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

Guest post: First steps on the road of Narrative Therapy. A mosaic of stories.

Hello everyone, my name is Annie. I work at a psychiatric hospital, offering pastoral care in the broad sense of the word: care in terms of creating space for conversations about meaning. In March 2015, I attended two introductory workshops about Narrative Therapy, from which I returned home veritably brimming over with enthusiasm! What surprised me most, though, was that I was able to immediately pick up some “little bits” of Narrative Therapy to help steer conversations in a different direction: naming a specific step; facilitating a rich story about a sparkling experience; digging up more stories in the same vein; placing the problem outside of the person …

I am reminded of Marcel

58 years old. He has not had a particularly nice life: child abuse (the scars of cigarette butts are still visible on his arms), at age 14 he started living on the streets, alcohol and drug addiction … His wife who ‘rescued’ him from that life, died well before her time, and on top of that he got Parkinson’s disease which limits his abilities to an ever greater extent. At some point he told me: I asked my counselor from Sheltered Housing for a new bed, even an expensive bed, so I would be better able to turn myself over. This sounded new to me, an initiative like this, so I decided to ask him, in a very ‘narrative’ way, what name he could give to his action. He did not know.

Hesitantly, I asked him: might it be something like ‘taking care of yourself’?

He resolutely told me: no, it’s sticking up for myself.

– Ah, like that, sticking up for yourself? How so?

– Well yeah, as a kid I got nothing but beaten, and no food; but now I can decide for myself.

– Could you perhaps tell me another story about sticking up for yourself, something from when you were young?

He could not remember anything from when he was a child or a teenager, but when he got married and decided to stop drinking because he wanted to have a good marriage, he considered that as ‘sticking up for himself as well as his wife’. Our entire conversation was tinted by it: how he had readmitted himself after she died, was something he now saw in another light. The fact that he is learning Spanish and English at the activity centre is in the same vein: I never had the chance to study, but now I am doing so anyway. Marcel does not have children, but he wanted to do something for children in need. He currently supports a Plan child in South America:

it had to be a girl, because they get fewer chances than boys, and I wanted to do somPlething for those who need it the most.

 

Besides the storylines of ‘being a victim’, ‘being ill’, ‘being dependent’ there also emerges a storyline of someone who can stick up for himself, and can also take care of others! In my eyes, he walks out of the front door more powerful than ever.

I am reminded of May

She is about 50 years old, and has gone through a whole psychiatric journey. She sees herself as being of little value and of no use. On several occasions, she mentioned she once owned a dog, as well as that she loves her mother’s dog, Blackie, and how he always comes walking up to her when she goes there. But I did not do anything with it, until I was given a few narrative levers. When Blackie was mentioned again, I wanted to see whether I could thicken this storyline:

May, could you try and explain to me what it is that you have that animals find appealing? As, to be honest, that is something that I do not have at all.

– Well, you know, she says, I just feel that love, and when I look into Blackie’s eyes, it calms me down, and him too. I think he can feel that.blackie

When I ask about other stories about peace and calm and love of animals, it turns out that, as a child, she used to protect the newborn kittens her grandmother wanted to put into the ground, and that she gave names to all the chickens so they would not go into the pot. With a shy giggle, she tells me that her neighbour did not like her, as she used to go over and pull out all of the mole traps.

From animals, we continue to human beings: she took care of her own children with patience, and when she was still working in care, she preferred to be with the senile patients:

I really like to do that, those people moved at a very calm pace, and I was able to care for them with lots of patient and tenderness; that also gave me peace. Most of my colleagues did not have the patience.

And then it turns out that this woman-who-thinks-she’s-worth-nothing has been visiting a mentally handicapped man every week for years now, together with her mother, and here too is able to ‘sense’ what it is that he needs: to have a smoke together, and eat four ham sandwiches. Much more would have been possible with this conversation, but May called it ‘a relief, nice memories of animals, and that I can actually have quite a lot of patience with people’.

 

I am reminded of Sam

35 years old. Usually, our conversations take only about 10 minutes. Because of his fears and paranoia, it is difficult for him to concentrate, and it takes a while before he says anything. Everything happens at a very slow pace. I knew he liked music, and especially U2, but, well, there the conversation often died out. Here too, Narrative Therapy offered inspiration, and I started to work on Sam and his music. What music does he like to listen to? Retro. Could he name a few groups? Woops, I’m familiar with only just one of those. Where does he find all that music? It turns out that all his CDs and records once got stolen, and he is now trying to find ‘a whole bunch of tracks from the old days’ back through YouTube … And how, or with whom, did that start?

My grandma gave me my first record player. And I used my pocket money to buy records. retro-platenspeler500

The conversation rolls on: once he was a popular DJ with his own nickname: Spy! And yes, that U2 concert at Werchter, and how Bono picks one person to dance with every time … He promises me to lend me a DVD of one of these concerts one of these days, because I need to have seen that! After 50 minutes, we have to end the conversation. Sam tells me that he has never told anyone as much as now. I have never seen him so ‘clear’ and sparkling (yes indeed!), even though he has relapsed now, and confined to isolation. But this sparkle, at least we’ve had it, and now I can see more in him than just a psychotic man. Now, I can also see the music lover, the DJ, the Sam who says that ‘music saved him’. Next time, I will ask him how music is saving him now!

 

I am reminded of Carla

26 years old … She tells me about her inferiority complex. I feel inferior, I can’t do anything, I compare myself to other people of my age and feel worthless. I am going to attempt to create a little distance between ‘the problem’ and ‘herself’.

So, I ask her: ehm, Carla, this may sound a bit odd, I know, would you mind putting this Inferiority Complex on the table over there. Now look at it. What does it look like?

– Small and dark blue and sneaky.

– What does the dark blue thing want?

It wants to drag her down, every time she feels good and kind of proud of herself. Then she tells me, apparently without any reason, a story about some girlfriends at secondary school who started to tease her in a ‘very sneaky’ way, who ‘dragged her down’ and messed up her relationship with her first boyfriend. It makes her quite emotional, and angry.

Friends like that aren’t really friends.

But because of the image of the ‘sneaky thing’ she says she is getting more of a handle on the problem.

It comforts her that it is not something within her, but just the voices of the past that still resonate today.

I wonder whether there might be some real friends in her life now, and I enquire after it. And yes, she tells me passionately about her three most important friends right now, how she got to know them, what they mean to her, and what she means to them. friendsA lovely tale of friendship from secondary school suddenly comes to her mind about ‘writing each other notes’ … Together, we come up with the idea that she could ask these three friends to write her a letter, with everything in it they appreciate about her. Those notes she wants to keep close, just in case the dark blue, sneaky thing wants to strike again.

 

 

These are just my first few steps on the road of Narrative Therapy; and I am hugely curious where it is going to take both me and my conversation partners.

Annie*

Click here if you want a pdf with some of the ideas Annie used: Inspiration_from_Narrative_Therapy.

 

(*This participant of some introductory days about narrative therapy wishes to remain anonymous. The name ‘Annie’ is fictional and also the names of the patients she writes about)