Posted on: 12 May 2022

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I’m Gareth, I’ll be writing to you every couple of weeks about ‘dialogical practice’ and my learning over the years about the Open Dialogue approach to mental healthcare; something I hope we’ll be able to adopt here in CNWL.

Finding Out more... 

I am getting more and more of you contacting me to say you want to find out more about how to access training and learn more. We have a ‘Register of Interest’, through which we can be targeted in communicating opportunities to people in the future. If you are interested in being added to the Register of Interest please email: nina.dawson1@nhs.net

We have a regular Special Interest Group, which is open for anyone interested to attend, on a monthly basis.  Our next meeting will be Thursday 9 June 15:30:

Click here to join the meeting.

Personal or Private

I haven’t been very well recently. My wife, children and I all got Covid, and it really did knock us for six. An enforced rest with the whole family left me feeling a bit emotional as most of the time we are constantly in motion and do not stop to ‘just be’ with each other. Covid is still out there and I hope you are all doing everything you can to keep yourselves safe. 

Before getting Covid, I also felt like I’d had one long string of viral illnesses over the last few months (other viruses are available!) I suspect that our immune systems have lost some of their memories with all the increased hygiene and distancing over the last couple of years; then with all restrictions dropping it feels like illnesses have been swinging around with alarming frequency. I know as I have been going around speaking to many of you that you’re having similar experiences too. I hope you’re all finding ways to stay healthy, look after yourselves and take rest. If you’re not, then please do take this as permission to do so; do something different from today that does take care of you. You are important.

I sit in a lot of meetings where people say “we need to take care of our colleagues”. It is said with genuine feeling and I know, like me, the leaders in the organisation really do care for you all. Sadly, it always feels like there is never enough time to explore the issue properly. It is one of the reasons I care so much about talking to you about Open Dialogue. The hope held within it and the more sustainable, caring way of working has seen me through some difficult times and I hope it will do the same for you. 

I wonder if any of you have ideas about how we could be taking care of you, or what you could be doing to take care of each other? If you do I would love to hear them (see my contact details at the end).

Starting as Medical Director has been a big learning curve for me. There are times I have got things wrong, where the workload has overwhelmed me and I have felt under prepared for the challenges the job would pose. At my most difficult moments, I worry that I’m letting people down. But I have been blessed by some remarkable colleagues here in CNWL; I am well supported by the amazing Ann and Kim and our Clinical Directors (Graham, Jasna, Deepti, Kemi, Kiran and Sujaa). I also know there are some things I have been getting right and I am buoyed up seeing the amazing improvements you are making in your services with things like Trauma Informed Approaches, Peer Working, the DIALOG scale, new technologies (ePMA and MaST) and the constant innovation you bring to improving the flow of people through our teams to ensure people get care quickly. 

As I have travelled around the Trust this first nine months, I have been really impressed by how hard you all work. I have also seen how tired most of you are; that you are getting sick and worn out. It upsets me to see this and I find myself worrying at times how we will keep the service going when this is how so many of you feel. The thing that sustains me is knowing that no one of us carries the responsibility on our own, that we really are a team and that we are looking out for each other. It is what got us through Covid and what will keep us going through this next phase. There are undoubtedly challenges ahead, but I do believe there is a much more hopeful, kinder future ahead of us in mental health.

Now I would not have dared write any of that so publicly a few years ago. I have spoken about the idea before in these blogs about needing to work out ‘what is personal and what is private’ for you.  I remember the first time this question was put to me at the first training week for Open Dialogue and feeling completely flummoxed by this question. Looking back now, I can see why this stumped me and felt like a silly statement when I first heard it. The reason was that for me as a doctor, a psychiatrist, a professional at work there was no difference for me. 

Everything that was personal for me was private and never shared with work colleagues, let alone the people we were trying to help. The implicit and sometimes explicit message given to me through my training was that you needed to maintain boundaries at all times, and be really careful of those people that would try to probe around or breach them. The message was that these boundaries kept them and us safe. 

Once I learnt to loosen that concept and share parts of myself more personally, I found that I felt lighter, that the people I was working with seemed to gain more trust in me and that something ‘clicked’ in the care process that helped everyone.

Through the course of the training we were encouraged to explore this and test that concept of ‘personal or private’.  We would work with colleagues to share deeply and personally.  Sometimes this felt great and a huge relief and sometimes I went too far and realised I’d crossed a line for myself and shared a bit too much. This is where I started to recalibrate and find what I could safely share of myself and what needed to stay just for me. I also realised that this was a constantly shifting line, and that what worked in one context did not always work in another. Particularly when working with a family it became clear that stories from my life often landed like lead and I could tell did not connect. I do not think they hurt anyone, but they also did not advance anything in the conversation and I risked making the conversation about me rather than them.

It can be a really tricky balance working out when a personal life story might offer a chance for connection or when it might risk being a distraction or moment of disconnect. Over time, I began to settle more on the side of sharing my emotional resonances from what was being said and that my own life stories might only occasionally be brought in. I have to say this is where Peer Workers taught me an awful lot; they really are the experts in this field and we need to bring them to the heart of what we do and how we train. 

I am afraid I do not have any easy or ready answers on how to get this part of the practice right. It takes time, it needs supportive colleagues to explore it, it requires some risk taking and it needs you to be kind to yourself as you find a new way with how you are with people.

I love hearing your responses to my blogs. Please send them to me at: Gareth.jarvis@nhs.net.