On Kindness

Today Not a Guru (NaG) is excited to collaborate with Psychological Wellbeing Practitioner and educator, Natalie Hanley. Natalie  has been doodling self care tips since 2017. She set up a social media account Tidyminddoodles on Instagram and Facebook in 2016 and 1 month ago  started a self care in lockdown YouTube channel to help key frontline workers as well as members of the general public to access simple self care tips  during lockdown/ the pandemic. 

The words below are from NaG, the beauty is from Natalie!

I’d worked as a Psychological Wellbeing Practitioner(PWP)/Low Intensity Therapist (LIT) for a few years before I was given permission to talk about kindness in IAPT. In 2013/14 (ish) we were one of the pathfinder sites for Long Term Conditions and Persistent Physical Symptoms adaptations in IAPT services across England. A local team of clinical and health psychologists were attached to our IAPT team to support us to adapt our interventions, as well as providing additional supervision and training. We worked with them to develop two Low Intensity psychoeducation courses, one for chronic pain, one for generic long-term conditions. In session four of the pain course, we came to slides on ‘Self Compassion’. 

In my time in IAPT I had never spoken about kindness, let alone self-compassion. How did it fit? Was I drifting? What on earth was I supposed to say? A big bit of me didn’t care. As I read Paul Gilbert and the slide notes that the clinical psychologist had written, I knew that these ideas were central to the practice of low intensity psychological therapies, it made sense of everything.  

Contrary to popular belief and hope, people don’t usually come running when they hear a scream. That’s not how humans work. Humans look at other humans and say, ‘Did you hear a scream?’  

Sir Terry Pratchett in Unseen Academicals

The years went by and our work, and my experience, progressed. We kept those slides on kindness in our courses, I spoke about them in training sessions, wrangled for them in clinical governance meetings. When we hit on a “final” version of the slides and material my manager gave me a stern look. ‘We don’t talk about compassion focused therapy, there’s no evidence base at step 2. This is just about basic human kindness.’ Brilliant! We needed to be able to talk about this fundamental human need without forcing it into some kind of pseudo-scientific model (with heartfelt thanks to the CFT folks for doing the work that gave kindness enough validity for IAPT to include it!). It really didn’t matter what we called it as long as someone in an NHS badge spoke to people who were enduring suffering and told them it was OK not just to address the content of their automatic thoughts, but to consider how they felt and spoke towards themselves, and to do that with kindness. ‘The NHS says it’s OK for you not to beat yourself up’ I’ll half-joke when I facilitate cognitive restructuring. The patient will snort-laugh, and you feel something in them ease.  

‘Compassion is a willingness to notice the suffering of yourself and others, without judgement, and with a deep commitment to try to relieve it.’ I copied into a self-help handout. When we spoke about it on the psychoeducation courses people’s faces would freeze in fear of being selfish. We teased out the difference between self-pity, self-indulgence, selfishness, and self compassion.  

‘Finding things difficult, making mistakes and being in pain don’t make you less acceptable, they don’t mean that you’ve done something wrong, it doesn’t mean that there’s something wrong with you; it means that you’re human… Even if you could perfectly balance your thoughts to make them realistic and not distorted, if your attitude towards yourself is blaming, judgmental and demanding, what effect will that have on what you do and how you feel?’ Just a few simple phrases that made the ideas and techniques that we offer accessible and, more importantly, that relieved knots of suffering which our patients had carried for years.   

Most of the longer-lasting LITs who I’ve met find a fun balance between a geeky interest in the theory behind our interventions and genuine human kindness; that willingness to notice and relieve suffering by standing alongside and equipping someone with new tools. When that balance is held, the interventions stop being demanding, mechanical and manualised, they start to live and breathe for the person who is learning them for the first time. In turn this makes interactions more rewarding, and the interventions more likely to work, which makes doing the job a joy.  

IAPT tends to be bad at making it OK to be kind to ourselves. The intention and aims of the IAPT programme are exciting and important. We want to make it easy to access effective and high quality psychological therapies that have got a good chance of relieving the suffering caused by depression and anxiety disorders. That’s something that I’m very proud to be part of.

‘sin, young man, is when you treat people as things. Including yourself. That’s what sin is.’ 

‘It’s a lot more complicated than that-’ 

‘No it ain’t…People as things, that’s where it starts.’ 

‘Oh, I’m sure there are worse crimes-’ 

‘But they start with thinking of people as things.’

Sir Terry Pratchett in Carpe Jugulum

Despite the admirable aims of the IAPT programme, the way that it is implemented is often unkind. There are ways to talk about the IAPT standards (access, recovery and waiting times) that acknowledge the human experience that they represent. I was inspired by Lizzie Gray, Low Intensity Lead from Health in Mind, Sussex, who spoke eloquently at an IAPT National Networking Forum event last week about the importance of connecting with the meaning behind the numbers. Lizzie in turn acknowledged the work done on this by Kevin Rozario-Johnson of the same service.

The standards require that someone with depression or an anxiety disorder who comes seeking help should be seen quickly, should not have to wait more than six weeks for treatment to start, and should have at least a 50/50 chance of being better at the end of treatment. These are admirable goals, as a patient we would want that to be our story. How this works for a Low Intensity Therapist on the ground is that there’s nowhere to hide from frequent comparison of us and our work to a huge dataset and numerical targets that can feel arbitrary and unrealistic. Depending on how the local conversation is held around targets, individual recovery rates of the required 50% don’t always feel good enough. There is a sense of shame when we don’t measure up. A LIT can feel powerless to change the factors that might affect their recovery rate, like the suitability of referrals to the service and the number and frequency of sessions that can be offered. The opposite of kindness is a judgmental, measuring, comparing, blaming, demanding attitude, and that is often how the standards are communicated.

 A Low Intensity Therapist/PWP offers empathy to people who are in real difficulty, people who often suffer profoundly. We engage directly with that suffering and come alongside; we equip people with ideas and support them to use those ideas to make changes. Even on the days when we want to, we can’t escape from the suffering that we encounter and navigate through to do our work.

‘The Librarian was not familiar with love, which had always struck him as a bit ethereal and soppy, but kindness, on the other hand, was practical. You knew where you were with kindness, especially when you were holding a pie that it had just given you.’  

Sir Terry Pratchett in Unseen Academicals

In the pandemic all of that difficulty and suffering is being encountered in the same space where we are expected to recover from it. If you haven’t already, please read James’ post on resilience in the blue link. Resilience is your ability to bounce back after the bad thing has stopped happening. In the short evening and weekend hours we’re expected to bounce back while cut off from many of the things that we love and value. Not everywhere, not all of the time, but too often over the years I have seen and heard many LITs tell their managers about struggle and difficulty that is caused by work, only to be met with blame (other people are managing so you should do something differently or better), impatience (we haven’t got time for this/not this again), fear (we need you performing efficiently or the service wont meet it’s targets) and more demands (try harder). That isn’t even the first step towards compassion (being willing to notice suffering). Very often it would be powerful and effective if difficulty was reported and the response was ‘This is a tough job and things have been really hard for you’. How much difference an acknowledgement would make.

Of course everyone has got a responsibility to look after themselves, I don’t mean to imply differently. Tools like a gratitude log or a journal where you record the moments that were successful, that you are proud of, can help. Good sleep and good food… It does help to keep up self practice of the Low Intensity interventions and maybe go easy on the booze if that’s starting to feel like the only way to cope. I know that I’m preaching to the converted, I’ve never met a LIT/PWP who was lazy about self-care. Above all, be kind to yourself, let go of demanding expectations and know that it’s OK to be imperfect, everyone is.  

The ingredients of self-compassion

• Mindfulness: paying attention on purpose to the present moment without judgment
• A sense of common humanity: remind yourself that you are one of the people who you work with, no different to your patients, or your managers!
• Kindness: be gentle, be generous and considerate towards yourself.

Allowing those for yourself can be difficult, but it is essential.  

Thank you for reading this post and for your interest in Low Intensity Psychological Therapies. If you would like to support the blog with a contribution towards web hosting and gifts for guest bloggers you can now donate from £1 at https://www.buymeacoffee.com/notagurublog