Note: This is originally from Frontier Friday, a weekly Substack published, originally released on 15 Dec. 2023
Part I
- “Nobody is so poor that he/she has nothing to give, and nobody is so rich that he/she has nothing to receive”
~ Karol Józef Wojtyła, Pope John Paul II.
Why I picked this: I’m thinking about situations where clients might benefit from engaging in acts of giving, even when they are down in the dumps, and others who have rarely made room to let others in, to depend on others, to receive, and to let others feel the gift of being able to gift to them. - “I have a deep sense, hard to articulate, that if we could really befriend death we would be free people.”.
~ Henri Nouwen
Why I picked this: Nouwen learned the value of “befriending death” from the depth psychologist, James Hillman. I’ve also learned about this from my mentor on “befriending grief” many years ago. To befriend, is to relate and integrate with the totality of our human experience. - “You can read a cookbook and still starve to death.”
~ From a client.
Why I picked this: I heard this line from a client from more than 10 years ago. The only way a cookbook is helpful is that we are cooking.
When you read a book, push yourself to translate the ideas. 1 translatable “call to action” for each chapter. - “You are here because someone has loved you into being.”
~ Fred RogersWhy I picked this: A reminder of how we came into existence. - “Stress is a perverted relationship to time.”
~ John O’DonohueWhy I picked this: Since hearing the late John O’Donohue’s utter this phrase, it has stuck with me. When we see stress in relations to time, we start to see the insanity of our daily actions, pushing ourselves closer and closer to the edge of what we can barely behold. For more, listen to O’Donohue.
Part II
- “It is utterly false and cruelly arbitrary to put all the play and learning into childhood, all the work into middle age, and all the regrets into old age.”
~ Maragaret Mead
Readers of the Frontiers will notice how much I emphasise the value of deliberate play.
- “Don’t aim to have others like you; aim to have them respect you.”
~ Kevin Kelly, from 99 Addition Bits of Unsolicited Advice
Not only do we need the courage to speak truthfully, and aim for others to respect you, we must also know who’s respect is of value. - “To forgive is to grieve—for what happened, for what didn’t happen—and to give up the need for a different past.”
~ Edith Eva Eger, from The Choice.
One of the common grounds many religious teachings hold is the practice of surrender. To forgive, is like a doorway to this practice.
When we work with people in our clinical practice, forgiveness and grief are common themes that will surface. Why? Because change is loss. - “The unexamined life is surely worth living, but is the unlived life worth examining?”
~ Adam Philips, British psychoanalyst, from Missing Out: In Praise of the Unlived Life.
Much more important to be engaged in living than thinking about it. - “Love people, use things. Not love things, use people.”1
~ Richard Rohr, from The Art of Letting Go audio series.
This is salient to me as I roam around Singapore. Nearly everyone (including the elderly), is hooked on their mobile device, playing a game, watching C-drama, or scrolling some 20-sec video.
I was thinking: Would we end up loving the things that we hold all the time, at the expense of people we love? Would our values be thwarted, as philosopher C Thi Nyugen called, “Value Capture”?
Part III
- 🧐 Research: Discontinuity… After Intake?
Sidenote: if you actually look at the list of contributors in this study, it’s astounding that 18 researchers were involved! Wow.
Question: If you pay attention to the models of service delivery around the world, do you notice it is getting more common for an intake therapist to conduct the first session, and then gets passed on to the “treating” therapist?
Here’s what the 18th researchers found about the unintended consequence of this approach:
– clients who saw a different therapist at intake were twice as likely to dropout from treatment and not attend the appointment after intake.
– In terms of outcome, clients seen by a different therapist at the get-go lagged in improvement by 2 sessions, compared to those who were seen by the same therapist, making it 19% more expensive when an intake therapist is used.
– Implication: Given the disruption and less cost-effective finding, the authors concluded the following:Abandon formal psychotherapy intake… begin psychotherapy at the first meeting. - 🧐 Research: First Impressions Matter: Patients’ Experience of Initial Assessment and Outcome Expectations and Subsequent Attendance
This recent study was part of the previously known as Improving Access to Psychological Therapies (IAPT) programme in England, now known as NHS talking therapies services for anxiety and depression.
Key Grafs:
– 985 out of 6051 clients (16%) did not return after the initial assessment.- Even if you have a different therapist that conducts the intake, who conducts this first contact makes a difference.
– Clients with more optimal outcome expectations1 at the beginning predicted them continuing therapy (but not dropout for the subgroup who started treatment). 16% of the variability was explained by who the therapist was, after controlling for client-level variables.
– In short, the first contact matters.Patients assessed by the above-average therapists were between 10% to 20% more likely to start treatment by comparison to those assessed by below-average therapists (based on their patients’ mean expectancy scores and associated odds of treatment initiation).
My thoughts:
Curiously, even if agencies decide to have a different personnel at intake, for triage or for whatever reason that they could justify doing so, given the above finding, would it be justifiable to employ less skilled therapist to do the so called “intake”?
For more about Outcome Expectation (OE), see our last book, The Field Guide to Better Results, Chapter 6, Hope and Expectancy Factors by Michael Constantino and colleagues. - 🧐 Research: What Can We Learn from Those Who Do No Attend
Another study from the previously known as IAPT services in the UK. this qualitative study interview 14 people who were referred for treatment, but either never attended, or only attended one treatment contact.
Key Grafs:
– Non-Attendance Rates for IAPT: approx. 47%!
– Waiting Process:
Waiting for treatment, which varied between 2–3 weeks and 9 months and the lack of contact from services:‘‘In the first 7 months there was nothing, absolutely nothing…not even recognition of being on a waiting list.’’- Expectation of Assessment and Treatment:
Some respondents expected that assessment would be both more robust and more personalised.‘‘When you finally got in there and feel like you actually might be speaking to somebody then it was very much about ‘oh no we are not going to speak about anything’ . . . she only wanted me to answer her questions’’- Disappointed to find out that often the assessor was not a trained therapist:‘‘[I] . . . had a good cry and she wrote some notes down but she was not a trained therapist’’- One respondent angrily reported that her desire to express her emotions contrasted with the practitioner’s expectation that she do homework:‘‘And I’m trying to tell her how I’m feeling and it’s just not good. ‘Go home and do this and we’ll talk next time’, No, I don’t think so.’’- Rigidity of Service:
Inflexibility of the IAPT services including communication with the service, appointment making, choice of treatment or practitioner and their experience of a heavily protocolised system
– Practitioner Contribution to the Relationship:
A significant barrier to the development of a good working relationship was the experience of heavily protocolised treatment and not being listened to because of this. One client thought that her practitioner addressed her in a patronising manner and offered little opportunity for a two-way dialogue:“…it’s insulting and, you know if I was eight, maybe fine. No. I think if I was eight years old I would still be cross.” - 🎁 Resource: Pocket Guide to The First Kiss
No, not a technical manual of how to be a good kisser, but a succinct summary of the nuggets to the book, The First Kiss: Undoing the Intake Model…
For more resources, check out the special link provided at the end of the book.
Download the Pocket Guide - ⏸️ Worths Worth Contemplating:
“The most important thing is to figure out what is the most important thing.”~ Shunryu Suzuki, 1970.
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