collaborative practice

“In the long history of humankind (and animal kind, too) those who learned to collaborate and improvise most effectively have prevailed.”

Charles Darwin

Our vision of practice focuses on supporting each person’s unique therapeutic process through listening to their voices and working collaboratively to develop their emotional health and wellbeing. It provides a better balance between the psychological, emotional and pharmacological approaches and values different ways of knowing about practice. Importantly, it also values professional support, recognising that those who are cared for are better able to care for others.

A focus on each person’s unique therapeutic process

“All happy families are alike; each unhappy family is unhappy in its own way.”

Leo Tolstoy, from 'Anna Karenina'

Each patient or client is unique … because no two of them have the same exact combination of psychological make-up, life story, current life-circumstances, cultural background and so on. Each person’s therapeutic process therefore needs to be contextualised, because their problems do not exist in isolation but have arisen from their unique context.

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The CPCAB model, for example, offers a useful way of understanding and working with a person’s context. It divides this context into three broad areas: (1) the internal context of the patient/client’s thoughts and feelings; (2) the context of their relationships; and (3) the context of their development and personal history.

The model also describes what kind of change is possible: (1) the person can’t change who they are, but they can change how they relate within themselves; (2) they can’t change other people, but they can change how they relate with them; and (3) they can’t change their past, but they can change how they relate with their past.

Listening to the voices of service users and working collaboratively with them

Because each person is the expert on their particular context, it follows that mental and emotional healthcare needs to be collaborative rather than practitioner or treatment-driven and that a one-size-fits-all approach falls far short of what’s needed. Patients/clients need to be engaged, along with their practitioner, in their own therapeutic process, rather than being simply passive recipients of treatment. Research has also shown that simply listening to the voices of service users also has a positive effect on their engagement and therapeutic process.

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This is not surprising given instances of the abuse of service users with, for example, medication being used as a means of chemical restraint. Moreover, psychiatric wards can be stressful, unpredictable, noisy and sensory-charged environments … in contrast to the obvious need for tranquillity and a feeling of safety for anyone suffering from emotional and psychological distress.

A collaborative approach also provides for:

  • Greater choice and control through person-centred and user-led forms of support. This includes alternatives to inpatient services – user-led crisis houses and supported living, for example.
  • The facilitation of safe spaces to regain confidence and skills as a basis for moving into mainstream society.
  • The removal of obstacles to family and community involvement.
  • A greater degree of participation in the design of therapeutic environments.
  • Championing mutual learning and being involved in the training and continuing professional development of all mental health workers.

“There is nothing worse that you can do to a human being in America today than give them a mental illness kind of label and tell them they need drugs … these children are 3, 4, … 8, 9 years-old”

Dr. Peter Breggin

Better balance between the psychological, emotional and pharmacological approaches to therapy

The rational-technical approach to mental health has led to an unhelpful fixation on diagnostic labelling and an attempt to categorise almost every type of emotional, personal and mental distress as some kind of ‘disorder’, ‘illness’ or ‘syndrome’. Additionally, once everything becomes defined in purely biophysical terms, it’s no surprise to see prescribed drugs become the main form of treatment, often at the cost of masking the underlying causes or sometimes suppressing a neuro-diversity that could be celebrated … not to mention drug side-effects and the drug-related drain on NHS finances.

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This imbalance needs to be addressed by, for example, enshrining within the NHS constitution the right to psychological therapies as an alternative or complement to the pharmaceutical approach. The issuing of drug-prescriptions should also be regarded as an option of last resort for those seeking help with everyday life problems or common (as distinct from severe and complex) mental health problems.

Imbalance also exists within the current NHS view of talking therapies, in the form of a bias towards the more rational-technical types of therapy, such cognitive-behavioural therapy, in contrast to various types of emotion-focused therapy. Additionally, because each person’s therapeutic process is unique, their healing is best served by having available a wide range of NHS-funded talking therapies, from which the best match can be chosen.

Valuing the practitioner’s emotional-knowing

Listening to someone else’s emotional pain can be very hard. This is because, outside of the counselling and psychotherapy profession, few mental healthcare professionals have been trained to uncover and care for their own emotional pain. So when they are working with people who are, for example, experiencing intense grief, they may avoid empathising for fear that their own emotions will overwhelm them.

This video opposite describes a research project by Marta Shepherd titled “It’s like sitting in front of myself” that examined how listening to a client can sometimes trigger overwhelming emotions in the listener. The research was awarded the 2016 CPCAB Counselling Research Award in association with BACP.

Experienced practitioners also draw extensively on intuitions derived from practice wisdom, but this type of knowing isn’t properly acknowledged, valued and researched.

Valuing the mental and emotional health of practitioners themselves

“Physician, heal yourself”

The Bible, Luke 4:23

A major long-term study of psychotherapists concluded that practitioners who were stressed were less effective. Because of the strong emotions and stressful situations encountered, ‘burn-out’ is also a professional hazard.

See The Developing Practitioner: Growth and Stagnation of Therapists and Counselors, by Michael Helge Ronnestad and Thomas Skovholt, published by Routledge, 2012.

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Quite apart from the effect on practitioners, stress and burnout also increases staff costs due absenteeism, sick leave and the big expense of bringing in agency replacements. This burden can be reduced by:

• Providing relevant CPD on managing emotions and stress.

• Offering individual and/or group therapy to practitioners.

• Providing appropriate supervision and/or mentoring.

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