4 Cumbersome and clunky

Exploring what Peer-Supported Open Dialogue is by creating a dialogue about it. In this fourth episode, Billy tells the sock story and we talk about the choreography of dialogues. We reflect together on how learning is sometimes unlearning and how to show emotions authentically whilst holding a space with appropriate levels of respect for those emotions.

POD at Central and North West London NHS Foundation Trust

Fiona Eastmond | LinkedIn

Transcript

Fiona 0:10

Episode four. Welcome to Open POD pod,

Amanda 0:12

Welcome everybody to Open POD pod. I'm Amanda Bueno de Mesquita, and I'm a systemic psychotherapist, an Open Dialogue practitioner, and I'm passionate about us bringing new ways of learning and talking and dialogue to each other. And that's the purpose of this And I'm very excited to be working alongside, my colleague Billy Hardy.

Billy 0:37

Hello folks. welcome to Open POD pod my name is Billy Hardy and I'm also a systemic psychotherapist and have been interested in working with the ideas of open POD pod dialogue. For many years now. So it's a great pleasure for me beginning this process because it Marks a new moment in the development of open dialogue in a different context.

Amanda Pod 3 1:01

Which interestingly is about practice as well, isn't it? It's like, I can't remember who it was. I think it was, There was a book, Fran,

Billy Pod 3 1:11

Hedges,

Amanda Pod 3 1:12

thank you. I love it when you finish my sentences. And she said something about the little bits of magic in the therapy are the bits that you don't tell your supervisor that don't have any methodology about them. They're kind of like, I think she likened it to that throw of ingredients that you throw into something that you're cooking. They're a little extra bit of salt or a little bit of flavoring or the word on the way out. And it's, it's the bit that becomes that is unteachable and is un and, and I think it's the bit that is a felt response. And, and that resonates really well because the people that we're talking to at the moment via these podcasts have just come off their second week of their POD training and they've been sent away and they've been told to just do it. Just get on with it. Just start, try, see what it's like.

Billy Pod 3 2:06

Yeah.

Amanda Pod 3 2:07

And they, and, and in an intervision, there's somebody said to me, but I don't quite know what to do. I don't feel safe. I'm not really ready to do, what am I meant to do? And I said, and I was talking to them about the difference between the kind of practical wisdom of, I think Aristotle called things practical wisdom, which is a kind of feeling around a situation. and it doesn't have that governance, it doesn't have that methodology. It's, to me it's the embodiment of uncertainty. One of the elements of uncertainty with open dialogue could be it's the live feedback in the moment with the conversation and the humanitarian connection with the person that allows you to be, rather than do, and I was trying to say to this lady in Intervision, you can do that even if the system isn't set up for you to go off and be an open dialogue practitioner and work alongside someone else and all of that, you can do that in yourself, in your bones, in your own practice. Does that make any sense?

Billy Pod 3 3:22

Yeah, it does. It does, because it, it just, as you were saying that, I was thinking, so people go off and they do the training and then somebody says, just go off and do it, but I'm not sure. cause I wasn't there, so I can't see what what was said or or what I would've heard. But before you do that, there's a scaffolding which may or may not be present and that is, this is the way that I would think about it. That the idea of just going off and doing it is, is to introduce the whole open dialogue process into a system. And if you think and prescribe it too much, then you lose the essence of it. So just doing it will make a difference.

Amanda Pod 3 4:12

mm I, I think I was also. Very taken this week with the idea of just doing it as long as you are allowed to make mistakes, and often the system doesn't permit that, and you are allowed to self-reflect because in order to become, you know, if, when you do something automatically, let's say for anything, even a sport, let's say playing golf, you don't become better at it by doing it again and again and again. So the time spent doing it, I don't think improves what you are doing. So only when you hone in to the nuance

Billy Pod 3 4:48

Mm.

Amanda Pod 3 4:49

and then self-reflect and adjust, you know, recalibrate. and you said something fantastic just then, which I heard you said. I wasn't there, so I don't know what was said or what I might have heard. And you put in, and I heard you say that, Billy, and I thought, oh my God, that's gold dust. That's like,

Billy Pod 3 5:12

self-correction. It's called

Amanda Pod 3 5:13

yeah, yeah. But isn't there a difference between

Billy Pod 3 5:17

There is, there is,

Amanda Pod 3 5:20

what's said and what we might have heard, which I think sort of segues nicely into what we are doing here now. What, what do people hear and how does it differ to what we say? And I just, I heard you say that'cause I was just listening. I was thinking, oh, that was just, that's, that's a magical sentence that I heard.

Billy Pod 3 5:40

There's another little, there's a little Instagram thing that I saw recently it included two very well known musicians. One is Herbie Hancock and the other one is Miles Davis. And it was lovely. It's a lovely little thing'cause Herbie Hancock is, this is about mistake making. and, and he says, I was just a young musician and I was playing a piece. And, and, he was over there and he, he was doing his thing. I hit a wrong note and, and I could see Miles looking at me cuz he stopped. And, and Herbie Hancock says, and I put my hand on my head. He said, we should never do that. But I was just a young guy. I didn't know what to do and I made a mistake. And Miles Davis. He said, he said, do you know what he did? he stopped and then he played the same note that I did, which was a mistake and made it part of what was gonna happen next.

Amanda Pod 3 6:34

Hmm.

Billy Pod 3 6:35

That's the essence of it.

Amanda Pod 3 6:38

And that's what you can't learn in your theory, because I think that also ties in beautifully with the fact that the Trust is enormous and I mean completely enormous and each, aspect of it needs different musical scores.

Billy Pod 3 6:58

Yeah. And it needs different, it needs different notes for different places, different contexts, you know, and it needs different nuances or emphasis or whatever the complexity is in that moment. It just needs something different so that we don't have that sort of one sock fits all, which I, I'm using the word sock because I have to tell you the sock

Fiona Pod 3 7:20

Oh, please tell us the sock story.

Billy Pod 3 7:22

I tell you, it's a great sock story. It, it concerns a place called Connemara. And Connemara is in the west coast of Ireland, which is a beautiful place. And I've been there, and I was there on a motorbike many years ago. My colleague Kieran, who Amanda knows, was recently in Connemara, whilst he was there, he thought about me there. So he bought me a pair of socks, which I have on today, in fact, and they're woolen socks made in Connemara now, he posted them to me in a Jiffy bag and inside the bag was a poem by Pablo Neruda called Ode to My Socks. And so I had a pair of socks and I had this poem by Neruda, which is absolutely wonderful, And you can get this, you could just Google it. It's just, just fantastic. It just opened the whole:. It just reconnected me with Pablo Neruda. And I'm mentioning it now because, those same socks, and this is the big, this is the error. This is the mistake the first thing that I had them on, I accidentally put one of the socks in the washing machine. You can imagine.

Amanda Pod 3 8:35

we can see it. The shrunken one against the one the right size. I can feel all the, all the wool's gone. prrrr

Billy Pod 3 8:42

yeah. Absolutely. The wool's gone, like it's gone to another place. Anyway, I knew this and I was very saddened today when I took the socks out and then realized I'd shrunk one of them, but I managed to get it on.

Amanda Pod 3 8:57

Ooh, there's a happy ending.

Billy Pod 3 8:59

So I do have both socks on, but one is shorter than the other so there is a mistake in the, in the sock wearing, but it's still possible to wear them. It's just that one is slightly tighter than the other.

Amanda Pod 3 9:12

You've adapted them.

Billy Pod 3 9:14

You've, I've adapted them. Other than cutting my toes off, I thought it's a good compromise. Anyway, it's, It's how, what you do with mistakes, you know, and I think it's a Batesonian thing as well, because Bateson always talks about, about error. something called error activated learning.

Amanda Pod 3 9:32

Exactly. Exactly what I'm talking about. It's that idea of practice, be that an instrument, be that a sport, be that being a therapist, be that being alongside people. But I think it's also, for me, it's about truly authentically listening because once we go down the path with Open Dialogue or with any of this to go down to dictate to people what they need, because the nuances with the individual context of what people will need will come out if we do less, actually if, if we don't go in as an expert, but we go in as a person and we just, when we sit, we need to actually be less active, I think. And that's, that's quite hard very hard.

Billy Pod 3 10:24

Well, you see, the, the problem that we have is the problem that we all have. It's a problem of language, isn't it? Because when we say something like if we do less, then we, then we create a different sort of conversation. But to do less, you need to work harder. It's like a duck, you know?

Amanda Pod 3 10:41

I I used to joke about it when I used to wear, cause I've never worn much makeup and I used to say, you have no idea how much effort it took me to look effortless

Billy Pod 3 10:51

Yeah. Well it does take it, you know, but it's, it's like when you see someone who's got great expertise, it does look effortless. It looks as if it's the difference between the embodiment of something,

Amanda Pod 3 11:03

Mm.

Billy Pod 3 11:04

And then you see it happening and you think, how did they do that? How did they say that? How did they think that? And so doing less, it's easy to fill the space if you go in as the expert, because the frame is set up for,'cause if you believe that you are the expert, if you're holding that and that's embodied and you, the thing that might happen is that you just fill the space. You fill the space with your words and it becomes, it becomes a monologue.

Amanda Pod 3 11:34

Mm

Billy Pod 3 11:35

That's the monological trap I would suggest.

Amanda Pod 3 11:38

mm With an illusion, I think of certainty.

Billy Pod 3 11:41

Yeah.

Amanda Pod 3 11:44

I, I used to feel, you just described or reminded me of how I felt when I would watch you and you trained me to be a therapist, and you always, I'd always go thinking, well, That look easy. You know, he didn't, he didn't, he didn't do very much, you know, to be fair, And then, and then as soon as I was in the room with my clients and you were watching me, I was terrified thinking how, what, what did he do? What did he say? How did he make that look so easy? And how did he turn the conversation and how did he know where to go with it? And, and, and you can't also l I think that's also, I've just ran into something else. You can't be someone else. All of the people that are listening and that are being trained can bring their own wisdom and themselves into the space alongside the people

Billy Pod 3 12:44

Yeah.

Amanda Pod 3 12:45

that they're with you. It's not something that you can learn to do in a way as such, it's not a toolbox that you just get out. It's a, it's a way of kind of finding the way, and I think that that's what, what is meant by just, just do it, you know, just get on with it. Because I think it's about us allowing the creativity,'cause it's creative. If you, if you restrict into your methodology, then you've lost your creativity, haven't you?

Billy Pod 3 13:15

well, I think so, but most, most practices as we know are, are as, as we can guess and gather is most of the practice is based on the mistakes that you make.

Amanda Pod 3 13:27

Mm-hmm.

Billy Pod 3 13:29

And, and there's that lovely piece of work that Ohad Naharin you know, the choreographer

Amanda Pod 3 13:35

Yep.

Billy Pod 3 13:36

where he, he's. Really important piece that you choreographed. People dressed they're sitting in a half circle, like a half moon. And it's a, it's a brilliant piece of choreography because the first person starts on the left hand side and they stand up in a particular way. And then it's repeated like the deck of cards, you know, and then a guest to the person at the end on the right hand side. And what he does is he falls on the floor as he stands up. And Ohad Naharin described that, he said this was a mistake that we incorporated into the piece because when it was first done, the person at the end fell over. And rather than saying, oh, we have to do it again properly, he said, no, no, we'll keep it in. it's, about it. It's about capturing those moments and, and allowing, you see the scaffolding I would suggest, which is maybe part of our thinking, is how do you create enough scaffolding for people to be able to make mistakes without falling over too often?

Amanda Pod 3 14:47

I think it ties in with one of your other teachings. I think we should put them in a book. The wisdoms of No, the Tao of Billy

Billy Pod 3 14:58

Oh gosh, that would be,

Amanda Pod 3 15:00

We put, we put it up there next to the one of Pooh. He's got one as well,

Billy Pod 3 15:04

Oh yeah. That, that that would be on the right shelf then, you know? Yeah. Yeah.

Amanda Pod 3 15:07

When we talk in general about right or wrong, I've given up right or wrong now, and I loved it when you taught me to replace it with useful or not useful, and I think that's part of these navigations with the family is with the people, with the things that we're doing. What feels useful, what feels not useful, and most importantly, this dance is not one that we set the notes to as the practitioners in the room. It's one that the clients set the pattern, set the rhythm. It's their, it's their life, it's their pattern.

Billy Pod 3 15:45

Yeah, you know, it leads to, because this, this stuff that we're engaging in is we can use all sorts of metaphors, can't we, about dancing and music and whatever, but sometimes we're led to be left with the dialogue. And so how do we transfer those metaphors into a dialogical relational process? And it, and it might be, it might be simply saying to the other person who you're engaging with, how should we talk today at this time? How should we put together the words that are going to be useful for this conversation today? And, and sometimes that seems a bit cumbersome and a bit clunky cuz why do you want to do that? Well, you might want to do it because it's, it prevents you from becoming the expert and it's invitational and it's collaborative and it's respectful and, and the tune that may come out of it is not solely your tune,

Amanda Pod 3 16:43

mm.

Billy Pod 3 16:44

if that makes sense.

Fiona Pod 3 16:46

I think it does make sense. I, I think it's also a very kind way of opening a session It, it opens up more of a blank sheet for a person to work with than saying, you know, what's your name? What's your diagnosis? Can I just check your date of birth?

Billy Pod 3 17:01

yeah, yeah. Oh, yes.

Fiona Pod 3 17:03

But I'm, I'm wondering, Amanda, are, you're talking about the learning and the people who are listening to this and, and things like that and being told to to go away and just do it and finding that really kind of, you know, difficult you might be talking about the stages of learning where you go from unconscious incompetence to conscious incompetence, which I kind of feel like I spend my life in conscious incompetence,

Billy Pod 3 17:28

Mm-hmm.

Fiona Pod 3 17:29

Where you are aware of what the skill is, but you don't really know how to do it. To conscious competence where you are able to use the skill, but only with effort. So it's exhausting and you're sitting there thinking, am I doing it right? Am I doing it wrong? To where Billy is. And I think where you are, which is this unconscious competence where performing this skill becomes automatic. So many of us have an unconscious competence with the day-to-day workings of our NHS teams. We're like, oh, well obviously we need to check for safeguarding are the benefits there is the you know, is there some money? What's the housing like? What's the medication? We need to tick, tick, tick, tick, tick. And it's almost just unconsciously we're very competent in kind of just slotting into that little rhythm. and we do that. And so we're, we're consciously kind of slipping back into that as we try this radically different way of communicating and sitting with uncertainty and not knowing and not being the expert. And this is, this is where I think that, we're in the messy middle where it all feels desperately unfamiliar. and is now beginning to feel difficult.

Amanda Pod 3 18:44

But I also think that that that automatic pilot that you are talking about of filling in a list is almost like automatic driving. You know, when I'm driving, I'm thinking of other things. I'm not thinking of my driving. My mind's on where I'm gonna get to, or this and this. It's quite, it's an automatic thing, and I think that once you go into this work with that automatic response, you stop actually learning and listening. Truly, truly listening

Fiona Pod 3 19:14

Yeah,

Amanda Pod 3 19:14

to what's going on in the room.

Fiona Pod 3 19:16

Yeah. I totally agree. And it's so it's so easily done. For, for me having the, the privilege of watching others learning during the week, it was really interesting to watch during role plays that we were doing. Really unconsciously competent professionals in character saying directly to the network. Okay, so me and the other doctors are gonna go away and discuss this, and then we're gonna come back to you with some thoughts or, or with some solutions. We're, we're gonna fix this for you. Please don't worry. And then immediately, you know, the role play was, was stopped and we were like, oh, no, that's not what we need to say. Also, we're not going away. Okay. And then there was this, there was laughter to try and diffuse the sort of in, in kind of, oh, oh gosh, I've just got something wrong. But then there was this kind of almost physical stepping back and actual sitting back and thinking, so now I'm gonna reflect, I'm gonna turn and reflect to my colleagues. And we're not thinking about fixing this, and we're not thinking about risk and these different things. And, and I think that So many of the, medics on the training are so very competent in their frameworks that you almost have to physically kind of click out of it. It was wonderful to watch that learning happening, but as people are kind of stepping. back, that they're almost unlearning. and and we felt that and discussed that in the group, that there needed to be some unlearning. And I think in a way that how that sometimes sits with medics is that it might feel a little bit like they're being told that everything they've learned is rubbish now. And now we've got this new thing. And I wonder if that's where the sort of the tension comes in.

Billy Pod 3 21:10

Well, you see, I think you've highlighted a, a beautiful relational process that's that this part and parcel of the whole endeavor, and that is, that is when professionals are professionalized and they're given to use a Glasgow word, patter or patois, that, that they take and usually it, it, it shows itself. You've just noticed it in the training. It shows itself. By highly experienced, highly paid professionals making statements to people. And so even that lovely example that you have, the the vignette was, me and the other people are going to go away and think about this. Now, if you weren't worried about that before they said that, you will be worried afterwards cuz they will be talking about you and, and you haven't been invited. And the last things the professional said was, there's no need for you to worry. I do need to worry'cause you're going away to talk about me That's the point. that's the whole thing about it, you know? And the unlearning is, you are right about the unlearning. And really when we get to practice and, and I always remember, a little few words in, in the book by Donald Sean, the reflective practitioner written in 1976, where he talks about the messy world of practice is, is where you get in the mud with your clients. That's where the learning is. You have to learn to sit in the mud with you, with, if it's a client or the other person, in order to have, in order to exercise wisdom, you have to be in there with them.

Amanda Pod 3 22:59

I want to turn you upside down and rattle you. I can't believe that you can remember the year it was published.

Billy Pod 3 23:05

Look, this is an occupational hazard. You know, you, when you work in a university and lots of students says, what year was that published? You go, blah, blah, blah,

Amanda Pod 3 23:13

it just comes out of you.

Billy Pod 3 23:15

and I've got, I've got stuff in my head, which are completely irrelevant, nowadays. But if you throw me into a room with that subject area, I'm sure it'll all come back. But, but because it's old stuff, I have to continue collecting new stuff, you know?

Fiona Pod 3 23:31

are, you are reminding me right now of the character of Connie from Tinker Taylor, Soldier Spy, the, the Alec Guinness version. And when Smiley goes to visit Connie, he visits her for her memory.

Amanda Pod 3 23:44

Oh.

Billy Pod 3 23:45

Yes,

Fiona Pod 3 23:45

take, he takes a little glass of, whatever the tipple is. And and she kind of first of all ticks him off and says, oh, you're my lovely George and talks about her time working in the M.I.5

Billy Pod 3 23:57

yeah,

Fiona Pod 3 23:58

Um, and then she just suddenly rattles off all these dates and exact times and things like that just instantly reminded me there.

Billy Pod 3 24:06

That's a lovely, it's a lovely example though. It's, it reminds me of working in multi disciplinary teams or when I worked in the health service, when someone would leave who had lots of experience, then there would be a huge chasm is then created. Cuz then nobody knows what's what has to be done.'cause person has left with all the knowledge.

Amanda Pod 3 24:27

That's really interesting actually,'cause you've just stumbled into something, That is very, very relevant to open dialogue and what's going on and has gone on with the ODESSI trial in general is that when people have left, and I don't know the reason one could hypothesize, it's because the scaffolding wasn't maybe in place around the practice, in the way that it takes so much time to build. It's very difficult, isn't it?'cause we're trying to sort of put in a cultural change into a system that is very results driven and what are the random control trials and what are the results, et cetera. And some of, some of what we're talking about is, is almost impossible to, discuss, to consider, let alone, to put into a graph. Which is why we've got, you know ethnographic researchers around it, et cetera. But it's still almost impossible to hold, isn't it? It slips through your fingers these conversations, and it's one of the reasons why I'm hoping that this method of having a dialogue around dialogue creates something that is more tangible in a way to hold onto and to create a polyphony of voices around and to bring more ideas into and to thicken each thing that we talk about can be then thickened by whoever. Like you said just before, what I may say or what someone might hear that we've said, the difference, the nuance. But it is difficult because when that person with the knowledge goes,

Billy Pod 3 26:01

Mm-hmm.

Amanda Pod 3 26:02

The pack of cards falls down, and I think that happens a lot with a rigid, with a rigid system, or even with this flexible one that's being put into the rigidity of business as usual.

Billy Pod 3 26:13

Can I give you a little example of, a story that was told fairly recently. So a, a very experienced therapist is looking to their team and the team that they're working with, they're not, they're not fully qualified in anything. And, and the therapist is seeking to create a polyphony of voices within the team. And, and it's a good thing because the therapist is mindful that the voice that dominates is, is their own voice.

Amanda Pod 3 26:46

Hmm.

Billy Pod 3 26:47

And they, express it as being bold with their own voice. And sometimes you can get that you, you, you constantly, and, and, and you know, I, I've said on quite a few occasions, you know when I've noticed that I, I'm, I'm saying something that I've said before, but I've forgotten that the people who are receiving what I've said before are a different group of people. So I'm trying to correct myself and and apologize for repeating myself, but they don't know that cuz I've never been there before. This very experienced therapist was very frustrated by not having the availability of a polyphony of voices for, for the complexity of work that they were doing in it's very complex, it's in an inpatient context, so it's relevant to some of the, you know, it's relevant to your context. And and, and, and I just asked a simple question and as they were talking about the thing that happens in the organization, which is, well, if you are of a particular band of salary, then that must equate with your ability to think. And if you have a particular band of salary, then you can only speak into a context, when you are allowed to by the other person whose band is higher than yours. So you need to get permission. Although people don't walk around with badges, and maybe they do in some places with their banding on, on their, on their shirt or their tunic or whatever, or tattooed on the forehead because we're trying to guess, and, and I make this, I ask a question, what would it be like if for a moment the frame was that you forgot about the banding and the inhibition of these people? And I just seek to have their voice in a conversation with them and just inviting them to ask them what they think and what they saw, and see what happens. Because one of the things that, one of the hypothesis that was going around in my head was it wasn't, it wasn't the team's inhibition about speaking. It was, it was potentially the therapists knowledge of what banding or grade that this person was at. And so therefore wasn't, it was about expectation

Amanda Pod 3 29:19

I think you've just stumbled into a whole set of new podcasts, Billy.

Billy Pod 3 29:24

Oh no.

Amanda Pod 3 29:25

I think you have. I think you have. And I think it, it touches on something because this is, you know, peer supported, open dialogue and you know, what, what are the peers? And, and is the organization of peers creating another kind of hierarchical structure within the already rigid hierarchical structure like a Russian doll of limitations and assumptions. Then we stumbled into something else, cuz we were talking about the fact that in open dialogue, or now we have permission like the peers to share of ourselves as practitioners and to show emotion and, you know, our, our medical director Gareth, who I'm. Working closely with, with this project him. I've seen him cry in sessions. I've cried with him in sessions. Fiona and I were discussing tears before and I said to Fiona, I've actually come to a conclusion. I don't think I cry too much in my work. I think other people don't cry enough. Really?

Billy Pod 3 30:28

it. It depends where you pitch crying as an emotional response to things. And I, I think it depends on the moments.

Amanda Pod 3 30:35

Mm-hmm.

Billy Pod 3 30:37

I remember, I remember as a young practitioner work in, in, in a psychodrama many, many years ago, and the person who was leading the whole process, and it was a, it was a brilliant experience for me. And and one of the things that was acceptable in that mode, if you like, if I can call it a mode or method or model or whatever, was that tears were readily flowing in that context. I have, I have also been in therapy where I, I'm holding back because it's not the right moment for the therapist to offer the tears. I've learnt because of the method to say things like, for example, when you tell me that story, I'm crying on the inside. It's still a message about tears and the message about the emotional connection to something

Amanda Pod 3 31:33

Hmm

Billy Pod 3 31:33

without dissolving in your own tears on the outside.

Amanda Pod 3 31:37

Hmm. No, it's just very important to make sure that your own emotional responses don't sub, don't subjugate what's going on in the room.

Billy Pod 3 31:46

And that's part, and that's part of the, that's part of the scaffolding process, you know, cuz lots of people have question. what if, what if, what if? What if? You know, what if this happens and I feel like this?

Amanda Pod 3 31:58

Mm-hmm.

Billy Pod 3 31:58

How should I respond in that moment? And it's just to, to create enough scaffolding to say, that's okay. How, how can you, how can you utilize your, if this is one of the basic systemic positions, really how do you, how do you manage your own emotional responses in the context of making a connection with the person sat in front of you without subjugating their story?

Amanda Pod 3 32:22

Mm-hmm.

Billy Pod 3 32:23

That's, that's one of the key principles, I think,

Fiona Pod 3 32:27

I think so.

Billy Pod 3 32:28

rather than saying, I know what you mean, it happened to me. That's not a good position to take.

Narrator 32:35

And that's it for this episode of Open Pod Pod. Join us for the next episode.