IS THIS A SIGN OF EMPATHY?

] The other day I came across a notice written by a well-intentioned occupational therapist for an elderly and forgetful patient.  It said: “HAVE YOU GOT YOUR WALKING STICK?  YOU NEED IT TO WALK SAFELY!”  It was not only in capitals but they were an inch high. Black. And filled an A4 page.  The notice shouted. It was meant to go inside the front door to make sure she did not go out with this safety aid.

The intention, I felt, was better than the execution.  Too many words to read. Too many for anyone, let alone someone whose focus and retention is not what it once was.  Too much type.  Too black.  And what’s with the exclamation mark?  To make this little lecture seem light and jokey?

At the other extreme, my favourite road sign in the world is the one you would see if you attempted to join the wrong side of a dual carriageway in Australia. It says: “WRONG WAY. GO BACK.”

I find these two messages symbolize for me good and bad empathy.  The writer of the first showed she had no idea of the inside world of an elderly person forgetful enough to need the reminder (and also now probably constantly being told what to do.)   Empathy would have boiled it down to something much easier to absorb.  Like maybe “Got your stick?” Not only easier to get but being reminded would be so much more likely to land than being told, yet again, what to do.

“Wrong way, go back” on the other hand displays excellent empathy because it gets it that a driver has only a few seconds to absorb and act on what could be a life-or-death message.

One of the hardest things to teach new therapists is empathy.  Often there is a natural abundance of compassion which is what has drawn them to wanting to do therapy in the first place.  But empathy is not compassion.  Compassion is caring about others.  Empathy is the (intention and) ability to get into another’s world.

When I am training therapists-to-be and they say something like: “I want to specialize in anxiety because I have had a lot of it and know what it is like” my heart sinks.  Having had anxiety oneself might be good for compassion but it is not for empathy.  We are not and should not be a reference source for our clients’ experience, only for our own. To find out about theirs we ask them.  And then listen.

Empathy comes when we forget what happened to us and focus on discovering what happened to someone else. And how they experienced it.

We know that empathy, as perceived by the client, is the best predictor of therapy outcome.  Which is to be expected.   Therapy, I  believe, involves doing our best to get into the shoes of the person we are working with and working with them in their world, not bullying them or dragging them or seducing them or cajoling them or shaming them or I-am-the expert-and-I know-besting them into ours.

It is for us to help them find their own answers.   As soon as we find ourselves tempted to impose ours it is time for us to remind ourselves: “Wrong way. Go back.”

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GIVE A DOG A GOOD NAME

I have always loved the way when someone clears a bunch of negative emotions they do not just feel different on the inside. They also find people responding differently to them.  It is one of the truly encouraging things about therapy with clients or on me.   You cannot change other people.  But it is surprising and delighting how much changing yourself seems to have changed others because they are reacting so differently to you.

It reminds me of the experiments I read about way back when I was a psychology student in which children started with new teachers with deliberately incorrect assessments from their old ones. Those whose new teachers thought they were doing better academically than they actually suddenly did better.  And the ones who had arrived with a “bad” report mysteriously saw their usually good grades fall.

I have recently had my own experience of what happens when you give a dog a bad name.

My central heating system broke down and I had to do the whole call centre queueing, clicking and switching various things under instruction on the phone twice, and finally waiting for an engineer to call.

I could not quite believe how polite the call centre people were.  I had this weird feeling that they were being almost too polite – though it seemed churlish to even think of thinking it. The first offered to wait while I went knocking on neighbours’ doors in search of an impossibly short screwdriver.  A second walked me through an even more extensive series of checks and kept thanking me for my patience and cooperation. I wondered why.  I had more to gain from being patient and cooperative than she did.

When the engineer was leaving next day, he showed me the job description on his handheld. It had a footnote that said:  “Client is rude and abusive.”  He had arrived in trepidation and found me so much not so he thought I should know what was on the system about me.  “It must be a mistake, “he said. “You must get them to correct it.”

Suddenly the penny dropped.  After the system was installed about 18 months earlier, I had to make an appointment for an inspection.  For weeks I got letters saying if I did not arrange it soon the warranty would be invalidated while I was spending hours on the phone trying to get through to arrange the inspection.   As I held on hoping to be answered eventually, I listened to the promise that emails were always answered within 48 hours so I sent a lot of them, too.

When I finally got an appointment and had to stay in for a 12 hour time slot for the engineer to come, he didn’t.

It was when I rang to ask why not and what would happen now, I struck someone so indifferent and unhelpful that I think the client did become “rude and abusive. “

So I complained about the label on my file and got an apology, and assurances that it had been removed and that call centre staff had been “reminded” what they could and could not record about clients.  “Needs extra time to answer the door” yes. “Client is rude and abusive” no.

But it really was an eye-opener to experience the treading-on-eggshells response I had got from two different people in the call centre not to my being rude and abusive but to label that led them to think I just might be.

And it reminded me how therapy enables that to happen on the inside. When we use EFT to change the writing we have about ourselves on our own walls it does somehow communicate itself to others.   Change it and we change the way others see us and respond to us and that makes us feel even better…  A blessedly virtuous circle.

WHY NOT TAP ON GRIEF?

I don’t often read a book that catapults me into as profound a rethink as The Truth About Grief has.   It is not a particularly riveting book.  It will never make it on to my top 20 greatest reads.   But it is making me question how I ever came to accept Elizabeth Kubler-Ross’s stages of grief as if handed down from above on tablets of stone.

One reason, I suspect,  is that before I encountered them as a therapy student I had already absorbed them through the pores of my skin. They have become part of our culture.   And then later, when EFT became the core tool of my therapy, I made decisions about whether/when tapping was appropriate for grief on the basis that that description of grief was a prescription – that it was normal and inevitable and to be messed with or missed out at our peril.  I thought it was fact, not merely belief.

And I also taught that.

So when I was in the gym and stumbled across an old BBC podcast on my iPod in which author Ruth Davis Kongsberg was interviewed about the lack of evidence for Kubler-Ross’s stages of grief and about more recent evidence that actually discredits them, I was online to Amazon to order her book quicker than you could say “workout over.”

Kubler-Ross’s original book was about how the dying face death, not how those left behind deal with it.  It grew out of unstructured interviews with terminally ill patients – not necessarily a sound methodology because not everyone is asked the same questions and questions reflect the questioner’s bias rather than the interviewee’s experience.  Kubler-Ross was initially more interested to understand better how the medical establishment dealt with death than how the dying, let alone the bereaved, did. That all came later.

It became a book when an editorial assistant at a publishing company, which had recognized a gap on its list for a book on death, read an article she had written and offered her a deal. She had three months to deliver.  And, in her autobiography, Kubler-Ross said it took her three weeks of late nights struggling to formulate a concept.  Then it hit her she said  – everyone who faces a loss including her dying patients went through the same stages.

The trouble, as I am now seeing it, is:  a) the stages getting to be seen as gospel  b) not just for the dying but also for those left behind c) and then for all losses including jobs and contact lenses d) giving rise to a culture, especially among professionals, that people need to go through these stages or they will be sorry later.   And it follows that e) if we professionals intervene, other than to listen and tell them what they are experiencing is normal, we do so at their peril.

In fact, Kubler-Ross never put her theory to any test.  She did not do research and have it published in a peer-reviewed journal.  She never pointed out that her theory was about how people faced death, not how those left behind coped with it.

In an interview with Playboy magazine in 1981 she said: “Even though I called it the stages of dying, it is really a natural adjustment to loss. Some people go through it if they only lose their contact lens.”

So where am I now?  I retain some old certainties.   When a death is traumatic, using EFT to process the trauma can be an extremely helpful way to move someone from the shock of the trauma to whatever comes next for them.  That has not changed.  And if grieving is unusually prolonged and disabling and the grief-stricken person wanted help I have never had reservations about tapping with them.

But the territory in between, the time I believed people needed to go through this “natural” process with support but without interference, is now a big question mark for me.   If there is no evidence for the validity or universality of the stages and there is no evidence that there will be detrimental effects of people do not go through them, why not just tap on what people are experiencing and want not to, just as we would with any other client?

My rethink is freeing me up to think it is okay to follow the philosophy I have always had with all clients – with the single exception of this group  –  that my job as a therapist is to get into the world of the client sitting with me as much as I can and work out together what would be helpful for them.

It doesn’t mean people will not grieve, that they will not continue to miss the person who died for the rest of their lives. It does not mean that sadness will not keep coming back from time to time for a long time, and possibly for as long as they live.

It just means that I no longer feel that bereaved clients should be deprived of the benefits of EFT just because they are bereaved, or therapists constrained by a belief about grief that an author dreamed up to meet a publishing deadline all those years ago.

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I have had some amazing experiences of working with someone on the memory of an accident and discovering that pain they had had for years thereafter has suddenly and seemingly inexplicably gone away.  Some have been demonstrations at workshops. Some have been private sessions. One recorded on one of my DVDs, is a woman who had had mega back pain after falling off a horse decades earlier.

I am intrigued about how this happens. So I was really interested to read that Professor Vania Apakarian at the Northwestern University in Chicago had investigated the link between chronic pain and the emotional response to the injury that caused it.  What Professor Apakarian found was that in the year after injury causing back pain, emotional response to the injury seemed to influence who did and did not tip over from acute to chronic pain which persisted after the injury had healed.   What particularly interested me was that this was not emotion as reported by the subjects on a 1- 10 scale as we use in EFT but neurological activity picked up in a succession of brain scans over that time.

It reminded me of some studies that challenged the conventional physical explanations for chronic back pain.  Doctors often tell patients that damage to discs or other spine structure problems  are causing their back pain. Yet in one study, it turned out that two-thirds of people who have never had serious back pain have the same sorts of abnormalities or damage.  And whether people continue to have back pain after surgical repair does not seem to correlate at all with the success of the surgery.

I also remember years ago hearing Bob Tinkner talking about his work with people who had long lasting whiplash following road accidents. He found that if he used EMDR* on the memory of the accident the whiplash just went away. Did people tense and freeze at or a millisecond before impact and unconsciously decide it is safer to stay braced that way?  Bob is just one of a number of people who have been trying to unpick the psychological from the physiological elements of whiplash.  (The thriving industry in suing for whiplash after traffic accidents is another story.)

So how does doing EFT on a trauma memory get rid of pain that has been around for years?  I cannot pretend to completely understand how this happens. But I have some clues.

Professor Apakarian did not get involved in what emotion people had about their accidents but he did show that the continued existence of negative emotion was relevant.  From my own work with people who have had accidents and still have pain from them the emotions have typically included fear, anger with the person they felt was responsible, anger (with or without an urge to self-punishment) with themselves, anger or sadness about the consequences for themselves and other people.  Sometimes the emotions were not about the actual accident but about something that was said or done, or not said or done, afterwards. When these emotions are cleared people are often also free of on-going pain or have it greatly reduced.

The thing is people often do not realize they still have the emotion until EFT puts them in touch with it.  Doing EFT might start with working on something like seeing the headlights of a vehicle closing in, or the metallic sound of the impact or some aspect of the incident itself and only after tapping on that does the unconsciously stored emotion emerge and make itself available to tapping.

That is what I so love about EFT. It always seems to know where to go….Image

How do you do that?

That’s the wonder …

I have had some amazing experiences of working with someone on the memory of an accident and discovering that pain they had had for years thereafter has suddenly and seemingly inexplicably gone away.  Some have been demonstrations at workshops.  Some have been private sessions.  One recorded on one of my DVDs, is a woman who had had mega back pain after falling off a horse decades earlier.

I am intrigued about how this happens.  So I was really interested to read that Professor Vania Apakarian at the Northwestern University in Chicago had investigated the link between chronic pain and the emotional response to the injury that caused it.  What Professor Apakarian found was that in the year after injury causing back pain, emotional response to the injury seemed to influence who did and did not tip over from acute to chronic pain which persisted after the injury had healed.   What particularly interested me was that this was not emotion as reported by the subjects on a 1- 10 scale as we use in EFT but neurological activity picked up in a succession of brain scans over that year.

It reminded me of some studies that challenged the conventional physical explanations for chronic back pain.  Doctors often tell patients that damage to discs or other spine structure problems  are causing their back pain. Yet in one study, it turned out that two-thirds of people who have never had serious back pain have the same levels of abnormalities or damage.  And whether people continue to have back pain after surgical repair does not seem to correlate at all with the success of the surgery.  There seems to be much more going on than physiology here.

I also remember years ago hearing Bob Tinkner talking about his work with people who had long lasting whiplash following road accidents. He found that if he used EMDR* on the memory of the accident the whiplash just went away. Did people tense and freeze at or a millisecond before impact and unconsciously decide it is safer to stay braced that way?  Bob is just one of a number of people who have been trying to unpick the psychological from the physiological elements of whiplash.  (The thriving industry in suing for whiplash after traffic accidents is another story.)

So how does doing EFT on a trauma memory get rid of pain that has been around for years?  I cannot pretend to completely understand how this happens. But I have some clues.

Professor Apakarian did not get involved in what emotion people had about their accidents but he did show that the continued existence of negative emotion was relevant.  From my own work with people who have had accidents and still have pain from them the emotions have typically included fear, anger with the person they felt was responsible, anger (with or without an urge to self-punishment) with themselves, anger or sadness about the consequences for themselves and other people.  Sometimes the emotions were not about the actual accident but about something that was said or done, or not said or done, afterwards. When these emotions are cleared people are often also free of on-going pain or have it greatly reduced.

The thing is people often do not realize they still have the emotion until EFT puts them in touch with it.  Doing EFT might start with working on something like seeing the headlights of a vehicle closing in, or the metallic sound of the impact or some aspect of the incident itself and only after tapping on that does the unconsciously stored emotion emerge and make itself available to tapping.

That is what I so love about EFT and why I so love teaching it. . It always seems to know where to go….Image

*EMDR is eye movement desensitization and reprocessing.

I have been pondering on what Mindfulness actually is.

The evidence that it is something we should be taking very     seriously is so convincing.  It has had such amazingly good outcome results I don’t think any therapist can now ignore it.   Doctors who do Mindfulness meditation burn out less than those who do not.  Mindfulness reduces the symptoms of Irritable Bowel Syndrome and of Multiple Sclerosis.  It helps with pain management.  Breast Cancer survivors who use it have less depression, less fear the cancer will return, and higher energy.  I could go on…

Studies at UCLA and Harvard show there are actual structural changes in the brains of people who practice Mindfulness meditation.  For therapists, it is particularly seductive that those changes are in the parts of the brain we need to support empathy with other people.

Outcome and neurological research have combined to convince me that I want some of this and I want my clients to have it, too.

So I have been trying to find out more of what it is and whether everyone means the same thing by it. And I have put a short new getting-started mini Mindfulness audio on my website www.judybyrne.co.uk (right down at the bottom of the home page.)  It is less than seven minutes long.

I had a model in my head of using Mindfulness meditation to discover how to regulate my attention and my emotions and to be aware of who I am and what my body is experiencing.  And that, as well as using meditation, doing things mindfully, with a present moment awareness of exactly what it is that I am doing, and what I am experiencing as I do it, as a part of the path.

Mindfulness guru Jon Kabat-Zinn defines it as: “paying attention in a particular way: on purpose, to the present moment and without judgment.”  Trauma expert Pat Ogden says it paying attention to particular elements of internal experience (body sensation, movement, emotion, five-sense perception, cognition) considered important to therapeutic goals.

In pursuit of a deeper understanding of what it is and how to incorporate it into our work, my EFT training colleague Richard Mark and I recently went to a workshop on Teaching Mindfulness to Clients and I have been digesting it since.  At times it challenged my working  definition or Mindfulness.  It seemed to be difficult to separate it from CBT.  And it has, of course, become big in CBT circles.  One particular demonstration that seemed to blur the distinction in my head was having an agitated client retell what had upset her in a completely factual way.   No comment. No feelings. No judgment.   Just the facts.

I have just had the chance to try it on myself.   And I must say the effect it had did surprise me.

It began in the supermarket car park when I pointed out to a young woman with no blue badge that she had taken a blue badge space and there were no disabled parking spaces left free for people who needed them – like a man I had just watched get out of his wheelchair, stow it in the boot, and get himself into the car.  She did not think it mattered because there were plenty of other spaces free. She did not get it that disabled parking spaces are not just near the door.  They are also wide to accommodate people who need to open car doors wider than the rest of us to get in and out.   I am not sure how she failed to get that because her justification for using the space was that she needed a wide bay because she had a baby to get in and out of the car.

I showed her that there was parent and child parking and where it was.  She switched from : “How dare you speak to me like this when I have my baby in my arms” to being extremely personally insulting.  And when her partner came out of the supermarket, she redirected her abusive rant about me from me to him.   She left me feeling extremely shaken, angry, and with all the things I stopped myself saying running round and round my head. As they do.  (Especially this bit: Her “How dare you speak to me about this when I have my baby in my arms.” Me: “ I don’t think your baby would have had any idea what I was saying in a quiet and quite measured way but your baby has certainly picked up the feelings of your rage as you scream at me.” )

I tried imagining tapping while I shopped.  Since I had no list and was menu-planning and buying for on the hoof, it was not easy to do both at the same time.

So driving home, I told myself the story out loud in a completely factual way. I really felt so much better.  I could actually laugh about one bit of it.

My lessons?  Whether I would call this Mindfulness or CBT or telling the story Mindfully and therefore either or both I don’t know –  but it worked for me.  I am glad I had had a shower mindfully before I went.  Otherwise I might not have thought to try it.

And if I see anyone else taking a blue badge space they are not entitled to I will say something again. Mindfully, of course.

MINDFULNESS – WHAT IS IT?

This time they’ll find me out

I see a lot of clients who would rather have their fingernails removed one at a time than make a presentation but who perceive that all possible promotion is being removed from their futures by the fact that they cannot. Their current job may even be under threat.

I have always thought (and taught) that it is a cardinal mistake for a therapist to think: “I know what that feels like. That has happened to me.”  Something similar may have happened to us but we never have any idea how it feels for someone else and the only possible  insight, such as it is,  comes from really listening to the clients, not from using ourselves for reference.

So the fact that I like presenting doesn’t make me feel disqualified from working with people for whom it is an ordeal.  But if I want to tap into my empathy,  I have only to think of my  own dysfunctional relationship with my DVDs and recordings.

I found myself a little while ago accidentally watching again the first EFT DVD I made.  It was filmed at my presentation at the first-ever EFT Masterclass in London in 2006. I had mixed feelings about it when I saw it again.  (Could have been better/better than I thought.) And  I was surprised how relaxed I was in front of the camera.  It didn’t throw me even when  a bit of microphone went down my trousers.   It was probably the day I discovered I am actually a ham.

But I hate watching or listening to myself afterwards .  When I originally got that first DVD,  I tapped and tapped and put it off and tapped some more.  It was weeks before I watched it.  I am still a work in progress on this.  I still dread seeing or hearing myself . It took me an age to look at my three DVDs on using EFT in Therapy and Healing the Past with EFT, even though I had had a ball making them with a great bunch of EFTers at Studley Castle in Warwickshire.  More tapping.  And still more when I got the DVD of Working with Trauma from my presentation at the 2009 EFT Masterclass.

Which is why I was anticipating the recent Innovations special weekend of free audios on the EFT Hub with mixed feelings.   I was really looking forward to listening to the other six Masterclass presenters (EFT Masters Jaqui Crooks, Ann Ross, Sue Beer, Emma Roberts, Tania Prince, and Gwyneth Moss). I was really dreading listening to myself.  I might be boring or inept or irrelevant or dull.   This might be the time I really get found out.

And now the recording is available again, free, on the Masterclass 2011 website http://www.eftevents.com .  All seven are.   Go there now to listen or to book or both.   The Masterclass is in York on October 22/23 and the early booking price lasts only until the end of August. I am really looking forward to presenting there.

But excuse me now.  I have to start tapping about that audio again.  I was just up to:  “Even though they might find me out …“