Therapy, a Two–Way Street: 8 anti-burnout questions for care-givers

Occasionally, you experience something that makes you realize that your life will never be exactly the same again.

Sometimes you realize that you have changed:

  • You see something in a different way.
  • You react in a different way.
  • You think in a different way.
  • You do something which is unusual for you.

When that happens to me, I wonder how that came about.

The way I look at PTSD (Post-Traumatic Stress Disorder), mourning and depression has changed through conversations with a dad and a mom. One of their children had taken his own life. Too much injustice at school, for too long. Thanks to the things they shared with me, I came to realize certain things. Such as …

That assigning a diagnosis like PTSD, complicated mourning, depression … does not necessarily contribute to acknowledgement and hope. Words like these had been experienced by them as a mockery of the value of their child and their relationship with him, as a disregard of the (not widely acknowledged) injustices that drove their child to let go of this life, as a trivializing of the impact it had on their lives.

That those words (‘PTSD’, ‘complicated mourning’, ‘depression’) contain a call to action: to ‘process it’, to ‘mourn successfully’, to ‘recover from depression’.

That something in this call to action added to their suffering because the words, concepts, and the preconceptions that come with it lead care-givers to engage in conversations and proposals which worked to isolate them even more.

For about 25 years now, I have been trying to make a difference for people at a time their lives are overshadowed by sometimes great difficulty, worries, issues.

Those conversations have their effects on me, on my job, and on my life.

In 2005, I attended a workshop by Michael White. The very first hour I knew it: My work would never be the same again. My life: never the same again.

Two years later: I – behavioural therapist, educator and supervisor – find myself in Australia for a year long training in narrative therapy.

The conversations change, in many ways.

A bigger and more clear and rich focus on what is valuable to people.

The life stories people tell me become richer, and because of that, more potent.

It makes me a witness of much that touches me on a personal level, and it touches me more deeply than it used to.

For example:

  • Someone has not abandoned the hope for a better life, despite many things discouraging that hope;
  • Someone has remained faithful to certain values, even with very little support.
  • The richness and depth of the connection someone has with someone else (even if that person might not be around any more);
  • The significance of a (at first sight banal) gesture, such as an expression of recognition, of support, of appreciation, of solidarity.

When a driver brakes to allow me to cross on a pedestrian crossing, I always give him a little thank you. There is pedestrian crossingalways that association with that ethically sensitive gentleman, with whom I had helping conversations. He once told me something about these kinds of crossing-the-street situations. He mused out loud: might this be the ultimate thing we can do to try and make the world a little better? Thanking someone for suspending – just for a moment – his own self-interest, allowing him to experience a bit of joy in the moment: and that he might do it again?

 

The one way view

How is the (correct) relationship between care-giver and the person in the client position often portrayed?

Care-giver => client.

The care-giver employs ability/knowledge/engagement => a positive influence on the life of the client.

One-way street.

A therapist who would let it be known that: ‘My life really changed because of my meetings with client X!’…

… might be regarded with suspicion as: ‘Having a problem maintaining appropriate professional boundaries?’

Years ago, a young woman told me about the meaningful relationship she had had with her grandfather. The remarkable thing was that her grandfather had died before she was born. His partner – i.e. her grandmother – had remained faithful to her beloved throughout her life, and introduced all the people she came across to her husband. Including, of course, her granddaughter. Which meant that from a very young age she had known that her grandfather would have loved to have seen her, and this was a reality for her that she had lived through. A reality that helped her when her life was recently turned upside down.

Was it shortly after this conversation that I told my little boy that I thought my dad (whom he had never known personally) would have liked about him? And about the kind of grandfather he would have been?

This one-way-street kind of presentation, what effects does it have?

One effect is that care-givers do not feel encouraged to consider questions such as:

  • What is the influence that these conversations with this person have (had) on me and my life?
  • How has this conversation enriched my life?
  • In what way am I not quite the same person after this conversation?
  • What have I learned? I.e. about life, about what matters, about what courage is, about …

This way, we miss out on much that is valuable, as we do not consider the ripples left in our lives by these meetings as significant. This way, we miss out on chances to make worthwhile discoveries, chances to develop both as a human being and as a care-giver.

And there is something else that comes into play with this one-way view: Sometimes the people who consult us are represented as mostly a cause for burnout, with all their issues and crises and vulnerabilities and needs. You get the advice: ‘Guard yourself! Set boundaries!’

Michael White raised some question marks about the whole one-way view. He questioned whether it might not contribute to the vulnerability of therapists for burnout.

As it makes them myopic.myopic

As it does not encourage them to notice how the meetings enrich and nourish their lives.

As it makes it more difficult for them to assign meaning to these experiences, to talk about it, to develop them in a more full and nuanced manner.

Also because it denies that we are not just ‘intervening’, but were are also witnesses.

 

How has my life become different due to the fact that people open their heart to me?

Those question marks have opened a door for me to ‘something else’.

What are some of the valuable things (of the people and of life) that I have learned thanks to the sincerity and trust that people who are in the client position have offered me?

That someone opens his heart to me, that someone takes me into her trust. What does this mean to me, as a human being? What are its effects on me, later that day? Later that week?

People who consult us introduce us to some of the important figures in their lives, and this way, we get to meet them as well. What are some of the ripples of those meeting in our work and our lives?

I will never forget how one mom – on my invitation – introduced me to her recently deceased little son. She illustrated in colour the kind of boy he had been, what he used to like to do, what others found special about him. And she explained to me the kind of mom she had tried to be for him, and the relationship they had had with one another. When and how she felt that he was close to her. What place she wanted to give him in her and their live. And much more moving stuff. At the end of the conversation, when I started to thank her for what I had experienced, as not ‘as a matter of course’, but as ‘a present’, I realized that my life had become enriched thanks to this meeting with this little boy whom I would never meet in person, and I expressed this.

How has this conversation enabled me to speak to a group of parents, some years later, who had all lost a child as a result of cancer? And to find a different way to listen to two parents who introduced me to their baby afterwards, with its little head tattooed on their lower arms?

Is it conceivable that ripples of this conversation have spilled into my life? In how I have related to the mortality of my own children?

The more people you meet, the more people you can ‘call on’ as a care-giver.

Your therapeutic repertoire becomes more polyphonic and your presence becomes plural, with the voices and the presence of people you have met in the past.

If someone told you that in his occupation, he has to travel quite a lot, with different people, into areas which are new for him and them. He never knows beforehand what is going to happen.

You ask him whether those adventures and experiences have some kind of influence on his life?

Answer: ‘Yes, of course, meeting people, the welcome as well as the not so welcome surprises, what you learn … all of that (and more) has a major influence on my life’.

Would this answer surprise you?

Is the job of a care-giver who tries to have helpful conversations any different?

catNever say “cat” to a cat. A woman – a single mom of a son – committed to provide her son with a home where he would always feel welcome. We started exploring where she had picked this up, and the skills she employed to realize this. At first we bumped into her overriding experience of the opposite when she was a child herself. When she looked a little deeper, she remembered her cat, and how it welcomed her as a child and gave her a warm feeling by rubbing against her legs and lying on her lap.

Could I have appreciated the contribution made by our cats to our lives in the same way without this conversation?

For 6 years, I worked on a psychiatric wing for people whose lives were overshadowed with anxiety and/or depression. During this time, I met many people who suffered a lot. Robbed of their ability to think creatively, to experience hope, to take initiatives. Often, I wondered whether I would be able to – under similar circumstances – keep myself from going under, to keep myself alive, to try out things, to dare to cherish a sliver of hope.

That is one of the things you learn when you have the privilege that people consult you about life questions: you start to realize that life can go into all directions, and that you cannot predict how you will fare when things get tough.

I do not know. Maybe that the memories of some – if it ever comes to that – will give me strength and inspiration: memories of them as a person, memories of the steps they took. Some of them, I also told them this at the end of our series of conversations. During this period, I have also encouraged people to defy their fears. Fears that had taken over virtually all their living space. Ideas and practices from behavioural therapy supported me to navigate them back to some more freedom of living.

Often, I asked myself – also out loud – ‘Johan, would you be able to muster the courage to conquer a fear like this?’

One effect of this question was that it raised my curiosity:

  • How is this person capable of doing this?
  • Where does she find the courage, the strength of will, the willingness … to take these steps?
  • Why is this so important to him/her?

Sometimes, this led to a conversation that helped her further along. And me too.

 

Transparent?

Of late, I ask myself: How kosher is it to keep these effects on your life 100 % to yourself? So that the people who consult us remain under the illusion that they are 100 % in the receiving position?

Of course, the people who consult us should be central a therapeutic meeting, as well as the people who are important to them.

And not the therapist.

But is it as blameless to act, ethically speaking – for ourselves and for the people who consult us – as if all influence travels in only one direction?

A woman tells me: ‘I want to learn. I want inspiration.’ And there is something in the way she says it. She convinces me. It resounds within my head. It haunts me for days after.

I realize that this is something I find important as well, and that I want to give it more space in my life – within a short space of time.

In the next conversation, I tell her something about this.

Is it possible to keep the person central, and to also be transparent about the fact that our work and our lives are touched by these meetings?

That you thought about something said by the person.

That you have done something because you have started to realize something, thanks to the person.

That you have learned something.

We are talking about a moment of considering suicide. She expresses how critically she was looking at things in her live she otherwise finds valuable. But it is no nonsense, this critical looking. No bullshit. Cut the crap. And she tells me about that side of her, and also about its value.

A day later, I remember and something tickles me. Now that is something: a force of will and acuity which makes short work of any illusions. I suddenly decide to trash a pile of papers that has been piling up for years. A week later, I get down to my inbox. It is empty in no time. Once again, I think about what happened in that conversation.

Should I tell her something about this, next time?

Does it add something? For her? For me?

A therapeutic practice which I have grown fond of: occasionally creating a document for the person, such as a letter describing the important developments in the person’s life, as well as about some of the new conclusions about who he (also) is and what his life is about. In the hope that this will contribute to an experience of realness, as well as the importance and the authenticity of these developments and insights.

Occasionally, I have added something to it about the effects of the conversations on my life.

‘It has been a joy to me to to witness your honesty, your quick, common sense, the way you interact with people and what people get out of that, your respect for children, your openness, your healthy stubbornness, your desire for happiness, your will to get all you can out of life, your vitality, your wisdom. That someone who is 25 years old, with so much pain in the history of their life, can demonstrate so much wisdom, has touched me and taught me that wisdom has nothing to do with age.’

 

Some helping questions

Over the years, I have come to experience these effects more frequently and more richly.

Amongst other things, this has also to do with a few questions I ask myself. Questions I have not invented myself. I have learned about them through a therapeutic practice where you work with outsider witnesses. And yes, that is what we care-givers are: Witnesses.

I have created a PDF with 8 of these questions.

You might want to try them out after a conversation. Or now and again.

They might help you to ‘capture’ some of the valuable effects of you being a witness, and they might assist you to give meaning to those effects. This might add to their potency.

They could support your development as a human being and as a professional, and they could also protect you against burnout.

(Click here if you want a pdf with 8 anti-burnout questions for care-givers: 8_antiburnout_questions_forcaregivers.doc.)

How do you experience this?

Do you experience any nice effects from your meetings with the people who consult you? On your life and your job?

What do you do with it?

Do you ever share this with the people who consult you?

How do they respond to that? How does that impact on you?

 

Johan Van de Putte

And God saw that it was good!? Expressing your appreciation in helping conversations?

In a recent post I discussed the giving of compliments to the people who consult us. However is it possible that the praise you express towards your conversation partner might be badly received? Or might it feel wrong to give praise, even if your appreciation might be sincere?

Michael White points out that power is not divided equally in a relationship between a caregiver and the person who consults her. Seen in this context:

  • a show of appreciation may be interpreted as: ‘according to my standards, you have done well’ and ‘I find it legitimate to make such a judgment’, and
  • a caregiver who gives a compliment may be seen as being patronizing.

Question: Can we express the appreciation we feel in a way which steers clear of being patronizing, as well as a kind of: ‘Let’sl happily encourage you to do things according to my own standards’?

Option: Situate your appreciation in your experiences.

What the hell does that mean? Situating your appreciation in your experiences?

The opposite of that would be: ‘Very well done, you!’

  • = Playing God (‘And God saw that it was good’).
  • = I keep the experiences that have brought me to this appreciation out of sight.

So, what does ‘Situating my appreciation in my experiences’ mean? An example:

‘You haven’t smoked a single joint for X months now. I really respect that. I will tell you why: During the past 25 years now, I have spoken with a lot of people who have struggled with substances like alcohol and narcotic-like stuff. These conversations have taught me that it isn’t easy at all to quit such substances, not even for a couple of days or weeks. My own … (relative) had an alcohol problem. As far as I know, he never took the step you have. That’s why I feel respect for what you have done.’

What happens here?

  • Appreciation is expressed, and
  • it is placed within the context of the experiences of life of the professional.

Advantages?

The person who is in the client position can understand where this appreciation comes from. He may understand it (or not). He may accept it (or not). But at least we have firmly departed from the ‘and God saw it was good’ context.

Another example of situated appreciation:

A young woman explained in detail how she managed to have an open conversation with her mum. I tell her that I couldn’t imagine working up the courage to start such a conversation with my parents at her age. Which is why I had such a feeling of Wow!, and it also made me imagine all sorts of other things she might be brave enough to do.

As such, the appreciation is situated in the caregiver’s life experiences, such as memories and fantasies. Similar to the following example:

I think it’s really exciting that you said you’re going to … You know, I once followed a workshop from someone about anxiety therapy. I will never forget that workshop. That guy – Omer van den Bergh – had a bunch of little spiders with him, and he made us practice in relation to our own fears. Now, I’ve got the fantasy that if Omer were sitting here now, in this conversation, he would say: … I have learnt from him … Which is why I think this is so exciting.

 

So this is what I mean with ‘situating your appreciation in your experiences’.  We can express our appreciation without playing god. And this allows our conversation partners to experience a greater level of freedom in how to relate to that expression of appreciation.

You can now also ask your conversation partner how he/she evaluates the act or initiative, and why.

Then the central issue is: the appreciation of the person in the client position, based on what he or she finds precious.

 

Johan van de Putte

P.S. As far as I am concerned, this has nothing to do what-so-ever with ‘(positive) reinforcement’. The word ‘reinforcement’ is usually used in the following context: ‘what can the caregiver do to gain control over the behavior of people?’ I.e.: ‘how can I make sure that the person does more X by praising him when he does X? Regardless of the question what he or she might want of finds important.’

Firstly: you cannot know whether a behaviour is being ‘positively reinforced’ when you praise someone for it. This will have to show from an increase in the frequency in this behaviour.

Secondly: if you praise someone after he has talked about something he has done, are you reinforcing the ‘talking about’ or the action which he is talking about?

Thirdly: I am concerned with conducting conversations that the person experiences as helping. Not to bring his behaviour under my control.