A debate flared up in a training event recently between members of the substance misuse service I was working with. Someone said, with noises of approval from others, that their client group, having lived (in some cases for decades) on the wrong side of the law, are experts at deception and manipulation, and so nothing they say can be trusted, because lying has become such an ingrained habit for them. Even their social relationships are ‘different’ – loyalty, for example, meaning something different in that social context, where people are so self-absorbed that they find it very difficult to put someone else first.
A couple of younger practitioners remarked that this was labelling of the worst kind and you had to retain your faith in people to keep going in this work. This was met with ‘yes, but’ from more experienced members of the group.
How do we work with clients whom we perceive, in the words of the first person, to be ‘making the wrong choices’? Clients who tell us one thing and do another? One practitioner told us that she’d recently bent over backwards to help a vulnerable client get the tenancy of a flat; within a matter of weeks the client had damaged the property and was back on the streets and begging for help again.
Hearing these things brings me back to what Insoo Kim Berg often said to clients: ‘you must have a good reason for doing X’
I think we can see this is powerful for 2 reasons: it means that we assume
• The best in people: that if we were in their shoes, we’d have done – or been tempted to do – the same thing
• The right of people to their own self-determination.
The latter point came to mind when someone else in the group, in response to a colleague saying that when people are making ‘wrong’ choices they should be challenged, said, simply, ‘why? It’s their life to do with as they please. If they tell me they aren’t going to use drugs and then go ahead and do it anyway, it’s up to them’.
This reminds me of what Steve de Shazer called the ‘radical acceptance’ of SF. Of course, there are limits to ‘radical acceptance’, especially for those working in public services. Practitioners are accountable and if the client is making the ‘wrong’ choices they feel it’s their job to challenge, confront, direct, advise etc.
Many years ago, when I was working (along with Evan and Chris) in an NHS mental health clinic, a nurse colleague admitted that when a family had arrived for a follow up appointment and she had smelled alcohol on the father’s breath, she felt frustrated and dismissive. She told me ‘I lost my curiosity’. I’ve never forgotten that phrase. I think ‘curiosity’ may be the ‘radical’ bit of ‘acceptance’ that de Shazer was referring to. One can ‘accept’ what one’s clients do in a resigned, hopeless I-give-up way. ‘Radical acceptance’ implies, to me, a more active acceptance, retaining an interest in what clients gain from doing what they do, and retaining curiosity in what they (still) want.
From a professional and ethical point of view it is still incumbent upon us to check if what we are doing is working. Different agencies with different client populations will decide on when to question the possibility of ending the work or trying a different approach. At BRIEF, as an independent no-strings-attached agency, we could question the value of our work by as early as a third session. In an agency where, as one person said to me a few years ago, ‘all my clients relapse’, you might take a different view, and have different criteria for success. This points to the importance of making our ‘contract’ (through the Best Hopes question) broad e.g. not set as (only) ‘not to drink or use drugs’, not (just) ‘get my kids back’, not (just) ‘go to another school’, but to be widened to include other aims that are achievable in the work in a reasonable time span.
By the way, the person who said ‘it’s their life’ asked me something I don’t recall being asked before: is there a difference between asking a client ‘what do you want?’ and ‘what would you like?’ He assumed that the second option is more useful, gets people thinking in a more personal way and is likely to lead to fewer single goal-like answers. I could only praise his question and promise to look at it in my practice in future!
Harvey Ratner
London
14 July 2017
