This morning I heard health expert Dame Prof Sally Davis, on BBC radio 4, talking about the health of UK children. (It seems that cases of rickets are on the rise. She suggested the introduction of vitamin supplements for all kids).
During the interview (which you can listen to here, at approx 2h 39min), she was also called upon to comment on mental health issues in family life, and their treatment.
How disappointing it was to hear the same old line trotting out once again, like a soundbite, or one of those management-speak buzzwords that seems to be infectious in the meeting-room spreading from one employee to another. It goes something like this:
(a lot of mental health problems) "will respond to.... Cognitive Behavioural Therapy... talking therapies..... "
The words used here are telling. They show a lack of understanding about the therapy world; its different modalities, and their potential use in the wide range of mental health issues. The words also show a willingness to endorse, publicly, a particular form of treatment.
I have previously drawn attention to this advertising of the CBT 'brand' here.
Dame Sally makes it very clear to us exactly why she wears this logo on her T-shirt. She says "I believe that we should only offer treatments that are evidence-based."
What she's saying, then, is that she only values treatments (and that includes therapies) which offer a statistical probability of "success" based on "outcome measures", and perhaps therapies which lend themselves to a widely-accessible "treatment protocol".
(For a deliciously sarcastic take on this kind of approach, see my friend Jason Mihalko's blog here).
Dame Sally is, of course, coming from her own training and heritage. She is steeped in the politics of medicine; a world of ever-increasing tension between public treatment needs and public costs. She values 'evidence-based' therapies, because, perhaps rightly, it would be hard to advocate the spending of public cash on therapies that aren't shown to be 'cost-effective'. The taxpayer deserves value for money, of course.
Evidence-based treatments are useful because, in the medical world, they offer the best assurance that a certain drug/intervention will work. The science tells us that in (n) cases, (x) show a measurable improvement compared to a control group who haven't been given this intervention. Therefore, the chances of your symptoms improving with this treatment are predictable to a certain level of probability.
Evidence-based treatments are also seductive, because they offer us a sense of safety and hope for a particular outcome that we are invested in.
We invest psychologically as patients, because we all want our symptoms to improve.
We also - as Dame Sally illustrates - invest financially. This, on a political level, has huge consequences, because government will clearly be much happier to offer therapy that offers clear, predictable outcomes.
Easy, then, to be fooled into thinking that therapies offering statistically-supported outcomes are the 'best'.
Sure, if you have the type of problem that fits neatly into the standardized diagnostic boxes that NICE and the APA prefer. But the problems of our life and our world are, to my mind, mostly in a different category than this.
How many times, for instance, have you lost a night's sleep because of a meeting, interview, or other event the next day that you are uncertain about?
We have all become stressed and irritable, maybe felt depressed, because of an ongoing issue in life that we can't control or predict.
Maybe you have thought about making a major decision in your life but have been held back for some time, because of the fear of the unknown. "If I knew I could get more work over there, I'd leave this job for good. But how do I know...?"
If only there were an assured, statistically-supported outcome, that you could be certain of....!
I don't believe I'm in the business of offering people assured or certain outcomes. Because in lots of ways, I don't believe there are many to be found. However, the selling of empirically-supported therapy is popular because it fits with an economic and medicalized model of human suffering. The natural human needs for self-exploration, mutual discovery and understanding, and psycho-spiritual development, are not necessarily part of the 'treatment plan'.....
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Infrequent musings and general comments on life, from the perspective of a UK psychotherapist.
Showing posts with label Communication. Show all posts
Showing posts with label Communication. Show all posts
Thursday, 24 October 2013
Wednesday, 4 September 2013
A-one, a-two- a-three .... and ....
It was the end of the session; one of those last-five-minutes that is an open space for anything to come in. The therapeutic work was done (?) , and the conversation drifted onto ... something quite random.... maybe colds or 'flu or something.....
An observation was made that the therapist had a gravelly voice this week.
"Yes...ok for talking, but with this kind of voice, you can only sing one song... and that's 'I Walk The Line'..."
"Hmm?" Puzzled, curiously. "Never heard of that one."
Then came a gravelly but tuneful couple of bars - "Because you're mine..... I walk the line..."
Okay - the song has been changed, and the example is deliberately vague - but this is a description of something that happened to me once, as a client in therapy. It was just a moment in the relationship, but now I'm writing about it, I realize that no therapist had ever sung to me in a session before (and hasn't since). What an interesting experience that was, on many levels!
I realize also that I have found myself singing in a session, more than once. This is usually because the musical world has so much to offer us, in illustrating the breadth of human experience. Songwriters, and composers, are chroniclers of the soul. Heartbreak, ecstasy, loss, disconnection, anger, eroticism, it's all out there - in a nicely distilled form that pools in our unconscious and reinforces our shared humanity.
Singing is also part of my life, part of my history. I guess singing in-session in a kind of self-disclosure, too. I am saying something about myself (or perhaps my inner 11-year-old choirboy is...)
In and out of the therapy room, I naturally reach to song lyrics or music, at different moments..... A friend is telling me about a situation brewing with her husband, and I find myself chiming in - "There may be trou-ble ah-ead....". Another friend stops for a chat, and for the rest of the morning I am singing or humming a song that uses her name. A fresh brew at the office brings delight and gratitude, and I find myself crooning in praise of caffeinated drinks.
I wonder if any therapist colleagues or clients out there have sung in-session, either 'accidentally' or deliberately, in order to communicate something?
In a spirit of playful curiosity, I invite you to share a story on my blog*, if you wish; let's see who the singers are! ;o)
References
"Let's Face the Music and Dance" - Irving Berlin (1936) http://www.youtube.com/watch?v=TnfKmNRfLYU
"Looking for Linda" - Hue and Cry (1989) http://www.youtube.com/watch?v=ONc3OMOb98I
"Java Jive" - The Ink Spots (1940) http://www.youtube.com/watch?v=iP6IUqrFHjw
*p.s. Professionals are gently reminded to protect the confidentiality of your therapeutic relationships, current and historical
.
An observation was made that the therapist had a gravelly voice this week.
"Yes...ok for talking, but with this kind of voice, you can only sing one song... and that's 'I Walk The Line'..."
"Hmm?" Puzzled, curiously. "Never heard of that one."
Then came a gravelly but tuneful couple of bars - "Because you're mine..... I walk the line..."
Okay - the song has been changed, and the example is deliberately vague - but this is a description of something that happened to me once, as a client in therapy. It was just a moment in the relationship, but now I'm writing about it, I realize that no therapist had ever sung to me in a session before (and hasn't since). What an interesting experience that was, on many levels!
I realize also that I have found myself singing in a session, more than once. This is usually because the musical world has so much to offer us, in illustrating the breadth of human experience. Songwriters, and composers, are chroniclers of the soul. Heartbreak, ecstasy, loss, disconnection, anger, eroticism, it's all out there - in a nicely distilled form that pools in our unconscious and reinforces our shared humanity.
Singing is also part of my life, part of my history. I guess singing in-session in a kind of self-disclosure, too. I am saying something about myself (or perhaps my inner 11-year-old choirboy is...)
In and out of the therapy room, I naturally reach to song lyrics or music, at different moments..... A friend is telling me about a situation brewing with her husband, and I find myself chiming in - "There may be trou-ble ah-ead....". Another friend stops for a chat, and for the rest of the morning I am singing or humming a song that uses her name. A fresh brew at the office brings delight and gratitude, and I find myself crooning in praise of caffeinated drinks.
I wonder if any therapist colleagues or clients out there have sung in-session, either 'accidentally' or deliberately, in order to communicate something?
In a spirit of playful curiosity, I invite you to share a story on my blog*, if you wish; let's see who the singers are! ;o)
References
"Let's Face the Music and Dance" - Irving Berlin (1936) http://www.youtube.com/watch?v=TnfKmNRfLYU
"Looking for Linda" - Hue and Cry (1989) http://www.youtube.com/watch?v=ONc3OMOb98I
"Java Jive" - The Ink Spots (1940) http://www.youtube.com/watch?v=iP6IUqrFHjw
*p.s. Professionals are gently reminded to protect the confidentiality of your therapeutic relationships, current and historical
.
Tuesday, 12 February 2013
The Carom Transaction in Social Media
I have fallen out of love with Facebook. I have become attached to Twitter. I have discovered LinkedIn. This is my current position; it may change!
Over the several years that I've been involved in social media, I have noticed more the vast array of transactions on display. Some social, some psychological, but all the different permutations of the Berne's original dual ego-state model are there.
Looking at the different ways in which people use the platforms of Facebook, Twitter et al, I have been reminded of an old, seldom-used bit of Transactional Analysis theory which I now feel deserves a fresh look.
The Carom Transaction
In the wider literature this first appears in Woolams & Brown (1978) although it's a very brief mention. Very simply, it's a kind of transaction where the speaker says something to another person in the vicinity of a third party ... the third party is the real recipient of the strokes. It's an unusual transaction because of its use of an intermediary. It is also an example of the social & psychological levels of action (i.e. Berne's third rule of communication*)
Here's a basic example:
"Carom" is a broadly European term that is found in Carom Billiards, where players must deliberately bounce (carom) the cue ball against a cushion or another ball, in order to progress. Carom transactions, then, are used to 'bounce' a message off one person, so that it 'rebounds' off to the next one (the real target).
Caroms may be used deliberately in a therapy. Usually this is done in order to reinforce a particularly important message, or to convey a point that couldn't be done directly for some reason. The client's partner, or other members of a group, may be the 'bounce-ees' in this respect.
The Carom in Social Media
Looking at Facebook and Twitter etc, it becomes clear how many of the postings, status updates or tweets are not actually intended for the supposed recipient. In fact, caroms are in play all over the place - intentional or not. The 'bouncees' are those others-out-there; the folks on one's Friend list (in the case of Facebook), or just other users in the Twittersphere (which can potentially mean millions of people!). Obviously the more public the settings, the more potential bouncings there might be.
Here are a few examples I have found:
1. The Old-fashioned carom
Simply, an indirect message conveyed in the manner we've just seen. Here's a kindly example:
Now, nearly everyone knows what a nice person Louise is. This is much more powerful than sending a text, or perhaps even a thank-you card (although that might depend on the wording). But it's potent; maybe because of its public nature, as depicted in the diagram below.
Of course, this kind of carom can be used in a not-so-kindly way. I have refrained from posting an example here, but I'm sure you have seen a status update in your feed that's of the "Levon is a doo-doo-head" variety.
I have seen this kind of carom escalate into something really gamey and poisonous; family feuds and bitter disputes have been played out in this manner.
2. "Now Hear This, Now Hear This"
This is an interesting one, where the 'target' of the message is everyone. The bouncee may not even be present amongst that following, but be referred to in the posting itself. Here's an example:
This is a loving parent. What's interesting is that the child isn't actually the recipient of the message. On the social level, this is a birthday greeting to someone (who 'happens' not to be there). I suspect that an ulterior message is being conveyed, and that the 'others-out-there' are the intended recipients (below).
Other forms of this type of carom can easily be found. If you "like" a particular posting or group, for instance, it can be a way of conveying a message to those around. (They will see that you've clicked on "No Tolerance for Domestic Violence", or "I Hate People Who Stand Still on the Escalator", and will know this about you).
3. Social Media as Marketing, or "Hey, Google, Look at Me!"
This is a double-rebound carom, which I think has been born of the digital age. In this situation, users of Facebook, Twitter, and bloggers in general have taken to using their social media as a marketing tool. Google (other search engines are available) is the driver behind this; SEO gurus tell us that Google looks for "quality content", and so we merrily type away in the hope that Google will hear us **. Of course, Google may not hear what we're saying; we just need Google to know we're here. Our Facebook Friends, Followers, and the general public may hear us, and if so that's good - but there is the added dimension of telling Google something about ourselves.
---------------------------------------------------------------------------
* Berne's Third Rule of Communication: Where there is a transaction on the social and psychological level, the outcome will always be determined by the latter.
** I am aware that many, many people write blogs and use social media for reasons other than marketing. Astute and/or prolific readers will have seen examples of those that do (write for marketing purposes) and those that don't. I can usually tell the difference; there is a difference in tone, and the 'marketing' writer often has little or no engagement with those who comment/tweet back etc.
.
Over the several years that I've been involved in social media, I have noticed more the vast array of transactions on display. Some social, some psychological, but all the different permutations of the Berne's original dual ego-state model are there.
Looking at the different ways in which people use the platforms of Facebook, Twitter et al, I have been reminded of an old, seldom-used bit of Transactional Analysis theory which I now feel deserves a fresh look.
The Carom Transaction
In the wider literature this first appears in Woolams & Brown (1978) although it's a very brief mention. Very simply, it's a kind of transaction where the speaker says something to another person in the vicinity of a third party ... the third party is the real recipient of the strokes. It's an unusual transaction because of its use of an intermediary. It is also an example of the social & psychological levels of action (i.e. Berne's third rule of communication*)
Here's a basic example:
Caroms may be used deliberately in a therapy. Usually this is done in order to reinforce a particularly important message, or to convey a point that couldn't be done directly for some reason. The client's partner, or other members of a group, may be the 'bounce-ees' in this respect.
The Carom in Social Media
Looking at Facebook and Twitter etc, it becomes clear how many of the postings, status updates or tweets are not actually intended for the supposed recipient. In fact, caroms are in play all over the place - intentional or not. The 'bouncees' are those others-out-there; the folks on one's Friend list (in the case of Facebook), or just other users in the Twittersphere (which can potentially mean millions of people!). Obviously the more public the settings, the more potential bouncings there might be.
Here are a few examples I have found:
1. The Old-fashioned carom
Simply, an indirect message conveyed in the manner we've just seen. Here's a kindly example:
Now, nearly everyone knows what a nice person Louise is. This is much more powerful than sending a text, or perhaps even a thank-you card (although that might depend on the wording). But it's potent; maybe because of its public nature, as depicted in the diagram below.
Of course, this kind of carom can be used in a not-so-kindly way. I have refrained from posting an example here, but I'm sure you have seen a status update in your feed that's of the "Levon is a doo-doo-head" variety.
I have seen this kind of carom escalate into something really gamey and poisonous; family feuds and bitter disputes have been played out in this manner.
2. "Now Hear This, Now Hear This"
This is an interesting one, where the 'target' of the message is everyone. The bouncee may not even be present amongst that following, but be referred to in the posting itself. Here's an example:
This is a loving parent. What's interesting is that the child isn't actually the recipient of the message. On the social level, this is a birthday greeting to someone (who 'happens' not to be there). I suspect that an ulterior message is being conveyed, and that the 'others-out-there' are the intended recipients (below).
Other forms of this type of carom can easily be found. If you "like" a particular posting or group, for instance, it can be a way of conveying a message to those around. (They will see that you've clicked on "No Tolerance for Domestic Violence", or "I Hate People Who Stand Still on the Escalator", and will know this about you).
3. Social Media as Marketing, or "Hey, Google, Look at Me!"
This is a double-rebound carom, which I think has been born of the digital age. In this situation, users of Facebook, Twitter, and bloggers in general have taken to using their social media as a marketing tool. Google (other search engines are available) is the driver behind this; SEO gurus tell us that Google looks for "quality content", and so we merrily type away in the hope that Google will hear us **. Of course, Google may not hear what we're saying; we just need Google to know we're here. Our Facebook Friends, Followers, and the general public may hear us, and if so that's good - but there is the added dimension of telling Google something about ourselves.
 |
| (Pink lines show the second carom phase) |
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* Berne's Third Rule of Communication: Where there is a transaction on the social and psychological level, the outcome will always be determined by the latter.
** I am aware that many, many people write blogs and use social media for reasons other than marketing. Astute and/or prolific readers will have seen examples of those that do (write for marketing purposes) and those that don't. I can usually tell the difference; there is a difference in tone, and the 'marketing' writer often has little or no engagement with those who comment/tweet back etc.
.
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