Walk and Talk

It’s been a while.  And somewhere, in the interim, I’ve been thinking about ways of catching up; of re-acquaintance.

I’m sure I’ve heard the phrase ‘walk and talk’ many times over the years, but I’m thinking of it now along the lines of how it was mentioned in a recent self-care workshop.  I’ll be talking about the presenter, Françoise Mathieu, a little later in this post.

Walk and talk is something we can do when we’re stressed and faced with strong emotions or with a sense of the need to connect.  So, it’s a good resource to have in our self-care toolbox.  Sometimes, what I find is that the resources that work during the hard times work even better during the easier moments of life.  And that’s one of the reasons we are always being told to practice.  How many times have we said, or heard? Don’t wait until you’re really upset to practice your yoga breathing.

I don’t think there’s any really formal definition to walk and talk.  It’s pretty self-explanatory.  The urge or need arises and you recruit a friend or colleague to spend some time with you while you get both your bodies in motion – either burning excess adrenaline, or simply taking the opportunity to break away from the more sedentary aspects of the day.

We won’t actually be walking and talking here, but we can run a mental simulation.  So imagine we are connecting again after a bit of a hiatus.  Choose your favourite walking route.  Imagine written words as dialogue.  And if something comes, please add your comment down below.

I’m unsure why I stopped blogging for a while.  There were probably different causes.  Sometimes we bring all the things in life together, and they still don’t add up, or so it seems to me.  And even when they do, life is a process of ebbing and flowing.

So (as perhaps we pass by your favourite tree, or garden) I am thinking now about where the flow of life took me away from the blog, from helping attend to my mother, who was terminally ill with cancer, as well as to other clinical and teaching responsibilities.  For now, - this weekend at least – there are no outstanding insurance reports, or PowerPoint slides to complete, or other details of life screaming for attention.  There’s time to touch the inner background of myself.

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It took me a while to sense a starting place.  This morning, I reflected on the number of conferences and educational events I’d attended in the past six or seven months.  And I thought there was the possibility of building a bridge here.  I would not try and summarize more than a few of the moments that stood out for me.  What are those moments?  What necessary and important truths came my way, during a period that began peacefully, and is ending at a time when the very fabric of physician-delivered medical care is being painfully assaulted in my province and perhaps in a far more widespread geography as well.

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Ferenczi 2015: Subcortical Cries and Preverbal Cues

There is something powerful and reassuring about the current resurgence of interest in the early Hungarian psychoanalyst, Sándor Ferenczi.  His interest in addressing the unmet needs and traumas of earliest childhood, now backed by modern scientific discoveries, contains the seeds of a more humane and effective model of psychotherapy and of human relationships.

I won’t review Ferenczi’s life and work.  It’s of value to point out that he believed that it would require tenderness and care to repair the traumas of early childhood, and that – in a later work, Confusion of the Tongues Between the Adult and the Child – he explored the difference between the tenderness of childhood sensuality and the passion of adult sexuality.  Of course, in that, we see the potential harm of confusing the two in our patients.  I’d like to say that this occurred mainly in the realm of the conscious, but I’m pretty sure when it comes to this area of concern, we are actually oblivious to much of what we inadvertently say and do.

So for Ferenczi, the deadness in the adult comes not from a death instinct, but from early object-relational or attachment loss.  He describes patients we see frequently, who come to us in dissociated states, split off from their sense of alone-ness, their sense of being unlovable and unwanted, and from the hopelessness and disappointments of their childhoods.

How do we reach these unreachable patients?  How do we induce the will to live, to choose life in a world that is almost always challenging and sometimes inimical?

Is there really a kind of dead or deadened child beneath the present hatred or coldness or despair.  Can we attend to these deeply wounded aspects of self?  We cannot offer the love and care those “ghosts of the past” did not receive, but we can offer our presence and gaze.

At this juncture, I became captivated.  Some of the speakers were describing and capturing deep truths for me.  I was touched by such liberating and honest terminology and testimony.  I heard speakers describe their felt experience of some of the loneliest places we can share with our patients, places where our training offers no tools, no techniques, nor even a map; not even the validation that these places exist.

I listened with rapt attention to Judy K Eekhoff, a Washington State object-relations analyst speaking at the well-attended international conference, taking place at Victoria College in the University of Toronto.

There are patients, she noted, who challenge more than our minds to find them.  We must utilize the full breadth and depth (and bodies) of who we are, and we must be real.  Drawing on Ferenczi and Bion, she reminded us that in finding some of the most inaccessible and hard to reach places in our patients, we are afforded the opportunity to meet those same places in ourselves.

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United in Common Cause

This year, the annual conference of the International Society for the Study of Trauma and Dissociation took place in Florida, during early spring.  It’s not always easy working in the traditional medical world, which continues to turn a mostly blind eye – even at its own peril – to the effects of trauma and unremitting stress on our health.  So, for my week in Orlando, I felt filled with gratitude at being connected to a large group of clinicians who felt like-minded and courageous in their ability to face some of the harsher and more complex aspects of the human condition.

In a room close by, a Polish clinician enjoyed the chance to travel locally, as well as attend this conference entitled Mastering the Complexity of Trauma & Dissociation.  She seemed exquisitely pleased with herself for having rented a car and visited Cape Canaveral.  Others wandered closer afield from the conference site.  A colleague from Alberta, who I’d done some training with, and who had recently survived a rough patch in her personal life, shed tears of joy after finally getting her magic wand at Harry Potter World.  It was just the one she wanted, with a unicorn hair inside.

The moment that stands out for me as I write now, took place during the awards ceremony, when Steve Frankel spoke.  Steve is a well-known teacher in the mental health care field, and is credentialed as both a psychologist and attorney at law.  As he spoke, he described, with passion, why he chose to devote so much time and energy to the ISSTD.  In other fields, like psychology and law, he watched those around him maneuver and struggle to find wealth and the spotlight.  Here, this evening, he recognized a group of individuals – lawyers, social workers, addiction counsellours, psychiatrists, psychologists and therapists – who were devoted and selfless in their one common cause: to end child abuse and the mistreatment of children.

You don’t need awards when you are doing this kind of work, but it was good to see ISSTD handing some out anyway.

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Beyond Kale and Pedicures

One doesn’t have to be Canadian to know Françoise Mathieu.  An interest in compassion fatigue and self-care will bring you to her.  This Kingston psychologist has been in the field of burnout and stress for a long time, working with the military, with emergency service workers and with health care workers.  At ISSTD, I had the pleasure of spending most of a day learning from Laurie Anne Pearlman, one of the true and original pioneers in this field.  During her presentation, some attendees asked who else they could look to in their reading and the name of two fellow Canadians came up first: Françoise Mathieu and Anna Baranowsky.

I felt quite proud in that moment, since our teaching series has featured both of these speakers, who otherwise have been more or less denied exposure in our more insular medical world.  I hope that will be changing soon.  We are learning very quickly that we are not super-heroes and that we are not immune to compassion fatigue, to burnout and to secondary traumatization.

I attended Françoise Mathieu’s day long workshop at the Hincks-Dellcrest Centre (having previously attended a two-day workshop with her through Leading Edge Seminars) knowing that it was time for our own education series to face what is becoming increasingly well-recognized.  This is the knowledge that the standard interventions for physician burnout, so widely disseminated, do not actually work.  What does work is a far more complex question, and one that Françoise Mathieu has no difficulty tackling. 

I hope that the Caring for Self while Caring for Others series will continue to tackle this difficult and pressing contemporary challenge, without flinching, or hiding in the comfort of old, worn-out assumptions.

What does lie beyond kale and pedicures?  Let’s keep walking and finish up with one final moment of inspiration.

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My New Operating System – Two Days with John Briere

In my mind, there is nobody better to speak about mindfulness and trauma than John Briere.  John has been another shining light in our field, and he continues to contribute prolifically through his teaching, his writing and his clinical work.  This was not my first time seeing him in Toronto.  Having also seen him very early in my therapy career, I was able to reflect both on how much I’d changed, and – in many ways – on how John has changed as well.

There’s something about the work he does (which involves things like emergency psychological interventions with major burn victims) and his years of contemplation and mindfulness practice, that add up to both a vulnerable and utterly convincing presence.  John understands science, and writes quite scientifically.  But, at the same time, his reverence and respect for his own and for the direct experiences of others have led to a kind of wisdom that will always remain elusive and mostly out of our reach.

The work we do changes us, and those of us who currently, or in the past have worked in emergency services, recognize just how quickly a life can change.  “I see you with your everyday operating system and two hours later in an ER with a new operating system for desperation and terror.”  This is, in a way, what PTSD is.

And that’s hard for those of us who are still (seemingly, sometimes) intact to get. We bring in our own operating system, and whether it’s based mostly on our own good fortune, or to our own accommodations to old wounds, it may be very different from the one our current patient is utilizing.

So, what do we do with that?  What do we do with a gang member, with a lot of numbing and hypervigilance?  They’re stone cold and hard to treat.  You can knock on their door, but you’ll most likely get very little response.  We see numbed out perpetrators and we want to say: Wake up, get out of it, you’re not helping yourself.  And then we can ask: Should you die because of your attachment style?  When you see highly avoidant perpetrators who were never loved or cared for, and who are consequently mean, cruel, sadistic, what kind of conclusions are there to make?

Do we also expect the victims of trauma to contact their pain, when they may not have the room or ability to access the emotions necessary to do so?  And when they don’t, we might comment that they asked for it.

Do we really know mindfulness until we bring it to bear on these most painful aspects of life?  Do we really become what we are meant to be until we find compassion and the ability to accompany others in their pain, until we recognize that “I am them and they are me”?  And what is the prize?  Nothing but the process of who we are becoming.

As John reminds us, in his song, Sting is essentially right.  It’s a song I always loved, from the first time I heard it in Buenos Aires, backpacking in 1986.  (I would again see Sting perform it again on TV while sitting alone in a hotel room in Dallas, a few days after September 11^th, 2001, where I was attending an ER conference).  We are fragile.

It’s a good ending to this brief autumn walk.  We can look around mindfully, gaze at our surroundings, and gently break contact.  With the music acting as transition …

The work changes all of us.