Blind Spots: An Exercise in Self Awareness and Introspection

	A driver who does not learn the location of (and frequently check) his or her blind spots while navigating busy traffic risks collision. Blind spots exist not only within cars, however, but also within us. We have learned from the psychological sciences that emotional mechanisms, learned earlier in life, but no longer seemingly appropriate, can obstruct our cognitive vision or restrict our emotional intelligence.1,2,3      Likewise, anxieties, fears, unresolved conflicts within ourselves or in our relationships, and assumptions about the way the world works and our place in it, can effect how we “drive ourselves” through life, denying us access to the full road available or even causing a crash–in the relationships we build and within our professional responsibilities. This is true within all professions that acknowledge a fiduciary relationship, and in Social Work, the effects can be very serious. Social workers, for example, when closed off from their true internal resources – intellectual as well as emotional and intuitive-- may crash into clients’ emotional barriers, for example, or may veer away from difficult but important decisions and conclusions. Likewise, they may make less than intended or capable good judgments in communicating their expectations with and responding to the needs of clients. The results can be missed opportunities for critical and meaningful interactions with others. On the other hand, the “fully present” and “mindful” Social Worker makes use of the totality of their internal resources. He or she is a more compassionate, more intuitive, and ultimately a more effective care-giver. One would expect that the professions comprising all of care giving would require skills in the subtle delineation of diagnostic criterion and the application of complex scientific findings, often within highly emotionally charged circumstances. They would also require skills at becoming aware of their internal circumstances. Indeed, what we don’t know about ourselves greatly affects our professional decisions and our way of interacting with both clients and our colleagues. In reality, there have been gaps in education and training. Many of us are rarely given the opportunity, let alone the tools, to explore, to understand, and to “work through” our individual blind spots. The essential skills, moreover, do not come easily, but only through hard work, discipline, and with the caring support of colleagues and mentors. This session will utilize small group reflective learning (SGRL) in teaching us to bring an empowering tool, The Awareness Wheel to our teaching and educational encounters.4 SGRL assumes that learners reflect on their experiences, assumptions, and inner life best when done in a small, supportive group, facilitated by a mentor or guide, and supported by other learners with the same objective.5. While all educators and supervisors will have had experiences in working with Social Worker’s defenses that interfere in total care of those we serve, The Awareness Wheel provides an educational structure and an articulated and practical vocabulary for seasoned practitioners and those new to the profession. This model delineates the various components of our identity, personal and professional, into universally applicable categories. It is believed there are at least six, but probably not many more. They include: thoughts, beliefs, intentions, physicals sensations, intuitions, and behaviors.  At the center of the wheel sits the Social Worker’s personality, prior experiences, and attitudes about care for others. By utilizing the components of the Wheel, participants will hopefully be better able to analyze and assess their interactions with patients and clients in a more illuminative, mindful, and insightful manner. List up to 4 objectives for the participants: After the completion of this seminar, participants will be able to: 1. Learn the concepts of what blind spots can be and their impact on client care and in training encounters with our learners. 2. Understand and conceptualize the use of The Awareness Wheel in working with blind spot behaviors. In this presentation, the intent is to use The Awareness Wheel to facilitate our emotional/professional growth, away from blind-spot-motivated behavior to a more integrated, whole and fully “present” practice. 3 Discuss the use of The Awareness Wheel in Continuing Education and professional development utilizing client-based education and traditional principles of adult education. 4. Introduce “mindfulness” as an integrated process in best client based-care.6 “Mindful practitioners attend in a nonjudgmental way to their own physical and mental processes during ordinary, everyday tasks. This critical self-reflection enables caregivers to listen attentively to patients’ distress, recognize their own errors, refine their technical skills, make evidence-based decisions, and clarify their values so that they can act with compassion, technical competence, presence, and insight. Although mindfulness cannot be taught explicitly, it can be modeled by mentors and cultivated in learners.   People can also engage in mindfulness training and learn to experience its usefulness.   As a link between relationship-centered care and evidence-based practice, mindfulness should be considered a characteristic of good clinical practice.”7 Describe session content:  * Introduction to the nature of blind spots and discussion of their effects on interpersonal /professional judgment. * Introduction to The Awareness Wheel and its component parts. * Participants will divide into small groups, with different levels of professional training and experience.  *. Participants will apply The Awareness Wheel to presenter-composed scenarios using its structure to articulate some classic blind spot motivated behaviors. They will then discuss both helpful educational strategies as well as pedagogical approaches to training Social Workers for further blind spot discoveries. * Participants will first be asked to consider a blind spot or two of their own, and then to share any of them they are willing to do.  The group will be there to assist and help in reducing blind spot behaviors in these practices. Experience has been that some blind spots are humorous and while they contribute to less than intended outcomes, they should certainly be shared. Participants will be engaged in this workshop by: * Actively contributing their own knowledge and experience to the general discussion of blind spots, and more specifically, to the problems germane to the effects of blind spots on quality care. * Analyzing the encounters to “practice the practice” of The Awareness Wheel technology. * Reflecting on how they might employ this technology as an adjunct to their practice and learning skill sets. Format and Time Limits  1. Ask participants to share their reasons for attending this session, order of presentation, themes and goals, terminology of blind spots and The Awareness Wheel. (10 minutes)  2. Divide into small groups, select a scribe, and begin to reflect on blind spots observed in learner interactions. (20 minutes)  3. Exploration of The Awareness Wheel using handout and visual aids. (20 minutes) Break (5 minutes)  4. Reflection-on-action for participants to compose their own possible Practice Plan using The Awareness Wheel. (30 minutes)  5. Consider future planning.  (5 minutes) 6. Evaluation and feedback ********* When others are generous enough to permit us to debate and assess some of their self described blind spots, we must always be cautious in judgment and conclusion.  Many of us may yet come to understand that “…blind spots are universal, and less a sign of inconsistency than proof of humanity.” 8    With this in mind, here are some examples of perceived blind spots submitted by graduate physicians in training, medical students, faculty, and other educators at medical conferences. While I am supposed to be non-judgmental about obese patients, I realize that I get angry and short with them. When asked why I wear a religious symbol on my lab coat, I got very frustrated and felt intimidated. My family came here with nothing, and I don’t like patients who take advantage of our opportunities to succeed.*  I just don’t like attending physicians that think and act like I am nothing to them.  I became a doctor to fight death. Now, it seems like I am losing that fight too much of the time. My family kicked me around and I never complained. * I used to think winning was just about everything to me. I feel there are too many lazy patients in my schedule. My mother taught me to always wipe myself well and I can’t stand it when I see patients with some poop in their underpants.* I get so angry when patients come to the office dirty and unkempt. I work harder than my patients do with their health problems.  Why aren’t they more responsible and motivated? Being a doctor isn’t what I thought it would be! I can’t stay focused on patients after a certain time of the day. I am their doctor.  Why can’t they just tell me what is going on? Doctors get a bum rap these days.  Why is that so? I wonder if I could handle their problems as well as they are doing? I struggled too much to have to put up with this patient’s bull. I wonder how long I can do this. I shudder when I see that patient’s name on my schedule. I can’t get any place with this difficult patient. I had the same problem with one of my family members.* Why does my patient always listen to everyone in his or her family and not me? Is every patient I see a borderline? *Our internalized family of the past can be a very potent force in our professional life. “We each live inside the domain of our own experiences.”9 ****** Finally, “Most of us do not realize the extent of our influence on others-and the potential of our inner world of attitudes and beliefs that affect such influence.”   Carl Jung Alan S. Wolkenstein, MSW, LCSW Clinical Professor of Family Medicine (Ret.) University of Wisconsin School of Medicine and Public Health Senior Educator and Consultant-Wolkenstein and Associates, LLC    References . 1.Shelton CM. Blind Spots. NY: John Wiley and Sons;2007. 2.Van Hecke ML. Blind Spots. Amherst, NY: Prometheus Books; 2007. 3.Covey, S. The 7 Habits of Highly Effective People: Powerful lessons in Personal Change. Ontario, California; Franklin Covey Publishing Company, 2001. 4. Gorman, J. “The Awareness Wheel.” Unpublished thesis, 2007. 5 Kolb D, Fry R. Toward an Applied Theory of Experiential Learning. In Cooper C.           (Ed.) Theories of Group Process. London: John Wiley; 1975. 6.Fulton P, Germer C, Siegel R. Mindfulness and Psychotherapy. NY: Guilford                      .Press; 2005. 7Epstein R. Mindful Practice. JAMA.1999; 282{9} 833-839. 8. Perry M. Truck; A Love Story. NY: HarperCollins; 2006,p.177. 9. Dell P. “In Defense of Lineal Causality. Family Process.1986; 25(4) 517.    Finally, let me suggest that this topic of blind spots and the utilization of the Awareness Wheel will serve well with a more varied audience of health care professionals beyond Social Workers in various stages of training and experiences. It has practical applications to all of us who provide direct and auxiliary care to those people and families entrusted to us…