Last updated on 25th January 2009
In blog postings earlier this month, I've talked about supporting my Mum after her recent couple of strokes. She's been shipped through three different hospitals and now is more peaceful in a nursing home. It's sad - very sad at times - and it's great that she seems more comfortable, better looked after, and more content. I definitely feel easier too. Less weight on my shoulders, less emotional aching.
Real life experience tends to be richer than any theory or model. I wrote three weeks ago about The bus driver metaphor and six days ago about the Emotions as different rooms in a house metaphor. They are both ways of providing orientation when we're faced by difficult experiences. How accurate and useful did I find them going through this stressful time? During the toughest time, the bus driver metaphor felt pretty apt - not just keeping on driving while "passenger" thoughts and emotions shouted away in the back, but also keeping on driving as the external stresses (weather and condition of the road) threw a series of different challenges at me. As things became a bit easier and the more difficult times became more spaced out, in some ways I found the notion of different emotions, different mind-body states, as different rooms in a house seeming to fit my experience better. Certainly while working, seeing clients, it felt very much that I mostly inhabited a "different room" where I could function well and focus on the client's issues rather than on my own. Sometimes something that was said, or a passing thought, would sound a bit like a quiet noise from a more personal, distressed room down the hall. Mostly though, it did feel like I could shift from one feeling space "room" to another pretty well.
An area where I think the bus driver metaphor scores well, is it's emphasis on the importance of values. This is well illustrated by Alim et al's recent research on how crucial a sense of meaning is in helping get through traumatic experiences. Self-determination theory (S-DT) also highlights autonomy and values as central aspects of supporting wellbeing. Excellent work on how people cope effectively with serious chronic physical pain makes the same point. Physical pain and emotional pain share many characteristics. The bus driver metaphor also usefully underlines the potential value of mindfulness, and it's important to realise mindfulness is not just "cold" awareness, but also open-heartedness to one's own very human experience.
It's helpful to bear in mind though the recent research I've mentioned showing that both cognitive therapy for depression, and mindfulness-based cognitive therapy seem to be more applicable in recurrent cases where external stresses begin to be less important and internal responses more important in deciding levels of distress. In non-recurrent situations, like the one I've been living through with my Mum, it may well be that problem-focused and emotion-focused coping (Ingledew et al, 1997) are more helpful (although mindfulness could be seen as a kind of emotion-focused coping). Certainly avoidance-focus (whether avoidance of external stresses or internal emotions) seems toxic, particularly in the longer run.
All this may seem a bit "heady" when talking about the real nitty-gritty of supporting someone who's seriously ill - or going through some other life stress. Both are useful though - having some intellectual understanding of what one's going through and also rolling up one's sleeves and getting on with it. Butler et al, many years ago, found that better understanding of stress and our reactions to it was a particularly highly valued component of their anxiety management course. As Einstein said "It is the theory which decides what we observe". And Kurt Lewin, father of social psychology, put it beautifully with his comment "There's nothing so practical as a good theory".