Sunday, March 27, 2011

Learner therapist (3) What’s a person…


Learner therapist (3) What's a person…
Torrey Orton
March 27, 2011


… an agent, with potential authority?


What are we trying to help patients 'fix' or to repair in themselves? For me it is essentially their agency, their ability to act or to influence their worlds. Psychic injuries, like physical ones, inhibit our power, render us weak where we could, or used to be, strong. The help we need is to restart our motivation (value) and improve our action competence(s) (behavioural repertoires). Notice I've slid from patients to 'us'. We are them, but they are usually not us, when in the room. For what follows, we are them, too.


This is a vignette to hang a theory of agency on. The theoretical connections are made through numbers in parentheses – eg (6) – which refer to examples of agency in the first paragraph after the vignette.


D


One day alcoholic D, about 40, walked in with his whole self on show. His hands were fairly damp for the first time in a while. He asked for tissues to dry them (6) as he noted the fact in passing. It was the first time in 16 months work that he had been fully present, though not for lack of trying. That he could be present was always on display (7) in his ambivalence about being here. He could talk about that easily, and did so every session (1). "I really don't have anything to say today" he would announce on arrival, while always being almost unclothed his defences were so slight.


He has a lot to defend – a lifetime's actual and threatened violence from a still living alcoholic father. One thing in particular: the fiercely vivid memory of repeatedly over his primary years having to lie silently in bed in feigned sleep to avoid his just-home-from-the- pub father's attention, consciously effacing himself by containing his terror from the senses of his terrorist. He has the finest detectors of non-verbal expressions I have ever met, attached to a capacity (2) to precisely test those perceptions.


...a glass of whiskey


But that day he arrived in such ambivalence that he had skolled a glass of whiskey from a local provider on the way over. His conflicted feelings (anger and hope, riding on the energy of interest) had bounced him back and forth in the bus on the way here, just as they do every day for him. But in the room they were visibly so as he shifted in the chair, giving and withdrawing eye-to-eye contact like a chimp in a cage. What he had to say this day, after briefly having nothing as usual, is that he was here with his fears blazing and his hopes leading (8). This is the motivation that brought him into the room.


We stepped from his present into its origins through the gateway of D's defences, a set of behaviours which mark his coming to the end of bearable exposure of his pain. These gestures all happening together – breathing out, shaping up to fight or fly (in the shoulders), scrunching up his face – lead to a visible / audible stop signal (4) from D, if I haven't already got their implication. When I use his name, D, it always elicits this expressive set, as if I called out from the end of his bed to waken him into the expected paternal violence. It is this set of behaviours which expressed his being in that life space while in the room and how he controlled his exposure to it.


Control the terrorist father within…


We worked on that space to reduce its terror. I explained that this was a normal approach for engaging traumas of many kinds. Through it he could learn the threat was no longer present in its embodied way, and that he could control the feelings. As we finished a few minutes exposure, he queried, "You've done this before haven't you?"(5) And, he was ready to consider starting (3) the reconciliation trip through which he might get final control over the terrorist father in him. We had approached it 6 months ago but it had seemed way over his horizon then. Now it's in view; feels possible and desirable (1).


When I'm working with D, I have an implicit model of a person in the near background of my approach. I listen and look for certain indicators of how he is. (1) Can he say what they want, (2) interrupt to clarify a meaning, (3) propose a direction for discussion (at the beginning or in the middle of a session), (4) request changes of time or place for sessions, (5) offer feedback on how it's going for him, (6) notice what his body tells him about how he is, (7) how he presents overall, or (8) have an inner sense of truth or direction which tells him what's right and not (often expressed as feeling unfairly done by), etc.…? These are access points to his growth potential, present motivation(s) and levels of need(s). They apply to everyone.


…anyone can grow


When I first had the idea of presenting my underlying therapy assumption it seemed easy because it is so obvious to me, revisited daily in my conduct of therapy. The foundations extend back to my past as a teacher, trainer, coach where my assumption always was, and remains in every new encounter in therapy, that anyone can grow if they are compos mentis.


This is not a value statement. It's one about our nature (to which our nurture may or may not add!). The value aspect arises in making the choice to apply this assumption to everyone I encounter, professionally or personally. This is our professional responsibility.


I have worked with this assumption in the US, France, China, Singapore and Australia. You probably have your own version of favourite indicators and there's probably a thousand books proposing various right or correct answers to 'What is a person?' For me, my version allows me to approach EVERY patient from the same foundation – that they all have an identifiable set of needs, core functions and basic necessities for effective living in their world(s). I find the details of their needs, functions and basic necessities arguable, but a lack of them is the boundary between human and android. At another time a full underlying theory of a person may be usefully added to my entry assumption.

Sunday, March 6, 2011

Appreciation (34) … Just do it!


Appreciation (34) … Just do it!
Torrey Orton
March 6, 2011


'Just do it!' should be a candidate for a Rectification. It reeks of modern mantras commanding effortless deployments of will for transformations of shoes, souls, or real estate perhaps. But this appreciation came to me in the flush of a therapeutic intuition.


Many years ago the impossible – reversal of a 90% public opposition to seatbelts – occurred in 6 months or less (the user survey did not identify at what point in the six months respondents' opposition to the innovation had ceased). It occurred by force (legislation). Six months later the numbers were almost reversed. 'Just do it' version 1, a seamless habit change, but a very small and doable one with almost zero post-adoption costs for drivers. Easy to do, and easy to police.


Then there's the Nike version arising out of the mindless careerism of the 80's – 90's driven by the silly but attractive proposition that everyone and every organisation should be "world class". A principal capacity for arrival in that class was action and that, in turn, was a mere matter of personal will. 'Just do it' Version 2. Implication: if you don't have the will you don't deserve the fill. Moral arm twisting and a competitive edge.


The version I want to bring into view arises from another developmental proposition altogether – though it can easily appear as just another version 1 or 2 above. This is the 'doing it' required for an experience one's never had. This extends across the full range of human activities from eating to loving. For me a recent one was taking up morning floor exercises when in partial recovery from pancreatitis.*


I was still feeling achy and dog tired much of the time, and this started from the beginning of the day. I wasn't improving my sleep either. Probably some connection between the two facts: low sleep and low feelings. So I decided to take up the sleep improvement program's first recommendation – learnt to relax, and practise it daily for 20 minutes. While at it, I thought I'd throw in a few stretches I'd learned in yoga 35 years ago, and then also a few tone builders for my weakened gut core. Some leg lifts, bicycling, arches, and various hip flexors. Altogether about 25 minutes.


No surprise to those on top of rehabilitation, but I got such a seriously clear lift in overall good feeling that I was looking forward to doing it again the next day. I've been at it daily ever since, on the back of the same daily reinforcement, which is now an inducement to persistence. It's an internal push rather than an external pull.


It struck me that there must be many variations on this theme of taking action to discover a need or want. Cuisines offer obvious (once discovered) taste titillations hiding behind the screen of olfactory repulsion – eg., durian, chou doufu, some wines and cheeses. Music provides similarly distinctive, and equally offensive to the uninitiated, variety – the modern atonal, Beijing opera, Middle Eastern rhythm and melodies. Visual arts are a storehouse of visions which have to be learned to be appreciated, or even seen in some cases – Cubism, Abstract Expressionism, etc.


Different degrees and kinds of actions are required to enter these worlds because they initially resist entry or even obscure the possibility of it. So it may be helpful to find a person's relevant previous experience(s) to build a first effort on. Relying on chance won't do. Explicit encouragement is required since the unknown cannot be chosen until it is known. A look at a durian does not invite a bite. A first hearing of a Beijing opera is a jangle. First sight of Blue Poles may be a downer.


Whatever the approach to taking action, the moment of action has to be faced. Having a purpose other than that which the action explicitly seeks can help cross the hurdle into a new experience. For some, just trying something new is enough. For others, the action's explicit objective could be to acquire a skill, a sensitivity, knowledge, etc. The implicit objective might be to validate their own sense of direction. Support is often essential to find an inner source of motivation so 'Just doing it' can be its own reward.


*A not to be recommended event which left me 10kgs lighter (which could have taken months of training to achieve but only a week of nil-by-mouth in hospital). The standard recovery period is 3-6 weeks, of which I am now into the eight week, restarting moderated work 3 weeks ago (therapy) and developing new self-management regimes in eating (no alcohol which I don't miss at all and one latte on clinic therapy days) and morning relaxation and exercise practices with daily consistency, so far!