How do you interpret behaviour?

The events below happened earlier this year, I’ve delayed pubilication as I wouldn’t want anyone to know the identities of the key players (other than myself – doh!)

We all consciously, but mostly unconsciously observe or notice things about others. Mostly it’s a casual observation but what if it’s not? You can say it’s their business, or give some polite feedback.

Well here’s a situation – I’m delivering a course on Dangerous Behaviour and a young female participant immediately announces that “no-one will get anywhere near me- believe me!” I interpret this as meaning “don’t mess with me.” Participants point out that if you get get on a tube (London Underground) you can’t avoid physical contact – yet she defiantly asserts “Believe me! It won’t happen.” Paradoxically she seems to be drawing everyone’s attention to a no-go area.

This is a training course, not group therapy, so I’d be happy to let it go. However, she pointedly looks out of the window, huffs and puffs, looks at her finger nails and storms out as soon as each session ends. Curiously, she always returns almost exactly two minutes after each session begins.

I experience some pressure because she is exhibiting difficult behaviour – and I’m supposed to be the expert, but I don’t want to humiliate her in front of her colleagues and yet she is always unavailable during the breaks.

I don’t work for this organisation, but I am torn. Whatever this woman’s issues, I have concerns for anyone who might depend upon her – her own children, clients – and for her. Do I walk away and say nothing? But I don’t know what I am dealing with and am I acting inappropriately?

Cowardly I said nothing all day. Yet I sensed that I was walking on egg-shells all day long – because of my uncertainty. At the end I thought it was one of my worst courses.

As she left, she did say “thank you” which surprised me. Afterwards I sheepishly asked the Training Organiser is there had been particularly negative course evaluations. To my astonishment, this woman, who many people in the department felt was “difficult” – thought that the course was “brilliant!”

I am not trying to blow my own trumpet. My first concern is that although this woman may be my advocate, and I should be grateful, she is also a support worker – and quite frankly, if I had any need for help, she would be the last person I would want anywhere near me. Given her employers cannot be unaware of the problem – what is my responsibility during and after a training event – to her, the training group, the organisation, her clients … and cowardly, myself?

Filed under: 1, Training, ethics, Training

Violence or Suicide Training?

Tomorrow, in Southampton, and then on Monday and Tuesday next week in Nottingham I am delivering “Razor’s Edge: Responding to Suicide and Self-harm.” That’s fine – but actually almost 75% of the training I deliver is on Violence.

I’m still in my hotel room so I’ll have to recheck this later, but I am sure that you are far more likely to be killed by yourself than by someone else. Indeed, although I have worked in, and visited some very violent places – actually the more everyday and persistent encounter is suicidal ideation. So you would think that mostly I’d be providing “suicide/self-harm” related training – but that’s not the case.

Suicide is probably (to many) more emotionally evocative than violence and my guess is that most organisations would rather be seen as negligent following an assault on a staff member than for the self-inflicted death of a service-user. Furthermore, in my experience, most people feel far more out of their depth in dealing with suicidal and self-destructive behaviour than they do with violent behaviour.

Well, you could say (this is me answering and refuting my own questions – because I know there is no one out there listening anyway) that this is because I am better known for my work on violence that suicide. This may be truse but if you google a bit, you will realise that there is much more information (I mean of a helpful kind) on suicide than violence, but when you look for training the picture reverses.

I don’t know. My first thought was that organisations believe that “if a person wants to kill themself they will do it” – no blame. But actually in my experience there is a lot more blame all around after a suicide (self, colleagues, family, organisation and even the person who died) – and it persists (you can’t ask the dead person “why”). A team can bond together after a colleague has been attacked, but can fall apart after a suicide – it’s the same with families.

That’s clearly the wrong track. Right now I do still think it has to do with culpability – but in a different way. I think organisations are wary of Suicide Prevention Training for a number of reason – all understandable:

• If you train a care-worker to deal with a suicidal crisis – will that give the message that they are expected and equipped to deal with a suicidal crisis (pay and responsibility implications)?
• If you provide suicide awareness training (for example in schools – best place for it)  what happens if a suicide happens afterwards?  Who will point the finger and who will take the blame? I’m sure if one of my sons killed themselves and I found out that there had been a suicide awareness class the week before, I’d want to point the finger – but the truth may be that many young people kill themselves because they couldn’t talk to anyone. And their best friend didn’t know what to say or do either

Now I was reaching some kind of conclussion, but that would be like suicide. Thankfully with all the interuptions, I lost the thread. May be I’ll return to it, or you can turn this into a debate?

Filed under: Suicide, Training, Violence, risk, Suicide, Training, Violence

The Parlous State of Trauma Training

Before I get going, I thought parlous meant “terrible, precarious, fragile, awful” but I just checked and according to the Free Online Dictionary (http://www.thefreedictionary.com/parlous) it means “perilous, dangerous” – so how appropriate is that!

Well during the early to mid-90s I was commisioned by the Home Office to design and deliver training primarily for Forensic Psychologists working in the Prison Service. Out of this came the Diploma in Post-traumatic Stress Counselling – an accredited competence-based award foir mental health and counselling professionals. Trauma training was a huge part of my work not only within the Home Office but for a wide range of groups ranging from the Trauma Teams in Belfast, International Crisis Aid Organisations, Victims Support, Local Authority Disaster Management Teams, the Emergency Sertvices, the Armed Forces – the list goes on. Nottingham Trent University also had an M.Sc in Trauma Management which I believe was well received. It looked like, for once we’d be ready for the next disaster. The American Psychological Asscociation had an amazingly active and vibrant Traumatic-Stress Forum and new ideas and treatments were being developed at an amazing speed.

Although PTSD may be narrowly defined, trauma underpins so much of mental ill health. Somehow, however, over the past ten years trauma training has become almost non existent. The demand is there – I am an continuously receiveing enquiries from individual practitioners about how they might access the training – but there is nowhere for them toi go. The ESTSS has an certificated scheme – but it requires you to attend relevant training gain points towards their award. The trouble is that for most people there is no relevant training available.

How did we get into this “Parlous” (really dangerous if you think that most mental health professionals have no specific trauma training) state of affairs? To me it’s quite clear. Money was moving into the field because employers were concerned about litigation and lawyers were rubbing their hands with glee. I remember being told that every police sergeant had to be trained to be a Critical Incident Stress Debriefer and that debriefings were mandatory following major incidents in the emergency services.

Then research (I’m in a hotel room right now, but when I get back, I’ll give you the references) that actually said “if you force someone to go through a debriefing in front of their colleagues soon after the incident with a debriefer who is not a trained mental health professional, this can have adverse affect” – that is not a quote, but my precis of what the research was saying. I don’t think anyone would disagree with that. However, how it was reported, repeatedly in the press was “trauma counselling makes you worse rather than better” – again my precis but the headlines were worse than that!

Obviously employers became scared and pulled back. Better to do nothing than risk being seen as making things worse. Training and research lost all funding and no-one put up a fight. A vacuum was left with nothing to fill it. It rermains that way today. The “power therapies” (EMDR, TFT, EFT, VKD – alphabet soup therapies) tried to fill the void with huge promises, but have since receded.

So if you want to become a trauma therapist, where do you go? Well I hope some one reading this has an answer, because right now, in the UK at least, it seems that there is nowhere.

Filed under: Training, Trauma, CISD, Debriefing, Disaster, EMDR, PTSD, Training, Trauma