Professional Tree of Life - with Dr Julie Fraser & Dr Liz Matias

SPEAKERS

Paula Redmond, Julie Fraser, Liz Matias

Paula Redmond: 00:04

Hi, I'm Dr Paula Redmond, a clinical psychologist, and you're listening to the when work hurts podcast. On this show, I want to explore the stories behind the statistics of the mental health crisis faced by health professionals today and provide hope for a way out through compassion, connection and creativity. This season is brought to you by the Association of Clinical Psychologists, the representative professional body for clinical psychologists in the UK. Join me as I talk to inspiring clinical psychologists about their work in this field, and learn how we can support ourselves and each other when work hurts. The Tree of Life is a narrative therapy approach that helps people to tell stories about themselves in ways that make them stronger. It uses the metaphor of a tree to support this process in creative ways and has a broad applicability in both therapeutic and professional contexts. Dr Julie Fraser and Dr Liz Matias, both clinical psychologists, have written about their use of the Professional Tree of Life to support NHS staff in the ACP-UK book Psychological Staff Support in Healthcare. In this episode, we discuss what the approach looks like, as well as the benefits and challenges. I began by asking Julie to outline the origins of the tree of life.

Julie Fraser: 01:38

It originated a think in the sort of late 90s, in the 90s, mid 90s, late 90s in Zimbabwe and some sort of and neighbouring kind of countries, there was a psychologist working there, in Zimbabwe, mainly, I think it was mainly Zimbabwe, where it was Ncazelo Ncube-Mlilo, she was working in what were camps for, and in Zimbabwe these camps were set up, they were called camps, like rehabilitation, recovery, kind of camps, which were set up for families in the area to go along and, you know, get help, get care, get psychological treatment. Because they had, these were multiple trauma, from multiple traumatised families. Lots of you know, loss, there was a war torn areas, there was a lot of political unrest, HIV, Aids were rife. So there was considerable trauma that these families were experiencing. And she was trained as a psychologist and in I think, in very kind of individualised ways of working, the sense where, you know, you talk about the problems and maybe these kind of ideas of catharsis where you talk about problems, you process them, you process the trauma, but in working with the children and the families in the camps that just wasn't working. The retelling of the problem story over and over again was traumatising. She and her colleague felt for the children and the families but also for the staff members, you know, for herself, they're becoming burnt out, they couldn't do anything. So she looked first of all, to the community for an approach that was from the, from the community where these families lived. And that's the, the origins of the Tree of Life is that it is a community healing approach called the Tree of Life, where the tree was used as a symbol of growth, of protection, of strength of, you know, even in a ground that has been scorched, you know, and burned. You know, so the area has been burned to the ground, you know, trees can regrow. And I think so there was this incredible symbolism that was important, important about the tree and the tree was seen as a sort of yeah, the symbol, but also, a kind of pointed where people would tell stories, and the tree was used to help tell stories about themselves. And these were stories about overcoming adversity, overcoming problems, you know, all of these kind of traumas. And so stories of strength and resilience. She was also studying and was interested in narrative therapy. So, and Ncazelo, I really hope I'm doing injustice here by describing your story, not that she might ever listen to this, but just in case, I want to make sure I do justice to how many times I've heard her sort of say this and how much of the background of the context of this model is really important. And so she connected with David Denborough, you know, and the Narrative Research Centre over in Adelaide, and they were interested of course, and so together there was this lovely, you know, kind of development joining of this community healing approach and the narrative practice, where it was used as three as a storytelling kind of healing approach, but then using, you know, adding and enhancing and enriching it with the narrative therapy questions, which were for each, because each part of the tree was telling a story, but the narrative therapy aspect was, well they used narrative therapy questions to enrich and then develop those and thicken those stories. So that's the kind of background to it and then of course, it became, she wrote a paper, she wrote a few papers, David Denborough wrote papers, she luckily shared her work. And yeah, we went along, and attended it and realised, actually because it was stories that were built on strengths and resources and relationships and resilience, that, you know, if there's a, if there's a service that needs that it's the NHS. We need that more than anything!

Paula Redmond: 05:44

Liz, just to bring you in here, I'm wondering what aspects of this as an intervention have really, have most appealed to you? What, what kind of hooked you about this work?

Liz Matias: 06:00

When I sort of heard about the, the Tree of Life I was working in, I was working in a sort of forensic setting, and I think, you know, I think there's a very much a dominant story within forensic of, you know, not only sort of mental health, but also sort of the offending, and I think makes it very difficult, I think, for people to, for service users to move on with their lives, and it's a very stuck, stuck kind of narrative. And I think, a Tree of... I think just using this approach, Tree of Life helped, I think people just to open up different sort of conversations, and foster sort of learn more about, I guess, you know, move away from the, the kind of label and the offence and to understand more about sort of the person and I think that sort of very empowering, but also that how much emphasis there is, in forensic on people going over, you know, very horrible things, mostly that they've done to other people, they're offending, which is, you know, probably traumatising in itself. But it has its roots probably in their own, the trauma that they have experienced. And that that is just impossible for people to do unless they are or they can sell in a sort of position of safety and strength. And I think that's, and that's the sort of whole premise of the Tree of Life is to try and through telling, using the metaphor of the tree to tell the sort of preferred story about your life that isn't about the problem, that moves away from whatever, you know, what narrative therapy's called sort of the problem saturated narrative, you know, moving away from that, connecting with that sort of preferred identity that so called the riverbank position that helps you to then be able to more safely, we're able to kind of to talk about the challenges and the traumas even if there has been things that you have inflicted on other people, which are the most difficult things to talk about. So I think, and I guess also thinking more from recovery focused point of view, thinking about how you help people to have hope. Because recovery starts with hope. And hope is about opportunities and possibilities. And you can't have that if you, all you have is a very narrow label about either being an offender or somebody with a mental illness. So it's really about creating hope. And I think yeah, possibilities, and helping people sort of work with them, because I felt essentially, it was just a really important tool for helping supporting recovery in a setting, which, I mean, everything was I don't know, I mean, I guess all the odds are against recovery, and it's just very challenging. So that's kind of I mean, yeah, it feels like a bit yeah, and I guess just just to kind of, there's moments that I will never forget, that I've experienced in sort of Tree of Life groups. I know, we're talking more about the Professional Tree of Life, but I think just thinking about how, you know, it opens up conversations, both, you know, when you're working with staff, but you know, I've been particularly struck by that, the power of it, you know, when working with clients, and, you know, I think you can sort of sit on a ward and have meetings day in and day out and hear the same old things and, but suddenly, you have the Tree of Life and it opens up conversations, and people talk about connections to people in their lives and people that, you know, in a way that you would never have heard about those things, you know, so otherwise. I don't, so those moments will always sort of stay with me.

Paula Redmond: 09:41

Yeah, and I can definitely resonate with that. I've participated in Tree of Life groups, you know, in the training and was fortunate enough to have some of that when I was working in the NHS, you know, as Professional Tree of Life, and to have facilitated and definitely those experiences, particularly as a participant have really stayed with me, and even when, you know, done it with groups of colleagues who I thought I know really well, and had worked for, for a long time, that experience of hearing those other stories, those richer stories, and something about the, that community aspect of it, that it can feel very safe and inclusive in a way, that's often the kind of meetings we have, don't feel safe, you know, it just can bring something very different. And I also love, just the creative part of it, you know, the getting out the colouring pens and creating the tree is also a lovely, you know, a lovely context for touching on this stuff.

Liz Matias: 10:51

There's something very soothing about it. But as you're, as you're talking, because obviously, you know, it's very much at the core of narrative therapies and, you know, you know, that sort of with, we can tell so many different stories about our life and our lives and multistoried. And every time I talk about the Professional Tree of Life, I'm connecting to different aspects. And at the moment, we are doing Professional Tree of Life in our own, my team staff support sessions. And that has been a... I haven't worked with, with a team very long, but nevertheless, I've learned things about them that perhaps even if I'd worked with them for another couple of years, I probably wouldn't have found out, you know, and I think it's been very nice, that sort of connection and building this connection and learning about people. And also, again, reconnecting with my own set, you know, because I'm thinking, what does it mean to be in this team? Now, I'm in this team and what, you know, and it's interesting, when you, you know, Julie, you might also connect with that, you know, because obviously changing teams and you know, and it's just nice to reflect on that, and to have that opportunity. And I think maybe, Julie, you know, maybe you know, our experience Julie is, we're sort of delivering it, but it's just nice to be able to have that opportunity to be on the receiving end. So I've really appreciated that, I think you do need that every so often. Yeah.

Paula Redmond: 12:06

I know that you have both applied the Tree of Life in some different contexts. And I wonder, maybe Julie, if you could tell us about using that in a supervisory context, just how that, your experience of that?

Julie Fraser: 12:25

So I am a systemic family therapist, and also as a systemic supervisor, and I have, I supervise the trainees, the family therapy trainees, as part of their kind of, you know, qualification route, that we have with placements, which means that every year I will have, you know, sort of four trainees and the final part of their training, where we run a clinic, which is set up of using a reflecting team model, and that's where I would as a supervisor be. They would take turns as lead therapist with families, and I would be live supervising. So I will be in the reflecting team and I will be giving sort of supervision, actually, sort of in the session and in the pre in the post around just sort of therapeutic work. So it's a new and it's obviously the way that that team working means that we have to get to know each other in a certain way. And we have to also really prioritise like good relationships with each other. And getting to know each and how we're going to work together. And over the, over the years kind of doing this, being a systemic supervisor with the trainees, I found that actually using the Tree of Life initially, but no more the Professional Tree of Life is really lovely to do just at the beginning and the end of the kind of year placement together. And it has so many different sort of functions it's as Liz was talking about with you know, yourself when you're getting you know, just to find out about who you are in a nice safe way because you have got this metaphor of the tree. So it's, you know, you can go really some way with talking about yourself as a tree. And you can see without actually seeing anything about yourself, like actually, you know, like well, I like this and I like that, you know, you can you can speak about you know that your, your favourite tree is an oak and that, you know, I love, you know, the strength of it, the age of it, the fact that actually you're saying a lot about yourself within the safety of the metaphor. So it's a really nice way of getting to know each other. And also those, so that safety that the questions it asks are, because they are strengths focused. They are about, and hopefully stories that you really want people to know about you. So it does that. So it's good for getting to know, building some trust, thinking about how we share and just thinking about that kind of feedback. So we use it in that sense at the beginning of the, of our placement, where we kind of build a forest, we find out about our trees, we have, you know we have it there as a sort of visual thing. But also it's just, yeah, also that transition because these are, you know, you're going from, you're a trainee and family therapy trainees always have a core profession, but they're making that transition from maybe a social worker to a family therapist, a clinical psychology family therapist. And obviously the tree is great about those stories about ourselves that are going to help make that transition, you know, that development of yourself, of identity, one of the, one of your stories of yourself, and what stories, what values about yourself and stories or principles do you have that you really want to, that are important and important to you and your work, and trying to really stay connected on what's going to nurture that, which is, I think, really important to do in the NHS, where people are defined in, in different ways, teams are defined and measured in outcomes and all the rest of it, I think. And then at the end of the, the placement, it's, it's also really lovely to look at it again, to revisit those trees. And then think about, we didn't do, we wouldn't do this necessarily, maybe it was the storms part of it, you have your tree, we've developed a forest and then you have the storms, you can think about how have we weathered those storms, and a real kind of rainbow sort of celebration at the end, that we've got through it and learned a lot from each other. So mostly, it's about privileging the supervisory relationships, and also just like, okay, in our, in our professional lives, let's remember what is actually really important to why we're doing this. How much of yourself do you want to bring into it?

Paula Redmond: 16:39

Yeah, I hadn't come across or hadn't, you know, thought about the application of tree of life within supervision. It's really interesting to hear of that and it, yeah, makes a lot of sense. And I guess I'm thinking about, as you were talking, about other teams, where you work closely together over an extended period of time, and, and the importance of the relationship to the quality of the care. And how useful an approach like that could be for that. And, Liz, I know you've been applying the Professional Tree of Life in a staff support context. And I'm curious about how that came to, that came about? How did you establish that?

Liz Matias: 17:32

So I kind of, there was a few things that sort of came together in quite sort of fortuitous ways, I guess. And I, I think in our, in our service, we were sort of a community mental health, community mental health service that I work in, and we were, we were sort of thinking to develop a Tree of Life for, for the community, for clients. And that had been very much influenced by Julie's work on inpatient wards. And I guess we were thinking about how to plant the seeds for that, how to kind of warm the context, this is in the wider service. And I think we was, and at the same time, just a very much unconnected way, I think, Julie, you had offered a Professional Tree of Life session to one of the community teams, that we would be recruiting service users from, for the Tree of Life group. And that then led to kind of, well, let's just offer it to everybody, all the teams, and it was very much a sort of shared project and all the sort of psychologist family therapists got involved in sort of co-delivering these sessions for the teams that they weren't linked, that they didn't work in. And so that was, I mean, you know, it sort of ticked a few boxes in that, well I was sort of, you know, and perhaps I'm a little bit more of a sort of selfish, and I thought, well, that's great everyone's gonna know what the Tree of Life is and when I started recruiting, I'll get lots of care coordinators knowing what I'm talking about, because they've done their workshops, you know. But also we were, we were sort of heading towards a brewing storm of transformation, organisational change, transformation, you know, perhaps there was going to be, one of those teams was going to be disbanded. You know, there was a lot of, I think, uncertainty on the horizon. And at that point, Julie, there wasn't any form of soft support at all being provided to the teams. No, so I think that's why I think they sort of do welcome it with open arms. I didn't, I don't remember Julie, I don't know if this is just my selective memory, there wasn't a huge amount of resistance towards having these workshops. Would you say that's...?

Julie Fraser: 19:49

No, I think...

Liz Matias: 19:50

Do you remember?

Julie Fraser: 19:51

Yeah. No, I think, I think they were welcomed. I think the attendance was good. And I think it came at a time when people really wanted to engage. I think it was, it was timely for certainly, yeah.

Liz Matias: 20:04

Yeah. So that's it. And, and it was also, I mean, you know, there was also another sort of more perhaps political reason why we might want to also highlight this work to senior managers in terms of the impact on staff and, you know, things from the storms, you know, we did get permission from all the teams to feed that back to the head of nursing. And I thought that was really powerful, it was really important that we did that. Because that was definitely a, you know, in response to a storm or to challenge that, I think, you know, staff felt would, I guess, help them, I guess, to give them a bit of a voice, I guess. And I think that was important that we took something beyond just the group that we sort of, you know, highlighted it. So that was, you know, that's, and then from that work, you know, you know, there was very positive kind of outcomes. It was a bit of a rough and ready evaluation. We just asked people how useful do they think it was? I got very high ratings of usefulness, and how, how interesting they found things. And there was also some really nice themes that emerged, which kind of fitted in with the things that we'd hoped the Tree of Life, Professional Tree of Life workshops would kind of support teams with. So team cohesion, people sort of were feeling much more connected to team members, there's more team spirit. And they were sort of also learning more about themselves, they felt more validated in their own kind of competencies, abilities. And there was also a specific mention, people valued being able to have that space to, to think about storms and how they can respond to them. So that was also a very key element, a key part of it. So going forward, you know, that shaped our kind of development of the model, which was sort of a two part workshop. So our offer for teams would be, this is what we're going to offer you, two parts. So the first part is, we come together, we think of ourselves as trees, you know, as Julie was saying it, it brings up, people start sharing, you know, very easily and naturally, and we sort of warm the context, we'd think about your favourite tree, you know, and then we would, as facilitators as well, bring a bit of ourselves to it, we would, we would sort of maybe think about, share, we would illustrate the different parts of the tree, what aspects of identity that represents by sort of maybe making reference to our own trees and what what are perhaps our roots, our trunks, our branches.

Paula Redmond: 22:32

And what, can you just say what they symbolise?

Liz Matias: 22:36

So I guess the roots are perhaps about what has brought you to the work, what's influenced, you know, your career or coming to the team. What's inspired you? And also, the roots can also be about what connects you with other members of the team. What does it look like to be connected? Like, I guess, roots in a forest and all the tree, you know, we know now trees, the science of trees, which is another thing we could talk about a lot, couldn't we Julie? We know, we know that trees form a connection, and a sort of you know, they connect with each other, and they communicate with each other in the forest, you know, so it's really important, you know, so I think part of the route is really, when you're thinking about the roots, it's really important to think about that bit as well. And so then what we do is, you can do this in any order, but I'm just working from the top up. But you know, so the ground is it's about kind of what does, what do you do day to day? What do you enjoy day to day? What's the bit of your job that gives you the greatest satisfaction? And why, why is that? Why is that meaningful to you? So it's your kind of everyday the ground. Then sort of the trunk. And that's kind of thinking about our values, our strengths, our skills, what we bring to the work, our assets. And I guess that that sort of usually those, there's a kind of influence of the roots into the trunk, we would see that there's, you know we can trace the history of the trunk and people's resources and skills from kind of their background. And then sort of moving up the tree, we've got the branches, and the branches, they're sort of longer branches for your longer term dreams and hopes for yourself, maybe for your team, for your clients that you work with, families, carers. And the shorter branches, maybe more sort of immediate hopes and dreams. And then what have we got next? Then we have the leaves and they're sort of the people that sort of, people that support you, whether it's people now or the past, or it could be, it could be people you know, or don't know, you know. So these are sort of significant others. So, the fruits are the gifts that you've received within your, you know, within your role, within your team. So things that kind of... gifts that kind of have made a difference to you, things you really appreciate. That can be things like support, understanding, it can even be, you know, being made a cup of tea, you know, things like that, you know, being offered a coffee break. And then the flowers are the things that you give to the team. And again, similar things it could be, you know, I dunno, if I was thinking about myself perhaps a bit of humour, biscuits, but also, you know, maybe psychological support. But and often we do find there's an overlap between, you know, the fruits and the flowers that's a kind of, you know, the sort of similarities within sort of gifts that you feel like you receive from your team and the gifts that you could kind of give. Yeah, they're the sort of fruits and flowers

Paula Redmond: 25:40

And any kind of, you know, in encouraging, facilitating people to you know, represent themselves in those ways, any particular examples or things that come to mind for either of you that have been interesting observations about that, that part?

Julie Fraser: 26:05

Yeah, Liz mentioned, the first thing we do at the beginning of any workshop is called warming, well warming the context is a sort of systemic term, but it's just using an exercise called what's your favourite tree. And actually, this, and I have to say that, you know, we have, it might seem like getting people to think about themselves as a tree sounds like a bit of, a bit of an out there kind of like a bit hippy, but actually, mostly, we find that people, there is something about that symbol of the tree and a tree, people have do have, they do have connections to trees, I mean, they are so integral to our planet. And I think, more so now than ever, I think we really notice them more than, than we did, maybe before. And I think that's something that we need to we've got, like a real responsibility to, to admire and value them and, and just, and just how important they are. But, and as Liz was saying with that sort of ecotherapy thing that we've kind of used, but anyways, this favourite tree exercise is brilliant, is absolutely my favourite part of the workshop. You really probably see the most, and it also helps you, it has lots of purposes, it gets you into that metaphor, like of the tree and thinking about what's, and it's not just your favourite, it could be like what's a significant tree? What's a tree that you like? What's a tree that you maybe see everyday or you notice? Is a tree from when you were younger? is that a tree from, you know, where you consider your homelands are? You're, just a tree that has some kind of meaning, or from a book, from a film. And people of all, like I say, people of all ages, you know, all different cultures, ethnicities, races, we're all in different places and people will always, there's people say something, they have got something to say about a tree. And it's, so it helps you get into metaphor, but it also, I think, brings out those stories from culture. Because often people will talk about trees that are from their countries of origin or, or where they, what countries they, they perhaps their family identify with, themselves identify with. And that's the rich start, you put good time into that setting up, that warming up, and really listen to the stories that people start to. Because they're thinking, it triggers other things, it triggers other memories, it triggers other thoughts, that and gets people into the place like, oh, actually, these questions are going to be a bit different. I'm going to be you know, this I'm thinking, and if you're also NHS staff or you're, you know, you're service users on wards and stuff, you as people buy trees, it, it lifts them out of where they are into a different kind of context to, to be creative, you know, and then which I think narrative practice of is incredibly creative practice.

Paula Redmond: 28:56

So everyone's kind of thought about themselves as trees and then developed their own tree and that can look all very different and what happens and what happens next?

Liz Matias: 29:12

And so then we would sort of invite each person to share what they would like from their tree. And yeah, that's always, and I guess perhaps speaks a bit to the challenges really, in that it's always a bit of a difficult balancing act, because you never have enough time and but, you know, but I think very much that individuals in charge of what they share and I think it's also important to talk, you know, to kind of talk a bit about sort of self disclosure and talk about sort of keeping things safe I think ahead of even before you even start the session, before you when you're selling you know, when you're sort of setting this up, even with the team before even get into the room, but I'm hopefully, by that point, by the time people have drawn the trees, and are sharing that, you know, you'd have to establish that sense of safety. And I guess everyone else is invited to kind of to listen, but I guess listening kind of with, with a purpose, and this is really sort of important part of this approach in narrative therapy, this idea of outsider witnessing from that, that everyone else who's listening has a role in kind of being able to, to kind of to reinforce the story, basically, to kind of, to think about, you know, what they connect to what resonates in them when they're listening to that story, and what they would like to kind of acknowledge in that person kind of story. So it's really important that people are sharing, everyone is listening, and then once the sort of, you know, one by one, you know, as stories are shared, you know, trees are sort of planted in the, in the forest, and that's done sort of symbolically by putting them up on a wall. And, you know, we have this lovely, then create sort of this lovely forest. And that's really, really important, because the forest is that kind of place of safety, it's that sort of connect, you know, it's that connection with everyone. And you kind of then have a bit of time for everyone to admire the forest, which is just to kind of have some time to look at the trees again, and to write messages of support, acknowledgement on each tree. So we just did that very practically by getting people just to write something on a post it note, and put something, and have a post it note on every tree so.

Paula Redmond: 31:43

And that's something that I've, you know, been again, you know, participated in and witnessed as facilitator, can be so powerful that bit of people kind of having... and there's something kind of quite public about it, you know, the fact that people are then saying something really meaningful, and often very moving and encouraging. Oh, it's really, you know, it can be so touching that bit, and to be kind of seen in those ways by your colleagues really can be, I think, quite profound. I can still remember, you know, years and years ago, being, you know, participating in that and being very, very moving experience, that bit those post its felt very precious.

Liz Matias: 32:38

And it kind of makes it sort of more real, doesn't it, and that sort of idea that, you know, identity is, it's sort of socially constructed, and having other people kind of sharing our values makes them more, I guess, and it's other people seeing our values that then creates that identity and reinforces our own sort of identity. And I think that's a really important part of the process. And as facilitators, then once we've, you know, we allow, you know, again, doesn't never feels like enough time, but we do really want people to be able to sit with the trees and look at the post it notes and kind of let it all kind of, you know, sink in, let them drink it in. And, you know, it is lovely, it's a, you know, it's a lovely part of the process. And as facilitators, then we kind of then do this sort of retelling, you know, we sort of then also thicken narratives, we kind of share what you know, reflections on the themes that we've heard, think about shared values. So the skills and the strengths and the hopes and dreams, and we really kind of really build that very, that sort of what's called a sort of riverbank position. Because we are kind of trying to establish that sense of safety and strength ahead of them the storms session, which will be the kind of the next bit of it.

Julie Fraser: 33:52

Within those questions, that the questions that each part of the tree asks and invites you to sort of tell stories about yourself. Within those questions, there are so many different narrative therapy techniques that are being used, you know, the kind of landscape of action, you know, which are the kind of when, and because Liz was sort of talking there about how you, you kind of hear those stories, but you thicken them. And that is, you know, in narratives when, just it's not, they're not just words, that you're not asking people just to draw a tree, and then go through these questions quite kind of mechanically, and just having a word here and there, that's that's just like a list. And that's not where the kind of therapeutic kind of task or value is, to it. So you use a lot of different techniques as the facilitators to sort of thicken those bits, those like little island of, of information into... so the land so like, yeah, so you're developing that island, that landscape, landscape of action questions, like so who, what, where, when? They're the kind of questions that kind of then give us more information, a landscape of identity that Liz was talking about. Okay, so what does this? What does this say about is important to you? Who in your life would notice this? How does, what does this say about what's important to how you know? Or how do you sustain that important hope that you have for yourself, for your team, for your service? And they're the kind of... but also, there's the re-membering. So it's like R E hyphen membering, like, who else is in the story? Who else would notice? They're all really lovely narrative techniques, ,the Tree of Life is just a, it's a brilliant, accessible narrative practice, you know, and narrative work is something that I really, I use a lot in my work, I think it's really useful. So, and that's the sharing part that Liz was like saying the sharing, it is the narrative principle is like stories told are stories lived and that its language doesn't describe one reality, our language creates the language that we, that we share with each other, in whatever different contexts it creates a reality. There is no, yeah, in all those multiple ideas, multiple stories, multiple truths that are going on in any one moment. And Liz I think use the word control, we have control. Which one do we, which one do we privilege? Which one is most important? And I think, I think that is probably the one of, the key sort of important things about using this approach in the NHS with staff. And we're saying NHS, but I have to, there is another project that we, that South London and Maudsley NHS had a really brilliant collaboration with the Keeping Well in Southeast London team and the care organisation, the care sector. So this, you know, are people working in care homes, and this was post, you know, post lockdown post COVID. And they used, they rolled out the tree, the Professional Tree of Life, to you know, dozens of care homes, hospices, organisations, in this brilliant collaboration, which of course, sadly lost its funding after like, you know, two years. But that was about you know, you know, offering this, this approach this wellbeing a group for everyone that worked like the domiciliary staff, the cooking staff, the catering staff, the managers all together, to who had gone through so much shit through, and been treated so badly, and with no support that actually yeah. And it was great. And the person involved in that is not here with us. But yeah, yeah, I'm just gonna nod to that amazing work that was done, actually. And yeah, so not just the NHS. Yeah, I think that is one of the great things, the accessibility and broad applicability and something that sort of, I don't know, speaks to a kind of common humanity threads. So Liz, I think we got to the end of the first part, did we in terms of what happens in that first workshop? And then you bring everyone back together for a second part?

Liz Matias: 38:19

Yeah, you in theory you bring every person who was in the first session back to the second session, doesn't always happen in that way. So that's another of challenges that Julie and I will speak to. And you gather again, as a forest, you, hopefully you've had, or if you haven't named the forest by then maybe think of a name, invite the team to, to name the forest, that's really important. And then again, think, reflect on, you know, we'll read over some of the post it notes, and just recap on kind of what was shared in the first session. And then we will, I guess, think about bringing, you know, talk a bit more about the difficulty that the team face, but using the metaphor of storms. And this is kind of, I guess, reflects another very key narrative therapy technique, which is kind of externalising the problem. So this idea that the problem is the problem, the person isn't the problem. And I think this is why this approach is so brilliant as a staff support approach, really. And I think, I think just of all the staff, you know, of all the sort of staff support sessions I've either facilitated or been part of, and there's been quite a few, and I think it's just been, I think, the most safest, I think the most sort of helpful has been sort of the ones that use a Professional Tree of Life kind of approach, in my view. And you know, and just say that some of the worst moments in my career in my life have been in staff support groups. So I you know, and so I just think that it's no wonder that I gravitated towards this work, actually, and I'm very, very, don't want to do any other sort of, you know, I'm very, very wary about any other sorts of approaches, but I do like the Professional Tree of Life. So you know, so I think thinking about then, you know, the challenges that team face and using this metaphor of the storms and has, so just like a forest and trees face hazards and storms, you know, we face those in our, in our professional work. And we then invite the team to think about the storms, name the storms. So think about what storms are, and then sort of the effects, so what impact does that have on them? And I guess, it's really important not to kind of get too stuck in that, to really then think about the responses, the preferred responses. So it's this kind of idea of a double telling that you don't just talk about the, you know, you can't just talk about the problem, you have to also talk about the preferred responses. And, you know, then it's going back to what Julie was saying, thinking about, you know, your expertise of facilitator and those narrative therapy kind of questions to, you know, to bring things back when teams perhaps invariably do get stuck in talking about the problem, bring it back to the problem, and then the sort of negative impact, and you're just trying to really think about, you know, well, you know, when you do that, well, you know, what, when has that sort of thinking about when's that storm been less present? Why, you know, what's helped? Or who, who has helped you at that moment? What, who in the team supports you? How do you as a team, you know, what, you know, what does it look like in a team when the storm has passed? You know, what, just kind of trying to kind of not get so stuck in the, in the trauma and that sort of story about the problem. And that's, I find, yeah, where it kind of is more the, where you sort of have to, yeah, maybe why some of the challenges do arise. And you know, to think, really about, what is it that the teams well want to commit to? Because it's very easy as well to sit there and say, well, yes, what we'll do is we will have, we'll go out for lunches more, or we'll try and take our breaks, or yes, what we will do is we will definitely try to, you know, ask for, you know, another OT, or, you know, we need... you know, and so it's a well, what can you kind of commit to, you know, or what is it that, you know, you're going to sort of do? Some accountability. And I think that's important and that's helped, I think, teams to make, to make changes in my sort of experience of having, of having that approach. And I think it was Julie, you know, I think if you remember you were the facilitating the Professional Tree of Life session for my team that was in at that point?

Julie Fraser: 38:27

That's right. Yeah.

Liz Matias: 42:00

And really sort of was like, well, yeah, what are you guys gonna do? What can you do? If I come back in, you know, you sort of came back for follow up? What are you guys gonna commit to? And we ended up deciding well, but I ended up, it ended up being me to sort of offer mindfulness. So every week we did, we did mindfulness, we were doing mindfulness before a team meeting. And we did that until, you know, sort of, I guess, we couldn't because of COVID social distancing, but it was that, it was really important that we had somebody there helping us, holding us to account a bit and really supporting us. Yeah, that's just sort of one example of yeah, of that.

Paula Redmond: 43:22

So there's something about sort of giving voice to the storms, but making it a different conversation to maybe what people are used to.

Liz Matias: 43:30

I think that's the key. Yeah, yeah.

Paula Redmond: 43:32

Yeah, kind of that accountability bit and thinking together as the forest about what they can do.

Liz Matias: 43:39

But also thinking a bit more about some exceptions to the problem, there will always be times when the problem is, this is another sort of assumption of narrative therapy, there will be times when there's less, you're less influenced by the problem. And to that, that's the important part, in kind of, you know, thickening that bit of the story. And thinking about how you then build on all the sort of resources that, you know, that live within the forest, and all sorts of themes that you've drawn up from the kind of the hearing y'know the trees and stories represented by the trees. And I think that's the kind of process really, that you're trying to aim towards. And you do have to sort of judge it as to how you're going to do that, because it depends on where the teams at, how much they're able to share more openly whether you're going to do that more in smaller groups, you know, you have to be very, very attuned to the team dynamics and if there's particular conflicts or difficulties, and you know, I think, you know, with any approach there's only so much it can do, and then thinking about, well, what else does this team, what else do you need? And it, you know, that's sort of a preferred response, but what we need to think about is how we then deal with these issues because yeah, I I think the Professional Tree of Life, you know, it's kind of obviously not a miracle cure for things but it, yeah, it does help. Yeah.

Paula Redmond: 45:06

And part of that, as you, as you said before, was about, maybe part of an action is sharing the storms outside of the group?

Liz Matias: 45:19

I think so because I think that steps away, you know, if you think about the dominant narratives, I think that we are just thinking about as an NHS member of staff, thinking about and particularly working mental health, and, you know, the sort of dominant narratives which are really unhelpful, like, you know, you must be able to cope, you have to cope, you know, whatever happens, you know, you have to just give care, you just have to, you know, you have to meet all the demands, if you can't, there's something wrong with you, or you can't ask for help, or there's so many of these very unhelpful, kind of dominant stories. And I think that's, yeah, I think that's why it's sort of taking a bit of a step back and thinking about yeah.

Julie Fraser: 46:01

And there's something about being, locating yourself in a forest where the forest withstands the storms, you know, that there's storms that you're all, that you're all experiencing, affect you all. And you know, I mean, using the metaphor, a tree in a storm in the middle of a field is not as protected as a tree in a forest when there's a storm going on.

Paula Redmond: 46:23

And what comes next, after the storms?

Liz Matias: 46:27

So then we do the sort of endings and celebrating the you know, the journey that we've been on and the work of the group and certificates. Yeah, and I guess Julie, it can also be things like, how do you sort of acknowledge each other? And in even during difficult times, or how to, you know, just something that's, you know, how do you? And even if, so, I think there's always going to be some sort of ongoing storm. But yeah, trying to kind of think about, well, you know, how do you sort of just come together make time for each other as a team? And what you know, and how do you mark significant kind of moments or, you know, sort of, I don't know, when people leave, or when people join the team or, you know, Christmas, different things, you know, just different things like that. And, yeah, so I guess you have to be a bit creative with it, as Julie was saying, it kind of depends a bit on the group, but it, yeah, but I do think that the rainbow has been that's a nice...

Julie Fraser: 46:38

Can I say actually, because I'm just thinking recently, we've kind of developed the, a rainbow. So we do a rainbow, where you sort of imagine you climb to the top of the trees, the canopy, and you look out and the storm is has left, it's you can see it the distance, it's you know, moving on, and then you have nature's beautiful gift to kind of celebrate the passing of a storm that you have a rainbow coming across. And then we have some questions that we've kind of created around, okay, so how do you... they're a little bit about how our preferred responses to storms, but also just sort of developing them a bit like how do you then celebrate the you've, that the storm has passed? Like, how do you, what do you want to share with others about what you've learned from the storm passing? But and you can be really, depending on your group, you can be really fun about that. Okay, you know, it goes down to that, okay, you're having a party, what are you wearing, what you're doing, what's sort of music are you listening to? You know, how do you all... but then sometimes that doesn't work. You know, that's not how people necessarily, your group might celebrate. So you keep that idea of celebration open. But then you, I mean, we might be, I could easily get into the challenges here about how storms, a challenge can be about well, storms never pass, we're in a constant storm. And how can we celebrate something that's never, you know, I'm thinking about in particular, in organisations like the NHS, where you've got all the systemic, contextual kind of circumstance stuff that just are beyond your control, andyou feel like you're in this perpetual storm. But again, there yeah, but there's something about well, it's not an actual storm, is it stories, it's our preferred responses to storms. I mean, the whole Tree of Life approaches about stories, and the telling of stories, and reminding that like Liz saying it's not a panacea, it's not a something, but it is an intervention, you know, an approach that will help us think about, create, share, and develop stories about how we want to respond. The preferred way of responding, yeah. And we draw that now, and it's something, like so we'll have the tree drawn on one page, and then you'll have that, you know, we'll put them together then, either sometimes, people put it on the other side of the page, or they take a fresh piece of paper and they draw storms. So for the storms exercise asking about okay, so how do you? And Liz, you talked about in the storms that it's not... we're privileging the response to the storm. And there's a belief within you know, and out of principle that in in any moment, we are responding, we are taking an active stand, we are, you know, we're not just passive recipients of, you know, we have agency, and that's what the narrative therapy stories are sort of tapping into that resource. And so you do the storm, but we've, we've made that more creative and we draw the storms, you write on the storms, and then you have this gorgeous big rainbow, like at the top, which is, you know, when you try and say to people use as many colours, bring stickers, glitter, you know, and just make this beautiful rainbow and then just write your rainbow, have the rainbow questions next to it. And then as Liz was saying, the certificates, I don't know if you want to say a bit about the certificates, how they work or different ideas of how you can use the certificates?

Liz Matias: 50:39

I gyess it yeah, I mean, it's the certificate, I guess what we tend to sort of put on them is kind of thinking about it's a way of kind of acknowledging people's hopes and dreams, appreciating the kind of people that support them, special people that have helped them or influenced their sort of their professional kind of career, and also thinking about their particular skills or strengths, that's something I've also put on certificates. So again, it's another way of telling, of thickening that story, and I guess yeah, a story told a story lived. So, you know, that sort of idea. And we just kind of get staff, members of the team to present them to one another. And I think that's kind of a really nice way of kind of doing it.

Julie Fraser: 51:32

And it's a way actually Liz, with when, now you saying about them presenting to each other, sometimes the sharing part, again, I mean, this is some of the challenges, actually some, y'know in talking about and be sharing your tree, you've got a lot of choice on what you share and what you don't. And actually, sometimes in a group, there are some groups where it doesn't feel quite safe and or it's a very short group, or it's a very it's, you know, you got one one week and then the next one a few weeks later, like in the storms follow up. But the certificate part is a really structured, safe, where it's got like it's an actual certificate with the three questions that Liz said, important people, hopes and dreams, and who would you know, who's contributed, I think to your, the people that have contributed to your life. You by asking them to fill in, fill it in for each other, then you, you read it out. It's a, it's just a kind of, a kind of sneaky way of getting people to share or to hear in a nice kind of way. So they just sort of present their certificate, and then at least you get yeah, and you think it'd be really cheesy, you think people are not going to be go for this, but actually, I don't know, a single group when people have not clapped, and been smiling and given their certificates and been like giggling like, oh, this is like school, you know? And it's it's actually been one of the really nice powers of it.

Liz Matias: 52:53

Very powerful. Yeah, yeah.

Paula Redmond: 52:55

And I know you've touched on, you know, some of the challenging bits, but any other things that you want to mention, for people who are listening, you know, things that...?

Liz Matias: 53:04

Go on Julie, you can start, I mean, how long have we got?

Julie Fraser: 53:10

There's a number of things about the sort of challenges I mean, okay, there's at every different level. I mean, maybe something about just actually in the group, because we're talking about the sort of pros in the group, people, some teams, where there are lots of maybe interpersonal issues going on or dynamics or just where it can be just, you can just it's tricky, those the kind of because it is an approach that kind of focuses on relationships and sharing and developing trust or, that can be tricky, with certain if you've got some difficulties in your relationships. But also, I think the setting up of it, what people are, so there's something about if teams are also like having a really hard time, and then my manager suggests something like oh go to your Tree of Life, that will really help the whole situation. And people are so pissed off, and they're so angry, and they're so, and there's so many complaints, and nobody's listening to them, that they get, they're really stuck in the problem story. And it's, and I think, in terms of a facilitator, you've got to do, it's really important to get a good idea, have a good kind of, before you go in and facilitate with teams get a good idea, a good session with the managers like what's going on? What's the context? What's going on for this team? What do we need to know? And give loads of information about what the actual workshop involves. And that's why we've developed these kind of self reflective workbooks where we give to teams now where they can, they've got the questions, they can think about them, they can start to get an idea and then they, you know, they bring that work into the group, which is also works really well with the time constraints. I mean, time constraints is another thing teams are like well, we've got 45 minutes, okay, I'm not sure we're gonna..! But yeah, so those kinds of things, lots of the setup, lots of what about expectations. Liz, do you want to? I've got a list, d'you want to, do you want to jump in?

Liz Matias: 55:11

No, I guess this idea of preparing the ground is, you know, as I referred to in the chat, you know, you've really got to do that. And, you know, because you, you know, that's you start building your sort of relationship with the team as a facilitator or facilitators and that's really important. They've got to know what you're about, and what's going to, you know, sort of what can and can't be achieved from the group. So yeah, you do have to put that time in first. And I think this sort of catch 22 situation really isn't it, that teams kind of well, that they kind of need the support, but they're almost either too sort of under pressure, too short staffed to make the time, they're too stretched, they need the support, but they're sort of can't access it, you know, it's just... so I do think we come across that quite a lot. And then it means that people can't, the time isn't protected, even if, you know, I dunno if a senior manager are paying lip services to the importance of it. But where's the, where's the time? How can you protect the time?

Julie Fraser: 56:16

And they maybe don't attend, and then that sends a message.

Liz Matias: 56:19

Yeah, so the other thing is about who attends. And when we, I think a lot of the feedback that we get when we ask people, you know, how was the session? What did you think, was the least helpful aspect? The most sort of one, of the most consistent bits of negative feedback is not everyone attended, or, you know, there wasn't, you know, wasn't key members of the team there. And it does really matter, it does make a difference. And I think it's difficult as well, more, I mean, Julie, maybe you're remembering this, the team that I'm talking about, but we had a bit of a an ordeal with offering the session to a particular team, there was a lot of conflict, a lot of issues. And, you know, when we offered the storm session, I mean, half the people hadn't been in the first workshop, and you just think, well, you know, what are we going to do here? You know, we're talking about storms, and some people don't even know what the Tree of Life is, they've not looked at the workbooks. So there's that sort of stuff that, you know, it's really difficult as a facilitator because you can only do so much, and if people aren't, you know, you, the sign up is that you can only do so much as that sort of sign up and if people don't want to do it, they can't engage then that's, I don't know, I haven't really found a very, you know, you can do all you can and then there's you know, there's only so much isn't there, Julie, but it, people still have to be ready and willing to do that.

Julie Fraser: 57:33

Yeah, so definitely doing the work before, setting it up well, what, what can you actually do, unlike when you spoke a wee bit earlier, Liz, about how, you know, the storms are preferred ways of responding to storms. What can you do when? And things like, you know, and it is about, okay, you know, realistically, let's give yourself things that you can. Is it, and being really, yeah, but the realistic of what's within our control and what's outside of our control in these large organisations? And actually, let's be careful not to put the emphasis on individuals and teams to correct problems that are not. And for people not to feel that they responsibility for those, for those, those changes. And actually, these are systemic issues. I think that's yeah, so it is about what does it achieve. But yeah, in time, what just, like Liz said, protected time, sometimes people would like say I've got an hour or an hour and a half, I've got okay, but again, then we can speak to some of the you know, real, the positive stuff about the flexible stuff, the accessible stuff about Tree of Life, that actually, you don't have to complete it, you can just do a part of it, I think in the different formats, you can focus on just one part of it, and you will still get something out of it. It's not, it doesn't have, it's not that the therapeutic value is completely, you know, removed or, you know, just because you don't complete the entire, go through the whole format. I think it's, but it just puts pressure on your facilitators, I think to, yeah, to deal with those kind of attendance issues and yeah.

Paula Redmond: 57:48

And I guess I'm hearing, you know, from you guys, some of those stormy bits that you've encountered in doing with work and, and your preferred ways of responding to that in terms of holding on to the bigger picture of things and, you know, doing what you can do with what you have. And I'm wondering about that next bit as we kind of come to the end of this, about what what celebrations you hold in, in having been part of this work? What are the things that you would be writing on your certificates as having done a lot of this work? What, what do you hold on to?

Julie Fraser: 59:45

Oh definitely. It's like working with people like Liz, you know, and we also have another colleague who knows we, that kind of a lot over the years, you kind of, you end up, so there's sort of certain people are really interested in this approach and you get to work with them doing it, training, and you know, designing our materials and things. So it's definitely about you can actually, yeah, get a lot from like working together in a way where we feel like it has actually has meaning and value to people. And Maggie, I'm thinking about Maggie. So the thing is, the big thing about our model that Liz and I have sort of, really sort of shaped in where we, in our NHS Trust we work in that is co-produced. So we, you know, we have some, you know, somebody with lived experience of using mental health services, who always kind of is part of that work, and also in the Professional Tree of Life. And that, I suppose, embodies the stories of like Liz was saying, of hope of recovery, of different stories of what people, and who we are, and we're not diagnosis, we're not just, we're kind of people and so we have this lovely colleague, Maggie who we've worked with for over 20 years, she's a service user. And I think that relationship gives, I mean having that, being able to work with Maggie in that kind of way has been, for me, like one of the really special thing in my my working career, like I said, keeps me going, because there are lots of things that are really rubbish about working in the NHS.

Liz Matias: 1:01:18

Yeah, I mean, I think it's really true Julie that I feel like reconnecting with the Tree of Life, any sort of, anything to do with the Tree of Life, has really sort of reinvigorated my sense of purpose in a sort of I think, you know, within my, and I've sort of, you know, it's been it, we've all, you know, obviously, everyone hasn't been an easy time for anyone has it over the past few years? But I think I had gone through a very difficult time, I was going through a very difficult time a few years ago, and really felt disconnected from any, from just any, from that sort of preferred identity about my myself as a professional, and really had to... and actually writing that chapter about our work with the Professional Tree of Life was really sparked, was really helpful in sort of I guess my recovery from that and sort of coming, I guess, being able to kind of, yeah, get through that sort of, very, sort of, I don't know, black pit of just feeling like, I just don't know what I'm doing in my job, and I don't like my job, you know, and lucky to get another role and a lovely team, other lovely team, but, you know, still to have those connections with the tree Life team and Julie and Maggie and to, you know, to be able to kind of celebrate the work that we've done with the Professional Tree of Life, which again, Julie, you know, we don't do enough of that, I don't really think we don't have enough time to write about what we do. Well I certainly don't, and maybe you've done a lot more of it. But and so I'm really thankful for you, Julie to you know, sort of, you did give me that opportunity, and a kind of it was a bit like, okay, bit of a kick up the backside. So yeah, come on, you've got to do something now Liz, and so I'm very grateful for that. And I think that that got me into a different kind of, yeah, sort of headspace and it made me think about sort of the more positive things that I've achieved, because I guess I was just thinking, no I just, I haven't done anything with my life, my career and just everything's rubbish. So, yeah, just thinking really about that.

Paula Redmond: 1:03:30

So being able to connect with those, you know, other stories within yourself.

Liz Matias: 1:03:35

Yeah. Other stories, and it's just very, it's just kind of yeah, like, it's just, it's kind of nice. It's like thinking well, yeah, you know, we've kind of, we have, you know, done a lot, worked quite hard, and, you know, Julie especially I think, so to kind of really, to create, you know, to kind of break to kind of establish the Tree of Life to the extent that it is in SLAM and beyond, so I do think that that is really important to celebrate that.

Paula Redmond: 1:04:08

Thank you for listening. If you've enjoyed this episode, please support the podcast by sharing it with others, posting about it on social media, or leaving a rating or review. I'd love to connect with you, so do come find me on LinkedIn or at my website. And do check out ACP-UK and everything it has to offer. All the links are in the show notes. Thanks again and until next time, take good care.