I was asked to do a video (cringe) about kindness, where I tried to emphasise how, for me, kindness is about compassionately giving what’s needed. There wasn’t the space or scope there to fully explore some of my ideas on the topic, which have continued to be shaped by my personal values, clinical practice, research and training, and reading testimony of users and survivors on Twitter.
I have noticed a lot of frustrated and angry accounts of how this year’s Mental Health Awareness Week and its kindness theme is dismissive and damaging for those who use/ have used services, many with impressive wit. Although I don’t share the same level of vitriol as some (probably because I haven’t experienced the same level of hurt caused by mental health services that occurs in some cases), I do agree that a simplistic model of kindness and its supposed virtues is not helpful. I don’t think that means we should do away with the concept or the drive for kindness in our systems and actions, but I do think it benefits from a more nuanced discussion. I believe that kindness is not an object to be given, but an interpersonal process and therefore its meaning and impact depends very much on the relational context (current and historical) in which it operates and the intentions of the people involved.
Particular actions are rarely kind or unkind per se; it is the interpersonal context within which they are offered and how this is done that matters. Giving someone a bunch of flowers – that’s a kind thing, right? Not when they’re allergic to them. Not when they are given by stalker to victim. Not when someone is starving and they asked for food. The quality of the gift is inherently coloured by the context; what is asked for, what is given and the nature of the connection between the giver and receiver.
I believe the same applies in mental health care. I know mindfulness has had a lot of bad press recently, probably something to do with the fact that a traditional Buddhist practice has been somewhat usurped by the capitalist machine. I regularly come across people who find the idea of mindfulness abhorrent, often because they have had bad experiences of it being offered to them in the past. Now, although it’s definitely not a panacea, I don’t think there is anything inherently unkind about mindfulness. The problem is how and when it is offered. If you tell someone you are struggling with thoughts of hopelessness and need help and they give you a mindfulness CD and tell you to go away and practice it, you will rightly feel dismissed. Because it’s not what’s needed and it’s given in a way that doesn’t listen to what’s being asked for. If, in the context of a trusting and collaborative therapeutic relationship, clinician and service user come to the joint decision that finding a way to curiously respond to painful thoughts and feelings rather than pushing them away might be helpful, try out some practices together and then the therapist offers the CD as a way to continue that practice at home, that might be experienced as kind. The CD and its contents hasn’t changed but the process and relational context has.
The other issue here, I think, is power. Kindness implies a giving from someone who can offer something to someone who can receive. Therefore a key aspect in how it is experienced – whether with compassion or contempt – is the position of the two people. It reminds me of the difference between empathy and sympathy. Empathy is meeting someone where they are and feeling something that they feel, developing an understanding of their internal world. Sympathy is noticing someone’s pain from a position of safety and relative power, trying to fix without developing connection. Thus, even when the action or what’s given is appropriate, the lack of the connection might render the experience dismissive and ineffective. Where individual clinicians are acting with compassionate kindness and giving what’s needed, this might still be experienced as an unkind thing if the wider relational context, the system in which that operates, is one of inherent restriction, power imbalance and coercion. If you were in brutal incarceration and one of the jailors gave you a bunch of flowers to brighten up your cell, would you trust them? Maybe, maybe not.
I guess this is why I put so much emphasis, in my practice, research and writing, into the therapeutic relationship. It’s why I have come to value the Cognitive Analytic Therapy approach so much, which puts the alliance centre stage. For me, individual therapeutic techniques are not kind, not effective, on their own. At worst, in a toxic relational context, they are not just unhelpful, they are damaging. There is lots of evidence to support this and it’s something I’m working on too. In part, it is an individual clinician’s choice to focus on fostering and maintaining the relationship. But this choice requires a supportive system. It requires sufficient time to develop, it requires pathways that allow flexibility in response and guidelines that promote person-centred decision making rather than diagnostically-driven textbook approaches. It requires working practices that don’t drain every last bit of resilience of staff and that allow challenge to processes that are unhelpful. It requires us to work (assertively, where needed) for services that allow meaningful, collaborative connection to take place, where clinicians can truly listen to what’s needed and have the resources to offer that compassionately.
I’m a clinical psychologist, fell runner and research fellow. This blog is mostly about those things, but other stuff might find its way here too. Find me on Twitter as @HartleySamantha
