"No man was ever wise by chance."     Lucius Seneca

Yesterday I wrote a post about working with personally difficult information ... in this example, challenging group feedback.  There are so many research teams and streams of fascinating information emerging that look at how to cope well in stressful situations.  I have already mentioned Carol Dweck's work on "mindset", the value of mindful acceptance & perspective-giving reappraisal, and the potential helpfulness of self-affirmation.  It reminds me too of the very interesting body of work that I came across recently using Garnefski & Kraaij's "Cognitive emotion regulation questionnaire (CERQ)".  There are a scary number of research studies showing its relevance across many different life stresses.  Again and again the same findings emerge ... there are three cognitive emotional responses that are routinely associated with worse subsequent outcomes and one that is routinely associated with better subsequent outcomes.  The three associated with worse are the usual suspects.  They are responses involving rumination, catastrophizing and self-blame.  And the response that is so often associated with better outcomes?  It's "Positive reappraisal" with affirmative answers to the four questions "I think I can learn something from the situation", "I think that I can become a stronger person as a result of what has happened", "I think that the situation also has its positive sides" and "I look for the positive sides to the matter".

Good, so what can I learn from the feedback I got in the group last weekend?  Well one of the first things is for me to check that I've understood what was actually said and meant.  I'm in the process of doing this and, no surprise, the actual messages seem like they were somewhat softer & kinder than I had remembered.  I've talked also to two or three people who know me well to get their take on these issues.  Helpful in giving a gentler broader perspective.  However there is useful learning in this.  As pretty much always in the richness of group interactions, there are a whole series of potentially good avenues we could explore involving all group members to a greater or lesser extent.  What I'd like to stay with here though is the message that "Sometimes I can come across to others as not really being as caring & compassionate as my language appears to indicate ... that, at times, it can feel to them like I'm 'going through the motions' of being understanding & warm ... sometimes more maybe from the head than the heart".  Guilty as charged!  I'm sure that sometimes happens.  Maybe, in the group, I have been dissonant like this more than others, maybe less.  It's not important.  What is important to me is that I don't want this to happen and I'd love to learn more about making my sense of care for others more solid & genuine & helpful even more of the time.  Good territory to think about.

Einstein is reported to have said "It is theory which decides what we can observe".  I certainly feel that the particular "lens" that I use to look at experiences heavily effects what I notice & learn.  So the two "lenses" I'd like to bring out here are the Rogerian triad of genuineness, empathy & unconditional positive regard and Shaver & Mikulincer's five behavioural systems of care seeking, care giving, exploration, sex & power.  Despite my core trainings being in medicine and in cognitive-behavioural therapy, I find both of these "lenses" very helpful as ways of getting "a compass bearing" in the ebbing/flowing complexity of interpersonal interactions.  I quite often think of the genuineness/empathy/care triad as a three-legged stool. If any of the stool "legs" is too long or short, the stool gets wobbly and interactions are likely to get more problematic.  If my attempts at caring outrun my levels of empathy & genuineness, this can produce difficulties.  Similarly in the Shaver & Mikulincer model, if any of the behavioural systems isn't responding optimally to relevant environmental demands, then the "programme" tends to move into hyper- or hypo- activation.  For care seeking this would involve anxious or avoidant attachment styles.  For care giving, we may move into a colder, more distant hypo-activated state or a smothering, inappropriate hyper-activated state.  

I'm interested here in the effects of my internalised messages that "I should be a very warm, loving human being" or even just "I very much want to be a warm, loving human being".  What does this do to the genuineness/empathy/care balance?  What does it do to the care giving system?  It's a tricky issue.  I'm moved when I read words like William Penn's "I expect to pass through life but once. If therefore, there be any kindness I can show, or any good thing I can do to any fellow being, let me do it now, and not defer or neglect it, as I shall not pass this way again" or the Dalai Lama's "My religion is kindness" or even Freud's "Love and work are the cornerstones of our humanness."  And the research by and large backs this up.  See for example posts on Jennifer Crocker's fine work "Recent research: egosystem & ecosystem" or "Barbara Fredrickson's recent research on loving-kindness meditation" or "Cooperative behavior cascades in social networks".  There are excellent reasons to hold that being warm, open-hearted & compassionate is likely to be good both for others and for oneself.  My query is "How can I best allow/nourish/support myself in being open-hearted & kind?"  And a second query is "Can I try too hard?  Is there a danger of pushing out of shape ... of growing care out of proportion to genuineness & empathy ... of hyper-activating the care giving system so it slides into insensitivity?"  I'm confident the answer is "Yes, I can try too hard or in the wrong way to be more caring and slide into states that are less helpful." 

I'm not "religious" in the sense of believing in a divine power, however I do "pray" for others each day or at least I practise a form of "goodwill meditation".  See the handouts & recordings further down the "Compassion & criticism" page of this website.  My aim in this "goodwill" practice is to affect myself and then, through this, other people.  And there are good reasons for thinking that this kind of practice can internally orientate me to respond to others with more kindness - see, for example, Hutcherson & colleagues' "Loving-kindness meditation increases social connectedness", Canevello & Crocker's "Creating good relationships: responsiveness, relationship quality, and interpersonal goals" and the blog post "4 studies on prayer and their implications for compassion, loving-kindness & goodwill meditation practices".  But it's so important that this orientation towards kindness is "real" and "authentic", not driven by "self-interest" or "obligation".  See "Motives for volunteering are associated with mortality risk in older adults" and "When helping helps: autonomous motivation for prosocial behavior and its influence on well-being for the helper and recipient" with the latter study highlighting that both giver & receiver benefit more when open-hearted behaviour is driven by genuine, self-chosen motivation rather than a sense that one "should" act this way.  Before the group last weekend, I spent a little time quietening and internally wishing all of us well, "praying" or "meditating" on the intention that each person would find the group helpful.  That doesn't mean that I wouldn't subsequently challenge people in the group.  Far from it, I think it makes it more likely that I would go out on a limb if it felt like it would be true and useful.  I'm sure though that this kind of goodwill orientation can, at times, become something of a habit, can at times look like the "polished bedside manner" that I was challenged on.

So how to respond to this possibility?  Partly I think by encouraging empathy & authenticity as I try to encourage caring.  The post "Meeting at relational depth" explores this territory well.  I do already pay a good deal of attention to empathy & authenticity, but maybe not as much attention as I pay to compassion.  Mindfulness - being aware of what is emerging in the present moment - is an obvious skill to explore here.  It's partly relevant, although the results reported by Escuriex & Labbé in their recent paper "Health care providers' mindfulness and treatment outcomes: A critical review of the research literature" are only tentatively supportive.  The abstract of their paper reads "A systematic and critical review of the research literature evaluated studies on whether ... health care providers who either practice mindfulness or possess greater levels of mindfulness experience better results with their patients than those possessing lower levels of mindfulness or those who do not engage in formal mindfulness practices ... Search keywords used were "therapist mindfulness," "outcome(s)," "client outcome(s)," "therapeutic alliance," "mindful therapist," "mindfulness," "therapist training," "health care professionals," "empathy," "therapist empathy," and combinations of these terms ... Twenty studies met the inclusion criteria ... The results are inconclusive as to whether those trained in formal mindfulness practices or who possess higher levels of mindfulness have better treatment outcomes than those who do not."  So the research on the value of mindfulness training for increasing empathy seems under-whelming, at the moment.

What's much more over-whelming is the value of getting feedback.  For more on this, see tomorrow's post.