7 Being the guardian of safety

Exploring what Peer-Supported Open Dialogue is by creating a dialogue about it. In this seventh episode of OpenPODpod Billy talks about how we can fit safeguarding in to Peer Supported Open Dialogue Network Meetings in an open dialogical and compassionate way. Content warning: contains some themes which may be upsetting, including mention of domestic abuse. 

POD at Central and North West London NHS Foundation Trust

Fiona Eastmond | LinkedIn

Transcript

Fiona 0:10

Episode seven. Welcome to Open pod,

Amanda 0:12

Welcome everybody to Open POD pod. I'm Amanda Bueno De Mesquita, 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

Billy 0:29

Hello folks. Welcome to Open My name is Billy Hardy and I'm also a systemic psychotherapist and have been interested in working with the ideas of Open Dialogue. For many years now. So it's a great pleasure for me to share some ideas with Amanda on these pods, and then see where it takes us

Amanda 0:51

The idea behind these, is to create dialogue. We are hoping that the people listening to us will create a reflection on what we are speaking about and hence create more dialogue and a polyphony of voices

Billy 1:07

You always say to me, do you remember,

Amanda 1:09

I know that's true.

Billy 1:11

is, it's hard for me to remember many things, not, I appreciate your recollection of them in such detail, but I'm just saying, do you remember?

Amanda 1:19

No, but you, sorry. It's just, it's really, I, what I think is interesting here is one of the key things we're trying to teach and talk about and blah, blah blah, is use of self, right? Let me just give me a minute with this. So people do genograms and they're thinking about use of self and blah, blah, and I'm thinking and reflecting. So then if you're thinking about use of self, when I'm saying, do you remember clearly I'm talking about something that matters to or matter to Amanda

Billy 1:50

Yeah.

Amanda 1:50

opposed to Billy? And I'm assuming that because you've got or had so many numerous pupils and so many numerous essays, et cetera, why would you remember mine? So I'm then, do you remember? But then I need to reflect on the fact that's important to me and therefore I remember. And then how often in our life and our work do our thoughts when we're with other people. How do we even recognize our own lens of what's important to us and why we think somebody else should remember or know? And then how do our. How do the people that we are meant to be caring for, obviously that's a very, you

Billy 2:36

okay. That's a great, but it is great that you do that cuz I'm remembering a conversation in a taxi with a man called Paddy Sweeney who was doing his PhD on Giann Franco Chickeen and I was there and John Franco was in the taxi. We were going for, we were going for dinner in Hungary. We were at a conference and Paddy has that. Very genial Irish. Sort of way of saying things, he would say, John Franco, do you remember the time? And he would say what the date was and you would be transported to this date just by, by Patty's description. Patty used to be a Catholic priest. You saying that Did his PhD at the Tavistock And John Franco. John Franco would look blankly. No. I don't remember anything Paddy. But but I'm sure you'll tell me. And of course then Paddy tells the story, and John Frank used to say, oh, yes, that's what happened.

Fiona 3:31

Brilliant. Do you know?

Amanda 3:33

you just for the sake of people listening, fill others in on who SEN was, please, Billy.

Billy 3:39

Who Quin was one of the original Milan team members. He was also if I can say this is my little moment because Jan Franco was the first professor in the UK of family therapy. And we were able to have him. Appointed as the professor at the Family Institute way back in 2002. So any other stories you've read about professors being appointed since then are off and claiming to be number one as they do constantly. But sadly, John Franco died on the February of 2002 and he did old lecture, but he was appointed by the university, so we're very proud of that actually.

Amanda 4:21

And he was the one, wasn't he, if I've remembered rightly, who thought about circularity, reflexing, and prejudice. in beautifully with use of self.

Billy 4:32

I think all of them did, I think, but he was just more, he did a lot more traveling than the other people did. And because usually Louis g Boscolo and him early on would travel all over the place. But there, there was a split in the team in the eighties and John Franco then became a frequent visit at the Family Institute in Cardiff before I worked. And he would come maybe once or twice a year. And so he was like a piece of the furniture after a while, yeah we'd meet up at conferences and stuff and all we wanted to do was just sit quietly and have a beer somewhere in a nice restaurant and have some nice food before we got, cuz normally. As at conferences, you can have, normally the food is not that brilliant but it also gets spoiled because there's too much talking about theory and stuff like that, and so it, anyway,

Amanda 5:20

Because cuz I've just come back from Finland. Where I went to home of open dialogue. Sitting with Yako and sitting with Harlene Anderson,

Billy 5:28

yes.

Amanda 5:29

it was really interesting cuz actually once I was sat next to Harlene Anderson for dinner,

Billy 5:34

Yes,

Amanda 5:34

Didn't want to talk about theory or about anything, and it was. It was, it's very odd to be sitting, which you've much more experienced at than me, as you've just demonstrated next to somebody who is, as I call them, my bookshelf people. Do you remember when I used to, I had a, when I was studying of getting selfies, taken as many bookshelf people as possible, like a child. But sitting there actually, you just wanna be with the person and not about stuff.

Billy 6:07

I found that out a number of years ago. When when I went to the First Towers Institute conference and the amazing thing about going to those conferences, for me anyway, I don't know how it was experienced by other people, is that the, those the experience that you've just described is that people want to know about you. Who are you? Why are you here? And it's just a very personal, intimate, conversational space. Whereas sometimes at conferences you meet lots of people who take a position of, do you know who I am? I'm very important. And if we eat dinner together, we'll have indigestion. Cuz I'll be talking all the time and So I've spent a lot of many years avoiding those conversations and finding more interesting conversations folks.

Amanda 6:53

But it is making me think about what this shift is meant to be doing. Isn't it meant to be finding an intimate, conversational space? Isn't it meant to be thinking about shifting the power and the word assessment to conversation

Billy 7:11

Yeah.

Amanda 7:11

finding out who's really in the room with us?

Billy 7:14

yeah, see. I think if you look at the world assessment, it was root meaning the means to sit with and of course sitting with someone. Being with someone is the assessment process. But because it be is now got a thingness about it, it becomes a thing that people do to others. So others people, if you say to someone, can I just sit with you? They'll be like, what the hell do you want to do that for? If you say to someone in a particular context I'm here to do an assessment then it changes the whole dynamic of the conversation cuz something's gonna get done to you.

Fiona 7:50

Yeah.

Billy 7:50

Which interestingly enough, most of the time you never get to see, and it's usually a, it's usually a few pieces of paper with lots of ticks on it.

Amanda 8:01

And then you've been done too.

Billy 8:03

And then you've been done too,

Amanda 8:04

with whatever that means.

Billy 8:06

Yeah. And however that's translated into something,

Amanda 8:08

I think the important not, there's so much of it's important, but there's the most of it. You never get to see, you don't get your input, you don't get your voice in there.

Billy 8:19

Yeah.

Amanda 8:20

You are othered, aren't you? You are a number.

Billy 8:23

It's very interesting that, one of the positions within an open dialogue is, It's why it's called open dialogue cuz you want dialogue to be in the open. But that includes all the professionals as well. And of course because we're in a context of open dialogue training, we're inviting people into openness. It's very frightening for people to step into that place

Amanda 8:48

I think it's frightening and I've given this a lot of thought obviously, and more and more thoughts come into my mind and there, there are two things that, two avenues that I think might be helpful here is. We can decide which one to go down or even split them, or maybe they're together. They probably are together, is one of the questions that's come up frequently at the moment is a question about how do you have safeguarding? What if there's an abuser in the room? What? What does that mean? Do you still call in all your statutory services? Are you saying to someone, Hey, say anything to me? And yet, Simultaneously, I'm gonna report you if you say X, Y, and Z. I think that's come up and in there is also the question of power. Authority bodies, it's all turning into a bit of a, once we go open dialogue, it's turning into a bit of a kind of soup when the usual statutory rules feel. Less secure for people who are

Fiona 9:51

Just to bring us back to what Amanda was talking about, safeguarding and the worry. And Billy, your comment about how. How difficult it is for people to sit there and there was something we, we've already talked about, tick boxes and ticked boxes of whilst it, it might feel like there's a tick boxiness to safeguarding. It's actually something That's it really. It's a legal requirement, isn't it? If I'm not wrong. It's a, it's something that we're legally required to do and I. I do wonder how we'll do that and how we can do that and feel safe

Billy 10:25

Yeah.

Fiona 10:27

or if that's just not possible. And I'd love to hear what you think about that, Billy.

Billy 10:31

I think that all of those things I look at them as layers of context,

Fiona 10:35

Yeah.

Billy 10:36

something like safeguarding and all the things that we have to take care of before we have a conversation, because rightly or wrongly I can see the frame of conversation as for example, I, I might be a patient in a psychiatric service. Or I might be an outpatient in a psychiatric service and I might be engaging with the NHS or some other agency, and therefore the agency has rules in boxes to tick with. And that's absolutely fine. But one of the things I do notice, I've noticed this for many years, is that people favor getting that information out at the beginning of a conversation. And I and in some ways you would think that's a good idea. I don't think it's a good idea. I don't think it's a good idea because if something is going to come up that feels rather unsafe or falls into the safeguarding sphere, then some of us might have the experience to notice that and say, when you say that, it makes me think about how safe your life might be. In moments like that, how should we talk about that? Now that's you addressing the safeguarding, but you address it from a position of safety. And so you don't automatically go into I need to do all these bits. I need to check all these things with you first before we have a conversation because I know that you can't keep this in. But there is a phrase that I heard a few days ago and someone said that person's pissed on the chips.

Amanda 12:08

No, keep it in. Dare

Billy 12:09

No but it's almost if you want to spoil a conversation, let's have all the rules first. But you see it's not the same as you see, it's not the same as what are the rules are for conversation in an open dialogue frame. It's not the same as how should we do this conversation? The tick boxing is full of power. And full of definition of that power and full of authority and full of the whole context of you are now at the becking call in the hands of the institution. And the thing that you must say and must never say is the what? No.

Fiona 12:49

In an open

Billy 12:50

forbidden.

Fiona 12:51

In an open dialogue meeting.

Billy 12:53

Sure. Or even in any exchange that requires between a professional and a client to a patient, the idea of saying no. It reminds me of all those meetings. I will go back to safeguarding cuz it's a, it's one of the things that for many years working at the Family Institute we explored time and time again, was the idea that you went to a safeguarding meeting of which we would generally not go to because we didn't see as we went state s Guarders, that we thought that was the local authority who would do that. And I think rightly so in a sort of legal sense. But when we did we would notice that when some, when the chair of the meeting and there might be 15 people in the room we would try and maneuver in some way. Certainly, I've done this, so I would be the last person to get asked the question of what I might think. So it's useful to find out where the chair sits and then ask what direction they're most likely to go in. Have you got the chance to do that? And of course when you get to be the last person, you notice the pattern of everyone saying yes, they agree with the safeguarding recommendations. They agree. And by the time you've got around the whole room, everybody might have agreed, cuz it's difficult to disagree until you've got. Someone who says, actually I don't hold the same position. And there are many ways of saying no. And sometimes people it's good to have those sort of conversations cuz if somebody said to me, would you come to an open dialogue meeting? And I would say, that would be fantastic. Or would I come to a review meeting for safeguarding? Then the life just drains out me at that prospect cuz it's not gonna be a conversation. It's It's an exchange of info. It's an exchange of data and with the conclusions already written, but as an open dialogue, it's a different negotiation.

Amanda 14:56

I think I'm also feeling about the sort of degree of experience because in one respect here we're talking about people that are new to this way of working And then comparing that with somebody like yourself who is very experienced and comfortable. Perhaps more comfortable with their position of being able to be nuanced and have a safeguarding con. And I've seen you have a safeguarding conversation, actually, I've witnessed you doing this. And what I noticed just as a, as an aside, is that I noticed a very obvious shift in your body as it happens. I remember you clearly moving yourself. To the front of the chair And being really very strong and much more directive in what you were saying. And in a way using, power and authority, but not in a way that closed anything down

Billy 15:57

Yeah.

Amanda 15:58

because we were sitting and working. I, as I recall, with the domestic abusive situation, which is one of the topics that's come up for us. Very recently on this training with people. And I'm just saying, I noticed that shift in your body language, which shifted the conversation where there was no mistaking that the people in the room knew that if they reached a point where statutory services needed to be called, they most certainly would be, The frank conversation did not mean they wouldn't have services called on them if the need was felt.

Billy 16:29

Can I give you a little example?

Amanda 16:31

Please do.

Fiona 16:32

Yes, please.

Billy 16:34

One, one. I could give you two examples cuz one covers domestic violence of a child against a parent and the other is, the two of them are parents and children. But in, in a recent encounter in conversation, I heard the conversation from a mother who's describing all sorts of very, which I was thinking was dangerous behavior. Yeah. And the way that I put this to this mother was, when I'm hearing you describing what things are happening at home, I don't become concerned about your son cuz he seems to get lots of attention. But I become concerned about your younger daughter who's only two. I wonder whether she will get caught in the crossfire of violence. And of course the mother hasn't thought about that cuz the focus is on the 10 year old who's. Who's being violent, and then I said to her and when you tell me the whole story of that moment I'm then pulled into other responsibilities as a professional practitioner that, that would mean that I have to call on someone And cuz I'm not allowed to do it. But I have to call on someone, and this is probably the moment, and I said this to this woman, a young woman in early thirties. I said, this is the moment where I think we need to call on the local authorities and we need to contact the local authority social worker. And the team that we're working with me behind the screen they're a, they are they're a bit bemused because what is the point of doing that? Because they don't respond anyway. That is not the point.

Fiona 18:11

No.

Billy 18:12

That is not in the consideration of where I'm sat or even in a D, which I think is an open dialogue with a young woman. And I negotiate with a young woman a very explicit contract, if you like. There's a different word for this, but we come to a place where I invite her to, to when she's finished the appointment with me because of the seriousness. And the dangers in the family home that she should go. She should go to the local authority, social work department and say, I'm concerned about the safety of my child from my other child. And she agrees to do that. And we conclude the session. And there was also safeguarding because one of the, one of the members of the team is a team leader in a, and this is in a third sector organization. And of course he he's alerted to the paperwork, the tick boxing exercise. He's already thinking this. And I say as a therapist, I say, I'm a, I need to write, I need to write to the gp. Cuz the reason why they came here has completely shifted. And now I need to contextualize our conversation. I'd already negotiated with the young woman that I would send her a copy of the letter so that she could also go to your GP and say, this is happening. So I did the letter that day and I gave it to our admin person who typed out the letter. It was very experienced, said, we don't usually send these letters. And I said I can't practice if I can't send a letter to gps. Who are the, who are they? Refer us to this. And so that needs to go and even if you don't want to post it, I'm happy to drive there. Cause it wasn't very far. But they sent the letter and they sent a copy of the letter to the to the woman. Now the next session, she comes back. Actually in that session this woman was very upset, as you can imagine when you're told this. But she was upset, so it wasn't tears of fear. I. It was tears that actually her life had been acknowledged, that somebody had noticed how dangerous it was for her living at home in this way. And thank goodness somebody has mentioned the local authority social work department, Cuz when she went home that night, cuz she came back for another session. And when she came back, she said, I did everything you suggested. I went to the social service department and they were really, they were keen to talk with you. Of course they would be, wouldn't they? But they were more keen to talk with her and the gp. When I went to the GP for an appointment, I took my letter. The GP was brilliant, and they did this, and they did that. Anyway, everything opened up for this woman, and this woman had a platform and she, she then found her voice from that moment on. And she also had an open dialogue meeting cuz I had a previous open dialogue meeting with the family cuz I'd seen them previously a few months before. And I said it would be good to gather your helpers around and and have a dialogue about what's happened than this therapy, which she did. And she never felt better in her life cuz she had a platform and everybody in the family were taking notice of her. She found a voice. Now even in the depths of thinking about safeguarding, it is not merely a thing that we do to others, but we can still collaborate with people. We still need their permissions to do things. And I think that, that moment, and of course it rested in the minds of the team that I was working with. And it wasn't the only one, but I'm using that as an example because. There is a switch when you see the bodily movement because I'm responding to the seriousness of the matter, and I think that's probably years, if I can say this, which is a previous history of working in forensic psychiatry, and I haven't spent over 20 years working in the psychiatric services that I became to appreciate my bodily responses to many things, and I think on several occasions it saved my life. So I always respond, and so you will always see a change in a shift when there's violence or danger or something like that. I go into another mode.

Amanda 22:23

And I think the interesting thing having seen that in New Billy is it stayed with me as it probably stayed with the people behind the screen recently. It stayed with me and I would often think, how do I do it? And then I realized, and I think this is maybe important for people to think they have to do them in the space

Billy 22:47

Indeed.

Amanda 22:48

You can't. You can't copy someone else. You can watch all the videos or you can be on hand with somebody more experienced than you, but at the end of the day, you're going to need to do your responses authentically.

Billy 23:04

Yeah.

Amanda 23:06

And even if you don't know, like you said, you, you touched on before, how difficult it is to disagree or say, actually I don't agree with what, what's going on in this. Moment. But there's also that difficulty in saying, I'm unsure how to deal with this at this moment, but I could invite to the network meeting, for example, X, Y, and Z, who maybe have got who? Who I would like to bring a colleague in if that's So you don't have to sit there panicking when you are newly experiencing something like that in the room.

Billy 23:43

I, and you've touched on an important gathering if you like, and that's network meetings because usually when you invite people to a network meeting, so sometimes the phrase gets corrupted, let's have a network meeting, but actually what they mean is a multidisciplinary team meeting and is very boring and. And it's not gonna go anywhere. So when you ask, what do you mean by that? You're beginning to deconstruct the whole thing so that you know that you're going into the right context. And also the network meeting is a place of, there's a lot of anxiety, but it should be anxiety provoking because most of those people will never have come together again. I'll never have come together before.

Amanda 24:22

But you just made me realize something. You'd said before and I loved it. I wrote it down cuz I liked it. Instead of who's important to you, you said gather your helpers.

Billy 24:32

Yeah.

Amanda 24:33

And I noted, I noticed that in your utterance and I was just thinking that we moved from this person in the network meeting in a open dialogue meeting with you had gathered their helpers and now we are talking about how staff can gather their helpers. So we've got a little multilayer of gathering your helpers

Billy 24:57

Absolutely,

Amanda 24:58

and, of course having helpers in one's in an open dialogical sense is in itself contributing to the safeguarding

Billy 25:07

of course is.

Amanda 25:09

you don't have what This, what I've called, is called a named professional, but I've called it a blamed professional cuz I'm sarcastic like that, because the blamed professional has got the. Framework and scaffolding of their own helpers around them and that in itself is a safer position to have difficult conversations from.

Billy 25:30

Yeah.

Fiona 25:32

It's very difficult when we're in a room with people and we feel like safeguarding needs to happen, especially in an open dialogue setting. How do we even bring that? And I'm really interested in what you said, Billy, and how you, that beautiful example and what you said, Amanda, in the way in which you said it. And I was reflecting and thinking about how I would try to bring safeguarding in to a meeting. And I think that I might. Either reflect with my colleague or directly say I'm now feeling a sense of danger, and I just want to talk about that a bit and we can talk about where that's coming from and what we might want to plan to do about that together to help keep you safe.

Billy 26:25

Yeah.

Amanda 26:26

I wonder if you remember you said you've got two examples, Billy, and I think this is such an important topic for everybody. I wonder if you can recall the other one as well.

Billy 26:36

I can recall the other one cuz it happened in the same clinic. And but before I do, I, one of the things that occur to me is how we use language I've referred to myself as being the guardian of safety. And I've played with that idea, especially with his children because I become one of the guardians of the universe and children get it

Amanda 26:57

Sword with that?

Billy 26:58

Yeah. And you get a big shield and all that. And I do all that stuff and I say I'm the guardian. I'm the guardian of safety. And people laugh at, and of course it, there is a, there's a humorous edge to it, but it's very serious. But when you're working with children you want to make that, you want to make that point. And this, the other example is very similar but it's very different where I'm talking with a 10 year old who had been violent to his sister. Who was more or less the same age as him? They's a d completely different family. But I took a position both parents who were divorced were in the room and the two children were there and this boy had been violent. And this boy was crying. This boy was crying. Cuz I was seeing things like, I'm an older man and I've got I've had children and if I thought that my children were. Something like this. If I thought that my children were in danger of being violated and violent or violent to each other, then I would need to do something about it. And for your family, I need to do something about it. And what I'm going to say to you is I think that this therapy that, that you think that you've been attending to is now not is now stopping. And you can see the face of the mother and the face of the father is like shock horror because now this thing they thought was therapy turned into something else. And I said, but let me clarify that for you. I said that there's far too much violence going on in this, going on in this family for me to continue to be a therapist with you. Cuz because what might happen is that you think that you'll come here and talk about things therapeutically. And it will be okay for you, the boy who is 10 year old to continue to batter your sister. And that's not the case. And I can't work with you on that basis unless you, the boy pointing to him and sitting and eyeballing him. Unless you can say to me, I will not be violent towards my sister in any, between any of the sessions and I won't be this and I won't be that and I won't do this and I won't do that unless you can assure me. No, your parents, cuz it doesn't matter what your parents are thinking at this moment. It's to do with me. And then I tell them the story of, cuz this is about my safety. And I say, I don't want to wake up tomorrow morning. And on the headlines it says, therapist in South Wales ignores boy who battered his sister and then he killed her with a hatchet and the therapist did nothing. I don't want that to be me.

Amanda 29:29

and

Billy 29:29

you can see it may sound a bit dramatic, it does happen. It has happened.

Amanda 29:34

it's, there's two things I loved about that story. The first one was that you used yourself, when we think about use of self and when we think about saying things that are personal. So you actually created a relationship with him as a dad, as a man with children which I think. Is an interesting way of us using ourselves when we talk about coming in. Because people often query that in the learning. How much do I share, how much do I not share? And what you've just shown is a beautiful example of sharing when it's relevant, when it's useful, when it's not too personal. It's measured, with all of those sort of scaffoldings around it. But I'm also wondering about, How the shift might come with adult to adult abuse. If you can see, for example a male or a female, being abused or feeling that tension in the room. How does one approach it then? Have you got examples that

Billy 30:34

I've got sadly, I've got hundreds of examples Over the years and, adults in my experience particularly when you're working with couples and in the context where there's. Distress and stress and illness and diagnosis and medications and all sorts of other drugs are being used and altering people's thinking and all sorts of stuff. Violence is a high context marker. At the Family Institute in the 20 years I worked there, 50% of the families that came there was violence in the family, 50%. But we weren't a violent, a violence prevention service. We were just a independent institute offering therapy, and that's shockingly high. And I could pick out lots and lots of different examples. The principle remains the same, whether it's adults, is that I'm sitting there with two adults and I'm saying, we have to stop the therapy. It's too dangerous to continue talking like this. And then I put out a contract with them. On the table, and this is largely based on two principle players in my thinking. One is Alan Jenkins From Australia and the other is Virginia Goldner from the US working with couples who, with us violent relationships and all these, all this literature is accessible online. And my colleagues working at the Family Institute over many years, so I have developed a. A positioning, that I'm always noticing and listening out for those things. And I'll give you a little example. A couple will phone up and say, I think we need therapy. We've got a communication problem. Alarm bell number one, communication problem. I usually say, I've what sort of communication problem do you have? And they say, oh, there's lots of arguing. Oh, there's lots of arguing. And how bad do the arguments get? This is in the first 15 seconds of the conversation, by the way, and how bad do the arguments get? Oh, very bad. I said, oh, very bad. Do they ever get violent? This is in the first 30 settings of taking the call. Yes, there's been some violence. Now I know where I stand. In the space of 30 settings, we can talk about things in a very explicit way. And I say to people, I think you've come through to the right therapist. Cuz I do work with couples who who experience violence. But let's get back to your communication problem. Is that separate from your communication problem or is it part of it? I think it's all mixed in. I said, that's good. You've come through to me. Cuz I work with people who want to improve their relationships and live a violence free life. If both of them want to, if both of them want to sign up to that. And then I say, Does your partner know that you're calling me and will your partner be coming to the session? Cuz there's no way I'm seeing someone on their own and I negotiate to both of them. And I would say, is your partner there in the room? Yes. Can I speak to him? Please? If it's a man, there may be a woman. And I speak to'em and I said, so you guarantee that both of you're coming to this session? Yeah. And I'm working as an independent therapist. This is not for a local authority or anything. And cuz they wouldn't do this sort of work. It's too risky. But I make it very clear. If you want to work with me, we, we do tick boxing. Th this is one of the areas I would suggest to you that it, the open dialogue approach becomes a bit flimsy in these contexts where there's danger to life. Although aspects of it are really important, the gathering of helpers helps to make things feel safer. But you, it has to be a, I don't like to use this a lot. It's not a great metaphor, but let's say it's a bit of a double-edged sword. You have to have both sharp edges and so you're positioning in terms of safety and violence. Because I'm very clear with people. I say the problem I have with violence is that I have a problem with it. That's the problem. A and the problem is I never speak to anyone whether there's violence and I don't do anything about it. I, and you don't need to engage with me. You're quite free not to come, but people turn up and we do some useful work, and people have proclaimed violent free existence from that point on. But they just didn't know how to do it.

Amanda 35:21

I think there's something in the witnessing, isn't there? something in the witnessing.

Billy 35:25

but you need to know how to use the witnessing. You're not just an, being an observer is not the same as being a witness. And I'm a bit vague on the translation here, but in Hebrew, being a witness is actually to do something. You can be a witness and you can be just an observer or you don't do anything, you're passive. I prefer the Hebrew definition of witnessing, which is you have to do the action, you have to do the follow through, you have to do it. It's not, you don't hear just for the ears you hear with your body.

Amanda 36:07

And of course that ties in with the principle of psychological safety

Billy 36:12

Sure.

Amanda 36:13

and continuity. And I think it's interesting how you start learning about open dialogue, but actually each of the principles as just. Wider and then wider again. And then wider again. They're all so multi-layered. They're so multi-layered. They're so nuanced. It's what makes it so difficult to teach, I think.

Billy 36:41

Yes and it's also difficult talking about these issues that are big, high context markers. I blame free sort of culture. I I'm not convinced by that. I'm definitely not convinced by that in an NHS context that ain't going to happen cuz I don't think of the NHS as a benign, beautiful organization whatever persona you want to add for that. Like some friendly old grandparent or something. It is not that, it is a government department. And it will do things to protect himself. And so to make a statement like this is a blame-free cult professional culture. I remember nearly 35 years ago a very important at the time professor of law when I was doing management training for the N H s. Said the thing that you need to be aware of is that you as professionals need to get your own private indemnity insurance. Cuz you might think that because you're employed by the government that if you, if something went wrong, that you would be covered. It's not how it works. And so from that day on, I had private indemnity insurance. And I banged on about it for years and years, and I've been on the o I've been on the other side of holding private indemnity insurance and seeing what happens and seeing what's happened to people when they don't have it. A and very competent therapists practicing open dialogue, I might say, in psychiatric services who have been. In some instances the the NHS thought at the time, they were just gonna hang them out to dry. They couldn't, and they didn't, but they tried. Thankfully that professional therapist is still in a post and doing some great work. So I've seen it, from, I've seen it from different angles.

Amanda 38:44

I think it's interesting in that at one point when I was in Finland our medical director Gareth, we were talking about the We were talking about the system, the NHS system, and it was, and it's what we're talking about now in a way, we were talking about the fact that actually the system is made up of people. It's not something that is solid and real. It, but we talk about it as if it's an insurmountable thing that's got some kind of form or shape to it, but it is only made up of the people that are in it. And therefore it truly should be however hard it is capable of change. And yet it's, it feels often insurmountable. I feel that personally, like I, I alternate between, yep, I can change this and oh my goodness, who do I, who am I kidding? Because it's made up of so many different people. And how do you. How do you encourage the philosophy of care to change or what one's definition of care is?

Billy 39:55

Yeah. Yeah. It's very diff I think it's very difficult. To teach people how to be compassionate. And you need compassion before you can care and you need to, how you nurture that if you're not a compassionate person, then steer cleared away from any caring profession, it's got lots of ingredients in it And I think in an open dialogue context cuz open dialogue and often as itself has made a very, you could say, has made a very fluffy invitation to us. Oh, open dialogue. Oh, it's open dialogical. Oh it's this and it's that. And we can do this and say that. And yes, we can say these things, but there's always a but. And the but is what is the context in which we're speaking into? Who is there, who is listening? How do you listen? How do you respond to what you hear? How do the listeners respond to what they've heard? How does the organization by which you're sat in respond to what you're thinking? Has everybody got your back? If you're a non prescriber, in an open dialogue context, working with people with diagnosis of schizophrenia. Have you really got the prescribers back on, on this or are they themselves gonna be pushed by the power of pharmacology? Cuz that's a that's a powerful sledgehammer. And you might get to the wire and all of a sudden a prescription of blah blah breaks all the sort of work that you've been doing potentially. But that's the nature of lots of different contexts where the layers of, and complexity of these places that we work in can seem insurmountable. Where we can say, and we're working intimately with people, if only this, if only that. But we have to look around this and say, who else is working with us? Who are we playing with? And are we playing to the same tune? Or everybody's got different pressures

Amanda 42:02

and I think that's That's really again, multilayered because it ties in for me with use of self and what that actually means, not just drawing a genogram on one session, but. Truly reflecting and then rere, reflecting on your own biases, on your own, prejudices, on who you are and to realize that the intervision and that aspect of it is because that reflecting on use of self is a perpetual process. You don't just get cooked, you change. You can change from a conversation, and if you're not prepared to then you are a hypocrite to expect others to change, to be direct. And so you've got the use of self and now you are also saying not only is it who you are in your context, but who is everyone else in your context then what do you perceive them as? What is the, your subjectivity of them and what is their objectivity of you? And the whole thing is mind blowing,

Billy 43:05

It is mind blowing. Just take the past week, for example. The Panorama program on antidepressants had up for me, had the people that I knew who were in, in the context saying what they were saying. They had the right people there. But here we are 40 years down the road saying there is a problem. And it only takes one person to say it. And then two or three people might say it, one person would say, but it saves lives. So does drinking water. Drinking water saves lives. And yet, they're still using those and still using hypothesis of brain chemistry to say, this is this, the, these are the things, this is the readings and the logic why we prescribed this thing. But it was all fake. It was all made up.

Amanda 43:57

Which actually ties into your comment earlier of how does one sit in the room. When we are thinking about power and pharmac, pharmacological interventions and the power of a psychiatrist within the system, how, when you have such a radical difference of opinion? It's not opinion. It's fact. Actually, it's one of you. That's the interesting thing. One is based on fact and one is based on the. I don't know many years of study and the self-reflection needed to say maybe I've got that wrong, is can be overwhelming. How does one sit there in that space with colleagues when you are gathering your helpers and you may be perceived as very unhelpful.

Billy 44:52

I don't have an easy answer to it. And I think that lots of people have their own pressures and positions that they're, they can get stuck in. And I think that also prevents people from making a change or taking a different position. But I have seen people, lots of professionals, including myself, who have shifted positions in lots of different ways and got to a position of, okay, we need to do something different about this. We need to have a different way of engaging with human beings. And we never thought we would say this but we could argue historically that the Victorians had a great idea.

Fiona 45:33

What idea was that?

Billy 45:34

The Victorians had a great idea that we should care compassionately for people and offer them asylum when they're distressed. And they invested lots of money in places where people could get therapeutic help. Very quickly, they turned into asylums in bad places.

Amanda 45:55

with the ultimate of othering.

Billy 45:57

yeah, that wasn't the intentions. I'm using it very loosely, of course, the Victorians, but it was in that era historically, that questions were raised. Particularly in York, you know where he said we, we need to do some, these questions have been asked before. They've been posed before. And yet we seem to go around. We seem to go into the same rabbit hole.

Narrator 46:24

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