Appreciation (28) … taking care and giving care challenges

Appreciation (28) … taking care and giving care challenges
Torrey Orton
Sept.27, 2010



To my co-workers in psychotherapy:


I noticed recently that caring is an important core part of therapy…not because I had not been being caring. The research on therapeutic effectiveness shows a 30% contribution from the therapeutic relationship alone, regardless of therapeutic paradigm or technique(s). The core of effective relationship is perceived care, arising from relevant therapist attention, interest, etc. 'Relevant' means felt by clients as directed accurately towards their needs at the moment.


Certainly I vary / waiver in my caring at times, but underneath all is unconditional positive regard as I understand it. My patients should feel, not always at the same moment, that I am caring about them and taking care of them. They need both to be taken care of adequately. If my care taking is not felt as caring, as specific to them and personal, it will not work in therapy.


If you have not been in therapy, you may have experienced care-taking from personal trainers, nurses, doctors, and other health providers which felt careless in the personal regard sense – as emerging from an automaton, or worse, someone who really doesn't like being with you. The effect may be to make you doubt the technical quality of the service provided, and that may inhibit its effectiveness, even if declared to be 'best practice', best of class, or similar marketised appreciations.


Unmarked detour: I did not expect to come to the following observation here but this is how writing goes. It is already noticed in Australia that the increase in non-native English speakers in aged care and some standard nursing is leading to a decline in perceived care because some care givers cannot communicate adequately with their patients. Similar is sometimes noted in general practice, and certainly the written competence of some NESB* medical practitioners is well below local high school graduation level.


This is not to impugn the intentions of care-givers. Rather it is to highlight that care – given and received – is expressed and expected differently in different cultures. Learning these differences and being able to produce them naturally is often a more than one generation's efforts away from an immigrant. The first level of that learning is linguistic, but not sufficient by itself. Many NESB immigrant groups in Australia have long had aged care facilities for own community patients for this reason.


Back on the road again. Herein lies a primary psychotherapeutic boundary issue – that taking care and caring seem inextricably intertwined. Taking care is analytically separable from the personal connection of caring / being cared for, but for the patient it is not. Nor is it separable for therapists, though efforts to do so by adopting certain distancing attitudes to patients suggest it can be. Care taking feels like it is caring, lacking which it feels mechanical (you're giving me a treatment rather than treating me) or experimental (you are using me / seeing me as an object of study). Even behavioural interventions for eating disorders, panic, phobias, etc., require a caring relationship to be effective because patient motivation is the key variable in interventions aimed to bring certain behaviours like binges under control.


People in treatment for such visibly behavioural troubles are there precisely because their self-control has fallen into the hands of a destructive habit. Habits are behavioural recipes for achieving aims without thought. They systematically solve recurrent problems with systemically repeatable solutions. They embody recurrent motivations (energy to achieve needs / wants). Motivation, in turn, stands on the back of self-confidence, self-worth, self-efficacy – all products of appropriate developmental challenges and relevant, timely appreciation by others, parents first among them. The therapist's task is to rehabilitate the injured selves. The first step is care for the patients. Doing so both suggests more or less explicitly that the patient is worth rehabilitating and that they have some of what's required already in them – their worthiness!


The danger of care, however, is its personal character and the potential for it to feel or be extended outside the therapy space and time. The boundaries for constraining care to the spacetime of therapy may constrain it out of reach for some clients…that such boundaries are needed is certain, but how they should be configured is a case by case, and often moment by moment, therapeutic task. Their importance is reflected in the articulation of professional guidelines for boundary construction and typical dangers of shoddy construction. Breaching some of these is a matter for de-registration. Case by case, moment by moment caretaking is delicate work.

Linguistic note: we speak of care givers and caretakers as if they were the same thing, though 'caretaker' has a more manorial, landed sense to it, while in ordinary usage 'care givers' are workers in respite or aged care country. How did those two usually opposed verbs come to signify the same action? Perhaps, the 'take' suggests a focus on the worker, an attitude necessary to effective care giving; the 'give' focuses on the receiver – the patient or client.

*NESB – non-english-speaking background

Perceptions and truth(s)

Perceptions and truth(s)
Torrey Orton
Sept. 23, 2010


I am struck these days by the various ways we can be deceived in our grasp of the world, and ourselves. This is apart from the consciously deceptive intent of our public world(s) and the conscious intent to create perceptions which our various artists demonstrate for us. There is also the unconscious distortion of our perceptions which arises from our premonitions of them in the form of 'previews' in the media, the reports of others about them, the interactions between the two and so on.

 For instance of the later, there was the Millau Viaduc in my mind from quite a lot of exposures at a distance, among them the BBC series of great modern constructions, a web page full of site clips and photos, some local (regional French) tourist encouragements – all contributors to a sense I knew what I was going to see. Almost all were taken from the level of the bridge or above. Our approach to the reality was from the level of the river Tarn 250 meters below the road way. Grand enough at that, but not the hanging in air glory that the previews supported. I was not stunned, shocked, shaken, uplifted….but thought I should have been, which added to the letdown. It did not occur to me that 90 minutes spent beforehand in the Roquefort cheese caverns 25 Ks down the road might have constrained my expectations to things just in front of me.

The reverse of this was my first sight of The Nightwatch through a small door on an oblique angle to the picture in the Rijksmuseum in Amsterdam 40 years ago… a view which amplified the commanding stature of the work, and which in turn was intensified by its unconscious comparison with two existing images in my mind: (1) that of the picture from an art history slide show screened in a format close to that of the real thing and (2) its micro version in the text book of the same course. Then I felt visually completed, fulfilled in an expectation I did not know I had until reality rewarded it with fact.Yet another access to the perils of perception is the very common experience of seeing something which at a certain moment looks like something it certainly is not. The rooster on the road is a web-honoured example of this, including its own self-test against variable perceptions.

Extending the avian theme, I saw a rosella of unlikely hues on the ground overlooking the Loddon River at Glen Lyon, Vic. a few days ago. This bird turned out to be a lichen infested rock declining in similarity to my first impression with every step closer to it. My focus of course was much more intent than the first glance which created the perception. My search for continuing likenesses to support that first glance moved with the insistence that self- justification demands. And, too, it was a very unlikely spot to find a solo rosella in the open, as my wife implicitly noted by immediately debunking my perception. I gave in two steps later, losing in the doing a hope that I had seen something normal in a very unusual way. Trouble is, it was wholly unusual and firmly no way. My point here, in case I lose it in short term memory glitches, is that it is very easy to see what we want / need where it is not. For my painter friends this is a good thing, for their work is to create what we can't see in what is there. Even a gathering of others may work against the clarification of the imagined when too much group membership is at stake in a threatened group perception. The research and experience on this tally fully for once.

So what is the effect of a world in which two kinds of realities are confused by misrepresentation? First the intimate is made public and then the public is made banal. Public intimacy is the content of "reality" TV …public banality is the censoring of human (and animal these days) realities like death, injury and other matters attracting notices of too dangerous to be seen without forewarning. Listen to police reporting road trauma, family violence, drunk violence, etc. Intention is the source of this misrepresentation – the intention to obscure our world and our worlds from each other. Among The effects are an untraceable paranoia, low grade fears that we are being got at…but by who? Obsessive vigilance sets in, with an air of preparation for battles. We know from the "fog of war" that persistent uncertainty in a context of potential threat is destabilising to selves and groups. The needs which are assailed by this dynamic are those for intimacy (love, care, etc.), affiliation (belonging, membership) and their facilitating ones (appreciation, acknowledgment, etc,).

The question is: is the misrepresentation intentional or consequential, or some of both? It really does not matter, except that apparently unintentional misrepresentation (deception) is an aggravated assault because it is unaccountable. The consequence is a sense of being either the authors of our own paranoia, or, as can be seen in exaggerated forms in cults and conspiracy theories (both which are massively facilitated by the Web), victims of veiled dangers. This effect is prominently on display in the US in the phantasies about Obama's origins believed by 20+% of the population, paralleled by the beliefs about alien visitors kept secret by the government, and the origin of 9/11 in the CIA, etc. Not surprising the Tea Party plays so well, hatched in a fog which we '60ers associate with another kind of tea.And, they tend to multiply and mutually reinforce. They are also untouchable by empirical truth, having emotional truths (the threats) already occupying the relevant brainspace.

 Woe are we, for these are the marginals. Woe are they because their leaders pre(a)y on and feed their paranoias. Under present conditions, the difference
between 'we' and 'they' becomes daily thinner.

Appreciation (27) … Learning to paint by painting

Appreciation (27) … Learning to paint by painting
Torrey Orton
Sept. 13, 2010


A client who is finding his way out of depression with a paintbrush was talking about his emerging experience of learning to hold the brush correctly. Though a graphic designer by trade, he's only recently started painting seriously. It's a gift he first glimpsed around age 5, but various things kept it out of the field of his life's play. Recently in a gulf between employments, he bought a painter's kit and started in.


He works at it three hours a day. Along the way he's learning the craft by doing. Brush wielding turns out to be a critical technical foundation. As he's learned to hold the brush ever further along handle, his view of the emerging picture has developed too. Grasping the handle just behind the brush, as if taking up a pencil, pulls the eye and body down into the picture. To see the point of application, to see the perception he was creating, he had to look around the brush tip.


I was sharing this progress with another painting client, who's further down the technique path. She noted that the shift from close to more distant application involved two other moves: standing while painting and painting from the shoulder not the wrist…demonstrating as she spoke with a solid but refined flourish of an imaginary brush …much as a conductor in a delicate slow movement in a classic.


….all of which put me in mind of my own painting career – for two summers between university years as an industrial painter, of schools at the time. . and what it took to learn to paint, especially "cutting in" or edging the boundaries of a surface; if attempted with too much precision, more slips occurred; a certain flourish lightly deployed cut the best edge, sweeping lightly in from the open spaces of the surface to the boundaries and then away again with each brush load. Most satisfying, even on recollection. There was a definite flow in the process, though we lacked the concept then. Or, rather, a flow was just what wasn't wanted in a painted surface, then or now!


By the way, this was edging in pre-masking tape times (late 1950's). Similar, but less delicate, flourishes were useful in coating the concrete block walls which made up the bulk of the paintable spaces with a 6cm bristle brush 15cm long and 4cm wide. Brush work was superior to rollers because the standard union contract of the time required them – brushing took longer. The technical argument was that brushing gave better filling of the rough surfaces. Compressed air spray guns were limited to painting obscure surfaces like the 15 meter high roof of the gym with aluminium based paint…. But I regress.


My emerging painter noted in passing that he can feel in the flow of his brush stroke that it is achieving the "look" he was seeking, that at once the body realises his unrevealed perception of the image he is producing. This has something to do with what is recently applauded as the muscle memory. The applause is only partially warranted since it takes the concerted effort of all muscles to train a few in a specific way, in other words a consciousness not just a body, arm or eyelids, among the subcomponents.


It has more to do with the relationship between perception and intention. Of this, more next week.