At the start of the pandemic I signed up with Project 5, a voluntary scheme to give NHS staff coaching or counselling. Registered psychotherapists such as myself are designated as wellbeing counsellors, offering each staff member three sessions (coaches offer 2). I was keen to make any contribution I could to those working their socks off, physically and mentally, to save lives while risking their own. And it didn’t escape my notice that the project organisers were recommending to their volunteers to use the Solution Focused approach.
Since the beginning of May I have worked (on Zoom, Skype, FaceTime or just plain ‘phone) with professionals across the whole spectrum, from nurses (district and ward), doctors (hospital and GPs), speech and language therapists to technicians, psychologists, counsellors and managers. The majority have been women, and a quarter have come from BAME communities. Not surprisingly, stress, anxiety and depression are the commonest complaints, and many would tick the ‘burned out’ box. A staff nurse found her place of work had been turned into a Covid treatment ward and she said ‘it has been exactly like you see on the TV’, going on to describe how traumatic it had been to be forced to wear PPE that staff knew was inadequate, to see deaths on a scale she’d never known before, as well as the agony of having to read out farewell letters from adult children to the elderly parents they were unable to visit. She was sleeping badly, crying persistently, losing her temper at the slightest thing, and of course this was causing considerable stress in her personal life.
The standard Solution Focus opening question is ‘what are your best hopes from talking with me?’ and it’s hardly surprisingly that in almost every case the staff member embarks on their story, as if I had asked them a completely different question. So I listen and acknowledge what they have been through, and then repeat the question, sometimes three or four times, before we arrive at something like ‘to go away with ideas to be able to be less stressed’ which I follow with ‘what difference would that make?’ and then there’s an answer like ‘calm’ or ‘in control of my feelings’ or ‘to be happy again’. And then the familiar Solution Focused pathway opens up: ‘if you woke up tomorrow and were happy again, what difference would that make? What would you be doing?’ (the Tomorrow Question or Miracle Question, leading to a detailed description of life the next day); ‘on a 0-10 scale, where 10 stands for everything you’ve described on this day at your best, and 0 is the furthest you’ve ever been from it, where are you now?’ (to find instances of success and exceptions to problems in the present and past).
The next session begins, of course, with the client being asked ‘what’s better?’ I assume it’s a matter of luck, but so far not one staff member has answered that question with ‘nothing’. Indeed, many have reported such significant progress from the first session that they have decided that they didn’t need the third (in those cases, I tell them to imagine it’s deposited in the bank, to be drawn on at a later date if needed). This tells me that the Solution Focused approach is ideal for this service, and that the 2 session offer for coaching and 3 for counselling is appropriate.
One staff member told me at the end of our work that the approach suited her because ‘it’s non-judgmental and you helped me build up my skills’. Her skills. As Steve de Shazer said, ‘the client has the magic, not the therapist’. Another client said, ‘I really valued the fact you only asked me questions, you didn’t tell me what to do, which challenged me and helped me to see that I can do things better myself’.
Sometimes it seems necessary to check out what the staff member wants to talk about at a given time. For example, one person said he needed to make a decision about what to do in his career. I asked, ‘if you made a decision that was good for you, what difference would that make?’ and he said he’d get his ‘energetic side’ back. I then asked him ‘what would be best for us to talk about now? Would it be the decision you have to make, or should we aim to draw out the energetic side?’ He went for the latter and so I focused on what he would be like, and what he would do, and what people would notice, if he had more of his energy back.
There are of course times when service users will branch off into an account of what they have had to endure in the past. After hearing about a recent stressful situation, like a confrontation with a manager or a row with a partner, I have asked questions like ‘how did you come out of it? How did it end?’ rather then asking for more detail about what happened. I also ask questions about ‘how did you cope? How are you managing?’ Using these coping questions (as they were called by de Shazer and his colleagues) leads to an appreciation of people’s strengths and resources. While it’s not in the nature of Solution Focused practice to guide people, there are times when I choose to pass on ideas I have learned from one person to another. For example, a staff member was saying that reading helped her to cope. Using that, I said that other clients had told me that writing down their anxious thoughts, thereby externalizing them, had been helpful; would that be useful to her? She said she remembered that it had been very helpful to write a journal when she was younger. At our next meeting she told me ‘I did what you suggested!’ and said writing had made a big difference to her. As a Solution Focused practitioner I’m pleased she made a change, but not that she ascribed it to me! Another example of sharing ideas is when people have described the importance to them, in dealing with stress, of being able to ‘be present’, to ‘be able to let the negative thoughts go and to accept what I can’t change’. I have a longstanding interest in mindfulness meditation, so inevitably my handling of these conversations are coloured by my own learning (and in one case I ended up giving some book references!).
This means that when, inevitably, I have a follow up session with someone telling me that things are not better, I can look with them at their coping strategies (‘what are you doing to stop things from getting even worse?’) and occasionally share with them ideas I’ve gleaned from others.
Finding the best questions to ask at any moment is a challenge as you can’t prepare everything in advance. BRIEF has produced a manual of practice but coaching and therapy can only be loosely manualized because we have to respond to people in the moment, using their words as much as possible. I’m enjoying rising to this challenge, and I can only hope the sessions have played their small part in giving a boost to the morale of staff members.
Harvey Ratner
London
11 August 2020
