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.

Magick I have known

img_0758

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.

Continue reading

Being Frank about therapy

img_0751

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

img_0743

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!

 

img_0670
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