Cognition: Disrupting negative patterns of thinking (II)
The Relational Worker
Direct disruption of the mind
A worker described to me the difficulty of engaging with people who have been through tough times:
The only power powerless people have is saying no, and they use it quite a lot. Actually, they overuse it, they say no to everything, you know? They may not get a yes to things, but yes, they can refuse things.
Other workers have told me about the cursing, the screaming, the no shows to appointments, or about the turning up high or drunk.
How do workers respond to such behaviours?
Those I studied displayed a quality I labelled ’sharp empathy’, the ability to call people on behaviours that could impact them negatively. Still quite abstract.
Here’s how sharp empathy is described by those who experience it:
no sugar coating,
no pussyfooting,
no feeling sorry,
no baby sitting,
never holding anything back,
no beating around the bush,
getting straight to the point.
Sharp empathy directly addresses the person in difficulty. It focuses on single aspects of dysfunctional behaviours, not on making global judgements. It zooms in on the behaviour not the person. It demands that people engage with the self that is hidden and disliked. It gets to the sources of shame. Anger confronted.
Behaviours challenged and not accepted.
A young person describes one of these moments: I’d be like outside where I was living in the hostel, and I’d be like outside smoking a joint or something like that and she’d come out — what are you doing? Know what I mean, she’d go, my office is there, all I can smell is your silly wacky baccy and all of that. And then she’d come out and flip, basically, and be like, If you want that go somewhere else. That’s not for us.
Workers did not accept the lies, the abuse, or doing things people could do for themselves. Workers make these boundaries clear: I say to all the women what I said to her: if I speak to you in a way that you find patronising, rude, condescending or anything, you tell me because I will tell you if you’re speaking to me or communicating to me in a way where I don’t feel respected and I don’t feel that I deserve it.
Workers model healthy ways of being in a relationship: You know, I never told you this, but I look up to you like a father, and I’m ashamed to tell you that I am using drugs, and I’ve been using heroin. I’m going to care about you whether you use drugs or not. It goes back to all I want for you is to be honest with me. That’s the only way we’re going to work towards getting you to a better place.
Helpers act as a mirror. Looking at the mirror, at yourself, is understandably not easy. The unworthy self is there to be seen. It provokes a reaction, first of feeling uncomfortable, then a need to retreat, and, only after gaining some distance, coming back to look more closely.
Holding up the mirror is hard. It generates appreciation and respect for the worker. It gives the worker permission to say what others could not, cannot.
First do no harm is one of the core ethical principles of most helping professions. And sharp empathy is a source of pain. Why not just be nice? Why not just accept the abuse, the lies, the cursing, the not turning up, and everything else bound up with being at rock bottom?
The answer comes back to ethics. Not calling people on what they need to hear would be, as workers told me, a moral disadvantage. They say they have a moral obligation to create a context for a recovery of self, which involves engaging with the source of its loss. The helping role cannot be about being soft, liked, or nice. The moral facet of sharp empathy is explained by a worker:
They’ve been disappointed and let down over, and over, and over again. That’s the consistency and the reliability. You might not like what I’m saying, but I’m going to be here, and I’m going to say it because I love you and I care about you. If I didn’t say it, I’d be doing you a disservice.
