Therapeutic Strategies - Page 3

Careful listening
• Listening for detailed understanding
• Listening for agency, knowledge and resource

As with many approaches careful listening for detailed understanding is vital. This listening is done with profound respectfulness, listening for agency, knowledge and resources as well as themes which may be significant for meaning making.

For instance, where a young person has managed to get through a difficult time in hospital, it would be possible to focus on what caused it to be so difficult, the effective strategies used by the staff, phenomenology of the distress, automatic thoughts contributing to the distress, etc. Any of these has their value, dependent on context. With this approach priority is given to listening focused on the agency the young person exercised and resources they drew on in taking up what the staff offered:

"I noticed that even though I could see your hands were shaking and you seemed to be experiencing a lot of distress you took up the invitation of [the nurse] to sit down and look at possible ways of managing the anxiety you were struggling with."
"How did you make the decision to sit down and engage in that conversation?"
"What experiences have you had in the past which enabled you to put some trust in the staff?"
"Were you surprised at how well you were able to talk about what you were experiencing and join [the nurse] in coming up with strategies to manage the anxiety?"

A second example is that of a young person who had previously described disliking treatment and wanting to be released from compulsory admission. He told a clinician how much he was enjoying the inpatient unit. When the clinician inquired further he said"

“I have decided to like it here so I can go home.”

This statement was rather surprising to the clinician and could have been dismissed as indicating the statement of liking hospital was untrue. However, focusing on the agency involved in making and executing this decision is more likely to bring forward agency and resource. For instance:

“How have you made that decision, did it come to you in a moment or have you thought about it for a while?”
“Was this a new idea for you or have you experience of something similar in the past?”
“Are you finding the liking comes easily to you or do you have to put a lot of effort into it?”
“How well is it working for you, are you finding it any easier to be in hospital?"

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