when the client does not have control of their own dissociative experience, simply generating reconnection will not be enough.

Dissociation is a powerful skill, that can veer out of control when no-one is in the drivers seat. By understanding and utilising this ability, a therapist can work with a client to enable them to grasp the wheel of their own experience. When helping a client to explore the phenomenon of their own dissociation, we can be a useful mentor in the passenger seat of the client’s experience as they discover that they can drive.

 

Tests test the test, not the tested

If all the people in the world lay on the ground, head to foot around the world, two thirds would drown.

I was a medical student when I heard this absurd statement. Perhaps I was not quite ready to see the relevance to statistical proclamations about humans, but something about it has always tickled me. Human beings are just not standard enough for statistical statements about them to remain static decade after decade. People are getting taller, larger, living longer, surviving childbirth more often, and all the while the planet remains two thirds covered by water. So what does a statistic that stays the same mean?

A good example is Herbert Spiegel’s hypnotisability scale. I never much liked the notion, but if you do it, you find 25% of the population are not hypnotisable. Stories of Erickson’s students turning up at these demonstrations and helping these non hypnotisable people experience trance in their own way, of course appeal to my mischievous side. The finding is a result of the construct of the test itself.

So what of the effectiveness of psychotherapy that has remained the same for the more than 50 years that we have been measuring it? What if it doesn’t actually say anything about people, it just measures the construct of psychotherapy and the goals therein?

Heinz Von Foerser, one of my heroes seemed to understand this kind of thing. He said that tests test the test, not the person being tested.

 

Reflections from the School of Health and Care Radicals

I was sent a link to The School For Health and Care Radicals ( #SHCR ) a couple of weeks ago. Cool title I thought, so I took the typical 7 and a half seconds to look. It is a free online training initiative from somewhere in the NHS in the UK.

Then I saw it…. “How to rock the boat, without falling out”.  It spoke to all my past frustrations where good ideas that I was initially fired up about, and keen to contribute to,  came up against the inertia of the system, and inevitably after a variably long and exhausting process, fizzled, and I took my bat and ball and left.

This school though, offers new hope and new ideas, with a distillation of what works. A novel idea, I know, to look at how great ideas actually became great actions, and see if, by replicating the “how”, we could be more successful in bringing innovative endeavours to life.

So Here’s what Ive learned so far:

The old pilot project is on the way out. They take too long and cost too much. Waiting 18months to find out your idea didn’t work wastes time, resources and energy. Change projects are now brief experiments. They are 30, 60 or 90 day projects or prototypes and require minimal infrastructure yet deliver useful information. Quite like the wave of pop-up restaurants, shops etc. they provide a similar efficient use of resources and you get immediate feedback.

The next biggest thing I discovered is that change begins on the edges, but mobilises through networks. Not just with bigger networks of the same people, but with bridging to other networks that have the same dream. For example the project I am involved with is to provide effective interventions for young people with mental health issues who have disengaged from school. The idea is that if I try that alone I won’t get far, and if I network with other GP’s we will miss something, but by including all groups that are passionate about good outcomes for this vulnerable group, we are more likely to bring about positive and sustainable change.

The last conference you were at, did you notice that there was more expertise in the audience than on the stage? Did you know that the employees in an organisation have 10 times the social connectivity of the organisation itself, but are rarely allowed to speak the voice of the organisation? Harnessing these networks and the vast expertise brings huge momentum to change processes.

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I learned that successful change embraces the trouble makers, and shifts their anger into passion. This happens by including them, and honouring their concerns, not by excluding them.

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That is my take on module one of this course. Take a look at the website or look on twitter #SHCR @School4radicals or facebook