Difficult situations
• Relational externalizing can support explicit discussion with space from the emotional intensity
• Use the power relation to change the form of unhelpful conversations

Johnella Bird's ideas are particularly useful in some difficult clinical situations, particularly those involving strong emotions. Relational externalizing allows us to lay out emotionally intense issues for discussion with some space from the emotional intensity they carry.

When one person is abusing another in a clinical situation, it is important to manage the power relation to interrupt the process and slow it down and engage in careful listening and respectful inquiry. . Possibilities include:

We can use the power we hold to change the form of the conversation, stop the interaction between the people in the room and interview each individually.

Inquiry to bring forward values and intentions can open space for movement. For instance:

In response to a threat:

“If you … I will kill you”

a carefully constructed respectful inquiry can change the whole tenor and focus of the interaction:

With someone who will not talk the strategies described above with respect to negotiating engagement can be helpful. Tentatively offering options in relational language and languaging the inbetween can support a person to engage.

“Sometimes when people find it difficult to answer questions there can be all sorts of reasons. Some people have had an experience of or a worry about information they have given in a situation like this being treated inappropriately, told to someone they did not want to know it. Many people who have been through difficult times manage the emotional discomfort they experience by putting the situation out of their minds. If this is one of the strategies you use I am wondering if you might have a concern that if you engage in the conversation you will find yourself talking about difficult issues and these feelings will come up meaning you will experience a lot of distress. Sometimes people find their thoughts are going so fast it is difficult to focus them on one question. Are any of these a little bit true for you?”