Clinicians working in psychiatry - can we ever be good enough?
As clinicians in mental health we do years of study and supervised practice to establish a knowledge and skill base to be of use to people. Our work is often challenging and stressful and not particularly lucrative or prestigious. Most of us engage in it out of a desire to be part of alleviating suffering and enabling people to have more fulfilling lives.
Yet, despite our commitment, we face an anti-psychiatry lobby telling us the practices we work so hard at are pathologising and spirit-breaking. We are told to focus on strengths, but we are also told that to 'add strengths and stir' is not enough. What are we supposed to do?
That is what this website is about. It outlines an orientation with specific skills and strategies to enable meaningful collaboration combining our professional knowledge and expertise with the personal and experiential knowledge of the people we serve.
Johnella Bird’s ideas for therapeutic conversations are a rich resource which underpin these ideas. The authors have found that applying Johnella’s ideas to core mental health activities has revitalized our practice, increased our usefulness to people and our passion for our work.
Please do contact us with any feedback that you would like to give. If you know other people who would be interested, please encourage them to have a look at this website.
1. Change nothing in your practice initially. Change offers the potential of both opportunity and loss. After you have finished a clinical conversation review it in your mind or with a colleague and consider where and when and how any of these strategies below might have been useful. As you become familiar with thinking about how they could contribute to a conversation they will find their way in.
2. In response to trauma or difficulty try:
How did you get through?
What kept you going?
We are trained to elicit trauma and difficulties as ways of understanding how this person ended up in this predicament. Questions like these have the possibility of opening up something quite different.
3. In response to hearing about something and noticing ourselves judging try (using a tone of voice and demeanour indicating interest rather than judgment):
How did you make that decision?
How well does that work for you?
What were you hoping when you …?
Answers can be surprising and we might find a sense in the choices people make which leads to discoveries for them and for us. The person may evaluate the action effectively and decisively.
4. At any time:
Are we talking about what is most important/useful/interesting to you?
This is a straight forward invitation to share responsibility for structuring the conversation. We need to have some openness for negotiation in case the person has priorities which are not the same as those we hold.
5. When offering a recommendation, or feel as if you hold some knowledge as to the most advantageous choice a person could make, pose it as a question.
What would happen if you …
Do you think it would help if you …
Asking for someone’s opinion indicates that you value it. If the idea you have is unhelpful, little is lost. If they take up the idea then they are making their own choice to do so, rather than following your instructions. Listening to hear what their ideas are rather than just waiting for their agreement and appreciation of the wisdom you are offering.
6. Summarise what the person has said.
This can be a powerful intervention done with varying levels of sophistication (see gathering threads) but even at the simplest level it slows the conversation down and gives everyone time to think. People usually find it soothing and acknowledging, hearing their thoughts spoken in the room by a person who holds power. It lets them know you have noticed and remembered what they said.
7. Ask yourself:
How well do I understand what this experience is like for this person?
What would help to increase the understanding I have?
Use the answer to guide you in developing more depth of understanding
The key to practising collaborative psychiatry is to make our knowledge and expertise available to people in a way which increases their sense of empowerment, autonomy, strengths and personal effectiveness. This can support people to develop a sense of our "expert" knowledge as existing alongside their personal knowledge - to be taken up by them as it enables them to live their lives by their ideas. The knowledge and expertise we offer becomes a resource they can make use of in their recovery journey. There are special challenges in doing this in mental health work. This is partly because the context we work in sets us up to be experienced as dis-empowering and also because of the fragility of holding of personal knowledge from a patient role.
To overcome these challenges we need:
- a social constructionist view of knowledge
- profound respectfulness for the knowledge and resources each person holds
- therapeutic strategies for bringing forward these personal resources