Contextualising Distress III: Therapeutic Conversations
Contextualising Distress III: Therapeutic Conversations
Issue 22 – May 2010 Authors: Bob Diamond and Steven Coles (steven.coles@nottshc.nhs.uk and robert.diamond@nottshc.nhs.uk)Key points
- Therapeutic conversations occur informally and in more formal settings.
- Therapeutic conversations should always be collaborative and involve a shared exploration of meanings and circumstances, so to make sense of experiences.
Implications for practice
- Therapeutic conversations are open to all of us and emerge from the way we are with one another (values), how we are with one another (behaviour), as well as what we say to one another.
- It should not be assumed that therapeutic conversations necessarily lead to changes in life. Usually for the latter to occur, it is necessary to consider whether a person has access to resources such as supportive relationships, housing, education etc.
Introduction
Therapeutic conversations are not just about conversations that occur in counselling, or therapy rooms, they occur all the time from the briefest of conversations in passing to more formal structured settings. They include how we are with one another and what we do with one another as much as what we say to one another. Therapeutic conversations do not occur in isolation and we should always consider the social, historical and environmental contexts in which they occur.Therapeutic conversations
Therapeutic conversations are defined through (see diagram below1): 1) Being Together; 2) Doing and Acting Together; 3) Supportive Conversations. ‘Being together’, includes: respect, dignity, acceptance, empathy, comforting and encouragement. ‘Doing and acting together’ recognises the significance of personally meaningful actions, this may include a whole range of possibilities, from providing information, developing social networks, access to education, reviewing incomes, moving home, along with many others. Supportive conversations occur through a reflective cycle of enquiry, through gentle curiosity, clarifying (times, places, people and events as much as emotional and behavioural states), validation and reflection, encouragement and identifying access or the lack of access to potential resources. It may be that a person is unfamiliar with talking about their distress and one way of coping with distress is to try to distance ourselves from disturbing experiences. Therefore, whilst therapeutic conversations might be gently curious, they also need to remain respectful of existing ways of coping with distress.What therapeutic conversations offer and their limits
Therapeutic conversations essentially offer 1) comfort (including developing trust and respect), 2) provide an opportunity to clarify and make sense of experiences and 3) encouragement (supporting someone to gain some influence over personal circumstances)2. However, we should not assume that therapeutic conversations lead smoothly to changes in either personal or environmental circumstance. Often, if more significant changes occur it is due to an increase in access to resources such as relationships, housing, money, education, activities and so forth3, 4. The proximal powers (Home and Family Life, Social Resources and Material Resources) will limit the changes a person can make with or with-out encouragement, though services might be able to provide practical help to access resources. Therapeutic conversations provide opportunities to validate and elaborate our experiences, this requires them to be collaborative5 in the sense that the dialogue is co-constructed. The meaning, validity and purpose of what is discussed are created between all involved in conversation. When listening to the accounts of anyone experiencing distress every effort should be made to look at the world and meaning through the eyes of the person. However, distal powers and mental health practice impose limits on the level of collaboration, an obvious example being a person sectioned under the Mental Health Act. Further examples include professional knowledge and expertise which might be imposed with scant regard for a person’s lived experience and perspective. It is important for therapeutic workers to have space through supervision and peer support to reflect on what they have learnt from being in a therapeutic conversation. This should include reflecting on the limits of such conversations and the powers imposed on all parties in a therapeutic conversation.Summary
A therapeutic conversation is like a craft process that involves the weaving of threads from what we have learnt from others with our own threads of knowledge and experiences, ultimately the cloth spun creates a unique tapestry. As a sense of trust and respect develops it becomes possible to articulate and elaborate the existing sense and meaning of experiences. As our circumstances become more meaningful, it may be possible to influence the life around us by connecting and engaging with personal, social and environmental resources.
REFERENCES
- Diamond, B. (2008). Opening up space for dissension: A Questioning psychology. In A. Morgan (Ed) Being Human Ross-on-Wye PCCS books
- Smail, D. (2001). The nature of unhappiness. London: Constable and Robinson.
- Hagan, T. & Smail, D. (1997). Power-mapping – I: Background and basic methodology. Journal of Community and Applied Social Psychology, 7, 257 – 267
- Coles, S. (2010). Contextualising Distress I: Background and powermapping. Clinical Psychology Bite-Size, 20 (January 2010)
- Hulme, P. (1996) Everybody means something: Collaborative conversations explored Changes, 14, 67 -72
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