Learning to act right (50)… Better not look down…

Torrey Orton

April 17, 2015

 

…says BB King in the song: “You better not look down if you want to keep on flying…put the hammer down, it’s full speed ahead”. Here’s the whole thing:

 

I've been around and I've seen some things
People moving faster than the speed of sound
Faster than the speeding bullet
People living like Superman
All day and all night
And I won't say if it's wrong or if it's right
I'm pretty fast myself
But I do have some advice to pass along
Along in the chorus of this song

Better not look down, if you want to keep on flying
Put the hammer down, keep it full speed ahead
Better not look back, or you might just wind up crying
You can keep it moving, if you don't look down

…

http://www.oldielyrics.com/lyrics/b_b_king/better_not_look_down.html

 

… Which came to mind as I was reflecting on my inability to give validity to those in developmental stages different from mine, people who, unlike BB, I want to tell are wrong. Or more saliently, I want to prevent them from doing wrong to others in the name of their right. In many instances it doesn’t matter. My irritation passes like the discomfort - not a lot!! - of a cool breeze on a warm night. However, when confronted with repeatedly immovable objects like the anti-abortionists at the Fertility Control Clinic, and the shameless fools pretending to govern us, my irritation is never far off rage.

 

My model for correct behaviour in these circumstances is Ken Wilber’s recommendation in his A Theory of Everything (Shambala, 2000) that “Everybody is right. More specifically, everybody - including me – has some important pieces of truth, and all those pieces need to be honoured…” The implications of this are massive for everyone and lead me to the view that  those more advanced, educated, gifted, successful and powerful have an obligation to honour the truths of those less well-endowed in any of those frames.

 

In my mind’s internal dialogue on matters of ethics at the Fertility Control Clinic, I can formulate relatively easily an appreciation of the position which the catholic anti-abortionist fraternity hold. It is roughly this: all human life is infinitely valuable and so deserves de facto whatever help we can offer it to exist and persist. I first encountered this view in the mouth of a long-term friend devoted to social justice 50+ years ago. He was certainly not Catholic and scarcely religious.

 

At the time it held no practical implications for me, though the mantra stuck, having acquired in the interim some passengers/accomplices like the therapeutic notion of unconditional positive regard and its everyday behavioural limbs like respectful disagreement, not playing the man and such appreciative tactics. He still holds it close to himself to this day. I have moments of doubt. The clinic prompts them.

 

What makes my self-imposed obligation a trial is that any of us, at whatever developmental stage we are in, are circumscribed by that fact in two respects: one, that’s as far as we’ve gotten in whatever developmental sequence we are in and so that’s as far as we can see; and, two, we need to feel that it is the truth in a sense sufficient to stand the winds of rejection from those we’ve left behind and the zephyrs of enticement from those above or in the neighbouring paddock suggesting we really haven’t gotten there yet (where they are of course in their respective certainties). Both breezes suck out energy and, so, enflame the defences of the self – the inward looking self-regard of the uncertain.

 

I could approach these anti-abortion folks with an attempt to establish my credentials of empathy by noticing they are in the field of preserving life which is under attack in many ways. These attacks come most unavoidably into play at the boundaries of life – birth and death. Hence, the armies of night and light arrayed around the entries to those two boundary states – anti-abortionists/pro-choicers and the natural deathers / euthanasiasts. Also at play in the fields crossing these boundaries are the life scientists and artificial intelligencers. The effects are disruption of boundaries, a process which once developed enough leads to degeneration of being, as childhood abuse does so clearly, whence flow the twin streams of suicide and homicide – both expressions of hopeless/helpless rage.

 

So, now to the boundary: when is an abortion a better choice than full term delivery? When the conditions into which birth will be made are so perilous as to ensure that the early steps in life and many thereafter (most of childhood) will be plagued with life-destroying potential on the best science of abuse outcomes. These conditions are both natural (birth defects, etc.) and institutional (families, schools, churches…) and we know enough about minimally supportive institutional conditions to know that they fail at rates better than chance conditions (from an ethical viewpoint – namely that no failure of intentional behaviour is good enough for a good enough life). Who is to decide when the conditions are adequate is a fine task from which we can exclude the agents and apologists of the various key institutions until they can guarantee that their respective institutions will not blight the lives of their participants. That is, in the case of child rearing, the prospective parents, and where the parental relationship is dubious, the prospective mothers should be able to decide. Our law now provides this should.

 

There is a similar argument for euthanasia, and against it.

 

The Hogpi’s trade on the life is any level of living fallacy in their street arguments and their theoretical ones, too. Namely that a vital embryo is a viable one and so a life - which it ain’t until 20+ weeks - and they don’t work thru the argument that viability on both ends of the life spectrum is massively distorted by science, whose benefits are inequitably distributed, which they’d acknowledge if they thought about it in this context, but don’t…

 

In the background lies the great paradox: that prospective parents can with a little attention mostly prevent unwanted children from being conceived, yet they often do not take that care. Otherwise a major proportion of those seeking abortion would never need to present. But then, the same adults drive while intoxicated and party when drunk and their demises are noted with the language of world changing human drama – tragedy, amazing, loving…. – which they certainly aren’t. All artefacts of banality?

 

“…What I am saying is that when one form of being is more congruent with the realities of existence, then it is the better form of living for those realities. And what I am saying is that when one form of existence ceases to be functional for the realities of existence then some other form, either higher or lower in the hierarchy, is the better form of living….” Dr Clare W. Graves

http://www.clarewgraves.com/theory_content/quotes.html

 

We are in times when many realities are in disarray and so the claim that any level of development is more appropriate than another is hard to sustain, but the desire to feel comfortable in my current stage is strong enough to maintain my rage. Maybe I’m just not accepting myself.

 

If only I could just “not look down”!!

Learner therapist (16)……What’s a good enough therapist

Torrey Orton

August 3, 2014

I set myself the goal for my CPD tasks two years ago to design a generic therapist competences framework. This is the first cut. It begins with the name – the good enough therapist – which intentionally borrows from Donald Winnicott’s ‘good enough mother’. We could do with a bit more good enough these days, and maybe I was thinking the same for therapists. My objective is to use this framework as a template for self-assessment, with elements of professional assessment added as possible – that is, as I can succeed in finding colleagues who are prepared to judge.

I have enquired around the formal psych fraternity – especially the APS and some of its associated colleges – to find so far that no one has a generic, or a context-specific, competence framework for therapists, even the CBT squad. So there is no agreed framework for evaluating anyone’s performance, apart from the “clinical psychologist” qualification standard of CBT masters and similar. Anyone with a slight degree of program evaluation experience knows that quals are only the starting place. It is therapeutic processes and outcomes that count for patients.

 And as for the processes and outcomes of therapy a few things are clear. First, the nature of the therapeutic relationship from both points of view is a major contributor to perceived therapeutic effectiveness. Second this effect stands without regard to the therapeutic system, modality, theory or fantasy which a therapist brings to the relationship. Third, therapeutic improvement can best be achieved by constant checking with patients about their continuing perceptions of effectiveness of the experience of being in therapy with one. Fourth, the generic therapist must be able to engage with any presenting patient, even if only long enough to identify that a referral to a specialist of some sort is appropriate (and have a resource of such specialists on hand).

 

Here are some competences, knowledge and skills: no special order. I am seeking all and any suggested additions to the following first. Then, I’ll entertain alteration or deletion suggestions to the items listed.

1)      Intercultural communication, which includes knowledge of relevant cultural differences affecting application of preferred treatment(s) and the capacity to negotiate the treatment process. The key test of this competence is the capacity to understand and accept that the suite of assumptions and practices which constitutes Anglo psychotherapy will not be wholly shared by cultures like Chinese, fundamentalist religious practitioners (Jewish, Christian, Moslem, Hindu….), etc. In the end this competence would be exhibited by not working with some cultures rather than assuming one can work with all which one doesn’t know enough to know they are immutably different from one’s own.

 

2)      In vivo, person to person negotiation of the therapeutic process, including review / evaluate each session with patients, without shielding oneself by a diagnostic stance presuming the therapist knows best. A test for this competence might be the holding of a patient who experiences themselves as sometimes ‘crazy’ or out of control and demonstrates that self-perception in the room.

 

3)      Knowledge of a full range of therapeutic approaches, techniques and work styles, including how these approaches integrate with each other at different times in the therapeutic engagement. E.g. – CBT, IPT, dynamic therapies, behavioural therapies, ACT, Mindfulness, etc.

 

4)      Experience being in therapy oneself, not just supervision, so the more permeable boundaries of one’s self are in view and acknowledged as such – as being in flux – and how affecting that flux is of one’s availability to patients under various personal circumstances and conditions.

 

5)      A theory of the self which is holistic, embracing at least the biopsychosociocultural paradigm’s domains, with awareness of the spiritual and economic.

 

6)      A theory of life span learning stages and the processes through which they are experienced by people, including micro learning processes and their integration into life span learning.

 

7)      A human needs construct like:

Elements of well-being (basic human needs)

*From: The Treatment of Sex Offenders: Risk Management and Good Lives.

Tony Ward, University of Melbourne, Claire A Stewart, Deakin University, 2005

 

Without specified needs we cannot decide how we are doing and what trade-offs are required to improve well-being. One approach to defining basic needs is this:

 

Needs	Wants specifications of needs
1) Life (including healthy living and functioning)	Adequate sleep, food, exercise
2) Knowledge	Knowing that…Knowing how to….knowing why…etc.
3) Excellence in play and work (including mastery experiences)	Play an instrument, a sport; Practice a profession, trade, art, hobby…
4) Excellence in agency (i.e., autonomy and self-directedness)	Cooperative activities; enlisting others in our activities
5) Inner peace (i.e., freedom from emotional turmoil and stress)	Meditation, martial arts,
6) Friendship (including intimate, romantic and family relationships)	Appropriate care, affection, connectedness….
7) Community	Authentic membership, identification, …
8) Spirituality (in the broad sense of finding meaning & purpose in life)	Relevant belief, imagery, contemplation….
9) Happiness	In my view this is not a need; it is one  outcome of well-being
10) Creativity	Opportunities to invent at whatever level or domain of life activity (also a doubtful need)

 

8)      Understanding of social systems and the individual’s place in them, especially family systems, workplace systems and social systems generally.

 

9)      Capability in leading patients through actual or virtual reconciliation cycles, including creating and sustaining the power to be heard within those systems.

 

10)   Ability to hold and contain intense feelings, with a view to building patient authenticity and authority about those feelings. Confronting high risk subjects: suicide, violence to others or self, crime, abuse and how to contain an emotional outburst of any kind.

 

11)   Ability to recognise and admit own mistakes appropriately as they happen…..be a continuing learner with specific development aims and goals.

 

12)   Understand what makes research good enough and what important emerging evidence-based research shows about good enough psychological processes. Neuropsychology presents as a must appreciate emerging field.

 

13)   Capacity to make good enough judgments in the room about:

Talking about possible need for medication

Knowing where patients are at, or up to

Managing exposure therapy at the right pace / depth

How far to pursue a patient who is loosely engaged in therapy

Appropriate self-disclosure

Quantity of therapist input required

Boundaries of contact: in the room only?

 

14)  Having workable definitions of the main therapeutic entities: person, couple, family….

 

15)  Knowing at least one therapeutic paradigm in depth and a number of others to level of workable confidence

 

16)  Supervision - peer and professional; one-to-one and group.

 

17)  Knowing when to refer and being free to do so

 

18)  Having a collegial support network

 

19)  Having had an ordeal to prove you’ve got the commitment to do therapy; mastery of personal suffering and success

 

20)  Wider life experience: jobs, vocations, volunteer work, etc.

 

21)  Having a workable theory of contemporary life: it’s challenges, rewards, distortions and distractions