Chapter contents
Introduction53
Narrative to aid reflection54
1st movement – Description – the story text56
2nd movement – Reflective text57
3rd movement – Dialogue between tentative insights and the wider field of knowing59
4th movement – Guidance60
5th movement – Weaving the narrative60
6th movement – Dialogue with others60
Conclusion61
References61
Further reading61
ABSTRACT
This chapter explores the potential for reflection and reflective practice to aid learning and enhance practice. It particularly focuses on the use of narrative, which can be a useful aid to facilitate the therapist to develop sensitivity and to learn from experience. Narrative involves describing in writing a recent experience in practice, then using a formal framework to reflect on it, exploring feelings, emotions, and practical and other issues which may assist in improving, changing or affirming practice for the future.
Introduction
In order to progress with their professional practice, clinical reflexologists need to develop the skills of reflection. Reflection is the process of learning through everyday experiences, enabling us to gain insight towards our practice. Through reflection we learn to become cognisant of the factors which constrain us, those which are either embodied within ourselves or embedded within normal organisational patterns. Through that understanding we can then act to shift them so that our visions can be realised, and, as such, reflection can be described as action-orientated. Reflection is an advanced skill which can be refined as time goes on, but one which has become vital in contemporary practice, providing the rationale behind our actions and words and stimulating our sensitivities to patients/clients, their treatments, their health or illness and their psychosocial well-being.
The reflective practitioner is curious about his or her practice and experiences with clients/patients, always challenging his own feelings, thoughts and actions. He or she is not attached to patterns of thinking and responding but is always open to new ideas, always open to learning. The practitioner maintains a commitment to find the ‘best way’ to practice, knowing that the clients deserve nothing less. The intent of the reflexology practitioner is, perhaps, to touch and thereby to ease the client’s suffering in a way which is best for that individual. Yet suffering has an intangible quality which is not easily grasped: it is sensed by, rather than known to, the therapist who needs to be sensitive enough to feel its nature. Knowing how best to respond is a focus of reflective inquiry. Responses can never be taken for granted simply because each situation is unique, even though it may be similar to other previous experiences – but it is not this experience. The reflective practitioner is mindful, approaching each situation as if a mystery is unfolding. Who is this person? What meaning does this person give to their experience? ‘Meaning’ changes like the tides in the roller-coaster of ill-health, particularly within the author’s own field of working with people with terminal illness.
Narrative to aid reflection
Reflective practice can be facilitated through the use of a written narrative and a systematic process of inquiry based on the content of the narrative (Johns 2002).
There are six dialogical movements to the process of reflective narrative:
1. Dialogue with oneself to write a rich, descriptive story of a particular experience that pays attention to detail involving all the senses (story text);
2. Dialogue with the story text as an objective and disciplined process (using a model of reflection) to gain insights (reflective text);
3. Dialogue between the text and other sources of knowing in order to frame emerging, tentative ideas from the text within the wider community of knowing;
4. Dialogue between the text’s author and a guide/mentor to clarify, deepen and co-create insights;
5. Dialogue within the hermeneutic spiral to weave the coherent and reflexive narrative that adequately plots the transformative journey (narrative text) (The hermeneutic circle describes the process of understanding a text. One’s understanding of the text as a whole is established through reference to the individual parts and vice versa. Neither the whole text nor any individual part can be understood without reference to one another.);
6. Dialogue between the narrative and the narrative readers/listeners towards a consensus of insights (evolving text).
As such, the six movements take the narrator (practitioner) through the stages of writing, moving through story text (what you write in your journal), reflective text (your reflection on description), narrative text (the presentation of insights in a coherent and reflexive pattern informed by dialogue with literature and with guides), into an evolving text through dialogue with readers and listeners. It is a systematic process of inquiry (Johns 2009).
Before considering in more detail the steps in this process, it may be helpful to consider the issues inherent in the following narrative about the interaction between Mary and the author.
Mary is a young-looking 63-year-old lady who had a mastectomy the previous year for breast cancer, but liver and bone metastases were then diagnosed. She is also diabetic and becomes very nauseous prior to eating. Her greatly enlarged liver is squashing her abdomen, making it difficult for her to breathe and her nausea difficult to manage. Curative options have been ruled out and we are on the long trajectory toward death. She feels its relentless pull and I am told she is anxious, although she appears to bear her tragedy with equanimity. One morning, on entering her room, I immediately detect that she is in pain and rearrange her pillows to ensure she feels more comfortable; she declines a heat pad which she had used during the night. The breakfast tray arrives but Mary’s appetite is poor, even though she knows that, being a diabetic, it is important to eat some breakfast. I suggest giving her reflexology later that morning, which may help her appetite before lunch.
It is 11.20 before I am back with Mary and she has been looking forward to the reflexology. I ask her how she feels and she tells me she is nauseous. ‘No,’ I say, ‘how do you really feel?’ She looks down and says she feels alone, that she knows she is going to die. She tries to be brave with her husband and children but finds it hardest seeing her grandchildren. Her mother died from breast cancer and she fears it is hereditary, but no one talks of these things. That’s why she feels so alone, as if some conspiracy of silence surrounds her to avoid upsetting her. I suggest maybe they avoid such issues for their own comfort. Mary can see some truth in that. ‘As a family we have always avoided talking about difficult things, Jim, my husband, in particular.’ I make a mental note to ask him ‘how things are’ when he visits that afternoon.
And yet, I am uncertain about pushing such issues. Perhaps I should have said, ‘How are things?’ in a more casual way rather than so directly and intensely – offering Mary the choice of whether she wanted to look more deeply at herself and her dying – although I know from past experience that people often appreciate the opportunity to go more deeply. Every person is different and such ethical judgement is always tentative, as if feeling my way along the person’s wavelength. Perhaps I should have asked Mary if she had spoken of her feeling to others, yet there was no mention of this in her notes. But then ‘notes’ don’t always tell the story. I feel comfortable talking to Mary whilst I give the reflexology treatment and she does not resist me. There is something about complementary therapy that opens an intimate space which fosters trust. I know that this space is vital for giving therapy and hence the preparation. I am not satisfied just to walk into a room, give the reflexology and walk out again. I visit once a week and have come to know Mary well, so should I be so concerned to open an intimate space? Is this more for my benefit than for Mary’s? To touch someone with our spirit is healing. Cancer rips through people, through families, tears them apart, fragments them. My intent is to ease suffering, to enable Mary to feel whole again. Reflexology is sacred space (Quinn 1992), where touch is a spiritual encounter, touching Mary’s spirit with my own. As such I have to nurture my own spirit. I do not tell Mary this; it is the ground for going deeper. I know that my presence in itself is healing, lifting Mary to a higher level of being (Rael 1993).
Her feet and lower legs are very dry and oedematous and she says they ache constantly. My training as a reflexologist was ‘technique’ focused – really just working the whole foot three times. Over time I have relinquished the emphasis on technique and learned to listen to the person’s body. For me, every therapy is an experiment, an opportunity to deepen my craft. This is why reflection is so vital to gain insight into myself as a therapist to become more effective in my quest to ease suffering. To be a holistic therapist is to appreciate the pattern of the whole person and any symptom against the whole. Hence, as I hold her feet I tune more deeply into her. As I do so I centre myself, bringing myself fully present to the moment. I hold her feet for about 5 minutes with my hands flat against the soles of her feet: a point of stillness in a frantic world. I do not usually pay much attention to various parts of the body, but today I dwell over the reflex zones for her liver and shoulders where the cancer has spread. Her liver reflex zone is pale and soggy. I simply hold the liver reflex point with a corresponding reflex point on the top of her foot. I feel the emptiness of this area, seeking to find an energetic balance. It takes a few minutes and then it pulses in. I repeat this on the other foot.
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