Author Archives: Admin

Do you care!? The importance of looking after yourself

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selfcare

I saw this image above last night on a friends facebook feed and loved it. I think it’s absolutely right. How can you take care of others if you are not taking care of yourself. If you’re stressed and frazzled, feeling lethargic and tired, feeling snowed under with stuff to do, how on earth are you going to ‘be there’ ‘in the moment’ with the people you are trying to support? You will be distracted and you won’t be delivering the best service you can. And if left unattended this will lead to self doubt, anxiety and stress.

You need the tools to be able to do something about this. I’m not sure professional training programmes and employers adequately teach people how to self-care. Yes, I hear about some employers running a session on mindfulness from time to time but I don’t hear of trainers and employers routinely teaching students and staff how to self care.

And you know what…. it’s not rocket science! But…. it is science. Advances in how we can observe the brain in action have led us to understand much more effectively how we work and therefore what we can do about it. You will already know all of these things but may need reminding or may not be fully aware of the importance of them.

Here’s a flavour of a few things that help support your psychological capital so that you can be productive and do a good job. I’ll start with the thing that me posting the above image led to a conversation about…..

Take a break
I can’t stress enough the importance of taking a lunch break! Never mind your legal right to one (which you have!) the impact of not taking a lunch break is significant.  There is evidence that says that simply by taking a 20 minute break away from your desk at lunch time and eating something healthy or maybe going for a short work will improve your productivity in the afternoon. You will get back more than the 20 minutes you might feel you are losing in improved functioning and improved concentration. Also, you’ll be less irritable. This is a win, win, win! A win for you because you’ll get more done and feel a whole load better, a win for your employer because you’ll get more done and you will alleviate some of the symptoms of stress which may well lead to reduced sickness, and it’s a win for the service users you are working for because you’ll be more focussed on them either face to face or in the work you are doing on their behalf in the office. A report in the Telegraph states that those who are most productive take a short break about every hour!

Exercise
You can use your 20 minute lunch break to go for a walk! If you want to improve your well being through exercise you may be surprised at how very little achieve’s a great deal. I’m not talking about you becoming a gym bunny! I’m talking about some regular moderate exercise. Research has shown that one single 20 minute exercise session (and that could just be a brisk walk) leads (in the short term) to faster cognitive processing, more effective planning, better short term memory, and more effective self control. Bristol University research showed that some exercise before work or at lunch time boosted mood by 40% and the ability to deal with stress by 20%. These things are a ‘no brainer’. Short and regular maintenance improves your outcomes!

Self Management
Being organised makes you feel more in control. I use something I learnt on a speed awareness course as an analogy here (I know I know Speeding is bad! I’ve learnt my lesson). We were told on the course that the three things that cause car crashes are speed, space and surprises. [More on this here]. And I think we can use that to think about Person Crashes! If we are hurtling along at break neck speed without taking stock then we will eventually crash. Something will go undone, or a deadline will be missed. Having a routine that makes you look at what’s to do on a daily basis will help avoid this. We need space – and I’ve talked about that above. Space to switch off for a short period so we can recharge. Diary in the lunch break. Have a morning routine that gives you some space to prepare for the day. Schedule a coffee mid morning. Find space for you to recharge. And finally surprises! If you are in the right frame of mind because you’ve had space and if you have a trusted system that means you know everything that is to do you will find it easier to deal with the surprises life throws at you. If you are using your diary effectively you’ll be able to see where the space is and use it to deal with that surprise or move stuff into it to deal with the surprise now!

There’s more on this here.

There are other things that I’ll talk about soon – mindfulness, sleep, nutrition, emotional intelligence – to name a few. But… for now…. make a start! Schedule that lunch break! Go for that walk! Trust me! It will help

Stop talking, start listening!

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listen-picAs social workers and social work students we understand, I suspect, the importance of effective communication and spend a lot of time thinking about what we should say and how we should say it. We think about what signals we send through our tone of voice and our body language. But, do we give enough time to listening and thinking about how to listen?

Listening is a physical and cerebral act. We need to engage our ears and our brains. As we physically hear we should be working through what is being said, why it’s being said, and just what does it all mean. All the time thinking about direction for the conversation. Keep all of your plates spinning at once springs to mind! So our brains need to be engaged in the activity and we need to appear present, not distracted, while all of this is going on. Exposure to doing this is really the only way you learn. I work with students from time to time on communication and they tend to leap straight to problem solving before finding out enough. There’s an urgency to intervene, to offer a solution, when often people just want to be heard. Simple? Not really!

Listening attentively is part of demonstrating empathy (but not the whole story!) We are trying to understand what a person means by understanding their position. We are trying to understand how they feel – something I feel we often miss at the expense of trying to get to the facts (I think evidence based practice has kicked intuition into touch at times). We are trying to ‘feel’ with the other person what their experience of reality is and try to show our understanding by feeding some of it back to them to confirm or develop our understanding. You can also show this non verbally through your facial expressions and body language.

You can never fully understand how the person feels and what they are experiencing but you must try to get close. As I once read somewhere (and I wish I could find where – if you know tell me!) – empathy is walking in the other persons shoes but with your own socks on! 

As practitioners we can’t always rely purely on our empathetic listening – there’s a tension between empathy and actually generating a direction – we are not simply in conversation – we are in a conversation with a purpose. We need to think, while ‘in action’ how to help a person move forward or we risk reinforcing the persons position having had them ‘tell all’ and simply leave them there. That’s not good! We have to deal, as far as we can, with what we are told. All of this builds up a working alliance, understanding, and trust. ‘Here is someone who is listening and is trying to help’.

 

The tension at times can be that we also need to listen objectively with a certain level of detachment. I don’t like that word but I still think it’s the right word. You have to be there in the moment, in the persons shoes (but with your socks on!) but also outside of the moment to offer that objective view that is also required just as much as the subjective view – or how would we ever get anywhere?

We need to be cautious that our objective view is not fuelled by our own value base and therefore imposes, through any power we may have, or be perceived to have, our way forward. To do this then we need to practice in a certain way. We need to engage in a equal conversation. Avoid phrases, or imparting knowledge that shows a power imbalance. Don’t interrupt but rather wait patiently giving supportive non verbal cues. We need to seek to understand both thoughts and feelings from the other persons perspective guarding against ‘expectant listening where you hear what it is you want to hear filtering out the bits of the message that don’t fit with where you want to take a situation. Don’t filter out things you believe to be untrue or irrelevant but hear them and consider them fully. If someone is telling you something that is not the truth – then why? When working with people with some sort of impairment or disturbance of mind their response may seem irrelevant in terms of what you’ve just asked but may be very relevant in terms of something they are trying to tell you. In these circumstances and others explore what you hear both literally and for underlying messages.

Also, attend carefully to messages the person sends about themselves and how they view themselves. Stereotypes exist not only in our minds but also in the minds of the people who the stereotype is deemed to fit. The media is a powerful thing and people will be acutely aware of how people in their position are portrayed and may well buy into that portrayal. In the way we talk and present we tell others, and feedback to ourselves, just what we think about ourselves. You may well need to unpick stereotypes that are influencing people in how they think about themselves.

So communication is physical and cerebral. We need to engage in both empathetic and objective listening. Most of all, for me, we need to show that we are alongside people and not there to simply ‘do to them’. Talking and listening are both powerful tools!

Frogs, elephants, and the 2 minute rule….

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P1090708I’m writing this on a Sunday afternoon thinking about how many of you will already be thinking of what awaits you tomorrow when you arrive at the office. There are some things that will help that I want to tell you about that take some time to get up and running but what about 4 things you can do first thing in the morning when you get to work that will make a difference straight away! Here’s how…

Apply the 2 minute rule
Hit your desk and look at what’s to do. Make a list if you want to. But, as you are making a list if it looks like it’s going to take less than two minutes to do it just do it – don’t even think about it…. just do it. Open your emails up (I’ve got more to tell you about managing emails another time – but for now…) work through them and apply the two minute rule… just do it if it’s going to take less than two minutes. If it’s going to take longer than that put it on your list or in your dairy. You’ll get rid of loads of emails using this 2 minute rule method I’m sure. Next….

Eat that frog
What’s the worst thing you can think of to do? Well, it might be to eat a live frog. And as this old adage goes – if the worst thing you had to do at the start of the day was eat a live frog, once you’d done it, there’d not be much else in your day that would be worse. So eat that frog! Do the worst first. What things in your email or in your diary are going to suck on your psychological capital all day if they remain undone. Right! Those things! Do them first! Then get to planning what you need to do and….

Eat the elephant one bite at a time
How do eat an elephant? One bite at a time – that’s how! If you’ve got a big task to do then break it down into small manageable tasks. Dairy the tasks – yes – all of them. Don’t just diary when the meeting is, or the report is due, dairy all of the steps that will get you to that point with some time to spare for slippage. Then you’ll be organised and can immerse yourself in the moments where you need to be completely focussed, spending time with a service user, writing a complex report, that kind of thing. Once you have all your ducks in a row so you know you’ve not missed something, once you’ve eaten all of the frogs, once you’ve dealt with all of those little tasks using the two minute rule then…. you can get on with the job.

David Allen, author of “Getting Things Done” says you can’t plan and do at the same time. You must start the day by planning, lining up those ducks, and then you can be productive in your doing.

Come on! You know you can! Positive thinking!

P.s. More on the two minute rule here

The stress isn’t going to go away. So what are YOU going to do about it?

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diarymgmtLet’s start with why did you decide that Social Work was the profession for you? Go on! Write a list! I guarantee somewhere near the top will be to help and support people, to visit people, to talk to people. I bet none of you have written, to write reports, to complete paperwork, to put data into the computer…. Am I right? I suspect I am. So, are the bits you came into social work for causing you the stress…. I suspect not…. I suspect you still get a buzz out of visiting people and talking to people. So…. is it the other stuff!? I suspect it is. Interestingly the people stuff is the hard bit. I suspect you were attracted to the profession because you were good at the people bit. The other bit, the bit that’s stressing you out – managing the logistics of the case load, writing the reports, completing the data input is actually the easier bit. The bit that lots of people could do. You are unique, and the profession is fairly unique because of the absolute necessity of needing particular sorts of people to be in it. My view…. you can’t teach anyone to be a social worker, you can’t teach anyone to communicate effectively, to show empathy, to ‘be there’ with someone. That is largely an innate ability. We can teach you theory, we can show you some skills to develop, we can give you models to inform or intervene (all valuable to you as professional) but we can’t teach you to be the right sort of person.

Ok now we’ve got that out of the way we are left with you. An effective social worker who has a whole load of administrative stuff to manage that often gets in the way of doing the social work. You have to work at this bit. You have to manage it. And I hazard a guess that no one has shown you how to do it. Being organised, getting all of your ducks in a row, is not, for most, and innate ability. We have to learn it. Because if you don’t control the bureaucracy it will control. You will be at the mercy of end dates creeping up on you, meetings appearing, as if, out of nowhere that you have no time to prepare for. Sound familiar. Do you spend Sunday night wondering what is in store for you on Monday morning? Do you spend Friday afternoon wondering what you’ve forgotten to do?

This is all too familiar and I argue that it is this and not the social work part of the job (the bit you came into the profession for) that is causing you workplace stress! Am I right? Well, if I am then we just need a system. We need a system to control all of that stuff that needs to be done, that won’t do itself, but isn’t the bit that you want to do. You need a system that manages this. This system needs to be worked at. It needs to be complete. It needs to contain everything, and I mean absolutely everything, that has your attention at work. Everything that needs to be done. From things that need to be done right now to things that you might need to do at some point.

The ‘art’ of knowing what to do is twofold. You need to know everything that you need to do either right now or sometime in the future so that you can decide what not to do. Knowing what to do is actually about knowing, with confidence, what not to do.

You can’t go past David Allen’s Getting Things Done Methodology for this. I’m not going to lie. It takes a lot of work to get up and running but once up and running, and maintained, as part of your regular routine it will take all of the unknown out of your work that is the thing that leads to the most stress. Crucial here is diary management and some way of recording everything that there is to do. In your diary should be everything you are doing. Not just events like end dates of reports and meetings you need to attend but also time identified for writing reports, preparing for meetings, making phone calls, reading reports. It should all go in your diary so you get a good idea of what there is to do. I use Google Calendar and find that electronic is best here because you can easily move things around as your day and week changes. I use the ‘hour by hour’ section to put in the things I mention above – things that must happen, must be done at that time – and then I use the ‘all day event’ section to put things that I need to do, that aren’t time and day critical, that I might get done today but it won’t matter if I don’t. When I have some free time I look at these ‘all day’ things and do some of them.

Allen says we can’t plan and do at the same time. So organising my diary is done first thing on a morning and the revisited last thing on a night. This means I know what’s in there and I know what I might try to get done time permitting. What I don’t get done simply gets moved into tomorrow. Once a week I have a bigger diary planning session (it takes about 20 minutes at the end of the working week – and I leave work knowing exactly what’s what – all my ducks in a row!) and in this session I go a month ahead and work backwards planning in the time I need to hit the deadline or event that’s in my dairy. So, I leave at the end of the week knowing what there’s to do, when I’m going to do it, and what I’m not going to do.

The jobs I’m not going to do just yet live on a spreadsheet that also gets checked regularly through the week to see if there’s anything on the ‘someday, maybe’ list that has now become time sensitive.

When I’m working through my emails or my notebook everything that has some sort of output that is required by me goes into the calendar, broken down into jobs to do to get to the end result, or into the spreadsheet to be considered later.

What does this mean in terms of my work related stress. Well it doesn’t eliminate it but it significantly reduces it. Allen says your mind is not a storage device. You are not as good at remembering as you think you are. So, you need to externalise all of the things you are trying to remember into your system and then look at your system frequently to be told what to do. Once they are in your system you can forget about them because your system will remind you at the the right time. You plan and then you do – you don’t try to do them both at the same time ….you can’t. I plan on a morning and yes, it sometimes takes me a good while, maybe an hour some days, but then when I start doing I just start doing the things in my diary and in my ‘all day events’. I don’t think about what to do… I’ve done that already… I simply do …and my productivity has gone through the roof and my work related stress has been minimised.

We work in environments these days where we have to accept that we will never be caught up so we need the confidence to know what not to do and therefore, by default, what we absolutely need to do.

Stephen is interested in working with Social Workers who want to implement a work management system based on David Allan’s Getting Things Done principles. If you’re interested in giving it a try and seeing if it helps then get in touch by emailing stephen@socialworkshorts.co.uk

 

Communication – The Impact of Context

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artfofconvCommunication is absolutely fundamental to social work practice. As well as communication taking place between individuals it also takes place within specific contexts. This is about environment but also the contextual framework in which the communication act takes place. Let’s have a look at a range of contextual factors

The Physical Context

This is firstly about the local environment in which the communication act is taking place. So , as social workers this may be in a range of settings. Primarily the majority of face to face communication is going to take place in people’s homes or in an office environment. The advantage of a person’s home is clearly that they are more likely to feel comfortable to an extent. It is their usual environment. Your presence is going to change the impact of that depending on how they perceive you. For example, do they perceive you as a threat to their autonomy, or do they perceive you as an ally. How you approach the initial stages of your dialogue will have an influence here (more on that in a later blog). The physical context can come with some obstacles. The environment may be noisy, other people may be close by which may not help in having personal conversation, it may be very warm or cold. All of these things will have an impact. Try to minimise noise. Ask politely for the television or the radio to be turned off. Suggest moving to the kitchen or returning at a different time for example. From time to time if service users were attending other locations, for example, a day centre, I would suggest meeting them there rather than at home. This may not be as comfortable for the individual in terms of it not being ‘their space’ but may have the benefit of being able to secure a private space for open conversation.

There are other sorts of ‘noise’ that may encroach on the physical context. The person may be unwell, or may have just taken medication that makes them drowsy. The may therefore not be as engaged. People may be hearing and responding to voices which will impact in their focus. The ‘noise’ that comes with the power they may perceive you as having may mean they don’t readily open up to you and only reveal limited information. (I intend to expand on this in a later blog).

Office visits, for me, should be avoided whenever possible. Obviously where risk to your personal safety is an issue then having a service user visit you where personal risk is managed is essential. But where there are safe alternatives office visits, I find, are often not productive. The power balance is shifted very much to you and the organisation and, I feel, people are less likely to relax and engage fully. There is also a lot to be said for seeing people in their own environment. Doing this will give you valuable information and you can use cues around the person to stimulate conversation. Asking about people in photographs was always a great opportunity for me, when working with older people, to find out more about their history and their family.

The Cultural Context

Cultural perceptions of power, position and authority also have an impact on how you communicate with people. I don’t know about you, but I communicate very differently when out for a drink with friends compared to when I’m work. We communicate differently in different settings based on what is expected of us culturally. For example, think of the hushed tones we often find ourselves speaking in when in a church, or the boisterous language used when in the pub. There is a language with goes with different cultural environments. There are colloquial turns of phrase that need to be understood and interpreted, and maybe unpicked, to make sure of understanding. If you are communicating with people in different locations they may expect different things from you or perceive you differently. In a care home, for example, someone may feel they have limited choice as to whether they speak to you or not so may readily agree when really they may not want to, while in their own home, they may well ask you to ‘come back later’. People may feel less empowered to make their own decisions when in the cultural context of the care home where they may feel their personal autonomy is eroded.

The Social-psychological Context

As I’ve already alluded there is a social and psychological status to us as individuals. As a social worker you have a real, and also a perceived, position in society and therefore in the minds of the people you may want to communicate with. Some of this may come with negative perceptions of you based on your position. We assume different roles with different gravity as practitioners. That of social worker, Best Interest Assessor (BIA), Approved Mental Health Practitioner (AMHP) to name a few. And all of them come with different levels of power. BIA’s and AMHP’s have considerable power while social workers may actually be perceived as having more power than they actually have. This can create a barrier if not managed effectively. So, the words you use to introduce yourself, and the manner in which you do so, may help to overcome some of this. Those initial few minutes (some would argue seconds!) are crucial in establishing a level of rapport.

The Temporal Context

This is the communication event’s position within a sequence of other events. “It’s not all about you”, as people are fond of telling me! The conversation you are about to have has been preceded by events for you and will be followed by events for you that you are already aware of. Don’t forget this is the same for the person you are talking to. They may have just had a great morning and be on top of the world or they may have had an anxious few hours waiting for your visit. They may have just received good or bad news, or just had a lovely, or fractious, visit from a family member. You will probably have no knowledge of this so how you initially approach your conversation should bear this in mind and should aim to establish emotionally and psychological how the person is and therefore how you may need to tailor the conversation to their requirements. Also, they will have things happening after your conversation, as will you. This may lead to someone wanting to prolong the conversation or cut it short and both of these things can have a direct impact on the quality of the interaction. No doubt you will have prepared for the conversation but will the other person? You will find you therefore can’t simply launch into your agenda at your pace but will have to effectively judge how to approach the other person.

So, be conscious of how you can best ‘shape’ the physical environment, be aware of any cultural norms that may be having an impact, and be mindful of the place the conversation is within yours, and the person’s, day.

coming soon
‘Noise’ and its impact on communication
The importance of conversational ‘openers’

 

Communication – the bedrock of practice

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comms

Communication skills are the bedrock of social work practice in all situations – when working with service users or their carers, presenting a case in court or at panel, or liaising with other professionals. How you engage, listen, and deliver your message is of huge importance. Words are powerful and body language is powerful. So how you use your communication can make or break a situation, can escalate or deescalate conflict, and can certainly change, for better or worse, the outcome of your involvement with individuals.

Carl Jung says that “The meeting of two personalities is like the contact of two chemical substances; if there is any reaction, both are transformed”. In this quote we see the power of communication. How we communicate can be dependent on our personality, dependent on what we ‘bring to the table’ and how we use it. When two people meet something will inevitably occur and something or someone will change or be transformed. Even if you walk into a room and the other person there ignores you they have told you something in that action and that will impact on what you do next. What you do next will impact on their next response. In this situation the ignoring is a reaction in itself. We can’t help but communicate!

William James offers us this, “A man (sic) has as many social selves as there are distinct groups of persons about whose opinion he cares. He generally shows a different side of himself to each of these different groups”. My first practice educator when I was training told me after my first observed practice, as social workers we are actors on the stage. He wasn’t suggesting that we fake anything but was alluding to the point that in trying to build a professional relationship quickly with someone we need to be who they need us to be. We need to find some common ground through our communication to start to build a relationship, engender trust, and demonstrate empathy. As a simple example, I would sense the broadness of my accent shift depending on the accent of the person I was with. I felt this was reflecting and responding to who they are and showing that we, inevitably, have some similarities. In a sense this was a subconscious reaction on my part bourn out of trying to establish a human, emotional connection.

There is more to communication in social work practice than simply having a conversation. I remember reading the phrase somewhere that it is a ‘conversation with a purpose’. So, what is that purpose?

Well, firstly we should endeavour to make it a positive experience. Now, I’m not dismissing the fact here that some of the messages social workers need to deliver are difficult messages and some of those messages may not want to be heard by the people we are working with but still, we should approach all conversation looking for positive outcomes. We should demonstrate compassion for the situations people find themselves in and not appear punitive in our actions. Our role is to minimise, as far as is possible, the potential for conflict and hostility that may result from what needs to be said. Aside from difficult conversations we should use our ‘human touch’ skills to make people feel at ease, as far as you ever can, especially in the early stages of relationship building.

So, an important part of our communication is therefore to relate to the other person. To form and establish relationships where we can work with and, where appropriate, on behalf of, the individual. We should listen more than we speak. We should be aware of body language and what someone is communicating through that. The ‘music behind the words’ as Lishman would put it.

We also may find we need to use communication to influence, to put other options and to consider strategies for change. We may want to strengthen certain attitudes while asking people to consider the impact of others. At times we may need to challenge, sensitively, and in a spirit of cooperation. When challenging we need to ensure that we are not trying to move someone to change or think differently from our own personal value base but rather that we are working with an understanding of theirs. What do they value? What is important to them? What do they feel they need to change?

We must not fall in the trap of thinking that we only communicate to acquire knowledge of the person. We communicate to build a relationship, to create trust, and to demonstrate empathy. Get it wrong and these things aren’t achieved. Get it right and we can create movement and develop understanding.

The other facet to communication is that we learn about ourselves. We learn about what makes us ‘tick’, what challenges us, what makes us uncomfortable. We need to listen to ourselves while we are communicating, creating a feedback loop, reflecting in action, and modifying our style as we go to enable us to work effectively with the individual we are with.

Not easy…..

But essential….

[Stephen Mordue]

Recommended Books:

Cut the risk of dementia with a sauna

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sauna

In the news is research that says that taking regular saunas can reduce the risk of dementia. Research published in the journal Age and Ageing explores the conclusions of a 20 year study that says that the men who go for a sauna 2 or 3 times a week are less likely to get dementia. The study looked at over 2000 men who were aged 42 to 60 in the 1980’s and followed them over the next two decades. Men who went to the sauna 2 or 3 times per week were 22 per cent less likely to get dementia even when adjusted for other factors. For those who went 4 to 7 times per week it was found that 66 per cent were less likely to get dementia.

In a sense this comes as no surprise. Lifestyle factors have an impact on all health conditions. Keeping fit, eating well, keeping mentally active, have all been reported to have a beneficial impact. Our bodies need to be looked after and the brain is an organ just like others. What you put into your body or do to your body has an impact.

Previous research by the leader of this current study has shown that saunas can reduce blood pressure and have beneficial impact on heart health. As we know these conditions have an impact on the risk around vascular dementia it is understandable that improving these conditions and general health will lead to a reduction to that risk.

Let’s hit the sauna! And what better during the cold British winter. A treat that’s good for you!

Read more at Alzheimers UK
or in The Telegraph

[Stephen Mordue]

The ‘Two Minute’ Rule

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2min

Being productive either at work or at home is a crucial part of being organised and being organised is essential to a happy and content life I feel ……All your ducks in a row so that you just get on with your day.

I live by the ideas in David Allen’s book “Getting Things Done” and by far the most effective, easy to implement, approach is the two minute rule. Simply put…. If it’s going to take you less than two minutes to do it just do it… don’t even think about it… just get on with it. This little productivity hack gets so much done in my world!

I find it most effective in dealing with email. As Allen points out your inbox is a collecting tool not a storage tool so your email inbox should be empty! How many of us can say that! The problem is once they disappear off the bottom of the screen you may as well delete them as they risk being forgotten about! The two minute rule is so effective at getting through the morning grind of ‘getting in to empty’, as Allen puts it, that my inbox is routinely empty (or nearly empty at least). It’s amazing how many things only take a small amount of time but how easily they all mount up and then become onerous. And once those emails disappear off the bottom of the page they get forgotten about…. You know they do… and then they eat away at you as you wonder what’s further down the inbox list! The beauty of emptying your inbox daily and doing something with the things you find there (diary it, delete it, delegate it, or put it into your ‘trusted system’ (more on this soon)) is that you know that, if you don’t get back to your email for the rest of the day, there’s nothing in there you don’t know about that’s more than a few hours old! That’s a great feeling.

The two minute rule works just as well in other areas! At home the dishwasher gets dealt with while I’m making a cup of tea, the bin gets emptied as soon s it’s full, the recycling gets put out, the cooker top gets cleaned while the coffees on… and on it goes…. Things just get done… and you feel so much better and have more space to do the important stuff. Simple.

SO what do you do if it’s going to take more than two minutes!? What’s this ‘Trusted System’ idea. Ah! That’s for another day…. Or do read the book!

[Stephen Mordue]

Communication & Eye Contact

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pelican

I love the Pelican Originals, which were published by Penguin from the ’30s to the ’80’s. I’ve got myself a little collection that I’m building; I love the blue spines and the cover art, especially of the ’60’s ones, and now when you buy them in second hand book shops they have that ‘browned’ look of old books. Love it! But… that wasn’t what I came here to tell you about…..

We talk a lot in social work about communication. We understand the importance of words but also the importance of non verbal communication. And one of the important factors we discuss is eye contact. So, you know how important eye contact is in demonstrating that you are there with the person, and how it goes some way towards showing empathy. Well, there are some interesting things that sit behind all of that.

I’ve been reading (some of) The Psychology of Interpersonal Behaviour by Michael Argyle (1967), a Pelican Original! And he tells us some interesting things. He says that there is evidence that as early as four weeks old babies show more interest in the human face than in other objects. He feels that this fascination with the face is an innate reaction and further that in research by Coss (1965) it was found that patterns resembling eyes produce a greater emotional response from adults than other similar patterns (pg. 26,27). So, eye contact is important to us from an early age and  Argyle comments that, for babies, following with the eyes is the equivalent to physical (i.e. following by walking) following. A visual dependence for eye contact is formed.

When talking about eye movements (pg. 44) he particularly observes that eye movements play an important part in maintaining the flow of conversation. The speaker looks up to gain feedback (is the other person interested, attentive) and will make eye contact for longer to signal that it is time for the other person to speak. Eye contact, he says, increases the sense of intimacy.

So, he suggests there are different elements to eye contact (pg. 84-93). There is looking as seeking information, and there is looking as a signal or social technique (e.g. to initiate a reaction, to show emotion). Also, there is a motivational basis to looking. Looking may be rewarded with information, a smile maybe, affirmation that we are being listened to and valued. As he said, this basic motivation to seek such responses may well go back to being a baby. He states that being looked at is emotionally rewarding. In tests on rhesus monkeys brain stem activity increases when they are looked at by humans, he says. He points out, however, that long gazes can feel uncomfortable, even threatening, suggesting that if eye contact starts to feel like ‘being observed’ it can disturbing.

Interesting!?

“The Psychology of Interpersonal Behaviour”, by Michael Argyle, (1967 – the year I was born! – I know hard to believe!) is a Pelican Original, published by Penguin Books.

[Stephen Mordue]

Reconstructing Memory

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memory

The advantage that memory gives us is the ability to predict the future. When confronted with a situation we can explore what we already know and act accordingly. If we do not know the specific situation we are presented with then we can make an approximation based on similar situations. Fernyhough (2012) seeks to overturn the ‘common sense’ view of memory as being, as he calls it, a DVD of our experience or specific snapshots of time, with a view that our autobiographical memories are reconstructed every time we remember them from a combination of semantic memory (memory of facts) and episodic memory (memory of events).

Each time we remember it is a reconstruction with the potential for flaws and embellishments. These memories then become our real lived experience of the ‘remembered’ event. This means that by supporting people to combine various strands of knowledge, memory finding may be supported. One significant aspect of remembering is emotion. We are more likely to remember the emotion of the event than the detail. This also has resonance from my own practice experience when discussing the events of the day at a day centre with a man with dementia. I found he could not recount what he had done but could remember the emotions he had felt. He was able to state that he had had a generally good day but something had upset him on the way home. It turned out that there had been an incident with the day centre transport, not involving him, that had been quite alarming. He remembered how he felt but not the events.

One important aspect in the reconstructing of memory, and therefore remembering, is environment. If people with dementia are reconstructing their memories it is important for them to have cues around them like photographs, the ornaments on their fireplace, or the view of their garden. Under such circumstances their capacity to remember may improve. They will ‘remember’ through exploration of their environment. We’ve all done this: you walk from one room to another and can’t remember what you were about to do so you return to the room where you had the thought and find you can remember by looking around for cues.

A practice example would be when people with dementia are in hospital their presentation becomes more confused and more disorientated but then when they return home these ‘symptoms’ improve. This has proved the case many times in my experience and I would argue you cannot adequately assess someone’s ability to be at home without them being at home. The value of a home visit while still an in-patient, or while in a reablement centre, is substantial in gaining a true picture of strengths and levels of independence. Convincing families and family carers of this can be understandably difficult, but anecdotal evidence shows the possibility of a successful return home under these circumstances to be significant.

In working with people with dementia there are also some opportunities we can utilise to help people remember. Fernyhough (2012) observes that remembering is a social process. It happens with other people and is often contextual. What you can remember may rely on cues, but also some of those cues can be the people you are remembering with. So, in the earlier example of the man attending the day centre if I were reviewing his attendance there I might want to do that at the day centre with staff, and possibly even other service users that he relates to, obviously considering the appropriateness of that in terms of service user choice and confidentiality, to help ‘scaffold’ his memories.

De Vries (2013) reports Normann et al (2006) found that when supporting people with dementia, close contact with family and caregivers improved lucidity. Even when not at the day centre, priming memory with facts, for example, “the place you go on the bus”, “where you see George”, may aid remembering.

So in undertaking interventions or assessment work with people with dementia we need to consider where we undertake the work we do, who we have present, and how we can assist the person with remembering in order to make sure they are fully represented in the interaction and more importantly that they are shaping the outcomes of our involvement themselves.

Fernyhough, C. (2012) Pieces of Light: The new science of memory. Profile Books:London
de Vries K (2013) Communicating with older people with dementia. Nursing Older People. 25, 4, 30-37. RCN Publishing Company

 

[Stephen Mordue]