Three Questions…

1: What about offering advice?

This brings up an interesting issue about the meaning of neutrality- a construct that is important to many clinicians and we agree. However, we don’t we lose neutrality by offering our opinion or advice; it’s all about how we expect that advice to be listened to. If it is seen as some- thing to be discussed, considered, amended and perhaps found useful: then it’s neutral. If we can’t share our opinion (we all have them) then we’re being secretive. If we want our service users to believe every word and do what we tell them etc. then it clearly isn’t neutral! We are experts after all and we should use what we know to facilitate them in their change.

However, we should hold our opinions lightly and not rush to them. There’s no doubt that too much opinion too early constrains the potential and curiosity. It can make the conversation narrower or make the other feel less free with their thinking (we all struggle with this sometimes!).

2. What are the challenges of working in a choice framework

There are broadly two challenges in fully working with choice.

Being curious about the person’s view in a really user centred way can be less familiar or hard for some clinicians. This is often more true in professions who have been trained to detect pathology or to diagnose, where their role may be seen as being expert. We tend to be less curious when we are formulating our own ‘full assessment’

For others who have been trained in a user centred stance the challenge can be formulating in a clear way that includes risk and possible diagnoses leading to clear goals.

We find that the biggest issue is how to be honest with our opinion. This is especially important when we identify risk. Saying what we think may make us anxious in case we are wrong or not seen as expert enough. Some clinicians may feel more comfortable being seen as the expert and then struggle to have a discussion with the client about their ideas. It is also hard to say things that might be challenging or upsetting to someone or that we know they will disagree with. For example, we may avoid talking about our concerns about the attachment relationship between a parent and child when their view is that they want a diagnosis of ADHD.

When can you do Choice?

One question we get asked a lot is when can you ‘do choice’?

‘Every time’ is our answer!

A clinical contact that has the eight choice components can be used in A&E, when you are thinking about the mental health law, in case conferences etc. All choices are constrained in some way, but a choice can nearly always be offered within the viable alternatives.

We think choice is particularly useful in child protection and statutory settings as:

  • Being curious gives the best chance of finding out how to engage a ‘difficult’ client
  • Using our honest opinion means we can talk about and manage and risk issues or safeguarding/child protection – we’ll be actually talking about the issues that need talking about
  • Being clear about any goals means services, when involved, have a clear focus and other agencies understand our remit.