NEW BEGINNINGS THERAPY



The colour of Spring- Service Evaluation February 2020




On the 13th of December 2019 during one of my scheduled sessions, my mind returned to an environmental dilemma "the tragedy of the commons" developed by a scientist Hardin, G. (1968) and published on 13th of December 1968. A good summary can be found here:

https://pages.mtu.edu/~asmayer/rural_sustain/governance/Hardin%201968.pdf


My intended article for this month were to write up a few of my professional encounters around uncertainty and the tragedy of the commons - both at theoretical and practice levels - and in doing so I were hoping to invite the readers to reflect ( in practice, too) upon potential similarities of both conceptual and theoretical grounds - my hope being to bring to light positive aspects of such reflections. My practice is born through theoretical and practical experiences, each and every session adds a better understanding to a concept and this is how professional development takes place. There is where the tragedy of the commons theory comes into play in understanding that in not thinking only to one but thinking to all - all have a greater substantial chance of achieving and change. The tragedy of the commons goes on at all levels, but what it has at its core or essence, if you may are possibility and potentiality/ essence of being human. "Focussed but not blind" is what compassionate and developing self-reflective practice means.

A way of being for any practitioner and for any individual for that matter is to practice self-awareness. On a situation such as change* being required to work from home, or a must return to work and or restrict your social life - all unprecedented times - and yet much of what is happening has a singularity across all wide world – everyone and everything is changing – news information, daily life is taking a new form as another day goes by. Living with uncertainty of tomorrow, with responsibility of your life and other people’s lives on a moment by moment and daily basis are part of life – for many cases that we worked with that is called normality to some extent. There are a wide range of cases and situations that came to mind – some such cases had found resolution and strategies, for many others current situation is experienced as monotone and being quite the reverse as to what had felt as a constant. It is a fact that Time* has different meaning when transitions such as Now* are happening.

Perhaps what is more important now than ever is to take time and see what it is that each day brings anew. What it is that is missed*/what is missing most from previous day/experience? These can be some of the very first key questions one could ask himself/herself:

1. What associations could be made?

2. What can be formulated as similar to previous experiences/situations?

3. How does one apply himself/herself to such anew situations?

For last few weeks – one specific aspect of my work has increased rather than decreased as I were in fact absolutely expecting it: Awareness – having to re/consider remote working and places of volunteering, private practice, mentoring and learning and rapidly but aptly adapting to new situations – all such situations increased my awareness to very high levels. I am still reflecting on how and why that is possible. What has also happened is that specific cases come to mind, experiences of former patients and current patients/clients/mentees etc. Each individual case is quite distinct but for some reason are now clustered on specificity and distinct factors.

A while back – sometime in January – I’ve started reflecting on potential changes of how best to continue both private practice and other avenues of income complimentary - it ended up being a rather enormous list of questions where each and every aspect of my work were scrutinized and various changes indicated.

At around same time, I created a framework and structure of work for another group that I am currently engaged with – something clear and straightforward that would provide clarity and enhance communication as a framework.

Below are the type of questions I engaged in as a process of reflection on awareness and evaluation of service provided:

Applications for developing techniques/strategies:

1. Think on how various projects can be developed from this type of work;

2. Reflections on what it is at fault with this as a process and wider economic, political and cultural implications as well as funding. How it enables/restricts me?


3.Can it all be transferred into private sector with expectations on employment, supervision and CPD – furthermore, how else it can be linked to other projects – Working with equality legislation and ways of access/referrals from ground up –


4. Develop strategies and learning outcomes  - Form a parallel process with therapy.

What is it that stands out and why – single incidents and event, experiences – what worked in terms of relationship and framework, what did not work and why?

5. Evaluate service = place, funding ways of communications and assessment, technology used = all systems = level of information, levels of access other services, levels and potential of referral;


Think about singularity but what can then inform myself at a larger scale?

Reflect on changes and impact - any points in development if any and training accessed and why and how?

Think about level and type of technology used - main methods of communication – relevance to skills developed, deskilling and access?

What can be used as an outcome measures/ statistics involved?


6. Risk assessment

Types of skills and experience that can be offered - what is relevant and why?

One of the pillar points to keep in mind is about mental health of prospective clients assigned through various agencies = agencies that at their core have no practice nor expertise as to how best can process various links to other agencies involved directly on client's issues i.e. specialist services. One of the students that I have worked with for past few months indicated that his schedule is quite so busy that he decided to delegate schedule of arranging appointments through one of his parents. As much as this sounds as quite extraordinary in terms of practice based example, it does happen and it is not singular in several many examples that can be accounted for. 

Responsibility of risk in such cases falls in various points of contact that have no real links with one another - a perfect example of cracks in the system. Agency 1 is absolutely of no reach and it is positively inadequate in any possibilities except for insurance purposes. Agency 2 or a second organisation is completely lacking a structure where client would have access to further services or needed services. Someone who would be directly implicated in this process, would have to conduct such a risk assessment mainly on their own and with knowledge accumulated across all reference agencies but none of real help in terms of practice based point of referral. 

It is not all hopeless at this point because a professional would assess that all involved so far would not be a point of contact but an integral part of agencies unaccounted for and follow suit with a process of elimination of all such contacts. 

Secondary to that, if the client comes from a point of referral through such points,  the client will be assessed   as any other person within a system that only option is without a possibility of referral beyond of duty of care applied to anyone including any member of the public at large. 

Another point of observance would be when an appointed parent with written consent from a client student comes into contact. In therapeutic journeys such an encounter is unlikely to take place but in other forms of contract such as mentoring, that again it's possible; if this happens, it would form part of a process of selection based on needs of individual student client. Parents are eager to continue their involvement in their children's lives and if it is a process of education with the student, that process of education can be extended to the parents under special circumstances i.e written request and consent from the student  - at this point it is a clear signal for any professional that prospective client/student cannot be considered with capacity (legally - the client student has no capacity) even if in other terms presented, legally that cannot be rephrased. When and if a parent of a prospective client /student without legal capacity, acts on services offered to client/students without legal capacity, than the parents are considered as part of client's entitlement of services provided and at any time/when they use such services, the understanding is that such service is offered to student and must be subtracted from client/student entitlement - furthermore - if this situation advances with specific agency introducing such a referral, the agency that made the referral failed to appropriately assess risk and follow appropriate protocol and protocol of referral.

A second example on similar terms is about a direct contact from an existing mentoring contract with a student. After preliminaries had been agreed with student, student's mother calls and starts a conversation like this: 

" Er... I am not sure if they told you..."


 - As a professional you are already clear that this is a potential case of distress whereas lack of information and or understanding a communication is the status quo - This is a failed case before it actually gets to any further assessment. If an individul makes that type of Third* party contact and starts with acknowledging an unknown* - it is simply equated with high degrees levels of distress and an indication of how much of that person's trust is placed on systems of support for herself/family and her child. Level of trust in such a case is equated to zero at most and moving on a spectrum of negative. That conversation could have just not taken place and situation would have been absolutely same - because the ruled applied by client's parent in that case was: 


"No matter what I do, I failed to communicate what I needed to communicate and I need to commmunicate it again, myself..."


This example is an example of a highly distressed individual with a history of distress million times multiplied with how long it took her to ask that very first question. 

As improbable as that may sound, it was an educational encounter for that parent. 


These situations exist at large in real life practices with real practical examples and are going to be summarised in next year 2021 service evaluation spring edition followed by an analysis of my level of communication– what is relevant and how it works –

- Who is the client? Who are outside agencies and their involvement? 

All above are part of a self-reflective practice exercise with questions that are at the core of anyone in practice and working with the BACP guidelines and ethical framework. 

The above evaluation is just an example and the list of questions is by no means exhaustive - it can be used as a template, at any time, independently of a practitioner's level of experience and or stage in their training.