‘My first thoughts were Why?’ Using Saul’s (2001) six qualities to get to the pearl grit of reflection

ABSTRACT

Reflection and reflective practice continue to be crucial elements of teaching, learning and development in health and care professions and can be used to identify elements of self, including values and experience, which impact the care we deliver. Whilst students grasp that reflection is a task they need to carry out, they rarely consider the philosophical underpinning of what reflection is for and, may not realise that reflective thinking is a step beyond simply writing about an experience. Using Saul’s notion of the Six Qualities which constitute human genius, I developed questions to guide reflection with these six qualities as themes then, working with two groups of undergraduate health and care students, delivered guided reflection workshops using found objects. Here I present some of the reflections recorded by the students during those workshops to show that, given time and a clear philosophical standpoint, students can be guided to consider the subjectivity of care and connection with others.

KEYWORDS:

• Reflection
• reflective practice
• Saul
• objects
• care
• connection

Introduction

Bolton (2014, p. 1) describes reflection as ‘… the pearl grit in the oyster of practice and education’. which, for me, paints a vivid picture of an itch, or irritant in practice eventually polishing up into something precious. As an educator and a practitioner I have found reflecting on my own work with others an uncomfortable process and, I am discovering, it can be just as uncomfortable to teach and encourage my students to engage in. As Bharutham (2018) warns, simply asking students to ‘reflect’ does not always lead to ‘reflective practice’. Reflection is more than stopping and thinking. It should be a process that allows us to consider the meaning and significance of an event (Van Manen, 1991) and to evaluate and make decisions for present or future action. This active engagement with meaning and Self makes reflection a crucial tool in people work but is not easy to do in the classroom. Here, I am offering my observations from classes I teach and my aim is to examine if we can get to the ‘pearl grit’ of reflection and reflective practice with undergraduate health and care students.

Humanity, reflection, and practice

I am interested in what makes us human and how this influences the way we think and act during key experiences with patients or clients we provide care to. I believe strongly that this capacity to understand our humanity enables us to connect with others in ways that supports empathy, care and compassion but popular models of reflecting can constrain that thinking by promoting the ‘correct’ way of doing things as determined by organisational structures. (Kelsey & Hayes, 2015). I wanted to introduce to my students some philosophical reasoning for reflecting as we often expect students to reflect without properly exploring ideas underpinning the models (Hébert, 2015). For me, humanist ideas, focusing on how humans can be strive to be their best, most authentic selves have always felt pertinent to people work and having read ‘On Equilibrium’, I suggest that Saul’s theory of developing human genius by exercising six of our qualities can offer an interesting starting point for reflecting on our work with people in health and care.

Saul (2001) states that what delineates humans from other species is our capacity to consider but argues that we need tools to free us from our own internal ‘dramas’ to consider questions, concepts and challenges in context. Through exploration of a number of key philosophical ideas from Plato through to German Romanticism, he concludes that there are six qualities, namely Common Sense, Ethics, Imagination, Intuition, Memory and Reason, which are the tools that we use to do this. Saul explores each of the qualities in detail to illustrate how we can use our collective understanding (Common Sense) of an experience and exercise our notion of a good life (Ethics) to acknowledge and appreciate the fundamental needs of others. He argues that our use of Imagination allows us to conceive of the other, use humour and avoid certainty whilst Intuition allows us to make decisions in an uncertain world. Finally, Memory enables us to apply previous experience to a situation and the application of Reason allows us to consider and draw from the findings of science and research. Saul carefully argues the equal value of each of the qualities and shows how aiming for equilibrium supports the growth of further qualities such as empathy and compassion. He concludes his thesis by showing that the tension between the qualities can help guard against us falling into a way of being that is driven by ideology. This, for me, is a call to action in reflection in health care, much like Schön’s (1983) experiential-intuitive model, where we can explore the guts of an experience to develop reflexivity rather than just stopping and thinking about an event.

In an earlier paper, I have attempted to use these qualities by developing themed questions to use whilst reflecting on my own practice in counselling (Eaton, 2018). This article aims to record some of the responses to those questions from students engaging in two guided reflection workshops.

The class

I teach on a Foundation Degree in Health and Social Care which is a two-year programme and many students move from here on to pre-registration programmes in nursing, midwifery and allied health. Reflection and understanding reflective practice are key elements in learning and validation for nurses (Esterhuizen, 2019) and other registered professionals in health and care and we encourage reflective discussion and writing throughout the two years of study. What is recorded in this article are the results of working with two different groups made up of second-year students to produce reflective records during two separate two-hour workshops. Group 1 (from 2018) comprised of six students, and Group 2 (2019) comprised of eight students. All but two students identify as female, one student is Black, two are from Pakistani heritage and one is Bi-racial. Out of the fourteen students, twelve gave written permission for their thoughts to be shared here and to anonymise each participant, I have referred to them by coding their first initial or second initial and the group they belonged to, e.g. T-G1.

Work experience or placement is a core element of the degree and students are supported to secure experience in a health or care setting. Each year students build an online portfolio of evidence of fundamental skills for care and we encourage reflective recording to focus on developing self, academic skills and practice decisions. Bubnys and Zydziunaite (2010) argue that reflection, extending an experience to stimulate critical thinking, should be central to higher education, and we introduce students to key concepts around reflection and reflective practice as part of a first-year academic skills module. De la Croix and Veen (2018) advise finding different methods to introduce reflection to higher education students to prevent them from simply going through the motions and becoming a ‘reflective zombie’. This, they argue, should include encouraging students to reflect on the action of reflection.

In an earlier paper (Eaton, 2016) I have described how students typically find it challenging to grasp what reflection is and for. Bharutham (2018) suggests that for some, reflection is something to be learned rather than a process needing active engagement and I would add that reflection is increasingly being used in healthcare for the purpose of showing that we are getting it ‘right’ rather than questioning what it means to ‘be’ working with another human being. Schön (1983) warns against focusing on purely rational-technical thinking if we want to develop a reflexive approach to practice and I wanted students to stop thinking about ‘doing’ improvement and to try thinking about thinking. I hoped this will help students identify some subjective influences on practice – the ‘me-ness’ of being with other people.

I uploaded a document for recording thoughts in each student’s online portfolio and developed a series of questions based on Saul’s (2001) six qualities (see appendix). Drawing on Camic’s (2010, p. 81) suggestions that objects play an integral part in our personal identity and that humans have always collected ‘… visually pleasing objects, things that arouse curiosity, and shapes that stimulate the imagination’. I gathered a selection of found objects from home to consider, including a toy car, a wooden artist’s mannequin, a geode and a small model of Buddha. Both workshops took place in computer rooms where students were able to log on to their portfolios and write directly in the template. I laid out the objects at the front of the room then invited students to choose an object, take it back to their seat and to note their first thoughts about the activity, how they felt at that moment and their initial ideas about their object. Using Powerpoint I gave a brief overview of Saul’s thesis and we worked through each set of themed questions with time for students to immediately record their thoughts and feelings. I felt it was important to capture immediate responses to give an ‘in the moment’ reflection rather than one which was pored over later. I also encouraged the group to share their findings with each other at every stage. I closed each workshop by asking students to offer their thoughts, both verbal and written, on the exercise and to give feedback on improvements for future sessions.

All the comments presented below are taken from responses written in students’ portfolio and it is important to note that not every student completed written responses for each set of questions. For this paper, I have chosen particular responses which I believe move beyond a descriptive answer e.g. ‘It could be used as a toy for a child. It could just be used as an ornament’. (C-G2 Buddha) towards a more obvious use of the themes and qualities described in Saul’s thesis. I recognise that I have been subjective in my choice of quotes and have not included the verbal responses gathered through class discussion and some implications of this will be explored later in the article.

What did we find?

Berman (2001, p. 60) warns that personal writing is like ‘a visit to the dentist’ and that we should not underestimate the discomfort of self-disclosure. This was a discomforting activity. At first students stated that they were unsure about what was expected from them, ‘My first thoughts were Why?’ (C-G2). Two students asked directly what they needed to write and one appeared frustrated when I answered that she could write anything. I encouraged students to describe their object and any feeling they had about it and most shared their notes. One student (T-G1) was unsure about her object (a wooden massager) but stated that she thought it was a musical instrument as it reminded her of instruments from her childhood. Almost all students reported that they had chosen the object because they liked it or that it intrigued them.

I deliberately chose questions about Common Sense next as these encouraged students to talk to other members of the group to discover their common knowledge about their objects. Most broadly agreed on an object’s function but identified different feelings and experiences with the object and its meaning. A student from Group Two who chose a frog ornament stated ‘Me and my partner don’t have a lot of knowledge about frogs but we know that they can catch flies with their tongue, they live in ponds and you have to kiss a few frogs to find your prince!’ (S-G2) capturing between them some fact and fairytale wisdom. R-G1 acknowledged difference in that the buddha statue could be perceived ‘… as a “ god” like figure’.

The next set of questions were based on Reason and I encouraged students to use the Internet to research their object. Most students found extra facts about their object that surprised them including value (J-G2 toy car) and geological processes (O-G2 geode) and all students in both groups shared that they enjoyed discovering new information. The student (T-G1) with her musical instrument discovered that it was a roller massager and declared that she was disappointed because she wanted it to be an instrument. She continued to engage with the object through the remaining questions as if it was her musical instrument.

Memory brought a nostalgic sense to the discussion with all students noting that they linked their object in some way to a pleasant memory. Six of the students linked their object to a memory with family or friends recalling holidays and specific events such as watching films or listening to music. The object almost became a gateway to these memories. O-G2 recalled seeing crystals and geodes used in meditation whilst T-G2 stated her mannequin, ‘Stirs something up, feelings in my mind that I can’t put my finger on but it is neither negative nor positive. It just is’.

The questions around Intuition drew some interesting answers ranging from simple pragmatic comfort ‘Easy object to choose as familiar and makes me instantly feel calm …’ (R-G1 Buddha) and ‘I am familiar with these [toy cars] as we already have lots in our house, so I felt comfortable with it’. (H-G1) through to more complex declaration of feelings about the object ‘It can change depending on choices which reminds me of life in general and that it is always changing’ (T-G2 Mannequin).

Questions around Ethics included reflecting on how the object could be used for good or bad and these drew some imaginative responses ‘I can use money positively to donate to charities I believe in, use money to live: buy a house, buy a car, fund my future children’. (S-G2 Currency). The student went on to talk about money also being used to fund addiction. M-G1 offered some ideas around good fortune, ‘Some people might find frogs lucky, because in China they have a “money frog” which represents a popular Feng Shui charm for prosperity’. I encouraged the group to consider the ‘wrongs’ around the object which produced imaginative responses ‘It could represent that people are puppets as it is something that can be toyed with and that idea may offend someone’. (T-G2 Mannequin) O-G2 reflected on environmental issues around her geode ‘Rocks are part of the environment and should maybe be left alone in their natural state. We should appreciate the earth and not abuse it through mining’.

The final questions were around Imagination and I encouraged students to think and speak from the point of view of their object which elicited some creative replies. R-G1 said of her Buddha, ‘… he would like to offer some wisdom and serve as a reminder that if you are struggling, ‘it is only a moment”’ and T-G2 stated that the mannequin ‘… would be everything and nothing. It would be whatever someone needed it to be. It would be unbiased and objective’. S-G1 imagined her troll doll ‘… wants to be played with and cared for and be someone’s friend’. J-G1 suggested that the toy car might say ‘I have a big mission on the horizon to conquer …’ whilst S-G2 presented a profound speech from money ‘The world is run by me. I am a very powerful thing. I have power over anyone, even the most powerful people in the world need me. However, despite being so powerful I have no control over what I am used for, this is where the problem lies’.

To finish I asked students to comment on how this guided reflection exercise felt for them and how it might affect their ability to reflect on their work with people. Responses ranged from a practical description of their process, ‘Before I started this exercise I didn’t think I would have much to write in each of the boxes, but when I actually got started and thought into it, my ideas flowed’. (H-G1) and ‘It’s an important process to always participate in, especially in working with other people. Always take a step back and think’. (T-G2) to a more critical reflection on reflection itself ‘From personal experience reflecting can often send you down a rabbit hole or vortex in which a situation can be taken completely taken out of context …’ (T-G1) Howatson-Jones (2016) advises that students need psychologically safe spaces to connect with others for effective reflection and despite some initial misgivings, the students generally enjoyed discussing their qualities and associated questions and appeared to get the purpose of the exercise. For some students, the exercise appeared to surprise them, ‘It has made me realise that I need to live my life learning from what happens to me …’ (C-G2) and they were able to consider its implications in practice ‘The exercise has helped a lot in terms of going into detail, and is challenging me to think about people in a microscopic way’ (M-G1).

What does this mean?

Saul (2001) is very clear that it is crucial to use the six qualities in balance and it was important for me to give equal time and importance to each reflective theme. He suggests that each of the qualities is a reflection of the others and although I framed the exercise in blocks, there is overlap in the themes of some of the student’s responses, for example, M-G1 brings reason (frogs eat flies and live in ponds) into her imagining of a frog’s voice ‘If the object could talk it would probably ask for flies, and a lily pond’. whilst T-G1 rejected reason (that the object was a massager) and brought elements of intuition, imagination and memory into her ethical use of her object ‘I would play or try to play the instrument to make someone smile … On the other hand … some people might not like the tune’.

What struck me was how involved with their object the students became and three students reported that they liked their object more at the end of the exercise than when they first chose it which suggested a relationship could be built in practice. ‘If I can reflect this deeply about something inanimate I should be able to get a lot more out of my reflective experiences with people’. (O-G2). For one student there was a connection that offered empathy ‘It’s a mix of emotions when you’re being spent for a children’s first Christmas present to then being spent to fund someone’s heroin addiction’ (S-G2, Currency). Fundamentally, this was an exercise in consideration, a skill which Saul (2001, p. 4) suggests gives us ‘… the ability to shape events rather than be shaped’. When we reflect on (consider) events, problems, interactions, we are offered an opportunity to be active participants in the future impact of that event. Here students actively considered their object, showing, as Camic (2010) describes in his research, a cognitive and social engagement with it as an anchor for deeper thought, leading them to identify the possibilities of asking those same questions in their work with people ‘… you get a better and meaningful understanding of the person when you reflect in great detail’ (M-G1).

What next?

As an educator and practitioner, it is my responsibility to view experience from different perspectives (Jacobs, 2016) and my aim for this exercise was to support students to do the same. I was keen to explore with my students a different method of reflecting to see if this could build a sense of connection and understanding from a different perspective. I have seen here that guided reflection on objects can encourage students to engage in deeper discussion and more critical thought and that they appeared to become freer and more creative in their reflections as they worked through each stage. I was worried that individuals would feel self-conscious sharing their responses, but each student was willing to interact with their object and each other in a meaningful way, moving from uncertainty to linking the exercise with reflection on people and events in their practice. As with all teaching events, what works for one group can be a complete failure with another and trying these questions with other groups could give me wildly different responses and interactions to consider. My own reflections on the activities have led me to consider refining some of the questions to stimulate critical enquiry around the values inherent in their response to the object, for example, on Reason, asking students to decide what would be relevant and irrelevant ‘facts’ about their object. It would also be useful to include a starter question on reflection in general to explore what students understand and feel about reflecting before we begin the exercise.

I acknowledge that I have chosen to quote responses that I believe most closely represent the qualities Saul describes and in doing so, I may have overlooked the significance of other responses. On reflection though, I recognise that even the most brief and descriptive responses have some elements of qualities in them, for example, ‘It is an orange toy car’ from J-G1 in response to questions themed around Common Sense, is this student’s understanding of the object in common with other students, specifically that they have agreed on colour, purpose and name. Supporting students to consider how they have come to agree could encourage them to question Memory and Reason, for example, and promote a more critical use of the qualities. The most exciting next step for me is to employ Saul’s Six Qualities to reflect on a person or practice event to test if, as suggested by this experience, they can encourage students to build connection and empathy with another human and I hope to present my observations in a future paper.

Acknowledgments

With grateful thanks to students from the 2018 and 2019 cohorts for allowing me to use your thoughts.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Colette Eaton

Colette Eaton is a lecturer in Health and Social Care at the University of Central Lancashire, Preston. After qualifying as a social worker and gaining her MA in Social Work and Welfare Practice, she worked for 15 years supporting disabled students in education. Colette retrained as a counsellor in 2018 and runs a small private practice alongside lecturing full time. Her research interests include humanist philosophy, exploring different modalities to develop reflective thinking and reflexivity in practice and the use of Self in reflective practice.