Professionals and ACE-awareness; Episode 3 – This time: Carla Brok; Part 4 (final)

Last week, together with social psychiatric nurse Carla Brok, we looked at the importance of paying attention to the context. In fact, this is the biopsychosocial approach that we have discussed before, an approach that recognizes that the physical, the mental and the social constantly influence each other. This week discusses how passion for your work helps to shape your way of working.

I start telling about someone at a foreign campsite who joked about a work appointment during holidays: “Ah well, vocation… vacation… it’s all the same if you love your work!” Working from ‘vocation’, from a calling, often does not feel like work, but simply like a passion and keeping the flow of things going. That is a wonderful way to fill in your work. The idea of ​​calling and passion reminds Carla of a very special situation that she recently supervised, in which the extremely remarkable behaviour of the child turned out to indicate very serious problems and to be partly caused by severe trauma in one of the parents. If she had only looked at the ‘outside’ and the superficial signs, she would have reached a completely different conclusion than what her intuition now led her to: ‘there’s a lot more going on here and it’s really, really serious’.

Eventually, this required a serious intervention, and Carla put in a lot of time, because the story she was told filled her with compassion for the parent’s trauma. “These are difficult situations and it takes courage to dare to see what is really going on”, she says thoughtfully, “and if you can look through the child’s eyes with genuine curiosity, then you can feel compassion, without feeling the need to emphasise shame and guilt. At the same time, you can acknowledge that certain ways in which we organise our society create power differences that cause harm to the child. What the one parent did… that was really wrong, but I managed to keep my interest in their life story. I don’t just accept everything; in fact, I think that I accept very little, but as the years go by I am allowed and able to bring in more and more softness and that benefits all parties. I see the process of becoming milder and softer as a task belonging to getting older.” I think out loud and wonder if bringing in more softness means less defensive behavior in the other person, making it much easier to discuss difficult matters with less need for normative judgment. Guilt and shame can be paralyzing and are hard to face. Without them, one can build a sense of security, that makes reflection possible, paving the way to growth and development.

We broaden our conversation and go from Carla’s experiences with individual families to the question of how she sees the attention for early childhood in Dutch health care. “That depends on the perspective; it has developed enormously since I started working, but at the same time I think it is still far from being enough. I think there is still too much normative thinking about how you should treat a baby. Feeding and sleeping, carrying and cycling, bottle or breast, toys, diapers, how a baby or a mother should behave… everyone thinks about everything and has a judgment about it. How helpful is that for parents?” I express my hesitation and say that I feel some tension regarding this. We have gained many insights over the last decades and we know that we should learn to see through the child’s eyes. Based on the biological blueprint, we also know that some biological setpoints are more difficult to adjust later on. This means we can conclude that some practices actually are more or, in turn, less beneficial. Hitting your child does not seem like such a good idea, to give an example, although that is a normative judgment. Here, Carla agrees: “Oh yes, certainly; parenting is by no means trivial. When someone says ‘We don’t hit that often’ … my alarm bells ring and then I reflect on how to respond without judgment, because I want to hear the story. After all, parental behavior also occurs when I am not there, so enforcing my norms onto the family situation would not work, while at the same time I do want to ensure that the situation improves for the child. If parents think that hitting is a solution to problems, then chances are there are many more things that are not going well.”

Carla is of the opinion that scientific insights are still clearly insufficiently integrated in practice. The current (COVID-related) impoverishment of perinatal care does not improve this either. She tries to navigate these aspects: “It is my responsibility to organize my schedule of care. Some problems are of a different order, of a different importance, and I will not let another person determine how to serve the family interest. I’m too stubborn for that.” That sounds like ‘daring leadership’, to quote Brené Brown, as a deliberate choice to guarantee continuity of care based on deeply felt professional ethics. That takes courage; that requires a willingness to stick your neck out and make time for it, something that fits Carla’s previously mentioned stage of life of generativity: transferring wisdom to the new generation. “And I also think,” she continues, “that there is still far too little attention in the training courses in this line of work to the fact that the parent-child relationship is always reciprocal. It is very important that the child is heard and seen. This sometimes requires thinking and acting outside the lines that are still often drawn in training and practice. Guidance and education for young children is so important; as a society, we should reward that much better. In those early stages, so much can go wrong, but also incredibly much can go right, as long as we make sure that the professionals are well trained and can see and interpret the signals that children give. As a professional you need the feedback of the child, the story of the child, to determine how to proceed in a difficult situation. I can sort of panic if I can’t ‘translate’ the child, if I can’t pick up on the child’s signals. I need them and they form the basis for how I try to keep in touch with the parents so that they and I can give the child what it asks for and what it is entitled to.”

We talk about how difficult it can be, to develop your basic ability to keep seeing perspective. This requires not only compassion towards the other, but also towards yourself – after all, you shouldn’t burn out as a result of disappointment about everything you can’t change. Carla: “I experience it as very important to keep my own social life in order, because that is the source from which I recharge when work demands a lot from me and I encounter many sad situations. Mindfulness helps me with this, as does trust in my intuitive perceptions and my old tendency to look a little further than what is directly observable. I actually keep working on those skills, because you really need them. I succeed better at that as I’m getting older. I move along with what the different phases of life require of me and they all have different accents when it comes to meaning. And in order to continue to experience life as meaningful, you need to be able to co-regulate with other loved ones, so that you regain your balance when you have lost it for a while. Walking with a friend, drinking tea with someone, telling your story to an attentive listener … those are very precious experiences in life.”

Due to another appointment we have to wrap up, but we conclude that we could have easily explored many more themes. I thank Carla for her time and her openness; I say that I have heard many beautiful things and that I look forward to working out her story!

Posted in Interviews professionals.