Detaching from Outcomes: The Power of Non-Attachment and Acceptance

Using data from a large prospective study of post-traumatic psychiatric outcomes (the AURORA study) supported in part by the National Institute of Mental Health, a multisite research team sought to identify underlying neural markers of persistent derealization. The researchers, led by Lauren Lebois, Ph.D., and Kerry Ressler, M.D., Ph.D., at McLean Hospital and Harvard Medical School, investigated whether neural and psychological markers of derealization were associated with later outcomes among people exposed to acute trauma.

Lebois, L. A. M., Harnett, N. G., van Rooij, S. J. H., Ely, T. D., Jovanovic, T., Bruce, S. E., House, S. L., Ravichandran, C., Dumornay, N. M., Finegold, K. E., Hill, S. B., Merker, J. B., Phillips, K. A., Beaudoin, F. L., An, X., Neylan, T. C., Clifford, G. D., Linnstaedt, S. D., Germine, L. T., . . . Ressler, K. J. (2022). Persistent dissociation and its neural correlates in predicting outcomes after trauma exposure. The American Journal of Psychiatry.

Detaching from Outcomes

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For patients who developed RRD in both eyes, only the first eye was included in the present study. Patients under 40 years of age (to avoid the influence of RRD from young myopes with atrophic holes and vitreous attached), or with aphakia, anterior chamber lens implant, giant retinal tear, retinal dialysis, macular hole-related RRD, retinoschisis-related RRD, and dislocated lens nucleus during cataract surgery were excluded.

The examination of patients with primary success and no PVR allowed a best-case scenario examination of visual expectation, and in particular allowed an investigation of foveal detachment and duration of visual loss. Having an attached fovea allowed a better visual outcome compared to fovea detached, even if the symptoms of visual loss were of 1 day only. The visual loss is limited to deterioration from median 6/6 vision in fovea on patients to median 6/9 in fovea off patients, but there may be other symptoms such as distortion and micropsia, which are more prevalent once the fovea detaches.22 Although other published studies have not found an effect on anatomical or functional outcomes following delays in surgery for macula on retinal detachments, very few if any of their patients became macular off while waiting for surgery.23, 24, 25 The results presented here demonstrate that there is a worse outcome following foveal involvement and therefore, as the rate of detachment cannot be accurately predicted, surgeons need to perform prompt surgery for fovea on detachments to avoid progression and foveal detachment.26

A potential flaw of the present study is the definition of visual loss, which could vary from peripheral visual field loss to central visual loss. As the former could occur prior to central loss, there may be patients recorded as having long durations of visual loss, who actually had only short durations of central loss, and therefore achieved better visual outcomes than would be expected. In addition, operation by PPV induces cataract, which reduces visual results and confounds interpretation of visual results in any study of PPV. After multivariate analysis, crystalline lens, pseudophakia and preoperative cataract were not associated with further visual loss, perhaps because any cataract was readily dealt with by peroperative or postoperative cataract surgery.

That there is a body of professional ethics and principles that exists to enable professional mediators to manage and ameliorate against any negative effects arising from their conscious and unconscious prejudices, biases and preconditioning.

That mediation is an honourable stand-alone profession with distinct ethical standards. That mediators hold themselves out to the public as possessing special knowledge and skills in a recognised body of learning derived from research, education and training and who are prepared to apply that knowledge and exercise those skills in the interests of others (Professions Australia).

There are always challenges in marrying theory with practice. Practice is a series of moment to moment fluid and unpredictable events while theory, at its best, seeks to understand with an eye to providing reference points for practitioners. However theory struggles for relevance when it moves from guidance to predictability. It over reaches where it tries to seek certainty in a world where nothing is certain. There is currently a disconnect between theory and practice in mediation particularly with respect to neutrality, just outcomes and balancing power.

Neutrality, just outcomes and balanced power have to be assessed within the context of the fluidity of moment to moment events. They are in a continuous state of gestation never reaching a static point until the mediation ends. It is at that point that theory can be used as a communication device to help explain, in established words, what has just happened.

It is relevant to look at the history of the modern Western mediation movement with respect to this issue. The attachment to neutrality, just outcomes and power equality as central mediation theories arose as result of the early pioneers having to fend off attacks by the established professions of the law and social sciences that asserted that only they were qualified to deal with the legal and emotional aspects of resolving conflict. The defence was to assert that mediators were simply neutrals who drew from their neutral toolbox of mediator skills and processes to help facilitate the resolution of a discrete dispute between the parties.

belonging to a state that thus stands aloof, exempted or excluded from active or passive hostilities ; indifferent; not distinctly marked or coloured, indefinite, vague, indeterminate (The Concise Oxford Dictionary).

Narrative fallacies arise inevitably from our continuous attempt to make sense of the world. The explanatory stories that people find compelling are simple; concrete rather than abstract; assign a larger role to talent, stupidity and intentions than to luck; and focus on a few striking events that happened rather than on the countless events that failed to happen (Kahneman p 199)

To practise as a mediator one still needs to be trained in mediation processes and to have a general understanding of communication, conflict and negotiation theory. However technical knowledge of a particular profession or field is static knowledge isolated from the here and now of the personal experience. To practise one has to continually overcome that knowledge so as to be able to engage in the here and now the moment.

We learn negotiation techniques including understanding the difference between positions and interests and the need to separate the people from the problem (Fisher Ury and Patton). We practise various mediation step-by-step models through simulated role plays.

The concept can be illustrated from a passage from the book in the exchange between Bagger Vance and Junah who was struggling with his golf swing. Junah was already 9 strokes behind Walter Hagan and Bobby Jones in a match play tournament. Jones and Hagan had teed off, lashing perfect drives down the fairway.

Watch how he sets it up right into the middle of it. Feel that focus. He got a lot of shots to choose from, duffs and tops and skulls. But there is only one shot that is his, in perfect harmony with the field. One authentic shot that is his shot. One shot that chooses him.

Decisions to act or not act at a particular point of time arise through the mediator being totally present in the moment sufficient to allow an intuitive thought to gestate. Often something emerges in that intuitive thought that is quite different from what is expected. It is often something that is incapable of being predicted.

These intuitive thoughts can produce a rich source of data which is immediate and specific to the parties at that particular point of time in the session. Like comedy, all mediator interventions rely on getting the timing right. Interventions are less effective if they are the product of mediator speculation, even if that speculation is drawn from a good pre-mediation hypothesis, extensive knowledge of theory and practical experience (Rooney 2008).

The word intuition is used here in its traditional dictionary meaning as an immediate apprehension of the mind without reason. In other words it comes from outside of ourselves and is not derived from our bodily senses or from any deductive rational understanding (Rooney and Ross).

Some people in the helping professions such as therapists and mediators can be drawn to these professions by the natural desire to help people. While this desire is admirable, it can have the unintended consequence of distorting our thinking process and thus our behaviour as professionals. Salzberger-Wittenberg addresses some of these issues in her advice to social workers. She warns against this desire to help, and suggests that it must be tempered by what is realistic and beneficial to the patient. She submits that the need to want to help can lead to social workers seeking approval from the patient, in being reassured that they are providing something of value.

The final challenge for the profession is how to go about teaching and training novice mediators to detach from their own memories, desires, the need to help and the desire to understand prematurely what is happening. How do you teach or train mediators to overcome all their knowledge and understanding and be totally present in the moment.

The purpose of this paper is to demonstrate that there is a body of learning derived from research, education and training going back to the earliest religious texts in the eastern and western traditions, ancient Greek philosophers, Shakespeare and the modern poets that attest to the personal power we exert as human beings.

Teachers often face high job demands that might elicit strong stress responses. This can increase risks of adverse strain outcomes such as mental and physical health impairment. Psychological detachment has been suggested as a recovery experience that counteracts the stressor-strain relationship. However, psychological detachment is often difficult when job demands are high. The aims of this study were, first, to gain information on the prevalence of difficulties detaching from work among German teachers, second, to identify potential person-related/individual (i.e., age, sex), occupational (e.g., tenure, leadership position), and work-related (e.g., overload, cognitive, emotional, and physical demands) risk factors and, third, to examine relationships with mental and physical health impairment and sickness absence. 2ff7e9595c