Three Reflections in Mar 2010

Rock Bottom (09/03/2010)

It has been six months since I started this learning journey. Time flies!  There were moments in the past months where I felt emotionally low and lost, questioning if I had chosen the right path for myself. Guess I came with high expectations, hearing the almost transformational experiences that I would have from such a course, so there had been some disappointments. On reflection, one key area was my expectation to gain my mind-stimulation through experiential learning, group-based activities and loads of hands-on sessions, constant discussion and being questioned about learning processes and self-reflexivity. Main goals I had - myself growing sharper in reading the moment and more articulate in the systemic way of convening a family session.

I see a leap from this rock bottom in recent weeks. One realization is that this path requires a more personal reflexive space for growth, through the recursive process of inputs (observing, listening, reading) and output (mainly writing and reflecting). I was told that first year is actually more theory-based while the second year there would be more hands-on exposure. Clinical discussion is another key area which I felt is important and could have more, perhaps from informal arrangements from my own initiatives as well.

Find this is good opportunity to review my learning process and what learning “gremlins” I spotted so far:

1.        I’m glad to see that I have not overly spent time in organizing things, though at times things do get rather disorganized. I have learnt to be not overwhelmed by them but periodically sort things out.

2.        A learning “gremlin” reappeared, which I’ve heard exist in other friends’ learning process too; at times I would simply just do anything under the sun other than readings or academic writing, even though deadlines could be close. As compared to the past, I find myself in better control, the gremlins tend to wonder still but at a shorter time span. Sometimes it also helps to see it as “I need to take a break”, eg. play Spider Solitaire, Hearts,  Chess, etc. even though sometimes the break overstreched, it’s okay, as long as I eventually come back!

3.        The importance of being consistent in writing and not to accumulate back log, something which I was mindful when I started working as an aftercare officer but lapsed over the months. This will be a huge goal I am committed to achieve and to gather mutual support from my colleagues! Yes, there are still back log, both in writing and reading. What has been helpful is the learning of speed-reading and letting go of the need to read everything. Rather to read with a purpose and make it interactive with myself or others. As for writing, well, much better than in the days of tonnes of casenotes  accumulating, neverending !but it is also largely because the caseload back then was impossible! Excuses:? hmm...)

A Letter to my Genogram (15/3/10)

At the last half an hour of the Personal and Professional Development (PPD) session, I was tasked to write a letter to my genogram that I drew and shared at the start of the course. This is an idea drawn from therapeutic letters often applied in the Narrative approach by Michael White. My mind was empty at the beginning but was amazed that ideas and thoughts just flow as I wrote! Here’s my letter:

Dear Genogram,

I don’t know what to say to you right now. Saw you at the beginning of this course, shared about you to my colleagues then, but just kept you at the book shelf since.

I remember our tutor expressed his surprise when I presented the pre-drawn you at PPD, as he said it could be risky to draw you alone. Fortunately for me, you were not as "poisonous" as how some other genograms might be.

If I were to look at you again right now, I wonder if you would have changed. My sense is that you would. As the family (past and present) drawing another tutor got us to daw at Cinical Skills seminar two weeks back is the you in dfferent set of clothes – you were wearing autumn clothes and that was you in winter clothes.

What do I notice changed in you? Perhaps the brigher part of you is shining on my life in London.

How would you be different in 1, 2, 5 years down the road? I kind of hope to bring the current you back in my luggage eventually when I return to Singapore for good, or to put you up like a poster in my bedroom if I were to be still in London then.

The colour I imagine you are now is red, a dimly-lit one. I wonder what feeling red expresses – not anger but probably a “stop”, a rest from the bustling life I was leading before I drew you, when I walked the streets of a city with four seasons.

Reflections from Seminars (23/3/10)

Last Friday we had a family therapist working in Adult Mental Health sector to conduct the Academic Seminar. Was really a great session! She positioned herself as a systemic psychotherapist with strong influences from the post-Milan social constructionist.

My key takeaways from the session:

1. The importance for the family therapy team to gain clarity right from the point of referral the following :

o   Who is asking for what? Eg. Referral to family therapy by care coordinator (an equivalent of caseworker in Singapore context) for a married couple, with concerns over the couple’s sexual issues, wife’s mental health and the couple’s parenting, as their only child is in the Child Protection register.

o   What are the systems of concern? Eg. Couple system, parent-child system (with strong linkage with Social Services because of child protection concern), mental health system, etc.

o   Who and how to invite? Eg. Invite as many of those significant in the systems of concern as possible for the first session so as to have a more holistic understanding of the family from as many perspectives as possible. For the first session, social worker, care coordinator, the couple. Child is excluded because of the sensitivity of the adult sexual issues. In the letter to the couple, ask if it were okay for care coordinator and social worker to be invited, and offer for couple to bring any significant others to session they find would be helpful. Collaborative decisions could then be made by therapist and couple who to include or exclude after the first session.

2. The role play at the later part of the session was very helpful, with the psychotherapist demonstrating her style as the therapist. She made a third of us participating in the role play, a third as her reflecting team and a third as an external team observing processes and techniques.  What was amazing is that she not only attained good therapeutic alliance, providing ample attention and engagement with the couple, care coordinator and social worker, but also was able to attain the level of interventive interviewing (having each question she asked as an intervention by itself) by asking and focusing primarily on process rather than content.

3. The inclusion of critical role and perspectives from professionals and referring persons right from the start in the first session is so crucial. Whether or not they continue to be involved in subsequent sessions depends on how closely-knitted that professional is with the family. It also helped the social worker to be able to give a different experience and observatory position to make child protection assessments.

4. The positive impact on clients hearing the reflecting team highlighting strengths and recognizing the clients’ struggles. The relevant professionals could in subsequent sessions join as reflecting team.

Interestingly, during the three-way discussion as my mid-term review of my clinical placement few weeks back, as well as during Clinical Skills Seminar yesterday, people's guesses are that I’m influenced by the Narrative approach in family therapy. In both accounts I clarified that I see myself fitting more with the Post-Milan approach. A colleague and tutor actually opined that I would make a good Feminist therapist too!

Another key point discussed at Clinical Skills is the distinction drawn between my personal approach and the approach(es) that would be most culturally feasible in Singapore. While my tutor and my sense is that Solution-focused and Behavioural approaches are more popular in Singapore, the contextual family approaches such as transgenerational approaches would be very useful too. I shared that many social workers in Singapore are very into the Satir Model too, which I personally was surprised how little emphasis on Satir’s approaches are in the UK family therapy field. For a first time I was given a contextual account of how Satir was initially very influential family therapy but later "sought asylum" in the Gestalt field of individual psychotherapy after some disagreements with some other leading family therapists back then. How interesting, and finally this cloud in my head since the start of this course has been cleared. I'm still disappointed though that not to be able to learn much of her approaches here but I guess there would opportunities in future in other means.