Use of the internet allows for global communication; for example, in Gardner et al. (2012), dentists in six countries use a web platform to facilitate collaboration and reflection. Their aim is to use reflection in dental education as a medium for thinking about practice and being empathetic with patients rather than seeking ‘set answers to set problems’ (p. 208); the authors had been running the scheme for five years at the point of publication. They argue that the project creates a community of practice between the students where they develop ‘global citizenship’. They collaborate on an assessment through which they learn to communicate in a professional and intelligent way but with kindness and warmth. A measure of its success is that students develop videos and other creative artefacts beyond the brief of the project.

Not all digital developments are on-line: digital stories are usually short accounts of a person’s life, or aspects of their experience, that are shared to facilitate understanding and reflection (Sandars & Murray, 2011). Oral and visual artefacts can be used with students to create a digital story about aspects of practice, which can be part of a learning process and may be submitted for assessment.

SEARCH AND EXPLORE

There are many digital stories deposited on-line. Search for ‘digital stories’ or ‘patient voices’ and you will find a wealth of examples. They are worth looking at in their own right, but also are particularly useful as triggers for personal or group reflection and as examples of a non-written way of conveying an experience or message.

A rare note of caution that may be particular to digital reflection concerns the ways in which on-line reflection ‘amplifies’ the surveillance elements of reflective practice (Ross, 2011). Ross’ research explores the experiences of people reflecting in digital forms and has led her to assert that it produces a very different form of reflection. She argues that the potential for constant monitoring by others and the openness of the digital world affect the ways in which people portray themselves. She uses the analogy of wearing many different masks and suggests that constant contact via the internet, which may be supportive and positive, can also be oppressive and controlling. In chapter 4, we discussed the ethical and legal status of written reflection; the golden rules listed later are perhaps even more relevant for digital reflection. Whilst you can destroy or restrict access to paper-based reflections, it may be beyond your control to retrieve and erase something you have recorded electronically, such as a blog or a tweet.

Professionals have different ways of reflecting

Most professionals use reflection in some way. For example, it would be impossible to become an architect without looking at buildings and thinking about them. When we look at a building, we quickly make a decision about what it is – for example, a hospital looks different from a house and a school looks different from a shopping centre. Old houses are built of different materials and to different specifications from new ones. But each building has a narrative in much the same way as a story has a narrative. Before it can be designed and built, the architect must think about its use, its construction and materials.

Aristotle defined the five senses as being sight, sound, touch, taste and smell. We store reflection, in the form of memory, through these senses. In their most basic form, they are part of our fight-or-flight response (Jenkins & Tortora, 2013). However, with experience, we add to them emotionally and intellectually.

SEARCH AND EXPLORE

If you search for Aristotle and the five senses, you will find a lot of information on-line. Since Aristotle’s time, other senses have been attributed to humans. One you will certainly be aware of is time – have a look and see what the others are. Do you think there is anything missing?

Through our senses, we notice very small changes to familiar things:

•  the choice of a slightly different colour on a letter-head, or when someone’s hair goes a couple of shades blonder

•  we remember the taste of another cup of coffee and whether it was better or worse than the one we are drinking now

•  we hear a snatch of our favourite song and it gives us a feeling of wellbeing and happiness

•  our hands reach out to stroke a piece of velvet that reminds us of our favourite toy

•  the smell of fresh baked bread makes us want a slice

TIME FOR REFLECTION

The German philosopher Immanuel Kant whom we mentioned in chapter 1 said that there were two sources of understanding. These he described as sensibility – meaning time and space – and understanding – meaning things we have not learnt from experience but are able to interpret to make sense of our experiences. He believed that the power to reflect upon experience helped people to develop a greater knowledge of themselves and the world around them (Pirie, 2009).

This chapter now devotes itself to suggestions for reflections that can be done without writing. They are offered to you to do in your own time or to use as part of a group reflection. Hopefully, we will have included something in this chapter that you will be prepared to try out as part of your practice and which will enrich your understanding. These are all exercises we have done with students and professionals, which have helped them to develop different ways of reflecting on their practice.

EXERCISE

TIME FOR REFLECTION

Think back to an incident which puzzled you. Gather the main things that you remember in your thoughts. Jot them down or draw a diagram if that helps. You are now going to try to reflect on it in a much more physical and sensory way than by writing.

Did you hear anything differently? Perhaps a client’s voice was quieter or louder than usual.

What did the things around you feel like? Did they feel dirty and gritty or perhaps you remember your knuckles as you clutched your bag or clipboard.

Taste is more difficult in these situations. Was the milk on the turn or the biscuit you were offered stale?

Light moves at 299,792,458 m/s. In practice, this means we often see something and make a judgement before we have had time to engage with it in any other way. Was something different as you walked towards the bed? Did a client appear more carelessly dressed than before? Was the person in front of you nervous?

The experiences above are mostly negative, but don’t ignore the positive. Perhaps the person you were with was more talkative than usual. They may not have said ‘I’m feeling better’ but for someone who has been depressed and unhappy a sentence like ‘Aren’t the leaves beautiful today?’ is a real step forward.

We have learnt as teachers that sometimes our students seem to grow in front of our eyes as they become more confident and gain better marks. Of course, they have not grown physically, but their progress and pleasure is reflected in their whole demeanour. Has this happened to you or anyone you know?

Adding these elements of sensory reflection together, have you been able to add to your understanding of what was going on?

Picture it

Thanks to new technologies we are living in a very visual world. We spend much of our time being bombarded with information which comes to us in a very visual way.

Many of you as students will have been asked to develop posters to convey information. This is a pictorial way of reaching as many people as possible. The KAWA reflective model uses a cross-sectional picture of a river in which you are encouraged to build up your personal reflection, using the depth and breadth of the river and obstacles such as rocks to represent your personal reflection. By using a picture and the familiar structure of a river, it transcends language and culture.

You will be familiar with pie charts but did you know they were popularized by Florence Nightingale who wanted a visual and shocking way to show the British army what was causing soldiers to die? Showing statistics in such a diagrammatical way made them easier to understand than a list of numbers and helped her to win supporters to her cause.

SEARCH AND EXPLORE

Just type ‘Florence Nightingale’ and ‘pie charts’ into any search engine and you will be able to see images she created. There are many biographies of her work. Bostridge (2008) is a recent and comprehensive account.

Schools, universities, sports clubs, businesses and others all try to brand themselves by using logos. These are images which represent the brand. The Buckingham Report (DCSF, 2009) is an assessment of the impact of the commercial world on children’s wellbeing. It says that children can tell the difference between a brand and a supermarket own version of the same product by the age of three. These children cannot read, so it is the images and logos that they recognize.

Reflection by doing

Sometimes, rather than talking it is better to ‘do’. This is often true in group reflective sessions without a leader, where time can be lost talking and trying to define individual positions.

Most people have experienced a time in their lives when they have been able to have a difficult conversation with someone else precisely because they were doing something else. An example of this is driving, when people find it easier to talk intimately because they can’t make eye contact with one another and are sitting beside each other rather than face-to-face.

Art therapy is a common practice in which clients are encouraged to draw, paint or mould a piece of work in response to what is troubling them. Usually in group reflective sessions there is no time to spend painting or drawing, and often people feel too embarrassed because ‘I’m not a good enough artist’ to work in such a way in a group.

One way of overcoming this problem is to use collage. A collage can consist of all sorts of things – you might want to use images, or words, or found objects. Any of these can be used to create a piece of work which gives you a picture of what you are reflecting on.

You might be trying to discover why something is making your group feel un-easy. At this stage, whatever is going on is one of those ‘just a feeling’ things for which you can’t find words.

EXERCISE

For this exercise, you will require some large sheets of paper, old magazines and colour supplements, scissors, marker pens, glue sticks.

Every participant takes a sheet of paper, on which they are invited to arrange images and words that apply to the way they are thinking about the problem the group is trying to solve. This doesn’t have to be literal. If someone is feeling angry, they don’t need to write ‘ANGRY’ in big red letters and find a face with a wide shouting mouth. Anger could be expressed by tearing things from magazines instead of cutting them or folding things tightly because they dare not let their feelings out.

Allocate ten minutes to this part of the session. When the time is up, ask the rest of the participants to look at all the pieces of paper and what is arranged on them. Do this in silence. When everyone has looked at everyone else’s work, put another piece of paper somewhere where everyone taking part in the exercise can see it. Now, with discussion, try to identify whether there are common themes between the first set of collages. Perhaps two people have chosen similar images or arranged things on the first piece of paper in a similar way.

Now transfer anything that seems a common theme to a new piece of paper. Do not add anything or any words that have not already been chosen. The idea of this exercise is to focus down and explore people’s first and immediate reaction.

When you have decided on what is shared, you can stick it down. Finally, ask the group whether they think anything has been missed from the shared collage. This could be from their own collage or from that of a colleague. If there is something a member of the group thinks must be part of the final collage, let them add it and decide where it should be placed.

Once the group has assembled the final collage, take five minutes to move away from it. Go and get coffee or walk outside for a breath of fresh air – anything which means you put a little bit of time between working on the collage and looking at it.

Now return as a group and have a look at what you have turned your feelings into. Feel free to discuss it with the other people who have created it. It might be useful to look at it from different angles. Do your feelings or those of others change as you look at the paper from the side or turn it upside down?

Many groups find it useful to photograph their collage as a way of recording it. You are now going to try and take one image from the collage as your final point of reflection. Often, through working together to this point, people find it easy to identify one shared image. When a group cannot agree, this usually points to an underlying dissension between members. This in itself can be an important discovery, so don’t feel that your reflection has not worked just because, as a group, you cannot agree. Being able to disagree about things but still respect each other’s point of view shows valuable maturity and professional understanding.

Walking for reflection

In the past, walking played a much greater part in people’s lives than it does now. For many religions, the idea of going on a journey such as the Hajj or a pilgrimage was a way for a believer to discover more about themselves and their relationship with their god. In Europe, one of the most popular pilgrimage routes still walked, by believers and unbelievers alike, is that to Santiago de Compostela. People say the experience changes them because it gives them a chance to think and take things at a slower (walking) pace in a very busy world.

We are not going to ask you to walk the Camino but it is possible to walk for reflection in your own environment. Unless we consciously try to break it, most of us are creatures of habit.

TIME FOR REFLECTION

Think of the order in which you get dressed in the morning. Was it the same this morning as yesterday morning? And the day before that?

Most of us take one direct and familiar route when we walk to places. Our aim is to get there as quickly as possible; we do not want to be distracted or held up on our journey. The idea of walking for reflection is to free your mind and enable things other than ‘busyness’ to enter.

The poet Wordsworth regularly walked for miles when he was trying to work out his poems and what he wanted them to express. His poem ‘Daffodils’ gives an idea of what walking for reflection can do for a person:

I wandered lonely as a cloud

That floats on high o’er vales and hills,

A host, of golden daffodils;

Beside the lake, beneath the trees,

Fluttering and dancing in the breeze.

Continuous as the stars that shine

And twinkle on the milky way,

They stretched in never-ending line

Along the margin of a bay:

Ten thousand saw I at a glance,

Tossing their heads in sprightly dance.

The waves beside them danced, but they

Out-did the sparkling waves in glee;

A poet could not be but gay,

In such a jocund company!

I gazed – and gazed – but little thought

What wealth the show to me had brought:

For oft, when on my couch I lie

In vacant or in pensive mood,

They flash upon that inward eye

Which is the bliss of solitude;

And then my heart with pleasure fills,

And dances with the daffodils.

For Wordsworth, something he saw on his walk gave him pleasure to which he can return again and again. But his ability to do this was because he noticed the daffodils in the first place.

Before starting your walking reflection, you need to decide where you are going to go. If you have not done a walking reflection before, it is a good idea to choose to arrive at a place you know and which is not too far away. If you have limited mobility, your walk might involve the help of a friend, or a wheelchair. Having a destination in mind will help you to focus on your walk as you will not keep wondering where you are going.

Warm and comfortable – are you ready?

Take a few moments to think of your reasons for doing the walk. These might be:

•  to have time to think

•  to spend time with yourself

When you are ready, set off. Walk slowly but with purpose. Notice things as you go. Let yourself focus on the things you see. If you find yourself particularly attracted to something, ask yourself why. Does the over-flowing litter bin remind you of your over-crowded mind? Perhaps a bird flying makes you feel you would like to be free. As you walk, be prepared to change course. Take roads and paths you have not taken before. Look up as well as down. Be conscious of noticing things that you have missed before as you have rushed by. Is there a date carved over a doorway? How long ago was that? How has life changed since then?

Often, when you concentrate in this way, you will become aware of your spatial relationship to your environment. Enjoy this. Feel what it is like to walk across the middle of a bridge. If you can, jump the last two steps down. Perhaps you always walk close to the wall – is this because you feel protected and safe by it? Or are you one of those people who walks in the road because you feel frustrated at having to negotiate your way round other people on the footpath?

The Native American / First Nation peoples reminded themselves of their journeys and mapped them by using a memory stick. This is a stick to which they attached things that reminded them of the path they had taken. A feather might indicate where they saw a bird, or a leaf might indicate where they had had to turn by a tree. We are not asking you to make a memory stick, but you might find it helpful to pick up things that you find on your way as reminders of where you have been.

You might want to take the same route home. If you do, notice how things change when you see them from a different direction. Walk back on the opposite side of the street and look in different windows. You may decide you want to take a different route back and explore different things. Feel free to do this.

When you arrive back, have one more quiet moment of reflection to think where you have been and what you have thought. If you have collected objects on your way, this is a good time to look at them and think about why you have chosen to pick them up.

This form of putting bits and pieces together to help reflection is seen in ‘memory quilts’. Don’t worry, we aren’t going to ask you to sew! Those of you who have seen a patchwork quilt will be aware that the composition and putting together of what could be random pieces creates something warm and comforting.

SEARCH AND EXPLORE

Try searching for The Names Project. This is a series of connected quilts that reflects on AIDS and those who have died of the disease. It is a piece of collaborative work by those who have shared experiences of a relentless illness.

Colours affect us

Colour is culturally defined; for example in Europe we associate black with mourning, whereas the colour of mourning in China is white. This means that reaction to colour is influenced by people’s expectation rather than the colour itself.

If you buy clothes in big shops or over the internet, you are probably aware of the way a pair of shoes or a tee-shirt, though of exactly the same design, seem to be very different when seen in a different colour. Colour changes our perception of things and objects. In The Mystery of Mercy Close (Keyes, 2012) – a very funny, serious novel about depression – one of the ways the heroine’s spiral into depression is depicted is through her admiration for paint colours with names like Gangrene, Poor Circulation and Frostbite.

EXERCISE

With colours

Collect together seven pieces of paper in the colours of the rainbow, and a piece of white paper. Now, looking at the colours, reflect on an incident where you had a role that did not go as well as expected. Tearing or cutting the colours, arrange them so that they symbolize what you felt at the time. Now think back over the incident again and notice where you could have made changes which would have led to a more positive outcome. Space out the colours wherever you think you could have said or done something differently. These times when you could have made an intervention are represented where you see the white spaces between the colours.

Now look at the white spaces. What could you have done differently in the moment they represent? Perhaps you could have:

  altered your behaviour

  spoken to someone about the way their behaviour was affecting you

  taken a moment of calm by stepping out of a situation

  been more honest with yourself

Colour doesn’t blame. But we can all beat ourselves up with words. Look at the white spaces and keep them as a reference for another difficult time.

EXERCISE

Using storytelling

Sit down together somewhere quiet where you can listen to each other. Now tell the other person about a feeling you had as the result of something that has happened to you in practice: not the process, not the outcome, just the feeling and the events around it. Ask them just to listen and not interrupt until you have finished. This will probably take about two minutes.

Now let them share their feelings about an event with you. This time it is your turn to listen. You will probably find this difficult. Usually when we are with people we give them conversational prompts such as ‘Then what happened?’

When you have both listened to each other, you are going to reflect back what the other person has told you. So if Malik told Sophie about his feelings of jealousy about someone getting a better mark, in the second part of the reflection Sophie is going to tell Malik how he felt. Again, it is important not to interrupt but to listen.

As you listen to your story back, you will want to interrupt and change what you are being told you said. Don’t! Now tell the other person what they told you.

When you have done this, share what you feel about what you have heard both about yourself and about your colleague. Does hearing about your own experience from someone else help you to look at that experience differently? What has being in the role of a listener taught you? Did you share your feelings in an open and honest way?

Enjoying satisfaction

One of the ideas we have introduced you to in this book is the importance of reflection on things that have gone well. It is important to be able to recognize the sense of confidence and positivity that doing something well gives us. Identifying why something works and making it good practice leads to happier working environments than a culture which only reflects on things that have gone wrong. This final reflection without writing is designed to celebrate your reflective journey.

Enjoy it. Pleasure in doing things well is a valuable defence against the times when things go wrong.

EXERCISE

For pleasure

  ice cream

  fruit

  nuts

  sprinkles

  chocolate

The equipment you need is spoons and tall glasses. You are now ready to make a Knickerbocker Glory based on the recipe of your reflection.

Method

Decide which of your ingredients represents the five components of reflective practice outlined in chapter 2. To remind you, here they are again:

  embed good practice

  record thinking process

  develop skills

  improve practice

  move difficult situations forward