Category: Change

Vztahy a drogy pred liecbou v recosializacii / What clients in therapeutic communities think about their past relationships

This blog post is in Slovakian*. For English version click here.

Na úvod

Na úvod by sme chceli poďakovať všetkým klientom a klientkám z resocializácie, ktorých výpovede boli použité v tomto článku a tiež personálu resocializačného strediska, ktorí nám láskavo umožnili rozprávať sa s klientmi/-tkami.
 
Predstavy o sociálnom fungovaní aktívnych užívateľov/-iek drog (UD) sú často sprevádzané stereotypmi a predsudkami, ktoré stigmatizácii UD. Tradičný, moralizujúci prístup na základe týchto stereotypných predstáv považuje všetky vzťahy UD za dysfunkčné a utilitárne. Na menej stigmatizujúci prístup je potrebné kvalitné porozumenie vzťahom počas užívania drog. Takýto realistickejší pohľad musí brať do úvahy: a. heterogenitu, ktorá existuje vo vzťahoch UD (typ a kvalita vzťahu), b. dôvody, prečo sú tieto vzťahy cenné a hodnotné pre všetkých UD, ktorí/-é sa v nich angažujú (okrem materiálnych dôvodov)1.  
 
Preto sme sa v nasledujúcom článku, spolu s klientmi/-tkami nemenovaného resocializačného strediska (RS), poobhliadli za ich vzťahmi pred liečbou v resocializácii. Našim cieľom bolo zamerať sa na dynamickú interakciu medzi užívaním drog, závislosťou a vzťahovým fungovaním u užívateľov/-iek drog (UD). Ich výpovede sme nahrávali na diktafón počas osobných rozhovorov a neskôr dôkladne analyzovali kvalitatívnym spôsobom pomocou tzv. „deskriptívno-interpretatívnej analýzy“, t.j. psychologickej metódy na spracovanie nahrávok osobných výpovedí2.
 
Skôr než začneme hovoriť o ich vzťahoch pred resocializáciou, priblížime priebeh rozhovorov s klientmi/-tkami. Pred každým rozhovorom sme účastníkov/-čky informovali o priebehu rozhovoru a ubezpečili ich, že účasť je dobrovoľná a anonymná. Do pilotných rozhovorov bolo zapojených celkovo päť účastníkov/-čiek s priemerným vekom 27,8 rokov, u ktorých dĺžka pobytu v resocializácii bola 2-6 mesiacov. Takmer všetci mali problémy s viacerými návykovými látkami (Pervitín, heroín, alkohol atď.). V rozhovoroch sme položili klientom/-tkám z resocializácie tieto tri základné otázky:
 
„Aké boli tvoje vzťahy s ostatnými ľuďmi predtým než si začal/-a brať? Čo sa dialo v tvojich vzťahoch počas užívania drog a závislosti? Akú úlohu v nich zohrávali drogy?“
 

Vzťahy a drogy

 
Nasledujúce výsledky boli vytvorené na základe výrokov klientov/-tiek a vyjadrujú spätný pohľad klientov/ klientiek na vzťahové procesy pred liečbou (resocializáciou). V tomto článku uvádzame iba niektoré zo zmien, o ktorých klienti/-tky v našom výskume hovorili. Rozsah tohto článku bohužiaľ neumožňuje popísať všetko čo klienti/ klientky uviedli, vybrali sme len najpočetnejšie a podľa nás najdôležitejšie vzťahové zmeny. Pre lepšiu názornosť sú výsledky analýzy rozdelené do dvoch období: (1) pred začiatkom užívania drog a (2) počas aktívneho užívania drog a závislosti (viď zoznam nižšie).
 
Vzťahy pred začiatkom užívania drog:
1. K mal pretrvávajúci až výlučný vzťah s rodinným príslušníkom (mama, sestra, babka)
2. K vníma vzťahy s rovesníkmi, v práci ako bezproblémové
3. Kolektív rovesníkov je priestorom pre experimentovanie s mäkkými drogami
Vzťahy užívateľov/-iek drog (UD) počas aktívneho užívania drog a závislosti:
4. K hodnotí vzťahy počas užívania drog ako neúprimné voči rodine a priateľom/-kám.
5. K rodina a kamaráti podporujú, motivujú k liečbe.
6. K „nerieši“ vzťahy počas užívania drog, t.j. nezaoberá sa nimi, ani nie sú prioritou.
7. Zmena okruhu kamarátov vytvára prostredie pre užívanie drog a relapsy.
Pozn. K= klient/-ka. Pre obmedzený priestor uvádzame len zmeny, o ktorých vypovedali aspoň 4 klienti/-tky.
V prvom období, t.j. pred začiatkom užívania drog, klienti/-tky opisovali celkové vzťahové nastavenie v rodine ako aj vzťahy s jednotlivými členmi rodiny a rovesníkmi/-čkami. Klient/-ka mal/a blízky až výlučný vzťah s rodinným príslušníkom/-čkou (napr. mama, sestra, babka), ktorý pretrval až do súčasnosti:
„starká bola vždycky nejaký môj azyl, to je to, bolo tak, že keď bolo neviem ako zle, tak som vždycky došla k starkej, jak mi bolo zle, tak som išla k nej“.
 
Účastníci/-čky vnímali svoje vzťahy s rovesníkmi/-čkami v škole a neskôr aj v práci ako bezproblémové:
„V rodine vzťahy super, s mamou, s otcom dobré vzťahy dodnes. V škole tiež normálne, priemerný prospech“.
 
Kolektív rovesníkov/-čok bol pre viacerých priestorom pre experimentovanie s mäkkými drogami:
„ja som bol s ňou a s jej kamarátmi a s tými kamarátmi som bol až do konca. S nimi to začalo a nejaký čas som chodil stále len s nimi, potom som naučil ja svojich kamarátov v mojom veku“.
 
V druhom období sa striedali fázy aktívneho užívania, návyku a pokusov o liečbu závislosti. Toto striedanie bolo prítomné aj v priateľských/ kamarátskych vzťahoch a najlepšie by sa dalo opísať ako oscilácia, či fluktuácia medzi svetom „normálnych“ ľudí a svetom „feťákov“ (podľa slov účastníkov/-čok):
„Potom som už prestal aj medzi nich chodiť, chodil som medzi úplne iných ľudí, čo mne vyhovovali, ktorí niečo brali“
 
Vzťahy s rodinou alebo s kamarátmi/-tkami hodnotili niektorí klienti/-tky s odstupom času ako neúprimné, pretože im nehovorili o svojom užívaní drog:
„to je inak strašné, jak som bola neúprimná, lebo ona mi hovorila, pýtala sa ma, že aké to bolo, jak som s tým dokázala prestať, ako som sa cítila a pritom som bola v období, kedy som zase brala tie drogy“.
 
Hlavnou témou tohto premenlivého obdobia boli zmeny v pozícii vzťahov na rebríčku priorít užívateľa/-ky drog (UD), kedy dochádzalo k tzv. re-prioritizácii. Účastníci/ -čky to opisovali ako „neriešenie“ vzťahov počas aktívneho užívania drog, ako otázku priorít a preferencie zaobstarávania drog. Miesto vzťahov na rebríčku priorít UD sa často mení, dochádza k re-prioritizácii, inými slovami čas/ energia venovaná zaobstaraniu drog je nevyhnutne bariérou pre vytváranie/ udržiavanie vzťahov:
„Proste som tie vzťahy neriešil, možno že som mal rodinu, lebo som bol naučený tak, že rodine môžeš veriť, tá ti môže jediná pomôcť, ale inak tie vzťahy, mal som zopár priateľov z ktorejkoľvek časti spoločnosti“
 
A práve rodina zohrávala dôležitú úlohu pri klientovej motivácii liečiť sa:
„Prišla na mňa kríza, tak mamka sa o mňa starala 3 dni, som tam krízoval, zvracal. Ten terapeut prišiel, lebo on bol na Vianoce tiež doma, on to sľúbil, tak sem zavolal, že príde, vybavil to tu a išiel som. Mamka sa pýtala, že keď chcem, nech idem, že ona to zaplatí a išiel som sem“
 
Závery analýzy priniesli niekoľko zaujímavých vhľadov do zmien, ktorými prechádza vzťahové fungovanie počas užívania drog tak, ako ich vnímali klienti/-tky s odstupom niekoľkých mesiacov po príchode do resocializácie. Najdôležitejšie sa týkali rodinného prostredia, opory a pomoci pri liečbe, prežívania blízkosti vo vzťahoch, a priorít v oblasti vzťahov.
 
Zapojenie klientov/-tiek v prvých mesiacoch resocializácie do nášho pilotného výskumu predstavuje zároveň silnú aj slabú stránku štúdie. Limitáciou je, že ich výpovede môžu byť skreslené selektívnym rozpamätávaním sa na minulé udalosti, t.j. vzťahy počas užívania drog. Silnou stránkou je, že takto sme získali výpovede aj od takých klientov/-tiek, ktorí z resocializácie odídu predčasne. Zistilo sa, že pacienti/ -tky, ktorí zostanú v liečbe dlhšie sa môžu líšiť v podstatných črtách od tých, ktorí liečbu ukončia predčasne3.
 

Prečo je dôležité rozprávať sa o vzťach počas užívania drog

 

 
Kvalitatívne rozhovory, ako výskumná metóda, neumožňujú zovšeobecnenie výsledkov na všetkých UD kvôli nízkemu počtu účastníkov/-čok. Na druhej strane kvalitatívny výskum pomáha prekonávať obmedzenia kvantitatívne orientovaného prístupu, tým že nachádza jedinečnosť, preveruje predsudky, mýty a nuanse interpersonálneho fungovania. Vytvára tak lepšie porozumenie v oblastiach, ktoré sú ťažko prístupné vedeckému skúmaniu. Porozumieť vzťahom znamená pre pomáhajúce profesie pristupovať bez predsudkov, lepšie pomáhať a zabraňovať udržiavaniu stereotypných predstáv o UD. Pre samotných klientov/-tky liečebných zariadení to uľahčuje vyrovnávať sa s vlastnou minulosťou a umožňuje rýchlejšie zakomponovať obdobia užívania drog do obrazu o sebe, či do osobnej histórie. A nakoniec, prínos pre širšiu verejnosť spočíva v zlepšení postavenia UD v spoločnosti, znížení marginalizácie a tým pádom prispieva k uľahčeniu prístupu k pomáhajúcim organizáciám.
 

Poznámky a literatúra:

6. Klimas, J. (2013). Vztahy, drogy a socialna prevencia v resocializacii. Socialna Prevencia, (1):25-26.
*Základ tohto článku tvoria príspevok prednesený na kvalitatívnej konferencii v Brne, 21. Januára 20104 a články v časopisoch Adiktologiea Sociálna prevencia6. Pri tejto príležitosti by som sa rád poďakoval Dr. Petrovi Halamovi za konzultacie a Dr. Matúšovi Bieščadovi za pomoc s analýzou rozhovorov.

The mystery of change (-ing others): article in the Irish Psychologist

How may I help you– change you?* 

“Change is the Law of Life. And those who look only to the past or present are certain to miss the future.” – John F. Kennedy


Trying to help somebody to change their bad habits is an admirable act of kindness. It shows our compassion and care for the less fortunate. The best is when it comes from the person’s own initiative. Motivated helpers are assumed to be good helpers. Some of us help others pro bono, while others do it as part of their job description. But what if the professional helper doesn’t want to help? How do you help the helper with change in others?

Encouraging professional helpers to address excessive drinking is a complex problem. It’s so complex and resistant to change, that their unwillingness to adopt these new practices can be viewed as a bad habit. Many experts called for complex strategies to persuade their clinician colleagues to address alcohol. But complex strategies did not help.
Professors Anderson, Laurant, Kaner, Wensing and Grol reviewed available scientific evidence and claimed it was possible to increase the engagement of doctors in screening and advice-giving for excessive drinking. They saw a potential in programs which were specifically focussed on alcohol and that were multi-component. Later, some of the original team tested this theory by doing a clinical trial, which is a type of study considered as a golden-standard by many experts. Their Swedish experiment “failed to show an effect and proved difficult to implement”. Are the Swedish too stubborn to embrace change? Let’s not be harsh by accepting this cultural stereotype as a plausible explanation for their negative findings, before we look at more perplexing findings from other countries.
When scientists ask doctors and other professional helpers about what’s so difficult in talking alcohol with their patients, they give the same reasons all over the world. The World Health Organisation (WHO) commissioned a multi-state study, at the beginning of the millennium, which documented all of these reasons – the myths about alcohol care. The myths were lack of time, inadequate training, a view that alcohol is not a matter that needs to be addressed by medical doctors, conviction that doctors’ advice won’t work and fear of talking about such sensitive issue. It seems that the next twist in the story of change brings us to helpers’ beliefs.
Recent research at the University of Michigan, cardiovascular centre demonstrated how doctors’ confidence in their ability to advise patients on diet and exercise correspond with their own personal health and fitness levels. Could this apply to alcohol too? Would it help if we use some evidence-based strategy to boost their confidence or ambivalence about drinking behaviours?
Motivational enhancement therapy (MET) is an evidence-based treatment which targets person’s ambivalence about unwanted behaviours including their attitudes and beliefs. A team supervised by Professors Hettema and Sorensen used this Swiss-army knife of addiction counselling to help doctors-to-be to resolve their ambivalence around managing alcohol and drug problems. They’ve put a group of nine medical residents through a brief MET therapy before they learned more about alcohol consulting and advice-giving. Five weeks later, their consulting and advice-giving went up, but due to the small numbers, the researchers called for caution with interpretation of their results.
Resident education was combined with a team-based approach to systems change in the Richmond clinic – a busy family practice in the south-east Portland, Oregon. Dr Muench led his team to change the way they deal with drinking issues – from receptionists, through medical assistants to physicians.
Dr Muench is a slim, middle-aged physician with a passion for teaching young doctors and helping patients from difficult backgrounds. Explaining their approach to practice change, he points out, ‘we’ve strengthened our practice systems, but the system leaks at three points. They are at the front desk, in the consultation room and in the teaching modules.’ In making these comments, Dr Muench argues that while their project led to many improvements, there are things that can be improved. Ultimately, Muench conveys a positive message about systems change being possible, although not without some obstacles. In the Richmond team-based approach, the receptionists should give patients alcohol check-ups while they wait for the consultation, but they often forget because the PC fails to remind them of this. When the receptionist doesn’t forget to hand out the form, and the patient brings it to a medical assistant, she frequently forgets to complete the full assessment. It is no surprise then that the next ‘cog in the machine’ – the doctors – ‘forget’ to discuss alcohol with patients.
What science tells us about implementing change is reassuringly similar to the traditional knowledge of common folk. If you can’t change others, change yourself. “We must become the change we want to see”, said Gandhi. Richmond truly became the change they wanted to see in others. And yet, the project’s 75% yardstick of engaging patients into alcohol discussions wasn’t met. Why was Richmond below targets? Embracing change in healthcare requires system changes and education on several levels – multi-level changes.

*This is a shortened version of my article published in the Irish Psychologist, Volume 40, Issue 2/3. Dennis McCarty, PhD gave me feedback on drafts of this blog post.

Citation for the full version of this article:

Klimas, J. (2013). The mystery of change(ing) others. Irish Psychologist, 40(2-3), 78-79. http://www.psihq.ie/irish-psychologist-journal-of-psychology

Re-entry shock – you can’t go home again

Culture shock is defined by Wikipedia as the “difficulty people have adjusting to a new culture that differs markedly from their own. A reverse culture shock a.k.a. “re-entry shock” or “own culture shock” is a state when returning to one’s home culture after growing accustomed to a new one produces the same effects.

First culture shock hit me when I arrived to Portland, Oregon, in March. I thought it was over then and that there will be no more surprises about adjusting to my normal life in Europe. I did not know that the second culture shock comes when people return to their home country. Many students on exchange programs experience it. Here’s my rant.

Big surprise

The shock of the transition to Portland, OR, was surprisingly weak. It took me only a couple of days to adjust and embrace the new life there. The easier this transition went, the more difficult the second transition was.  It was new and unexpected for me. The beginnings were really difficult, manifesting in confusion and other negative feelings.

Business as usual – as if we never left

My normal life, as I knew it before, was over. Most things remained the same. The things I hated before are still there and I still hate them. But I was not the same at all. I could not avoid a feeling of disconnect between the past and the present life. Another fellow told me a story of how on her first day at work, everything turned as it was in a split second. There was just one word of her boss and just one look of her colleague and she was back to her old relationships.

Repulsion

Stereotyping and hostility towards host nationals were not as new to me as other re-entry symptoms. When we came to Ireland first time, everything and everybody looked very different. This time, my eyes became very critical this time, though; every small weakness of the new-old country seemed like a giant disadvantage.

Physiological stress reactions

I was lucky not to have any serious stress reactions, but some of my friends suffered. Depression was lurking in the background and sometimes jumped into Facebook statuses, e.g. “I have grown two wings but I can’t fly”. Examples of what happened to people who came back included divorce, no house, no job, mood swings, or people at work are not welcoming them. Compulsive eating/ drinking/ weight gain occurred too: another fellow have lost 5 kg while on fellowship but upon her arrival she toured her family for 2 weeks and gained that weight again. My mother in law lived in UK for five years and when she came back home, she wanted to return to UK immediately.

Disappointment – inability to apply new knowledge and skills

People aren’t interested in my experiences from abroad. I will never be able to use the knowledge I have gained abroad. Ambitions and competition hinder cooperation, people see you like their enemy. In the previous country, if they saw you being good at something, they supported you. Here, they envy you and try to make it harder for you. This country is broke and there are no growth opportunities. There are no money, no jobs. I could do much more if I stayed there. Smart people struggle to survive here. How can they live in such miserable conditions?

Rootlessness – I don’t belong here

Feelings of alienation and withdrawal are common symptoms of culture shock. I felt that people aren’t nice here. They don’t appreciate if I smile at them or if I start talking to them. They don’t like me and don’t understand me. I feel so weak here, so helpless and isolated. I need their response or feedback. I need to engage with them. People see the “wrong” changes when they look at me. “You’ve lost weight” somebody said and I didn’t believe her. Three other people said it later. This was not the type of change I was proud of or that I wanted them to recognize.

Boredom

The shift from a big town in a big country to a smaller country was dramatic. This is a small town, there’s nothing here. This is nothing. No life, no culture, no fun. It is boring. Services are undeveloped, ineffective and slow. They are not customer orientated. People are dull and everything is made on such a small scale that it doesn’t even matter. Everything is small. Cars, trains, houses are small; I need more space to live better. Bicycling is unsafe, there are no bike lines and cars don’t share the road with cyclists. The streets are dirty and the greens are overgrown; nobody cuts them regularly.

Our flat is very small; we need to move out to a better place. I don’t like this area; I don’t understand how I could live here before. We threw away most of our things when we came back home. Our home was not our home any more. This state is well phrased in the saying “you can’t go home again,” first coined by Thomas Wolfe in his book of the same name.
Hope

When people return home after living abroad, it can take a while to adjust to their home country. Some don’t get used to it at all. I had the privilege to meet people who succeeded in bending their new lives. The new life wasn’t great. They lived in small apartments and struggled financially. But at least some of them enjoyed what they worked on. It was a demanding and low-salaried job, and often not just one. This gives me hope that things can get better. This country doesn’t have big events, venues or communities, but there are many small, which can serve the same purpose.

A decade in the addictions field

book, envelope, window

Edited March 4, 2020 by janklimas

… or women, men and non-binary folk who mentored me.

Career in addiction health services research can be daunting. There are moments when people in this career path struggle at work. Have you ever been in that situation yourself? Here’s my story.

Needle exchange movie at 16

The internet was still a toddler and I watched the TV rarely. But when I turned on the box on one of such occasions, a summer afternoon, I was brought into the streets of the Slovakian capital, Bratislava, which was a world far far away for me. Young social work students backpacked those streets with bags full with clean needles and distributed them to drug users and sex workers; they talked about what this exciting and controversial pastime meant for them. They worked for a needle exchange project – Odyseus – and I wanted to do it too. I was excited to help drug users in the same way these women did, but I had to wait a couple of years until I grew up.

At that time, they still called it ‘Street work’ which later became ‘Terrain Social Work’. In the following years, I learned from my future boss that the Slovakian public TV screened the film quite often, but mainly as a filler in the downtime hours.

Unanswered phone call at 20

After acceptance at the psychology degree, my world changed and the range of my interests expanded. Nevertheless, I never forgot about that documentary. It was in the second year when I saw a poster at our university board, at advertised Needle Exchange as a part time job for students. I picked up a public phone and dialled a number from the poster – following my teenage dream. Nobody picked it up, so I left a message which too remained unanswered, forever. The number on the advert wasn’t for the Needle Exchange which the documentary talked about, but I didn’t know it at that time. By chance, I ended up working for the agency from the documentary movie because they had an email address posted on the internet and were more responsive than the project which advertised on our student board.

Student project at 21

Part of my comprehensive exam in the 3rd year of my undergrad was a research project. As most of my friends, I struggled with access to patients. Because of that, almost everyone did a literature review – without having a clue what we were doing. I chose the role of family and drugs as my topic, but it wasn’t an easy choice. At that time, my interest in drugs was drifting away and I felt like researching something else, for example depression or disabilities. I don’t remember how I ended up with drugs again, but my review led to working with Dr Timulak, and eventually, to my MSc and PhD projects.

Dr Peter Halama, PhD and Hungarian trams at 25

Dr Halama, PhD was this new face at the Trnava University, when I wrapped up my comprehensive exam. They were good friends with Dr Timulak and when I asked him about ideas for my MSc research, he said that Dr Halama was doing some interviews with drug users. Two years later, I found myself co-presenting our findings with Peter at a psychotherapeutic conference in Slovakia. Read more about that research here. From there, it was easy to continue in my research with Peter at a doctoral level. I enrolled as a part time student in Social Psychology, which did not convince him that I would finish it. When I announced – after two years of studies – that I’m moving to Hungary for a year, I think Peter had a hard time suppressing his doubts that I would finish my PhD from Hungary. My Hungarian adventure was, however, a real turning point. I had to commute between offices and spent long hours in trams. Being too bored of watching cars and people pass by, I started to read open access articles which I downloaded from internet the previous day. Some were more interesting, others less, but when I found something really relevant to my work, I felt like a gold miner who just dug his jewel out of piles of dirt. My passion grew stronger with every new paper.

Irish job hunt at 28

When we arrived to Ireland in early Autumn 2008, all I had was a small EU grant with a budget of 3000 euros and an unclear host organization. We managed to survive for almost a year with a great help of my wife’s EVS stipend and occasional p/t jobs. The work on my PhD and the EU grant took most of my time, leaving only a couple of hours for finding a more stable position. When I eventually ran out of money, it was late winter and the job market had dried up. I submitted my resume to many advertisements, including a research job on men’s sexual health. I must say that research was not on my list of Top 5 jobs, but when this position came up after 8 hopeless months of job hunt it was a true God-send. The pictured ad initially offered a PhD post in drugs research, but at the interview, my current boss – Prof Walter Cullen – told me about a p/t place on the same project. That’s how I came to research drinking among methadone patients in primary care at UCD.

Dr Dennis McCarty, PhD at 31

OK, I know I said that there were 5 key decisions earlier, but there has been a lot going on recently. In July 2011, I have been to a summer school on drugs in Amsterdam, Netherlands – no one could imagine a better place for this adventure. Dr McCarty, lectured for several days on different policy models and evidence based treatments. Two years later, I’m sitting in an office down the hall from Dr McCarty’s office, writing my final report about the INVEST fellowship. Visit this post to read more about how I got here. I did not think that the summer school would lead to a fellowship in Portland, OR and I’m most grateful that it did.

With Dennis, I have learned about things I thought did not exist. For example, about researchers who enjoy writing. Writing up research projects is a task that many new researchers fear the most. Dennis is a master writer and his craft is contagious; I’ve discovered a need in me, a strong urge to write a lot and in many different formats. I hope this ‘fire’ will keep on burning for at least another 10 years.

Engage in not for profit organizations.

Two organizations jump started my work in non-profits, the University Pastoral Centre and a youth club. I learned the power of community building through youth activism with John Lesondak and taught team building for non-profits with Ivan Humenik. With Ivan and friends, we also had a musical band, JK& band. These activities inspired me to get involved in the community projects for people who use drugs.

Access mentors in voluntary service programs.

Petra a Ivan Sedliacik connected us to the world through the European Voluntary Service, which is a training program of the European Union. My youth exchange training took part in Budapest, Hungary, and a small suburban town called Goddollo with Zsuzsa Szabo. I was trained as European volunteer, improving soft skills and contributing to the common good. Petra and Ivan continued to support me throughout my training and shared their own experiences from living abroad and being European volunteers.

Be a life-long learner.

A Leonardo Da Vinci Scholarship, which was European Union’s Lifelong Learning Program, took me to Cork city on the south of Ireland. Geoff Dickson mentored me in the city’s YMCA. A few miles away, in Ballincolig, Ivan McMahon overlooked my evaluation of youth programs for early school leavers and single moms. It was great to see the practical application of science in Ireland while doing my part time doctoral degree. I got to evaluate training programs, develop program databases and identify best practice approaches for real life problems by searching the literature.

Write outside your comfort zone.

While writing scholarly articles is difficult itself, one can easily fall asleep their comfort zone. I stepped out of this zone in 2013 when I enrolled in a prompt-based creative writing workshop in Portland, OR, housed by the state’s largest bookstore, the Powell’s books on Burnside street (https://writearound.org/). This is when I began to take my writing interests seriously thanks to our volunteer instructor, Matt Blair. His workshop re-invigorated my passion for writing and taught me the value of daily writing practice.

Doing research with busy doctors – an open space world

Family doctors are notoriously busy. Lack of their time is the number #1 barrier of doing anything outside their patient workload, including research. And yet, some enthusiasts get involved in the research endeavour, believing it can enhance primary care.

Knowing this, I looked for ways to do research with busy family physicians for my INVEST fellowship in Portland, OR. I needed to get them in one room and ask the group a couple of questions about their recent resident training initiative, SBIRT Oregon. The only time when my doctors were all in the clinic was right after another meeting. One of them suggested doing an open meeting technology. The phrase vaguely rang a bell with me.

‘Open space’ describes the process by which a wide range of individuals, in any organisation, can facilitate creative meetings around a complex theme of importance to all stakeholders 1. While a theme may be important to all stakeholders, they may have differing perspectives and responses, so this approach permits all voices to be heard and facilitates a process where stakeholders move from conflicting views to consensus. The approach has been widely used in commerce, religious communities, (non-)governmental agencies and war zones 2.

How did this work for us?

Our field ‘experiment’ lasted for about 90 minutes with two meetings in one room, right after each other. The meetings were unrelated, but 3/4 of the participants from the first meeting were scheduled for the second meeting too. I and my co-facilitator arrived well ahead of the first meeting. As doctors started to show up for the 2nd meeting – the 1st meeting was still in progress – some people were confused; others patiently listened to people talking at the 1st meeting. I found it very useful to sit on the 1st meeting and the transition to the 2nd meeting was much easier – all were in their seats already.

All in all, this set up had many advantages for multiple meetings with extra busy attendees. It can help solve problems and it works best with many people attending your meeting, but maybe it’s not ideal for research focus groups. A tip for a freshman facilitator: it’s amazing how much powerful an incentive for research can food be, especially pizza.

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1http://www.michaelherman.com/cgi/wiki.cgi
2http://www.openspaceworld.com/papers.htm