People often comment that there seems to be some magic in Solution Focused working; the client simply describes being a preferred version of themselves, then they seem to magically transform into that version!

Everything we regard as science was once thought of as magic. The technology at work in your mobile phone is all explainable scientifically, and yet seems like magic sometimes.

Science is providing possible answers as to why we observe the transformation we do in clients engaged with a Solution Focused process.

Basically, it appears that our brains are constantly constructing and reconstructing our perception of ourselves and the world around us, then sending instructions to every part of our body based on that perception. As a result, when we perceive ourselves to be happy, we smile, and when we identify ourselves as capable, we physically interact with our surroundings in a capable way.

Because there are so many perceivable changes in our internal and external environment happening all the time, we tend to be selective in what we pay attention to as a way to avoid becoming overwhelmed with too much information.

In reality (subjective and constructed though it is), we all experience every conceivable range of emotion in a kaleidoscope of varying intensity, duration and order from one second to the next. If, for whatever reason, we’re identifying in any particular moment as being, for example, a ‘depressed’ version of ourselves, we’re more likely to notice the emotions (or lack of intensity of emotions) that fit with that construct. This can reinforce it and influence our subsequent interactions with ourselves, other people and our environment. Conversely, when we identify as another version of ourselves; let’s say ‘fully functioning’, then we’ll be inclined to notice all the emotions, actions and thoughts that make sense to us in that context, in amongst everything else we might have noticed to a greater extent previously, and also as we notice all these little things we’re doing it’ll provide further evidence in support of the notion that we are a ‘fully functioning’ person, so that it then becomes our predominant construct of ourselves.

This phenomenon is now observable due to advances in technology used in brain scans, which can show in real time the electrical activity taking place within different parts of the brain in response to stimuli (including the delivery of solution focused questions). We can literally see the creative process in action.

By inviting clients to notice the evidence of the existence of their preferred self being present all along, albeit previously unnoticed, we can fuel this creative process with a fairly reliable outcome of the client and everyone they come into contact with consistently noticing the hoped for evidence, and therefore the constructed preferred version of them. It needs to be a polite, respectful and compelling invitation to be accepted by the client, which is where the skill of the practitioner comes in.

The outcome of engaging with a solution focused process can seem like a magical transformation, and effectively it is, because it has a scientific basis. It’s simply a constructive use of the technology we all have in our brains.

 

1: Thanks for seeing me at such short notice, I’ve just been so stressed

2: No problem. What difference are you hoping this’ll make?

1: Just to help me cope with it all. I’ve got so much going on and it’s really affecting my mood. I just can’t find the motivation. Even when I do have some motivation, I just don’t know where to start

2: So if you just have a place to start next time you have some motivation…

1: Yeah, well that would certainly help. But if so much hadn’t happened all at once I don’t think I’d be feeling like this. I need to get some things sorted, then it’ll probably feel a lot more manageable

2: Hmmm. What else do you hope will change when you get some things sorted?

1: If I can manage to do that somehow, I’ll be a lot less stressed for a start

2: And instead?

1: …This isn’t me. I’m usually so confident in myself, and capable. Everyone who knows me would tell you I’m a completely different person to this. They wouldn’t believe I’m saying what I’m saying right now!

2: Ah I see. Tell me more about who you are usually

1: Ok, well, no matter what comes along, I just deal with it. Nothing ever stops me from doing what needs doing. I’m dependable, hard working, easy going. In control.

2: And people who know you well? If I were to ask them, what else would they say about you usually?

1: Oh, err… they’d say all the same things… And they’d say I was fun, full of energy

2: So that’s who you are usually? Fun, full of energy, hard working, dependable?

1: Yeah exactly, that’s why this is such a shock, to find myself stressed and, and… incapable like this! Ugh!

2: So if coming here today leads to you leaving here and at least having a sense of starting to head back in the direction of being your usual self again; fun, full of energy, capable, all those things, then it will have been worthwhile?

1: Yes. Exactly. That’s… what I want! More than anything. I just want to be myself again!

2: Cool. Ok, so what would be something you might notice about yourself in any given moment, in any typical everyday situation, that would be a sign of you being yourself again?

1: Well, like that. Full of energy.

2: And how might that energy show up? Have a go at describing how it’d show up in any particular situation.

1: Well, like when I wake up, when I’m at work, err… after work, when I get home, I’d still be full of energy instead of drained and not wanting to do anything.

2: Ah ok, so pick any of those times, what would you be doing differently in the moment that would show you are full of energy, in a way which fits with you being yourself again?

1: So, if I pick one… when I get home. I’d get changed straight away and head straight into the kitchen to cook myself something nice to eat, then think about nice ways to spend the evening.

2: So… describe how you’d be heading into the kitchen differently, like maybe the way you’d be walking through the doorway which is typical of you being yourself again, with this energy.

1: The way I’d be walking through the doorway?!… well, ok, yeah it would be different actually, yeah, I’d be doing it… purposefully, upright, moving like this (sits up straight, moves arms around)

2: And to notice yourself doing that, what difference would that make for you?

1: It’d be nice, it’d feel like me, like… nice, yeah, nice

2: Nice, ok, and it’d feel like you. And how might that affect the way you do the next thing you do? I think you said you’d be cooking?

1: Yeah, and I’d be cooking something nice, properly, not just like a ready meal or something.

2: What would you cook?

1: Oh well, if I could cook anything… Mmm, moussaka!… I’d need to get some stuff in from the supermarket on the way home

2: And can you see yourself doing that?

1: Definitely. It’s on the way home, and I know exactly how to make the perfect moussaka! It’s kind of my speciality!

2: And cooking it in this different way? As yourself again? Can you see yourself doing it?

1: Yeah of course!… I mean, I’d need some things to change, to get into that space, y’know, but yeah I could see myself doing that again at some point, yeah

2: How will you know when you’re getting into that space? When any changes you’ve made, and any others that come to pass somehow have worked, so that you’re finding yourself getting into that space?

1: Oh, err… I think I’d just feel it, y’know?

2: Yeah, why not! What would you feel?

1: Oh I don’t know… no… I, err… no I don’t know…

2: ….

1: … I err, well sort of, I’d just feel… more… alive

2: Alive? Nice!

1: Yeah, I’d just feel alive!

2: What the closest you’ve come to feeling alive in that way recently?

1: Oh well I’ve felt it quite a lot recently. This morning. Walking here in the sunshine… I saw a baby sitting up in their pushchair, waving at the ducks! So cute!

2: Ah lovely, how do you account for your noticing that and feeling alive in that moment, instead of just, y’know carrying on, head down, being stressed, all that?

1: That’s a good question!… I think I just took a step back, even before I left the house. I don’t know how else to put it. I stepped back, took a different view, y’know? I just thought “oh whatever, let’s just do this” took a deep breath, took a step back and left the house.

2: Where did your next step land?

1: Ah! I see where you’re going with this! My next step, my next step landed in today! In a good day!

2: And who are you today?

1: Me! This, this is me!

2: Awesome! Well we’re just about of time here. Do you mind if I ask you just one more question?

1: Of course! Go ahead!

2: Ok, so I’ve asked you a lot of questions, and you’ve answered every one. I think it’s the answers, more than the questions, that can make a difference, so I’m wondering – what answer that you came up with stands out for you as something that might be useful to be taking away from this conversation?

1: Ooo good question!… I think, well obviously the thing about taking a step back… and feeling alive, just reminding myself of that feeling of being alive.

2: Nice. Really nice. Well, it’s been a pleasure meeting you.

1: You too. Thanks. Have a nice evening.

2: You too. See ya!

Talking about our problems doesn’t help.

That’s a myth.

Talking about our hopes and achievements despite, or in response to, our problems helps.

We’ve all found ourselves sitting in a group of people bonding through a shared moan about politics, societal issues and the state of the world; ‘putting the world to rights’. Think about it; nobody’s feeling better during the moments in the conversation in which we’re just focusing on what upsets us.

It’s the realisation that others appear to value our perspective, that connection, that starts to lift our spirits.

Then it’s the part where we’re talking confidently, with gratitude, defiantly even, about the good things we’re enjoying in spite of it all, and what we’re looking forward to doing next.

Then there’s the moments during the conversation when people recall reassuring and motivating exceptions; “I just despair of youngsters these days… mind you, you know that young girl down the street? She helped me with my bags the other day! Saw I was struggling and came over to offer some help! I was so knackered I decided any help from anyone was welcome! She turned out to be really nice and polite! So considerate! Glad I decided to trust her actually! Perhaps there’s still some hope for us all yet!”; “Makes you feel like just staying in bed doesn’t it! Still, good job we managed not to or we wouldn’t be sat here enjoying this coffee and cake right now eh! And each others charming company of course!”

Problems often naturally come up in conversations, including those about our hopes and shareable resources, but don’t be fooled into thinking that this problem talk in itself makes a positive difference in our lives.

The positive differences in our lives that we notice whilst acknowledging our problems are where the hope, the belief and the talents we can use to build a better future are found.

So with this in mind, if we wish to help someone find hope and believe in their ability to build a better future, then we can do so by gracefully inviting them to notice, from their perspective, the positive differences and exceptions in what they describe.

Not in a “cheer up, it’s not that bad!” way, though. It’s important to make this distinction. More in a “how awful. How are you getting through to the extent that you are?” way.

Inviting them to notice from their perspective, not trying to force another perspective, even if our opinion is that another perspective might be more helpful (it won’t be, guaranteed. Not if it’s imposed, no matter how politely and subtely).

This applies whether they are talking about the past, present or future, because believe it or not, I swear, everything needed for everyone’s hopes to be realised is always there already, just waiting to be noticed.

I’m not the only one with this understanding of what works. There are thousands of professionals thinking the same way to the benefit of their clients.

Next week, Rayya Ghul, a fellow solution focused practitioner and writer, is basing her act at the Edinburgh Fringe on problem talk myth busting in what promises to be a humourous, entertaining and profound show. Details can be found here

 

 

I’m trying something a little different this time around; a short video blog (or ‘vlog’). There’s a transcript and further discussion below. This also marks the launch of my new YouTube channel, here: https://www.youtube.com/channel/UCI_dwh-vpxOznEI5IvVFH6Q/featured

It is intended as an introductory piece beginning to explain the solution focused approach, or at least my personal take on it. It seems to me as good a place to start as any!

It is primarily aimed at anyone with an interest in using the solution focused approach in their work. This includes coaches, therapists, counsellors, nurses, social workers, doctors, youth workers, business consultants, tutors, supervisors, mentors and probably many more professionals and volunteers I haven’t thought of in the moment whilst writing this!

There’s an application for this approach in the context of any conversation between people in which talking leading to hopes becoming reality is sought, and particularly where a practitioner wishes to ensure they are working in an ethical, compassionate, respectful, empowering and efficient way.

–

Transcript:

“Over my shoulder you might be able to see there’s a radio telescope.

It’s on top of a space centre, and inside that building scientists are trying to make new discoveries about the universe.

When they analyse the data that’s collected by that radio telescope, sometimes they’ll see things which look familiar.

In order to make new discoveries it’s very important that they don’t know, that they try very hard not to know what it is they’re looking at, and just take it for what it is.

And when we’re talking to people, in our conversations, in the course of our work, it’s very important that we do the same thing. That we just listen to people, listen to the words they’re using.

Even though we might have some interpretation, even though they might sound familiar, it’s very important that we decide not to know, and we just listen.

And that’s how new discoveries are made.”

–

Further discussion:

I would like to add something about those discoveries.

The only discoveries we need to pay attention to are the specific words used by the person we’re talking with, which they provide in their answers to our questions, and which they use to describe the version of themselves they are hoping to realise.

Whatever meaning or significance any of those words has for us is important to put aside. We simply listen out for them, note them, and collect them. Even if they sound familiar, or remind us of things we’ve heard or experienced ourselves before, the best way for us to remain on a direct course in providing a useful interaction is to choose to stay in the moment, remaining aware of the context of listening, collecting and conversing with the person in front of us.

We are simply using discovered words to carefully construct useful questions.

To be conversing in a solution focused way, this is what we must choose to do instead of taking perhaps enjoyable but not particularly relevant or useful detours through our own interpretations, theories, philosophies, memories and other imaginings. It takes discipline and charity, but it is also often enjoyable for all participants in the conversation, and perhaps most important of all, it works!

The reason we stick to using as many of the other persons words as we can, regardless of any irrelevant interpretation we might feel tempted to entertain, is so that whatever meaning and significance that person attaches to their words in that moment echoes, reverberates and becomes amplified for them.

Our intention is that through this process the preferred version of themselves they are realising in their mind comes closer to their noticed reality through definition, through being talked about out loud using specific defining words. They increasingly hear themselves being referred to as that version of themselves, and referring to themselves in the same way. This often seems to build confidence in the existence of that version of themselves, so that their gaze shifts towards noticing the evidence that they are that version of themselves, leading to their consistent identifying as that version of themselves, and eventually realising that they truly are that person.

 

*(taken from the line “Your signal in the distance, to whom it may concern” from ‘Walk’ by Foo Fighters – a particularly solution focused song!)

There’s this popular idea that 1 in 4 people suffer with ‘mental health problems’, which has led to the instinct to try to identify which amongst us is that 1, so that we might help them.

Looking for signs of ‘mental health problems’, then, has become the go to starting point in ‘mental health awareness’, and ‘mental health first aid’. So much so that if you ask attendees at the outset of an awareness course or training, “what do you need?” they usually answer with replies about information on “what to look out for”.

This is a perfectly fine and natural response, especially given the cultural context.

Even though it typically refers primarily to looking for problems, because the prevailing cultural norm has been to assume that doing so is constructive, it can easily lead to an even more constructive discussion about what we might all notice about ourselves and each other than can be useful for us all to continue forwards in the direction of ‘mental health’.

This is what would happen if the facilitator of the course or training were using a solution focused approach anyway, otherwise it would typically lead to something more along the lines of instruction in a crude interpretation of psychiatric diagnostic technique, with the intention of equipping all present to accurately spot ‘symptoms’ so that they might go on to accurately signpost to ‘experts’ who can administer effective ‘treatment’, and hopefully, along the way, prevent harm and provide some support and reassurance.

There is a very nice intention behind such ‘mental health awareness’ campaigning, but often an unfortunately flawed approach.

The ‘1 in 4’ statistic most likely reflects the proportion of people identifying or being identified with the theoretical construct of ‘suffering with mental health problems’ and willing to disclose this when asked to in surveys.

In reality, because the one constant in life is change, everyone experiences the elements of any construct to varying extents at various times throughout their lives. Whether it defines who they are is a choice, and that too is subject to change.

Therefore either 4 in 4 or 0 in 4 is probably more accurate, depending largely on whether the construct is taken as a fixed and/or accurate interpretation of human experience.

Recognising that everyone is potentially suffering in some way in any given moment, so simply being as compassionate and respectful towards everyone around us as we feel able to be in the moment makes sense as the best mitigation. Looking for signs of managing to find ways to at least stop things getting worse, perhaps signs of turning things round for the better, or even of thriving, despite inevitably suffering at times, is a useful starting point in building confidence that ‘mental health’ is ahead.

Instead of trying to identify the 1 in 4 people to target for support, help or even for ‘treatment’, it is far simpler and more reliable for each of us to simply make a pragmatic choice to believe in everyone we meet’s capacity for change and usefully support each other by acknowledging each other’s strengths, resources and achievements as well as problems, no matter what statistical demographic any of us might appear to fit into.

Crazy as it might seem, we don’t actually need to try to find out who amongst us has something wrong with them, who has the problems, and how they might be fixed.

I once witnessed a person open up to their friends about suffering to such an extent that they were seriously considering suicide. Their friends instinctively hugged them and told them that they loved them.

A short while later they told me a lot had changed, they were no longer suffering to the same extent, and even when they were still suffering they remained determined to live.

I asked them what had made the biggest difference, and their reply was “realising that I am loved”.

This is just one example. In fact I’ve seen the same thing happen countless times with countless people.

We can’t always, for reasons including cultural appropriateness, hug people and tell them we love them. But we can always talk with everyone in the way we talk with someone we love.

So, back to that question of “what do you need?” Well in terms of awareness, and ‘first response’, there’s one answer I long to hear above all others, because the question of addressing ‘mental health’ only really requires us all to remember one thing.

As The Beatles reminded the world half a century ago, in an epiphanel moment as we all stood at various socio political and mass cultural crossroads, as we all do again today; “all you need is love”.

 

“Look into your mind’s eye see what you can see, there’s hundreds of people like you and me”
(Hawkwind; ‘Hurry On Sundown’)

The town I grew up in was renowned for its Friday night street brawls, conspicuous uneven distribution of wealth and availability of illegal drugs. It was once described in a national newspaper, albeit rather sensationally, as ‘The English country town that is a heroin hell’. It was rough, commercial, competitive and garish in town, the absolute embodiment of tacky 1980s dog eat dog Britain. But the surrounding countryside was truly beautiful, so that’s where I chose to spend as much time as I could.

Close to Stonehenge and several disused airfields, the area was naturally adopted as an epicentre of the free festival/rave scene at that point in time. I found myself amongst like-minded revellers during summer months, who had also chosen to turn away from the cold concrete architecture and attitudes, forming a counter culture of tolerance, collaboration and mutual appreciation of humanity and all creation (of hope, love, trust and belief in each other, in other words).

In spite of where we’d come from, no matter what was holding us back, we found a way to peacefully co-exist as the people and the community of our wildest, most blissful imagining.

This joyful communion was expressed through radical new trends in art and music, and the ensuing celebrations were collectively dubbed ‘the second summer of love’.

Thirty years have passed since then. I’m a different person now, because I’ve had to constantly adapt to an ever-changing world. But I’ve kept the aspects of that version of me (and other people, of you even) which have been most useful in pursuit of my hopes for what tomorrow brings.

All human beings, like you and me, truly have an amazing ability to follow their hearts desires and reinvent themselves as necessary, doing whatever comes naturally to them in line with the direction of that reinvention, that preferred identity, no matter what their starting point.

We all carry around hundreds of constructs of the person we can be. Hundreds of possible versions of ourselves (more than hundreds really, countless, but that’s how the song goes!)

More than what we might do, where we might be, it’s who we’ll be in that moment that defines us.

That moment when our hearts desires about the person we can be become our reality.

How would we be ordering a coffee as that version of ourselves?

How would we step out of the car as that version?

What would the people around us notice?

What would be different?

What do you see through your mind’s eye?

There is a relational aspect to this reinvention. That which makes us all ‘like you and me’. Our interactions are integral to our constructs of who we are and who other people are.

People are simply people.

I’ve lived and worked in all sorts of environments with people experiencing all sorts of different problems, and one thing I’ve noticed is that people find a way, regardless of the nature of the obstacles in their path.

Many of my fellow health/psychology professionals, when responding to requests for help with emotional/’mental health’ matters, still seem to think in terms of matching an approach to client presentation, carrying an assumption that there’s a different way to appropriately therapeutically interact with someone struggling with, say, ‘depression’ or ‘anxiety’ compared to someone with, say, ‘psychosis’ or ‘complex trauma’.

The thing is, no matter what anyone’s struggling with, there exists a common baseline which we all share, which is a concept of how (who) we’d like to be, and it’s evidently achievable no matter what is getting in the way of being that person right now.

So by simply engaging in natural, person to equal person conversation with someone, inviting them to use their ‘mind’s eye’, keeping focused on their recognition of the signs of their reinvention becoming their constructed reality, regardless of current ‘symptoms’, regardless of any pre-conceived ideas about how this might be achieved, the process of bringing about desired change becomes much simpler, and characterised by hope, love, trust and belief.

It makes no difference where someone has come from, how they ‘present’ or how we interpret their words and actions. They have a concept of who they want to be in the life they want to live, even if they might struggle at times to articulate it.

They know. We all know.

And they have the innate human ability to create what they see in their mind’s eye, even if it’s difficult, even if at times it seems impossible.

The first step in this creative process begins with imagining, with dreaming, with a look into the mind’s eye, noticing the differences. Then those same differences can be recognised for what they are as they manifest in tomorrow’s reality.

All we professionals need do is respectfully, politely, with hope, love, trust and belief, invite our clients to take that first step.

So enjoy the summer solstice people, and “hurry on sundown, see what tomorrow brings”.

I recently learnt that the BACP (British Association for Counselling and Psychotherapy) discourage counsellors from working with people experiencing psychosis unless they are working in a specialist setting, and have specific supervision and experience of working with this ‘client group’. This is described by them as ‘working within our competence’.

This intrigues me.

I’m not a counsellor or BACP member myself, so I’m kind of ‘on the outside looking in’.

As a mental health nurse, I’ve never really experienced exclusivity. I’ve always been expected to work with everyone who comes my way, and as a result, what’s struck me is the human commonality amongst everyone, regardless of diagnosis and clinical presentation. People really are simply people.

Apologies to any counsellors and/or BACP members reading this if I’m missing crucial considerations here, by the way. Please feel free to share your perspective if so.

How can a counsellor (or anyone, for that matter) truly know if someone is experiencing psychosis?

History (including diagnostic history) is the past, it is no certain indicator of the future, any more than eventual outcomes being dependent on current obstacles (they’re not – anything is possible whilst obstacles are being negotiated).

Every word someone uses to describe their situation has unique meaning to them. We cannot have an accurate understanding of the meaning behind their words without actually being them.

When someone tells us they are ‘psychotic’, or if someone else tells us they think that person is ‘psychotic’, or if we start to explain our internal response to the things they’re saying or doing in terms of an interpretation that they are/might be ‘psychotic’, we’re being distracted by, as Steve De Shazer sometimes put it, a red herring.

Here’s an example of how this might show up in conversation:

“The doctor has prescribed these anti-psychotics. They help a bit, but I don’t like the side effects and the idea of relying on them, you know? I prefer to be free from all that, independent, so I don’t always take them”

A lot of people living in a culture infused with the language and taught perspectives of western medical practice, consumerism and risk aversion, would be likely to respond to hearing something like this with reservations about the wisdom of the choice to not take the medication, and might also wonder about the meaning of ‘free from all that, independent’ in this context – possibly even construing it as a preference to be psychotic.

Now if we substitute ‘anti-psychotic’ with a word we’re culturally more likely to believe refers to a surmountable obstacle, and something we’d be more inclined to trust someone’s subjective judgement about, we might end up with something like:

“The doctor has prescribed these painkillers. They help a bit, but I don’t like the side effects and the idea of relying on them, you know? I prefer to be free from all that, independent, so I don’t always take them”

In both cases, the same desire is being expressed – to be ‘free from all that, independent’, the potential obstacles being psychosis, pain and/or a prescription. One needn’t detract from the possibility of the other (in fact, in the examples above, there is a clear possibility that the person could be describing managing to experience the closest they can get to the realisation of their desire at this point, although I personally would still prefer to keep an open mind and not draw any conclusions). The natural flow of the conversation could therefore be considered to continue with asking the person about what being ‘free from all that, independent’ means to them (not so much so that we might share their understanding, but simply so that they can further develop their own clarity around what they hope for), what difference it would make in their life, how it would impact on the other people in their life, what else they might do to help them become more ‘free from all that, independent’, how they would know they’re succeeding in being ‘free from all that, independent’ in a way that was right for them and other people, and so on. ‘Psychosis’ and ‘pain’ actually needn’t come up in the conversation again from this point forward in order for it to be a useful conversation with someone about how they might continue towards the future life they would like to live.

These are simply words. They could mean anything. People recover from anything. Everyone is capable of change (in fact we can’t not change), and a key catalyst in change happening is talking with other people who believe change is possible. This has been evidenced many times by research.

If a car breaks down, we open the hood, look for the broken part and fix it. But we don’t really currently have the technology to do that with the human brain. Besides which the human brain is very different to a car engine. It literally constantly rewires itself, and part of this process (as has been uncovered through advances in neuroscience research) involves us thinking about what we’d like to experience.

Therefore, a really useful thing for us all to talk about with anyone looking to recover from anything (including ‘psychosis’) is what their recovery will look like to them and the people around them. The self re-wiring nature of their brain will take care of the rest. This can take place alongside use of medicine if felt necessary too. Whatever anyone finds works for them is all good.

Counsellors can do that. They’re generally highly skilled in doing that. Research has identified the common factors in effective counselling. They were recently very eloquently discussed by Professor John Murphy, in the Simply Focus Podcast (episode 56): http://www.sfontour.com/project/sfp-56-dont-assume-ask-a-unique-conversation-about-common-factors-respect-and-keeping-clients-at-the-center-with-prof-john-murphy/ ; the ‘alliance’, expectancy, hope, acceptance of the client’s viewpoints and a willingness to work on what the client thinks is important. All of these can be part of the clients experience regardless of the approach used by the counsellor, and regardless of whatever problem the client brings (including ‘psychosis’)

In the February 2019 issue of ‘Therapy Today’, the BACP’s journal, there was a fascinating article discussing the influence of a culture of psychiatric diagnosing on the work of counsellors. It is available to read online here: https://www.bacp.co.uk/bacp-journals/therapy-today/2019/february-2019/who-needs-a-diagnosis/

If individual practitioners feel unable to work with particular clients for any reason, then I think it’s right that they signpost them to someone else. However, I would also like to invite the counselling profession as a whole to move on from doing this purely on the basis of an excluding interpretation of the clients perceived mental state, instead simply encourage each other to work with anyone they believe is capable of change, and recognise that belief as their competence.

Within the realms of hypothetical possibility, no matter how unlikely, and within your sphere of influence, taking into account any constraints you have to contend with, what would you most like to achieve?

Suppose that you somehow achieve it at some point. What difference would it make to you and others? What difference would it make to the way you view yourself – the person you would consider yourself to be? And the person others would consider you to be?

Now suppose that somehow, at some point, you become that person. That person you’d most like to be. No matter what happens in your life from this point forwards.

If you could somehow send a message to yourself back through time from then to now, what would that message say?

What would you notice that’s different about you in any particular situation, from that point on?

What’s different about how you might handle such a situation then, compared to now?

What would a small difference be in the way that you handle such a situation between now and then, if it were to be a little closer towards how you would then?

What would you like to keep about how you handle such a situation now?

What about in other situations?

In as many other situations as you can imagine? Typical, everyday situations.

What else, out of everything you’ve been doing so far, might be useful to keep doing?

What might other people notice about you that could be a sign that you’re on your way to becoming this person?

How might you know they’ve noticed that?

What difference would it make for you to notice this happening?

What signs have you noticed that you might already be on your way to becoming this person, even if only sometimes?

If you like, list 10 more signs, then another 20, then another 50.

Out of all the answers you’ve come up with to these questions, what stands out to you as something that will be useful for you going forwards from this point?

See you then.

This post touches on the same themes I addressed in my previous post ‘A Matter of Life or Death‘. I hope it reflects how my thinking has developed.

Asking a client “what’s been better?” is a typical way for a solution focused practitioner to begin a follow up meeting.

I received a powerful reminder of why this is recently.

A client had seen me and several of my colleagues over consecutive or near consecutive days during an apparent suicidal crisis. In between contacts with the client, we were all saying things to each other like “they’re in a really bad way” and “they’re really struggling”.

When it came to my turn to see them again, I had a brief moment of doubting whether “what’s been better?” would be an appropriate opening question, given how much we all knew they were in a really bad way and struggling.

…Then it occurred to me that we didn’t know that at all!

Nobody knows how someone else has been since they last met, even if other people have told them what their impression was when they saw that person during the interim. This is because the only information to go on is an interpretation of a third party’s description of their perception in a moment that came and went, which represents a tiny proportion of the other persons experience.

By asking “what’s been better?” we’re at least entertaining the possibility that a corner might have been turned, even if only fleetingly, perhaps unwitnessed by others at the time. In actual fact, it’s more than a possibility, it’s a certainty, because we know that experience is inconsistent. It just doesn’t always seem that way at first glance.

In reference to state of mind, nobody can possibly know how someone else is right now if that person is not in front of them. Even then, they can’t actually know, because perception is always subjective. The closest anyone can get to knowing is through their own interpretation of verbal and non-verbal language, filtered by their own assumptions, experiences and expectations. Attempting to know is therefore inherently futile, so not likely to be particularly useful.

Also, there’s no accurate way of knowing what the future holds. The only thing we can know with any real certainty is that everything changes. That’s the definition of the passage of time as we perceive it.

By asking about the moments in which our clients experienced/might experience preferred changes, and what was/might be different about them in those moments, especially about the part they played/might play in constructing and sustaining the change that took/might take place during those moments, we’re amplifying their skills, resources, solutions and their reorientation towards the life they hope to live.

An alternative, less solution focused question could be “how are you?” or “how have you been?”, and this type of enquiry may conform more with cultural norms. We can ask this and still listen to the reply with a solution focused ear, catching references to better moments. The reason why we opt for the less conventional “what’s been better?” is that it’s more direct. It’s also literally safer to assume that relatively better moments have occurred and choose to ask about those moments. Those are significant moments in the client’s life, most aligned with the direction of travel towards the life they hope to live. Opting to focus straight in on the safest moments by asking directly about them is the more efficient use of time, given that our intention is to maintain and cultivate safety. “How have you stayed safe?” would be an alternative solution focused question. However, it’s possible that things have improved for the client to such an extent that staying safe is now a given, and they’ve moved on to even better progress. We wouldn’t want to inadvertently disregard such progress, so a more general enquiry is preferred (we could always ask that as a next question, should their reply indicate that safety is still their primary concern)

…So, armed with this perspective and a decision to trust the process, I asked the client “what’s been better?”

And their reply?

… (after some thought) “Quite a lot actually!”

We went on to discuss how they had achieved this progress and what their next step would be.

They could have said “nothing” or even “nothing, it’s worse”, in which case we could have talked about how they stopped it from being even worse, how they held on to enough hope to keep going sufficiently for us to be talking with each other again today, and what would be the signs to look out for going forward that indicate that things are getting better again.

In any case, the point is I can’t possibly predict an account of the past any more than I can predict the future, and the present is equally subject to perspective, so in order to have a useful conversation with someone who has talked about struggling to stay alive, the most appropriate questions for me to ask them are those about the moments in which their struggle results in them staying alive and heading towards a better life. Not so that I might attempt to know anything, but simply so that their answers might provide useful insights for them about how and why they’re doing that.

“What’s been better?” is a very good start to a conversation like that.

The following poem is the result of a collaboration between me and my Dad, Tony Ward.

His poetry book,  ‘Unravelling Sussex’ is available from the publisher here and from other booksellers. He recently won best poem by a primary carer in a National Memory Day competition, sponsored by The Alzheimer’s Society, for his poem ‘What Will Survive of Us’, which can be found here

——–

I’m putting myself back together

I used to think,
“I’d better not show my mania”.
Then I got tired of worrying about what people might think,
and decided to just be myself.

Now people keep saying to me
“I love your enthusiasm!”

I used to think,
“I’d better keep a lid on my psychosis”.
Then I remembered the value of having an open mind.

Now people keep saying to me “you’re so creative!”

I used to think,
“I need to get rid of my anxiety”.
Then I found out what it takes to do the things I never thought I would.

Now people keep saying to me
“you put so much energy into that!”

I used to think,
“I can’t afford to lose time to my depression”.
Then I noticed my emotions gradually returning.

Now people keep saying to me
“you have such patience!”

I used to think,
“this is an addiction. I need help to avoid losing everything”.
Then I discovered I can take it or leave it whenever I choose.

Now people keep saying to me
“You always have the solution!”

I say to them,
“Just listen, just listen to yourself,
there is no problem you cannot solve,
no condition you cannot overcome”.

Now people are saying to me
“If only she had heard
those crucial words!”

But, haunted by praises, unseen,
she left too soon.

And now, I must myself believe,
that had she heard, that had I seen,
I would not be weeping now beside her grave,
putting myself back together.