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Therapeutic Strategies - Page 9
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Moving out of binary
• Binary allows only 2 positions, precarious or undesirable
• Languaging the in-between opens possibilities

A binary allows only two positions, even being positioned on the positive side of a binary is precarious. For instance, if I focus on being a good clinician then if I am conscious of doing less than optimum practice at some time I am at risk of slipping into the role of being a bad clinician. However, if I am aware of having certain practices, skills, values, knowledge, experience, etc which I engage in, then those are not wiped out by my finding I have areas in which I need further development, practices I need to look at doing differently, or that on a certain day, in the context of stress I did not use some of the strategies and skills I normally would. Similarly with the question above about being an OK parent.

Or one might ask:

“Is there anything good enough about the parenting that you do that CYFS [child protection agency] hasn’t noticed?”

Moving out of binary facilitates negotiating engagement. We need not be limited to considering having or not having trust, anxiety, etc. There might be beginning trust, fragile trust, or we can talk about the process of developing trust. Similarly there is anxiety which works well to keep us on alert when we need to be, or stimulates focus in a situation like an exam. Careful listening, inquiry and gathering threads can support negotiation of a consensus of meaning and develop language for the in between.

Context
• Mitigates totalising
• Requires researching for detail

Fleshing out the role of context in relation to an experience can support the possibility of movement. It mitigates totalising by focusing on a range of factors, any of which may be available for the person to have agency in relation to.

Moving focus from “I am suicidal” to “the suicidal thoughts I experienced when …” opens up the idea that these thoughts occur more in some contexts than others, that they are not a static part of self. With this can emerge a sense of possibility for movement. It can also bring forward a knowledge of what supports this experience, practice or idea.

Detail, including emotional experience is important in generating context:

  • “Step me through it.”
  • “What is the history of this idea, has it been around for a while?”
  • “How is this idea nurtured, supported and understood?”

Look at the effect on the relationship, person, etc:

  • “Who notices the caring you do/the effort you are making?”
  • “What would let you know if they noticed?”

It can be that the context needs to be addressed for the person to be able to exercise agency

“Given these circumstances how can you be a good enough parent?”

Context is about detail - when, why, who, before, like, making sense, meaning. Context can have a powerful effect on the process of developing engagement:

“Have you ever had a good experience with an institution such as this? … How can I support you to let me know if this conversation is starting to feel like that? …How easy is it to be here given that…?”

This can include effects of gender, institutional, political and cultural context.

 
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