Sunday, October 31, 2010

Journey to Health: Eight Weeks Post Surgery

Entry for 31 October 2010:

It has now been 8 weeks since my surgery. I have spent that time off work, on medical leave, getting lots of sleep, spending an increasing amount of time on pelvic floor muscle (“Kegel”) exercises, walking 30 – 45 min/day, reading, doing email, writing & beginning to do phone consultations with my research students. It has been a time of healing, rest, recovery, but also frustration as I have had to deal with post-surgical complications (urinary incontinence) that were worse than I had anticipated (hence the exercises).

When the biopsy results came in, they indicated that the cancer was more advanced than anticipated (T1c => T2c), but that they had got it all (the prostate margins were clear of cancer). It’s a very good thing that I didn’t wait any longer to have the surgery!

I did a bunch of reading to try to understand what was happening to me, and what I learned struck me as deeply ironic and darkly humorous: While women have only one urinary sphincter, controlled by the pelvic floor muscles, men have three: one between the urethra and the bladder, the prostate itself, and the external sphincter, which is the same one women have. This is why women have more trouble with incontinence generally than men, and especially after giving birth vaginally, and why most women are familiar with Kegel exercises. I had apparently been relying heavily on my other two urinary sphincters, which now had been removed surgically along with my cancer and associated replumbing. This put me on an even footing with all the women in the world, including my new granddaughter Mizuki! There appears to me to be some sort of poetic justice to this. And while the adult women I know clearly now have a headstart on me, I am pretty much in the same camp as my granddaughter, trying to learn how to use a part of me that I wasn’t even sure I could sense, let alone control. I feel like I now have a new body, which I have to learn how to use.

From my research I learned that I was likely to have to practice these exercises for as long as six weeks before I would even begin to see any effect. I would have to do them on a sort of blind faith; I would have no basis for judging my trajectory of recovery. The research I read indicated that a systematic program of exercises of at least 6 weeks was likely to produce substantial positive results; however, I had no way of knowing if those average results would apply to me. To tell the truth, I found the whole situation scary, embarrassing, infuriating, and as I said ironic and darkly humorous.

I’ve now been doing my Kegel exercises for 5 weeks now, and am starting to see some results, but it’s slow, incremental progress. Over time, they’ve become a kind of prayer, for myself and friends who are going through a hard time.

All through this period, I gradually increased how much work I could do, to the point where I was easily doing 4 or 5 hours of email, writing and phone consultation a day. I managed to work my way through the enormous backlog of emails dating back to last January. I wrote a challenging book chapter on negative therapist reactions.

Last week, after having had my medical leave extended to near the end of October, I met with both my GP and the University’s occupational health physician. They both agreed with my assessment that although I am not currently able to work full time, I am fit enough to go back to work on a part time basis, on a “phased return to work”. The plan is for this process to continue for the next 6 weeks, between now and the Christmas holidays, with me gradually increasing the amount of work I’m able to do. This makes eminent good sense to me, although it is requiring some renegotiation of commitments for that time period. Tomorrow (Monday) I give my first lecture in months!

In the end, as much of a nuisance as the incontinence is, it is infinitely preferable to having a cancer that I now know was far more dangerous than I realized at the time. I am enormously grateful to have that burden removed and equally so for this time of rest and healing, which I so badly needed. This is clearly a much more healthy way of life. I am also deeply grateful to all those who brought by gifts (some quite creative) and cards or who sent positive thoughts, prayers, and wishes my way. Although I have spent most of the past 8 weeks in my flat, I haven't felt lonely with all of this caring around me. Thanks!

My current challenge continues to be, as one of my friends recently wrote to me, “master of my flow”. But after that, the even bigger challenge will be learning how to master the flow of my life so that it is no longer overwhelming and harmful. It is now clear to me that this will be a matter vital for the health of both my body and my soul.

Thursday, October 21, 2010

Theories, Models or Approaches?

Entry for 21 October 2010:

I’m still at home, recovering from surgery, but sometimes I get questions out of the blue, little bits of grace like falling autumn leaves:

Dr. Elliott-

I first would like to apologize for the forward nature of this email as I am indeed a complete stranger to you. However, I have spent several days searching for an answer to my query and am at a loss as to who to turn to for assistance. I first emailed Dr. [Clara] Hill who promptly referred me to you (see her response below). Please know any information you can provide if your time allows will be warmly welcomed and greatly appreciated.

I am currently a graduate student at the University of __ in a counseling skills class where [Clara Hill’s] book Helping Skills: Facilitating Exploration, Insight, and Action is being used as our text. I was recently in discussion with a peer about different models that explain the concept of helping skills. I think the term 'model' is what has me blocked. My first response was simple...person-centered or a humanistic approach (the basis for the exploration stage), a behavioral model, and of course a psychodynamic model all came to mind as models used in the helping process. I realize after further thought that these concepts are theories and may not be considered 'models' within the realm of helping skills. The scope is certainly much broader than that. My friend argued for a more complex idea that 'models' include approaches such as motivational interviewing, solution-focused brief therapy, and the like. To me, these are methods or techniques used in counseling. Would you consider these approaches to fall under the category of helping skills are they 'models'?

It is quite possible this makes no sense to an outside expert, so please let me know if further clarification is needed. I just wanted a little guidance on what the term 'model' in reference to helping skills might mean to you. Dr. Hill labeled her approach as an integrated three-stage model; are there other models such as this with different theoretical foundations authored by other practitioners/researchers in the field?

Again, I appreciate your valuable time in offering any insight to this query. Have a wonderful day in the meantime; it is an honor to communicate with you.



Graduate Candidate in MHR

Dear Carissa,

You are engaged in philosophy! The questions of what is a theory and what is a model and how they are and are not similar; these are philosophical questions. Philosophy can be very useful for clarifying what we are talking about, and reducing the probability that we are talking nonsense! Of course, an awful lot of what we do when we talk about counselling and psychotherapy is, from a philosophical point of view, nonsense, because we usually don't stop to clarify our concepts.

To properly answer your question, we would have to look at how people (philosophers, scientists) have defined the words "theory" and "model". I'll leave that for you to do a bit of investigating into; you'll soon find that there are lots of different definitions and views, but in general we're talking about systematic representations of reality. Beyond that, it quickly gets very complicated. This means that whenever you or someone else uses a word like "theory" or "model", you or they need to be clear about what they mean by the word. What kind of systematic representation of reality? For what purpose? How systematic? Descriptive or prescriptive? Big or little bits of reality? etc.

What I generally say to people when they ask me a question like this is, "Isn't it fun how many words there are in English that mean roughly the same thing? And isn't it interesting how when there are a bunch of words meaning roughly the same thing, people start inventing distinctions and attaching them to the different words?" But if you were Winnie the Pooh, you'd laugh and say "It's the same thing!"...

"When you wake up in the morning, Pooh," said Piglet at last, "what's the first thing you say to yourself?"

"What's for breakfast?" said Pooh. "What do you say, Piglet?"

"I say, I wonder what's going to happen exciting today?" said Piglet.

Pooh nodded thoughtfully.

"It's the same thing," he said.

I hope haven't been too irreverent in addressing your question. The fact is, models, theories and approaches to counselling are very interesting and exciting and fun. It sounds like you are enjoying yourself and I hope you go on doing so!


Robert Elliott

Footnote: I should also have added that underlying Carissa’s question is an ancient distinction that goes back to the Greeks: theoria vs. praxis: theory vs. practice; that is, how we represent the world vs. what we actually do. Theories, models and approaches are different ways of talking about representations; counselling skills (or help-intended speech acts) are what we actually do in practice.