Emergency on planet earth
Private Practice, June 2023

The latest report from the Intergovernmental Panel on Climate Change¹ confirms that the jury is now officially in. Anthropogenic climate change is underway to such an extent that we are facing a species-wide challenge. Theories abound, not only about how we have ended up in this mess and what needs to happen next, but also about what could happen should responses continue to be inadequate. For some, civilisational collapse and human extinction in the near term are inevitable.^2,3 For others, we’re on the threshold of a major transformation of human consciousness, which represents the next evolutionary leap for our species.⁴

Between these two poles seem to be a range of positions and narratives. As a registered healthcare practitioner working in mental health nursing, I’m still unsure as to whether we’re talking about hospice nursing or midwifery with complications. In any event, as a species we seem to be in the deepest of trouble. To use a medical metaphor, if our home planet were a patient, there would be a crash team, tubes, bleeping machines, an army of nurses and a small gaggle of specialist consultants on hand. What we have is planet Earth triaged onto a waiting list, with the paramedics trying to keep her going and pushed up the list as a matter of urgency.

While I have used a metaphor drawn from physical medicine, we know that where there is physical trauma, psychological trauma is often not far behind. As a mental health nurse working with people who have been profoundly impacted by our climate and ecological crises, I’m forced to ask myself, ‘What does mental health actually mean in a context that is so unstable and where the future seems so bleak?’ With the term ‘eco-anxiety’ entering the narrative, and the arrival of the Hogg eco-anxiety scale,⁵ people’s genuine and valid fears for the future are seemingly being pathologised. Waiting in the wings are fledgling recommendations for the ‘treatment’ of ‘eco-anxiety’.⁶ While some of the initial findings are promising and the absence of a pharmacological approach reassuring, the use of the word ‘treatment’ remains worrying.

Joanna Macy more aptly uses the term ‘environmental despair’.⁷ In subsequent writing, this experience isn’t packed neatly into a pathological framework, but more eloquently and thoughtfully discussed from an ecosystemic perspective.⁸ The excruciatingly painful experiences of environmental despair are seen as a sign of healthy awakening to, and empathy for, the distress and suffering of a world – human and non-human – that’s in freefall destruction. The suggestion is that each of us is as connected to each other and the entirety of life as our earlobes are to the rest of our bodies. Dan Siegel, in coining the term ‘MWe’ (Me+We)⁹ seems finally to be bringing social neuroscience in line with Joanna Macy’s thinking. Do you see Patient Earth on the waiting list? That’s us, in the ‘planetary MWe’ sense of the word. Small wonder that our mental health has been taking such a battering.

To return to Patient Earth, languishing on the waiting list, there seems to be a similarly baffling array of formulations as to how ‘MWe’ ended up in such a pitiful state. We have a smorgasbord of conferences, workshops, webinars, Slack channels and books with new perspectives, debate, controversy and theories emerging… and yet Patient Earth remains, firmly, stubbornly, on the waiting list. I have worked for 30 years in the public sector, so the phenomenon of the waiting list is not new to me. In fact, it was the final straw that led to me abandoning so much of what I had been taught about mental ill health and its treatment. I needed a different paradigm with which I could approach the diverse and growing tidal wave of human suffering that I was facing in my work. Enter the solution-focused (SF) approach.

The solution-focused approach

The question, ‘What is solution-focused practice?’, invites conceptual responses (what it is all about) and practice responses (how it is done). There’s much I could write about the former and some of that will emerge as I turn my attention to the latter. My starting point is Shennan’s observation that: ‘…the solution-focused approach is a questionbased approach. The solution-focused worker tries to find useful questions to ask, rather than answers or advice to give.’¹⁰

There are two broad approaches to using SF practice. I’ve used it in a formal and structured manner in ‘clinical’ settings in children and young people’s mental health services, where referrals have been made and allocated and there’s an expectation of ‘therapy’ being ‘done’. I’ve also used it less formally in situations where there’s been a need to respond more organically to people in crisis, without necessarily following a formalised and structured approach. I recommend Guy Shennan’s text¹⁰ as an excellent entry point for the newcomer, or Evan George’s short video explanation.¹¹ Having said that, I’ll take the variety of descriptions available as licence to add my own perspective, in the context of working with people for whom thinking and talking about our environmental crisis have been having a devastating impact on their mental health.

My observation is that people who have come to talk about how information about the climate emergency is impacting them are in crisis. It’s not so much that they have been experiencing the ‘environmental despair’ described by Macy,⁷ but that this experience has been unexpected and unmanageable and has been having serious and multiple negative impacts on their lives.

My perspective on the SF approach is derived in part from the work of Assay and Lambert¹² and descriptions of the nature of the relationship between the person coming for help and the person offering help that are to be found in much of the literature on SF practice (for example Ratner et al).¹³ From Duncan and colleagues’ perspective, the client is the hero of the story.¹⁴ From a SF perspective, I would agree with Anderson and Goolisham’s framing of the client being the expert.¹⁵

To expand further, the client has the knowledge, resources, creativity and, indeed, ingenuity to navigate the ups and downs of their life. The practitioner will therefore inevitably be in a not-knowing and non-expert position. This idea of the practitioner not having ‘expert knowledge’ seems to be a logical outcome of how SF practice developed. It emerged not from any set of psychological theories about human behaviour or psychopathologies, but from practice, as practitioners continually sought to ask themselves and the people they were helping how they might be more effective. Ratner and colleagues suggest that ‘Attempting to understand the cause of a problem is not a necessary or particularly useful step towards resolution’.¹³ I’ve found this stance to be particularly helpful as we all grapple with the magnitude of what’s been happening in the world and where it’s leading.

Professor Phil Barker, one of mental health nursing’s leading academics, has long contended that the project of helping people with their problems is both deeply relational and reciprocal.¹⁶ I suspect this was never truer than it is today. Having been personally deeply affected by environmental despair and engaged in an ongoing journey of discovery about living with and being informed by it, rather than ‘curing’ or ‘managing’ it, my expertise comes less from study and training and more from lived experience.

How does the therapeutic encounter work when the people within it are both ‘helper’ and ‘helpee’, and, at the most fundamental human level, peers who are deeply affected by the same issues? I’m forced to ask myself, ‘What does it mean to be a therapeutic practitioner in our world today?’ Can there ever be a place for a first-person description from a therapeutic practitioner of their own experiences of reckoning with environmental despair? If so, where is that place, and does it belong at all within the therapeutic alliance?

Mae’s story

I use a vignette from a conversation with a client to illustrate how this might work. I am grateful to ‘Mae’, both for allowing me to record it for publication and for being part of my own journey of learning about how best to respond to and live with what’s unfolding. Their name and identifying details have been changed to preserve their confidentiality.

F: So, what are your best hopes from us talking together, Mae?

The wording of the opening question – as with all subsequent questions – is vitally important. I could have asked, ‘What brings you here?’ or ‘How can I help?’, but I want to ask a question with the word ‘hope’ in it. This is a common opening question in SF practice. It not only establishes a clear purpose and direction but also introduces the possibility of something hopeful happening for Mae, at least at some point over the next hour.

M: I’m feeling completely overwhelmed by the whole climate thing. Everything I read and hear is just so… horrible. Most days, I just want to curl up under the duvet and cry all the time… I feel like I’m no use to the kids… My GP told me that I’ve got depression and that I should see a counsellor. I’m not interested in taking pills – that doesn’t solve anything.

Mae doesn’t answer my question. This is common – some people will start by letting me know what they need me to know at the time. I listen carefully in a very particular way, described by Lipchick as ‘listening with a constructive ear’.¹⁷ My interpretation of this is that, when listening to someone’s description of their suffering, rather than listening for information that will contribute to a hypothesis about them and their problem, the SF practitioner is listening for strengths, resources and personal qualities in the quest to define the suffering as containing the seeds of some sort of achievement.

F: It sounds like things have been terrible; feeling overwhelmed by what you’ve been finding out about the climate thing, having kids to be thinking about as well, and then not feeling any use to them. What on earth gets you out from under the duvet and keeps you going?

Here is an example of O’Hanlon’s ‘acknowledgement and possibility’ principle.¹⁸ O’Hanlon points out that acknowledgement of a person’s suffering is an absolute prerequisite for introducing the possibility that there might be nuggets of gold to be found in there somewhere. I do this by summarising, using selected words from Mae’s description in my response to weave a co-created narrative. But the key in this particular response is in the words ‘have been’. Placing these experiences in the past creates some space in the present moment for this new narrative. The question is designed to gently invite Mae’s attention to a possible nugget of gold and a hint of her own agency, given that she’s been feeling overwhelmed. I’m assuming that something has been getting Mae ‘out from under the duvet’ and keeping her going. My evidence, slim though it might be for some – but I’ll take it – is that she is here talking with me now. I therefore place the question in the present.

M: Well when you’ve got three kids… you know… you’ve just got to keep going somehow…

The casual ‘you’ve got to keep going somehow’ is a response that I’ve heard so many times, and one that I’ve uttered myself. I want to invite a consideration of the enormity of what Mae is achieving.

F: Blimey… three? M: Yep, and a dog! And no help. My husband died a few years ago, so it’s just me and… and… this… [starts to well up with tears, then starts sobbing].

F: Yep… this…

I am sticking closely to the O’Hanlon principle¹⁸ and staying with acknowledgement of ‘this’, echoing her ‘Yep’. I have had my own version of ‘this’, but I’ve no idea whether my ‘this’ bears any relation to Mae’s ‘this’, so I tread carefully. The ‘not-knowing’ position I referred to earlier needs to come into its element right now. However, let’s recap what I do know, from what Mae has told me. She’s a single parent with three children and a dog. Her husband died a few years ago. Something has launched her into finding out information about a topic that many people find hard even to begin to engage with. The challenges of parenting three children alone, coupled with the overwhelming emotional impact of what she’s been learning have been significant. There are so many questions to be asked. But the task of the question is not for me to find out more information. The question needs to be useful to Mae, right now, in this moment. So, I wait, watch and listen, until Mae lets out a sigh.

F: How are you doing? Need to get a tissue?

M: Nah… I’m alright. I needed that. Thanks. Now I’m curious – what did I do?

F: Thanks? M: Yep, you just let me cry and didn’t interrupt or give me all that s**t about (in parody voice) ‘Oooh… it’s OK to cry. It’s fine’. It’s not fine – it’s completely s**t. Everything’s so f****d up.

F: OK, so one of your instructions for me is, ‘When I cry, shut up and let me cry’?

M: (Laughs) I’m sorry that sounds bossy… but, yes, that would be really helpful. I don’t cry in front of the kids, and when I start crying around friends or family, they keep fussing over me, telling me I need to see my GP… so, I’ve just been holding it all in…

Despite Mae’s apology, I can sense the therapeutic alliance developing and know that she needs me to see and acknowledge her emotions as they arise. The subject of emotions has been an area of contention within, and misunderstanding from without, the SF approach.¹⁹ However, Lipchick is very clear about the centrality of a concern for human emotions in our experience, which therefore should be incorporated into the approach. When practitioners listen and attend to their clients’ emotions and struggles, as well as their strengths and ‘gold nuggets’, people can make their own changes. Lipchick’s perspective has been central in my use of SF practice in this context.

F: Thank you for being so clear about what you need from me. So, one of your best hopes from our talking together is…? [I pause, searching for the right words].

M: …for me to have a good cry! Mae finishing my sentence indicates that we do seem to have the makings of a good therapeutic alliance and the co-creation of a narrative in the present moment about her situation. Notice how I’ve returned to ‘best hopes’ but have framed her need to cry and be seen as one of her best hopes. I’ve done this because, as Shennan points out, when people come to talk, the assumption is that they want something in their life to be different.¹⁰ I want to invite Mae to consider what difference her stated best hope so far would make in her life in the future, beyond our conversation.

F: So what might you notice yourself doing differently in your life if you could have a good cry?

The ‘what difference…’ question invites Mae to consider what she would like to be different outside the conversation, once it’s complete.

The future is of primary focus in SF practice. What I’ve found so fascinating in these conversations is that the approach brings this elusive place – which doesn’t exist in reality and yet causes so much distress – closer to the present moment in a more manageable and bite-size way. The use of the word ‘might’, rather than ‘will’ or ‘would’, holds this future lightly and implies that possibility and uncertainty are close relatives and that their impacts can be nuanced and context dependent. The words ‘notice yourself doing’ contain some essentials of SF language. The word ‘notice’ invites a shift in attention away from what might be problematic/distressing for a person and towards a future where there is a possibility of something that might be helpful to them. The word ‘doing’ is also key in that it assumes and introduces thinking about a person’s agency into the conversation.

M: [Heaves a big sigh] Mmmm… I’m not sure… that’s a tough one… I don’t know…

F: OK, that’s a tough one… let’s try another one. Who might be the first to notice you doing something differently after we’ve finished talking?

Notice the pattern of my use of Mae’s language as the building blocks for my next question. I’ve also made the question more specific to the present moment, as she seems to have had a good cry in the presence of an acknowledging witness. Also, particularly important is the widening of Mae’s field of vision. I’d assumed that she might notice herself doing something. Part of the language of SF practice involves drawing in outside perspectives, which invites Mae to step briefly outside of herself into the little bit of the future after the conversation.

M: Ah… that’ll be Rufus, our dog… poor thing. He gets such a raw deal. He’s so lovely. And I’ve just been rotten with him. He needs a good cuddle… we could both do with a big cuddle. And a nice long walk. I’m always badgering the kids about him being their dog… he’s nobody’s dog! He’s a member of the family, and I’ve completely forgotten him. He was Steve’s idea, not mine. Then he offs and dies, leaving me with three kids and a dog. Poor old Rufus…

I’m surprised by this answer – and secretly delighted by its length and how Mae has suddenly launched herself into a conversation that seemed to me was really one with herself. I don’t want to interrupt, just echo what strikes me…

F: A cuddle and a nice long walk with poor old Rufus…

M: Yeh… but when am I going to find the time to do that with three kids and a job? I’m briefly thrown off balance by the word ‘but’ and momentarily concerned that Mae will talk herself out of her potential solution. I snap out of it quickly and just put my faith in the process that seems to have started in Mae’s previous response.

F: That sounds like a tough one…

M: Look, I don’t want to be funny… this is helpful… but can I just go and grab Rufie and take him out? I know that we’re supposed to be talking for an hour, but the kids are parked, and I’ve left myself time to recover because I was expecting to be in a right state after this. I had no idea that therapy made you feel better. I was expecting all sorts about my childhood and that… There’s some lovely woods, Rufie loves them and I never get the time. I think it’ll do me some good. I really wasn’t expecting this at all! There was me thinking that we were just getting started, and Mae decides to go and take the dog for a walk. She’s come up with the perfect plan to make the best use of her time and do something that she’s realised might be helpful. From my perspective, this is a beautiful example of someone finding their agency, creativity, connection with nature, all under their own steam. And I love that I can only speculate as to how this happened.

M: So, what happens now? Do I book in another appointment?

F: If you think that would help, that would be fine.

M: When do you suggest?

F: Remember, you’re the boss, you’ve just come up with a great plan for the next bit of time ahead. What do you think?

M: I think… I think I need to get out of the house with Rufie more. Maybe take the kids with me if I can’t get out on my own. Mmmm… Rufie and me… Rufie, me and the kids. Would it be OK if I gave it a go and come back in a week’s time?

Mae wants to try something she might find useful. We agree to meet again so that she can fetch Rufus and go out to those woods. We meet a further five times, during which Mae builds on her discoveries in our first conversation and goes on to draw on her experiences of navigating herself and her children through uncertainty and grief to work out, in her words, ‘…how we’re all going to live our lives in a world that’s crumbling around our ears’.