A Holiday Tale

I'm on holiday in Fuerteventura - fantastic island. Good, steady, reliable weather which always helps with holidays.

I came here before in my 20s and didn't make the most of it at all - was seeking fun and sea and sun only, didn't have a car, and didn't make any effort to explore the richness of this island. My sense was 'not much there' which was purely on me for not seeking it out. I remember loving the beaches but being 'too cold to sunbathe' so returning (often hungover) to the pool at the apartment (and still being chilly).

The island's name is "a compound formed by the Spanish words fuerte (either 'strong' or 'fort) and ventura ('fortune'). Traditionally, Fuerteventura's name has been regarded as a reference to the strong winds (fuertes vientos in Spanish) around the island coastline, and the resulting danger to nautical adventurers." (Wikipedia) I thought it meant 'great adventure' which I didn't have first time round, but I am having this time. Age can bring some wisdom/smarts to getting the most out of life.

I'm writing this on my last day of being 56, with my 57th birthday tomorrow. So much musing and reflecting on life, holidays, parenting, ageing and being human, and therapy. Last week- my first week here- it gradually dawned on me that I wanted to get my hair cut short. Last time I had short hair was again in my 20s. I realised all the hassle with long hair on holiday - wind, pool, sea - was something I could do without. However - challenging in terms of aesthetics - I don't have strong eyebrows/big eyes/big lashes so my face could just disappear without some 'hairdo' around it, and I might feel that I look boyish/unattractive, especially at my age. Partly through reading the shortened version of 'Women Don't Owe You Pretty' (Florence Given) that I bought for my daughter for Christmas (though she'd already read it and had the full copy), and partly through processing and reflecting, I realised that I don't care if I looked 'attractive' or not in terms of the male gaze/internalised female beauty standards. I sometimes would like to 'look sexy/attractive' for a certain reason/occasion, however that can be achieved in other ways (makeup, inner confidence, clothes, hair things). On a daily basis, I rarely look at myself in the mirror and don't (mostly) gauge my worth in terms of how I look.

For me, 'Women Don't Owe You Pretty' is mind-blowing. I know for my kids that it isn't- great! It means a lot of the ideas are second nature to them already. There have been a few films/books like this recently, where I have been 'blown away' by what seems to be 'radical ideas and representations' - e.g. 'Bottoms' or 'Ride the Cyclone' - and my kids have been more 'yeah, sure'. 'Barbie' was an interesting one - I love that the cultural image of 'Barbie' and all she represents had a radical 'do-over' in the recent film, and that those ideas are out in mainstream culture. However, I thought there were still lots of stereotypes and assumptions that weren't 'exploded/challenged' including, mostly, heteronormativity. Generally, I'm way behind my children on these ideas. I guess 56 years of living with patriarchy and internalised sexism takes its toll. I've never had an eating disorder, thank goodness, but I know for a long time I had internalised that the 'Barbie Body' is the norm for women and all evaluation of my own body - perfectly healthy and functional and able-bodied - was against this internalised standard. So, for these issues to be addressed in the recent 'Barbie' movie was great, and Given's book gave me some language and understanding of how much I still have to work on/understand about being a woman in this society.

I decided to get my hair cut short. What's the worst that could happen? If I don't like it - it will grow,  and if I don't feel attractive - I'll live with it and process what that means to me, and about being a person. Also, I am cheating here, as I happen to feel loved and desired by others in my life so I felt fairly sure that wouldn't change. External validation always helps, though isn't/shouldn't be essential.

Grappling with poor WiFi, a lack of digital skills, and Spanish words, I tried to book a haircut. Andrew was able to understand my ‘¿hablas inglés?' enough on the phone for us to book an appointment.

Best hair appointment of my life! Not only do I love the cut - which is very easy to look after and will be great for ease and efficiency/playing sport- but I also loved my conversation with Andrew.

From Andrew I Iearned the difference, from his perspective, between a 'stylist' and a 'hairdresser'. Andrew is from near Milan and his first language is Italian. I have the usual British skills when it comes to languages other than English, so Andrew and I conversed mainly in English, but with a bit of Spanish/Italian, a bit of Google Translate, and nonverbal communication through 'acting it out' and hand gestures.

Andrew's sense of being 'a stylist' matches my sense of being a good/decent/good-enough therapist:

Stylists

• Greet each individual customer warmly - from first contact/phone call, to welcoming into the salon

• Listen to the customer

• Triage and assess - the customer, their hair, their needs, their face shape, their lifestyle

• Clarify the customer's desires/needs, and share their own thoughts as someone with expertise/experience - e.g. ‘that might not work with your hair type, I think this style would be better as you go to the gym every day and frequently wash your hair’

• Gently challenge fantasies/assumptions, and guide the customer towards what might best meet their needs

• Work in collaboration with the customer - your needs, my skills

• Don't accept the work if the expectations are 'unrealistic' in terms of the 'raw material' (hair type/lifestyle), the customer's desires, the time needed or the stylist's skills

• Be clear about the price/time the appointment will take

• Talk about aftercare and wish them well on their way

Before holiday I was talking with various people about 'standards/quality' of therapy on offer to clients. One of my ways of making sense of this is with bronze, silver and gold.

Bronze - You are trained in your style of therapy, and you do it 'to' the client, no matter who they are/how they different from your other clients/what age-stage they are in life, and however they present. Sometimes this works well, but often more by luck than judgement. Clients may get allocated/end up with the therapist who is right for them at that time.

Silver - You have a broad overview of different therapeutic modalities/ways of working, so you can tailor your offering to the individual. You can bring in wider thinking than one individualistic model of the psyche/human nature. For example, you may be trained in CBT, but you are always aware of sensory processing/trauma/neurodiversity and how this may impact your work with any individual. You may be trained in more than one type of therapy you can offer. Without the 'gold' mindset, however, the client may have to work very hard to get their needs met. My friend who has suffered with crippling anxiety for all his life and has had various 'goes' at therapy (including some bronze that just made him feel worse for 'being a bad client'/'therapy not working') was recently brave enough to give therapy another try. He liked his therapist and felt they were doing good work, but they hit an impasse. This wasn't acknowledged/noted by the therapist and my friend worked hard to communicate his experience and needs, eventually writing down a list of what wasn't helpful for him at this point in time, and what he really needed from therapy. I'm so pleased the therapist listened, and adjusted, and therapy is 'back on track' and my friend is feeling much more able to navigate life without his constant crippling anxiety. It hasn't disappeared - that wouldn't be a realistic goal - he is a human being and so some anxiety is inevitable, especially if it is rooted in some sensory issues/trauma/long standing ways of being. However, he finally has been heard and the therapy has given him what he has wanted/needed for years, in terms of tools to manage himself/his catastrophic/paralysing thoughts. Happy Days. I would class his therapist as 'silver' because my friend did a lot of the hard work, 'making' his therapist listen and adjust to his needs.

Gold - Whether or not you are trained in just one way of working (eg person-centred) or have an integrative training, you have an 'integrative mindset/a multi-lens perspective'. You know yourself and your craft well, and you take time to listen to and collaborate with the individual who has come to see you to ascertain their hopes/needs/goals from therapy with you. You 'triage/assess and formulate' on an ongoing basis. You know that you don't know everything, and that sometimes it becomes clear that what you can offer isn't going to be right for this person at this time. Sometimes you have a sense of who/what might better meet their needs and you refer on, or make a suggestion. You are aware that you will have blind spots/assumptions/habitual ways of seeing the 'therapeutic task', and you are open to reflection and challenge - from the client, in supervision, and in your own personal development as a human and a practitioner. You don't have to 'know it all/do it all' and be 'a jack of all trades' - that won't help your client and won't be true to your training/personhood/way of being in the world. You won't be able to help everybody - sometimes it is not a match through modality/timing/price/personalities. However, you do your best to use the skills and experience you have to tailor your offering to this person, at this time. And you evaluate as you go - whether that is formal in the terms of questionnaires/ratings, or informally with the client (and whoever is paying for the therapy, e.g. parents, organisations.) For me it is not enough to have a set of skills and a set of beliefs – e.g. ‘CBT works for anxiety’ or ‘all human beings have a self-actualising tendency’ - without owning that our skills are inherently limited and our beliefs are just that. Without 'holding our beliefs lightly' they can turn into assumptions and truisms that can hamper our ability to support and help our clients. We can stop seeing the person in front of us who is inevitably a unique human being - we may know a lot about human beings, and things that can help, but we need to make sure we are really seeing and hearing this individual and their frame of reference/belief system/unique challenges and strengths/what they want and need from this therapeutic encounter.

So maybe a 'gold standard therapist' is similar to a 'hair stylist', and maybe the client/customer has a better experience if they are lucky to find one. In my work - teaching and supervising therapists - I am hoping that my input creates more 'gold standard' therapists out there in the world, so that clients don't have to be 'lucky' to find one.

Ciao! 

Be the Change You Want to See

Blood and Belonging - Part 1

Ripples and Mindmaps

I have an ongoing awareness that many people who are trained to work therapeutically with children, aren’t necessarily fully prepared within their training to work with parents/adults too. (Luckily in the days when I did IATE training, we qualified to work with both adults and children – although obviously not as indepth a training for either). Even if not doing p-c work – this feels so essential – from the minimal working alliance with a parent of a child/yp client in private practice; through regular meetings with a parent in a school setting; to responding for advice and guidance from parents of clients; to know when and where to refer a parent for their own work to working with the network of a child,– teachers, referrer, social workers etc.

I therefore ran a course in Brighton to explore some of these elements and to help skill people up/develop our thinking around this.

I keep thinking about the relevance of – systemic thinking, couples work, dyadic work, filial therapy, theraplay – and that some of the work we are undertaking draws from all of these elements but is different too.

So important to me is ‘dual empathy’– which sometimes broadens to ‘system empathy’ or ‘network empathy’ – trying to ‘get alongside’ or see the viewpoints of/work well with others – eg referrer, social worker, head teacher – which is difficult but often most effective way to help the child – yet always keeping the child at the centre. It is a delicate balancing act - weaving the different strands of their needs and our experience to make an individual tapestry of support for each family.

The temptation can always be there to ‘side’ with the child which feels slightly different from keeping the child at the centre – because the former can include us ‘acting out’ towards others – blaming, distancing, criticising, demanding of – which may well be part of transferential invitations/projective identification from the child.

I love the simplicity and tangibility of Dan Hughes’ description of being ‘open and engaged’ – O&E – I can feel in myself when I am this way with the child, with the parents, with others – and can relate PACEfully – and it almost always facilitates better communication and working alliances – which ultimately is better for the child – than when I become ‘closed’, ‘defensive’ etc. My being O&E with others, is more likely to enable them to be O&E and from there all connection and working together flows. The more PACEful I am with adults, the more likely, I believe, they are to be PACEful with children.

So I’m passionate about my work with parents – psychoeducation, positive parenting skills, emotional support, gentle challenge, exploration from the secure base of feeling safe with me – all whilst keeping child’s needs as paramount.

My fantasy is the development of services – where any family is struggling – and the first response is W, L &A – welcome, listen, and assess. Looking at the family as a whole – and starting where it makes most sense to start. I have often been referred parents for ‘therapeutic parenting’ work when my observation and experience of the family functioning is that they are skilled and able parents – room for improvement of course (for us all as parents I imagine!) but it’s not the sticking point, the key issue. One parent I worked with in this capacity, we both pushed very hard for assessment (which was resisted as child was adopted so all was seen through the lens of attachment and trauma – and therefore she was seen as needing to be a better therapeutic parent) and her child was eventually diagnosed with pathological demand avoidance, autistic spectrum disorder, adhd, sensory integration issues and dyspraxia. So she still needed parenting support and guidance, of course, but she actually felt heard and met in this. Equally I’ve had children referred for ‘anxiety’ for individual therapy – and have morphed into working with the parent – to help them with their anxieties, skill them up as a parent, explore their fears – and it has seemed to be that this has been the most effective way to work with the family. It would be great to have a central referral where the most appropriate way to start with the family is skilfully identified and the practitioner decides if they are able to do it or an appropriate referral is made – eg to Occupational Therapist as early brainstem regulation work is needed before we can even think about helping parent and child to connect better (eg Theraplay) or child to recover from past trauma (eg individual therapy). The parent, also , may need some pre-therapy type work or prep – eg some therapeutic input to help them regulate their anxiety, process their grief – before we would invite them into some dyadic work to connect with their child, where we want them to be our co-therapist and be O&E towards the child and their needs.

In this way I believe the dyadic work isn’t like couples work – it isn’t giving an equal voice – the parent totally deserves a voice and a space to tell their story, but the DDP work would be focused on therapist and child working together to empathise with the child and help the child’s story to be told. Equally, with older young people, there may well be some productive ‘couple type’ mediation-like work to be productively done – where both perspectives are expressed, validated, communicated, guided into assertive expression, conflict refereed, and both helped to stay O&E towards each other supporting ongoing communication, problem solving, mentalising etc. Here solution focused therapy, family coaching skills, mediation skills may be very helpful.

I’ve been using mindmapping with some recent referrals to try and ‘map’ the family and the issues – where the potential areas are to explore/work with, and to try and work out to start and where the most leverage might be. Obviously this may be where the most effective leverage seems to be from my professional point of view, or may be where the parent is willing to start. Any part of a system one can support/improve, will ripple out.