It has only just begun

28 Aug 11

The original plan was to record my two years of my learning journey public on this blog. I found myself stop posting the reflection online since Jan 2011, after 15 months of blogging. Part of the reason was the preoccupation with the demands of the MSc level. Another part of it was that my reflection became more personal and not suitable for public reading. I will instead, post the titles of the past 7-month entries here as a record:

Jan 2011 Slow

Mar 2011 Mindfulness

Mar 2011 Research Reflection

Apr 2011 Good enough relationship

Jun 2011 Internalised other

Jul 2011 Father’s worry

Jul 2011 Aftershock

The final stage of this course, which is the clinical examination, is approaching in a week’s time. When I submitted my dissertation report recently, my research supervisor commented that it has been such a marathon. Indeed, not just the research but the entire course journey has been a marathon!

I also like a saying by another tutor, that there are specific jargons and languages used by Family Therapy and Systemic Practice because it is an exclusive club. Graduating from this course and eventually registering as a qualified systemic therapist is just like fulfilling pre-requisites to acquire this Systemic club membership. This juncture only marks what has only just begun.

There could be a possibility that I will continue to use this space to blog about my continuous journey as a systemic therapist. I will remain non-committed and flirt with different possibilities for now and see how the future unfolds itself.

Compulsive Floating

It seems like ages since the last time I set time to have a private time with my Reflective Diary. The Autumn term was an amazing transition for me, a step from Graduate Certificate to MSc year. Nearing the end of 2010, I would like to take a lift to explore the changes inside and outside of me, in relation to my personal and professional journey I'm venturing.

I realise my default position in life is floating. I feel calm and at ease with myself most of the time, at times too comfortable that it becomes a compulsive stagnancy - not wanting to get out of bed, playing repetitive computer games like Hearts or Blackgammon non-stop, delaying time to go toilet despite the call of nature or walking to the kitchen to refill my water bottle even when thirsty. There was also a few days in November when I felt rubbish and wished I need not go for appointments scheduled with clients the following day. A familiar feeling that I had before when I was working in Singapore. My default strategies back then was to turn up late for work, chose not to see clients for the whole day or hoped that the client cancel the appointment. What has not changed though is that this feet-dragging feeling evaporates whenever I am in-session convening the therapeutic discussions. The sense of fulfillment usually last for a while after each session but eventually it would revert to a drag to write the casenotes and anticipation of not wanting to go for the next appointments. One strategy I had back then in Singapore was to commit myself and client to a definite date for the next appointment. Penning it down in my diary and verbalising it to the client set as a speech act, an external control for me to commit despite the feet-dragging feeling.

I notice that this feet-dragging feeling lasted for quite long period of time in Singapore; whilst over here it only lingered a few days and disappeared. One major difference is that back then the caseload was over 30 active cases, whereas at this moment, it is only about 6-10 active cases. Flight and staying afloat elsewhere seem to be my coping strategies when I feel overwhelmed.  I believe this survival instinct became part of me during my adolescence when I was at the same time seeking yet running away from myself and my relationships, especially with my parents. This escapism turned into frustration when I felt "pricked" by others, or panic and anxiety when I hear other's feedbacks as criticism, or when I  faced with the reality of deadlines or a backlog of overdue tasks to complete.

Efficiency is one of my key new-year resolution to fight my Compulsive Floating. I also see it to be the key tool to ground me from running away when feeling overwhelmed. It takes quite a bit of determination and planning beforehand in my mind - thinking ahead little steps and the sense of urgency while doing the actual task.  I already see a glimpse of this happening to me in the past months.  It does need some level of external pressure and encouragement for this to happen. One example is the requirement for casenotes at my clinical placement to be entered in the computer system within two working days and my Supervisor's trust in me meeting this timeline and my own (and her) witnessing me doing it brief and fast. I have been able to be on the ball and writing the casenotes  sor far almost immediately after each session for the past month.

Barry Mason's concepts of relational risk and being creative inspired me to play the computer game Hearts differently once. The aim of the game is to either win all the Heart cards and Queen of Spade, or to totally lose all of these 14 cards to other players. I created totally different emotional experiences and journeys when I asked myself, "what if the rule of the game remain unchanged for others, but I changed it for myself?" That liberated me to feel a sense of achievement when I aimed to "lose" the game or when I decided my aim of playing is to enjoy the process of it. I think this is an important experience that informs me to dare myself to think on my feet and aim to go a different direction from my conventional way of facing challenges in life or in my clinical work, eg. the next time I dragged my appointments when my caseload were to shoot up to beyond 10 families, where appropriate, I could start some of the sessions with asking, "I felt overwhelmed recently and had thoughts of not turning up for our appointment today, I wonder if you feel the same at times? I think what made me come is [said something I see as a strength in the family]. What could I possibly say or do wrong today that may make you feel reluctant to come again for the next session?" Or I could use my experience of changing the rule of the Hearts game by telling myself, “Right, what if I were to imagine that I’m going to attend the session not as a therapist but an active audience participating in a small but important page in the development of the family’s life story? It could be fun or dreadful but I’m willing to give it a shot!”

Afternote: It was not Compulsive Floating that defeated me for the past month but my decision to priortise in other aspects of my coursework. It is a month late but I managed to edit and have it published in the end!

Positive Stories of My Genogram

I enjoyed yesterday's Personal and Professional Development session a lot - an exercise for us to share positive aspects of our own genograms (a clinical term for family trees). I was amazed at how cross cultural family relationships and experiences could be! An unplanned common thread among us was about our fathers.

My father grew up in a big family, the fourth of five sons. When he was a child, he was often the first person to be blamed and physically punished by my paternal grandfather whenever something went wrong in the family. According to my father, most of the time he was not responsible for the mischiefs or the occurences! I believe this childhood experience had such huge impact on my father that when he himself became a father, he was determined to be totally different from his own father. The clinical term I could relate this to would be what John Byng-Hall  labelled as a corrective family script, i.e. a guide to actions taken in family relationships that is the total opposite of what was done in the previous generation. 

Througout my childhood my father never used corporal punishment on any of his children. There was only once he lost his temper with me. That was a morning when I was in primary one when I felt really lazy and not wanting to get out of bed. I told him I did not feel like going to school. He was so furious that he took my school uniform and threw it onto the floor. I was so shocked to see him angry with me that I went to school that day.  I never played truant throughout my school days (well of course not counting my college days:). That was the one and only time in my childhood when I experienced my father losing temper. It was not even projected at me but directed at my school uniform!  I could still remember  this incident after so long,  imagine how traumatic it would have been for my father when he was a child or for children who experienced much worse, such as witnessing or experiencing domestic violence.

In a way, I feel priviledged that I was spared from the negative childhood experience my father went through. It probably took lots of conscious and efforts at his end as a parent to refrain from adopting my grandfather's parenting style. I personally do not think that my lack of traumatic childhood hinder my clinical practice. On the contrary, it provides me the strength and curiosity to explore such themes with clinical families without unnecessarily triggering any personal scars or memories that may cloud my clinical neutrality or judgement.

Blog or Block?

One full year of integrating my private reflection and clinical learning with the public domain has been very fulfilling. Yet at the same time I wonder if I have compensated too much on those aspects that are too private to be shared publicly, yet pertinent in my learning process? Also, discussions with new people in this new year made me realise protecting confidentiality of clients in the public domain goes beyond just using pseudo-names or changing some storylines or details; it has to be done in such a way that they themselves and those who know them would not recognise when they read the entries. With these concerns and considerations, I've removed past entries that have direct references to clients. Moving on, my blog will be restricted to only reflection pertaining to my personal and academic learning.

Same-sex Connections

Pic 1: Fisherman's Wharf, San Francisco, 2009

Siegel: For heterosexuals, generally speaking, a supportive family is a given... [For g]ays and lesbians... [e]ven... if...  families in which a gay member is completely and lovingly accepted, where his sexuality is no more an issue than his age or his hair color, he is still alone among family members with his feelings about who he is and where he fits into the larger society... He cannot help but know that the members of his family felt a profound sense of loss upon their discovery of his being gay. His being - who he is - saddens his family. Even when a family evolves through a process of acceptance of a gay or lesbian member, they work themselves through the stages of loss and grief, as does the gay family member.

Walker: I would like your ideas on how straight therapists could be sensitive and helpful to the gay person coming out to the straight family...

Sigel: ... The process of coming out starts with a self-awareness... [i]n most cases, gays and lesbians are dealing with so much negativity from the outside world that some amount of shame exists as part of their experience. Managing both their personal and public responses to feeling or being shamed should be part of the therapeutic preparation for coming out to family and friends. Coming out publicly should represent the culmination of dealing successfully with developmental issues.

...

Siegel: When a family member or friend says to a gay person upon disclosing his homosexuality, "I still love you," it generally means I love you despite your homosexuality.

 Walker: ... what you are saying is that you have to be comfortable enough in yourself to be able to deal with the pain of that. Yet I don't know at what point a person is strong enough to challenge the implications of "I still love you."

Siegel and Walker, 1996: 56-57

Pic 2: Two embracing women, Victoria and Albert Museum, London, 2009

I was quite touched reading this conversation between a gay and heterosexual therapist. The quote abstract above summarised well lots of the pain individuals and their families have to go through. I can also see the paradoxical and interconnected positions faced; the closer the gay person is to the family, the higher the need to "come home" (coming out to family), yet the more disclosures were to be made, the more possibilities of both ends experiencing loss and grief. Unavoidably there are influences from the wider context of the family and societal values, often passed down over generations. This is especially apparent whenever conflicting lifescripts (what one defines onself to be) or cultural values and beliefs become the highest level of interactional contexts, eg. a daughter who identifies herself as lesbian whilst her family believes there is only one way for a woman to lead a happy life - marry a man and have children (doesn't this sound familiar? A challenge faced in societies fighting for women's rights and gender equality? The difference though is that even if she were to divorce or remain single for life, she could still be deemed to be better off than  being a single or coupled lesbian). The more one end pushes the other to accept and agree with oneself, the more the other would retaliate or oppose. This is analagous to the equal action/reaction law in Science, or the political fights we see in the world that often results to violence and war. I think this is quite a natural phonemena from a systemic point of view too - for change is resisted if it is perceived to be imposed by "external forces" eg. daughter seeing her family's rejection of her sexual identity as a  heterosexual oppression, or the family labelling lesbian identity as a "Western" influence and not part of an "Asian" culture. Both are very strong positions soaked with strong feelings, so strong that direct challenge or drawing on facts to refute would not shift either end anywhere nearer to each other.

I could still remember how emotional a guy Z was at the private event of IndigNation 2008, Silence and Aching Hearts. Z was saddened by the fact that his parents were still unable to fully accept his sexual identity even after he came out to them many years ago. The late Mr Anthony Yeo and Mrs Juliana Toh, the family therapists on the panel, consoled him that it does take a long time, just like it took him a long time to accept himself; what would be helpful is to focus on building up the relational closeness with them despite their different belief systems. I could fully appreciate their words now; what it takes for change to occur often is to turn the highest level of interactional context from culture/ lifescript, to relationship, i.e. instead of  fighting for the other end to hear you shout "you have to accept me!" focus on building mutual understanding, respect and trust. Not an easy wheel to turn though, as there are often intense feelings that are like rocks blocking the wheel, rocks of anger, guilt, shame, fear, blame, etc. It does not help to add more or throw more rocks at the wheel, at the same time it is often tough for one to let go of these battles, beliefs and feelings.  When the rocks are simply too heavy and too many, could Z and his parents (and many others in similar situations) leave the wheel  behind instead and walk the rest of the journey together? 

Pic 3: Hanoi, Vietnam, 2005. Same-sex love, a "Western" influence, an embedded "Asian" culture, or both?

The next reflection came through a connection I had  in early 2009 with two family therapists in Singapore, which had personally helped me a lot. This may be more of an Asian cultural issue but I suspect it could apply to other cultures as well, especially in this global village where younger generations grow up with multiple cultural influences. Most Asian parents play more of  a “caregiver” role to their children,  providing basic needs and care,  yet many children today grew up experiencing the loss of wanting parents to be  more than just caregivers but “parents” who could share with their children in-depth social and emotional bond.  How much sense does it make for a gay or lesbian person to come out to his/her "caregiver", or the "caregiver" to confront the gay or lesbian person, when their daily interactions  hardly move beyond exchanges about physical health, food and care issues? If "coming home" is inevitable or occur unexpectedly, how could the relationship be elevated beyond caregiving and to an emotionally close and safe level first? Where are the family or community cushions that could one party or both rest on while both ends grieve and heal? Could love be embraced despite differences and persistent familial and societal prejudices? Do family therapists and other helping professionals see a role in improving our compassion, sensitivity and competency in working through these challenges with our clients and patients?

- written on 13 Aug 10, edited on 3 Oct 10

Pic 4: Brighton Beach, UK, 2010. Just as Dr John Corvino said, could we judge other people not by who they love, but whether they love?

References

Connections. In: LAIRD, J. & GREEN, R.-J. (eds.) Lesbians and Gays in Couples and Families. San Francisco, California: Jossey-Bass.  (Siegel and Walker, 1996)

New Stories about Personal Agency

Reading Freedman and Combs (1996) reminded me of my days as a volunteer counsellor, how I felt powerless whenever I encountered clients who talked about problems that were not within their locus of control, eg. societal perspectives about homosexuality, what kind of parents they have, etc. I would always try to get them to see how pointless it would be to focus on what is beyond their control and look at what is within. Reflecting back, I had probably made them feel belittled or small. Now I could see that there is never such a clear distinction between what is internal and external locus of control; they are interconnected in multiple ways. In fact, having clients who externalise problems is a good opening space for exploration of how they could deal with the problems as a separate being, eg. the "society's problem" rather than "I am the problem". 

There have been people (including myself) wondering how systemic is Narrative Therapy when it often favours stories from one person's perspectives but wait a minute, isn't the very act of helping a person externalise the problem an approach that work with the person and problem as if they are two separate members of a system? I think this is the same argument for working systemically with an individual - exploring his inner world and this relationships with the outside world.

I think Coordinated Management of Meaning (CMM) goes an extra mile. It not only look at stories from a person's perspectives but also from how stories are formed through the social interaction between two or more people. This implies that the moral positions and sense of responsibilities to the stories told through a therapist-client conversation could evolve overtime. Both Narrative and CMM models see that the very act of speech is itself a commitment of seeing or doing things in a different way.

This thought bring me back to the impact of the final group supervision I participated end last month. It was a closure session for the Children Mental Health family therapy clinic that was terminated. During the session I asked - couldn't we manage the challenges ahead by being flexible and versatile? Being in an environment that lacked understanding and support of family therapy and systemic practice, we could continue to practise what we believe in and be the ones to nurture and influence others, in hope that in the near future attain a ripple effect?* Group supervisor's reply was that the problem with being too flexible is that overtime, our passion and ideas would be washed away by other people. I felt quite perturbed by her reply then. Days after, her answers began to make sense to me. I remember the days when I first started my first direct social work full-time job working with at-risk and offending adolescents and their families. How enthusiastic I was in believing I could make a difference. To date I do believe that I had made some differences, yet a larger part of me, overtime, simply adapted to the system, or should I say, was recruited to become part of the muddle?

Through the supervision conversation, I felt our group supervisor had helped to pull us together to a balanced position. I will bare in mind my key takeaway - the need to keep a semi-permeable boundary; to continue to keep like-minded people close at heart to co-construct empowering stories for ourselves and our clients, yet at the same time stay in contact with the not so like-minded ones to keep in touch with the contextual interactions and events. Whether or not this constellation of interaction makes a difference at a wider context, I believe is a matter of time. 

* Recently read the 110th issue of Context, Aug 2010 and understood that that the essence of systemic practice is to cross-fertilize such practices to other colleagues or settings such as social care, education, etc. 

References

FREEDMAN, J. & COMBS, G. 1996. Questions in Action. Narrative therapy : the social construction of preferred realities. New York ; London: Norton.

Strange Loop

Find this quote really apt in describing many great divides within individuals, groups and the wider societies when it comes to issues pertaining to  social issues such as racisim, terrorism, censorship, sexuality, etc, issues that are often interconnected with one or more of the Social GRRAACCEESS, i.e. Gender, Race, Religion, Ability, Age, Class, Culture, Education, Ethnicity, Sexual Orientation, Spirituality (Burnham et al, 2008):

"The strategy that members of the community used for managing experiences of discomfort was one of enacting a feeling (of fear) rather than speaking about it and exploring (and developing its meaning). This fragmentation precipitated a strange loop of oscillating encounter and withdrawal. The fear that was associated with encounter was thus temporarily but not permanently disposed of... The difficulty was connected to a problematic shared belief that conflict was problematic... fear of a lack of shared vision had meant that discussion at the level of vision and strategy never took place in any grounded way. Behaviours that seemed to indicate extreme differences became feared as representative of divison and incommensurability; fears bred more fears."

quote and diagram (Oliver, 2004:132, 138) 

It resonates a lot with the Milan Team's and Bateson's idea of paradox/ doublebind and Motivational Interviewing ideas of ambivalence and contemplation. 

When would individuals, groups and societies put aside fears and blames? I believe it will take a critical mass of people to come together working towards a common stake (Tan, 2005). Love this quote too, "Focusing on ones own vulnerability makes one more attractive to the other and paradoxically helps to build strength." (Oliver, 2004:136). 

References

OLIVER, C. 2004. Reflexive inquiry and the strange loop tool. Human Systems: The Journal of Systemic Consutlation & Management, 15, 127-140.

Burnham, J., Palmab, D. A. & Whitehouse, L. 2008. Learning as a context for differences and differences as a context for learning. Journal of Family Therapy, 30, 529-542.

Tan, C. K. 2005. Loving Myself Workshop. Singapore: Oogachaga.