The heart of the matter: Pat Lamdin’s legacy

screen-shot-2016-09-30-at-10-54-59Pat Lamdin has just retired after years as a drugs worker. His legacy was an important one, say Neil Hunt and Sean Tanzey, for he put his clients’ welfare and happiness above targets, audits and outcome monitoring

Old fat bloke retires; so what? Happens every day, why does it matter? It matters when people like Pat Lamdin retire, because we’re not making them like that any more.

When the careers of people devoted to public service come to an end there is something of a bias towards publicly honouring the accomplishments of people who have long since ‘progressed’ and moved on from their original vocation: typically, to a series of successively better paid, higher status leadership roles.

Other exceptional careers, however, are based on deliberate and sustained efforts to avoid promotion (despite regular encouragement) because promotion would inevitably be a distraction from a calling and particular talent for working with people experiencing problems with alcohol or other drugs.

Pat Lamdin’s practice warrants celebration in these pages for this reason. He worked directly with this population until he retired – not because he was someone who lacked ambition, but because his simple yet worthy desire was to continue doing the work he had chosen to do many years earlier. Doubtless this was one of the reasons he always seemed so bloody good at it.

It takes an unusually dedicated person to choose to do this and spend pretty much their entire working life in counselling rooms decorated in the bland ‘shabby magnolia and woodchip chic’ historically favoured by the voluntary sector. If you doubt this, just ask yourself how many retirement parties you have attended for people who have worked more or less continuously in such ill-paid positions.

Regarding which, Pat never had much time for the treatment sector’s seemingly endless enthusiasm for semantic navel gazing about what to call its workforce or the people it aims to help. He seemed less bothered than most about whether his job title said he was a psychiatric nurse, counsellor or prescribing or recovery worker. Or whether the people with whom he spent most of his time were now called patients, clients or service users. Probably this was because, whatever terminology was used to describe it, he always had an unswerving sense of what his work entailed – meeting people on their terms and helping them as best he could

As numerous colleagues from across the years would attest, Pat was an exceptional colleague who had as much time for the administrators as for the chief executive. When practitioners and the occasional researcher sought his advice, this would frequently be as wise as it was blunt.

What special qualities does Pat have? This is an important question. When talents like Pat’s leave the workforce due to retirement (or other causes) it is vital that they are replaced by new practitioners with the skills necessary to those who need help. All that can be done here is to refer to a couple of aspects of how Pat worked.

You know those rare people you meet who immediately engage with you fully and often leave you feeling curiously better about yourself? Well Pat is one of those. Perhaps the capacity to do this is that thing known as ‘unconditional positive regard’ (UPR), which many aspiring counsellors first learn about in An introduction to counselling skills? But establishing the therapeutic alliance is a profoundly important skill that a good practitioner develops throughout their working life. Pat would cheerfully tell anyone who would listen that no care plan ever saved a life, but skilled workers could do. And, he would say, if you were still listening, you don’t give workers skills by just giving them a manual to work from.

The treatment field has a mountain of controlled trials comparing ‘this therapeutic model’ versus ‘that therapeutic model’ and the only consistent finding is that interventions tend to be much of a muchness. As it turns out, the variable that explains the largest difference in outcomes is ‘therapist factors’, ie what that person is like and how they treat you.

This is why people with this remarkable talent for UPR are so valuable in the workforce. After all, it isn’t a giant leap of logic to suppose that, if a practitioner immediately enables a client to feel genuinely valued, safe, and perhaps a bit better about themselves, then perhaps they’ll feel more ready to talk about something they find incredibly difficult for the very first time, or stick with doing something that is very difficult to do, or go away and attempt something they didn’t believe they could do?

He was walking proof that being a corpulent, 6’1” bloke with a pink Mohican and an ear expander big enough to pass your granny through (plus her handbag) is no barrier to engaging with people at any stage of their life, if forming the therapeutic alliance is uppermost in your mind.

There seemed something about this combination that almost instantly reassured people who were nervously attending their appointment. It says, this is someone who seems unlikely to be judgemental, or shocked by any revelations, however shameful. On the contrary, it’s easy to imagine his own past might contain a few demons and a little shameful behaviour too. Or maybe quite a lot. Though whether that is true, it’s probably not the sort of thing to reveal in an appreciation of someone’s career.

Strangely, this Renaissance prince of the liberal humanities wasn’t universally popular. If managers required Pat to attend a meeting, he would take gleeful pleasure in requiring them to listen to what he had to say. Over and over again. Our clients deserve workers with skills beyond completing paperwork. Groups are highly difficult treatment approaches, not a cheap option beginners can run unsupported. Data is a tool, not an objective. Not music to every manager’s ears.

But let’s salute a contribution made over four decades, across the NHS and voluntary sectors. As a seasoned marathon runner, Pat knew about staying the course, in mental health, homelessness and substance misuse, which demonstrates a level of commitment and resilience few sustain at the client-facing level.

Committed, because although the work can be hugely enjoyable when you work with people who at times can be wise, witty, heroic and much more (such as the epically strange); it also requires being a witness to a relentless flow of lives blighted by tragic and traumatic events with the intractable problems that follow.

Resilient, because when you are an expert at your craft who has studied extensively to obtain the necessary qualifications and also acquired the subtler, sophisticated understanding that can only be obtained by spending thousands of hours talking to hundreds of people… well it can be bloody annoying when policies and procedures seem to be constantly changed for no discernible good reason by people you sometimes suspect haven’t a clue what your work entails. Or because your employer has suddenly changed, though your clients haven’t. Or the irritation of dealing with the ‘bean counters’ and the ever-increasing demands on your time from their array of clinical audits, activity monitoring forms, outcome tools and other performance monitoring data, much of which seems ill-conceived, irrelevant and a hindrance to doing your work in the way clients need.

When Pat left, some of his clients wept. No manager did.

He’d settle for that.