3.5 Modalities Of Helping

In the helping professions, different methods of helping are often called modalities, which means, the way things are done. I might as well use the term because I like the way it rolls of the tongue.  And even though I try to steer clear of jargon, it is a useful word to know.  And it’s not that jargony really!

Now I will not be doing an A to Z list of modalities with each one defined and then described with historical references to origins and evolution.  This can be found in any Internet site or, if you don’t trust the Internet, any library – and indeed they are useful to know.

This website is about what I consider to be the best way to do things in supporting families in the Focus Group, so the content of this Chapter will, I hope make sense, in the context of the first four Chapters in Section Three; A Bit Of Theory.

There are loads of people who have had troubled childhoods that grew up to be responsible adults.  And there are loads of people, who, one would have thought, had good childhoods but got involved in criminal behaviour and went to prison.  This, as I stated a few times already, is a bit puzzling.  This post in the Chapter on Trauma and Related Topics hopefully threw some light on this apparent contradiction.

This Chapter on Modalities will follow on from that, and describe – based on our Universal Theories of Change – the kind of support that needs to be put in place to optimise children and young people choosing positive and responsible lifestyles as adults.

The content of the Chapter is based 1): on my own experience of which modalities work and 2):  valuable feedback (some directly, some in code) that I have been privileged to receive over many years.  And while I will not be doing an A to Z, I will be mentioning the modalities that I feel are particularly helpful and describing those in the general text.

The Chapter is divided into 13 Sub-Chapters

3.5.1                MODALITIES OF HELPING – INTRODUCTION

3.5.2                PASSION IN THE WORKPLACE

3.5.3                THE POWER OF COMPASSION – AND SURPRISE

3.5.4                COMPLEX VARIABLES

3.5.5               ’HARD’ AND ‘EASY’ PROBLEMS FOR HUMANITY

3.5.6                IMPACT OF COMPLEX VARIABLES ON PRACTICE

3.5.7                COGNITIVE-BEHAVIOURAL MODALITY

3.5.8                PERSON CENTRED MODALITY

3.5.9                MUSINGS ON ‘THE WAY THINGS ARE DONE’

3.5.10              PROBLEM SOLVING – MALE AND FEMALE

3.5.11              BEYOND ASSERTIVENESS

3.5.12              LISTENING

3.5.13              MODALITIES OF HELPING – CONCLUSION – INVITATIONS TO RESPONSIBILITY

Because this website is concerned with the family and we are enthusiastic about everyone within the family growing and thriving we will start with a family situation. 

What modality do we use (i.e. what way do we do things) if we are good enough parents and our 7 year old child is in distress due to a relatively minor incident such as a cut knee?

Our first priority is to connect with the child – and then assess what is wrong.

In the case of the cut knee, the method of connection might be to kiss it better and offer understanding and sympathy.

Connection in this context is an act of love and it assures our child that we really care.  Our assessment will involve estimating the seriousness of the cut and deciding what form of plaster or other healing device will be used to ensure that it will heal properly and quickly.  (Our assessment will rarely if ever be written down).

Unless it is a very complex situation the assessment will be done so quickly after the connection that both connection and assessment seem, to the child, to be one and the same process.  While the assessment is important, (so we know what to do), for the good enough parent, the connection, i.e. the act of love, is the priority – it is our immediate response.

Following the assessment, what most practitioners call an intervention takes place.

So in terms of healing, whether it is an emotional or physical wound, I firmly believe that the connection is at least as important, if not more important than the intervention in respect of the healing that will take place.

That is not to say that the intervention isn’t important.  There is no point in kissing it better and offering love and sympathy over and over again while the cut knee bleeds profusely.  A practical intervention, e.g. a sticking plaster will also assist greatly in the healing process.  Indeed, the practical response is also an act of love.

Nor (to give another example of expression of parental love) is there much point in connecting endlessly with a teenager who has a tantrum, and who refuses to stop smoking joints in his room, without intervening, i.e. having a common-sense strategy to ensure that the rules of the home will be adhered to, clearly outlining the consequences if they are not, so that he learns to take responsibility for his actions.

But in both cases, the intervention (that is, the practical step we use to effect change i.e. healing) is greatly enhanced, and is actually optimised, by the initial, spontaneous connection.

I also propose that the feeling of being loved and cared for, (i.e. that the hurt child senses that the healer – in the above cases, the parent – has a genuine interest, and is not just going through the motions) has huge implications as to how quickly healing takes place.

That’s because what is most important for healing cannot be touched or seen – it is held in the heart!

What I described in the Introduction to this Chapter is what usually happens in a family. Mostly, the reason that a parent will kiss a 7-year-old’s cut knee better is because of the love that the parent has for the child. He is drawn into the care-giving role without thinking about it.  

Now what do we usually do in a healing type workplace?

That is, an agency, whether voluntary, private, or statutory, whose responsibility is to support people who are in distress?

There are many workplaces where people who come in feel a sense of connection – I am not denying that – and it assists greatly in the healing.

But in far too many healing environments this may not be the case.  If someone comes in emotionally vulnerable or hurt, the first thing that often happens is that they are assessed.

This usually involves answering a lot of questions, the vast majority of which do little to alleviate the hurt.  The one-way knowledge flow paradigm mentioned in a previous Chapter is generally adhered to in this process.

The belief that someone has to be formally assessed, with a practitioner asking questions and the person in distress answering them, before any decision is made as to what the practitioner might do, or the agency does, is so common that it is almost beyond our ken to think that there could be another way.

But there is. 

Imagine what would happen if, in a helping agency, instead of being assessed on arrival, a very hurt person’s distress was immediately alleviated, even if that was done by simply listening to their story? Or even, before they tell their story, making them feel at home!

I propose that what would happen is that the hurt person might feel a sense of power.  They may even begin to think ‘I matter more than my condition’, or, indeed, ‘I might be able to help myself here’.

And suppose the listening was accompanied by the person feeling cared for, or even loved?

The parent kissing the child’s cut-knee better was drawn to do it – without thinking or planning too much – because of the love (one of our root foundations) that he has for his child. A workplace is, of course, different. Love has the power to heal, but because of its associations with losing a sense of ourselves (i.e. falling in love, romantic love, sex, no boundaries etc.) it’s a bit risky for the workplace.

But love, connection and relationship are a lot wider than that.

Now, if we compare love and passion we can see that the lines between them are blurred.  What I mean is, if we love something we are usually passionate about it, and vice versa, i.e. if we are passionate about something it is probably because we love it! 

And I argue later on that love is connected to both Creativity and Leadership. There is no one more creative than a lover.  If we are passionate about something, really love it, but it seems beyond us, we can find all sorts of creative resources within ourselves to make it happen!  (Remember, here, emergence, from our Chapter on Systems Theory which we also named as a root foundation in the Chapter on Universal Theory of Change).

In my experience, passion, creativity, and love all seem to be very threatening to the bureaucrat or, generally, the Pillars because the system doesn’t feel in control of the entities (whether they be organisations or individuals) that are passionate, loving, and wish to be creative.

The unconscious purpose of the bullying power of mediocrity that we mentioned already) may well be to keep everything safe, non-threatening, harmless, and above all controlled.

But – I have some very good news for money-conscious bureaucrats!

The up side of employing creative people with passion who love what they are doing and letting them at it, (within, of course, the boundaries of the workplace), is that productivity is far higher among such people. (There is a lot more about this in the Chapter on Leadership).

It is self-evident that people are more likely to get a lot more done if they are doing something that they love, and are passionate about.

In my experience creative people often struggle with boundaries, and need a little assistance, but they also respond well to common sense. So leaders may have to bend the rules a little, have flexibility, take a few risks and be courageous enough to be firm about boundaries.

But, trust me, it is worth it.

Passion induces energy, creativity, and tenacity.  And we are all innately creative anyway – that is, creativity is available to every individual – not just to those who are considered to be creative people.

Creativity is a necessity in any modality for effective work with families in our Focus Group.

My experiences through many years of work, in different settings, but particularly on the street, formed my opinions as to what modalities I feel should have dominance, or have a substantial influence in supporting people in such deep distress that they are on the margins of society.

In a previous Chapter I referred to liquids defying gravity at temperatures close to absolute zero.

Analogous to that situation, I have met people who have suffered deep hurt and trauma, and whose confidence, esteem and general sense of self is so low that I sometimes imagine them to be at a kind of psychological absolute zero, where the cognitive process that most of us use in decision making doesn’t work.

To demonstrate this point I will recall two incidents in the next two posts – illustrating the power of compassion and surprise in situations where normal cognitive behavioural interventions, would have (in my opinion anyway) failed abjectly.

I could have chosen many examples – I chose the ones in the next two posts because I thought that should the actions not have had the effect that they did the outcomes may have been, well, pretty bad!

I am sure that you (that is, if you have worked in this area for any length of time) will have stories of your own illustrating how compassion worked when all else failed.

I encourage you to dig them up from the deep nooks and crannies of your memories and reflect on them.

In the previous post I stated that I’d give examples of situations where compassion and surprise (which is linked to creativity) worked when (I believe anyway) nothing else would have worked.

This incident happened many years ago one night, quite late, doing streetwork.

It was in a dimly lit corner of a housing estate and I was with a female colleague.  We were with some young men who were obviously stoned and a row broke out and it got quite serious.

One man who I felt was higher on drugs than the others pulled a knife and swung it in the direction of the face of the young man he was having the row with.  He cut him on the forehead – and some blood immediately began to ooze out.  The volume of the shouting and roaring rose and two or three on each side began to adopt the fight position as another knife was pulled out.  (There was going to be no flight here)!  I froze. 

I was not expecting this – it had blown up out of nowhere.  My immediate thoughts were that someone might be killed or seriously injured.  I hadn’t a clue what to do – all young men were way beyond bargaining and I felt that anything I did would make a bad situation worse. We were also far away from everywhere – i.e. help was not nearby, mobile phones hadn’t been invented, and it was also late at night – everything was closed.

But I decided that I’d have to do something – perhaps shout louder than all the others with threatening statements about doing life in prison, is it worth it, etc. – a kind of desperate final effort to impose my adult authority and, through fear of dire consequences, make the young men think!

(Now it must be remembered that all the above happened in a split second).

My colleague, however, was not at all in the state of panic that I was in.  Acting on what I can only assume was her womanly intuition she leaned forward, and without saying a word, with a white tissue, wiped the blood off the forehead of the young man that had the cut.

In another split second the entire atmosphere changed.

Calmness descended on the entire scene.  Knives were put away.  The young men’s body language changed from aggressive fight position to a kind of fuck it resignation.  After a tense moment or two they went their separate ways.

As we debriefed later my colleague told me that she only saw the wound, and she was oblivious to everything else.  We were trying to analyse it, but it was beyond analysis at that time.

This is the second incident of two illustrating the power of compassion – I described the first in the previous post.

Just a reminder; these incidents are examples of situations where compassion and surprise (which is linked to creativity) transformed impossible situations.

This incident happened when a female student who was on placement with our Project was on an activity with me.  We were bringing a young woman on a recreational activity.

This young woman was one of the most hurt that I have ever met, and her family would have had all nine characteristics in my description of our Focus Group. In her younger years she had been in care but now, at 15, was back in the community again.

On the activity, our student got on great with the 15 year old, and showed her a precious family heirloom that had been given to her by a deceased relative, and how precious this item was.

As we were returning home, after a very good day, the student suddenly noticed that her heirloom was missing.  We searched everywhere in the minibus, front, back, seats, floor, dashboard.

Now there was no doubt in my mind that the 15 year old had taken it.  Her body language and demeanour, anger at being asked a simple question, etc. were all a giveaway.  I tried everything.  For example, how much it meant to the young student with whom she had built up a very good relationship.   Also, what consequences would ensue if we went to the Gardaí and reported the loss – as we would have to do, it being such an important item.  This cajoling, bargaining and threatening went on for quite some time.  Even though I was getting angrier, I was getting absolutely nowhere, and I knew it.

For a short while, there was dead silence in the front of our little minibus.

Next thing, I noticed the student weeping very gently.  This was not pretence, or done for effect.  The tears being shed were very genuine tears as she faced the loss of her precious keepsake.  Weary from the struggle, I had no idea what to do or say.

After a few moments, the 15 year old piped up ‘Oh look at the floor, I think I see it’. 

And with great speed, and impressive sleight of hand, managed to pick it up from the floor, presenting it to the student with great joy.

With unbridled relief the student thanked the 15 year old for her honesty and I also weighed in with some positive comments on how good her eyesight was.

In the next post I will attempt to unpack this incident and the previous one in respect of compassion.

If I was analysing the two incidents described in 3.5.3.2 and 3.5.3.3 now, I would identify a unique human characteristic, compassion, as being a major influence in what I might call – given the context of the two incidents, relatively successful outcomes.

In fact, as I thought about it, I came to the conclusion that the only other thing that might have worked was to raise the level of fear above the level of the young men’s out-of-control anger, (in the first example), and above the level of the 15 year old’s compulsive acquisitiveness (in the second).

And what would that have done – even if it had solved the problem in the immediate situations?

It would have affirmed the belief that fear is the best way to solve a problem.

I realised that it had been an extraordinary privilege to have been present at such rich learning experiences – not that I’d wish to have too many of them again!

But I actually learned more from those types of incidents than I could have learned from a thousand books.

And while I have focused on the power of compassion in the above incidents it must not be forgotten that the other major factor was, of course, surprise, a kind of first cousin of creativity.

That is, doing something totally unexpected and, perhaps, what the young men (in the first example) or the teenage girl (in the second example) may never have experienced before.

And, reflecting on my own and my colleague’s input (looking back on the knowledge that I have now), something in our unconscious may have been willing to hold the situations and trust the root foundation of emergence.

I could give loads of less dramatic examples which occurred more often (and still do) but which, perhaps, carry a lot less emotional energy than the experiences just described! It was because of such experiences (and many others like them) that I formed the opinions that:

1. Modalities that include compassion, warmth and presence with, indeed, an element of good surprise and creativity will stand a much better chance of success in firstly engaging with and then effecting healing in people who are on high alert, are very hurt and under extreme stress or pressure, i.e. members of the families that constitute our Focus Group.

2. If Cognitive Behavioural Therapy (CBT), which I will describe below and which is very common and proven to be successful in many diverse settings (and which I hold in high esteem) is used it needs to be used within a frame of compassion, presence, warmth and similar traits.

In addition to solving the problem in the immediate, I believe that compassion, creativity and surprise also serve to assure people in the long term that they will be included and valued.

The usefulness of such traits is discussed in far more detail in the following Sections, and in particular the Section on Practical Applications.

Before I come to actual descriptions/critiques of modalities that I consider helpful I would like to discuss the presence of what I will describe as complex variables (things that are complex, and are continually varying, or changing), and their significance in family support work. (If you have skipped to this post it might be helpful, before you read on, to read the post on complexity in the Chapter on Systems Theory).

In addition to the real-life examples of the incidents in the last Sub-Chapter, this Sub-Chapter offers a theoretical rationale for the selection of some modalities over others.

Having studied mathematics and physics in some depth I became familiar with complex variables.

When I first learned about them (or tried to), they applied in engineering, and in electronic communications in respect of transmission of radio waves and such matters.

Because I went straight from the world of radar and radio to the world of helping people in distress I often pondered on what I carried with me – and how they could be applied, that is, if they were of any practical use.

The thing that struck me when I thought about it a bit was that the understanding and use of complex variables for the benefit of humans was primarily in the mental sphere of our being.

But in the emotional sphere, there is complexity also – though of a different kind.

Compare the heart (what we feel – complexity – fluidity – aliveness – uncertainty) to the head (what we think – complicated – separate moving parts – mechanical – certainty).

That is not to say that one doesn’t get emotional about matters of the head, i.e. mathematics – it can be an immensely exciting and at the same time frustrating discipline!  But when it’s done it’s done, and the same equations can be applied at different times and in different places and give us the same results.  And a radio wave transmitted from Ulaan Baatar will have the same properties, and will be similarly affected by different factors at both its point and path of transmission, as one transmitted from Lesotho.

As I gained more knowledge and experience of psychotherapy, social work, youth work, community work and such disciplines I learned words and phrases such as social capital, person centred work, developmental milestones, resilience, pro-social behaviour, recidivism and many more.

These terms replaced the terms that I was accustomed to using up to that time, such as communication, propagation, attenuation, amplification and complex variables!

I was often struck at how some of the terms could be applied in both fields.

The most striking one that was common to both was, of course communication. Electronic communication and personal communication are quite different, but there were other less obvious ones.

For example, the uncertainty principle (which I first came across in quantum physics) I recognised to be of particular relevance in the field of helping people. Another word propagation (which has a specific meaning for radio waves) – has a slightly different meaning in the human context.

And, having come from the Army, words like security and secure (locks, bolts, guardrooms armaments, secrecy) have completely different meanings in the military and the security forces to the meanings that they have in the world of relationships and helping people. Remember the secure base in this post?

And finally, the above mentioned complex variable, a term that I don’t remember seeing in a social work, psychotherapy or community work manual or book, is, (as I will argue in the next post) very relevant in the world of helping people in distress.