Extract from the Foreword
The Healing Power of Presence is a powerful articulation of what compassionate and spiritual relationships can achieve. Forster captures the reader with a narrative born of more than four decades of experience in pastoral care and teaching. No lectures here though, just deep insights into what it takes to be present and to do the emotional labor of healing. There is some theory of course but theory rooted in practical experience. Michael has lived it.
This book takes the reader on a veritable road trip from the unconditional positive regard of Carl Rogers to the wounded healer of Carl Jung. Via Old and New Testament we go; concepts of presence, companionship, truth and trust are our traveling companions. At one point Forster quotes from King’s Mountain Top speech delivered at the headquarters of The Church Of God in Christ in Memphis Tennessee. It was the eve of King’s assassination. He came to Memphis to be present with Sanitation Workers whose voices were weakened and unheard. In that same speech Dr. King talks about his own road trip on The Road to Jericho. He described it as a difficult indeed somewhat dangerous road, and yet he travels along it any way.
In a similar way Michael Forster has travelled a sometimes-difficult road, one where he has supported people in profound distress along the way. This has been a journey that has required him to integrate the very best of his spiritual and counseling skills. A road trip from which he has learned so much, lessons he now so generously shares with us.
In a strange twist of fate I now find myself working in Memphis Tennessee in a Faith based healthcare organization called The Church Health Center. We are based just minutes away from The Lorraine Motel, the place where Dr. King was gunned down.
Our focus is the least of these. There is no litmus test to either use or work in our organization, but we do believe that mind, body and spirit are connected and this is reflected in how we care. This book will encourage and inform anyone interested in such a connection. They will feel more competent and inspired after reading it. They will understand that healing is a process, which makes us whole.
Prof Anthony Sheehan, President of the Church Health Centre in Memphis, Tenessee, and formerly CEO of Leicestershire Partnership NHS Trust
(C) Michael Forster
Chapter 1. Being There
Most of us are familiar, to greater or lesser extent with the idea of ‘being there’ for another person. Hopefully, we may know and value in our own lives people who are good to have around in troubled times even though (or maybe precisely because) they don’t try to fix things but are simply there with us. For me, and for my wife, the Dedicatee of this book is one such person. So I’d like to look at three quick sketches that I think shed light upon this, and we begin with a rabbit, a monkey and a potato.
Talk to the rabbitA mental health service user, temporarily living as a resident in a therapeutic community, was attending a review with his consultant psychiatrist along with his named nurse.
‘So,’ the consultant observed, ‘I gather you’ve been managing your anger much better these days.’
‘Oh, yes,’ replied the patient. ‘That’s all down to Edgar – he’s been really helpful.’
‘Would you like to tell me more?’
‘Well, he’s great, is Edgar – he’s always there for me. And whenever I feel angry, instead of lashing out, I go and talk to Edgar for a bit. I always feel a lot better afterwards, and talking it through helps me see it differently and find other ways of handling it.’
The consultant was glancing down the list of staff involved in the patient’s care. ‘That’s really good news! I’m just wondering who Edgar is – I don’t see anyone of that name down here. Is he a relative or friend, perhaps?’
Embarrassed, the named nurse shuffled in her seat and looked at her shoes as she said, ‘Well, actually . . . Edgar’s the unit’s pet rabbit.’
It isn’t really that hard to understand what was happening here. Edgar the rabbit had a great asset as a therapist: he didn’t talk. He had two large ears, one very small mouth that was usually preoccupied with food-processing, and the one never got in the way of the others. Edgar just sat and ‘listened’. He could not pass an opinion, could not offer gratuitous advice, and – perhaps most importantly of all – could not judge. The residents in the unit found that particularly helpful, They would climb into the rabbit pen to squat down beside Edgar – often equipped with a few tit-bits to hold his attention – and start to voice their feelings. As they talked, they began to hear themselves in new ways, and were able to process not only their emotions but the issues that were driving them. It was not surprising that many of them left Edgar’s run with a much clearer view on their lives and their problems while Edgar awaited his next client, completely unaware that he was an essential contributor to a highly effective therapeutic process.
Many pastoral companions will have had the experience of being effusively thanked for helping someone to clarify their thoughts when in fact all they have done is provide a focus for the other’s thinking aloud. It is of course easier for a rabbit to do that than a human being, the latter having to resist the temptation to butt in – and that is without doubt the first discipline that any aspiring pastoral companion must learn.
Watch the monkeyWhat is it that helps? It’s a good question, and one that preoccupies people whose role is to care whether they be ministers, counsellors or pastoral companions. Much time and money is spent on research trying to answer it – and it often tends to be rather inconclusive. That’s partly because we can’t remove the biggest variable of all – the person of the companion – from the equation so we don’t really know for sure how far it is a specific approach or school of thought that is benefiting the other and to what extent it is the personality of the individual companion. However, it seems not unlikely (at the very least) that the approach and manner of the companion – and the quality of relationship with the other – might well be the single most important factors.
I am convinced that we can gain some valuable insights from rehabilitation work being done with traumatised animals. Clearly the distinctions between competing approaches to ‘talking therapies’ hardly come into play when one is trying to rehabilitate a primate, and the only tools we have are those of environment and relationship. So in this context we are able to see clearly the effects of those two factors without the waters being muddied by competing theoretical models. And what we see is a remarkable illustration of the effect that environment and relationship have on wellbeing.
I have been particularly struck by the evident success at Dorset’s famous ape sanctuary, Monkey World, in working with primates damaged by lifetimes of abuse whether as tourist attractions, household pets or in experimentation in the drugs and cosmetics industries. Their work has been followed in several series of TV documentary programmes where the progress of individual animals and the social groups in which they live can be observed over significant periods of time. Usually, the animals when rescued are far too damaged ever to hope to return to the wild so the aim is to enable them to live as natural a life as possible in captivity. To that end, they are introduced to an environment as close to their natural habitat as is realistic, to live in social groups with sensitive monitoring by the keepers and good healthcare from specialist vets. What strikes me about this is how rapidly the animals begin to change positively. Some even need to learn the basic fact that they are apes and not humans, and how to behave in a social environment that they have never experienced. Some of the psychological scars clearly remain in evidence and – like physical scars – will probably never fade completely; but the healing is nonetheless real and positive benefits rapidly begin to show as they grow in confidence, learn to socialise and soon display the signs of becoming better-adjusted primates, relatively happy and at ease in their new lives. The significant point is that their healing comes not from the input of a wise minister or counsellor but from exposure to a healthy environment and the opportunity to build (in terms of their own species) normal, healthy social relationships.
There is of course an obvious flaw in this comparison: for better or for worse, we are not in a position to rescue and transplant those whose pastoral companions[1] we are in quite the same way – one of the frustrations many pastors and therapists alike experience is the knowledge that after an hour with us people will return to the often-unhelpful environments of their daily routines. However, the purpose of observing this work is not that we might construct some kind of template for our helping relationships with people but rather that is does show – with, I think, quite stark clarity – the importance of a healthy environment, which for our purposes means a psychological one (there is usually little we can do about the physical circumstances). However, there is at least one more important thing we learn from observing the work with primates. And the best illustration of that is found if we take a further step away from the world of human interaction and eliminate the sentient element altogether.
Consider the potatoThe psychologist Carl Rogers, founder of the school of thought that became the Person-Centred Approach to counselling (on which more later) found inspiration in, of all things, a potato – rather a sad specimen, in fact, left in a cellar without soil or other sources of nutrients. What Rogers noticed was that the potato continued to ‘try’ to grow (something we may all have observed in potatoes left too long in the vegetable rack). From this, he formulated the theory that all living organisms have a natural drive for self-actualisation and development that is active throughout life and cannot be stopped even by a poor environment. More important than that, though, was that the potato, deprived of the necessities for healthy development grew in unhealthy ways and became distorted, unattractive and probably inedible in the process.
This, he said, happens with all living organisms including the human ones. Put us in a poor environment and our inner drive toward growth and actualisation will continue – but in such an environment that unstoppable process will be subverted into unhealthy development. This is a point I used to make when in healthcare chaplaincy: if we concentrate solely upon a person’s clinical need to the neglect of other aspects of their being (in particular for us, their psycho-spiritual needs) then they will not simply put those matters on hold but are likely to be damaged by the continuing drive toward growth . We are also learning (far too slowly, I fear) that the human organism is a unified whole and a person’s mental and spiritual wellbeing will affect their ability to heal physically. If, for example, someone is ill with appendicitis, then a less holistic approach might suggest that the important thing is the care related to that – medication, surgery, after-care, infection control and so on – while other matters about their human need for warmth, their spirituality, relationships, self-esteem etc. can all be simply put on hold while the experts concentrate on the job in hand. However, it is now becoming increasingly recognised that if those other matters are well catered for the patient is likely to recover more quickly and remain well for longer after discharge. Indeed, the value of Pet Assisted Therapy, where appropriately selected animals (e.g. ‘PAT dogs’) are taken to the ward for patients to stroke, is gaining recognition.
We shall look at this in more depth later, but it is easy to see how it relates to the experience of the monkey sanctuary where animals come in profoundly damaged and – simply by their intelligent introduction to a healthy environment – are enabled to become more truly themselves. In Carl Rogers’ terms, they progress toward being ‘fully functioning’.
So far, we’ve seen at least three important things which can be summarised by back-tracking along our diversionary route to where we began.
1. The potato shows us the importance of environment, for good or ill. If Rogers is right (and the evidence seems very compelling that he is) then we cannot help but be affected by our (psychological as well as physical) environment. We cannot stop the internal drive toward growth and development which in a good environment will tend to be healthy and in a poor one will be to some extent or other maladaptive.
2. However, from the example of the work among monkeys we see a vital corollary to that: the possibility of redemption. The work at Monkey World and other similar sanctuaries provides abundant cause to hope that, in sentient beings, at least some of the maladjustment can be reversed and some degree of healing experienced
3. And finally, returning us to our point of departure, the rabbit assures us that our simple, wordless presence can have astonishing healing power in the creation of such a helpful and healing environment.
Risky businessOne of the things any observer of a primate sanctuary quickly realises is that this process involves accepting and managing risk. The apes are not kept in protective isolation – there would be nothing enabling about that – but expected to live in social groups that resemble as closely as practicable the situation that would apply in the wild. The adaptation process can be scary and downright dangerous as they learn, for example how to find their appropriate place within the hierarchical structure and build their own social relationships within those constraints. The keepers’ role in this is apparently to observe and provide support, intervening when appropriate but also knowing when to stand back and allow conflicts to be resolved by the apes themselves. Rather than protecting the animals, the staff are there to enable them to cope with the day to day problems and conflicts – and to experience the joys and fulfilments – of life in their own society.
This highlights one of the basic dilemmas of human relationships: when should we intervene directly to protect, help or advise the people whose companions we are, and when would doing that simply create dependence, stunt personal growth or change our relationship in other detrimental ways? Again, we can see from the back-stories of the rescued and rehabilitated primates how our well-intentioned attempts to ‘care’ for another (assuming of course that we had the range of skills required to do so) can make it impossible for someone to function in their social environment – and how that can be transformed by a more creative risk-acceptant, approach. Every parent, every teacher and youth worker – indeed every one of us in some part of our lives – has to make judgments about that. Sometimes – hopefully more often than not – we get them right, but sometimes we don’t and any seasoned pastoral companion must almost certainly have had to learn from that experience at some time.
What all of this is amounting to is that what has traditionally been called ‘pastoral care’ is much less about ‘caring for’ someone in a quasi-clinical sense, and much more about providing a psychological environment where they can find and come to trust their own resources for becoming.
The resident in the therapeutic community whom we met at the beginning of this chapter was not suffering from delusions and of course knew perfectly well that Edgar was not literally listening – still less, talking – to him. Edgar provided a focus and, if you like, gave him permission to speak when no one else was going to interfere, and in doing so to discover his own inner resources. He became more confident that much of the help he needed was ‘in here’ rather than ‘out there’ and came to trust his own considered judgments. Therein, though, lies an important difference that we have to recognise. He also knew, if Edgar wandered off or turned away, that it was not a personal slight against him – and it did not affect the value of the session. In the case of a human presence, however, things are obviously very different in this regard. A therapist who required a constant supply of food in order to hold their attention, and whose gaze occasionally shifted to look at the scenery outside, would not be tolerated in the same way. So it is now time to consider what it is about the presence of another person that is helpful.
[1] This term will be used throughout the book in place of the more familiar ‘carer’, as discussed under ‘Terminology’ (p xx)
© Michael Forster
The Healing Power of Presence is a powerful articulation of what compassionate and spiritual relationships can achieve. Forster captures the reader with a narrative born of more than four decades of experience in pastoral care and teaching. No lectures here though, just deep insights into what it takes to be present and to do the emotional labor of healing. There is some theory of course but theory rooted in practical experience. Michael has lived it.
This book takes the reader on a veritable road trip from the unconditional positive regard of Carl Rogers to the wounded healer of Carl Jung. Via Old and New Testament we go; concepts of presence, companionship, truth and trust are our traveling companions. At one point Forster quotes from King’s Mountain Top speech delivered at the headquarters of The Church Of God in Christ in Memphis Tennessee. It was the eve of King’s assassination. He came to Memphis to be present with Sanitation Workers whose voices were weakened and unheard. In that same speech Dr. King talks about his own road trip on The Road to Jericho. He described it as a difficult indeed somewhat dangerous road, and yet he travels along it any way.
In a similar way Michael Forster has travelled a sometimes-difficult road, one where he has supported people in profound distress along the way. This has been a journey that has required him to integrate the very best of his spiritual and counseling skills. A road trip from which he has learned so much, lessons he now so generously shares with us.
In a strange twist of fate I now find myself working in Memphis Tennessee in a Faith based healthcare organization called The Church Health Center. We are based just minutes away from The Lorraine Motel, the place where Dr. King was gunned down.
Our focus is the least of these. There is no litmus test to either use or work in our organization, but we do believe that mind, body and spirit are connected and this is reflected in how we care. This book will encourage and inform anyone interested in such a connection. They will feel more competent and inspired after reading it. They will understand that healing is a process, which makes us whole.
Prof Anthony Sheehan, President of the Church Health Centre in Memphis, Tenessee, and formerly CEO of Leicestershire Partnership NHS Trust
(C) Michael Forster
Chapter 1. Being There
Most of us are familiar, to greater or lesser extent with the idea of ‘being there’ for another person. Hopefully, we may know and value in our own lives people who are good to have around in troubled times even though (or maybe precisely because) they don’t try to fix things but are simply there with us. For me, and for my wife, the Dedicatee of this book is one such person. So I’d like to look at three quick sketches that I think shed light upon this, and we begin with a rabbit, a monkey and a potato.
Talk to the rabbitA mental health service user, temporarily living as a resident in a therapeutic community, was attending a review with his consultant psychiatrist along with his named nurse.
‘So,’ the consultant observed, ‘I gather you’ve been managing your anger much better these days.’
‘Oh, yes,’ replied the patient. ‘That’s all down to Edgar – he’s been really helpful.’
‘Would you like to tell me more?’
‘Well, he’s great, is Edgar – he’s always there for me. And whenever I feel angry, instead of lashing out, I go and talk to Edgar for a bit. I always feel a lot better afterwards, and talking it through helps me see it differently and find other ways of handling it.’
The consultant was glancing down the list of staff involved in the patient’s care. ‘That’s really good news! I’m just wondering who Edgar is – I don’t see anyone of that name down here. Is he a relative or friend, perhaps?’
Embarrassed, the named nurse shuffled in her seat and looked at her shoes as she said, ‘Well, actually . . . Edgar’s the unit’s pet rabbit.’
It isn’t really that hard to understand what was happening here. Edgar the rabbit had a great asset as a therapist: he didn’t talk. He had two large ears, one very small mouth that was usually preoccupied with food-processing, and the one never got in the way of the others. Edgar just sat and ‘listened’. He could not pass an opinion, could not offer gratuitous advice, and – perhaps most importantly of all – could not judge. The residents in the unit found that particularly helpful, They would climb into the rabbit pen to squat down beside Edgar – often equipped with a few tit-bits to hold his attention – and start to voice their feelings. As they talked, they began to hear themselves in new ways, and were able to process not only their emotions but the issues that were driving them. It was not surprising that many of them left Edgar’s run with a much clearer view on their lives and their problems while Edgar awaited his next client, completely unaware that he was an essential contributor to a highly effective therapeutic process.
Many pastoral companions will have had the experience of being effusively thanked for helping someone to clarify their thoughts when in fact all they have done is provide a focus for the other’s thinking aloud. It is of course easier for a rabbit to do that than a human being, the latter having to resist the temptation to butt in – and that is without doubt the first discipline that any aspiring pastoral companion must learn.
Watch the monkeyWhat is it that helps? It’s a good question, and one that preoccupies people whose role is to care whether they be ministers, counsellors or pastoral companions. Much time and money is spent on research trying to answer it – and it often tends to be rather inconclusive. That’s partly because we can’t remove the biggest variable of all – the person of the companion – from the equation so we don’t really know for sure how far it is a specific approach or school of thought that is benefiting the other and to what extent it is the personality of the individual companion. However, it seems not unlikely (at the very least) that the approach and manner of the companion – and the quality of relationship with the other – might well be the single most important factors.
I am convinced that we can gain some valuable insights from rehabilitation work being done with traumatised animals. Clearly the distinctions between competing approaches to ‘talking therapies’ hardly come into play when one is trying to rehabilitate a primate, and the only tools we have are those of environment and relationship. So in this context we are able to see clearly the effects of those two factors without the waters being muddied by competing theoretical models. And what we see is a remarkable illustration of the effect that environment and relationship have on wellbeing.
I have been particularly struck by the evident success at Dorset’s famous ape sanctuary, Monkey World, in working with primates damaged by lifetimes of abuse whether as tourist attractions, household pets or in experimentation in the drugs and cosmetics industries. Their work has been followed in several series of TV documentary programmes where the progress of individual animals and the social groups in which they live can be observed over significant periods of time. Usually, the animals when rescued are far too damaged ever to hope to return to the wild so the aim is to enable them to live as natural a life as possible in captivity. To that end, they are introduced to an environment as close to their natural habitat as is realistic, to live in social groups with sensitive monitoring by the keepers and good healthcare from specialist vets. What strikes me about this is how rapidly the animals begin to change positively. Some even need to learn the basic fact that they are apes and not humans, and how to behave in a social environment that they have never experienced. Some of the psychological scars clearly remain in evidence and – like physical scars – will probably never fade completely; but the healing is nonetheless real and positive benefits rapidly begin to show as they grow in confidence, learn to socialise and soon display the signs of becoming better-adjusted primates, relatively happy and at ease in their new lives. The significant point is that their healing comes not from the input of a wise minister or counsellor but from exposure to a healthy environment and the opportunity to build (in terms of their own species) normal, healthy social relationships.
There is of course an obvious flaw in this comparison: for better or for worse, we are not in a position to rescue and transplant those whose pastoral companions[1] we are in quite the same way – one of the frustrations many pastors and therapists alike experience is the knowledge that after an hour with us people will return to the often-unhelpful environments of their daily routines. However, the purpose of observing this work is not that we might construct some kind of template for our helping relationships with people but rather that is does show – with, I think, quite stark clarity – the importance of a healthy environment, which for our purposes means a psychological one (there is usually little we can do about the physical circumstances). However, there is at least one more important thing we learn from observing the work with primates. And the best illustration of that is found if we take a further step away from the world of human interaction and eliminate the sentient element altogether.
Consider the potatoThe psychologist Carl Rogers, founder of the school of thought that became the Person-Centred Approach to counselling (on which more later) found inspiration in, of all things, a potato – rather a sad specimen, in fact, left in a cellar without soil or other sources of nutrients. What Rogers noticed was that the potato continued to ‘try’ to grow (something we may all have observed in potatoes left too long in the vegetable rack). From this, he formulated the theory that all living organisms have a natural drive for self-actualisation and development that is active throughout life and cannot be stopped even by a poor environment. More important than that, though, was that the potato, deprived of the necessities for healthy development grew in unhealthy ways and became distorted, unattractive and probably inedible in the process.
This, he said, happens with all living organisms including the human ones. Put us in a poor environment and our inner drive toward growth and actualisation will continue – but in such an environment that unstoppable process will be subverted into unhealthy development. This is a point I used to make when in healthcare chaplaincy: if we concentrate solely upon a person’s clinical need to the neglect of other aspects of their being (in particular for us, their psycho-spiritual needs) then they will not simply put those matters on hold but are likely to be damaged by the continuing drive toward growth . We are also learning (far too slowly, I fear) that the human organism is a unified whole and a person’s mental and spiritual wellbeing will affect their ability to heal physically. If, for example, someone is ill with appendicitis, then a less holistic approach might suggest that the important thing is the care related to that – medication, surgery, after-care, infection control and so on – while other matters about their human need for warmth, their spirituality, relationships, self-esteem etc. can all be simply put on hold while the experts concentrate on the job in hand. However, it is now becoming increasingly recognised that if those other matters are well catered for the patient is likely to recover more quickly and remain well for longer after discharge. Indeed, the value of Pet Assisted Therapy, where appropriately selected animals (e.g. ‘PAT dogs’) are taken to the ward for patients to stroke, is gaining recognition.
We shall look at this in more depth later, but it is easy to see how it relates to the experience of the monkey sanctuary where animals come in profoundly damaged and – simply by their intelligent introduction to a healthy environment – are enabled to become more truly themselves. In Carl Rogers’ terms, they progress toward being ‘fully functioning’.
So far, we’ve seen at least three important things which can be summarised by back-tracking along our diversionary route to where we began.
1. The potato shows us the importance of environment, for good or ill. If Rogers is right (and the evidence seems very compelling that he is) then we cannot help but be affected by our (psychological as well as physical) environment. We cannot stop the internal drive toward growth and development which in a good environment will tend to be healthy and in a poor one will be to some extent or other maladaptive.
2. However, from the example of the work among monkeys we see a vital corollary to that: the possibility of redemption. The work at Monkey World and other similar sanctuaries provides abundant cause to hope that, in sentient beings, at least some of the maladjustment can be reversed and some degree of healing experienced
3. And finally, returning us to our point of departure, the rabbit assures us that our simple, wordless presence can have astonishing healing power in the creation of such a helpful and healing environment.
Risky businessOne of the things any observer of a primate sanctuary quickly realises is that this process involves accepting and managing risk. The apes are not kept in protective isolation – there would be nothing enabling about that – but expected to live in social groups that resemble as closely as practicable the situation that would apply in the wild. The adaptation process can be scary and downright dangerous as they learn, for example how to find their appropriate place within the hierarchical structure and build their own social relationships within those constraints. The keepers’ role in this is apparently to observe and provide support, intervening when appropriate but also knowing when to stand back and allow conflicts to be resolved by the apes themselves. Rather than protecting the animals, the staff are there to enable them to cope with the day to day problems and conflicts – and to experience the joys and fulfilments – of life in their own society.
This highlights one of the basic dilemmas of human relationships: when should we intervene directly to protect, help or advise the people whose companions we are, and when would doing that simply create dependence, stunt personal growth or change our relationship in other detrimental ways? Again, we can see from the back-stories of the rescued and rehabilitated primates how our well-intentioned attempts to ‘care’ for another (assuming of course that we had the range of skills required to do so) can make it impossible for someone to function in their social environment – and how that can be transformed by a more creative risk-acceptant, approach. Every parent, every teacher and youth worker – indeed every one of us in some part of our lives – has to make judgments about that. Sometimes – hopefully more often than not – we get them right, but sometimes we don’t and any seasoned pastoral companion must almost certainly have had to learn from that experience at some time.
What all of this is amounting to is that what has traditionally been called ‘pastoral care’ is much less about ‘caring for’ someone in a quasi-clinical sense, and much more about providing a psychological environment where they can find and come to trust their own resources for becoming.
The resident in the therapeutic community whom we met at the beginning of this chapter was not suffering from delusions and of course knew perfectly well that Edgar was not literally listening – still less, talking – to him. Edgar provided a focus and, if you like, gave him permission to speak when no one else was going to interfere, and in doing so to discover his own inner resources. He became more confident that much of the help he needed was ‘in here’ rather than ‘out there’ and came to trust his own considered judgments. Therein, though, lies an important difference that we have to recognise. He also knew, if Edgar wandered off or turned away, that it was not a personal slight against him – and it did not affect the value of the session. In the case of a human presence, however, things are obviously very different in this regard. A therapist who required a constant supply of food in order to hold their attention, and whose gaze occasionally shifted to look at the scenery outside, would not be tolerated in the same way. So it is now time to consider what it is about the presence of another person that is helpful.
[1] This term will be used throughout the book in place of the more familiar ‘carer’, as discussed under ‘Terminology’ (p xx)
© Michael Forster