From Periphery to Peripheries of Excellence
Dariusz Baran
(published in CONTEXT No 16 , Autumn 1993 )
Creating his own “Prague Bridge”, Dariusz Baran, psychologist in Rzeszów, Poland visited the UK last year. A widening experience in several ways, on his return he composed this reflective account.
From a geographical point of view, Poland is situated in the centre of Europe. But a visit to Donbass in the former Soviet Union (eastern Ukraine) in August 1989 and to Cologne, Germany in September 1991 made me come to the conclusion that I lived on the peripheries of Europe (not Asia, I hope) between the west and the east. 'Between' because our tradition is rooted in Christianity in spite of forty-five years of communism. Comparing the western to the eastern part of Germany it was easy to see that communism was a terrible waste of time and energy imposed against our will. Feeling bitterness as a victim of Yalta, I contacted Nick Child after seeing the abstract of his Prague workshop on working 'in the peripheries'. I eventually dared to ask for a visit to the Child and Family Clinic in Motherwell, Scotland. He consulted his work colleagues and their answer was 'welcome'. After briefly consulting my wife, Aleksandra, I was granted a leave from home for a month.
I work at the Family Health Clinic in Rzeszów, in the south-east of Poland, with my colleague and boss, Zdzisław Kuśnierz. We are both psychologists and provide a service to individuals of any age, couples and families in a population of over 500,000. A sexuologist and a sociologist work part-time with us. We are all male. In the same premises there is a Childbirth School run by an obstetrician and midwife, my friends. Next door, there is the Mental Health Clinic for Children and Adolescents, with a child psychiatrist, nurse, four psychologists, and two registration workers. They are all female. We all share some time working together with families.
So, in mid-March 1992 I set out from Poland by coach. Two days later, Jenny Duckham Sevitt met me at the station in London. Jenny and Mike Sevitt offered me the hospitality of their family's home in Kingston-upon-Thames for a few days. In the meantime, Nick and his colleagues in the three teams of the Child and Family Clinics of Lanarkshire Health Board were busy with a three-day AGM!
I was amazed to see staff without white uniforms, and nurses talking about therapeutic process.
I was glad to have time to walk around London and to visit the Adolescent Unit in Long Grove Hospital where Mike worked. I was amazed to see staff without white uniforms, and nurses talking equally with psychiatrists about therapeutic process. On the wall in the accommodation part of the unit, I could read the sign 'I hate calories' - an anorexic's manifesto. Angela Sheppard-Fidler let me see a new building where the unit would be moved. She wondered what adolescents would do with the spotlessly clean walls in the new place.
SCOTLAND
At last in Scotland I was curious about the people who described themselves as 'working in the peripheries of excellence' and who were prepared to take the risk of welcoming me without any reference. The first week I stayed with Nick and Maureen in Edinburgh, using the commuting time for discussion. Facing the oncoming election day, we talked about political life in Scotland and Poland, differences and similarities. It was time for hope of a Labour government in Great Britain and hope for overcoming post-communist corruption in Poland. Several weeks later it was clear that we were dreamers each of us in our own country.
On Thursday 19th March 1992 at 9.00am I entered by the front door of the Child and Family Clinic. In the entrance hall, there was an aquarium with silvery-red fish, the only in-patients at the clinic. A week later, as a qualified therapist, Nick bought a new sort of very nervous and hyperactive fish — undoubtedly for treatment. At the beginning of each work day there is an informal 'tea(m)-making' meeting. Here I met John, June, and Annabell (psychiatrist, social worker and clinical psychologist) of the Hamilton-East Kilbride team. Later I met Liz and Karen (secretaries) as well as Sally, a social work trainee on part-time placement from a course elsewhere, and Anne and Rachel (social worker and clinical psychologist), the other members of the Motherwell-Clydesdale Team.
Nick's first appointment was with a couple. Unfortunately, without Anne and Rachel, the routine live team method wasn't possible. He invited me to make a team with him. We had a discussion in Anne's room before the interview. Having been met by Liz, the couple was sitting in the waiting room where Nick asked to use the screen with his visiting Polish colleague. Then he introduced me to them and led us down the corridor to the interview room. Moving from one place to another seemed to me like being guided through the unfamiliar territory of life. I could hardly follow the couple's Scottish accent, but I could understand Nick quite well. My attention was focused on the couple's non-verbal responses. For instance, they tapped their fingers at one moment in complementary, at another, in symmetrical ways. Nick took a break in the interview, curtained the screen and went out. We moved into a room away from the screening one. This was the daily ritual of moving out and coming back. We shared our experience of the session. I shared my understanding of the process. Coming back, Nick knocked on the door to the couple. Then he spoke about our discussion, including what I had noticed. I could feel my heart beat speed up with alarm. If I had know about his frankness, I would have been more careful in what I said. Some time for talking, making an appointment, and saying goodbye. A few minutes for short discussion after the interview.
Day by day, I joined the Hamilton and Motherwell teams at work and rest. I took part in different kinds of meetings, family sessions with screening, team case discussion meetings, allocation meetings, clinic business meetings, training meetings, consultations and case discussions with GPs, social workers, educational psychologists, liaison meetings with senior social worker and a business meeting with the general manager. Desk work, 'phone calls, and letters were the covert part of everyday work at the clinic. Every commitment had its precise time and place, I mean a room, with clear responsibility for who was key worker per case, who was chairperson of the meeting, and what the issue was being talked about. Any ideas and further steps were fully discussed. And - what was most amazing for me - a three-discipline team with flexible leadership. In Rzeszów, we are psychologists and only informal contact with other professionals sometimes enables us to overcome uni-disciplinary ways of work.
TAKEN FOR GRANTED
I was impressed by the referral letters from GPs and social workers, written in ordinary language, as were the replies. In Rzeszów, a patient just brings a piece of paper with a description of symptoms and diagnosis in medical terminology and 'please see for further assessment and therapy'. There is no story about his or her complaints, about difficulties in the course of dealing with the case, about underlying reasons for referring and so on. On the other hand there are self-referrals and we can set up appointments directly. Nick explained that the quality of letters in ordinary language was established- over many years' of careful attention to liaison with physicians and social workers, clarifying questions of who and what business belongs to a family, to CFC, and to other systems and agencies in the case.
In Motherwell, all notes of interviews and letters are typed and well ordered. As is usually taken for granted in the west, carefully set up commitments are protected from incoming calls and emergencies by the secretaries. This I envied. In Rzeszów, typing is my job - usually formal applications for the general director's permission to photocopy clinic forms in the general hospital where we are employed. Sometimes we do not get his permission. We have no secretary -though later I realised that many doctors in Poland rely on the nurse to function like one in some ways. People can come in the room or call us up during interviews to ask for information or to make an appointment. When my colleague is busy I try to protect his interview and vice versa. When we both are busy, a client may have to wait for as much as an hour. People are accustomed to spending hours in the narrow corridors of clinics in the Polish National Health Service.
Nick initiated me into the 'secretary test'. They have discovered that the secretaries' first impressions of people are a reliable indicator of, for example, their qualities as team colleagues. Before they have adjusted it for the professional staff, a secretary hears a person's true voice on the phone and experiences their true attitude to 'lesser rqortals' at the front door of the clinic. This upset me, because Liz and Karen spoke a perfect Scottish accent and I could hardly follow what they said. I tried to respond suitably, but I felt rather clumsy. A failure in the secretary test was inevitable. On my last day, Liz came to say goodbye. Unexpectedly, she gave me a squeeze. That warm gesture encouraged me to have a talk with Karen as well. I wondered whether the secretary test was correct in any case.
From Edinburgh to Kirkintilloch and Holy town at Anne's and June's family homes. Outside work, I had a chance to ask more personal questions. I was curious how it was possible to trust one another at work. What about competition and gender issues? Several years of the challenge of running a service had made them pull together as a team, working through unpleasant polarisation and disagreement with enthusiasm and respect for differences. This required personal work about themselves and their own families, about the philosophy of life and work as a whole. And the most important discovery was that they were happy to work in Motherwell, in the periphery of excellence.
FREE IN POLAND?
I thought about Poland, Rzeszów, my wife Aleksandra, relatives, colleagues at work and out of work. Do we value the place we live in? Do we enjoy our way of living and working? Poland, my oppressed fatherland. Polish people are freed from communism now, but what about repressed feelings of anger at being mistreated and fear for safety. The health service was free in Poland, but it has been an established custom that a patient give a gift to the doctor like coffee, chocolate, flowers, liquor, to mark his or her gratitude. A very nice gesture after complete cure of a disease, but what about gifts before the next appointment? Those of us working in the health service are mainly offered gifts in the hope that we can work a miracle. It is difficult to re-frame the misbehaving child in the family from the view that it is a cancer to be cut off, irradiated or destroyed in any way possible. Several years ago it used to be said that you could lie in a corridor of the hospital and your relatives discover that meanwhile another patient had got your room having gained the favour of the staff in charge of the ward. Waiting to be admitted for specialist assessment or an operation was another good reason to establish a good relationship with the head physician. Maybe this was common under the communist government when a free health service was a myth, but not now. On the other hand, when you are ill it is still not easy to take a chance that the doctor will do his or her best without offering any gifts, money, connections and so on. When a doctor tries to decline these offers, the patient gets very anxious indeed.
When June told me of her work with sexually abused children in families, I realised that this was an unknown issue in Poland. Is it a specific problem in the west or an undiscovered taboo in the east? I thought about my work in the Family Health Clinic in Rzeszów. I deal with young engaged couples referred by family courts. In Poland men between 18 and 21 and women between 16 and 18 have to be granted a court's permission to get married. From a legal point of view a man comes of age at 18, but without the right to decide about marriage on his own until 21. Applying for court permission he or she has to enclose an affidavit about the woman's pregnancy and physical health from a physician. I was asked in Scotland: 'How do you work with them? Do you make a report to the court?' No! When we first meet, if they want, I just give my signature that they have come to the Family Health Clinic, and nothing else. After a brief introduction, we talk about whether maturity can be assessed at all, about writing reports, and understanding the reasons for referring them to a psychologist. I explain that the procedure was established twenty years before.
It is not my business why they want to get married.
I have dealt with young couples for two and a half years. From my point of view it is not my business why they want to get married earlier or later, nor how mature they are. My job is to talk with people about any issues they would like to discuss. Couples are usually distrustful, but some of them can tell stories, picked up from their colleagues about investigation at the family court. Sometimes they say: 'It is humiliating to answer questions like how long do you know each other, how do you know you love her or him, did he abuse you or did you freely consent to have intercourse with him? So is it a crime for people to love each other in their own way? It is obvious that parents could be disappointed that a daughter is pregnant and a son is going to get married at a young age. But is it okay for a judge to interfere in someone's personal life just because they have the executive power of the legal system? In Poland they say that young couples should be taught about the duties, and warned about the difficulties, of married life. This could be the self-fulfilling prophecy that begins a couple's breaking up. From the state's point of view, the number of broken marriages is a reason for ever more intrusive ways of protecting young couples. How do we stop this vicious circle? At our obligatory clinic meeting, I try to shake the deeply rooted stereotype of marital and gender competition. From a task-solving approach, I suggest that marriage and family life is a challenge for men and women of all ages to grow up even more than they have.
At the end of my month's visit to the peripheries of excellence I was declared an Honorary International Life Associate of Child and Family Clinics in Mother-well. I esteemed it an honour. On 12 April I set out on the two day journey from Hamilton in Scotland through Europe to Poland, back to my peripheries of excellence.
Dariusz Baran, Honorary International Life Associate Member of Motherwell CFC, with Anne Hood
Dariusz Baran
(published in CONTEXT No 16 , Autumn 1993 )
Creating his own “Prague Bridge”, Dariusz Baran, psychologist in Rzeszów, Poland visited the UK last year. A widening experience in several ways, on his return he composed this reflective account.
From a geographical point of view, Poland is situated in the centre of Europe. But a visit to Donbass in the former Soviet Union (eastern Ukraine) in August 1989 and to Cologne, Germany in September 1991 made me come to the conclusion that I lived on the peripheries of Europe (not Asia, I hope) between the west and the east. 'Between' because our tradition is rooted in Christianity in spite of forty-five years of communism. Comparing the western to the eastern part of Germany it was easy to see that communism was a terrible waste of time and energy imposed against our will. Feeling bitterness as a victim of Yalta, I contacted Nick Child after seeing the abstract of his Prague workshop on working 'in the peripheries'. I eventually dared to ask for a visit to the Child and Family Clinic in Motherwell, Scotland. He consulted his work colleagues and their answer was 'welcome'. After briefly consulting my wife, Aleksandra, I was granted a leave from home for a month.
I work at the Family Health Clinic in Rzeszów, in the south-east of Poland, with my colleague and boss, Zdzisław Kuśnierz. We are both psychologists and provide a service to individuals of any age, couples and families in a population of over 500,000. A sexuologist and a sociologist work part-time with us. We are all male. In the same premises there is a Childbirth School run by an obstetrician and midwife, my friends. Next door, there is the Mental Health Clinic for Children and Adolescents, with a child psychiatrist, nurse, four psychologists, and two registration workers. They are all female. We all share some time working together with families.
So, in mid-March 1992 I set out from Poland by coach. Two days later, Jenny Duckham Sevitt met me at the station in London. Jenny and Mike Sevitt offered me the hospitality of their family's home in Kingston-upon-Thames for a few days. In the meantime, Nick and his colleagues in the three teams of the Child and Family Clinics of Lanarkshire Health Board were busy with a three-day AGM!
I was amazed to see staff without white uniforms, and nurses talking about therapeutic process.
I was glad to have time to walk around London and to visit the Adolescent Unit in Long Grove Hospital where Mike worked. I was amazed to see staff without white uniforms, and nurses talking equally with psychiatrists about therapeutic process. On the wall in the accommodation part of the unit, I could read the sign 'I hate calories' - an anorexic's manifesto. Angela Sheppard-Fidler let me see a new building where the unit would be moved. She wondered what adolescents would do with the spotlessly clean walls in the new place.
SCOTLAND
At last in Scotland I was curious about the people who described themselves as 'working in the peripheries of excellence' and who were prepared to take the risk of welcoming me without any reference. The first week I stayed with Nick and Maureen in Edinburgh, using the commuting time for discussion. Facing the oncoming election day, we talked about political life in Scotland and Poland, differences and similarities. It was time for hope of a Labour government in Great Britain and hope for overcoming post-communist corruption in Poland. Several weeks later it was clear that we were dreamers each of us in our own country.
On Thursday 19th March 1992 at 9.00am I entered by the front door of the Child and Family Clinic. In the entrance hall, there was an aquarium with silvery-red fish, the only in-patients at the clinic. A week later, as a qualified therapist, Nick bought a new sort of very nervous and hyperactive fish — undoubtedly for treatment. At the beginning of each work day there is an informal 'tea(m)-making' meeting. Here I met John, June, and Annabell (psychiatrist, social worker and clinical psychologist) of the Hamilton-East Kilbride team. Later I met Liz and Karen (secretaries) as well as Sally, a social work trainee on part-time placement from a course elsewhere, and Anne and Rachel (social worker and clinical psychologist), the other members of the Motherwell-Clydesdale Team.
Nick's first appointment was with a couple. Unfortunately, without Anne and Rachel, the routine live team method wasn't possible. He invited me to make a team with him. We had a discussion in Anne's room before the interview. Having been met by Liz, the couple was sitting in the waiting room where Nick asked to use the screen with his visiting Polish colleague. Then he introduced me to them and led us down the corridor to the interview room. Moving from one place to another seemed to me like being guided through the unfamiliar territory of life. I could hardly follow the couple's Scottish accent, but I could understand Nick quite well. My attention was focused on the couple's non-verbal responses. For instance, they tapped their fingers at one moment in complementary, at another, in symmetrical ways. Nick took a break in the interview, curtained the screen and went out. We moved into a room away from the screening one. This was the daily ritual of moving out and coming back. We shared our experience of the session. I shared my understanding of the process. Coming back, Nick knocked on the door to the couple. Then he spoke about our discussion, including what I had noticed. I could feel my heart beat speed up with alarm. If I had know about his frankness, I would have been more careful in what I said. Some time for talking, making an appointment, and saying goodbye. A few minutes for short discussion after the interview.
Day by day, I joined the Hamilton and Motherwell teams at work and rest. I took part in different kinds of meetings, family sessions with screening, team case discussion meetings, allocation meetings, clinic business meetings, training meetings, consultations and case discussions with GPs, social workers, educational psychologists, liaison meetings with senior social worker and a business meeting with the general manager. Desk work, 'phone calls, and letters were the covert part of everyday work at the clinic. Every commitment had its precise time and place, I mean a room, with clear responsibility for who was key worker per case, who was chairperson of the meeting, and what the issue was being talked about. Any ideas and further steps were fully discussed. And - what was most amazing for me - a three-discipline team with flexible leadership. In Rzeszów, we are psychologists and only informal contact with other professionals sometimes enables us to overcome uni-disciplinary ways of work.
TAKEN FOR GRANTED
I was impressed by the referral letters from GPs and social workers, written in ordinary language, as were the replies. In Rzeszów, a patient just brings a piece of paper with a description of symptoms and diagnosis in medical terminology and 'please see for further assessment and therapy'. There is no story about his or her complaints, about difficulties in the course of dealing with the case, about underlying reasons for referring and so on. On the other hand there are self-referrals and we can set up appointments directly. Nick explained that the quality of letters in ordinary language was established- over many years' of careful attention to liaison with physicians and social workers, clarifying questions of who and what business belongs to a family, to CFC, and to other systems and agencies in the case.
In Motherwell, all notes of interviews and letters are typed and well ordered. As is usually taken for granted in the west, carefully set up commitments are protected from incoming calls and emergencies by the secretaries. This I envied. In Rzeszów, typing is my job - usually formal applications for the general director's permission to photocopy clinic forms in the general hospital where we are employed. Sometimes we do not get his permission. We have no secretary -though later I realised that many doctors in Poland rely on the nurse to function like one in some ways. People can come in the room or call us up during interviews to ask for information or to make an appointment. When my colleague is busy I try to protect his interview and vice versa. When we both are busy, a client may have to wait for as much as an hour. People are accustomed to spending hours in the narrow corridors of clinics in the Polish National Health Service.
Nick initiated me into the 'secretary test'. They have discovered that the secretaries' first impressions of people are a reliable indicator of, for example, their qualities as team colleagues. Before they have adjusted it for the professional staff, a secretary hears a person's true voice on the phone and experiences their true attitude to 'lesser rqortals' at the front door of the clinic. This upset me, because Liz and Karen spoke a perfect Scottish accent and I could hardly follow what they said. I tried to respond suitably, but I felt rather clumsy. A failure in the secretary test was inevitable. On my last day, Liz came to say goodbye. Unexpectedly, she gave me a squeeze. That warm gesture encouraged me to have a talk with Karen as well. I wondered whether the secretary test was correct in any case.
From Edinburgh to Kirkintilloch and Holy town at Anne's and June's family homes. Outside work, I had a chance to ask more personal questions. I was curious how it was possible to trust one another at work. What about competition and gender issues? Several years of the challenge of running a service had made them pull together as a team, working through unpleasant polarisation and disagreement with enthusiasm and respect for differences. This required personal work about themselves and their own families, about the philosophy of life and work as a whole. And the most important discovery was that they were happy to work in Motherwell, in the periphery of excellence.
FREE IN POLAND?
I thought about Poland, Rzeszów, my wife Aleksandra, relatives, colleagues at work and out of work. Do we value the place we live in? Do we enjoy our way of living and working? Poland, my oppressed fatherland. Polish people are freed from communism now, but what about repressed feelings of anger at being mistreated and fear for safety. The health service was free in Poland, but it has been an established custom that a patient give a gift to the doctor like coffee, chocolate, flowers, liquor, to mark his or her gratitude. A very nice gesture after complete cure of a disease, but what about gifts before the next appointment? Those of us working in the health service are mainly offered gifts in the hope that we can work a miracle. It is difficult to re-frame the misbehaving child in the family from the view that it is a cancer to be cut off, irradiated or destroyed in any way possible. Several years ago it used to be said that you could lie in a corridor of the hospital and your relatives discover that meanwhile another patient had got your room having gained the favour of the staff in charge of the ward. Waiting to be admitted for specialist assessment or an operation was another good reason to establish a good relationship with the head physician. Maybe this was common under the communist government when a free health service was a myth, but not now. On the other hand, when you are ill it is still not easy to take a chance that the doctor will do his or her best without offering any gifts, money, connections and so on. When a doctor tries to decline these offers, the patient gets very anxious indeed.
When June told me of her work with sexually abused children in families, I realised that this was an unknown issue in Poland. Is it a specific problem in the west or an undiscovered taboo in the east? I thought about my work in the Family Health Clinic in Rzeszów. I deal with young engaged couples referred by family courts. In Poland men between 18 and 21 and women between 16 and 18 have to be granted a court's permission to get married. From a legal point of view a man comes of age at 18, but without the right to decide about marriage on his own until 21. Applying for court permission he or she has to enclose an affidavit about the woman's pregnancy and physical health from a physician. I was asked in Scotland: 'How do you work with them? Do you make a report to the court?' No! When we first meet, if they want, I just give my signature that they have come to the Family Health Clinic, and nothing else. After a brief introduction, we talk about whether maturity can be assessed at all, about writing reports, and understanding the reasons for referring them to a psychologist. I explain that the procedure was established twenty years before.
It is not my business why they want to get married.
I have dealt with young couples for two and a half years. From my point of view it is not my business why they want to get married earlier or later, nor how mature they are. My job is to talk with people about any issues they would like to discuss. Couples are usually distrustful, but some of them can tell stories, picked up from their colleagues about investigation at the family court. Sometimes they say: 'It is humiliating to answer questions like how long do you know each other, how do you know you love her or him, did he abuse you or did you freely consent to have intercourse with him? So is it a crime for people to love each other in their own way? It is obvious that parents could be disappointed that a daughter is pregnant and a son is going to get married at a young age. But is it okay for a judge to interfere in someone's personal life just because they have the executive power of the legal system? In Poland they say that young couples should be taught about the duties, and warned about the difficulties, of married life. This could be the self-fulfilling prophecy that begins a couple's breaking up. From the state's point of view, the number of broken marriages is a reason for ever more intrusive ways of protecting young couples. How do we stop this vicious circle? At our obligatory clinic meeting, I try to shake the deeply rooted stereotype of marital and gender competition. From a task-solving approach, I suggest that marriage and family life is a challenge for men and women of all ages to grow up even more than they have.
At the end of my month's visit to the peripheries of excellence I was declared an Honorary International Life Associate of Child and Family Clinics in Mother-well. I esteemed it an honour. On 12 April I set out on the two day journey from Hamilton in Scotland through Europe to Poland, back to my peripheries of excellence.
Dariusz Baran, Honorary International Life Associate Member of Motherwell CFC, with Anne Hood