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Audio Overview
Spiral State Psychiatry: West Dorset Crisis Team Introductory Module
Draft v0.1 | For Shared Reflection and Co-Initiation
Prepared by: Dr Paul Collins
Intended Audience: West Dorset Crisis Team – practitioners, coordinators, support staff
Initiation Date: May 2025
Welcome to the Spiral Journey
This introductory module serves as a foundational step into the principles and practices of Spiral State Psychiatry, specifically tailored for the unique challenges and opportunities within the West Dorset Crisis Team. Our aim is to foster a deeper, more relational approach to crisis intervention, moving beyond conventional models to embrace uncertainty, co-creation, and the inherent wisdom of individuals and their systems.
Through this module, we invite you to explore:
💡 The core philosophy underpinning Spiral State, emphasizing interconnectedness and dynamic processes.
✨ Practical insights for cultivating a more present and responsive stance in your daily crisis work.
🗣️ A shared language for discussing complex human experiences within a crisis context.
🌱 Opportunities for personal and professional growth that align with compassionate, person-centered care.

by Dr Paul Collins

What Is This?
This is not a training manual in the traditional sense. It doesn't offer a rigid set of instructions or a prescriptive methodology to be memorized and applied mechanically.
It is an invitation into Spiral listening. This means it's a call to a deeper engagement with yourselves, your colleagues, and those you support, moving beyond surface-level interactions.
It is not about imposing a new model, but rather a framework for reflecting on and refining practices you already intuitively employ. We are not introducing a foreign concept, but gently bringing existing wisdom into sharper focus.
It is about uncovering what you already know – the inherent capacities for empathy, presence, and relational attunement that are fundamental to effective crisis work. This module seeks to illuminate and amplify these vital qualities within each of you, recognising that the deepest insights often come from within.
We believe that true understanding in crisis work emerges from a space of openness and reciprocal learning. This module provides tools and perspectives to help foster that environment, allowing for more fluid and responsive engagement with complex situations.
Consider this a guide for exploration, rather than a definitive statement. It's designed to encourage personal reflection and shared discovery within the team, building on your collective experience and compassion.
A Guide for Exploration, Not a Definitive Statement. A Journey into Inherent Wisdom.
Recognising Spiral Medicine
👂 When we listen beyond words
This involves attuning to the unspoken, the emotional resonance, and the subtle cues that often convey more than explicit statements. It's about creating space for deeper understanding.
👐 When we let go of needing to fix
Instead of rushing to provide solutions, we embrace the power of presence and acceptance. This allows individuals to find their own path to healing, trusting in their inherent capacity for growth and resilience.
❤️ When we show up, even when we feel tired or uncertain
True compassion means being fully present, even in challenging moments. It's about offering a stable, compassionate presence that acknowledges vulnerability – both theirs and our own – and builds trust.
🌀 When we recognise that healing is not always linear
Crisis work often involves cycles of progress and setbacks. Embracing a non-linear perspective allows us to meet individuals where they are, understanding that recovery is a complex, often spiralling journey.
A Mirror, Not a Directive
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💡 This module is here to name, reflect, and hold that kind of practice.
It recognises that all of us already practice Spiral medicine in some way, perhaps without even realizing it. This module aims to articulate and validate those intuitive, person-centred approaches that often arise naturally in the complexities of crisis work, giving them a shared language and framework.
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🪞 It is not a directive.
It is a mirror. This means the module isn't prescribing new rules or methods you must adopt; rather, it offers a space for you to observe and understand the wisdom already present in your daily interactions. It is designed to reflect back the inherent strengths and subtle insights within your current practice, fostering a deeper awareness rather than imposing external mandates.
Who Is It For?
This introductory module on Spiral State Psychiatry is designed with a broad and inclusive audience in mind, acknowledging that effective crisis care is a collaborative effort involving many roles and perspectives. It's not limited to a select few, but rather intended for anyone who interacts with individuals experiencing mental health crises within the West Dorset Crisis Team.
Our aim is to provide a shared framework for understanding and engaging with Spiral Medicine principles, fostering a common language and approach that strengthens our collective capacity to support those in distress. This material builds upon the inherent wisdom and existing practices that many of you already employ.
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👥 The Entire Crisis Team
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🧑‍🤝‍🧑 Not Just Clinicians
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🤝 Not Just Managers
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🌍 All Who Contact People in Crisis
Specifically, this module is relevant for every member of the West Dorset Crisis Team, whether you are directly involved in clinical assessment, providing support, managing resources, or engaging in administrative tasks. Crisis work is multifaceted, and insights can emerge from any interaction, in any setting.
By ensuring that all team members have access to these core principles, we can cultivate a more cohesive, responsive, and humane approach to crisis intervention. This shared understanding empowers everyone to contribute meaningfully to the therapeutic environment and the recovery journey of the individuals we serve.
Recognition of Insight Sources
📋 Assessment Room
Formal clinical spaces are where traditional evaluation occurs, providing a structured environment for gathering essential information. However, insights here can sometimes be limited by the formal setting, with individuals perhaps feeling less open to share deeply. We recognize this as a starting point, not the whole picture.
🚶 Corridor
Transitional spaces, like corridors or waiting areas, are often where unexpected connections happen. These informal, brief moments can surprisingly lower defenses and reveal genuine feelings or concerns that might not emerge in a more formal setting. Pay attention to the fleeting interactions and quiet observations made in these in-between places.
🚗 The Drive
Mobile spaces, such as during home visits or transport, can be incredibly fertile ground for insight. The act of sharing a journey, even a short one, can create a sense of shared experience, allowing barriers to lower naturally. The lack of direct eye contact and the moving scenery can facilitate deeper, more reflective conversations and disclosures.
☕ Shared Cup of Tea
Informal moments, like sharing a cup of tea or a simple meal, are powerful catalysts for human connection. These seemingly mundane interactions create a sense of normalcy and comfort, fostering trust and allowing individuals to feel seen and heard beyond their crisis presentation. It's in these moments of shared humanity that profound insights often surface.
What Matters Most
In the complex landscape of crisis work, certain truths stand paramount. These aren't just guiding principles, but the very essence of effective, compassionate care within the Spiral State approach.
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💖 Our presence matters more than our performance
Being fully attuned and available, fostering a space where genuine connection can emerge, goes beyond simply following clinical checklists or predefined outcomes. It's about being human, first.
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🫂 Healing often begins in the relationship
The shared human connection, built on trust, empathy, and mutual respect, becomes the true catalyst for profound change. This therapeutic bond transcends formal interventions and creates a foundation for safety.
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🔍 Not just in the referral
While structured pathways and administrative processes are essential for coordination, the deepest insights and therapeutic breakthroughs frequently arise from informal moments and authentic human interactions, rather than mere documentation.
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💡 The client holds invaluable insight
Each individual's lived experience and internal wisdom are primary sources of guidance and understanding. We must actively listen for and prioritize this inherent knowing, which is often overlooked in favor of external assessments.
Core Principles: First Glance
Principle 1: Presence Over Perfection 🤝
Prioritizing authentic presence and genuine connection over the pursuit of flawless performance.
Principle 2: Listening is More Than Hearing 💭
Engaging deeply with what is expressed, paying attention to both spoken and unspoken cues.
Principle 3: The Field Is Alive 🌐
Recognizing the dynamic and interconnected nature of interactions within the therapeutic space.
Principle 4: Nobody Owns the Truth ❓
Adopting a humble stance that acknowledges multiple perspectives and avoids dogmatic certainties.
Principle 5: The Land Is Part of the Work 🏞️
Understanding and integrating the influence of the physical environment and natural world on well-being.
Principle 1: Presence Over Perfection ✨
In the challenging and often unpredictable landscape of crisis work, there's a natural inclination to believe we must be at our absolute best, perfectly composed, and entirely knowledgeable to be effective. However, Spiral State Psychiatry invites us to shift this perspective towards a more human and resonant approach.
We don't need to be fully rested, emotionally clear, or wise to be helpful. Showing up as we are often opens the deepest healing field.
This principle encourages us to release the pressure of unattainable ideals. It emphasizes that authentic connection, rather than flawless performance, is the true catalyst for therapeutic engagement. Our vulnerability and willingness to be genuinely present, even amidst our own fatigue or uncertainties, can create a powerful space of trust and acceptance. This realness allows for a profound therapeutic field to emerge, where both practitioner and patient can meet each other in a shared human experience, fostering deeper understanding and more meaningful healing than any attempt at contrived perfection ever could.
Principle 2: Listening is More Than Hearing
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🤫 Silence
True listening often begins in the spaces between words, in the comfortable and uncomfortable quiet. It's about creating room for what needs to emerge without rushing to fill the void.
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👋 Gesture
Observing the subtle movements of hands, the way someone holds themselves, or how they interact with their environment can reveal unspoken narratives and emotional states that words alone might miss.
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🧍 Body Language
The entire physical presence speaks volumes. From posture and facial expressions to shifts in tension or relaxation, the body offers profound insights into a person's inner world.
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🌳 Land
The connection to place and environment profoundly impacts well-being. Listening includes acknowledging the land beneath our feet, its history, and its influence on individuals and communities.
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🧬 Ancestry
We carry generations within us. Spiral listening recognizes the echoes of ancestral experiences, cultural heritage, and family histories that shape present-day challenges and strengths.
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✨ Intuition
Beyond explicit data, our gut feelings and intuitive responses offer vital clues. Valuing these subtle perceptions, alongside conscious observation, deepens our understanding of the whole person and situation.
Spiral listening extends beyond simply processing spoken words. It encompasses a holistic awareness that includes silence, gesture, body language, the presence of the land, the echoes of ancestry, the prevailing mood, and the quiet guidance of intuition.
This approach values what's felt and perceived through all senses as much as what's explicitly said. By attuning to these diverse layers of communication, we create a richer, more responsive healing environment in crisis work.
Principle 3: The Field Is Alive
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People
Beyond individual narratives, the dynamic interplay between the individuals directly involved in the conversation creates a living tapestry of connection and shared experience. Their presence, emotions, and unspoken intentions contribute to the field's vibrancy.
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🏠 The Room
The physical space of interaction is not merely a backdrop but an active participant. Its atmosphere, acoustics, light, and arrangement can either facilitate openness and connection or inadvertently create barriers. We acknowledge its subtle influence on the unfolding dialogue.
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🏞️ The View
What can be seen and sensed beyond the immediate interaction – through a window, or even imagined – influences the internal state of those present. This connection to the broader environment, whether urban or natural, can offer perspective, calm, or inspiration, becoming part of the therapeutic process.
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🤫 The Unspoken
Much of what shapes a situation remains unsaid but powerfully present. This includes subtle cues, emotions, histories, and shared understandings that reside beneath the surface of explicit communication. Attending to this silent dimension is crucial for deep understanding and true connection.
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📜 The Past
Historical context, both personal and collective, profoundly shapes the present moment and the dynamics within the field. This includes individual life histories, family legacies, cultural heritage, and broader societal narratives. Recognizing and acknowledging these threads from the past can illuminate current patterns and open pathways for healing.
Healing happens not just between two people, but profoundly within the dynamic, responsive space around them. Spiral practice actively embraces and attends to this broader, living "field," which includes not only the visible elements like the room and the view from it, but also the subtle forces of the unspoken emotions, deeply held beliefs, and the echoes of personal and collective pasts. By recognizing and engaging with the entirety of this alive field, we create richer, more authentic environments for connection and transformation.
Principle 4: Nobody Owns the Truth
Shared Meaning-Making
Spiral State Psychiatry aligns with Open Dialogue, valuing shared meaning-making over expert-driven narratives.
Truth emerges through conversation and connection rather than being imposed by authority.
This principle invites practitioners to step away from the traditional role of sole expert and instead co-create understanding with the individual and their network. It emphasizes humility and an ongoing curiosity about what is truly happening for all involved.
Valuing Every Voice
Every perspective within the conversation holds value, and the "truth" is built from the interplay of these diverse viewpoints, not from a single, authoritative source.
Process Over Prescription
The focus shifts from diagnosing and prescribing fixed solutions to engaging in a dynamic process of dialogue where new possibilities and understandings can emerge collectively.
Embracing Uncertainty
Recognizing that there isn't one fixed truth allows for an embrace of uncertainty, fostering an environment where ambiguity is not a failure but an opening for deeper exploration.
Empowering Individuals
By decentralizing "truth," individuals and families are empowered to contribute their unique experiences and insights, becoming active participants in their own healing journeys.
Continuous Learning
This principle encourages practitioners to remain open to learning from every interaction, acknowledging that their own understanding is always evolving alongside those they support.
Principle 5: The Land Is Part of the Work
🏞️ West Dorset's Natural Beauty
The healing potential of local landscapes extends beyond mere aesthetics. Engaging with the rolling hills, ancient trees, and coastline of West Dorset can offer a profound sense of calm, grounding, and perspective. This connection to nature can be a powerful resource for both practitioners and those in crisis, fostering mindfulness and emotional regulation.
📜 Local Stories
The narratives embedded in place are rich and diverse, reflecting centuries of human experience. Understanding the history, folklore, and community spirit of West Dorset can provide a deeper context for the challenges and strengths encountered in crisis work. These shared stories contribute to a collective identity and resilience, offering valuable insights into individual and communal well-being.
🌊 Natural Rhythms
The cycles that influence wellbeing are deeply connected to the natural world. Observing the changing seasons, the ebb and flow of tides, or the daily rhythms of light and dark in West Dorset can provide a sense of stability and predictability. This attunement to natural rhythms helps to anchor individuals amidst the disruption of crisis, reminding us of the inherent processes of change and renewal.
We recognise that we work in a place (West Dorset) that holds its own stories, rhythms, and healing potential. This principle invites us to consider the environment not just as a backdrop, but as an active participant in the therapeutic process, influencing our perceptions, emotions, and interactions.
By acknowledging and integrating the unique qualities of West Dorset's natural and historical landscape into our practice, we can create more holistic and context-sensitive approaches to mental health care. This deep connection to place enhances our ability to foster genuine healing and well-being for all.
Why Start Here?
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🧠 Because we're already doing this
Many of us instinctively bring compassion, intuition, and a holistic perspective to our work, even within existing frameworks. This module helps name and honour these invaluable, often unacknowledged, aspects of our daily practice, recognising the inherent wisdom within our team.
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🔥 Because crisis work demands that we move beyond protocols and into presence
In moments of acute distress, rigid adherence to checklists can often obscure the unique human experience. Spiral thinking encourages us to be fully present, responsive, and adaptive to the emergent needs of the individual, fostering genuine connection and co-creation beyond prescriptive steps.
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🔋 Because many of us feel burnt out by systems that expect certainty
The relentless pressure to provide definitive answers and predictable outcomes in inherently complex human situations can be profoundly exhausting and lead to burnout. This approach offers a framework that acknowledges the inherent ambiguity of human experience, reducing the burden of needing to 'fix' everything and allowing for more authentic and sustainable engagement.
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🌀 Because Spiral thinking gives us a way to honour our work without having to have all the answers
Instead of viewing uncertainty as a failure or a problem to be solved, Spiral thinking reframes it as an essential component of deep healing and growth. It equips us to navigate complex, unpredictable situations with greater integrity and peace, fostering resilience in both practitioners and those we support by embracing the evolving nature of understanding and support.
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🌱 Because it cultivates a more sustainable and compassionate practice for all
By fostering deeper self-awareness, shared understanding, and interconnectedness within the team and with patients, Spiral State Psychiatry aims to reduce compassion fatigue and promote a profound sense of shared humanity. This holistic approach benefits not only practitioners, leading to more resilient and fulfilled professionals, but also results in more responsive, nuanced, and truly holistic care for patients, creating a virtuous cycle of wellbeing for the entire West Dorset community.
Not Replacing, But Deepening
❌ This is not about replacing anything.
Existing practices and knowledge remain valuable. Our goal is to build upon the strong foundations already in place within the West Dorset Crisis Team, acknowledging the immense skill and dedication that defines your current work. We recognize that the established protocols and individual expertise are crucial to effective crisis intervention.
✨ It is about deepening what already works.
This approach focuses on adding dimension and awareness to current approaches. By embracing Spiral State Psychiatry, we seek to enhance your intuitive understanding of complex situations, fostering a more nuanced and responsive engagement with individuals in crisis. It's about enriching your toolkit, not discarding it, allowing for a more profound and adaptable practice.
This introductory module serves as an invitation to explore new perspectives that complement your existing methods. We are not introducing a rigid new system, but rather offering a framework for recognizing, articulating, and expanding on the implicit wisdom you already bring to your interactions.
The aim is to cultivate a richer, more resilient practice that honors both your professional expertise and the inherent complexities of human experience in crisis.
A Beginning Journey
This module is a beginning. It's an invitation to embark on a shared path, not just a set of instructions. We are starting to explore how we can deepen our practice and understanding. 🗺️
It is a way to listen to the field together. This means tuning into the subtle dynamics, the unspoken communications, and the broader context of every interaction and situation within our crisis work. It's about recognizing that every moment holds information, and that our collective awareness can illuminate new pathways. 👂
This journey encourages us to step beyond conventional approaches and embrace a more intuitive, interconnected way of being with those in distress. It's about cultivating a shared presence and sensitivity to the emerging patterns within the crisis landscape. 🔗
First Practice: Mirror Check
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What feels alive in me right now?
Connecting with your present state
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What do I sense (not just hear) in this person or moment?
Expanding awareness beyond verbal communication
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What happens if I stop trying to help and start trying to meet them?
Shifting from fixing to connecting
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Where is my attention truly resting?
Noticing internal and external distractions
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What unspoken invitation might be present here?
Opening to subtle cues and emerging possibilities
Before your next contact with someone in distress, pause and ask yourself these questions. This simple "Mirror Check" is designed to ground you, broaden your perception, and invite a deeper, more resonant engagement with the person before you. It's an invitation to shift from habitual responses to a more fluid, responsive way of being in the moment.
Allow these questions to open a space for insight, not just about the other person, but also about your own presence in the therapeutic relationship. This practice is a cornerstone of Spiral State, fostering connection and authentic encounter.
Finding Your Way
You might not find an answer. But the Spiral will start to open.
In the complex and often challenging landscape of crisis work, immediate solutions are not always apparent. The "Spiral" here refers to a process of deeper engagement and unfolding understanding, rather than a direct path to a single, definitive answer.
This journey invites you to trust the process of discovery. It’s about becoming more attuned to the subtle shifts in dynamics, the unspoken narratives, and the emergent possibilities within interactions. As you lean into the principles of Spiral State, you may find that insights emerge not from a forceful search, but from a receptive presence.
Allow yourself to wander, to explore, and to be curious about what unfolds. The act of "finding your way" is less about reaching a fixed destination and more about cultivating a deeper awareness of the journey itself, for both yourself and those you work alongside.
What Comes Next?
Having explored the foundational concepts of Spiral State Psychiatry, this module serves as a compass, pointing towards the deeper dives and practical applications awaiting us. The journey continues with a series of modules designed to enrich your understanding and integrate these insights into your daily practice with the West Dorset Crisis Team.
👂 Spiral Listening in Action
Practical techniques and approaches to deepen your listening skills in crisis situations.
🧘‍♀️ Working with Silence and Space
Exploring the power of non-verbal communication and creating therapeutic presence.
🗺️ Mapping the Field
Understanding the wider relational and energetic landscape in crisis work.
🌱 Deepening Practice
Strategies for integrating Spiral thinking and awareness into your daily clinical work.
🤝 Co-Creation & Evolution
How we collectively develop and refine the Spiral approach as a team.
Future Module: Spiral Listening in Action
Practical Techniques
Specific approaches to deepen listening practice, including active and reflective listening skills tailored for crisis intervention. We will explore methods for acknowledging, validating, and containing intense emotions, alongside the art of asking open-ended questions that invite deeper narratives. Focus will be on micro-skills for immediate application, fostering trust and psychological safety in the moment.
Reflective Practice
Learning from shared experiences through structured peer supervision and group discussions. This involves a deep dive into case vignettes and challenging encounters, fostering a culture of curiosity and continuous learning. Participants will develop a robust habit of self-reflection to understand personal biases, emotional responses, and the impact of their presence on the therapeutic encounter, supporting professional growth and resilience.
Measuring Impact
Recognising the profound difference Spiral listening makes on service user outcomes, team cohesion, and individual practitioner well-being. This includes exploring qualitative indicators such as enhanced communication, improved therapeutic relationships, and increased feelings of being heard. We will also consider how to observe and articulate shifts in practice, gathering feedback from service users and reflecting on the observable positive changes in crisis resolution and support.
Future Module: Working with Silence and Space
The Power of Silence 🧘‍♀️
Understanding how silence creates room for emergence, allowing unspoken needs and deeper truths to surface without pressure or immediate intervention. This fosters a non-directive environment where genuine insights can arise.
Techniques for becoming comfortable with silence include mindful breathing, slowing down one's internal pace, and intentionally resisting the urge to fill conversational gaps. It's about cultivating an inner stillness that supports external quiet.
Recognising different qualities of silence is key: Is it a tense, anxious silence? A rich, contemplative silence? An empty, avoidant silence? Or a receptive, generative silence that invites connection? Each quality offers different information about the relational field.
Silence is not merely an absence of noise, but a potent container for presence, reflection, and deeper communication beyond words. It can facilitate profound shifts in understanding and connection.
Creating Therapeutic Space 🏡
Physical arrangement considerations are important, such as ensuring comfortable seating, soft lighting, and minimizing distractions. The aim is to create an inviting and safe physical container that supports openness.
Energetic aspects of the environment involve the intention and presence brought by the practitioner. This includes cultivating a calm and non-judgmental stance, holding the space with warmth and acceptance, and being fully present without personal agenda.
How to hold space without filling it means trusting the process and the individual's capacity for self-discovery. It involves resisting the impulse to advise, interpret, or direct, instead allowing for pauses and offering supportive, open-ended invitations.
This active 'holding' involves creating an atmosphere of psychological safety where individuals feel seen, heard, and valued, even in moments of quiet or emotional intensity. It’s about being a steady anchor in times of uncertainty.
Future Module: Mapping the Field
👤 Patient
Understanding the individual's unique experience, their personal history, and their current presentation of distress or challenge.
This includes their strengths, resources, social networks, and cultural background, all of which contribute to their unique "field."
🤝 Practitioner
Acknowledging the practitioner's personal state, their professional training, and their unique perspective.
Consider how their presence, biases, and theoretical frameworks influence the interaction and the co-created space. Self-awareness is key.
🌍 Environment
Assessing the physical space, its atmosphere, and the broader systemic context in which the interaction occurs.
This includes the tangible (lighting, comfort, privacy) and the intangible (safety, openness), as well as institutional policies and community resources impacting the situation.
🔗 Relationship
Examining the dynamic field co-created between all individuals present, including the patient, practitioner, and any family or network members.
This involves observing patterns of communication, power dynamics, and the evolving emotional landscape that shapes the therapeutic work.
Future Module: Integration with Open Dialogue
Open Dialogue Principles
  • Immediate help
  • Social network perspective
  • Flexibility and mobility
  • Responsibility
  • Psychological continuity
  • Tolerance of uncertainty
  • Dialogism
Spiral State Synergies
This module delves into how Spiral State Psychiatry profoundly enhances and complements the established Open Dialogue approach, fostering a more integrated and holistically informed practice in crisis work.
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Deepening Relational Presence:
Exploring how Spiral State's emphasis on authentic presence enriches the dialogical foundations of Open Dialogue.
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Expanded Network Conception:
Integrating the Spiral State view of "The Field Is Alive" and "The Land Is Part of the Work" to broaden the social network perspective to include ecological and systemic influences.
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Navigating Complexity and Uncertainty:
Building on Open Dialogue's tolerance of uncertainty with Spiral State's tools for embodied awareness and acceptance of non-linear processes.
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Practical Integration Strategies:
Discussing concrete methods for weaving Spiral State principles into daily crisis interventions, including mindful communication and resource utilization.
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Case Examples and Reflections:
Analyzing real-world scenarios to illustrate successful integration and foster reflective learning among practitioners.
The integration of Spiral State Psychiatry with Open Dialogue offers a powerful framework for navigating complex mental health crises. By bridging network-focused care with a deeper understanding of relational fields, embodied presence, and environmental connection, practitioners can cultivate more adaptive, compassionate, and effective therapeutic encounters. This module is designed to provide both conceptual understanding and practical tools for this vital integration.
Future Module: The Role of the Land
🌳 This module delves into the profound significance of the natural and historical landscape of West Dorset as a therapeutic resource within crisis work. It explores how a deeper connection to place can offer grounding, solace, and a sense of continuity for individuals navigating acute distress, recognizing the land itself as a powerful, non-human contributor to the healing field.
📍 We will identify and explore various 'Local Healing Sites'—from ancient woodlands and coastal paths to community gardens and historically rich landmarks—and examine their unique potential for integration into our practice. This includes developing practical strategies for guided walks, reflective outdoor sessions, and nature-based interventions that leverage the inherent calming and restorative qualities of these environments, allowing for a broader understanding of "therapeutic space."
🌱 The aim is to enhance existing therapeutic approaches by embracing the non-human elements of the field, fostering resilience, and supporting well-being not only for patients but also for practitioners within the West Dorset Crisis Team. Practical case examples and opportunities for experiential learning will be central to this module, encouraging a more holistic and ecologically-aware approach to mental health care.
Future Module: Reflections from Staff
🤝 Co-creation, not top-down
Staff experiences shape the development of the approach. This module provides a dedicated space for team members to share their insights, challenges, and successes, ensuring that the Spiral State Psychiatry model evolves from the ground up, reflecting the realities of frontline work. Their voices are central to its ongoing refinement.
📖 Narrative Integration
Personal stories become part of the shared understanding. Through facilitated discussions and reflective practices, staff will explore how their individual narratives intersect with the principles of Spiral State. This process deepens empathy, fosters collective learning, and enriches the team's capacity for compassionate care.
✅ Practice-Based Evidence
Real-world application informs ongoing development. We will examine case studies, discuss practical dilemmas, and share effective strategies derived directly from daily interactions with service users. This emphasis on lived experience and practical wisdom builds a robust evidence base for the Spiral approach.
♻️ Continuous Learning and Adaptation
This module reinforces the dynamic nature of Spiral State Psychiatry, highlighting that it is a living framework constantly informed by the experiences of those who implement it. It encourages a culture of curiosity and adaptability, crucial for navigating the complexities of mental health crisis work in West Dorset.
For Now, This Is Enough
We've covered a significant amount of ground in this introductory module, touching upon core principles and future pathways. It's important to recognize that true integration doesn't happen by rushing through information.
Allow yourself the space to absorb, reflect, and simply be with what has been shared. This pause is not an ending, but an essential part of the unfolding journey.
But for now... this is enough.
Allowing space for integration before moving forward
* This is now.
Bringing attention to the present moment
— Trust the process.
Letting insights settle and unfold at their own pace
— Embrace stillness.
Finding clarity and presence in moments of quiet reflection
Honouring Your Practice
You are not being trained. You are being honoured.
In this module, we step away from traditional notions of instruction and instead invite a deeper appreciation for the wisdom you already possess. Your presence, intuition, and lived experience are invaluable assets in the complex landscape of crisis care.
This is an opportunity to recognize and validate the profound contributions you bring, often unconsciously, to your work. We believe that true insight in Spiral State Psychiatry emerges not from prescriptive methods, but from a heartfelt acknowledgement of your innate capacity for compassion and connection.
  • ⭐ Recognizing and valuing your inherent skills and empathy.
  • 🍃 Creating space for your unique way of being and working.
  • 🌳 Affirming the deep wellspring of knowledge within you.
  • ⬆️ Moving beyond a deficit model to one of appreciation and strength.
Let's Begin
Let's begin.
✦ → 🌀 ✦
Welcome to the introductory module of Spiral State Psychiatry, specially designed for the West Dorset Crisis Team. This is not just a training, but an invitation to explore new perspectives and deepen your inherent wisdom in crisis work.
As we embark on this journey, we encourage an open mind and a willingness to engage with the subtle, often unspoken, aspects of human experience. The spiral path is one of continuous learning and unfolding, where each turn brings new insights and understanding.
The Essence of Spiral Listening
Spiral Listening transcends mere auditory reception; it represents a profound and holistic engagement with the entirety of an individual's lived experience. It calls for a multi-faceted approach, rooted in core principles that guide our interactions and deepen our understanding in crisis care.
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🧩 Integration
Bringing together multiple perspectives
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🔍 Depth
Moving beyond surface presentation
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✨ Presence
Being fully available in the moment
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🌱 Adaptability
Responding to evolving needs
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🤝 Connection
Building genuine rapport
These five interconnected elements form the bedrock of Spiral Listening, enabling practitioners to foster deep connection, cultivate comprehensive understanding, and respond effectively within the complex dynamics of mental health crisis work. Each principle builds upon the last, creating a reinforcing cycle of compassionate and insightful engagement.
Spiral Medicine in Daily Practice
☀️ Morning Check-in
Brief self-awareness practice before beginning work, setting an intention for presence and openness. This helps practitioners align with the day's encounters with a grounded and compassionate mindset.
👥 Team Meetings
Incorporating spiral principles into discussions, fostering a space where multiple perspectives are genuinely heard and integrated. This encourages a collective understanding of complex situations and supports collaborative decision-making.
👂 Patient Assessments
Bringing deeper listening to clinical encounters, moving beyond diagnostic labels to truly understand the lived experience of the individual. This involves paying attention to subtle cues and creating a non-judgmental atmosphere.
📝 End-of-Day Reflection
Brief practice to integrate experiences and process emotions from the day's interactions. This helps in personal and professional growth, ensuring that learning is continuous and well-embedded.
The Journey of Crisis Work
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💥 Initial Distress
This is the critical point where an individual experiences a profound sense of crisis, leading to their first contact with the crisis team. It's often marked by intense emotional turmoil, confusion, and a feeling of being overwhelmed, indicating a pressing need for compassionate intervention.
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🤝 Meeting in Presence
At this stage, an authentic and non-judgmental connection begins to form between the individual and the practitioner. It emphasizes being fully present, listening deeply without preconceived notions, and meeting the person exactly where they are in their experience, fostering trust and rapport.
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🛡️ Holding the Space
This involves actively creating a safe and supportive environment through the practitioner's consistent and unwavering presence. It’s about allowing difficult emotions and experiences to unfold without judgment, providing a contained and empathic container for the individual's distress, and ensuring they feel seen and heard.
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🌱 Emergence
Following the process of being met and held, new possibilities and pathways begin to appear for the individual. This is a subtle yet profound shift where clarity might emerge, new perspectives are gained, or a sense of agency is rekindled, leading towards a path of recovery and integration.
Benefits for Practitioners
Embracing Spiral State Psychiatry offers profound benefits for mental health practitioners, transforming daily practice and enhancing professional well-being. By shifting perspectives and integrating new approaches, staff can experience renewed engagement and a more sustainable career path in crisis work.
😌 Reduced Burnout
Less pressure to have all the answers, fostering a more collaborative and shared understanding of complex situations.
  • Greater resilience through shared responsibility.
  • Opportunity for self-compassion and less self-blame.
🤝 Deeper Connections
Cultivating more meaningful and authentic therapeutic relationships with patients and their networks.
  • Moving beyond rigid professional roles to true human connection.
  • Fostering mutual learning and growth.
✨ Enhanced Intuition
Developing confidence in trusting clinical instincts more fully, informed by mindful presence and openness to the 'field' of interaction.
  • Integrating diverse sources of knowledge beyond protocols.
  • Greater clarity in complex and uncertain situations.
🔗 Team Cohesion
Building a stronger, more supportive team environment through a shared language and consistent approach to crisis work.
  • Improved communication and mutual support among colleagues.
  • A collective sense of purpose and shared vision.
Benefits for Patients
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Being Truly Seen
Experience of being met as a whole person, not just a collection of symptoms.
Recognition of personal narrative and context.
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Reduced Pathologizing
Less emphasis on diagnostic labels.
More understanding of crisis as meaningful response.
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Agency and Participation
Active role in making meaning.
Partnership rather than passive recipient of care.
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Empowered Journey
Profound sense of being understood and validated, fostering trust and emotional safety.
Actively co-creating their path to recovery for sustainable outcomes.
Through Spiral Listening, patients report a profound sense of being understood and validated, fostering a deeper sense of trust and emotional safety within the therapeutic relationship. This human-centered approach encourages open dialogue and reduces the anxiety often associated with traditional, more prescriptive interactions.
Ultimately, this leads to a more empowering journey for the individual in crisis. By valuing their perspective and innate resources, Spiral Listening supports patients in actively co-creating their path to recovery, leading to more sustainable and personally meaningful outcomes.
Spiral Listening vs. Traditional Assessment
Understanding the fundamental differences between Spiral Listening and conventional assessment methods is crucial for embracing a truly person-centered and responsive approach to crisis care. While traditional models focus on categorization, Spiral Listening prioritizes relationship and emergent understanding.
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From Label to Life
Traditional assessment often begins with a focus on diagnostic labels, seeking to fit an individual's experience into predefined categories. Spiral Listening shifts this focus, aiming to understand the person as a unique individual, situated within their life story, relationships, and broader context. This honors the complexity of human experience beyond a set of symptoms.
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From Interrogation to Invitation
The process of traditional assessment can feel like an interrogation, with a structured, linear flow of questions designed to elicit specific information. Spiral Listening, conversely, fosters an emergent conversation. It's an invitation to explore, allowing the narrative to unfold naturally, following the threads that are most alive and meaningful for the person in crisis. This creates space for deeper, more authentic connection.
The Role of Uncertainty
🔍 From Problem to Mystery
Seeing crisis not as puzzle to solve but as mystery to witness.
This shift invites us to approach situations with curiosity and a willingness to simply be present, rather than rushing to a definitive solution.
It encourages a deeper observation of the unfolding narrative, allowing for insights that might be missed when solely focused on problem-solving.
🤝 Holding Not Knowing
The therapeutic value of acknowledging uncertainty.
By openly admitting 'not knowing' we create a shared human space, fostering authenticity and reducing the pressure to have all the answers.
This stance allows for collaborative exploration and empowers those in crisis to participate actively in discovering their own path forward.
🦋 Space for Emergence
How uncertainty creates room for new possibilities.
When we resist the urge to immediately fill the void with predetermined frameworks, we allow for novel perspectives and unexpected solutions to emerge.
This openness to the unknown can unlock profound shifts and innovative approaches that truly resonate with the individual's unique situation.
Working with Difficult Emotions
Fear
Recognising fear as information rather than obstacle. It often signals unmet needs or potential threats, inviting us to explore its roots and understand the messages it carries, rather than simply trying to suppress or avoid it.
Anger
Meeting anger with presence rather than reactivity. This involves acknowledging its existence without judgment, understanding that anger can be a boundary-setting emotion or a response to perceived injustice, and allowing it to be expressed constructively.
Grief
Creating space for grief without rushing to comfort. True healing comes from allowing the full spectrum of sorrow to be felt and witnessed. This means holding a container for the pain, honoring the loss, and trusting the natural process of mourning to unfold.
Confusion
Sitting with confusion as part of the process. Rather than seeking immediate answers or clarity, embracing confusion allows for new perspectives and deeper insights to emerge. It can be a fertile ground for discovery and a necessary precursor to understanding.
The Language of Spiral State
In the Spiral State approach, how we speak and listen fundamentally shifts. It moves away from conventional, often deficit-based language, towards a more relational, open, and emergent way of being with others in distress. This intentional use of language fosters connection, validates experience, and opens possibilities for shared understanding.
Moving From
  • ✗ "What's wrong with you?"
  • ✗ "Let me fix this"
  • ✗ "This is the diagnosis"
  • ✗ "Follow this treatment plan"
  • ✗ "You should..."
  • ✗ "How do we manage this symptom?"
  • ✗ "Your past defines you."
  • ✗ "We need to control the situation."
Moving Toward
  • ✓ "What happened to you?"
  • ✓ "I'm here with you"
  • ✓ "What sense do you make of this?"
  • ✓ "What might be helpful?"
  • ✓ "What are your experiences telling you?"
  • ✓ "What emerges when we sit with this?"
  • ✓ "What potential lies within this moment?"
  • ✓ "How can we create space for what is?"
This image illustrates a therapeutic conversation where the focus shifts from a problem-oriented mindset to one of shared inquiry and authentic presence. It reflects the diverse interactions within a West Dorset setting, embodying the compassionate and collaborative nature of Spiral State communication.
This reorientation in language is not merely semantic; it reflects a profound philosophical shift in how we understand and engage with mental distress. By choosing words that invite curiosity, validation, and collaboration, we create a more empowering and healing environment for everyone involved in the crisis team's work.
Spiral Awareness in the Body
Developing Spiral Awareness involves a deep connection to our own bodies and the physical signals present in therapeutic encounters. It's about grounding ourselves and becoming attuned to the subtle, unspoken language of the human experience.
Breath: Awareness
Using breath as a conscious anchor for presence, allowing practitioners to regulate their own nervous system and remain grounded even in challenging interactions. Observing shifts in a client's breath can offer vital, non-verbal cues about their internal state, fostering a deeper, more intuitive connection.
Body: Embodied Presence
Understanding how physical posture, both ours and the client's, profoundly affects therapeutic connection and the overall dynamic of the space. A relaxed, open, and grounded stance communicates safety and attentiveness, creating an environment where authenticity can emerge. Conversely, tension or closed postures can inadvertently create barriers.
Somatic: Signals
Learning to read the body's subtle wisdom and intuitive signals in clinical encounters. This includes noticing shifts in muscle tension, gestures, eye contact, and subtle energetic changes. These somatic cues often provide crucial information that words alone cannot convey, guiding the practitioner towards a more holistic understanding of the client's experience.
Creating Therapeutic Environments
🏠 Physical Space
The careful arrangement of furniture, thoughtful lighting, and the integration of natural elements such as plants, natural textures, or gentle sounds are crucial. These elements work together to create a calming and safe atmosphere, reducing anxiety and promoting a sense of ease and receptivity for both practitioners and patients during sensitive conversations.
🌀 Energetic Preparation
Beyond the visible, the energetic quality of a space profoundly impacts interactions. This involves intentionally clearing any stagnant or residual energy from previous encounters before sessions begin, and consciously setting a clear, compassionate intention for the therapeutic work to unfold. This mindful preparation helps to foster an environment conducive to deep connection, trust, and healing.
🏞️ Alternative Settings
Recognizing that not all healing happens within traditional four walls, Spiral State Psychiatry encourages the thoughtful and appropriate use of alternative therapeutic settings. Engaging with nature, such as walking in a local park or conducting sessions by a river, or utilizing community spaces like a quiet cafe, can offer unique therapeutic benefits, fostering a sense of grounding, spaciousness, and connection to the wider world when clinically appropriate and safe for the individual.
Spiral Approaches to Risk
In the West Dorset Crisis Team, our approach to risk assessment goes beyond mere compliance. It integrates established protocols with a deep, holistic understanding of the individual and their unique circumstances, ensuring that safety is addressed with both rigor and compassion.
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📝 Traditional Risk Assessment
Standard protocols and documentation are foundational to ensuring safety and accountability. This includes comprehensive checklists, formal assessments, and clear care plans.
These structured methods provide a necessary framework for identifying potential harms and establishing a shared understanding of immediate concerns within the system.
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✨ Enhanced by Spiral Awareness
Spiral awareness enhances this process through deeper listening and attunement to intuitive signals. It involves paying close attention to unspoken cues, energetic shifts, and the subtle dynamics within the person and their environment.
This allows for a more nuanced and dynamic understanding of risk, moving beyond static checklists to a living, evolving assessment that acknowledges complexity and emergence.
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⚖️ Balanced Approach
Ultimately, our goal is to achieve a balanced approach that effectively meets both system requirements and human needs. This means ensuring thorough documentation and adherence to guidelines, while simultaneously honoring the client's lived experience and fostering genuine connection.
It is about navigating the tension between external safety measures and the internal world of the individual, recognizing that true safety often emerges from a sense of being seen, heard, and deeply understood.
Working with Families and Networks
Working effectively within the complex tapestry of families and broader social networks is a cornerstone of Spiral State Psychiatry. This approach acknowledges that an individual's well-being is deeply intertwined with their relationships and environments, moving beyond an isolated view of crisis to embrace a holistic, contextual understanding. It emphasizes collaboration and respect for the diverse ways people find support and healing.
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👨‍👩‍👧‍👦 Family Systems
Seeing the person in relational context
  • Understanding family roles and communication patterns.
  • Identifying sources of support and and tension within the family unit.
  • Supporting families in co-creating pathways to recovery.
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👥 Community Resources
Connecting with local support networks
  • Leveraging existing community strengths and assets.
  • Facilitating introductions to relevant services and peer groups.
  • Building broader webs of resilience and mutual aid.
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🌳 Generational Patterns
Awareness of inherited trauma and resilience
  • Exploring historical narratives and intergenerational experiences.
  • Recognizing patterns of coping and adaptation across generations.
  • Helping families to process and integrate past experiences.
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🌍 Cultural Context
Honoring diverse meanings and practices
  • Approaching each family with cultural humility and sensitivity.
  • Understanding how beliefs, values, and traditional healing influence crisis.
  • Collaborating with cultural leaders and community elders when appropriate.
Spiral Documentation
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📝 Meeting System Requirements
Fulfilling necessary clinical documentation with clarity and precision, ensuring all essential data points are captured for regulatory compliance and continuity of care.
Translating the rich, nuanced insights gained from spiral conversations into the structured, often linear, required formats, without losing the depth and complexity of the lived experience.
  • Ensuring adherence to all legal, ethical, and organizational standards for record-keeping.
  • Balancing the narrative richness of spiral work with the need for concise, actionable information.
  • Prioritizing key findings that inform subsequent care planning and interventions.
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❤️ Honoring the Experience
Finding innovative and compassionate ways to capture the unique quality and felt experience of each encounter, reflecting the authentic voice of the individual and their network.
Actively incorporating and synthesizing multiple perspectives—from the person in crisis, family members, other professionals, and the wider community—to build a comprehensive understanding.
Explicitly acknowledging and embracing uncertainty, ambiguity, and the emergent nature of the crisis process within the documentation, moving beyond rigid diagnostic categories.
  • Documenting the relational dynamics and shifts observed during interactions.
  • Reflecting the non-linear progression and unique journey of recovery or stabilization.
  • Allowing for descriptions that convey the emotional and energetic landscape of the situation.
Spiral Supervision
Spiral Supervision is a dynamic and evolving approach designed to support the West Dorset Crisis Team. It moves beyond traditional hierarchical models to embrace a more holistic and emergent process of reflection and growth. This method fosters a continuous learning environment, crucial for navigating the complexities of crisis work.
💡 Personal Reflection
Individual contemplation of clinical encounters and personal responses. This involves journaling, quiet thought, or engaging with one's own inner landscape to process challenging situations and identify areas for personal and professional growth before formal discussions.
🤝 Peer Dialogue
Sharing experiences and insights with trusted colleagues in a supportive, non-judgmental space. This can take the form of informal conversations, dyadic check-ins, or structured peer supervision sessions, allowing for mutual learning and empathy.
🌍 Group Exploration
Team-based reflection on common patterns, systemic issues, and emergent themes arising from collective experiences. Facilitated group discussions enable the team to co-create understanding, identify strengths, and address challenges from multiple perspectives, strengthening collective wisdom.
🔗 Integration
Bringing insights gained from reflection, dialogue, and group exploration back into daily practice. This final step ensures that learning is embodied and translates into tangible improvements in patient care, team dynamics, and personal well-being, fostering a cycle of continuous improvement.
Through these iterative steps, Spiral Supervision cultivates a culture of deep listening, shared responsibility, and compassionate inquiry within the West Dorset Crisis Team, ultimately enhancing resilience and effectiveness in their vital work.
Measuring What Matters
In the Spiral State approach, understanding impact goes beyond conventional metrics. It involves a holistic consideration of what truly fosters healing and well-being within the complex dynamics of crisis work. We believe that true success is found in the subtle shifts and deeper connections, not just in numbers.
🔭 Beyond Metrics
Recognizing the limitations of quantitative measures alone, and embracing a broader view of progress.
💬 Qualitative Feedback
Gathering rich stories and lived experiences directly from patients, families, and staff to understand impact.
💡 Emergent Outcomes
Being open to unexpected positive developments and serendipitous moments that arise from the work.
🔗 System Integration
Meeting required organizational measures while always honoring the deeper values and principles of the Spiral State.
❤️ Relational Quality
Assessing the strength, depth, and safety of the therapeutic relationships formed, as a core indicator of care.
🌱 Practitioner Well-being
Measuring the impact of the work on the resilience, compassion satisfaction, and overall health of our team members.
Spiral Ethics
In the West Dorset Crisis Team, our approach to care is deeply rooted in a set of ethical principles that guide every interaction and decision. These are not merely abstract ideals, but living commitments that shape our presence with individuals in crisis. Spiral Ethics emphasizes a dynamic, relational, and context-aware way of being, ensuring that our interventions are not only effective but also deeply human and respectful.
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✅ Integrity
Alignment of values and actions
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🙏 Deep Respect
Honoring each person's inherent dignity
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🌱 Humility
Recognizing the limits of our knowing
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💪 Courage
Willingness to be present with suffering
These foundational principles empower our team to navigate complex situations with clarity and compassion. They remind us that our role is to meet people where they are, without judgment, fostering environments of trust and genuine connection. By embodying these ethics, we strive to create a practice that is truly responsive to the unique and unfolding needs of those we serve, while continuously learning and growing together.
Challenges and Resistances
Embracing Spiral State Psychiatry within a busy crisis team environment inevitably brings forth a unique set of challenges and areas of resistance. These often arise from a natural tension between established systemic demands and the fluid, person-centered approach that Spiral Medicine advocates.
⏳ Time Pressures
System demands for quick throughput can often conflict with the unhurried, attentive presence required for Spiral Medicine. The pressure to move rapidly through assessments and interventions can make it difficult to create the space needed for deep listening and emergent understanding.
📝 Documentation Requirements
Integrating the nuanced, often non-linear insights gained through Spiral approaches into standardized, structured documentation formats presents a significant hurdle. Capturing the richness of a 'field' interaction or an emergent truth in conventional tick-box forms can feel reductive and challenging.
❓ Professional Skepticism
Resistance can also stem from professional skepticism towards approaches perceived as "soft," non-medical, or lacking traditional evidence bases. This may manifest as reluctance to engage with unfamiliar concepts or a preference for more established, biomedical models of care.
🔄 Habitual Patterns
Overcoming deeply ingrained habitual patterns of working, which often prioritize efficiency and control, can be difficult. Shifting from a directive, problem-solving mindset to one of open curiosity and collective discovery requires consistent effort and a willingness to step outside one's comfort zone.
Recognizing and compassionately engaging with these challenges is a vital part of integrating Spiral State principles. They are not obstacles to be eliminated, but rather invitations for deeper inquiry and collaborative adaptation within the team and the broader system.
Working with Resistance
Resistance is a natural and often unconscious response that can arise in any therapeutic or helping relationship. In Spiral State Psychiatry, we view resistance not as an obstacle to be overcome, but as valuable information and an invitation for deeper understanding. It often signals unmet needs, protective mechanisms, or systemic challenges.
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👁️ Notice
Becoming keenly aware of resistance as it arises, both in the person you're working with and within yourself. This involves paying attention to subtle cues, shifts in energy, and unspoken tensions.
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✅ Accept
Allowing resistance to be present without judgment or the immediate need to change it. This radical acceptance creates a safe space for expression, reducing the need for the resistance to escalate.
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🔍 Be Curious
Exploring what the resistance protects or communicates. Instead of pushing against it, inquire with genuine curiosity about its purpose, its history, and the underlying fears or needs it might be safeguarding.
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🧩 Integrate
Finding the wisdom or valuable insight within the resistance. By understanding its protective function, we can acknowledge its validity and work collaboratively to integrate its message into the therapeutic process, leading to genuine transformation.
This cyclical approach allows practitioners to move beyond simple confrontation, fostering a more compassionate and effective way of engaging with challenging dynamics. It transforms resistance from a barrier into a pathway for deeper connection and healing.
Spiral State and Evidence Base
Understanding the foundational principles of Spiral State Psychiatry involves recognizing its diverse evidence base. This approach synthesizes insights from established therapeutic practices, the invaluable wisdom gained through direct clinical experience, and the dynamic contributions of cutting-edge research, forming a comprehensive understanding for crisis intervention.
Traditional Evidence
🤝 Connections to established systemic and relational approaches, such as Open Dialogue and Family Therapy.
🔬 Relevant research findings from psychotherapy outcome studies and attachment theory.
✅ Outcome studies of related methods, emphasizing their effectiveness in crisis resolution and long-term recovery.
❤️ Principles derived from humanistic and person-centered psychotherapeutic models.
📖 Insights from qualitative research methodologies exploring lived experiences of mental health.
Practice-Based Evidence
🧠 Clinical wisdom and experience, refined through years of direct patient engagement and reflective practice.
🗣️ Patient feedback and stories, highlighting lived experience, subjective change, and recovery journeys.
💡 Practitioner reflections and ongoing supervision, fostering continuous learning and ethical practice.
📝 Insights derived from co-created care plans and collaborative decision-making processes.
🌟 Emphasis on individual narratives, subjective well-being, and culturally sensitive outcomes.
Emerging Research
🌐 New studies on presence, relationship, and the neurobiology of intersubjectivity and connection.
🔗 Interdisciplinary connections with fields like complexity science, ecological psychology, and social neuroscience.
📈 Innovative measurement approaches for relational and systemic outcomes that go beyond traditional symptom reduction.
🌳 Exploration of the impact of natural and built environments on mental well-being.
✨ Narrative approaches and autoethnography as valid forms of evidence in understanding complex human experiences.
By embracing this multifaceted view of evidence, Spiral State Psychiatry aims to offer a holistic and adaptable framework that continuously learns from both rigorous academic study and the rich tapestry of lived human experience. This integration ensures relevance, responsiveness, and a deeper understanding in the complex field of crisis care.
Spiral State in Different Contexts
Home Visits
Working in the person's own environment allows for a deeper understanding of their daily life, supports, and challenges. It enables practitioners to observe family dynamics and environmental factors directly.
This approach fosters a sense of comfort and safety for the individual, reducing the power imbalance often felt in clinical settings and promoting a more authentic engagement.
Inpatient Settings
Bringing presence and the Spiral State principles into clinical environments involves creating spaces for genuine connection and shared humanity amidst structured routines and medical interventions.
It emphasizes mindful interaction, collaborative care planning, and acknowledging the person beyond their diagnosis, even within the confines of an inpatient ward.
Community Spaces
Working in shared and public contexts like community centers, cafes, or parks allows for natural interactions and destigmatizes mental health support. It emphasizes meeting people where they are, literally and figuratively.
This expands the therapeutic reach beyond traditional walls, fostering inclusion and building networks of support within the broader community fabric.
Spiral State with Different Presentations
🌀 Psychosis
Meeting unusual experiences with openness and curiosity, the Spiral State approach focuses on understanding the meaning and narrative behind a person's perceptions, rather than solely pathologizing them. We aim to co-create a safe space where all experiences can be explored without judgment.
🌧️ Depression
Being present with profound emptiness involves sitting alongside deep pain without needing to fix it immediately. This approach emphasizes compassionate accompaniment, validating feelings of despair, and gently holding space for the possibility of light and connection to emerge.
⚡ Anxiety
Grounding presence amidst fear means offering a steady anchor when individuals are overwhelmed. By attuning to their nervous system and remaining calm, we help to regulate distress, inviting a return to the present moment and fostering a sense of safety within their body and environment.
🩹 Trauma
Creating safety through attuned relationship is paramount. Spiral State principles guide practitioners to move at the person's pace, recognizing the wisdom in their protective responses, and carefully building trust to allow for the gentle processing and integration of traumatic experiences, always prioritizing agency and choice.
⛓️ Substance Use
Acknowledging patterns with compassion means moving beyond judgment to understand the underlying pain, coping mechanisms, or unmet needs that contribute to substance use. We explore these patterns collaboratively, supporting harm reduction and fostering intrinsic motivation towards well-being and different ways of relating to distress.
⚖️ Eating Disorders
Nourishing body and spirit involves a holistic and non-shaming approach to deeply complex relationships with food, body image, and self-worth. We aim to create a relational container for exploration, encouraging self-compassion and supporting a journey towards balanced physical and emotional nourishment.
🕯️ Suicidal Ideation
Holding space for despair and hope requires profound presence and active listening without shying away from the intensity of suicidal suicidal thoughts. This involves validating immense pain, exploring reasons for living, co-creating safety plans, and affirming the person's inherent worth even in their darkest moments, ensuring they don't feel alone.
🧩 Personality Disorders
Navigating complex emotional landscapes means approaching intense relational patterns and emotional dysregulation with unwavering curiosity and compassion. Spiral State emphasizes understanding the historical and relational context of behaviors, fostering consistent and attuned connection, and supporting the development of new ways of relating to self and others, valuing the person's inherent capacity for growth and change.
Personal Practice for Practitioners
In the demanding field of mental health, especially within crisis intervention, maintaining personal well-being is not just beneficial—it's essential for sustainable and effective practice. Spiral State Psychiatry emphasizes that practitioners are integral to the therapeutic field, and their capacity to hold space for others is deeply connected to their own inner resources.
Cultivating a robust personal practice provides the foundation for resilience, empathy, and clarity, enabling you to remain present and attuned even in the most challenging situations. These practices are not an optional extra, but a core component of compassionate and impactful crisis work.
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🌀 Daily Reflection
Brief practices to cultivate presence and self-awareness are vital. This can include moments of mindfulness, short meditation exercises, or simply taking a few minutes to consciously breathe and center yourself before and after significant interactions.
Journaling can also be a powerful tool for processing experiences, identifying patterns, and acknowledging your emotional landscape, preventing burnout and fostering continuous personal growth.
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🍃 Nature Connection
Engaging with the natural world offers a profound avenue for restoration and grounding. Spending time in green spaces, even for short periods, can significantly reduce stress and improve mental clarity.
Whether it's a walk in a local park, observing the changing seasons, or simply bringing natural elements into your workspace, consciously connecting with the landscape helps to recalibrate your nervous system and re-establish a sense of calm and perspective.
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🤝 Peer Support
Sharing experiences and insights with trusted colleagues is a cornerstone of maintaining well-being in emotionally intense work. This involves creating a safe space for mutual support, where vulnerabilities can be expressed without judgment.
Engaging in regular informal check-ins or more structured debriefing sessions helps to normalize difficult feelings, gain different perspectives, and reinforce the communal aspect of care. This shared understanding strengthens team cohesion and collective resilience.
By intentionally integrating these personal practices into your routine, you enhance not only your own well-being but also your capacity to offer a more grounded, compassionate, and effective presence to those in crisis. This commitment to self-care is a professional imperative in Spiral State Psychiatry.
Team Implementation
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➡️ Introduction
This initial phase involves providing teams with foundational knowledge and concepts of the Spiral State Psychiatry. It's about planting the seeds of understanding and familiarizing everyone with the core language and philosophical underpinnings of this approach.
  • Introductory workshops and presentations.
  • Access to foundational reading materials.
  • Open forums for initial questions and discussions.
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💡 Exploration
Once introduced, teams are encouraged to begin experimenting with Spiral practices in a low-stakes, supportive environment. This phase emphasizes learning through doing, allowing practitioners to safely test out new ways of being and interacting within their roles.
  • Supervised practice sessions and role-playing.
  • Small-group discussions for peer learning.
  • Initial application in less complex client interactions.
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🤝 Integration
As comfort grows, the focus shifts to systematically incorporating Spiral principles into daily clinical routines and team dynamics. This requires conscious effort to embed the approach, transforming theoretical knowledge into consistent, applied practice across various scenarios.
  • Regular supervision and reflective practice groups.
  • Case discussions viewed through a Spiral lens.
  • Adapting existing documentation and assessment tools.
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🌀 Embodiment
The final stage represents a deep internalization, where the Spiral approach becomes an inherent, intuitive part of the team's professional identity and working culture. It signifies a collective shift towards a more fluid, responsive, and relationally-centered way of providing care, no longer requiring conscious effort but flowing naturally from shared understanding and experience.
  • Spontaneous application in complex and crisis situations.
  • A shared team language and understanding.
  • The approach influencing new policies and service development.
Leadership in Spiral State
✨ Holding the Vision
Maintaining focus on core principles
Leaders serve as beacons, consistently articulating and reinforcing the foundational concepts of the Spiral State approach, ensuring the team remains aligned with its values and objectives.
🌱 Creating Conditions
Establishing supportive environment for practice
Effective leadership involves cultivating a safe and nurturing space where team members feel empowered to experiment, learn, and apply Spiral State practices without fear of judgment or failure.
👣 Modeling Presence
Demonstrating principles in leadership style
Leaders embody the principles of presence, active listening, and open inquiry in their daily interactions, setting a powerful example for the team and fostering a culture of authentic engagement.
🔗 Bridging Systems
Translating between spiral approach and organizational requirements
A key role of leadership is to adeptly navigate the interface between the innovative Spiral State methodology and existing organizational structures, policies, and broader NHS frameworks, facilitating smooth integration.
The Wider Context
Understanding Spiral State Psychiatry within the West Dorset Crisis Team requires us to consider the broader ecosystem in which we operate. Our practice is not isolated; it is deeply interwoven with national frameworks, evolving mental health policies, the unique characteristics of our local community, and even global advancements in psychiatric care. This interconnectedness shapes our approach and ensures our interventions are relevant, sustainable, and truly responsive to the diverse needs of those we serve.
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🏥 NHS Framework
Our work is firmly embedded within the National Health Service framework, navigating its complex governance structures, established patient pathways, and the ongoing drive for integrated care. This involves adhering to national standards of practice, ensuring compliance with regulatory bodies, and collaborating seamlessly with other NHS services to provide comprehensive and joined-up support for individuals experiencing mental health crises.
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📜 Mental Health Policy
We actively align our practices with current mental health policies and evolving standards, both at a national and regional level. This includes integrating evidence-based guidelines, responding to new legislative changes, and adapting our care models to reflect the latest directives on person-centered care, early intervention, and community-based support, ensuring our interventions are always current and impactful.
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🏘️ Local Community
Our approach is intrinsically linked to the specific needs, demographics, and unique resources available within the West Dorset community. We prioritize building strong relationships with local organizations, volunteer groups, and community leaders, leveraging their invaluable insights and assets. Understanding the cultural nuances and social determinants of health within our district is crucial for delivering sensitive, effective, and truly localized crisis support.
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🌐 Global Movements
While rooted locally, we remain connected to broader international developments and global movements in mental health. We draw inspiration from innovative practices and research emerging worldwide, exploring how insights from areas like Open Dialogue, trauma-informed care, and holistic approaches to well-being can inform and enrich our local practice, ensuring we continuously learn and evolve in a global context.
By consciously acknowledging and engaging with these wider contexts, the West Dorset Crisis Team strengthens its capacity to deliver compassionate, effective, and responsive Spiral State Psychiatry. This holistic perspective ensures that our work is not only clinically sound but also socially responsible and deeply connected to the realities of our service users' lives and the evolving landscape of mental healthcare.
Resources for Further Exploration
Reading
  • Key texts on presence in healthcare: Explore foundational concepts for deep, empathetic engagement in clinical settings.
  • Open Dialogue literature: Dive into collaborative network approaches for acute mental health crises and family support.
  • Trauma-informed approaches: Understand frameworks for sensitive and healing interactions that prioritize safety and trust.
  • Systems thinking in mental health: Gain insights into complex interconnections within care systems and community dynamics.
Practice
  • Reflective practice groups: Engage in structured reflection to deepen professional insights and integrate new learnings.
  • Mindfulness resources: Cultivate present moment awareness and compassion for personal well-being and enhanced patient connection.
  • Embodiment practices: Explore the mind-body connection to enhance therapeutic presence and resilience in challenging situations.
  • Nature connection exercises: Utilize the healing power of natural environments as a therapeutic tool and for personal restoration.
Community
  • Local practice groups: Connect with peers for shared learning, mutual support, and discussion of complex cases.
  • Online communities: Engage in virtual forums and networks for broader discussions, resource sharing, and global insights.
  • Conferences and workshops: Participate in events to learn from leading experts, discover new methodologies, and network with professionals.
  • Peer supervision networks: Form supportive relationships for ongoing professional development, feedback, and ethical guidance.
Expanding Your Toolkit
💻 Digital Learning Platforms
Access comprehensive online courses, interactive webinars, and curated digital libraries for continuous professional development at your own pace.
🤝 Experiential Workshops
Participate in hands-on, immersive sessions designed to integrate theoretical knowledge into practical skills through role-playing and group exercises.
🔬 Current Research & Innovation
Stay updated on the latest scientific findings, emerging treatment modalities, and innovative practices in crisis care and mental health services.
Questions for Ongoing Reflection
How does this approach resonate with your existing practice?
Consider the core principles introduced, such as presence, deep listening, and working with the living field. Where do your current methods and values align with these ideas, and what aspects feel familiar or intuitive?
  • What current practices might already embody elements of Spiral State Psychiatry?
  • In what ways might this framework affirm or validate your experiences?
What challenges do you anticipate in implementing these ideas?
Reflect on potential obstacles, whether they are systemic, relational, or personal. This could include time constraints, organizational culture, team dynamics, or moments of personal discomfort with uncertainty or non-direction.
  • Are there specific scenarios or client presentations where applying these principles might feel particularly difficult?
  • What internal or external barriers might emerge as you try to shift your approach?
Where do you see the greatest opportunities for transformation?
Think about how adopting these principles could positively impact your work, client outcomes, and team well-being. Consider areas where current approaches might fall short and where a spiral perspective could offer significant enhancement.
  • How might this approach deepen therapeutic relationships or improve crisis resolution?
  • What new possibilities for collaboration or personal growth does it open up?
What support would help you develop this approach?
Identify the resources, training, supervision, or peer networks that would be most beneficial for integrating these concepts into your daily practice. Consider both formal and informal sources of learning and encouragement.
  • What kind of ongoing education or experiential workshops would be most valuable?
  • How can the team collectively foster a culture that supports these spiral principles?
Next Steps
🤔 Personal Exploration
Individual engagement with concepts and practices presented in this module. Take time to reflect on how these principles resonate with your current understanding and experiences in crisis work. Consider how you might personally integrate elements of Spiral State Psychiatry into your daily interactions and self-care routines.
🤝 Team Discussion
Shared reflection on potential applications and challenges within the West Dorset Crisis Team. Engage in open conversations with colleagues during supervision, team meetings, or informal discussions to explore how these approaches can be collectively implemented and adapted to your specific context and patient needs.
🛠️ Practical Implementation
Trying approaches in everyday work with patients and their networks. Begin by experimenting with one or two principles that feel most accessible or relevant to your current caseload. Observe the impact of these small shifts and be prepared to learn from both successes and areas for further refinement. This is about iterative growth, not immediate perfection.
📈 Ongoing Development
Continued learning and adaptation through further modules and sustained practice. The journey into Spiral State Psychiatry is dynamic and continuous. Look forward to future sessions that will deepen your understanding and provide more advanced tools for engaging with the complexities of mental health crisis in a spiral-aware way. Your insights from practical implementation will inform the collective evolution of this approach.
Feedback and Co-Creation
Your Experience Matters
This approach to Spiral State Psychiatry is not a static blueprint; it is a living, evolving framework designed to be shaped by the very people who practice it. Your unique insights, practical experiences, and thoughtful reflections from the front lines of crisis work are invaluable.
Every team member, regardless of their role or tenure, is not just invited but actively encouraged to contribute to its ongoing development. We believe that the most effective and relevant practices emerge from the collective wisdom of those who navigate the complexities of real-world mental health care every single day. Your voice is crucial in ensuring this framework remains responsive, effective, and truly reflective of our shared journey.
Channels for Input
  • 💡 Reflection sessions: Dedicated group dialogues and structured debriefs, fostering collective learning and shared understanding of emergent themes and challenges.
  • ✍️ Written feedback: Formal and informal opportunities to submit observations, suggestions, and critical analyses, ensuring every perspective is heard and considered systematically.
  • 🤝 Practice sharing forums: Regular sessions to present successful applications, innovative adaptations, and the nuanced challenges of applying Spiral approaches in diverse clinical scenarios.
  • 👥 Case discussions: In-depth analysis of specific cases where Spiral principles were applied, allowing for peer learning, collaborative problem-solving, and the identification of best practices.
  • 🛠️ Co-creation workshops: Facilitated, collaborative sessions specifically focused on developing new tools, refining existing resources, or adapting the framework to address specific needs or contexts.
  • 💬 Informal conversations: We also highly value your spontaneous observations, questions, and ideas that arise in daily interactions, recognizing these as vital contributions to our continuous improvement.
This deeply collective approach underscores our fundamental commitment to fostering a dynamic, responsive, and practitioner-led practice within the West Dorset Crisis Team. It’s not about merely adopting a predetermined, rigid model, but rather embracing a collaborative journey where our collective wisdom, grounded in lived experience, continuously guides the evolution and refinement of Spiral State Psychiatry.
Your active participation is the cornerstone that ensures this framework remains firmly grounded in reality, continuously optimized for the best possible outcomes for both our dedicated practitioners and, most importantly, for those we serve in crisis. We genuinely believe that true innovation in mental health care flourishes when it is co-created and nurtured by the very individuals who dedicate their lives to this vital work.
The Invitation Remains Open
This introductory module serves as a foundational step, extending an ongoing invitation to explore the principles and practices of Spiral State Psychiatry. It is not about prescribing rigid methods, but rather about creating a space for shared understanding and evolving practice within the West Dorset Crisis Team.
This module is here to name, reflect, and hold that kind of practice. It is not a directive. It is a mirror.
We understand that each team member brings unique experiences and perspectives. This module is designed to resonate with and reflect the inherent wisdom and compassionate approaches already present within our collective work. It encourages self-reflection and collaborative growth, empowering each practitioner to deepen their connection to the work and the people they serve.
The invitation is open to:
  • ► Engage with the core principles at your own pace.
  • ► Reflect on your current practice through a new lens.
  • ► Contribute to the ongoing development of Spiral State approaches within our team.
  • ► Discover renewed purpose and connection in crisis work.
The Spiral Continues
The journey with Spiral State Psychiatry is not a destination but a continuous process of growth, learning, and refinement. It's an iterative path, always unfolding, inviting deeper understanding and richer engagement. Each step builds upon the last, creating a reinforcing cycle of practice and insight.
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1
🌱 Beginning
This phase marks the initial awareness and exploration of Spiral State principles, recognizing the potential for new ways of seeing and engaging in crisis work. It's about opening to fresh perspectives and foundational concepts.
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2
🤝 Practice
Here, theoretical knowledge is actively integrated into daily crisis team work. It involves applying the core principles in real-time interactions, fostering practical skills, and experiencing the dynamics of Spiral listening firsthand.
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3
🤔 Reflection
After practice, this stage encourages deep contemplation and learning from experiences. It's a time for self-assessment, peer discussion, and understanding what worked well and what could be refined, fostering continuous improvement.
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4
💧 Deepening
This phase involves a richer, more nuanced understanding and embodiment of the Spiral State approach. It's about moving beyond surface-level application to a profound integration of its philosophy into one's professional and personal being.
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5
🔗 Sharing
As understanding deepens, the focus shifts to sharing insights and experiences with others. This includes mentoring colleagues, participating in workshops, and contributing to the collective wisdom of the team and wider community, fostering collaborative growth.
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6
🔄 Evolving
The final stage in this cycle is recognizing that the spiral is ever-evolving. It's about adapting to new challenges, embracing continuous transformation, and allowing the principles to grow and shift with each new experience and insight, leading back to a new beginning.
This continuous spiral ensures that the practice of Spiral State Psychiatry remains dynamic, responsive, and deeply rooted in lived experience and ongoing learning. It is an invitation to remain curious, adaptable, and perpetually engaged in the evolving journey of care.