Chris Ward asks about safety . . . Do you ever find yourselves stepping outside of the solution focused process in order to take action to ensure someone's safety? If so, what do you typically notice during the conversation that triggers this response from you, and what sort of action would you typically take?
‘Stepping outside the solution focused process’ in relation to the client’s safety can happen in many ways, and some of those ways may not be enormously obvious. An obvious example however happened just recently when I was talking with someone referred to BRIEF by a Mental Health Crisis Intervention team. At the end of the session I found myself asking her ‘should I be worried about your safety?’ and what followed was a conversation about how confident she was of keeping herself safe until we met again. The client had not raised the issue of safety and I was thus introducing it and to that extent imposing it without the justification of it forming an articulated part of her ‘best hopes’. What was it that triggered this untypical, non-Solution Focused response? Well of course the nature of the referral, and I knew who the referrer was and where he worked, already set the tone to some extent. It is not possible to ‘not-know’ once we have become aware and it is hard for that knowing not to influence our hearing and our thinking. And then a story she told me about how she had recently ended up in an in-patient mental health unit and what had precipitated this surely had the effect of shaping and focusing my attention. The level of distress in the session and the difficulty in describing a preferred future will no doubt have increased my concern as did the extent of her worry about feeling herself a burden on her network and the guilt that she described in relation to this. So to an external observer the moment when I stopped being Solution Focused might have been the point at which I asked the question ‘should I be worried about your safety?’ But that observation of the moment of obvious divergence would not in my view be the point at which I actually started doing something else. As I have tried to suggest there were a number of pre-cursors, there was a context from which the question emerged. I am sure that I was beginning to notice things, to hear things and typically when that happens, at some point I do indeed notice that I am listening differently.
When I sit with clients I work hard to stay in their narrative, to hear their words and to scan what they have just said for ‘conversational hooks’, little bits of what they have just said to which I can attach my next Solution Focused question. We might call this process scanning for SF conversational opportunities or openings. And after a bit this process becomes habitual and familiar. The client for example says ‘I won’t be so miserable’, I hear the word ’won’t’ and respond, almost instinctively, with the question ‘what will you be instead’ or ‘what would you like to take the place of miserable’. There seems to me to be very little thinking going on. I am certainly not asking myself the question ‘what does the client mean by miserable’ or ‘how miserable is this client’ or ‘how come the client is miserable’. All I am doing is responding in a largely predictable way, a way that sustains and develops a very particular form of talking that we have come to define as ‘solution talk’. I am playing my conversational part in a process that is merely intended to engage clients in describing their lives in this way. And this is, I think, what we are doing in SF, we listen for conversational opportunities rather than for meaning.
However when I begin to get worried about my client I notice that I start listening differently, I start listening through what the client has said, I start listening for meaning. I begin to notice myself asking myself ‘what does the client mean by miserable’, ‘how miserable is this client’, ‘and if they continue to be miserable what might they do’. Something has triggered me to worry about the client’s safety and I continue to listen through until the worry is resolved. Very often by the end of the session, a session in which the client might not even have noticed my concerns since from their point of view I have done nothing different, my worry is answered and I do not need to take any action, and then on a very few occasions the worry is not resolved and I find myself asking something along the lines of ‘should I be worried about your safety?’
In my view safety comes first, simply and straightforwardly ‘safety first’ and for any professional, whatever approach they use, sitting somewhere in their hearing, should be a concern for and an awareness of their client’s safety. Some practitioners action this concern in every session by carrying out a risk assessment. This is often a response to operating within a context where significant risk is thought to be a characteristic of the client population and often where agency policy requires the practitioner to ask certain ‘set’ questions to every client regardless of the circumstances. However even if we do not work in such an organisation or in such a context we are not, I believe absolved from ‘risk aware’ or perhaps ‘safety aware’ working. Somewhere ticking away in our hearing, a different level of hearing perhaps, should be a pre-occupation with safety.
Moving beyond this awareness, in my work, has happened rarely. However I have had conversations with clients about their confidence in keeping themselves safe, how they have kept themselves safe in the past, how they and others will know that their confidence in keeping themselves safe in the future is growing. I have also, even more rarely, talked with people about the need for me to share my concerns with an appropriate person in their life and have done so and on one occasion decided that the only step that I could take was to contact the client’s doctor without telling the client beforehand that I was doing so since I believed that the telling beforehand might precipitate the client’s suicidal planning and intent. And on just one further occasion in a parent’s project in a children’s centre, following a client talking with me about ‘smacking her so hard that there are still marks on her the next day’ and following a discussion about safety within which neither the client nor I were convinced that the child’s safety was adequately safeguarded, I terminated the session half-way though and accompanied the client to the nearby Social work office to ensure that a respite care arrangement already in pace was activated.
As it happens I do believe that the Solution Focused approach itself tends to build safety in client’s lives. Inviting clients to describe a preferred future and inviting clients to describe that future interactionally in a way that connects clients to those around them is likely to be protective however I do not believe that this feature of the approach absolves us from ‘safety aware’ listening.