Welch, L., 2014. Politics, Reciprocal Roles and Dialogue. Reformulation, Winter, pp.6-8.
This article is a brief resume of a workshop I ran at the 2014 ACAT Conference, aiming to develop the article “Reciprocal Roles In The NHS” (Reformulation: Issue 39 Winter 2012/13). It combines theory with some exercises to help the reader to consider the personal experiences of the political.
The essence of reciprocal roles is that we experience them at a micro level and the nature of our work is to endeavor to help patients to become aware of the profound effect apparently ‘minor’ triggers can have on them. Here musicality (Malloch, S & Trevarthen, C (2009)) is a very helpful framework as often it is not the content of what is said that affects us but the emotional weight put behind phrases. This means fi nding a place, an observing eye in CAT language, where we can notice the strength of certain feelings within us and how this can unconsciously determine how we react to things.
There are two divided spaces in which to experience the world. The world is highly personal; we each have our own specific experiences of the world. While others clearly experience pain, embarrassment, anger etc, the actual experience of the specifi cs is mine. ‘Our’ or more specifi cally ‘mine’ is the only world that really exists for each of us. This world comes to an end when we each come to an end. Alongside this is the awareness that the external world clearly continues after we have gone. However, it is easy for the external world to take over our consciousness and for us to loose sight of the ‘personal’. This is particularly the case for therapists working with patients, as we need to be alert to the specific reactions that they generate for us. However, it is easy to then get caught in the ‘personal’ dimensions and forget the wider political issues the patient may bring. For example, what do you feel when patients talk about how they are working zero contract hours; describe a situation of bullying at work; describe a difficult interview concerning their benefits; tell you they have been refused asylum status and face death should they return to their country?
It is easy to feel shocked, overwhelmed and helpless by these situations or, alternatively, to switch off from them as not being relevant to psychological work. This is where it is important to be alert to our own situations such as, at work, where we feel, for example, that those in a position of authority above us are putting unreasonable pressure on us; where we feel anxious about making a mistake because of how we fear we will be seen; where we feel we are having to carry out tasks which conflict with our own values; where we fear being downgraded or losing our job because of a service configuration.
Being alert to our personal reactions in these situations enables us to be more empathic with the patients we work with. This involves thinking about what feelings are generated; how easy it is to articulate those feelings; where the feelings are experienced physically. How we manage our initial reactions to difficulties at work can give us a powerful sense of what our patients are struggling with. Do you feel you switch off and tell yourself to ‘just get on with it’? Do you look for another job? Do you feel able to talk about the feelings? Can you share them with close friends or family? Can you talk to colleagues about them? Have you discussed these feelings with a union officialor someone who you feel can support you in taking action?
The next phase is around the actions we feel able to take: Can you find a way of articulating your thoughts and feelings to the people above you? If you can, do you feel your questions or views are attended to by managers? Have you ever taken strike action? What thoughts and feelings do you have about this? What stops you from doing this?
The difficult situations we face, the reactions we have to them and how we manage and act on our responses are all situated within a political context. The final set of questions is thinking about your view of the political: Does it engage you? If it does, what excites you about it? If it doesn’t, what turns you away? Would you describe yourself as political? How do you feel about other people who are political?
Another example of the interface between the wider political forces and the personal is how we understand the ‘legal’. It can be asserted that something is the ‘law’ but the language quickly makes us forget that the ‘law’ is the response of specific individuals. The assumption is that all individuals should respond in the same way. When someone asserts that something is a legal requirement, it is very easy for our minds to obliterate the fact that the ‘legal’ world is made up of individuals. If the police come and arrest you, it is not actually the ‘police’, it is Joe or Joanna Bloggs who happens to be in a uniform. While they may be compliant with the rules that they are subject to, they will be interpreting and acting out those rules in their own individual manner. We can quickly defer to the magistrate or the judge who will make a decision but forget again about their individuality. Our experience of the ‘legal’ can place us in an automatic compliant, accepting place where we feel we have to go along with whatever happens. Alternatively we might shift into an excited, rebellious state where we are ready to assert ourselves and fi ght but actually are still driven by instinctive responses rather than observant thought.
In the NHS, this means being aware of very powerful relational messages. Targets, statistics and finance override professional knowledge of complexity of patient care. Messages are communicated with authority and confidence, questions are dismissed. These tensions are particularly prevalent in the workplace where the managers just want to get things done, wanting to extract the most labour they can get from the workforce in the least amount of time and disregarding of the staff’s points of view, which they see as irrelevant. Managers can express their opinions with considerable force and be dismissive of any reflection on what they say as they simply experience it, in turn, as dismissal or criticism. However, they are in a highly subordinate and compliant position to those above them and usually accept the messages they are given. Those in positions of power are only concerned with getting a message across, not with dialogue. They seek to identify minor problems or discrepancies with those below in order to keep up the pressure. The workforce all too often slips into a compliant position, accepting the structure as reality, believing those above know best.
How do we build a climate where we can ensure that dialogue becomes part of the world? The challenge is that we inevitably generalize about dialogue from our specific experiences. This is particularly important for parties on the left where it is easy for differences to lead to conflict which diverts attention away from basic common assumptions. Our generalization may be ‘true’, based on a profound knowledge of the complexity of the world. It will also have a huge emotional weight, an assertion that rejects counter views. It can be entirely dismissive of others’ points of view. There are many times when this is legitimate, say, over the dictionary definition of a word though there still needs to be engagement with the other. There are many times when one party is right, the other wrong. However there are probably many more times when the ‘truth’ is fuzzier. It is here that it can be very difficult to manage dialogue partly because of our personal diffi culties in being with uncertainty or with complexity. There is a powerful desire to simplify and just ‘sort things out’ particularly when discussion seems endless and no-one wants to commit to a solution or the solutions seem too frightening.
It is important therefore to be mindful of how we assert the need for dialogue. Because we are rightly convinced of the value of dialogue it doesn’t mean that the word itself communicates to others why it is the way forward. We need to ensure that dialogue is about ensuring that clashes of opinion do not as a general rule, lead to immediate breakdown in relationships. We need to develop dialogue where it is possible to have differences of opinion and still to be in discussion.
Malloch, S & Trevarthen, C (2009) Communicative Musicality: exploring the basis of human companionship Oxford University Press Welch, L “Reciprocal roles in the NHS” published Reformulation: Issue 39 Winter 2012/13 (pgs 14-18)
Lawrence Welch is a Founder Member of ACAT and a member of the Catalyse Training Committee. He is a Consultant Psychotherapist in the North Tyneside Psychological Therapies Service though he will be redundant from 17 December. firstname.lastname@example.org
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