Understanding the Real You

As a psychologist, many clients want me to help them understand themselves better. Who am I? Who is the ‘real’ me? How do I become more like the real me?

And because I am all seeing and knowing, I am able to tell them and their lives are transformed.

In particular, people going through a transition (for example a career change) are understandably keen to understand who they really are, because this will help guide them and inform their decisions.

It is very easy to believe that if we can just understand who we are, then we can be  liberated to be that person.  It is an alluring thought, as the pull to certainty always is.

The problem is that whilst the idea of a ‘core’ you; a fixed, immutable essence of you (that sounds like a brand of perfume: Immutable Essence of You by Chanel) is alluring, it is also dangerous.  It can lead people to see their lives from a narrow perspective, as the content of their history and experience. Then we create powerful stories of who we ‘really’ are – I am an introvert, I am bad at Maths, I am depressed. In ACT this is known as the self as content perspective.

Yet there is another perspective of the self which is where we are the context or the holder of our ever changing experiences.  This allows us to take a more fluid, flexible perspective of our selves. One exercise I like to do with people to explore this idea is to take their Myers Briggs ‘type’ and then list all the ways in which they regularly act against their type. It is easy to do, and helps loosen the power of the self as content perspective.

In this short video Julian Baggini explores exactly this idea, but what’s interesting is that he does this without any knowledge of ACT, thereby bringing a fresh perspective.  He asks whether the self is an illusion, and concludes that this is not a helpful question. It is more helpful to see the self as a process, rather than a thing.

It is this view of our self as a process which can liberate us. Instead of something fixed to discover, our selves become something we create.  Instead of ‘being’ depressed, I am someone who sometimes experiences feelings of depression.  What I like about this advert is that it takes just such a view – I have pain and my life is bigger than pain:

In turn this flexible, ‘context’ perspective helps us act more flexibly.  We are free to experiment, and to transcend narrow, fixed views of ourselves.

Instead of asking who we really are, we can begin to see that we are the person we create, one behaviour at a time.

ACT and conscious evolution Part A: Why cant we get our act together to respond to global change?

We live on a planet completely transformed by humanity.  Our impacts upon the planet are so great that scientists have now coined a term for a new geological age – the Anthropocene.   We are changing the climate, the chemical balance of the oceans and soils, biodiversity and even the physical structure of the planet –humans move more sediment and rock than all natural processes combined.  Together this is referred to as ‘global change’.  Whether we like it or not, and whether we are conscious of it or not, we are designing the future of not just our species, but every other species on the planet.

In this blog and the next I argue that Contextual Behavioural Science is not just a tool for individual wellbeing, it is a tool for global transformation.  For future generations to live meaningfully, happily and sustainably, we must master our thinking and feeling at least as much as we have learned to master the physical world. We need to more consciously evolve our behaviour, choosing our evolutionary path instead of reacting unconsciously.

Getting better at choosing is critical for many of our most pressing problems, but nowhere is it more important than the choices we make about our treatment of the natural world. The natural world is the context for everything else: It is the cradle of our development as a species, the support system for our thriving today and the legacy we leave our children.

Evolution has provided us with great strategies for coping quickly with simple, short-term, and individual challenges, but these very strategies get in the way of coping with complex, long-term and collective challenges.  In this blog, I outline some of the reasons we seem to be so ineffective at collectively responding to anthropogenic changes to the natural world.  Next week I will explore some ways contextual behavioural science can help us to respond more effectively to such wicked problems.

Why cant we get our act together?

From a contextual behavioural perspective, human beings have at least six characteristics that get in the way of successfully responding to complex problems [1].   These characteristics served us well in old contexts, but might just be big problems for our ongoing survival.

Responding to reinforcement

a)      Immediate consequences outweigh delayed consequences – we might be concerned about the fate of our children, but we tend to act on our desire for that new car or second helping of food right now.

b)      Strongly unpleasant stimuli presented abruptly prompt action, but gradually increasing unpleasant stimuli do notThis is the story of the boiled frog. So long as global conditions worsen gradually, we will tolerate bad air, foul water, and species loss that would once have been considered intolerable.

Complexity and Accuracy of Thinking

c)       Simple, familiar ideas are often preferred over complex, alien ideas that are more correct. It is estimated that evolution, about as well-established a fact as it is possible to obtain in science, is rejected by 46% of the American population, one of the best educated populations on earth.  This figure doesn’t appear to be changing – there is a limit to the power of science and education, in part because…

d)      Coincidental events often strengthen ineffective behavior –  Short term weather events lead to claims that climate change isn’t happening. Our cognitive systems are tuned to use even random patterns as evidence supporting our beliefs.

e)      Thinking more complexly puts us in contact with uncertainty and paradox which can both feel aversive – As we learn language we are repeatedly rewarded for being coherent [2]: Parents discourage children for saying they like spinach one day and not the next.  Uncertainty, ignorance and inconsistent beliefs feel deeply aversive for most of us and thinking about complex environmental issues inevitably exposes us to these states.

Our relationships

f)       Consequences for the individual usually outweigh consequences for others although we can and do act altruistically, our primary concern is usually to protect ourselves and satisfy our own needs.

So what can we do about it?

This is a pretty depressing list. But actually these characteristics are just the products of human evolution.  Evolution has provided us with great strategies for coping quickly with simple, short-term, and individual challenges, but these very strategies get in the way of coping with complex, long-term and collective challenges.

But what makes human beings really interesting are the times when we act differently to the basic tendencies outlined above.  Next week I will explore how ACT and contextual behavioural science help us to make sense of what happens when we are at our best as a species – when we plan well for the future and act beyond our own self-interest.

Between now and then, you might like to see if you can notice examples of these evolved tendencies in action.  How do they serve you and how do they get in the way of living the life you want to live?  I would love to read about what you notice.

1. Chance, P. (2007). The ultimate challenge: prove B. F. Skinner wrong. The Behavior analyst, 30(2), 153-160.  Available at http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2203635/

2. Hughes, S., Barnes-Holmes, D., & Vahey, N. (2012). Holding On to Our Functional Roots When Exploring New Intellectual Islands: A Voyage through Implicit Cognition Research. Journal of Contextual Behavioral Science, 1, 17-38. doi: 10.1016/j.jcbs.2012.09.003. Available at http://www.sciencedirect.com/science/article/pii/S2212144712000075

When Feeling Awkward Gets In The Way Of Change

Have you ever wanted to try something new but because it felt awkward you backed away from the change and went back to what felt more comfortable, even though part of you really wanted to persist with the change?

I have been struggling with such a difficulty.

I recently become aware of something small that could lessen the influence I potentially have in the world. It looks like this:

Dotty Rachel

When you look at that photo do you think – ‘There sits a credible executive coach and corporate facilitator?’ I didn’t think so!

Although I don’t actually turn up to meetings with clients looking this dishevelled and dotty (really I don’t!). I do have wild hair and a tendency to present myself a bit like a kindly lady doctor (as this is what I was for many years!).

However, I recently read this paper and also this one and realised that appearances do impact on whether others take us seriously. Then a dear friend, who is also a client, told me, ‘Rachel, one of the things I love about working with you is that you turn up to run a session and people don’t expect you to be so competent because you aren’t dressed in a sharp suit and you appear so unassuming and then you do amazing work and they are surprised‘.

And I became concerned. I want my work to have a significant impact on others. I want to play a part in helping people to have more vitality and meaning in their work. I don’t want something as simple as my appearance to mean I am starting at a disadvantage with new clients.

So I decided that I wanted to present myself in a way that is authentic but perhaps a little more skilful. Goffee and Jones call this: Be Yourself – More – with Skill.

What does that look like for me? Probably not a sharp suit but perhaps a little tidier?

So I ask my lovely daughter, Ellie, to teach me how to put my hair in a bun. I have found this new skill very hard to learn. I feel clumsy and awkward. My mind kicks into action telling me, ‘Why are you wasting time learning something so silly when you could be learning something useful and important like Relational Frame Theory‘. The bun falls out halfway through the day and my mind says, ‘Told you this was ridiculous’.  I start to wear a little more make up and my mind tells me ‘It is so superficial to focus on your appearance’ and ‘Everyone is judging you‘. I feel like a fraud. But part of me is excited about the possibility of who I could become.

In the presence of these conflicting thoughts and feelings I remind myself that the best values and actions are freely chosen. It is okay for something as small as learning how to put my hair in a bun to matter to me. I ask Ellie to help me again..and again. I write down her instructions and follow them carefully.Notes on how to make a french roll I am still rubbish at buns but I persist. One day I will be a lady who weaves beautiful buns, knots and french rolls. Hopefully, as a result, I will look a little less dotty and a little more competent and I will ‘be myself – more – with skill’.

If you were to ‘be yourself – more – with skill’ what would be different about how the world experiences you? Is there a change that you want to make but it feels awkward?Would the change be a move towards your values? If so, are you willing to persist with the change and have the feelings of awkwardness?

I hope so! Because:

‘It is never too late to be who you might have been’

George Elliot

I am going to be the lady who both knows Relational Frame Theory and wears a beautiful bun.

How about you? Who will you be?

(How to) Stay on The F*****G Bus

I recently came across Helsinki bus theory, an interesting metaphor by the photographer Arno Minkinnen which is usually applied to creativity.  Being a big fan of bus metaphors, I started using it with my coaching clients and it resonates, so let me explain:

In Helsinki all buses follow the same route at the start of their journey.  For at least 1 km all buses take the same route and make the same stops, irrespective of their number and eventual destination.

After this they diverge and the differently numbered buses start to separate into more distant and less familiar parts of Helsinki.

Let’s imagine that in the metaphor you are a new artist who wants to create innovative art.  Each bus stop represents one year of your life, so the third bus stop represents 3 years of learning your craft and trying new things out.

After 3 years people begin to notice your work but they start by comparing it to people who have done similar work before.  Being driven to do something unique, you feel discouraged at finding you’re following someone else’s path.   So what do you do?

You get off the bus, go back to the terminus and try another route.

This time you take a different number bus in the hope that it will lead to something different.

But the same thing happens.  You had the intention of changing to something new, but you get compared to others and feel discouraged.  So back to the terminus you go. As Minkinnen says “This goes on all your creative life: always showing new work, always being compared to others.”

So what’s the answer?

Well the advice offered by Minkinnen is simple:

Stay on the fucking bus.

Exactly!  Stay on the bus!  And this is true not just for creative endeavours, but for anything that requires persistence, including career, life or behaviour change.  As this HBR article makes clear, it is long term commitment to a direction which is often the key to success.

The Problem with Staying on the Bus

Unfortunately, most of us find staying on the bus very difficult, mainly because we are directed by our short term thoughts and feelings. Just as in the case of the artist, we feel as though nothing has really changed, that this is just the same as before, that maybe we should have taken a different route.

This is where we all need help to understand how to stay on the bus.

How to Stay on the Bus

The first step is to get clear on which bus you want to get on.  I suggest a combination of decision science, The Dip and values work for this.

But next we need to learn how to deal with the thoughts and emotions that come from staying on the bus.

Let’s be clear that it is not the feelings themselves that force us off the bus.  It is our interpretation of those feelings – our relationship to them – which leads us to get off early.

The Role of Psychological Flexibility

Psychological flexibility is the ability to see our immediate experience from different perspectives.  For example, instead of thinking about our immediate thoughts and emotions, we can consider our longer term values.  Instead of seeing emotions as reliable guides to behaviour, we can place them in a different context as the flipside of what really matters.   Instead of running away automatically from certain thoughts, we can see them as just learned behaviour and not something we necessarily need to listen to or struggle with.

With practice, we can become less influenced by our short term impulses (‘this is just the same as last time!’) and more by our long term values.

This can help us to stay on the bus, and to persist even when our immediate thoughts and emotions make persisting difficult.

Passengers on the bus

The Dangers of Language

“So, how do you feel?”

“I feel like I’m grinding through life, sort of like I’m pushing a heavy boulder uphill.  Every day I’m grinding forward, but it feels relentless.”

“So how does this feeling of ‘grinding’ actually show up in your body?”

Pause.  Interesting question.

I was receiving supervision from one of the most respected therapists within the ACBS and the question threw me for a moment.  I scanned my body as mindfully as I could.

“I notice I feel a bit tired.”  Pause.  “And I notice that I have some tension in my shoulders”.

“OK.  Anything else?”

“Hmmm.  Not really.  The tension is certainly there but it’s not that severe.  It’s actually pretty bearable.”

“OK.  So what would the person you want to be do next?”

Another long pause.

“I guess I would take a few more breaks, but other than that nothing, actually”.

And there we had it. For several weeks my mind had been telling me about the grind; how tough my life was and how relentless.  But on closer examination that story turned out to be based on feeling slightly tired and having slightly sore shoulders.  From where I was now – skillfully led to a different perspective – my life was actually going really well.  I was doing the work I wanted, with people I liked, whilst making my own small dent in the universe.  If this is a grind, then it is the kind of grind I would definitely have chosen.

This is a clue to one of the most powerful lessons within contextual behavioural science; that part of our lives (or ‘context’) is shaped by the words that we use to describe it.

If we get it wrong, language has the capacity to sell us a version of life that is not particularly accurate or helpful and which may leave us feeling shortchanged.  In my case this was certainly true as it was detracting from the joy and privilege I felt when doing my job.

This was a timely reminder that whilst language is incredibly useful and powerful, it should come with a warning.  Checking in on the accuracy of the metaphors we us  in everyday life is really useful (as the brilliant Yvonne Barnes Holmes makes clear in this talk about constructing effective metaphors).

But every now and again it also pays to connect to our actual ‘felt’ experience of life, and separate this from the language we use to describe it.

Closing the intention-behaviour gap

Over Christmas I put on an additional 3kg. I have been getting rid of it ever since and I have realised that losing weight is a fantastic practice in psychological flexibility.  Just about every minute of the day there are opportunities to be mindful of bodily sensations associated with hunger or satiety, and each day there are dozens of opportunities to reconnect with why losing weight is important to me.

This experience also got me thinking about why weight is such an enormous problem. Obesity rates doubled globally between 1980 and 2008.  In 2008, the total annual cost of obesity in Australia, including health system costs, productivity declines and carers’ costs, was estimated at around $58 billion.  In Australia 68% of men and 55% of women were overweight or obese in 2008. Part of the problem here is diminishing physical activity. The World Health Organisation reports “Globally, around 31% of adults aged 15 and over were insufficiently active in 2008 (men 28% and women 34%). Approximately 3.2 million deaths each year are attributable to insufficient physical activity.”  Nobody wants to be obese but people are getting fatter, and everybody knows that they should exercise more than they do.   Clearly there is a disconnect between intentions and actual behaviour. 

We don’t do what we say we will do

Many studies have examined the relationship between intentions and behaviour and, somewhat surprisingly, the correlation between the two is not all that high.  Have you ever had the experience of setting strong goals to exercise or eat well and then not followed through?  Timothy Wilson wrote a fascinating book called “Strangers to Ourselves” outlining all the evidence for unconscious, automatic influences upon our behaviour.  Meta-analyses have revealed:

“… intentions account for a weighted average of only 30% of the variance in social behavior (Armitage & Conner, 2001; Hagger et al., 2002), mainly because people with strong intentions fail to act on them (Orbell & Sheeran, 1998).”  (Chatzisarantis & Hagger, 2007).

Why might this be the case?  One reason people fail to act on strong intentions is because they simply forget to start the behaviour.  Have you ever said something like “This week I will exercise three times” and then before you know it, the week is over and you haven’t exercised at all?  This is why setting specific goals and thinking about contextual reminders is so important.  In the literature, this sort of planning is called “implementation intentions”.

But another reason why people fail to act on their intentions is because their responding has become habitual and automatic.  When we don’t reflect on our moment to moment behaviour we are very likely to do what we have always done in the past.

Mindfulness helps us act on our intentions

From one point of view, this might be a bit of a problem for the ACT model.  If our behaviour is relatively independent of our intentions, then what is the point on getting clear on our values when we might just act out of our habits and unreflected impulses anyway?  This is where mindfulness becomes really important.  Values clarification on its own is of little use unless we bring awareness to what we are doing and we have the self-regulatory skills to enact new behaviours.

But is there any evidence that mindfulness can help us do what we want to do?  Chatzisarantis and Hagger (2007) explored how mindfulness affects the relationship between people’s intentions to engage in vigorous physical exercise and their actual behaviour.

First they confirmed that people’s intentions to exercise didn’t actually predict whether people exercised or not. But the really interesting finding was that more mindful people were more likely to act on their intentions than those who are less mindful, even controlling for the physical exercise was already a habit for the participant.  So mindful people, but not non-mindful people, were more likely to do what they said they would do!  Isn’t that just the coolest reason for learning to be mindful?  “Learn mindfulness and you will do what you say you will do!”

Why does mindfulness help us act on our intentions?

The authors then went on to explore reasons why mindfulness might strengthen the relationship between behaviours and intentions. Before we go any further, what do you think? Why might mindfulness increase the tendency to act on intentions?

Got something?

Perhaps mindfulness increases awareness of goals in each moment and therefore reduces the tendency to forget what we said we would do. Or perhaps mindfulness improves our self-regulatory skills so that we are more likely to be able to manage the difficult emotions that arise when we do something new or challenging. Chatzisarantis and Hagger (2007) tested a third possibility, that mindfulness helps us control counter-intentional behaviours, in this case binge drinking.   They reasoned that binge-drinking probably interferes with doing vigorous physical activity (is it just me or do you too have an image of lying on a couch with a pillow over your head?), and that mindfulness might reduce the extent to which habitual binge-drinking interferes with intentions to exercise.

And this is what they found:

C and H 07 Fig 2b 3

Let me step you through this diagram.  Start with the dotted line first. What this says is that people who are NOT mindful and who habitually engage in binge-drinking are LESS likely to engage in physical exercise. That is, habitual binge-drinking decreases the likelihood of engaging in physical activity. So far so good, this confirms the idea that binge-drinking ain’t great for getting up in the morning and going for a run!  But look at the solid line. For this group, even if they did engage in habitual binge-drinking they were still just as likely to engage in exercise as those who did not habitually binge drink. So some mindful folk still go out on the town, but they don’t let this interfere with their intentions to exercise.  In the words of Chatzisarantis and Hagger (2007: 672):

“These results, therefore, corroborate the view that greater awareness of and attention to internal states and behavioral routines helps mindful individuals shield good intentions from unhealthy habits and thus can play a key role in fostering effective self-regulation. In contrast, diminished attention and awareness of counterintentional routines and habits is likely to prevent individuals acting less mindfully from engaging in effective self-regulation, as the negative relationship between habitual binge-drinking and physical exercise suggests (see Figures 2a and 2b).”

So maybe next Christmas I will be better at mindfully saying no to that Christmas pudding!

The Different Motivational Properties of Values and Goals

When committing to a new course of action it’s useful to distinguish between values and goals because they have different motivational properties.

  1. Goals can be achieved.  This is why they motivate – we enjoy the feeling of purpose and progress this brings.  Yet, once the goal is achieved what then?  Very often we revert to our previous behaviour.  This explains the diet industry.  And why it is hard to get a taxi in New York in the rain*.
  2. Goals can’t be achieved right now.  So they can be bad at motivating right now (when I need it).  For example, I have a SMART goal to lose a half stone in weight in the next 2 months.  The trouble is, I have had that goal for about 3 years….  The problem lies in the fact that whilst I cannot meet the goal today, what I can do is eat a piece of cake.  So, when I see a piece of cake a question arises in my mind; can I eat the cake and still meet my goal?  Then some uncertainty arises in my mind – maybe I can have both?  Minds hate uncertainty and they will do almost anything to get rid of it.  So what do you think I do to get rid of the uncertainty?
  3. Goals are powerful motivators. Humans are intrinsically goal oriented and our minds like the feeling of purpose which goals offer.  Yet goals can be set without us really examining why.  Once set, their gravitational pull can pull us away from the things we truly value.  Hence, for about 10 years I busied myself pursuing promotions which I did not really care about.  Whilst pursuing I felt busy and purposeful, but once achieved I felt empty and sad.  I worked so hard to climb the ladder, only to find the ladder leaning against the wrong wall.

In contrast values have different motivational properties which can help us in many different ways.

  1. Values can never be achieved.  So values retain their motivational properties long after a goal’s have been ticked off.  Whilst my goal of losing half a stone could be achieved, acting in accordance with the value of health can never be.  Is it important or not?  If it is, then when will it cease to be so?
  2. Values can be lived in each moment.  So, although Viktor Frankl was not free inside Auschiwtz, he was able to make the value of freedom important by choosing his response to the tyranny he saw.  In this way, values can bring us powerfully into the present moment and, over time, can bring greater coherence to patterns of behaviour over far longer periods.  This builds a much more powerful sense of meaning in life.
  3. Values are what we most want to stand for in life.  They are how we want to be remembered and what we want to stand for in life.  When we act in line with our values we act authentically and in alignment with our deepest motivations and aspirations. Maybe (like me) you have spent much of your life pursuing meaningless goals before realising that life is a musical thing – and we are supposed to sing and dance whilst the music plays…

*They knock off earlier because they meet their daily goal earlier

Training People To Do What You Want – Ethically

There is an episode of The Big Bang Theory where Sheldon trains Penny to do what he wants. He uses chocolate.

We are all constantly ‘training’ the people around us but we don’t usually use chocolates and it is rarely deliberate. Because we aren’t even aware we are doing it, we are often inadvertently rewarding behaviours that we don’t want and punishing the behaviours that we do want.

For example, imagine your new enthusiastic staff member stops taking the initiative and starts waiting to be told what to do, what could have caused the change? It might be because you criticised her whenever she didn’t follow the correct procedure and didn’t encourage her when she was proactive. Gradually, over time you shaped her behaviour.

So it seems like a good idea to become much more aware of the impact of our behaviour on others and start to more consciously reward people when they do what we want.

But people can feel manipulated by this approach. You don’t want to be like Sheldon.

So what is an approach that feels more ethical and less like manipulation?

To be collaborative. Rather than deciding what behaviour I want to shape in the other person, I ask them directly, ‘Who do you want to be at work? What behaviours do you want to demonstrate? How would we recognise those behaviours? How can I support you in those behaviours?’

It is also helpful to acknowledge that these interactions work both ways. So I talk to my direct reports about how I want to behave as a manager. And then I ask, ‘Would that work for you? Are you willing to encourage me when I do those behaviours? And let me know when I am drifting away from them?

This more collaborative, transparent approach builds trust and engagement. How could you apply it at work this week?

You might also want to take a look at this earlier post on the 10 factors to consider when rewarding staff.

How You Can Make 2013 A Successful Year

So here we are in 2013. What will it take for you to define this year as successful?

Let’s start by looking back on 2012. What did you achieve? What mistakes did you make? Where do you feel you failed?

measuring up
measuring up (Photo credit: woodleywonderworks)

Did you get a promotion or an increase in salary? Did you buy something important like a house or a car? Did you fail to get elected to serve as President of the USA?

It can be easy to focus on these external markers of success or failure. But what about your internal yard stick? How much were you the person you want to be? How often were you mindful or generous or brave or loving or …(insert your own values here).

How good were you at noticing the times when you weren’t living your values and then gently adjusting your behaviour so it aligned more closely with who you want to be?

‘Values are your heart’s deepest desires for how you want to behave as a human being. Values are not about what you want to get or achieve; they are about how you want to behave or act on an ongoing basis.’

Russ Harris  – The Happiness Trap

Measuring your life by what you achieve isn’t wrong but the research suggests that we over estimate the impact of these events. We think that if we get the good job and nice house we will be happy and so we conscientiously pursue those goals. Sometimes we are so busy striving that we neglect other important aspects of our life, like nurturing our health and our relationships, and we forget who we are and what we want to stand for.

The second way of measuring your life – Did I live my values? Was I the person I want to be? – is both more likely to create richness and meaning and will tend to support you in making those moment to moment choices that determine the direction of your life.

So as you review 2012 and before you set yourself some goals for 2013, spend a few moments revisiting your values.  Lundgren’s Bull’s Eye activity is a cool way of doing this.

Tackling Our Culture of Cruelty

A recent Panorama investigation found systematic abuse of elderly residents going on in a UK care home.  Some of the most vulnerable people in our society were being ritually abused by their so-called carers:

On the top floor of a special hospital, locked away from their families and friends, a group of men and women are subjected to a regime of physical assaults, systematic brutality, and torture by the very people supposed to be caring for them.  The victims are some of the most vulnerable in society – the learning disabled, the autistic, and the suicidal.

Sadly, this may be merely the tip of the iceberg.  In this week’s Sunday Times Minette Marin wrote of the terrible neglect of nurses that she witnessed first hand.  Similarly, the MP Ann Clwyd has told of her husband’s inhumane treatment at the hands of the NHS and asked whether cruelty is now normal in the NHS.  Today I listened to a phone in programme where one man described a ward of vulnerable geriatrics and simply said:

“Nobody seemed to care”.

How does this happen?  Presumably no nurse goes into that profession for any other reason than to care for others?  So what happens?

Organisational culture is clearly a factor and a number of systemic problems contribute –  poor job control, lack of autonomy, lack of a proper leadership.  But at some level cruelty is an individual choice.  We create our cultures, then they create us.  So what can we do about that?

I think this is a problem of experiential avoidance.  I propose that nurses dealing with ‘difficult’ or elderly patients are brought into contact with their own fears and insecurities about becoming old, infirm, or mentally impaired.  These fears – being intolerable – can only be dealt with by distancing themselves from the patients and dissociating from them.  And we don’t have to go far back in history to see the terrible, shaping effects of dissociation on human behaviour.

So what can be done?  Plenty, and we could start by not dissociating ourselves from the nurses.  The problem is that the alternative – empathy – is not the simple panacea that most people assume.  It takes real effort and psychological skill.  It is not something we can just do, any more than we can suddenly start sticking to diets or going to the gym five times a week.

The key to empathy is reducing experiential avoidance.  And we know how to do that.  Firstly train people – help them – to gently reconnect with what they care about.  Then help them to defuse from the difficult thoughts and emotions that will arise from taking valued action.  We know we can’t get rid of those fears and demons, but we can respond to them differently, and in so doing shift the context for our behaviour.

People often talk about practicing empathy and practicing compassion.  That’s good, because these things do take practice.  But in order to practice we need to understand what prevents us from practicing.

In most cases, it is our own demons.  And we have been running from them for too long.

warning, this is a harrowing clip: