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G Bolton. Paul Chapman Publishing Ltd, 2001, £16.00, pp 219. ISBN 07619 6729 (PBK)
During the last twenty years professional people have seen their autonomy being gradually eroded and the decision making process becoming mechanised. Economic and political forces have contributed to this change, transforming the professional person into an operative. The advent of evidence based medicine and clinical effectiveness has propelled the medical profession into a structured protocol approach. The art of being a good doctor is undermined and sidelined. In parallel the only research that is deemed acceptable is that based on groups of patients. The value of what can be learnt from one patient is rubbished as anecdotal. These changes are totally at variance with the uniquely personal response that is necessary in a patient centred approach in the caring profession, where there is a great need to access the world of feelings and fantasy. In a culture which is totally preoccupied with the scientific approach, personal and emotional factors are completely marginalised in professional life.
Reflective practice (RP) is a new development which seeks to explore feeling and understanding across the boundary between one's profession and the outside world. This technique of exploration and questioning helps to establish bridges between these two areas. It helps to integrate the technical expertise of the professional with the personal and emotional qualities of the individual. Emotions can be a source of understanding but today the idea has a novel ring about it. Reflective practice allows our natural instincts to interact with a professional approach. Actions are so much more powerful if they arise from both feelings and thoughts.
This book is a timely contribution which aims to promote a perspective that underpins a holistic therapeutic approach. It describes how writing, and creative writing in particular, can be the vehicle for developing personal skills in parallel with technical expertise. Essentially reflective practice encourages us to explore our experiences in a reflective way, to write down the results of our reflection, to convert what we have written into a fictional form and then to share our work with others. As the pieces are discussed with a colleague, mentor or small group for feedback and analysis, constructive criticism is received and further insight created. This approach has many similarities with the pioneering work of Michael Balint, who was interested in the emotional and relationship problems of general practice. He started seminars for general practitioners in Budapest in the late twenties. In 1950 he established seminars at the Tavistock Clinic in London for groups of general practitioners where they could explore the emotional aspect of their work and to maximise the use of “the doctor as a drug”. Similarly, RP aims to expand and enhance the contribution of the person towards a more successful therapeutic outcome.
This textbook is a comprehensive introduction to writing and to its use in professional development. It is a manageable size, well written and clearly set out. It is a good manual for those who want to start writing. It is full of encouragement and has many useful tips. The detailed instructions and guidance are easy to follow for those who want to use this method in individual postgraduate development and for those who want to introduce the technique as a teaching method. It is also useful reading for professional people who want to embark on creative writing based on their day to day activity. The only part of the book which is not “reader friendly” is chapter 2: Principles of Reflective Practice. This attempts to set out the theoretical principles which underpin this approach. As the purpose of the book is to develop the craft of writing this part can easily be skipped.
Since the early nineties, social work colleagues have used RP as an integral component of postgraduate training, with a focus on analysing and integrating the personal/professional boundary, and on exploring how emotions and ethical attitudes contribute to the decision making progress. Hopefully the medical profession will follow suite so that RP becomes an integral part of higher training and continuing professional development. Certainly this book will facilitate that process.
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