Home > Focusing and . . . > Medicine > Leratong ~ "The Place of Love": Focusing in a South African Hospice
From June to the end of August 2009, twelve staff members at Leratong Hospice were trained in Focusing as a personal practice and introduced to the basics of applying Focusing to nursing and counseling.
The training program was designed and facilitated by me, assisted by Patricia Oliver (we are both Clinical Psychologists and Accredited Focusing Professionals). The training was funded by AusAid.
From L. to R. from Back Row to Front: Shonisani Netshikweta (Administrator);
Margaret Majola (Professional Nurse); Mary Ntshudisane (Professional Nurse);
Thumelo Thubakgale (Auxillary Social Worker); Henrietta Pitsi (Professional
Nurse); Richard Ngxulelo (Head of Maintenance and Security); Kagiso Sebopa
(Driver); Pat Oliver; Catherine Johnson; Maria Rakgoale (Professional Nurse);
Patricia Kutu (Carer); Tshidi Lekganyane (Deputy Matron); Mildred Khoza
(Secretary); Remigia Tloubatla (Matron)
This report documents our three-month training program with a group of 12 staff members of the Leratong Hospice. I have written it with two groups of readers in mind: firstly, the Leratong training group and secondly, the international Focusing community.
To the Leratong group and Director Father Kieran Creagh: I would like this document to be useful to you. I’d like it to feel alive for you, as a reminder of our learning process, and as a source of acknowledgement and support for the exceptional work you do at Leratong.
To the Focusing community: I’d like you to meet these twelve hospice workers, to get a sense of how Leratong Hospice serves the community of Atteridgeville, and the role that Focusing now has in supporting that.
Background to the Focusing training at Leratong:
Leratong is a hospice located in the township of Atteridgeville, 20km west of Tshwane (Previously Pretoria), with a population of over 500 000, many of whom live in expanding informal settlements, which have no running water or electricity, and other facilities.
Father Kieran Creagh, director of the hospice, contacted me with an interest in some Focusing sessions for himself. He’d been given my name by his mentor in Ireland, Father Pat Duffy, whom Kieran had accompanied years previously on an introductory Focusing workshop.
Kieran and I talked on the phone, and our discussion got around to the staff at the hospice and their training needs. As we talked, Kieran began to feel sure that Focusing offered his stretched and stressed staff a practice that would support them in taking care of themselves, and also provide them with support in the challenging work they do.
The nurses and counselors have been without outside supportive supervision of their work for almost 18 months. In some ways it seemed as though the unit as a whole was still recovering from an incident 18 months earlier when Kieran was shot by a gang of armed robbers on the front stoop of his flat in the grounds of the Hospice.
He almost died, and spent eight months recuperating at his family home in Belfast, Northern Ireland. The staff had feared that he would not return, but he insisted on doing so as soon as he was well enough to resume work. Recent newspaper clippings pinned up inside the hospice show Kieran, flanked by several staff members in their Leratong uniforms, outside the court on the day of sentencing of his attackers. Unfortunately the end of the trial and the carrying out of the sentencing do not automatically end the trauma of such an experience.
It has been through the interest, commitment and drive of Kieran that I came to be on a small plane with my colleague and training assistant, Pat Oliver landing at the tiny airport of Lanseria near Atteridgeville on a late autumn evening in May. We are about to meet the Leratong staff members whom Kieran has selected to be part of the Focusing training program that will run from early June to late August.
From Lanseria airport to Leratong:
First we meet Kagiso Sepoba, the driver at Leratong. Traveling back to the township with the retreating sunlight on the red sand and scrubby open plains and hills, we learned something from Kagiso about what daily work is like at Leratong Hospice. The hardest part of Kagiso’s work is having to fetch patients who are in the late stages of Aids (the most common diagnosis of Leratong’s patients) and taking them in to the hospice. He often finds them severely neglected and uncared for – unwashed, not fed and dying. Sometimes he meets anxious families, wanting to be reassured that their family member will return home well. These experiences are very hard on him and he finds them on his mind a lot.
Kagiso steers us expertly through the clusters of children playing in the streets, dogs trotting or watching; past the tents erected in the dust for evening evangelical worship, the spaza shops and phone booths where youth gather to pass time. Cresting a hill, he indicates to turn right into a gated, electric-fenced property.
The security guard greets us at the gate and Kagiso eases the mini-bus into a parking spot outside the entrance to Leratong Hospice (Leratong means “The Place of Love” in SeSotho – the most common language of the area).
We’re warmly greeted and welcomed by some of the staff on duty. We meet Tshidi (deputy matron); Shoni (administrator); Thumi (auxiliary social worker); Mildred (housekeeper), Patricia (carer) and Richard (head of centre maintenance and security). Leratong works from within a "patient centered," “holistic model.” In terms of the training of staff, this means that all staff members are trained in counseling, with the knowledge that a patient may feel more comfortable confiding in a person who may not officially be a counselor. So our Focusing training course takes place with a diverse group of nurses, counselors and care-givers, administrative and support staff.
How do things work at Leratong?
The model and the manner in which it is implemented here are clearly effective. Shortly before we first came to Leratong, it had gone through an extensive grading and evaluation, emerging with a score of 98%, making it the top township hospice by far and rivaling the best hospices in South Africa. In a country where state medical services are overburdened, under-resourced and often inefficient, hospices like the 18-bed Leratong facility offer an indispensable service.
Leratong provides various kinds of care, including material support, medical treatment and psychosocial services, and it collaborates with other services operating in the township, e.g. local clinics, home-based care teams. Leratong offers palliative care to terminally ill patients and respite care (including counseling) for their families. Its staff does not receive salaries, but works for a small stipend, supplemented by other contributions such as some groceries.
Despite this, many of the team members have been with the hospice since it opened in 2004 and continue to work here, even though some of them (e.g. the senior nurses) could command good salaries in the private sector.
After we put our bags down in our flatlet, Tshidi shows us around the Hospice. Everything gleams – from the glass of the framed logos of Leratong’s main funders (Anglo American, Irish Aid and The Catholic order of the Passionists); to the floors and the frames of the beds where the patients lie settled for the evening.
We greet an elderly-looking man in the men’s ward, then a young woman (whom we later learn came into the ward delirious and near death) who leans on a trolley, chatting with a nurse. At Leratong, it often happens that patients who are admitted in the late stages of Aids-related illnesses such as TB, -- once hospitalized and on anti- retroviral treatment -- stabilize and strengthen, which allows them to be discharged back into their communities. In the course of our time here, I meet a middle-aged man coming into the reception area, who has recovered a great deal of his health through his admission at Leratong. He praises the centre and its staff as he awaits the start of a discharged-patients’ support group, saying that he owes his life to Leratong.
Leratong Hospice was founded by Father Kieran, as a response to his observation that HIV positive people in the township seemed to undergo a rapid progression from infection with the virus, to AIDS-related illnesses and death, and that they often died in squalor and isolation. Fired by his passion and his powerful orientation towards “making things happen,” he obtained funding to buy land and to establish the hospice. He drew on his congregation to staff it – his energy and commitment coaxed out of retirement several highly skilled senior nurses who are still central pillars of the Hospice today, five years on. These women are respectfully and affectionately referred to as gogos (grandmothers or female elders).
8am on June 2nd:
Matron Remigia, and senior nurses Mary, Margaret, Henrietta and Maria make up this group of gogos. They will be part of the group of 12 that we will be working with over the next few months. We meet them early on a crisp Tuesday morning in Leratong’s foyer as we prepare to leave for the training venue, forty minutes away.
Reflecting on the day to come, I’m aware of my tiredness (the taxis in the township begin hooting to alert customers to their readiness at about 4:30am in the morning and I’m a light sleeper), but I’m buoyed by a burst of pre-training adrenalin and the anticipation of this long-prepared-for training beginning at last.
Preparation and planning for the training:
We’re mindful of the fact that all the staff we will be working with have taken part in a 40-hour counseling training some time ago, apart from what they’ve learned from Kieran, who is a trained counselor. We are keen to bring in Focusing as something that will support and extend what they have already learned, and how they already work, rather than something to replace their existing approach and accumulated knowledge.
I’ve designed a two-part program, each part using two days of intensive training; a three-week break for practice and integration; supported by a follow-up day of supervision and trouble-shooting. The first part will teach the group what I call the basic skills of Focusing (felt-sensing, the focusing attitude and listening) as a personal practice. We will work with the group in establishing Focusing Partnerships as a medium for learning these skills and practicing them during the time that we are away from Leratong. The second part of the training aims to introduce the basics of bringing a Focusing approach to the nursing and counseling which the group does at Leratong. A training manual supports each part of the program, and an evaluation is to take place after the final day of the training (see appendix to this document).
In designing the program, I draw most strongly on the invaluable, consistent support and creative thinking of my mentor, Lynn Preston (in New York), also Ann Weiser Cornell and Robert Lee’s Focusing teaching, the work of Joan Klagsbrun on Focusing with nurses, and Charlotte Howorth’s input around program design in mental health institutions.
8:45am on Tuesday:
Pat and I take silly photos of each other in the car as we speed across from Leratong to the Catholic Retreat Centre at Hartebeespoort Dam. Chatting starts up with Shoni, Richard and Kagiso with whom we share the journey. These men with their warm and affectionate manner become the team that will ferry us around on our trips up to Leratong – hugging us hello and goodbye at the airport and refusing to let us carry our suitcases.
9:15am: Our first conversation begins:
Day one starts in a big chilly room at the retreat centre with a prayer and singing by the team. We then settle into a go-around that asks the participants what they have “left behind” in order to be here today.
We ask the group, “If you could get anything you needed from this workshop, what might it be?”
There seems to be a theme in the participants’ responses -- people are living with high levels of stress that come from home and family issues, as well as from the strain of working with death and dying in the Leratong Hospice.
One participant sums it up as the difficulty of “being a mother for the patients”; another as the challenge of “persevering” in the work; another person touches on the need to become more “empowered” at home and at work; another talks about having to manage feelings of failure when a patient dies.
We introduce the Focusing attitude:
After introducing and outlining the program that we hope will address many of those needs, we begin an experiential exercise on the Focusing attitude. People seem to find this exercise surprising and challenging in various ways. One of the men says, “Being gentle was hard; I take things on, and I want to do more; being gentle feels like being useless. But I’d love to find a way to be gentle to myself.”
Cultivating the Focusing attitude becomes one of the aspects of the training that has the most powerful impact on people’s relationships with themselves, with those at home, and with their patients.
Wake-ups and warm-ups:
We soon find that wake-up breaks are a necessary thing – the fire we’ve started to warm the room seems to be making people drowsy and the intensity of the learning is tiring too. The gogos, all wrapped up in their shawls, are reluctant to get up from their chairs, but Pat’s compassionate and energizing approach eventually has the group stretching “in the way your body feels it needs to” and later learning a circle dance. The staff then teach us a game that involves music, dancing and someone being called out into the centre of the circle. I successfully manage to lurk just outside the circle, taking photographs.
Asking permission to document the training:
We ask the group’s permission to document the training using photographs, notes taken by Pat during the training days and eventually, this written report. We explain that our Focusing colleagues in other countries will be very interested to hear about this “first truly African training” in Focusing, about the work at Leratong and about how we taught the Focusing and whether the program has been a success. The group gives the go-ahead for the documenting to take place. Once they have read the report and given their consent, they are satisfied for the final document to be shared locally and internationally.
Clearing a space for the first time:
I guide the group in clearing a space, connecting to what they may have been leaving behind today in order to be here at the training. In the past, I have tended not to teach clearing a space to groups, since on my first attempt at it, some people were confused by the process. However, I have decided to make it an important part of this training: The work of Joan Klagsbrun on varieties of clearing a space and the value of this Focusing step in working with cancer patients and the medical staff who care for them is informing my approach.
To my relief, the clearing a space practice becomes a strong anchor for the group over the three months. Several participants bring their own metaphor for the process: one participant says, “I feel like a trash bin, and clearing a space helped me to take these things out, one by one, and then I could clean the bin! And then I could feel whole and satisfied, like I can be kind to myself…less critical.”
Another of the gogos speaks beautifully in her deep, slow, quiet style about her experience: “It was like unpacking a suitcase of problems. Although I can forgive, I don’t forget. Since I got married, things began to happen to me – and I packed them away. I felt the heaviness of all those things; but unpacking let me put them outside of myself, in a container. I had this sense of a kind, compassionate something above me (she gestures with her hand above her head) like a shower of shining water.” The metaphor of “unpacking my suitcase” sticks in the group’s languaging of this step of the Focusing process from here on.
As I write this piece, browsing through the notes Pat recorded during the program, I’m freshly moved by the participants’ sharing of their experiences. This was said by one of the senior staff: “Clearing the space was like clearing my wardrobe and putting aside clothes that don’t fit, but it was hard that there are problems that can’t be solved. At the end it felt clearer, even though those things were not yet solved.”
Someone else found curiosity emerging for her in response to her clearing the space experience: “At first I found a wonderful peaceful place inside, but then the question led to … something I’m denying or avoiding… I can’t open a space… when I become angry, I can’t free myself of it. I can find a peaceful place alone, but I can’t take with me the person who made me angry. I wonder why I get the wonderful, alone, peaceful place.”
What’s the hardest part of the work at Leratong?:
After lunch we do another guided exercise in the big group, asking in a Focusing way about the hardest part of their work and what they find most rewarding. A theme that emerges prominently from the senior staff is the stress of trying to give their best at work when they feel depleted and exhausted by the expectations their families have of them to sort out problems with younger members of the family. These problems include financial trouble, physical and mental illness and marital conflicts. The staff are central in their families, carrying responsibilities that they now realize are draining them and wearing them out.
The nature of the work at Leratong – caring for the dying in their last days or weeks of life and supporting their families – brings up a lot for the nurses and counselors. Many of them speak about how they struggle with their own emotional responses as they listen to their patients’ painful stories. These stories are of terrible financial burdens; being unable to work; often estranged from families who reject them because they’re HIV positive; or keeping themselves from family because they fear having to disclose their diagnosis; sometimes having nowhere to live and no way of buying food.
The staff speak about how helpless they can feel when hearing these life stories, how they often became very active at this point – organizing social grants, contacting family, partly because it helps them to feel better in the face of their inability to do much to change the desperate life circumstances in which many of their patients live.
Participants report how painful they find it to counsel young people in their twenties who are dying from Aids-related illnesses, when the thought that keeps coming up for the counselors is, “What if this one day happened to my child?” The participants speak of becoming close to some patients, and grieving when they die.
They talk about the difficulty of families asking for assurances that their dying relatives will return home well, or imploring staff to “do something” for a patient whom the nurses know is dying. They struggle with having to hurt families and patients with the truth that death is nearby.
As the participants offer us these glimpses into the hardest parts of their work, I ask several people for permission to work a little further in a Focusing way with what they are sharing with the group. I use this approach throughout the training, based on the understanding that we learn Focusing most readily when we experience it directly, and that learning within a real interaction with another person is most powerful. I work a little with someone, and then include the group – pointing to some of the six Focusing steps that emerge in the exchange with the person. I ask the other participants what resonates inside them as they listen to their colleague and we explore together in a Focusing way.
As I do this, Pat extracts some situations where the participants are really needing our help and writes them up on newsprint. We’ll be using these in the second part of the training, about bringing Focusing into their work as counselors and nurses. On this growing list, questions like this one appear: “I always find that I don’t know what to do when my patients start to cry… and sometimes when I listen to them, I feel like I want to cry… what can I do?”
Partnering to Focus for the first time - Language issues for Pat and
We ask the group to divide into pairs where they will practice Focusing together, sensing whether it feels right to return to what had come up during the clearing of space or to sense if something new might be calling for their attention. I use a system of self-guiding cards to support the Focusers and Listeners as they begin to practice. For this first Focusing, the listeners are to accompany the Focuser with the whole of their being or bodily presence, but silently. This helps to loosen their well- developed professional ways of listening as nurses and counselors and it also serves to emphasize that “the Focuser is in charge”.
Strolling around the gardens, I notice that the winter sun has drawn the birds, blooms and retreat-centre cats out of their early morning hiding. Pat and I visit each set of partners to see how they’re doing with the Focusing and Listening. I sense the challenge of language differences. We have already encouraged the participants to put felt sense words into their chosen language as we talk, Focus and discuss exercises in the big group. We have also encouraged them to partner in the language in which they feel most comfortable.
We now find ourselves sitting in on Sesotho Focusing, trying to peer beneath a language we don’t speak or understand, in order to sense whether Focusing is taking place. We can pick up on stories being told, emotion being released, a slowing down, pausing and some checking inside through gestures made towards the middle part of the body. We realize we have to trust that, just as in all the other workshops we’ve done together, the participants will find their own way into Focusing, in their own time.
There are moments on this first day when we feel worried about this, and frustrated with the limitations of our language skills. Most of the participants speak more than one of the nine official African or Nguni languages most commonly spoken in South Africa. Several in the group speak on average three or four of these languages. In addition to this, they all speak English and some speak Afrikaans – two of the other official languages, although neither is their first language. It is important to note that English is only the fifth most common language in South African households, although it is the language of formal economic activity and public institutions.
As I write this report, I think of something I read the other day, in a book by the New York psychoanalyst Donna Orange, where she writes about the misunderstandings that can arise when we read a translation of an author’s work. She says; “Speaking a second language is speaking from one world into another world within a shared world.” I wonder if the Leratong group would agree with this?
Language in the group is diverse and dynamic: we discover that Richard, who grew up in the Eastern Cape area of S.A. speaking IsiXhosa, also speaks IsiZulu, and is married to a woman who is SeSotho speaking, which he has now become fluent in, and which his children also speak. And yet there are urban-rural differences. Richard says that when he returns home to the Eastern Cape, the “high Xhosa” that is spoken there uses many words and terms that he no longer remembers and which would not be used by urban isiXhosa speakers. Remigia and Patricia chuckle together one day as they chat in Afrikaans – as it is spoken in the working class areas of the Western Cape, some 1600 kilometres away from where we sit in the retreat centre in the Tshwane metropole in the central part of the country.
The group gives feedback from their first experience of Focusing Partnership:
What begins to emerge as we ask for feedback from the partners into the big group is the relief of burdens shared. I’m struck by their honesty and courage as the participants tell of their surprise at what has come for them during the Focusing: things they didn’t know were bothering them, hurts they thought they’d long ago finished with, inner places they’d refused to acknowledge or hear from. One of the men shares, “Usually, I keep all my problems to myself. I don’t talk about what bothers me, I try to solve everything for myself. But I found that I could share what I was feeling, just the felt sense, not the details of the story, and that really helped me to feel relieved.”
The group pulls closer together, the Focusing attitude begins to soften inner and outer barriers, and people marvel at how their bodies have been whispering to them their whole lives, but until now, they haven’t known how to listen and reply.
However, it’s not all easy for them this first time. The listeners report how hard it was to carry out my instruction that they listen silently. They felt they weren’t being helpful, that they were failing to support their Focusers. They report being relieved that they could still use touch to comfort their partner – something that they do a lot with each other and with patients: a hand around the shoulder, patting the knee, sitting with their knees touching the other’s knees.
Again they speak about being heavily impacted, sometimes overwhelmed as listeners, “His emotions began to affect me – it brought back my own memories. So, I took a break, relaxed my body and breathed deeply, and then it felt better, but as I listened, it came again quickly.” It becomes important throughout this training to give the participants the space to work with the distressing personal issues that come up for them, and to adjust our pace to accommodate that.
Day 2 -Teaching listening:
The emphasis of the second day is on listening, with further Focusing partnership in which to become a little more familiar with Focusing and to begin to try out reflective listening. We use Ann Weiser Cornell’s round robin exercise that begins with the Focuser searching inside and finding “one real and true thing about how I’m feeling right now”.
Again during this exercise, I am struck by how my experience of learning and practicing Focusing in English has poorly prepared me for the challenge of teaching Focusing to people for whom English is a second language and for whom it is mostly not their language of choice.
One of the challenges I face comes from the fact that, as a Focusing teacher, I have been influenced by Inner Relationship Focusing. Its “facilitative language” for both Focuser and Listener is taught in a rather invariant way and is full of set sentences that can feel formulaic and awkward in the mouths of English first language speakers for a while. This effect is multiplied many times for English second language speakers.
In designing the workshops, I pared down this Focusing terminology and retained the terms I felt were most useful. One of these is “something.” For instance, when reflecting, the listener says; “there’s something in you that feels…” I find this a helpful way of pointing to an inner experience with the “open-endedness” we want as listeners and Focusing-oriented counselors. It invites the client to sense inside, and to come into direct, felt-contact with that unclear "something" that the counselor is pointing to.
As I teach, I ask the group how that term works for them. How does the “it” inside feel about that word “something”? I ask the group if there might be a better way of saying it. Gendlin’s work on the experiential use of concepts switched on a light for me as a psychotherapist trying to make theoretical sense of the work I was doing with my clients. I feel freshly indebted to him as I reflect on how the Leratong group, Pat, and I tried to find ways to communicate that could bridge the divides between us.
The close of the first 2-day workshop:
After our afternoon tea, we discuss how we’d like the group to practice while we are away. The participants pair up with a colleague who will be their weekly Focusing partner through the next four weeks. Everyone is given journals to jot down any experiences with Focusing that stand out for them, or any problems they find with their Focusing practice.
We close the day by checking in with everyone as to what was hardest in the two days, and what came that felt new: One participant says, “I’ve learned that I can’t give others what I don’t have for myself – love, gentleness, caring.” This was echoed by several other participants. Another person spoke of “having the courage to listen, and mostly the courage to be a Focuser and to share.” “In clearing the space, I was able for the first time to listen to myself and learn what makes me hurt,” says one young woman. Her colleague says; “I found some space in my heart… I found peace.” A challenging comment puts a zing into the atmosphere, as one senior staff member says; “This is a personal development course; what I really need is a way to work with my patients.”
Late on Wednesday afternoon, tired and stretched, but satisfied with how things are going so far, Pat and I made the journey back to the airport in the Leratong bus with Kagiso, Richard and Shoni.
Arriving for the first follow-up:
Pat and I arrive in the early evening of June 23rd. Richard and Kieran fetch us and on the way back to Leratong, we stop in at the petrol station. Kieran goes into the nearby butchery, owned by a Catholic family who donate their high quality meat to Leratong free of charge. This meat feeds the patients and staff and is one of the many kindnesses shown to Leratong by people Kieran has met and built relationships with in his time in Atteridgeville. Tank full, ready to go, we wait for Kieran. When he arrives back at the bus, it’s with an invitation from Michael, the owner, to stay for special Portuguese coffee, followed by a tour of the butchery.
The staff who handle chicken are dressed in a different color uniform and use knives with a different color handle when dealing with the chicken, since this meat is vulnerable to bacteria which could contaminate the red meat carcasses if it comes into contact with them. Tired from a day’s work and the flight from Cape Town, I’m struck by how this butchery tour is completely outside my usual experience, a sense that I’m to have often during my time at Leratong. As we follow Mike in amongst the lamb and mutton carcasses hanging from a metal pulley system, shoulders of beef brushing up against my jersey as I pass, I notice a few chicken carcasses on a table in the red-meat room. I tease Mike – saying I thought the hygiene rules would strictly forbid this. He blushes and calls someone to attend to the problem, while behind me, in his wry tone, Kieran says, “Well Catherine, that’s lost someone their job today…” We end the night in Kieran’s flat with a large meaty meal, a special gift from Michael.
The follow-up day:
Our purpose for this first follow-up day is to check in with everyone as to how the Focusing partnership is going, what experiences stand out for them, and what problems they're having. Remigia isn’t with the group today; she is in Italy with her husband celebrating their wedding anniversary.
To grow the cohesion of the group, we start the day all together, with a clearing of space and a go-around. Pat and I then meet with the Focusing partners, pair by pair, sitting in on their Focusing sessions, intervening where we feel it to be necessary.
Clearing a Space:
In the go-around, I notice that a couple of people are using the clearing of a space to keep out certain feelings or issues that bother them. I take this and several other opportunities throughout the day to gently bring the Focusing attitude into my interventions with the partners. This I continue to emphasize throughout the rest of the training, using my own journey with self-empathy to illustrate the power of cultivating the Focusing attitude. I appreciate having learned, through Focusing, how to touch into and gently sit with something painful, rather than sending it into exile.
In the go-around, one person says that she realized during her 3 weeks of practicing Focusing that "there is no point keeping all this stuff inside me... Focusing has opened space inside me now." She tells us how important it has been for her to realize that as she begins to give attention to long-held worries and problems, there has not been an uncontrollable tumbling out of things; her fear of this was unfounded.
Another participant says, "I'm not sure I understand Focusing as a course, but I can say how I'm feeling so far: I feel relieved...and empty...like I am a new person. I have space for disappointment, but I am also peaceful..."
One of the men tells us that when he Focused last week, anger came up -- and that this made it hard for him to give space to it, and to find acceptance.
Participants share the symbols that arose during their clearing of space...one person describing in rich metaphorical language how the "four pillars of strength" that she has always relied upon in her life to sustain her, "all have thorns on them at the moment. I can't hold onto them..."
Another person adds that in the past three weeks, she found significant peace with several long-standing issues, but that two days ago, "the storm came back." She says, "I can't stop this rough storm...only God can help with that... but I can be kind to myself while I am in the storm."
Another participant in her 60's speaks with a broad smile; "I realized that this felt sense has always been there with me, but I didn't know it was an important thing. Now I know. I'm going to feel 'the kick in the stomach' -- it's really there! -- my body has been telling me things all these years, but I didn't know they were important.” She uses a phrase in SeSotho, which refers to a wellspring in nature, in order to illustrate her point. She ends with another smile; "I've got a spring inside me...it tells me where to go in my life."
Relief, the easing of longstanding anxiety, happiness, peace of mind -- all were mentioned as shifts that people had experienced in their three weeks of practicing Focusing.
One of the gogos says she has been looking back on her life, and realizing she has always solved problems using her mind only, not connecting it with her body. She says that finally she feels as though she is able to find the felt sense inside her, and that she is using it to help her find ways forward with long-standing physical pains in her body.
Our Time with the Focusing partners:
After tea and scones baked specially for our visit, we begin the sessions with the partners. Some questions arise about listening; partners say they are uncertain when to be silent and let the Focuser continue to sense, and when to come in with a reflection.
As I sit in on their Focusing exchanges, I notice the warm presence that listeners bring to their listening. I feel pleased as one listener reflects the shift that their Focuser experiences... “from tightness, to soft and open.” I’m excited as one of the Focusers corrects her listener's reflection, adding to it what she needs to hear back.
I step in at one point to help a Focuser who is getting overwhelmed with many different feelings and issues, and we use this as a teaching reminder about the safe distance, and Gendlin’s “right distance for smelling the soup.” As the day goes on, it emerges that this is a crucial piece of learning for several people. One person speaks about how hard it was, listening to her Focuser working on feelings of loneliness and the listener finding herself surprised by her own feelings of loneliness that grew so strong that at one point she felt almost overwhelmed by them. This became the subject that she then Focused on when it was her turn, releasing a huge amount of sad, distressed energy.
With several other pairs, I intervene with invitations to the Focusers to check inside, to resonate with their bodies. Listening from the felt sense is not something that’s happening much yet, although people are listening with a great deal of care and receptiveness.
Whew! We reach the end of another intense day. I feel grateful for Pat’s support and also really proud to see her stepping up to the challenge of guiding the group in clearing a space, and working with some of the pairs. It seems that we are all growing through this experience. 4:30pm and our bags are packed, ready for Kagiso and Richard to take us to the airport for our trip back to Cape Town.
August -- the second workshop:
August 3rd and Pat and I leave a very wet and wintry Cape Town for the sunny dryness of Tshwane. We’re about to start the second part of the training – two days on how Focusing can help with counseling and nursing.
We begin the first day with the group in the way that’s slowly becoming familiar: clearing a space, sharing how we are and how it’s been going with the Focusing. We find intense pockets of feeling in the group.
Since we were last here, one of the participant’s mother spent her last week of life in the hospice, in the final stages of cancer. The nurses cared for her and supported their colleague through this process. Several people are now sitting with grief and sadness.
Examining how this experience has been for them, they speak about how hard they found it being honest with this mother about her condition – to confirm what she was expressing – that she was going to die soon; and how they felt awkward with their colleague, sometimes unsure of how to comfort her. One person spoke about standing beside this mother’s bed, praying for her, and struggling. “I couldn’t find the right words… ‘let her go’ didn’t sound right, because I didn’t want her to think we were hurrying her towards death.” Someone else agreed, saying, “I kept telling myself, she’s going to be alright, although I knew she was dying. I kept busy, I wanted to avoid her. It’s normally ok, but so much harder when it is someone you are close to.”
Another theme in the sharing is that the participants are feeling the benefits of their Focusing partnerships: the relief of being able to share worries and stresses and feeling “clearer inside” after each Focusing exchange. Two people express their surprise and pleasure at finding that Focusing on their own has been possible and fruitful, and a third agrees, saying he is noticing “how I am learning to listen to myself.”
Sharing her experience of clearing a space, one of the older women says she got a picture of her life being like “a restless sea – things happen every day, and I’m accepting that as long as I am alive, there will be problems. Some of these I can sort out, some will just be there, like the sand making a hole under my feet as the waves come and go…”
The Focusing Tree:
I use the metaphor of a tree in explaining how the different aspects of the training fit together. I talk about attitudes, or ways of being, and skills. I have emphasized the Focusing Attitude as our root in Focusing and in this training. We’ve been establishing a strong, deep root, which we’ve fed and nurtured. How well we’ve done that, is now going to shape the growth of the branches and leaves of the tree – the skills. The skills can’t flourish without the Focusing Attitude sustaining and nourishing them. This approach echoes my sense of the importance of Focusing as a way of living. If we are to practice it effectively in our work, it must be firmly rooted in our ways of being in the world.
Situations with patients that the group asks us to help with:
We invite each participant to bring a situation in their work with patients that they need some help with. Pat gets busy with her koki pen and records a list that includes:
“How to deal with the family of a patient when they can’t come to terms with the patient’s condition; they feel something more must be done, but we can see that it is futile, that the patient is going to die soon.” Several counselors also have situations arising where their patients refuse to acknowledge that they are HIV positive and that their illness is related to this.
Another counselor says she is concerned about a patient of hers who seems “free and open with her family, but when she is with me, she closes down, doesn’t communicate or seem to understand… like she’s just lost.” Another person brings a similar situation – her patient is from a neighboring African country and doesn’t speak English, leaving them with no language in common.
The matron brings the problem of how to counsel patients towards compliance in situations where culture clashes with the medical model that the nurses are working in. She cites a situation, common to South Africa, where patients with Aids-related illnesses refuse TB and Anti-retroviral medication in favor of visiting a traditional healer or sangoma for herbal and other remedies.
Another of the senior nurses asks; “How can we ask questions to get the patient to tell us more about themselves and their background, without seeming inquisitive or judgmental?”
A conceptual question appears on the list too: “I’m trying to understand this – what is the difference between Focusing and counseling? And between counseling and psychotherapy?” We will be working through this list of situations tomorrow.
Pat and Catherine’s theatre piece:
After morning tea, Pat and I step into the centre of the circle of chairs. Pat is wearing a cardboard crown, saying “number 1” on it. We explain to the group that our talents include acting – and that we’d like to do a little theatre piece for them, in order to present our ideas about how a Focusing approach understands what brings emotional suffering and how we can allow change to come to that. This little theatre piece emerged from a conversation with my mentor, Lynn Preston, when we sat, she in her consulting room in New York at lunchtime, me in Cape Town at 7pm, having dialed her through my computer. I mentioned that I was trying to find a way to illustrate some of the principles of Focusing, without giving the group a lecture. What Pat (in her hat) and I are about to act is the result of that conversation with Lynn.
Pat takes the role of a counselor, wanting to be a “Number 1 Counselor”, with all the fantasies that go with that – how admired she’ll be among her colleagues, how her patients will love her, how she’ll do everything right, and never make a mistake. As she smiles and gazes off into the distance, weaving her fantasy, I prepare myself. Just as she marches off to see her patient, I step in front of her and she falls over me! After several attempts to get around me, she realizes she has a very stubborn obstacle in her way. She tries to push me aside, she insults me, calling me “a failure” and “bad.” She begs me. She calls for the security guard to remove me. She loses a tug of war with me. When she has run out of ideas, we ask our audience for suggestions. They quickly come back with things like, “Talk to her;” “Find out why she’s doing this;” “Use the Focusing Attitude.”
Pat begins a dialogue with me, initially in a demanding way (which I refuse to respond to) and then gradually with curiosity and gentleness, slowing down to let me find the words for what I’m trying to say. In the process she learns that I am not trying to ruin her life, but that I get scared when I see her moving so fast with such big and grand fantasies about being the best, as though she has no vulnerabilities.
We get to act the easing and shifting that comes as the fearful place is acknowledged. We show that the goals you set out in your rational mind may be changed completely as your being starts to move forward through being deeply listened to and asked about what it needs. Eventually, Pat invites her fearful place to come along with her as she learns to be gentle with herself, with all those fears and concerns about herself, with those vulnerabilities, and to do her counseling from this place of greater wholeness. The play brings lots of laughs and involvement from the group, and the crown is later seen on the head of Shoni, posing next to the Leratong bus for the camera.
Discussing the theatre piece:
We use the play to point to a few Focusing ideas. We talk about a “being” versus a “doing” approach to living, about the Focusing Attitude, and about building a relationship with what is inside us, especially with those places that we tend to fight with or be afraid of.
We ask the group to imagine, “What if we could trust that in every situation, even the obstacle is trying to move forward?”
We talk about the “stubborn patient” that one of the counselors wanted help with. What if we, as counselors, could take a leap of faith – to trust that what we call stubbornness is something that can be understood and received in such a way that it can allow his whole being to move forward? The participants are intrigued by this idea and it sows a seed that several people refer to throughout the course. Having experienced what the Focusing attitude can do in their relationships with themselves and their family, they say that if they can be like this towards their patients, it will make a huge difference to how their patients feel.
I introduce the idea of “openness to surprise” (borrowed from the writings of a Roman Catholic Benedictine monk, Brother David Steindl-Rast, whom Lynn Preston introduced me to). Our openness to surprise as counselors invites us not to imagine in advance that we know what a patient is doing and why, but to begin to discover with the patient what is true for them.
Using role-play in learning how to counsel with Focusing:
After lunch on the first day, Pat and I introduce the concept of role-play as a learning tool for counselors as they try out ways of bringing Focusing into their work with their patients. We will use role play to explore those counseling situations the group has asked for our help with. I experience again the value of this method of using the felt sense of our interactions with our patients to help us learn and think further about them, instead of just talking about patients using only our thoughts and ideas.
An exercise in “listening from underneath”:
We ask for volunteers to take part in the first role play, and within minutes, we have two participants who seem eager to get involved. We are going to use an exercise that has recently been developed by Lynn Preston and another New York Focusing colleague, Charlotte Howorth. It involves making an audio recording of a role-play interaction between the “patient” and “therapist”, in which they are meeting for the first time.
As they observe the role play, the group concentrates on the explicit or expressed level of the conversation e.g. What is the problem the patient is bringing? What is the story, the content? What are possible solutions or recommendations? Then the group listens to the recording of that first conversation, this time listening “underneath” the obvious level. They listen for the felt sense, for what is not yet fully expressed.
Today, we’re going to have to improvise with our version of the exercise -- Richard and I spent half an hour early this morning running around the hospice trying to find a radio-tape player that can record without a special microphone having to be attached. We don’t succeed. We’re going to need the role-players to play the interaction for a second time, with the instruction to the group that they listen underneath the level of content.
The group responds well to the exercise – it’s clear that that they are listeners with a good capacity for sensing the worries and concerns that their patients are sitting with but may be unable to put into words. The skill of finding their own felt sense of what the patient is expressing and of the conversing taking place between them is still developing in the group, but several people are already able to resonate with the felt sense of their patient and of the interaction. The group offers suggestions and comments, and we ask the “patient” if these resonate or feel true for her. Almost all the suggestions are helpful and the person playing the patient feels more understood.
Does Focusing bring anything to counseling?
A stimulating challenge comes from one of the counselors that afternoon. She says, “I can’t see that Focusing is any different from counseling. It’s the same – you don’t give advice, you just guide the patient to the outcome.”
I open this comment to the group, and several people disagree with their colleague. They share their ideas of what Focusing brings to counseling by telling us what they have experienced with Focusing so far. One of the men explains that he had a situation of experiencing great anger in a personal relationship and that Focusing on this anger helped him to be able to see the other person’s point of view. He says this happened through the Focusing attitude and through being able to sense what was really at the heart of the anger.
Another of the men talks about an incident that arose in the last month while he was counseling a patient who was in denial of her HIV status. He says that practicing the Focusing Attitude towards both her and himself; “helped me to go the route (of a second test) with her – even though I felt sure she knew that she was HIV positive. She just wasn’t ready to know it yet.”
Pat and I give examples from our own lives and therapy work where we have benefited from being able to work with the felt sense. We also refer to Joan Klagsbrun’s work on using Focusing in nursing and in patient-nurse communication. (We have included this in the manual accompanying this second part of the course).
At the end of this session, one person sums up what I had been hoping to convey: "Yes, I’m happy now to be clear that focusing is not the same as counseling, but that counseling is something that you can do in a Focusing way.”
Talking about culture:
I have spoken earlier in this report about my own experience of the language differences on this training. In South Africa, language is historically linked to race and class, and therefore to power and dominance. In the field of mental health, as in most others, training is conducted in English, although most of the people attending that training will not be English-first language speakers (nor will the patients they counsel). With differences in language come differences in culture.
Pat and I hope that how we deal with issues of language and culture in the group will allow the participants to feel empowered by this training. We would like them to experience the training as a two-way learning process, rather than as a one-way transfer of expert knowledge from us to them.
At this point in the training, I’m aware that I want to find a way for us to have a conversation together about some of these issues. The perfect opportunity comes as we talk about an exercise we’ve just done – called “the safe distance exercise”.
I ask the group to stand in two parallel lines, facing each other, about four metres apart. People in the one line very slowly move forward in response to the instruction of those in the other line, who are sensing inside their bodies for the right and comfortable distance for their partners to be from them.
In sharing their experience of this exercise, up comes the issue of culture. Comments were made like, "I'm not comfortable touching or making eye contact with an older person.” A male participant said, "I can't come too close to a woman who is my own age.”
Not only the experiential exercises, but also asking the group to form Focusing partnerships, touches on issues of culture. There are cultural norms shaping how some people in the group are relating to these aspects of the course. It becomes clear that these cultural norms are differently regarded by men, by women, by older and by younger participants. And of course some individual differences emerge.
One male participant says about choosing a Focusing partner, "I can feel comfortable talking about my problems to a gogo, but I can't hear a gogo tell me details about her problems." Some gogos in the group objected loudly to this, saying, "I regard a younger man as my son -- he is there to help me and support me, so I can take any problem I have to him.” I try to support the young men in what they are needing the gogos to hear -- that even if the gogos are comfortable revealing all, the young men aren't comfortable hearing it, so they would prefer not to partner with any of the gogos. They also express the feeling that their culture dictates that they need to respect the opinions of elders -- and that this could mean that they would have gogos giving them advice instead of being open, receptive listeners.
Going further from here, I comment that Focusing can often seem to clash with ordinary social rules, as it has its own culture such as interrupting, reflecting, making a very important place for self-expression. I reflect out loud on how, when I was learning, some of this clashed with my culture, and I ask the group if they can relate to this. I ask, “Are we expecting our patients to do things that clash with their culture when we counsel them in a Focusing way?”
There’s agreement with these comments. One senior nurse says that to talk openly about her feelings within her family is a culture clash, especially when she talks about death and dying. Others agree. The younger people in the group seem to feel relatively more free to be open. Considering how these issues come into play within counseling, people give examples: "I shouldn't interrupt an older person when he is speaking, even if he is my patient,” and "my patient may not know what I'm talking about when I ask him how he feels – this is confusing language for him," and "this new language for Focusing that we are learning is unfamiliar to me even, so what kind of language will I use with my patients?"
What might “African Focusing” be like?
As we talk, I consider the spread of Focusing from North America out into countries who are culturally very different from North America. I think of Japan, Eastern Europe, China, and Afghanistan. Focusing must become changed by its encounter with those cultures and countries in order for it to be truly useful to the people who learn it. At the same time, it must retain what is at “the heart of Focusing”.
It’s interesting to think about what that is, that heart. Does it lie in elements of the practice, for example, felt-sensing, or is it broader than that, for example is sensing emotion part of it? Must there be an emphasis on bodily-felt experience to make it Focusing? Is cultivating the Focusing attitude essential to Focusing? Is Focusing partnership and building Focusing community essential to the practice of Focusing? What are the values that we want an “African Focusing” to have? This African Focusing does not yet exist, but I feel very encouraged that this group at Leratong has a role in shaping what it will become.
Taking Focusing into counseling can seem confusing:
Around 3pm in the afternoon of the first day, one of the nurses puts up her hand and says that she's feeling puzzled. "Am I supposed to be teaching my clients how to Focus? Because if I am -- I don't think that I can do that.” As a Focusing trainer, I’m pleased to hear this question. It allows me to point to something fundamental that I learned from my mentor in the early days of my exploration with Focusing in my work as a therapist. I learned that Focusing is something that the therapist or counselor needs to do, not something the client has to be able to do. An example is that, as a counselor, I can embody the Focusing attitude towards myself and my client. The client doesn't have to know about it -- she will feel it. She will feel how it is inside herself when I bring that attitude to my relationship with her and with parts of herself that she may not know how to make a relationship with. We talk over this distinction in the group, and several people express their relief at this – they had been worrying about the same thing.
Checking in with the group the next day, there seems to have been a leap forward in the understanding people have of Focusing and its place in counseling. Several people express that reading the second manual last night has further clarified things for them. One person says, “Since we started this course I’ve been asking myself, what’s this all about?... how is this going to help me at work? I tried to imagine using it with a patient and I thought, ‘no, it won’t help me.’ So I’ve been coming to each day of the course, but dragging my feet. But since yesterday, aaah, I understand, now I’m light-footed and happy to be here!” We went on to review a number of ways in which the group could be using Focusing with their patients that don’t involve “fancy moves” or teaching patients anything. These ways are simply about the counselor Focusing inside themselves as they are being with their patients.
Day 2 – The specifics of Focusing skills in counseling:
Day two gets underway. I’ve planned that we will spend it on the specifics of Focusing skills – the branches and leaves of our Focusing tree. We use the time to work with each of the situations the counselors brought yesterday. We mostly role- play the interaction between the counselor and the patient and invite the audience to be aware of their own felt-sense responses to the situation unfolding in front of them. We ask for suggestions from the group as to how they might intervene as counselors and we try them out and ask the “patient” and the “counselor” how the intervention felt for them. Pat and I add our own suggestions. We then invite the group to reflect together on how the “sessions” went.
In the discussions of the role plays, I point out the skills I was using as the counselor. How to help the client feel safe (with the counselor, and within themselves e.g. when they are in contact with a feeling or felt sense) is a vital skill that I relate back to the "safe distance" experiential exercise we did yesterday. Pat and I continually bring reminders about bodily-felt presence, the value of making space, of pausing, of listening for and from the felt sense. We suggest basic Focusing invitations that help the patient to get closer to what's really bothering them, without them having to know Focusing.
I suggest to the group that they encourage their clients to notice the felt shifts they experience, just as we’ve done in the Focusing partnerships, for example; "Oh, so you're feeling more relaxed and at ease now that you've decided to tell your mother about your status – maybe we can just take some time here to notice how your body feels different inside now.”
A role-play about “putting ourselves behind the reflection”:
I also introduce the group to a skill that I was taught by Lynn Preston -- what she calls "putting ourselves behind the reflection" in counseling and psychotherapy. This is more than simple reflective listening; it is about learning to hear the deeper need the patient is expressing. Putting ourselves behind the reflection maximizes our attempt to understand the patient, and in turn to make them feel more heard and understood.
The situation we role play is of a patient who seems reluctant to talk to anyone in the ward, and insists that she doesn't want to be in the hospice, that she wants to be discharged. The counselor bringing the situation asks me to be the therapist, and she takes the role of her patient.
I enquire gently about "Monica's" request to be discharged. She tells me that she doesn't want to be here, that staff at Kalafong (the state hospital in Atteridgeville), promised her she would be comfortable and happy here, and that she isn't feeling happy at all. I reflect this with concern, saying that we want her to be as comfortable with us as possible. She begins to open up, and talk more about her discomfort with the staff and her desire to go home. I ask about this -- what is it like at home? What does she find there that isn't here? After a while, she reveals that she is worrying about her boyfriend -- a miner living in a hostel. She’s afraid he will get bored without her and find a new girlfriend. This will mean she will lose the bed and roof over her head that she has had at night. If that happens, she will be on the street with nowhere to live. Because of her illness, she is unable to work, so she isn't even able to buy food at the moment.
I continue to gently acknowledge her predicament, and her concerns. Eventually she asks me, "Can't I come home with you to your house, to stay with you?" I know I can't meet the significant material needs that Monica has, but what I can do is to make her feel as though her deepest needs (both material and emotional) are being heard and understood. I can also give her a sense of how important I think they are. I reflect her longing to be safe, to be cared for, to be able to rest without the constant worries about food and shelter, without fear of being left by her boyfriend and being alone and unloved. I reflect more than she has actually told me -- I also reflect what I am sensing about her needs and longings, and I ask her if what I have said feels right to her. "Might this be how it is for you?"
This role-play turns out to be a very significant experience for the counselor. She returns to the follow-up day three weeks later saying that she had been practicing trying to listen underneath the surface of what her patients are saying to her, to find their deepest needs and longings underneath that, and to reflect those with empathy and understanding. She said that it has changed the way she is with her patients. “I’m motivated to be more aware of my patients’ needs and I want to be there to help them say it.”
A role-play about the violation of privacy and confidentiality:
Privacy and confidentiality become an issue that we get to touch on in a very alive way. One staff member role-plays her patient expressing reluctance to speak with her counselor, saying that she has heard nurses repeating confidential information about her to other nurses, within earshot of other patients. The “patient” adds that she has heard nurses referring to her as promiscuous.
This situation brings up feelings in the group – confidentiality rules are emphasized at Leratong, but the group admits that it does happen that these rules are broken or bent. Focusing gives us three specific guidelines that help ensure the safety of Focusing partnership (confidentiality, no comment outside the exchange about the Focusing, and the choice to keep content private). These are appreciated by the participants, and seem to provide a helpful model for how they might strengthen confidentiality in day-to-day work situations at Leratong.
An ending – the final follow-up day:
Our final day – Wednesday 26th August arrives. An ending feels palpably present. Kieran is away in Ireland on leave so our usual evening dinners and late night talks in his flat don’t take place this time. We share our flat at Leratong with a young doctor from Yorkshire who is working here for a few weeks before she flies to East Africa to take up a medical post. A few days before we arrived, she had her first experience of a patient dying in front of her. She reports how shaken she felt, but how supportive the staff have been towards her. Pat and I appreciate her whole-hearted embracing of her African experiences so far, and her certainty that this is where she has always wanted to work. She tells us that she’d have become bored and dull if she’d stayed on working in the safe familiarity of her home country.
Our aim for the final day of training is to give sturdy support to what we imagine will be the group’s first tentative steps towards applying some of what they’ve learned about Focusing in their counseling and nursing. It’s to be a day of supervision and trouble-shooting.
Clearing a space and finding painful things:
The morning clearing the space is a quietly reflective time – people describe how their lives have changed over the duration of the course. Several participants report that their tendency towards being emotionally hidden and self protective has shifted into a more open and receptive way of being with themselves and with people around them. A related theme is that of greater self-awareness and self-empathy.
Several of the older staff say they have been using Focusing successfully with chronic pain they’ve suffered with for years. One person with a cough says she asked her cough what it was needing, and that it had eased; another had experienced relief from muscle pains in her legs, and today, someone who began the morning with a sore scratchy throat reports to me at lunch time that it has disappeared.
Alongside this, I become aware of several things in the morning’s go-around that lead me to alter the day’s program in an effort to address what’s arising. Several people refer to the project of applying Focusing to their work, saying that are feeling that they need more practice using it for themselves before they will feel confident enough to bring it into their work. Others report bereavements and severe illnesses amongst family and friends that have de-railed their Focusing routine. Still others refer to issues that are causing them great distress. A sense of turmoil thickens the atmosphere of the group this morning. I feel strongly that all this needs immediate attention before we can talk about work.
Focusing partnership – so powerful, but is it easy to sustain?
I decide to invite the group into their partnerships for a Focusing exchange until morning tea time and everyone seems pleased to have this opportunity.
As we do another go-around after the partnering, it’s clear that some of the dense clouds have dropped their load and dispersed. The comments coming from the group suggest this: “I’m surprised – I feel light now... I didn’t even cry… and I made a very important decision about a family member.” Another of the senior nurses says, “I’ve come to terms with my problem – I accept it, even though there’s still a dark cloud hanging there, it’s no longer overwhelming. This Focusing work is like spirituality,” and one of the young men says, “I feel relieved now, and hopeful.” Another man says, “I was confused by a problem I was having, and I didn’t want to look at it, but I did, and now I’m clearer and I’m looking forward to solving this problem.”
Aware of my concern that the group may not sustain their Focusing partnership practice, I remind the group of this feedback they gave. I remind them that they have just experienced how only 50 minutes of Focusing partnership brings about a dramatic change in their state of being; that everyone is speaking of the value of what comes to them in partnership. I link these personal benefits they are experiencing to their work. I point out how important Focusing partnership can be as a place to take difficult feelings about patients, for example when they feel helpless about patients in denial of their HIV status, patients who reject current medical treatment in favor of traditional medicine, patients in dire socio-economic situations that lack food or shelter.
Focusing partnership offers a non-judgmental, caring space for counselors to be with and process those feelings. I tell the group about times when I use my weekly partnership to focus on a client situation where I feel ill at ease. I also emphasize that regular Focusing practice with a partner is good self-care for counselors working in settings as stressful as Leratong.
Writing now, I wonder where the group is at with their partnership practice. I wonder if they are keeping it up, and if they are, whether they’re still finding it transformative. I am aware that Focusing partnership can seem at first to be something that takes time from our schedule. However, as we practice it more, we come to realize the spaciousness and energy it brings, and soon we find ourselves actively protecting those 50 minutes a week that are often the only time that is dedicated to taking care of ourselves.
We talk together about death and dying:
After lunch, when I invite the group to bring any situations that they’d like our help with today, we enter directly into the challenge of caring for those who are dying: “When you ask into the patient’s deepest feelings and what they express to you feels too hard…too much for you to tolerate…what can I do?” I open this experience up to the whole group to see if they relate to it.
A number of responses come back in support of what this nurse expressed. One counselor explains,“I don’t even allow myself to think about my own death. I can talk with any patient about their death but I don’t allow myself to think of my own – I don’t even have a funeral policy!” Another replies, “Yes, I can’t bear to think about my own death. I always joke with my colleagues, ‘if I die, I won’t really die, I’ll be back here with you every day as a ghost!’” An elderly nurse tells us how she speaks often with her family, reminding them of the care she wants when she is dying. “I am so afraid to die the way some people do – unloved, uncared for, neglected.”
As more people share their deepest concerns, I look through the window and see a large Grey Loerie (a plain feathered but otherwise very parrot-like bird) awkwardly stepping from branch to branch with first beak and then foot. I’m aware how we sit as humans, doing this simple thing of speaking about our situations, our living, in the midst of our environment – our lives with other living things. I gently respond to the group from a place of empathy, telling them how self-empathy helps me be with myself in the midst of these really big fears. I remind them about how we are starting by just tapping that big, scared place, and then we move away, and then back to tap again – making it safe for ourselves to slowly build the courage and strength to sense into something we are too afraid to go near.
Our final closing:
It’s late afternoon when we close the training course. The group is sitting in a circle, and we invite each person to walk into the centre and to symbolically “leave behind” something that the course has helped them to shift, and to “take with them” something new the training experience has brought them. The centre of our circle piles up with self-limiting beliefs and worn-out ways of being; old ways of pushing feelings away, of isolating; of trying to be everything for everyone. It fills with painful constrictions around old issues; long-carried fears and losses. The things people are taking away with them include: “the Focusing attitude;” “courage;” “gentleness;” “love and care for myself;” a sense of being supported by colleagues in a new way; “hope;” “lightness;” “freedom;” and the ability to know themselves.
4:30pm and the Leratong bus fills up with people – we’re all traveling together to drop Pat at a petrol station nearby, where her friend from Tshwane will meet her and take her the rest of the way to the airport. After lots of hugging and kissing and special words, Pat is on her way. I go into the shop to fill requests for Fanta and Coke after which Kagiso steers us back to Leratong, music pumping, while everyone tucks into drinks and bags of chips.
Back in the flat at Leratong, I slide into a warm bath for some rest and solitude. Tomorrow morning early, I will meet the group to do an evaluation of the training (See appendix to this document) and then my active part of the training process will be complete. As Focusing teachers and therapists, we always tell the people we work with that the process of change that Focusing brings doesn’t end when the session does. Instead, it continues to be lived forward in our dreams, our next waking day, our next interaction with a person. Remembering this helps me to prepare for leaving Leratong, not knowing whether I will work with this group again, but feeling hugely privileged to have been able to do so.
5th December 2009
The process of evaluation began with checking in about the group’s permission for me to document the learning-training. The following was agreed upon:
My write-up would describe Leratong and its work, and would introduce the staff members by name and occupation. Photographs could be used with staff names and occupations. It was agreed that direct quotes could be used in the write-up, but that in the body of the document, no names would be attached to quotes, and staff would mostly be referred to as "a participant" or "a staff member", with occasional references to age (e.g. "a younger participant or an older participant") or gender or occupation where that was relevant, but still vague enough not to be revealing to those who had not participated in the training (e.g. "one of the professional nurses").
It was further agreed that one person (Shoni or Kieran as possibilities) would receive the draft of the write-up, and would call a meeting where the document would be read to the group, after which the group would discuss and come to a conclusion about whether they were happy to give the go-ahead for the article to be circulated internationally e.g. in a Focusing Institute publication or on a Focusing website.
The following evaluation questions were posed verbally and an informal discussion was held in the group, with care being taken to encourage broad participation in the discussion. Notes were taken to assist in recall and write-up of the feedback:
"We've just completed our 2-part training. Can you say something about how safe this experience has felt for you in terms of:
a) Being in a group with your work colleagues..."
There was an age-related trend in the safety of the experience for the group, with younger participants having been "cautious" in what they expressed, and older ones feeling far more free to share whatever they wanted. But the younger ones felt their need to share in a more unreserved way had been fulfilled in the focusing partnerships. Some people also recounted how they had become increasingly comfortable to share in the big group as they grew trusting relationships in their partnerships.
Two male participants spoke about how the course had helped them become more open and comfortable with sharing their feelings and concerns -- something that ran counter to their culture. Two younger people spoke about how it was difficult to challenge the elders in the big group -- that this was where they would be most reserved. One person spoke about not feeling safe that what she shared in the group would be kept there. She said that she was someone who didn't like to speak out about her feelings in a group, preferring to speak on a one-to-one basis within the context of a trusting relationship. She and another participant expressed appreciation that Focusing had taught them how to keep the content private, while sharing their felt sense, with one of these people saying that she had found this useful in her counseling -- that she had helped a patient gain the relief of sharing feelings, without having to give the content of the problem which had felt unsafe to do.
For most people, there was trust that the confidentiality aspect of sharing was respected. Several people said that the group felt like "my family", and felt comfortable sharing in the group. But an interesting discussion ensued about different versions of what constitutes "keeping confidentiality", with respect to referring in the big group to something that had taken place in the partnership. One person expressed that she felt it was acceptable to share with the big group feelings that had emerged during her partnership e.g. that her partner had cried while Focusing, while another person made it clear that he would not like his partner to tell the big group that he had been crying during Focusing.
b) “My facilitation of the process:”
People shared their first and later impressions of me as facilitator. There was general agreement that Pat and I had made the process feel safe for people to enter. They mentioned the importance there of my non-judgmental attitude and non-critical way of correcting or intervening, my attitude of "not knowing" and "humbleness," and how that had helped them to feel able to share of themselves, and to feel comfortable and trusting, and also like they wanted to be more like me. They also mentioned their appreciation of the non-professional, non-hierarchical way in which I worked with the group. One participant said that it felt as if we were sharing together, rather than an expert coming to impart knowledge which they had to take on and learn to do in the teacher’s way.
“Was there anything that could have been changed to make it feel safer?”
The group expressed that there wasn't anything that I needed to do to make the experience safer for them, that any lack of safety that was present was an unavoidable part of the situation.
“We've had a 2 part training, each 2 days long, plus a follow-up day. What have you found the most valuable in the training we've done?”
One person said that learning to clear a space and learning how to find and work with the felt sense were the most valuable things he got out of the program. He said that being able to sense into his body and find a bodily felt sense of problem had been a revelation to him. Another person said that the emergence of symbols which were at first mysterious, but that with deeper entry and enquiry, yielded their meaning, had been wonderful for her.
The transformative power of the Focusing attitude was cited by several participants (6) as having been the most valuable thing they got out of the training. They talked about how the Focusing attitude had altered their experience in their daily lives, as well as their perspective on life in general. They said that this new attitude was coming across in their dealings with other people including their patients. Someone spoke about this having the effect of "The more I take care of myself, the fewer problems I seem to encounter."
Other qualities/skills mentioned as important learnings from the training were: slowing down, making space for themselves, and prioritizing self-care. Several participants, especially the elders, spoke about how they had over the years become like "social workers" in their families -- carrying burdens and solving problems for family members who very often didn't seem to take their share of responsibility for the problems and in generating solutions to them. Someone expressed this situation as; "In past years, I didn't know I existed -- just problems and other people." One person said firmly; “'I'm not going to be a dustbin man again. People must solve their own problems; I'm not a dumping ground anymore!"
One participant spoke about the value of "finding that space inside that knows," and that guides her when and how to touch into and engage with a problem. Another person added that the Focusing way of working with fear is going towards it rather than pushing it away, being with it, and sensing "what's underneath it;" this had been especially helpful for her to learn.
Another person illustrated how Focusing has been transformative in her life by referring to an incident that had happened the previous night, when she was hugely surprised to find herself responding to an extreme situation in a very calm manner, full of gentleness towards herself. She said she would not have been able to respond like this before she learned Focusing.
Another participant talked about how stress in his personal life had been so bad that it felt it was affecting his work. He said that Focusing has made him more able to take care of himself, that it has brought a new openness to his way of relating to others and a trust of the group that he hadn't had before, where he is now able to realize the supportiveness that has always been offered by the group but that he was previously unable to accept. He talked about a new self-confidence in his work and personal life since the Focusing training, saying that Focusing seems to have "given me the self esteem to trust myself."
Another participant asked if she could share her story about moving “from cleaner to carer” through the support and encouragement of the team. In telling her story, she spoke about how proud and grateful she felt taking her place on the course as a caregiver, and how much having the opportunity had benefited her.
Another participant mentioned appreciating the self-development that the Focusing training made possible. She spoke about how valuable she finds the new sense of her "bodily self" as a resource, of being able to feel her mind and body being connected. She says she now prepares her "whole being" when she goes on duty. She added that she has been communicating with her community about Focusing, offering suggestions where she can, to help those who consult her with problems.
Another participant spoke about the 2nd part of the training (basics of Focusing in counseling and nursing) as helping her a great deal with the application of the new skills she was learning. She said that she'd wondered during the first part of the training; "How will this help me in my work?” With the 2nd part, she said she got a good sense of this.
“Was there anything in the training that you didn't find useful/valuable?”
This question did not elicit much of a response. One person said that he had experienced moments of confusion during the training, but that by the time he got to the end, he experienced that "it all fits together." Several people re-affirmed that the course had only been useful and valuable. After some minutes of silence, I encouraged them to ask the question again, quietly, to themselves, and at least to acknowledge internally whatever might come up in this more private enquiry.
“Since you've done the training what have you noticed about how you listen (to yourself, to colleagues, to patients)?”
One participant spoke about how it felt new to listen with her "whole self." Another agreed, saying that she now found that she prepared herself internally before an interaction with someone, "making room inside me for listening to the patient or my colleague." She said she put her opinions aside, a step which felt new to her, and then made space for the other person to express what they wanted. She said it seemed to her that in this new way of listening, the patient felt really heard -- that this is healing in itself.
Another agreed, saying he'd realized that before the Focusing training, he did “selective listening,” “only hearing what I wanted to hear, interrupting often.” He said that practicing the Focusing attitude when he is listening to someone had changed his listening dramatically.
Another participant talked about what she'd learned from listening in Focusing partnership -- that it had been a really good experience to learn to emphasize what kind of listening she needed from her partner... that she enjoyed being able to direct her own process "just to go East, West, wherever I want to go and have my listener follow me." Others supported what she was saying from the perspective of learning to listen to their Focusers in the way they needed -- that being responsive to what the other needed (as opposed to applying a one size fits all approach to listening) had brought new learning to them as listeners, not just in partnership, but also with their patients.
“How are you finding your partnership? What steps could you take to make it more useful to you as a support or help?” (Participants were asked to record these steps in their journals as a support towards taking action.)
This question brought up a fair amount of discussion: Focusing partnership had been spoken about throughout the training as being a forum where participants experienced powerful release and unburdening, feeling heard and supported, and being able to approach and deal with long-standing unresolved issues in their lives that had been causing them significant distress. Appreciation of what partnership had made possible seemed to be unanimously felt and expressed. However, at the same time, at least half the group expressed difficulty in overcoming the practical issues associated with setting up and maintaining partnership. This is cause for concern in terms of partnership Focusing practice being sustained now that the training is over.
Several participants said they had experienced some difficulty in making a regular time with their partner due to incompatibility of their work shift times. One person said this was much easier with his new partner than his first partner, but he went on to suggest that finding a fixed day and a place that offered quiet would help him.
A couple of participants expressed difficulty with fulfilling the recommendation of regular partnership with the same person, preferring instead to approach a colleague in an ad-hoc way when they felt they needed to speak about something. Responses from the group to this included the concern that someone approached like this may feel awkward about saying no because they were too busy. I recommended again that regular partnership, although initially difficult to set up and prioritize, tended to best serve the needs people had for Focusing and being listened to.
The issue of fullness of the ward and work demands came up - that people find it hard to make space for partnership when they are battling to keep up with their work responsibilities. It seemed agreed upon that Focusing partnership during on-duty hours was not advisable or possible.
“How are you feeling about carrying Focusing forward in your work with patients? Do you feel able to do something with it? What steps do you need to take or what might you need to do in order to feel competent using Focusing in your work with patients?”
An interesting related issue was discussed in response to my curiosity as to how the emphasis in Part 2 on counseling had been for those staff members for whom counseling or direct patient contact is not the main requirement of their jobs. One staff-member whose primary work is administration said that the holistic model at Leratong meant that sometimes he or other non-counselors would be chosen by patients who specifically wanted to talk about something bothering them, so the counseling training felt relevant and useful to him. He said that he'd also found the counseling training personally expanding, which he had enjoyed. He and several others referred to the experiences they typically had in their out of work life, where they have come to be identified within their communities as "a good person to talk to." They said they were already finding the Focusing very helpful in that context. Another person said that she was trying out things she'd learned with friends, and was surprised to hear how helpful they found a question she'd asked in a Focusing way or a Focusing suggestion she'd made during listening to their dilemmas.
So it appears that the part 2 emphasis on the application of Focusing in counseling and nursing had not been experienced as excluding or irrelevant for anyone in the group.
In response to the main question (in bold above), several participants expressed that it felt too early in the process for them to be able to evaluate how they were finding the application of Focusing to their work. A couple of people expressed some nervousness with bringing this new skill into their work, feeling that they needed more time to master it first for themselves.
One participant said that when the ward was full, she found it difficult to find time for counseling, her time being consumed with administration and medical care. She found this stressful. Another participant responded by saying that the counseling had to be seen as part of the care offered, as important as medical care.
One person expressed the wish that the group could come together for Focusing and Focusing discussions in thefuture "to check if we're still on the train," and a couple asked whether I would be able to do this with them. I noted this need and encouraged the group to think about ways that they could continue to meet as a group to keep the Focusing at Leratong going even if I were not present.
I suggested the possibility of a morning “mini clearing of the space,” where they could share this easy process with staff who had not come on the training. Several people seemed interested in this, as well as in the possibility of trying out the protocol for a "community focusing group" given in the first training manual. One person volunteered to try and guide the group in one of these meetings. I offered to be available on the phone to talk through the protocol and how the experience went. Two people expressed wanting to try and bring Focusing to their facilitation of outpatient and family groups.
One participant whose work is mainly direct care of patients said she had found the learning about "listening for what the patient needs" to be very powerful. She said that just in the past week and a half of doing this kind of listening with her patients she had noticed a change in how she was relating to her patients and how they seemed to feel in response.
Bringing the Focusing attitude to their work seemed to be the kind of start most people were feeling was possible to make with the application of Focusing to their work.
Regarding the integration of Focusing into the work at Leratong, I think that this ideally requires ongoing Focusing-oriented supervision and support. If this specific form of supervision is not possible, my opinion is that it is vital that the staff receive some kind of counseling supervision, due to the challenging nature of the work at Leratong.
This concludes the evaluation of the Leratong Introductory Focusing Training.
This page was last modified on 19 September 2010