constructivist ideas in practice

sally robbins Sally Robbins first came across PCP as an undergraduate, but really got interested during her training as a Clinical Psychologist, especially on placement at Bexley Hospital in the late1970’s, in the department that Don Bannister had only recently left. She has found it more and more useful in making sense of the world, personally as well as at work, and has been using and teaching PCP ever since.  

Mary: Last time we spoke about your work, you were on the cusp of change - soon to leave the NHS, and at the end of the coaching programme. You were thinking about developing a different and more individual practice. How have things been going?

Sally: As you know, I had the idea of work based on Jerald Forster’s AST model (Articulating Strengths Together) which starts by highlighting qualities and strengths rather than starting with problems. It is a very different approach from my NHS work with older people with long-term psychological health issues which was, quite reasonably, very focused on difficulties – at least as a starting point.

What I developed was a variation on Jerald’s AST model, which added a variety of follow-on sessions which drew on PCP. I had to change some of the language, both for UK/US differences in language, and also to speak to different client groups. I discussed this with Jerald, because even the title was changed to Recognising Your Strengths. This was much better understood by my groups, even though I realise it is significantly different from Jerald’s emphasis.

The basis of Jerald’s work is that recognising your strengths helps you to resist threats to your well-being and helps overcome that sense of vulnerability which is very common as people get older. The focus is on qualities that help you to thrive. There is a very clear Positive Psychology aspect to this, so I also wanted it to be closer to my PCP practice, and not to move too far in that direction. In the follow-on activities I incorporated a variety of other PCP techniques, such as Finn Tschudi’s ABC, and particularly Heather Moran’s exercise on exploring the ‘Ideal Self’.

Mary: As I remember, your plan was to aim this at older people, which had been your specialism for many years, and perhaps as a support to retirement particularly.

Sally: Interestingly, it hasn’t been so much with older people! I’ve had two very interesting projects in collaboration with a major UK mental health charity, in their drop-in centre and in a collaborative project with a job centre. I ran a series of sessions fitting in to a four week programme, helping people to think about their strengths, and perhaps open up future possibilities.

At the drop-in centre, attendance was unpredictable, so not a stable group over the 4 weeks. These were people with ongoing mental health difficulties living in the community. In the job centre I worked with a group who were long-term unemployed. The two groups were a bit different, not least because attending the drop-in centre was people’s own choice, but the job centre clients had to attend a certain number of programmes as part of their contract, and I was part of that. But the focus was the same - looking for more and different strengths, and for aspects of themselves which may have got buried or forgotten over time, and which could help people take a different view of their lives and their futures.

Mary: Listening to you, I can imagine that this would be a very different approach for many people in both of these groups, and an important one. I would guess that, generally, the emphasis might have been on what problems they had, and what support they needed, rather than their hidden strengths - would that be true?

Sally: I think so. In the mental health drop-in group they did already focus on things like ‘well-being’ and ‘self-care’ but this was often in a more practical and less psychological way. And in the job centre the focus was obviously narrowed down to matching the needs of jobs available.

Mary: How did you introduce your sessions then, as this was perhaps an unusual offer, with groups not used to seeing much potential? Sally: I usually started by suggesting that many of us are very used to putting ourselves down and noticing what we can’t do, and that becomes a habit - so perhaps we could try to putting the balance back, as an experiment, just to have a try.

Mary: That’s one of the lovely aspects of PCP work I think, to offer things to try out, rather than bringing ideas about what would be ‘good for' people.

Sally: Yes, my angle was very much ‘try it on for size’. It helps people have a go. In the ratings and comments at the end, people said that they felt better, and that they had never thought of looking at things in those ways. It was very encouraging, because some of those in the job centre group had more or less lost hope and didn’t really see much way forward. And it was helpful that some people actually got a job during the 4 weeks, though I’m not necessarily claiming any cause and effect there!

Mary: Were there particular themes that emerged in the kinds of strengths people were discovering or reclaiming?

Sally: I would say that they were mainly relationship skills, things like paying attention to others, kindness, patience, being helpful - the human things.

Mary: Were they immediate responses, or did it take a lot of work to uncover?

Sally: It felt like a kind of archeology - brushing away at the sand, remembering things done and achieved in the past. At times, you could see people sit up straighter, have a different tone in their voice: ’yes, I did that!’. We were finding things that remained - they were not lost, just not much used.

In some ways it was the opposite of the work I had been doing in psychology services where we were often trying to leave things behind, to make things less permeable to allow us to move on. This was about uncovering and re-discovering valuable things. That’s Jerald Forster’s emphasis on articulating good experiences from any time in our life, and of any scale - nothing is ‘trivial’.

Mary: Would you still expect this kind of work to be useful with older people, as you had originally anticipated?

Sally: I certainly think it could be. I had thought about it at the point of retirement. As you know from the research I did on the coaching programme, the people I spoke to were very keen to avoid what they saw as society’s assumptions that their productive lives were over. They saw themselves as bolder and more forward-looking than those stereotypes, and they talked a lot about valuing their new freedom. This work may not have have been so necessary for them as I had thought, but still interesting perhaps.

I’ve also been recommending a book of interviews with older women which fits with this – Bolder and Wiser by Sarah Dale. I’ve also been thinking also about older carers, for example those supporting someone with dementia. It would have to be modified of course, because their opportunities to experiment may be very constricted, but I have known many carers to feel that ‘there is no more of me’. It’s hard to keep alive a glimmer of who they are outside the caring role.

Mary: How did the Ideal Self exercise work? I know you have used it in various ways before, including for yourself, but Heather did develop it originally for working with children.

Sally: The main difficulty, as you can guess, is the request to draw something. So many people are convinced they can’t possibly draw anything. It’s a hangover from school, where most people came away thinking they couldn’t draw, or sing, and so it’s a threatening exercise in that way. But I know from years of using it on the PCP foundation course, that it is one of the most powerful and useful exercises for exploring our selves. I do my best to make it safe, to keep it structured, and to let people keep their work to themselves if they want to. It’s just a thing, something to try out, and oh, the joy in it when they have a go! It connects back so easily to the ordinary, possible, things in our lives.

Mary: Yes, it is a very beautifully structured exercise, step by step.

You mentioned not wanting to move too far towards Positive Psychology, and you know that I’m very much with you there, but I’m wondering how you achieve that, given the continual emphasis you have described on strengths and achievements and ideal selves?

Sally: By always being interested in both poles.

Mary: Of course - PCP’s greatest gift!

Sally: In this work, the positive poles are often the ones that have been submerged, and that we’re digging out of the sand. But it’s not about just changing poles - that would just be slot-rattling. When we uncover the positive pole, we now have a dimension we can work with. We’re not changing from thing to another, but opening up more possibilities in all directions.

I also steer away from going back to things, to exactly what worked in the past, because I find many people wanting to be who they used to be. My response depends on how robust they are, but usually I can say that we will need a new version of that, for how things are now. That takes us back to exploring, with the ideas and memories of the past as a prompt rather than the goal. I also use the ‘pyramiding’ method a lot, to keep the experiments small and specific enough to be practical and useful. I sometimes use the metaphor of getting things out, dusting them off, having a good look at them and then putting them back. And I do actually use things in the room which come to hand as metaphors, because talking about ourselves is difficult for many people, really quite threatening, and it can be a relief to look at a pot or an ornament from different angles to get the idea of it!

Also, if people have very clear ideas about what they ‘should’ do, PCP explores these very well with ABC for example. It’s like walking round and seeing what else is in the building, exploring implications in all directions, and the subtleties of those implications. They might well be good things to do, but there is also a note of caution, and openness to other ideas.

Mary: As we talk, I’m aware of the way in which, using these techniques, people are working at the intersection between their own personal construct systems and the dominant social and cultural constructs of a jobless person, an older person, someone with a mental health diagnostic ‘label’, or being a carer. These roles are laden with cultural expectations and constraints in so many ways.

Sally: I think the strength-based work tends to be loosening. It also often dilates aspects which may have become very constricted, and it helps to sort out a bit whether the limits are open to change, or, realistically, not. To take a fresh look at that, with no preconceived expectations. It does help put people back in touch with being ‘more than’ the role or label, and that’s a very big thing.

Mary: Because you were on a programme when you started developing this model of working, you tried some of it out on yourself - do you have reflections on that now, three years later?

Sally: For me, I still hold to the metaphor of self/life as a jigsaw, my curiosity about the different pieces and how they fit, and my wish to keep all the pieces in play. I label the various components of my life, for example: physical, intellectual, social, spiritual, a focus on others, and so on. I want to make sure there is time for each one, and that they take their place. It’s not about completing the picture - I don’t even want to arrive at the picture! It’s about keeping all the components on the table, and not to lose one without noticing. It’s very alive for me.

I also love three specific bits of advice that came up from my research with people in retirement. For myself, I try to remember these three things:

“Do it now!”

“Establish your own routines - don’t just do things with your spouse”

“Remember it’s better to burn out than to rust out!”





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