Transcript for
Co-design: Disrupting business as usual – part two

Narrator [00:00:02] Welcome to the Emerging Minds podcast.

Lydia Trowse [00:00:08] Welcome to part two of our conversation about co-design, I’m Lydia Trowse, child and family partnership coordinator here at Emerging Minds, and I’m once again joined by our child and family partner Jason Tyndale, psychiatrist Jackie Amos and researcher Rhys Price-Robertson. If you haven’t already, please go back to part one of this series where we set the context for this discussion and cover practical tips and insights for a successful co-design process. This second episode looks at the reflections and lessons learnt during the writing of this co-design paper. Jason, Jackie and Rhys, welcome back.

Jason Tyndale [00:00:44] Hi.

Jackie Amos [00:00:45] Hi.

Rhys Price-Robertson [00:00:45] Hello.

Lydia Trowse [00:00:46] Jason, I was wondering if you could start us off by talking about the importance of relationships for you in the co-design process.

Jason Tyndale [00:00:55] I think it’s important that people that you gather together are aware that there’s going to be different dynamics involved when you gather a group together. So it’s important to be prepared for that. For example, I knew that Jackie was a psychiatrist. I have had bad experiences with psychiatrists in the past in the clinical setting. So I was quite nervous, I was quite apprehensive. And then meeting Jackie was a whole different experience. So, but I knew I had to go into it with an open mind. So I think as far as relationships are concerned, going with an open mind so that you can be prepared for the situation that comes to hand, that’s probably the most important thing to me with relationships, was just going in with an open mind.

Lydia Trowse [00:01:50] Well said, Jason. Jackie, did you have any reflections on the relational and attitudinal aspects that help us succeed?

Jackie Amos [00:01:59] I’m just recalling there was a very particular moment when we were introducing ourselves where I was suddenly relieved that I went last because both Jason and Rhys shared about themselves personally as well as the roles they’d had and I think that there was a moment where Rhys introduced himself personally in a very full way. And I suddenly went, “oh, I can bring all of myself to this process, not just my psych- my psychiatrist self.” And so I think one of the things that was very key for me was realising that whatever aspects of myself get missed out of my role and I hope there are not too many, but there are obviously some that I needed to draw on all of who I am in order to be able to meet both Rhys, Jason and yourself kind of fully, respectfully and genuinely or sort of with that authenticity. If I’m missing any part of myself in this process, then something is gone out of my authenticity. So that sits alongside that open mindedness that Jason’s referred to that I think is central. It was that sense that I had to bring all of who I am, not parts or an edited version.

Rhys Price-Robertson [00:03:24] When Jason was talking about being prepared for the dynamics and I was nodding along to that, an important part of ensuring that good relationships ensue in projects like this is probably about carefully choosing the type of people that are going to be involved. Because I think, again, Jason, you were talking about important that people feel, you know, comfortable in relationships and there being a kind of trust. I think that’s like, actually vitally important. I think that I’m really interested in the idea of emergence, what can emerge when the conditions are there, when there’s an openness, when people trust in the process. And there are so many ways that the openness that’s necessary for that and the time and the trust and the comfort can get derailed. There’s just so many ways that could get derailed and then you won’t get the emergence of really interesting things. Really, relationships of trust and comfort and reciprocity are really important. And also, I think in terms of preparing for the dynamics is probably important to choose the right people to the extent that you can.

Lydia Trowse [00:04:30] Yeah, I think we would definitely be really lucky that I think it was very quickly apparent that we were all going to enjoy each other’s company and get along, which I think made the project hugely enjoyable. I was wondering if anyone had any reflections on how it might have been or tips for people if they find themselves in a co-design process where everyone might not be on the same page or things might not be going smoothly?

Jason Tyndale [00:04:58] I think it’s important that you have someone like yourself, Lydia, a support person for the person with lived experience just to be there and also as a facilitator to make sure that people supported… you’ve got to have someone there who can sort of throw the flag down, so to speak, and just try and get everything back on track, but I have a hard time trying to visualise how that would have been. Like, you see, everything had gone sideways so, how how we would have got it back on track. But somehow I feel that with the personalities that we had in the room that it wouldn’t have been a big issue. I think we would have been able to sort it out like grown adults and come to some sort of terms in regards to disagreements. But I think even if we did have disagreements, I can’t think of any that we had, if we did have any, they were smoothed out pretty quickly because I can’t remember anything like that. But I think having supports in places is important in that, in that respect.

Jackie Amos [00:06:02] I was just picking up on the word that you used, Jason, disagreements. And I think one of the things that didn’t happen so much for us, but that could be complicated in a process is if you ran into a situation where differing perspectives led to disagreement. And so part of what I was thinking about is that it it kind of the onus is on each participant, I think, to recognise when they start to want to defend their perspective or stay in their own viewpoint and dig in and convince others of that perspective. And so probably having people who can self-monitor around becoming defensive and allowing themselves to then reconnect with the vulnerability that probably lies behind the defensiveness, and also to understand that differing perspectives don’t mean one person’s good and one person’s bad or one perspective is good and one is bad, but trying to get out of that kind of binary of good and bad into what we can learn from each other. And I think, you know, that can be complicated. But awareness and self monitoring and maybe a contract at the start around how people might do that, both a contract that people should do that, but some support and ideas about how people might do that and how they might recognise defensiveness when it’s arising could facilitate this kind of process where different, differing perspectives didn’t for us become disagreement, but could easily become disagreement with a different set of people or a different set of vested interests.

Rhys Price-Robertson [00:07:52] Just picking up on things that you both said, I completely agree with you, Jason, around the importance of Lydia’s role in situations where things weren’t operating so smoothly. You know, in our project, Lydia had a, had a light touch, but you can imagine as projects that were getting more complicated or if there was disagreements or ruptures, then it would be necessary for someone in a role like Lydia’s to step in more and play a more active role. And I think it’s an interesting point, the one about the disagreements, there wasn’t a whole heap at stake in our project. You know, we were writing a paper and it was important to us, but there wasn’t like heaps at stake. You can imagine a co-design project, say, where it was different, it was about setting up some kind of organisation, and there’s a huge amount of funding involved, and there were different players and different kind of intersecting forces, it might feel like there was a whole lot more at stake. And I imagine in situations like that, there’s going to be a much greater chance that it’s going to be disagreements or different perspectives or ruptures. And in that situation, again, I think it would come down to the importance of having a really strong, facilitative presence, which would make it a different process to the one that went through, which was very, very even and very collaborative.

Lydia Trowse [00:09:03] I think from my perspective, thinking about my role, if we were doing this process with a group of different people who maybe were not sharing power quite so equitably, I think it would be important for me to have support from an organisation, you know, Emerging Minds as the organisation creates this authorising environment for co-design to happen, and I’m very well supported by the organisation in doing this kind of work. And so that, I think, would give me a lot of confidence to have a more assertive facilitating role if that were required. So I think that that’s an important feature as well.

Jason Tyndale [00:09:46] I like Jackie’s idea of the contract just to build that that trust, that that foundation of of understanding, I think having a contract of some sort, you know, to state how we’re going to do it in a nice way, not a ‘you-must-do it-this way’, in a nice way of saying, you know, let’s all agree to do it this way and we can agree to disagree.

Lydia Trowse [00:10:07] I think in this project, we really acknowledged that there can be a real power imbalance between people with lived experience, clients of services and people in professional roles. And we tried to be really explicit in ways that we tried to balance that power. And one really obvious way of doing it was that we centred Jason’s voice in the paper. So the paper was broken into sections and Jason had the great pleasure of writing first for each section. Did anyone have any reflections on how that worked in an exercise of trying to balance power?

Jason Tyndale [00:10:47] Since I had to go first [laughs]. That was no pressure. No, it was a little bit daunting because I wasn’t sure what I was doing, to be honest with the paper, I’ve never written a paper before. So that was something that was just something new to me. So that was a challenge.

Lydia Trowse [00:11:06] Was it unusual, Jason, for you to have people in positions such as Jackie and Rhys who were sort of really stepping back and saying, ‘no, you know, you go first, what do you think?’ Was that strange or how was that for you?

Jason Tyndale [00:11:22] It was, but Jackie and Rhys had to give up a little bit of their power to get it to work, so it turned out really well. And that was, that’s one of the really good things about this project, is that I honestly, authentically, genuinely wanted it to work. And I think, I believe that that Jackie and Rhys would agree to that, that’s something that they wanted it to work too. And it was a real team effort by we’re all equals in in that respect. We all have different strengths and skills, but it was a cooperative effort to work together. And so being, first off, off the rank to do the writing, I think just set the stage for how Jackie and Rhys could respond to what I’d written and give them time to reflect perhaps on what I’d written and also time to reflect on how they would respond to those statements. But Jackie’s really grounded in families and children, so she knows what she’s doing there. And Rhys was really able to narrow the focus down things and pick the meat off the bone. So I think it all worked out really well in the end.

Lydia Trowse [00:12:35] I feel like there definitely was some kind of coming together where people sort of stepped back and allowed the process to work. But at the same time, people had critical skills that they also brought into the process and it was interesting how we all kind of negotiated it, it was like a little dance. It wasn’t always spoken, but there was a bit of checking back in and I remember Rhys saying, he was helping to formulate our ideas into a plan, you know, checking that everyone was happy with how he was doing that section of work. And so it was quite a nice collaboration in that way of people with different skills.

Rhys Price-Robertson [00:13:15] Yeah, that was a thing I did struggle with a little bit when we were talking about in terms of power and voice and because I did, I found myself up on the whiteboard with a butcher’s paper that we had and I was like, you know, people would talk for ten minutes, and I guess it’s the tendency I have or it’s the thing that I do, he would talk for ten minutes and then I’d write like a kind of like a single sentence or a line down or whatever. I’m like, ‘this is what I think we’re talking about, what do you guys reckon?’ And the one hand, I think that it did help the project and it was important part of the project. And that’s the feedback I got from both of you, all of you. But on the other hand, I was I was very aware that, well, that’s an act of power there, taking ten minutes worth of speech and turning it into a single sentence is an act of pretty strong interpretive power. So, yeah, I found it hard just to kind of straddle that throughout this project. I think it was necessary, wasn’t just like, ‘OK, we all just have to, like, drop our power down to zero’ or something, because so that was a type of power that I was that I was enacting but it was. It felt uncertain and it felt like I had to keep checking in and the feedback I was getting was like, this is appreciated. But yeah, it was something to, certainly something to navigate.

Jackie Amos [00:14:29] And just reflecting on what you’re saying Rhys, I started to think that there’s some really subtle and complex things that go on when we’re balancing power, because there’s a tendency initially to think, well, we just have to jettison power or redistribute power. But in some ways, then if we just jettison what we bring, we then lose the contribution that we have to make. So it felt quite delicate and I think it was being able to check back and have immediate feedback, but also trust that the feedback we were getting from others was actually real. So that you know, we we would build a sense that somebody would say, ‘well, actually Rhys, no I don’t want you to do that.’ Or, ‘actually, Jackie, you’ve been talking for the last 25 minutes, it’s time to stop.’ I think that was really crucial to balancing power is how can we bring our richness, bring ourselves and bring our contribution. So it’s like somehow embodying our personal position or our personal power without imposing power was that kind of really delicate dance. And certainly I can speak for myself, I was desperately relieved when you started to do that, Rhys, because it’s not one of my superpowers at all. And so it was really a moment of appreciating a skill that you brought that was vital to the process.

Rhys Price-Robertson [00:15:56] Mm hmm. I was just thinking about how that worked out for us and how in some other situations it might not work out. You know, in some other situations, if I embody my power as a white gendered man with a fair amount of educational privilege and so on, if I embody that, then that’s going to feel disempowering to people almost no matter what, I think. I agree with you, it’s a complicated and tricky thing and it would be kind of case by case and group by group how you would have to negotiate the use of power and the way that you’re talking about, the way that we’re talking, yeah.

Jackie Amos [00:16:31] And I think that brings me to something that is also a practice issue, which is that context determines so much of what is going to help a process along or impede a process or even how power is read or, you know, like you’re, like you’re saying in some contexts, you sitting in yourself could feel intimidating or disempowering, as certainly me sitting in myself with my role could. So there was something about the need for each particular context, for the balance and the negotiations and the delicacies to be attended to, rather than thinking that there’s one way to balance power. But certainly a very important first step is that we understand the power that we carry or the power that we don’t carry, so that we can nuance things within a certain context. If we don’t know that we have power or don’t have power or traditionally inhabit a certain position, then we won’t know how to navigate from that position into a new one.

Lydia Trowse [00:17:41] I think this is sort of starting to highlight how unique each group of people coming together would be and the kind of work that they might be trying to achieve together and just how vastly different it would be in every single co-design process. And I think that’s why sharing co-design work in this way lets others hear little tips and tricks that they might be able to take. And knowing that not all of them are going to be relevant for their work and their situation because it will be so vastly different in each context. One of the things that I was reflecting on is because you’ve all brought so much of yourselves to this project, that outcome, which is the paper, is something that you all really care about and are invested in and it’s an important piece of work. What was it like seeking feedback on the paper initially? And was it harder than maybe other pieces of work or other things you’ve received feedback on in the past that haven’t been co-designed?

Rhys Price-Robertson [00:18:46] I think anyone who, who writes things, gets things published and produces reports or whatever else would have a kind of their own experience of getting feedback. Often you get feedback from a lot of people. Feedback can be highly variable. You know, I edited a journal and I get a first-hand glimpse of how subjective and sometimes random the process of peer review in journals can be. And what I’ve found sometimes it’s necessary for me to be open, I think often it’s necessary to to have an openness to feedback and to be really prepared to hear what people are saying and really prepared to see that your paper could, although your work could be improved. And very often it is through the process of getting feedback. But other times, you know, a number of times in a number of pieces of work, I go into like defensive mode. I become like a, like a defensive father, like protecting the piece of work that I’ve created. And in some ways I feel like I have to make a stand around, ‘well no, no, the paper shouldn’t be changed, you know, this is important, it’s important this stays this way, it’s important we use these words’ or, you know, ‘it’s important that this bit doesn’t get taken out’, even though that person suggesting that it does, it’s important that it stays, they don’t understand as well as me who wrote the paper. So this, this difficult mix of sometimes being open and then sometimes also being kind of being defensive and defending the integrity of what you’ve created. And so I think in this process, I felt a little bit pre-emptively defensive because I was like, this doesn’t seem like any paper I’ve ever written before. This doesn’t seem like the kind of paper that the organisations we’re working with have traditionally published. So I was probably pre-emptively kind of ready to do battle in some way. It doesn’t sound like the ideal attitude to go in with, but but I don’t know, it’s honest. You know, I don’t think I needed to do battle in the end, but it felt necessary, like I was talking about before, to do some shepherding and to say to people, you know, ‘hey, here’s what this is. This is what it’s like. This is why it’s not like a, like a normal paper.’ And we ended up getting feedback that was actually really great and made it clearer and made the paper stronger in the end. So that was really good.

Lydia Trowse [00:20:58] How was it for you, Jason, seeking feedback, because I’m reflecting that this paper really centres around your voice and a lot of your family’s experiences. So it’s quite personal for you in a way, getting feedback on this paper. How is that for you?

Jason Tyndale [00:21:15] Yeah, I was really nervous because I just thought, as Rhys pointed out, not a paper sort of been done before or or is is common in those circles where it’s been distributed to. So I was really nervous thinking, well, how is, say, some clinical professionals perhaps reading it? How are they going to take what I’ve said? And that’s quite critical of clinical psychiatrists and I was just worried that maybe people would read it and go, ‘oh, you know, it wasn’t great’ or that my my experiences weren’t interesting enough or that my voice wasn’t strong enough to get across what we were trying to do. So there was a lot of this involved. But when I saw the positive feedback, I was overjoyed and thought, well, this is really good because people are reading it, that’s a start. And then getting positive feedback was really nice because I thought, well, people are reading this and they’re taking it on board and I’m hoping that people will use it as a guide, I guess, to co-design and maybe it will make a difference somewhere down the line. And even if it only makes a difference to one person or one family or one child, then it’s made a difference somewhere along the line. And I think for me, that’s the joy that I get from working on projects like this.

Lydia Trowse [00:22:41] Thanks, Jason. Jackie, did you have any reflections to add on that?

Jackie Amos [00:22:45] I just wanted to say that I sit very much alongside Rhys in terms of having had experiences of publishing, so that balance between being open and defensive was something that was in my mind when I knew that we were sending this out for review. But there was a sort of wild card that I experienced when we got the feedback, which was that I had become so comfortable with our little group understanding me as a person that I forgot that the reader would only understand me as a psychiatrist. And so we had some feedback about the way that I had worded things that really indicated that if you only read from that perspective, it didn’t sound so great. And I understood when I read it, I went, ‘oh, good point.’ But the really beautiful thing was that, Jason, you came to my rescue and kind of said, ‘yeah, but Jackie didn’t mean it like that.’ And given where we started of being quite nervous about meeting, that was a very special moment for me in the process. But it also reminded me so much of, you know, how much somebody knows about where you come from in the world completely affects how they hear what you say, whatever your intention. And that was, I hadn’t expected that feedback and it was a really good reminder that unless you know me, then you only know me as a psychiatrist and that will come with certain assumptions. So that was an interesting part of the feedback.

Lydia Trowse [00:24:23] Yeah, that was I think we were all really grateful to get that feedback so that it could be portrayed as we know you in the paper, Jackie, which I think was important to everyone. I was wondering if anyone had some comments on how this kind of co-design work might make a difference to families and children across Australia.

Jason Tyndale [00:24:47] I’m hoping that the practitioners that read the paper will not just focus on that person, but look at all the factors surrounding that person, so their carer, their children, their whole family unit. I think it’s a key to unlocking a lot of things surrounding the individual. And you’ve got to look at how it affects families, how people can see the big picture, I guess, is what I’m trying to sort of paint. So that will go to helping families by practitioners looking at the whole jigsaw puzzle and not just one piece. And that hopefully they can take all the pieces and then put it together and that’s where good practice comes in, I think, when you can involve everyone, because if you’re going off, say, someone with lived experience like myself who went through a lot of issues, but my family was suffering at the same time, and it was really difficult for me to express that to practitioners that I was going to. They didn’t want to involve the family, they just wanted to put me in a little box and prescribe me some medication and say, ‘well, off you go.’ But they weren’t looking at the fact that I wasn’t responsible enough to take my medication, I had to have my my wife, my carer. She was responsible for that and she was responsible for looking after a family while she’s trying to look after me. So I think if one thing comes from it, it’s that they look at the whole picture and try to make things work for everybody and not just for the one person, but to actually look at the whole family.

Rhys Price-Robertson [00:26:34] I hope the practitioners would read it and would be using the kind of reflections that we were using in our co-design process and those questions that we came up with and bringing that to their practice. So that’s one way it might help families and children. I mean, how much a single paper can help families and children? I’m not so sure, you know, bit by bit, each little paper maybe. And you get more papers like this and you get more writing like this, it might start to help. You know, I think that goes to another point, which is, which is kind of like, you know, one way maybe this can help and this is a kind of an indirect way, but this is a way that maybe could build is that doing projects like this, it starts normalising things like co-design, you know, some people see this on the Emerging Minds website and then they listen to this, this podcast. And lots of people are talking about co-design and the idea of including people with lived experience in research projects or in policy making initiatives or in practice in ways, that all becomes more and more normal. So I think maybe we’re kind of part of a process of normalising the kinds of power relationships that we’re, that we’re exploring in the paper.

Jackie Amos [00:27:41] And I think just a little bit from my perspective, is that as clinicians, perhaps we consciously strive to hold our preconceptions and theories and technical knowledge lightly and make sure that it doesn’t get in the way of relationship, that if that message somehow reaches into the the clinical community and encourages us to keep reminding ourselves to do that, then that would be one of my hopes.

Lydia Trowse [00:28:19] Hearing everyone talk about the design process, it strikes me that it’s a lot of thoughtful work and potentially challenging work for each person involved in their own way. How did you guys find this experience? Was it worth it from you, all the effort that you needed to put in and all the careful consideration you had to give, everything that you said and wrote about? Was it worth the effort?

Jason Tyndale [00:28:51] It was totally worth the effort. I loved every part of the project and I was so excited when we started and I was still excited when we finished and, and then we had the opportunity to do this podcast. And I thought, well, that’s a great way to wrap it up, because we put so much time and effort and I put a lot of myself into it, just wanting it to work. So, you know, I think it was great, it was totally worth it.

Jackie Amos [00:29:20] I agree that it was totally worth it. A personal kind of side effect, if you like, of being engaged in this project that has been just a delight for me, is that I have struggled for many years straddling two worlds, the world of psychiatry and the world of gestalt psychotherapy, and have, for better or for worse, undervalued the gestalt side of things perhaps in my public life, but completely relied on it in my practice with families. And this process, I suppose, privileged my gestalt voice and so I have become much more confident in coming from that place more publicly in my thinking, my writing and my work. And, um, that’s just been lovely for me.

Rhys Price-Robertson [00:30:19] Well, yes. I mean, a strong agreement with the others that, yes, it was definitely worth it, the time and effort that we put into this. You know, just before we recorded this podcast, I was reading over the paper again and I hadn’t read it probably since we published it. And, uh, you know, I liked it. I was reading it and I was like, yeah, this is good. Yeah, we said we said good stuff, this is interesting. So it was worth it in one sense, like we produced something nice, produce something that seems to be of value and that’s interesting and it’s different. But also I think there’s kind of there’s an intrinsic value that I’ve found of just kind of like going through the same process as you can go through it that have value in and the in and of themselves. Even if we never published the paper, let’s say the paper got held up or we never ended up finishing it, I still think there would have been value in in us, you know, working through the things that we worked through. And there probably would have been value for each of us individually. You know, Jackie you’re talking about the value for you, I had a bit of a similar process in terms of feeling like for me, in many ways I feel like I have been and really am now kind of moving away from research in the way that I traditionally did it and this was, this was a kind of reminder like, oh I know, you know, there might be ways for me to to find a place that straddles research and the type of practice that I want to do as well. And that feels like an intrinsic value, regardless of whether we produced a good paper or not.

Lydia Trowse [00:31:43] Thanks, Rhys. I feel like Jackie and Rhys have probably touched on this final question, but see if you want other things to add. But I’ll start with Jason. Jason, has the process for you changed anything for you personally or any of your interactions professionally or personally?

Jason Tyndale [00:32:06] Yes. I don’t have such animosity towards psychiatrists anymore. I think it’s because Jackie showed me that they’re human and that they have their personalities, I guess. And it was just lovely that Jackie has such a lovely personality, is so easygoing and laid-back and easy to talk to. And I thought, well, if I go into the next doctor, I’ve just got to sort of like go, oh you know, they’re human, I’ve just got to maybe refer them to this paper. But it’s giving me an opportunity, I guess, to just look at all of the different things that I’ve done in the past and it’s just a little, I guess, a feather in my cap to say that, you know, I’ve worked on a project that I feel really proud of. And I think that that’s worked for me really well and it’s just been a pleasure to work with everyone and it was a good project and we didn’t know where it was going to go when we first, when we first got together. We had, we really had no idea, I guess, of how it would turn out. We just had, I guess, little arrows pointing us in the direction where we wanted to go and we followed our hearts and we came up with something that was really nice, yeah.

Lydia Trowse [00:33:25] I think I would add that doing this co-design process has reaffirmed that the process works and that at the start you don’t know what you’re doing. You don’t know where you’re going, you’ve got a rough idea. You’ve got a few constraints, maybe budget or timeline. But really, you need to trust the co-design process will get you through. And in this case, it definitely did get us through and it’s probably the highlight of my year with being involved in in writing this paper. So it’s a real honour to work alongside the three authors.

Jackie Amos [00:34:02] I just wanted to add one thing that the other thing this has done has focused me on looking everywhere for opportunities to involve lived experience in things that I do. And that’s been another really important professional outcome.

Jason Tyndale [00:34:24] Excellent.

Lydia Trowse [00:34:25] Thank you for your time today, sharing these reflections. You’ve highlighted the importance of relationships, having an open mind, embracing authenticity, power sharing and equity in the co-design process. You’ve also spoken about how we hope co-design processes like these might make a difference to families and children. We hope this series has shown you some of the possibilities co-design offers and encouraged you to give it a go. You can find a link to our co-design paper in the show notes. Thank you for listening.

Narrator [00:35:00] Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.