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Courage to Imagine

September 19, 2008—

Soul Medicine

The circle of doctors and their partners is still and quiet. The person receiving the group’s focus begins slowly, perhaps with long pauses between sentences, to describe an opportunity or challenge before him or her. A crossroads.

For two hours the group will sit, reaching beyond their medical training—which urges them to diagnose—and into the intuition and wisdom of their souls to see if there is a question, free of judgment and agenda, to ask the focus person. Perhaps such a question will come and the focus person will receive it deeply into his or her own soul. But it’s possible a fellow will say nothing, while inside comes a personal revelation…of how different his own life or her own practice of medicine could be.

At the end of the two hours, no one in this circle will ever speak of what has happened there, not even to each other, not even to the focus person.

This is a Clearness Committee set inside a circle of trust. This is double confidentiality. This is Courage to Imagine.

Courage to Imagine

Four times a year, using the seasons as metaphor, the current CTI cohort gathers for a weekend in a retreat setting. The time is spent in individual reflection, group work, journaling, connecting with nature or resting. “Everything is about invitation,” Ulstad said. “This work really respects each individual’s wisdom to know what they need for themselves.”

As facilitators, Ulstad and work partner Laura Kinkead “create a spaciousness for the retreat but also a fierceness for what Palmer describes as ‘suspending the rules of usual discourse.’”

New fellows are invited to join the CTI cohort for that year. And to bring along their spouse or partner, which most fellows do, because, as Ulstad said, “what we know about fellowships is the partner goes on the fellowship too.”

About 75 percent of fellows accept, and most of those who decline do so because of calendar conflicts. Ulstad and Kinkead mix in a few senior fellows. But any distinction between partner, fellow and senior fellow quickly disappears.

“Val and I are able to work creatively,” Kinkead said, “and often without a lot of conversation. We talk about concepts we’re drawn to. When we’re in the work, we trust each other, so we’re shifting in the moment based on what the group needs.” It’s a different kind of leading. Palmer trains facilitators to be “a guide on the side, rather than a sage on a stage.”

“As an educator,” Ulstad said, “I’m used to being in a big auditorium and having the control of knowing where things are going, but with this work I have to give myself over to what’s happening in the room.

“Courage to Imagine is not therapy, not even a support group, but a community of individuals you respect and who have their own wisdom and where there is space to do inner work using the resources of community.”

Countering medical training

As a physician, Ulstad understands what can make the circle of trust, Clearness Committee and other techniques of CTI challenging for physicians. “First, it’s hard to sit still for two hours. The tendency to want to help people is overwhelming. Docs are trained to ask leading questions and to think of things as problems rather than really listening. So holding that silence is challenging.

“Discovering the gift of a really good question—one where you can’t possibly know the answer—is a hurdle for docs to get past because we want to be experts.” Instead, the CTI process invites participants to “speak from their story instead of their expertise. When people make that switch in the retreat it’s quite a moment of authenticity, of showing up.”

Kinkead agreed. “One of the great things about the Clearness Committee is that you don’t learn it, but experience it. As you step aside from your ego and offer up open and honest questions, rather than advising or offering agenda-laden questions, you begin to see how the focus person is going deeper than if you had brought forth your own agenda.”

Finding Courage to Imagine

The story of the birth of CTI is mostly about synchronicity.

Kinkead was an executive in the administration of Allina health systems with an MBA, but it was inner work that fascinated her. She came to Palmer’s work through a consulting project at the Center for Spirituality and Healing at the University of Minnesota, where she was involved in program development for a program called the Inner Life of Healers, that was parallel to CTI, for medical fellows. (Of note, The Inner Life of Healers program was created by 1997 Bush Medical Fellow Henry Emmons.) Kinkead resonated deeply with the purpose and intention of Palmer’s work and applied in 2003 to be in his first cohort of facilitators to work across disciplines.

Rewind to 1995 where cardiologist Val Ulstad, like many in her profession, was working “really hard.” A colleague suggested she read Palmer’s book The Active Life, which is about achieving balance between being engaged in the world and being contemplative. Ulstad devoured it and his other writings; the book captured her attention in such a way that when she applied for her Bush fellowships, she wrote about it in her applications. Two fellowships and some years later, colleague Brian Campion (BMF’87 & BLF’88) set offered Ulstad an opening would bring her to that same first cohort across disciplines as Kinkead.

Synchronicity continued. Ulstad joined the BMF Policy Board in 2004, just at a time when it was wondering how it could create deeper community for the fellows and at the same time facilitate their development. Ulstad had a ready answer; since from her 2003 Courage Facilitator Preparation training, she had “brought an imagination that Bush would be one place to bring Palmer’s work.”

Kinkead said, “This retreat series fills such an important need for medical fellows. All of them are in that place of wondering and considering options as they’re moving into their fellowship. We hear from fellows how wonderful it is to have a community of people to be connected to when they are starting to disconnect from past communities and not knowing quite yet where they are headed.”

A profound impact

Developmental and behavioral pediatrician Jud Reaney, M.D. (BMF’05) was in the first cohort of medical fellows to go through the CTI process and spoke powerfully about the impact it had on him.

“It was wonderful to be in a circle of trust where I felt that I could bring my authentic self and really be heard, and also where I could hear other people’s stories and be present for them. I was able to reconnect with my most deeply held values and to be clear about the meaning and purpose that I have found in being a healer.”

As many Bush fellows report, Reaney’s ensuing fellowship came with some surprises. He has just finished training as a Courage and Renewal facilitator through his fellowship, something he said “wasn’t even on the horizon for me before.”

And he’s taken a new job, as physician lead for professional renewal for Park Nicollet Clinic (PNC), a 645-physician, multispecialty practice in 25 clinics in Minneapolis and surrounding suburbs. Next year he will be leading five Courage and Renewal retreats for PNC physicians. “I don’t think that would have happened if it hadn’t been for the fellowship and Courage to Imagine.”

As to how he believes this work can change his profession, Reaney answered: “In medicine we are very much trained to be doers. Sometimes we lose our way because we think that doing is more important than being. Only the patient ultimately can experience her or his own illness. In order to be fully present for a patient and accompany him or her through illness, the physician must bring a whole and undivided self to that encounter. Courage and Renewal work facilitates that process.”

Standing in the “tragic gap”

One powerful concept of Palmer’s work is the idea of the tragic gap, which he defines as “the gap between the way things are and the way we know they might be.” Or as Kinkead said, “holding hope but holding the reality at the same time.”

Ulstad feels that one of the things that’s been really great about CTI work for physicians is that “you talk about the professional/technical skills of physicians and then you talk about the wisdom and intuition. That’s a tragic gap in its own. You try to draw from both of them to be the best physician you can be.”

CTI work invites fellows to, as Ulstad said, “begin to believe that bringing your unique self fully present to the world is the gift you have to give the world. That is leadership. It would be transformative to the medical profession, and certainly to our culture and the world, to create a space for our amazing variation and potential.”

Click on the following link to see a PDF of this article that includes photos and additional information:

Courage to Imagine (1.4 MB)

To learn more about Parker Palmer’s work, visit www.couragerenewal.org. You can contact Val Ulstad at valulstad@earthlink.net and Laura Kinkead at lakinkead@kinkeadconsulting.com.