Learning from success

Prof. Shula Ramon shula.ramon@Anglia.ac.uk

Andy Quin andyquin@mac.com

2nd December 2015

Failure and Success

• Failure and Success in working with people who use mental health and child care services are key points on a continuum of intervention outcomes and processes

• Definitions

• Significance of failure

• Significance of success

• Occasions in which this is not the case occur in care practice, and in any other service practice, when it is tacitly assumed that the specific success is unlikely to be maintained and is perceived as only short lived; often tacitly not celebrated.

• For example, in a small scale study of how people moved from a psychiatric hospital admission to the community (Ramon, 1991) most of the participants mentioned no ceremony of celebrating success upon leaving, often being encouraged just to take one’s belongings in a plastic bag and leave the ward via a back door, with no one waiting for them in the community to celebrate the success of their recovery. The very term “discharge”, used to denote leaving a hospital ward, suggests a military order, rather than the completion of a therapeutic interaction.

• Yet the entry to a psychiatric hospitalisation episode is marked by a degradation ceremony, a term coined by Garfinkel (1956) in describing the meaning of the process of re-configuring one’s past history in the light of the failure that such an entry confers.

• This type of failure is all too often portrayed as an individual failure, rather than a possible system failure.

• The belief in the inevitability of an admission is a way of justifying chronicity and the belief that the person has no future prospects of improvement in their mental health state.

• Only rarely do we come across a ceremony of re-gradation, in which the success of recovery from a mental health crisis of a person, or a whole group, transition from an institution to the community is noted (e.g.. Trieste opening of the hospital to artists and to the community at large ; see Del Guidice et al, 1990).

The tradition of learning from failure

• Failure makes us:

• doubt our abilities,

• weakens our motivation to invest in new learning,

• may lead to reduced aspirations and self esteem,

• move away from a particular avenue of self investment altogether.

• engage in strategies of hiding failure from others and from ourselves.

• On the whole the training of all helping professions does not include learning from success as a strategy, beyond following a list of actions proven by past experience to lead to success.

• The Paradox of not learning from success in capitalist societies

• Perhaps the fact that the helping professions do not focus on economic success , which is the one that counts most in our neoliberal systems, leads to ignoring the value of any other success.

• The competitive nature of success in neoliberalism may be another component that makes helping professions recoil from focusing on success, as this type of competition has no ethical place within the range of activities these professions engage in.

• It could also be that the often observed partial success is perceived as not good enough.

• Within the helping professions the partial answer is the reliance on caution in focusing on failure as the dominant feature of our practice, given the complexity of the issues we are dealing with, as well as the focus on risk avoidance.

Professional satisfaction

• Satisfaction from professional activities within the field of mental health has all too often been related to making people more comfortable, reducing suffering, reducing negative risk and increasing conformity with social norms, accepting mental ill health as something we cannot change and need to accept as a given.

• Indeed, traditional psychiatric textbooks teach us to judge patients by the degree to which they accept their illness as a sign of insight, to view their non-patienthood ambitions as untenable, and to require of them to give these ambitions up altogether (Lysaker et al, 2007).

Perceptions of success by parents, children and professionals

• Service users and professionals differ in their perceptions of success.

• The differences relate to the vested interests each stakeholder has, but also to their subjective and intersubjective experience, as well as to their order of priorities.

• The bar set by professionals for specific success is often higher in scope than the one identified by parents and children, raising the possibility of a mismatch of expectations which may contribute to a lower level of success (Diggins, 2016).

• Moreover, both parents and children are able to identify success of intervention processes and not only of outcomes, as the processes focus on the relational aspect of the intervention which is often not perceived as part of the outcome.

Differences in perceptions of success

• Both Marie Diggins’ research and that of Andy Quin on safeguarding children highlight that parents were more at ease in identifying success than the providers were, and were able to identify the role of service providers in this achievement, as well as their own contribution.

• The providers’ difficulty to apportion success to accepting partial failure and moving on.

• This is an issue deserving our attention, not only because it may confirm the fear that failure may be larking behind even when success is taking place, but also perhaps because it illustrates providers’ scepticism that the client’s effort - and their own effort - are not going to be sufficient to ensure success

Learning systematically from success

• Learning by example has been found to be a particularly suitable way to introduce desirable change (Rosenfeld et al, 2010 ) (Ramon, 2011 ); requiring unlearning and relearning by providers and service users alike.

• Motivational interviewing (Miller and Rollnick, 2012) offers another route for clients, which focuses on eliciting the value of a specific change to achieving the aims a person has, alongside confidence boost of their capacities.

• Group learning is another methodological device found useful in enabling a collective to reflect on how to achieve objectives which seem unachievable within a traditional perspective on disability, but become achievable within a shift in our perceptions of what a person with a disability can achieve (Rapp and Goscha, 2012).

Systematic learning from success II

• A fascinating example of research on the meaning of success in domestic violence perpetrators programmes (Westmarland and Kelly, 2013) illustrates the scope and depth of success for women victims of such violence, their children, and the perpetrators.

• Based on interviews of all stakeholders (perpetrators, women victims, providers and commissioners), they highlight that the substance of success in such programmes is much wider than the formal definition of success, to include:

• improved couple relationships underpinned by respect and effective communication,

• expanded space for action ,

• empowering through restoring their voice and ability to make choices while improving wellbeing, safe, positive and shared parenthood,

• men’s enhanced awareness of self and others, and a safer, healthier childhood for their children.

The Conceptual Underpinnings of Learning from Success

• The strengths approach (Rapp and Goscha, 2012)

• The new meaning of recovery (Davidson, 2003, Bird et al, 2014, Tew et al, 2012)

• Agency and hybrid identities (Archer, 2003, Longden, 2010, Glover, 2012, Breakwell, 1986)

• Empowerment (PSW: Meddings et al, 2015)

• Reciprocity (co-production of research and training, Ramon, 2003)

• Collaboration (Rapp and Goscha, 2012).

• These approaches relate closely to the assumption that service users are people rather than a collection of disabilities, and by virtue of being human are likely to have abilities as well as weaknesses (Ryan and Deci, 2001).

• The abilities may not have been developed to their full potential either because of the limitations imposed by a disability or by the social and professional perspectives which view them as incapable of anything.

• The latter is a reflection of the impact of the master status of being a person with a disability, in which we name the person by their disability or diagnosis , and literally forget about any other quality they possess (Goffman, 1963).

• The value of experiential knowledge (Shared decision making, Morant et al, 2015)