Discovery Oriented Conversational Process

Inspired by Johnella Bird

Listen to audio Part 1:

Tania Windelborn and I (Josephine Stanton) began this project of putting out some strategies and ideas from Johnella’s because we found that even just beginning to learn Johnella’s approach we noticed an added freshness and interest to our clinical work. People seemed to find us more helpful. We wanted to make Johnella’s work more widely available because we could see it had something important to offer.

Sadly, Tania passed in 2023, but the project continues to evolve. Including audios is a new development to make the ideas more accessible to people who would rather than listen than read.

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At the time we developed the first version of the website Tania and I were working in a fledgling child and adolescent community mental health service in a largely rural area in northern New Zealand. There was a lot of poverty and disadvantage but also a richness of community spirit, cultural heritage and a commitment to supporting children. Fifty percent of the population are Maori (indigenous people of New Zealand). Tania, who sadly passed away in 2023 was Maori and well embedded in her extended whanau (family), iwi (tribe) and cultural mores and practices.

Reflecting on it now I realise that though Tania and I both grew up in New Zealand she had grown up in a non-Western Maori world. Conceptualising the world in a more collective, relational way came naturally to her. Her professional training was a degree in nursing she had started after having her children. She took to Johnella’s work like a duck to water, using it creatively in all sorts of contexts.

In contrast, I had grown up in a Western individual focussed culture, trained as a doctor, specialised in psychiatry and engaged in a range of therapy training, My own family background was somewhat unconventional but I had a whole lot of indoctrination into cultures and mini-cultures I had to fight my way free of. Tania was immensely helpful to me in this process.

While learning from Johnella I have been in the professional role of a child and adolescent and perinatal psychiatrist. This is a very different context from that of a therapist. Child Psychiatrists were a scarce, expensive resource and my time spread thinly over the people I saw. Core tasks I had to achieve were diagnostic assessment, managing risk, medication prescribing and use of the Mental Health Act where compulsory care was needed. Families would often attend appointments with ‘the psychiatrist’ so much of my work was in a family context. The services available to the people I worked with were very limited. I wanted the maximum benefit from any conversation I had with young people and their families. Every interaction a therapeutic interaction was an ideal I strived for. The stance of profound respectfulness and focus on bringing forward people’s resources I found in Johnella’s work was just what I needed.

Learning Johnella’s approach from the starting point of a psychiatrist may well have made it harder than for many other clinicians and therapists, and people from other cultural backgrounds and it is still an active learning process. The process of developing this website has been a very rich learning experience for me and continues. I hope that the challenges I have had in learning Johnella’s approach has left me with some conscious awareness of what I have learned which can be of use to others. Working on this project has certainly been a powerful learning experience for me.

I would greatly appreciate any feedback on any aspect of the website and podcasts. There is a feedback button adjacent to the text you can click on at any time for anonymous feedback.

I would also appreciate emails at info@talkthatheals.org so that I can reply.

Like the perfect golf swing or tennis shot, Johnella’s work looks simple and not so hard to do. Her therapeutic conversations appear ordinary but can be transformational. This difference is ‘felt rather than heard’.

Conversations focus on the resource and agency of the people we are working with. They open space for people to feel listened to, experience and hear themselves differently and find possibilities for movement.

What is offered here, in these podcasts and on the website, is a taster, an invitation to explore. Much more can be found in Johnella’s books, DVDs and website.

5 strategies to experiment with – a toe in the water.

The focus in this approach is on practice, the craft in what we do. The theory supporting it is complex but these strategies are tools you can try to put a toe in the water, to begin to get an idea if you want to go further with this. …

Strategy 1

Consciously remind yourself that this person/family negotiates a life we have little understanding of and uses skills, knowledge and resources we want to learn about.

As you ask a question, ready yourself to listen to the answer, looking for wisdom and open to hearing what you don’t expect. …

Asking a question with the aim of bringing forward resources of the people we are working with is a different activity from asking a question to elicit information for us to process.

Think of asking someone who has made an obvious blunder, ‘What was the process you went through to come up with that solution?’. We are wondering how they could have gone so off track, identifying a deficit. Compare this with asking the same question of someone who has found a creative solution to a challenging situation, ‘What was the process you went through to come up with that solution?’ You are hoping to learn something which might help you. This second orientation is how we are wanting to approach the people who come to see us.

I noticed an example of this contrast from my own life. When my children were little I had a friend whose children were a bit older than mine. I really admired her parenting. I would often ask her things like: “What did you do about pocket money?” “How would you decide if the children could go and stay over with someone?” The purpose of these questions was to elicit wisdom, ideas which I thought might help me in my parenting decisions. The conversation was based in the respect I had for the parenting I saw my friend doing. It struck me one day at work, in a clinical interview, that my questions were focused totally differently. I was looking for what parents were doing wrong, gaps in their parenting capacities that I could help with.

Engaging someone in a collaborative discovery conversation entails the assumption that the resources they have will be, not just helpful, but essential in making the shifts they want in their lives. This is in stark contrast to the deficit focus so common in ordinary thinking, particularly social and other media and much professional thinking. These resources are often not available in conscious awareness. We often make decisions which feel instinctive, but discovery oriented exploration can bring forward experiences, knowledge, values and intentions which contribute to this ‘intuitive’ process. Making these resources explicit can be personally affirming and mean they are more available to support movement.

Strategy 2

Replace telling with inquiry.

‘Would it help if you …?’
‘Do you have some experience and knowledge about depression? Might this idea be useful here?’

…

If we have a recommendation to give or some information we want to offer we can try asking the person about it. For example:

If we want to recommend exercise we could say, ‘Lots of people find exercise is helpful. Do you think it would be helpful for you?’

Or in engaging people in the idea of learning emotional regulation skills, ‘Do you have strategies for getting through and easing strong emotions?’ Would you like to hear about some that other people use?

Asking rather than telling is a deceptively simple, counter-cultural shift to practice. If we ask a question in a way which puts into practice the respect we have for people’s views, they will feel that respect. In answering they may surprise themselves as well as us. In an adaptation of the words of E M Forster, ‘How do I know what I know until I hear what I say?’

Asking a question has another great advantage of being low risk if we are not getting it right. If we suggest a change in behaviour which does not fit with the person’s capacity, ideology or values they often experience this as unhelpful even though they may well not tell us. However, if we ask them what it would be like for them to do this in an attitude of exploration we may all learn about the capacities, ideology and values which guide their lives. More examples could be:

‘What sorts of things have you tried, or thought about trying?’ ‘Are increasing social contact or looking for a job things you have considered?’

‘Is bringing these concerns you have up directly with your boss an option you would consider?’

Similarly for ideas we have about how to make sense of what is happening in their lives. Asking about what the person thinks about an idea has the possibility of stimulating their thinking with limited risk around getting it wrong. The role of the power dynamic in the therapeutic relationship adds a lot of complexity to this. But that is addressed in Point of Difference 2.

When we want to offer ideas or information we can actively seek feedback.

‘You are describing a strong emotional response in these interactions with your partner. Do you think the intensity of the response you have is partly due to old feelings left over from the abuse you experienced as a child? ‘What comes up in your thoughts and feelings when I make that suggestion?’

This feels rather odd, telling about how telling is a limited strategy. But I am hoping that by experimenting with these strategies you might notice something which opens possibility. I would also like to ask you two questions and ask you to notice any differences in the effect of the question.

The first question is: Is what you are reading making sense?

The second question is: What is coming up in your thoughts and feelings as you are reading these ideas?

I have found, when I am choosing to do telling. that the question, ‘What is coming up in your thoughts and feelings?’ has a better chance of eliciting tentative responses people have than, ‘Am I making sense?’ Was this true for you?

Strategy 3

Ask for feedback as you go along.

For example:
‘I would like to just stop you for a minute and check if you are finding this conversation helpful.’
‘Can I just check, are we talking about the right stuff?’

…

You may get some surprises. I certainly have. During my training I saw an adolescent who came to appointments but I never felt I engaged with her effectively. About a month after I had moved to another placement she came in specially to thank me. She asked the staff to tell me that she did not know how she would have got through that term at school without coming to see me. I was mystified. I have also had the converse experience of feeling specially pleased with the work I was doing with someone only to find later that that was not how it seemed to them. The earlier we can get this sort of information the better.

The process of asking for feedback demonstrates an interest in and respect for the person. It can be surprisingly helpful and surprisingly difficult to remember to do. When I do remember to do it I usually find it brings a pause and sometimes an unexpected and very useful answer. An example of this happened in a conversation with a young woman and her father about the low mood and lack of motivation she was struggling with. I asked if we were talking about the right stuff. They stopped, looked at each other, and said, ‘no’. What they both agreed we needed to be talking about was the amount of marijuana she was smoking.

In this context switching the focus to marijuana made good sense to me. But where we have a different idea, this may be an area for further discovery or negotiation.

‘That is really interesting, I didn’t realise that. Thank you for telling me. Can you help me understand how you have figured that out?’
Or
‘What are you hoping for in a conversation about x’?’
‘Is y something you would like to come back to later, or is it not of interest to you?’

When we feel a conversation is not going well, eliciting feedback can give a welcome opportunity for reflection and possible refocusing. When we have a high level of certainty that we are ‘on the button’ and doing something useful, eliciting feedback as to how the other person is experiencing the conversation can be even more important. Our certainty could reduce the sensitivity we have to picking up on tentative doubts in the other person. There is a risk of sweeping them along with our enthusiasm in a direction which may not be so helpful.

When someone is venting it can be particularly helpful to ask if they are finding the conversation useful. Some people report venting being particularly useful at times, although it can also use a lot of time going over the same ground. Enabling someone to pause and reflect can require significant assertiveness in this context, sitting forward and a hand gesture can help.

‘Can we stop for a moment. I just want to check in. Are you finding this conversation useful? If you are, that is great, I am more than happy to be here to be part of it. Let me know if you notice it not being useful any more. I would also like to check with you again. Would that be OK?’

We may need to provide support to enable people to give feedback. In the socio-cultural environment we operate in, there is an underlying expectation that we are experts, there to draw on the knowledge and skills we hold. This frame does not support people to bring their thoughts and responses forward. Particularly if they have only a tentative or half formed idea they may well not let us know.

Making explicit anything we notice in the room can help:

For example:

‘I noticed a very quick ‘yes’ without much time to consider, if you did have a sense that we need to shift the focus of the conversation, how easy would it be to let me know?’ ‘Would there be some worry about the need to be polite or worry about hurting my feelings?’

‘I noticed some change of expressions on your face and some looking around. What did you notice in your thoughts and feelings when I asked you that?’

‘I noticed in the beginning of the conversation you seemed to be talking more freely than you are now. Has something I have said made it less easy to talk?’ ‘Are you noticing some judgment or criticism?’

In a family context, another family member can be helpful, eg.

‘Do you think Mary-Anne would tell me if she wasn’t finding this helpful? How likely would she be, to feel able to say that, or would she be likely just to go along?’ ‘Would you be able to tell by her expression or body language?’

These conversations are potentially rich with discovery opportunities around issues which are not only important for the therapeutic process but also for negotiating any relationship.

Strategy 4

Focus on Agency

‘That certainly sounds tough. How did you get through?’
‘What kept you going in the face of all that?’

…

When hearing about traumatic events or overwhelming hardship it is natural to offer empathy, to acknowledge and validate how hard it must have been. This can be important and helpful but is unlikely to bring forward anything new.

Early in my career the recommendation was made that people be described as ‘survivors’ rather than ‘victims’ of trauma, a simple linguistic manoeuvre to support agency. This is a start. We can do a lot more by engaging people in a collaborative discovery process exploring the detail of how they got through, what support was available and how they were able to make use of that support. This can be personally affirming and bring into conscious awareness resources which could be useful in their current lives.

People use a vast range of strategies. Dissociation or cutting off part of their awareness is common. Many people maintain ongoing vigilance, actively looking out for a hint of a slight or untrustworthiness in others. Some limit the interpersonal contacts they have in their lives. Some people focus on protecting younger siblings, taking up adult roles in their families or avoiding vulnerability or dependence on others. It is easy to pathologize these strategies but we can also explore them as choices which they have made and used agency to engage in.

This is an example I have made up drawing on my experience of many real conversations with mothers struggling to parent against the odds..

Therapist: ‘They sound like gruelling times. What kept you going?’
Mum: ‘The kids, I would not abandon my kids. I get stoned every night when they are in bed, but I am always there for them during the day.’
Therapist: ‘The determination you describe to be there for your kids, where in your life did you learn that determination?’
Mum: No one was ever there for me. I hated that and I did not want that for my kids.’
Therapist: ‘I’m really interested in that. You can imagine someone saying ‘no one was there for me, how could I be there for my kids?’ But you are not saying that, you are saying that what you have taken from that experience of not having people there for you is a determination to be there for your kids, to make it different for them.’

There are many possibilities for exploration, some possible next directions could be:

‘How does this determination to be there for your kids that you are describing show itself in everyday life?’
‘How do you manage to get through the days without using marijuana? What/who supports you with that?’

Asking for feedback is important, specifically, we need to check explicitly for any judgment she is experiencing in the conversation.

Strategy 5

When noticing judgment coming up in ourselves, explore.

‘Is that the approach you usually take?’
‘How well did that work for you?’
‘How did you make that decision? What did you think about? What were the hopes and values that supported the decision you made?’

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Before I met Johnella my response to noticing myself experiencing judgment was to shut down that response and note a problem which might be returned to. Shutting down the response is obviously preferable to expressing judgment but it can also mean a missed opportunity. When judgment comes up for me I am noticing something. This something, which I cannot name in the moment, may be an opportunity for exploration.

It is also possible that in experiencing the judgment something of significance in my own life is being triggered. I may need to address that in another context. But an inquiry made from a position of profound respectfulness carries low risk of harm to the conversation and I might be surprised. I find it useful to have a prepared range of questions which come easily to mind

When I had not long been working on learning Johnella’s approach I met with a woman seeking help for her son who was about 11. He did not want to be in the room and she suggested he go to the shop and buy a drink. She gave him some money and what followed was a complex conversation about what he was to do with the change

He appeared a little agitated at times. I noticed judgment coming up in myself, something like, ‘This woman cannot set a limit.’ Ideas of how to upskill her in limit setting started to form in my mind. However, thinking of Johnella’s instruction to, ‘Hold the judgment and make an inquiry,’ I asked her about how she generally managed money issues like this. I was surprised. The complexity and sensitivity of her thinking about it filled me with admiration. I had nothing to teach her about managing limits with her son.

More examples of questions which can be used in a range of situations include:

In response to a parent lecturing, haranguing or criticising a child:

‘How well do you find this works at home?’ can be a useful question.

I find the parent will often laugh and say, ‘Not at all’.

In response to a negative comment to someone else in the room:

‘What are you hoping Mary-Anne will take from this?’ can help the person reflect and bring forward resource,

Where someone is describing being in an abusive relationship it might be helpful to ask:

‘You are describing a lot of pain and hurt from what happens in this relationship, what keeps you there?

Six key points of difference in Johnella’s Approach

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Part 2:

Johnella’s approach is profoundly countercultural. This is what makes it so intriguing and liberating. However, it can also be profoundly disturbing. It challenges much that we hold dear. I am bringing some points of difference forward to invite you to make a positive choice to engage with them with curiosity. When faced with something which is disturbing it is a common response to dismiss, ignore or focus on ways in which it is wrong. I find conversations about these responses to Johnella’s work intriguing. They help me learn. I am interested in hearing about the points of tension and what people find disturbing. Please let me know, along with any other feedback, on info@talkthatheals.org

Point of Difference 1

1. Profound respectfulness – People have important resources we and they may not be able to name. Central to this work is bringing forward those resources.

Moving away from a deficit focus is a widely held intention. It is not the intention that is a point of difference but the practical skills and strategies which enable us to engage people in discovery oriented conversations, crafting conversations which put this intention into practice. …

As professionals we are not coming as naïve inquirers. Engaging people in a discovery oriented conversational process is a skilled craft. It requires 100% focus, emotional and cognitive presence, flexibility and openness of thinking, attuned observation and all the personal and professional knowledge, skills and experience we have. It can be useful to share some of the knowledge we bring with the people who consult us, but crucial to enabling change are the skills and strategies we have in bringing forward the knowledge, resources and sense making processes the other person brings to the conversation. …

Johnella’s approach goes beyond the identifying of resources. It uses them as a beginning point for exploration, not as an answer or end in themselves. Much of what is identified in this focussed exploration would not have been named in an open or differently focussed conversation. …

Point of Difference 2

2. Do no harm – Address the power relation in the therapeutic relationship

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Part 3:

The risks of this power dynamic are widely acknowledged in the prohibitions on engaging in sexual contact with a client or patient. But much less attention is paid to the more common and subtle risks, of the person in the client or patient role feeling misunderstood, missed or discounted.

The therapeutic relationship is set up with the expectation that a therapist will have particular expertise in understanding and making sense of our experience. These expectations enable the person seeking help to relate in a more open and less guarded manner. However, even with a highly skilled and attuned therapist, they may have an experience of feeling misunderstood, missed or discounted. This experience can be more powerful than it would in another context and the person is at risk of making sense of it in terms of something the matter with them. We may not find out about this. They are likely to resort to silence, or just not come back rather than let the ‘expert’ know they have got it wrong. …

We may not seek or value the power people experience us holding in the therapeutic relationship. We may not even notice it. This does not mean it is not there. We tend not to notice the power we hold in any relationship. The power we experience others holding in relation to us feels much more apparent. …

We cannot ‘disappear’ the power relation by being open, warm, unassuming, and accepting. …

We need to be active in engaging the person’s participation in a collaborative discovery process. We can begin by exploring the hopes they have for the conversation. A starting point might be:

If this conversation was useful to you, what do you hope would change?

…

Ongoing negotiation of the agenda can be supported by checking in as in strategy 3 described in audio 1 or, in the context of drawing threads together in Point of difference 3 described in Audio 4. We might ask something like:

Are we talking about what is of most interest to you?

[or if we are giving a summary] Of these themes we have been talking about what are you most drawn to?

Positive action to engage participation in building trust and safety together is also needed for a collaborative discovery process. This will be described in Point of difference 3.

As you can see by my referring all over the place this division into strategies and points is somewhat artificial. They are overlapping and interdependent.

Unless we engage in active prioritising of a person’s own knowledge and resources they are at risk of experiencing their knowledge as of less value than the knowledge we hold. If we make sense of the person’s experience in a way which does not sit well with them they are at risk of taking up our ideas and dismissing their own. The set up we work in prioritises the knowledge we hold so that our knowledge will trump theirs and send their knowledge underground. It takes positive action on our part to prevent this imposition of knowledge from happening.

Colonisation provides a stark example of imposition of knowledge. The colonised people suffer losses in many ways. One of them is devaluing and even loss of the knowledge, customs, language and mores of the colonised group who risk coming to experience themselves as of less value. A practical example of this is the knowledge held by generations of the indigenous people of Australia in using controlled burning to manage the risk of forest fire. The navigation skills used by Pacific peoples to find relatively tiny Pacific Islands in the vast Pacific Ocean have come dangerously close to being lost forever.

Power dynamics and prioritisation of knowledge are two sides of the same coin. Making sense of this requires a post-modern epistemology. The nature of knowledge is fascinating and libraries are written on it. It may seem peripheral to the activity of crafting conversations which are helpful to people, but I have included some grossly simplified context.

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In the Dark Ages knowledge was established by royal or religious decree. Knowledge was valued according to the power and position of the person who espoused it. This method of evaluating knowledge still persists in more subtle ways in the prioritisation of knowledge of groups holding power.

Moving into the age of enlightenment there was a paradigm shift to the idea that knowledge can be gained by the individual knower. With astronomy this was by careful observation of the heavens. In a modern context it is hard to conceive that this idea was revolutionary. This revolution gave rise to Modernism and the scientific method.

Modernist epistemology is the foundation of modern science, technology and medicine. Knowledge is understood as building sequentially towards absolute truth. Scientific method maximises objectivity. Language functions as a mirror of reality, describing the world objectively. Modernism has been very successful, underpinning almost every aspect of our modern lives, including evidence-based practice.

Evidence-based practice is grounded in the modernist study of natural phenomena.. Causality is understood as linear, with one event causing another which follows the initial event. This contrasts with circular causality in terms of interacting systems, such as ‘vicious cycles’. ‘Underneath explanations’ of phenomena are prioritised, ideally biological causes, reflected in the common desire to ‘get to the bottom of this’. than

Deducing and testing hypotheses are valued activities, with the randomized, controlled trial being the gold standard. Developing and applying evidence is dependent on labelling and categorizing. Research in this paradigm has yielded helpful treatment interventions which can be lifesaving and have the potential to improve people’s quality of life. It is strongly institutionally supported and explicitly prioritized over personal, experiential, cultural or any other sort of knowledge.

Working in a modernist epistemology positions the clinician as having more and better knowledge and uses this knowledge to assess, identify problems and intervene from an expert position. The prioritizing of clinician knowledge risks undermining the person’s sense of the value of the knowledge they hold so that it gets sent underground and we lose access to it.

Experience in quantum physics has shown seeking underneath explanations in terms of causation by underlying structures to be a limited strategy. The further physicists looked ‘underneath’ for smaller and smaller particles, the more they were led to empty space and the less they were able to engage in objectivity. They could not observe sub-atomic particles without affecting them. In working with people, looking underneath leads to pathologising formulations. Even trauma based formulations often focus on damage rather than resource and agency.

Study of weather systems has also demonstrated the limitations of linear causality. The role of interacting systems affecting each other is what makes weather so hard to predict, like human behaviour.

In contrast, social constructionism is a post-modern view of knowledge. It does not limit us to linear causality and the idea that making sense of phenomena is based on underlying causes. The social constructionist understanding of language and sense making is more complex.

Rather than being understood as a cumulative progression towards an absolute truth, knowledge is understood to be represented in meaning which is constructed in social interaction through generations and day to day. While starting off with innate reflexes and behaviour patterns a new baby learns to attend preferentially to what is important to its parents.

This is in contrast to the idea of knowledge being ‘found’ by objective study and looking underneath. Meaning is embedded in language. To describe oneself as a therapist, or a document as an academic paper is quite a different activity from holding up a mirror. Such descriptions depend on a range of shared cultural and sub-cultural understandings. In a simplistic way we can describe language and shared constructions as lenses through which we perceive the world. Our sense of ourselves and reality is socially constructed.

Knowledge constructions held by those in power often trump others but they can serve us better if evaluated according to their effect and usefulness. A social constructionist epistemology opens us up to the possibility of multiple viewpoints, each with validity. It gives us a way of understanding people’s knowledge as sitting beside ours, with both as possibilities, rather than having to let go of one to take up the other.

Knowledge supported by randomised controlled trials is heavily institutionally supported as evidence based practice. The idea of a randomised controlled trial of Johnella’s approach sounds paradoxical but it could and should be done.

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Imposition of knowledge is a subtle process and will happen without being apparent in the natural flow of conversation. We need 100% focus on identifying opportunities to interrupt this flow and bring forward thoughts and feelings coming up for the other person. What is happening in the room is alive with possibility. Describing the responses we notice in the room can enable the person to bring forward something they may only be barely aware of themselves. We may hear all sorts of things we don’t expect.

For example

‘Can you put words to those tears?’ … ‘What was I saying when you started to notice that sadness?’

…

When do tell people about our ideas we can take care to minimise the risk that we trump their knowledge as described in Strategy 2 . We can ask them for permission to offer our knowledge and actively seek the responses they are having. …

The approach Johnella has developed is not alone in having strategies to address the risk of imposition of knowledge but I have not come across any approach which offers anything like the richness in Johnella’s approach, or that can be used in any conversation. …

Both Motivational Interviewing and Brief Solution Focused Therapy centralise strategies and skills to bring forward wisdom the client holds and prioritise this.

The Gift Box has a different approach to supporting people in accessing knowledge they hold but cannot easily bring to mind. It contains hundreds of cards with words and phrases on them, which have been developed collaboratively with experience-based experts, professionals and others. It also includes ‘wild’ cards where people are invited to suggest other ideas. People look at cards around a range of issues and identify those which resonate for them. Particularly for people who have difficulty coming up with descriptions of their experiences, thoughts and feelings, selecting answers from possibilities is an easier cognitive task than generating answers. This is essentially a multiple choice task which could be seen as limiting possible answers. But the very large number of cards and the wide range of experiences they cover conveys an acceptance of whatever the person might come up with.

Mentalization based therapy addresses the risk of imposition of knowledge in an invitation to the client to ‘think together’ with the therapist. It actively teaches the idea that

whether we are in a client or therapist role, any mentalizing any of us does of anyone else, is a guess and needs to be checked out. It has arisen out of a tradition of psychoanalysis which offers abundant open space for the client to talk, without active imposition of the therapist, but therapist knowledge is prioritized in terms of interpretations offered.

The ‘I don’t know, you know’ stance in some forms of narrative therapy and the ‘unconditional positive regard’ central to Rogerian counselling prioritize attending to the person. Both of these approaches can be experienced as supportive and helpful. In contrast to Johnella’s approach neither involves specific skills and strategies to manage the risk of unintentional imposition of knowledge or to bring out agency, knowledge and resources. The potential power of collaboration can also be limited by discounting the knowledge we bring as professionals.

Point of Difference 3

Recognize and make effective use of the power we hold.

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Part 4:

A collaborative discovery process will not happen if we ‘go with the flow’ and follow the lead of the person or people who consult us. We need to take up the power we hold and actively craft conversations which invite reflection so that people find a way of speaking about what they may not have noticed.

…

Using the power we hold to slow the conversation down can open space for people to have a different experience, to hear and feel themselves and each other (in a family context) speak.

For example …

‘I want to stop you and slow down the conversation. What you are saying is important and I want to be sure I am getting it.’

…

We can open space for discovery by using the power we hold to interrupt the flow and support the person to move between being immersed in their experience and reflecting on it.

For example ….

‘Can I just check, is this the usual way you do things?’

‘This sounds important, this a familiar experience?’

(in the context of family members interacting) ‘I want to stop you and just ask, does this sort of talk happen a lot at home?

‘Does the intensity of the anger you are describing relate to the strength of the love you feel for Johnny?’

…

Stopping the conversation to summarise themes and drawing threads together is important for providing opportunity for reflection and ongoing negotiation of the focus of the conversation. …

Another important use of the power we hold is to engage people’s participation in a process of building trust and safety. …

Point of Difference 4

Listen for opportunities for exploration of each person’s unique experience within their social and environmental context.

🔈Listen to audio

Part 5:

We hear what we listen for. A collaborative discovery conversation requires us to listen for opportunities for discovery. Our natural way of listening is to categorise, to fit what we hear into something we understand and have knowledge of. To keep listening for the unique aspects of a person’s experience with a focus on opening inquiry takes more cognitive effort. …

We can listen in many different ways. In social conversation we might be listening for a description of an experience we resonate with, an opportunity to tell one of our favourite anecdotes or a description of an enjoyable travel experience which gives us an idea of where we might spend our next holiday. We listen differently, with different amounts of focus depending on our relationship with the person who is talking.

The therapeutic approach we are using and ideas we have orient the listening and observing we are doing differently. In any approach we might be listening for universal human experiences such as loss, grief or loneliness. Listening for indications of specifically defined diagnoses is a particularly tightly proscribed process. In Motivational Interviewing we would be listening for opportunities to elicit change talk. In CBT we might be listening for core beliefs or unhelpful thoughts and cognitive distortions we have strategies to address. In an assessment process with the goal of a psychological formulation the therapist may be listening for traumatic events, experiences indicating attachment problems or indicators of use of psychological defences. Any of these could help build the therapist’s understanding of what the person is experiencing. All these processes involve focusing listening on identifying themes and threads which fit categories in our thinking.

These approaches to listening and observing are core to evidence based psychological interventions. Most of us have put a lot of time and effort into develop competence in using them. They yield information which guides us as to strategies which are shown to be helpful and information we can give people. Offering people an explanation informed by psychological theories, diagnostic systems and information about other people’s experience is often helpful. It can be a relief for people to find they are not the only one. Having a therapist make sense of experiences they are having can be validating and reassuring. Clinicians can offer interventions which make a difference. We also use this sort of listening in a collaborative discovery process to access knowledge and experience we hold which might be helpful to the process of guiding inquiry and in other ways.

Crucial to Johnella’s work is holding this categorising sort of listening in the background while orientating to listening for this person’s experience and responses in their unique context. We are looking to go beyond what we know and understand, beyond categorisation and beyond what the person holds in their conscious awareness. We know we are on the right track when the person says something like, ‘I didn’t know I knew that.’

This focus on listening for the detail of what this person is experiencing and doing in their individual context makes our work much more challenging. …

We need to hold lightly and maybe even let go of the experience of competence in identifying, ‘I know what this is. We don’t know what anything is for this person unless we can support them to put their experience into words and tell us. It also makes our work so much more interesting. I am often surprised by what I learn about how people are negotiating their lives and relationships and how they are experiencing the conversation with me.

I have an example from my personal life I have permission to use in this context. Becoming a grandparent was an exciting prospect for me. Many of my friends had spoken about how they loved being a grandparent. While it has been a source of great joy and discovery to me I have also found challenges I didn’t expect. I felt unsure how to conduct myself in a new context with my daughters and their partners. I experienced a doubt about my parenting skills with this new infant for whom I felt such strong feelings but who was unfamiliar and wasn’t my child. I had little in the way of parameters to guide me as to what was required of a grandparent. I noticed myself comparing myself with the child’s other grandparents resulting in feelings that I didn’t match up.

When I have talked about these challenges with my friends who have been extremely positive about their experiences as grandparents they shared some of them and seemed to appreciate their being named and open for discussion. When a friend of mine talked about becoming a grandparent being an emotional ‘roller coaster’ I responded by validating how challenging I and others have found this new role. Then I stopped, thought again, and asked her about what the roller coaster was for her. This opened a conversation about her anticipation of becoming a single grandparent rather than becoming a grandparent with her children’s father from whom she had long been separated. Reflecting on her individual circumstances had the potential to open up conversation about issues quite different from what other people had described. An important one was the feelings she had about his new partner being part of the family.

In writing this I asked for her feedback. She reported finding it validating to hear that other people also have struggles in becoming a grandparent but felt that being invited to tell me about the specific experiences she was having was validating on a deeper, more connecting level. She was endorsing a ‘both and’ approach, appreciating validation of both generalisable and personal aspects of the experience.

In my initial response to my friend’s description of becoming a grandparent as challenging. I put it together with other similar descriptions I had heard. She experienced this as helpful, but in doing this I lost detail. Going beyond the categorisation to asking about her specific experience in her context opened the possibility of a richer conversation.

Focusing on unique aspects of a person’s experience is one of the ways we ‘interrupt the flow’. It is part of what is so counter-cultural, exciting and challenging in using Johnella’s approach. …

Putting things in categories and connecting them with other experiences we have had are strategies we all use and couldn’t live without. They help us make sense of the world and access relevant knowledge and experience. The depth of knowledge and experience we have augment what we offer people in a collaborative discovery process. We do not serve people best in the role of naïve inquirer from a ‘not knowing’ position. Our knowledge and experience can inform our inquiry and help us to identify opportunities for exploration so that we can go beyond them. Hence the importance of keeping our listening open to what surprises us.

This contrasts with the ideal of a therapist as someone who has such a high level of attunement and ability to read people that they can know another person more completely than the person can verbalise or communicate explicitly. In any human interaction it is a special experience to feel understood completely without having to use words. However, a discovery oriented conversational process requires supporting the person to put their thinking into words. Making the implicit explicit increases what we have available in conscious awareness with the possibility of identifying agency and resource. Responding with warmth and accurate empathy offers the person something important. But they don’t learn anything new. The accuracy of this empathy is likely to be partial at best and risks shutting down, rather than opening up, exploration even if we have got it mostly right.

Simply asking, ‘What do you mean by x?’ can be helpful, but asking about an experience in context can help focus the person’s attention on the detail of their experience.

‘The desperation you felt when you heard David had lost his job, can you put words to this desperation.’ ‘How did this desperation affect you?’

There can be an experience of validation in immediate expression of understanding, as with my friend when I initially identified a range of experiences associated with becoming a grandparent. But there is a risk of loss of detail and the richness in the detail.

In order to bring out detailed understanding we need to use the power we hold to engage people in carefully negotiating meaning, using the person’s own words where possible. …

Point of Difference 5

Conceptualising and describing in relational terms.

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Part 6:

Relational Externalising is a use of language which involves conceptualising and describing everyone and everything in relation to everything and everyone else, including moments in time. It involves quite a shift, specially for people who have grown up in Westernised, individually focussed cultures, people like me.

For example:

‘the sense of desolation you felt as you saw your daughter walk away’

This description centralises the experience, desolation, as separate from and connected to the person. It places it in the context of the relationship with the daughter and a moment in time. The detail in the description supports the person to connect with being in the experience. The separation supports reflection, moving out of the experience and looking in on it.

…

Another example might be”

‘the furious rage you experienced as you heard your partner accept an invitation to watch the game’

In contrast, ordinary language identifies the person with the problem, often using binaries and absolutes. For example:

‘I am depressed’

‘He is violent.’

She is dependent

Traditional Externalising was an important innovation by early narrative therapists, Michael White and David Epston. It separates the problem from the person as if it has a separate agency, a life of its own.

For example

‘What sort of effect does depression have on your life?’

‘How did hitting get into this family?’

When did the stealing start?

‘How did that sneaky pooh get into your pants? It is pretty crafty.’

Using traditional externalising the therapist and family members can engage with the person to address the problem. It is specially helpful with young children. With issues open to judgement it can reduce experiences of blame and shame. It has been moved into institutionalised mental health care in evidence based treatment of Obsessive Compulsive Disorder in children and is widely used by people working with Anorexia Nervosa.

For example

‘Is that you, or the Anorexia talking?’

‘Did that mean OCD make you use up all the hot water again even though you didn’t want the family to run out of hot water? Me, your mum, your dad and your sister, we are all on the team to help you get that OCD out of your life so that you can choose when to turn off the shower and get into doing all those things you want to do.’

Relational Externalising is an innovation developed by Johnella. It places the issue in relation to the person in context: Here are some more examples,

The suicidal feelings you experienced as you walked away from your friends.

The guilt and self-hate you experienced after you told your grandmother you did not care about her.

The desperation and confusion you felt when you learned your son had taken an overdose after you had had such a good day together.

The shift to using language in this way can look a bit clunky when written, but it doesn’t seem to feel like that to the person. Like traditional externalising it creates space between the person and the problem, but puts the feeling or idea in relation to the person. The person has the opportunity to experience themselves as an active ‘I’ having the experience that is ‘of me but not the whole of me’.

Relational language has the potential to free us from black and white or all or nothing thinking, enables us to shift from a deficit focused view, to engage in possibility and to use imagination as a therapeutic resource.

In contrast to the black and white, all or nothing, binary thinking of ordinary language relational externalising helps us find language for the in-between. Binaries, or absolute descriptions are common in ordinary language but they don’t do justice to the complexity and richness of our experiences. …

Consider these examples:

‘I am a good mother’ vs I am a bad mother

‘I am a confident person.’ Vs I lack confidence

I am a good clinician vs I am a bad clinician.

A binary allows only 2 positions; the valued and the not valued. It is rare for anyone fully to belong at either extreme, and neither is a great place to be. No one wants to be on the negative end of a binary but being on the positive end is precarious. If you fail, even once, to keep up the high standard required by the valued place in the binary, what is left? If I am seen as a good, rather than a bad clinician does that mean that with one error of judgement I stop being a good clinician and become a bad clinician? How can someone offer me formative feedback if identifying something I might do better could imply I am not a good clinician?

Once I move out of binary thinking I can hold my sense of value as a clinician even if I become aware of a situation where I was not able to contribute. I can reflect, consult and explore how I can develop and enrich the skills and knowledge I bring to the role.

In comparison to absolute, binary descriptions, relational language allows a richer, more detailed level of description.

For example:

‘… the confidence you showed in leading the team through the new exercise.’

‘…the valuing of yourself as a likeable person you continued to hold when going to the new school even when the other kids did not initially invite you into their friendship groups.’

‘…the good mothering you showed when you managed the intense feelings you experienced and stayed calm supporting your daughter through the painful procedure.’

Whatever lapses in confidence, loss of self esteem or not good enough mothering may happen at another time these events have happened and cannot be cancelled out. Consider the contrast with black and white descriptors such as; a ‘good mother’, a ‘confident person’ or being someone with ‘high self esteem’.

We can explore context and use relational language to shift a totalising black and white response

For example ‘I am hopeless’ might shift into:

‘The pattern of setting high goals for yourself and pushing your limits has worked well for you in many situations. It matters a lot to you to do the best you possibly can. However, you sometimes find yourself taking on more than you can manage. In trying to achieve the impossible you have found yourself falling short. In the process of becoming aware of falling short you are finding it impossible to hold any sense of your abilities and become overwhelmed by a sense of hopelessness.’ STOP DONE

Relational language can help us move away from a deficit focused approach. …

Relational language is important in summarising themes in the conversation. The detail in the description supports the person to connect to the experience, The space created around the experience and describing the context support the person to look in on the experience. This not only protects against losing what has gone before in the conversation, but holds it with richness. It provides a multi-faceted platform to negotiate the ongoing focus of the conversation.

Summarizing in this way requires the therapist to write careful notes as the person is speaking. …

Point of Difference 6

Collaborative development of a personal narrative

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Part 7:

Pain is an inevitable and important part of life. The stories we build around painful events can intensify the distress we experience by generating feelings such as guilt, fear, shame, blame, abandonment, worthlessness and rage. It is common, in any disaster associated with someone we love to add considerable suffering to the unavoidable grief and loss by making up stories about our having failed the person, not done enough.

A collaborative discovery process engages the person in building a narrative or sense-making description which they experience as intellectually and experientially coherent. Woven within this narrative is evidence confirming and producing a sense of personal agency. Incorporating the values and intentions they hold is personally affirming. Developing a narrative or description like this can have the power to move the suffering generated by the stories our minds build into manageable pain. This can shift the experience of being disempowered and immobilised to provide a platform for movement.

For the narrative to have the power to make this shift it needs to be built out of the knowledge, values, experiences and intentions the person holds. All our professional knowledge and experience cannot build such a narrative for someone else. The knowledge, experience and skills we hold are important in helping us identify areas for exploration but we cannot know what the person will bring forward. What they bring forward will often surprise them. A traditional psychological or bio-psycho-social formulation developed collaboratively, that is, collaboratively in the sense of asking for ideas and checking with the person as to whether it is making sense to them, can also help with shifting suffering. But it is unlikely to have the same sort of power.

If in any collaborative discovery process we find ourselves saying, ‘Does this make sense?’ this is a red flag and we need to consider whether we are developing the narrative and checking that we are taking the person with us, rather than using skills in engaging them in exploration to build the narrative out of what we find together.

I have illustrated this with examples from my own life. …

This is not because my life is so fascinating everyone wants to read about it, but, that I have permission to use my own information in the detail needed.

Personal Example

The first example from my own life is around processing the loss of my younger sister. She died after a completely unexpected heart attack. Losing her was painful. There is no quick and easy way through a loss like this. But my mind made up a story of how I had let her down. ‘If I had tried harder I could have prevented her death’. This was not completely outside of the range of possibility. She had had an unusual illness in the week before the heart attack which her doctors realised, after her heart attack, might have been unstable angina. If this was the case and she had had an ECG during that illness she could have had a stent and heart surgery before the heart attack happened. She would have had a good chance of survival, possibly for many years.

She had had no specific pain, even when the heart attack happened. She had had video appointments with her GP. I made several offers to go and see her, offer her help, but she turned these down. On the other hand, she did seem to be significantly unwell with no sign of improvement for a week. I still wonder whether I could have, somehow, ascertained, that this was a very odd illness and persuaded her to go to a comprehensive face to face assessment. This would have had to be by clinicians in gowns, masks and gloves to protect them from the possible infection. An ECG might have identified unstable angina, if, indeed, it was there. In the intensity of this story that I had let her down, I was suffering. I found myself unable to engage in life, work and relationships. Neither could I accept or begin to process her loss. My focus was on fault in myself, on guilt, shame and harsh self-judgment.

I discussed possibilities with my GP, thought of how, post Covid, we were much more circumspect about having contact with people who are ill and could be infectious. I talked with other people and reflected on the values which had supported the decision I had made not to go against her wishes, see her in person and interfere in her health care choices; even if I could access the assessment. In retrospect I regret that decision but I have made sense of how I made it and the context around it. I am left with sadness but have been able to let go of the suffering. I moved into feeling the loss, a loss I could share with family and friends. The suffering I had been so alone with, was transforming into manageable pain.

Personal Example

A more multi-layered example occurred in the context of my having a 5 minute slot to speak to the review committee overseeing the rewriting of the New Zealand Mental Health Act. This opportunity came up when I was away on a sailing holiday with my husband. On one level it seemed pointless to interrupt this precious time for a five minute time slot but the Mental Health Act has such power over so many people’s lives I wanted to take up the opportunity of any influence I might have, however small. Making a zoom appointment on a sailing holiday is challenging. Internet access is variable. Choices we make about where we sail when and where we anchor are dictated by the direction and strength of the wind. This is hard to predict.

I booked a slot at midday, hoping it would work out. The day the of appointment we had internet access but we also had the wind we needed to move to the next harbour, about 20 miles away. The wind tended to drop away later in the day so it was frustrating to have to delay our departure to the afternoon.

I zoomed in and waited my turn. I was a little flustered but spoke clearly, and felt I made reasonable use of the limited time available. Despite this, I was overwhelmed with distressing feelings I struggled to name. They were something like shame and incompetence. A family member, whose judgment I respect, had happened to watch and rang me, indicating support for what I had said. I appreciated the call but there was only a brief attenuation of the distress I was feeling. I rang a friend and vented briefly but she had limited time available and my husband was keen to set off. As we all know wind and tide wait for no one. The sails were ready, we started the engine and pulled up the anchor.

I struggled that afternoon. I was aware that I was being irritable, picky and fault finding but I didn’t seem able to stop it. This added to my distress. I knew it was to do with the hearing, but I couldn’t make sense of it. Of course, it felt belittling to be given 5 minutes to speak to such an important issue when I had nearly 20 years’ experience in thoughtful, careful use of the existing Mental Health Act. Our unit had led the way in stopping use of seclusion. I knew my friend would understand those things immediately. She had but as with the phone call from my family member it had made only a momentary dent in the distress I was feeling. My mind was building a story around, ‘What’s the matter with me?’

Through the afternoon and evening I festered over it and struggled to manage my behaviour. I was able to enjoy the remote, unspoiled beauty of the sail and our next anchorage but it was tempered. I apologised to my husband for the way I was behaving but the well-oiled cooperation and shared joy which were usually part of these holiday activities were somewhat dampened.

After considerable self-reflection and some collaborative discovery conversations with my friend I was able to make sense of the experience I was having. This was a process, rather than an ‘aha’ moment and I have done my best to describe it succinctly.

I figured out that speaking to the review committee for the MHA was triggering an experience I had had in an inquiry over a decade earlier. This inquiry was an important piece in the puzzle but just making that connection wasn’t enough to take the heat out of the effects of the ‘What’s the matter with me?’ narrative.

The patient involved in the earlier inquiry had not died but there was concern about the approach to care we had taken. This involved responsible risk taking, minimizing coercion and optimizing the patient’s autonomy. It was supported in the recovery movement and DBT approaches but was well ahead of standard practice. We did not use seclusion and avoided use of restraint even in contexts such as headbanging or reported secretion of sharp objects. We had a locked area in the unit but minimized time young people spent there and supported escorted and unescorted leave even when there was risk of absconding.

The choices we made would not have been seen as so remarkable now, in the context of ongoing risk to self in people with intense unstable emotions. What is likely to make a difference to their risk is a shift in their ability to manage emotions and distress combined with hope of a life worth living. Physical containment and restraint can give an illusion of containing risk but also have the potential to undermine recovery and exacerbate risk. The lead member of the inquiry team did not support the approach we took.

The flavour of the inquiry reminded me of televised courtroom dramas where lawyers cross examined of witnesses with the aim of discrediting them. There were two specific points where I remained silent when I could have spoken in my own defence. In one, a specific choice I made was represented in a misleading and negative way by one of the other witnesses. I could easily have given more context to explain the choice but didn’t. There was another point where I had completed a legal form inadequately. I had explained my thinking in my clinical notes, which the inquiry team had access to. But the brief statement I had made on the legal form was did not describe this adequately. This was brought forward in a way which made me look incompetent. Again, I could have spoken to the context, but didn’t.

The advice we had been given by the legal team was to say as little as possible in case we made things more difficult for ourselves. I am also aware that in clinical work engaging in an argument is seldom constructive. But neither of these things accounted for my failure to speak up where I was being misrepresented to my detriment. I had fallen into a victim role of powerless passivity. This was fertile ground for my mind’s narrative around, ‘What’s the matter with me?’ which flooded me with feelings of shame and incompetence.

I had thought I had shifted this experience in an inquest for a young person who had died the previous year. In preparing for the inquest I was determined that I would not repeat the failure I remembered from the inquiry. I would speak what I knew. This was partly fuelled by the experience of sitting at my sister’s bedside in ICU knowing that she might die, as she did. It was a great comfort to me that she was getting good quality care. I found it unbearable that the parents of the young person who had died should suffer, not only the loss of their child but also not be able to make sense of the care that she had been offered. I had prepared carefully for the inquest and felt satisfaction in the way I had been able to answer the family’s concerns about their child’s care. I could not make sense of why this had not super-ceded the previous experience of my taking up a victim role.

It took some collaborative discovery conversations with my friend to make sense of my taking up the passive role in the earlier inquiry. Key to this was an episode of sexual abuse by a stranger I experienced as a child. Though I finally ran away, initially I went along without challenging the abuser despite uncomfortable feelings I could not name or process. I had lived most of my life feeling it was not particularly significant.

In the process of writing the book, Finding hope in the Lived Experience of Psychosis I described this episode and found it was more significant than I had realised. Doing some structured exposure with self-soothing and distraction took some heat out of the effects of the experience. But in a conversation with Johnella about this exposure as an example of a therapeutic process she named the abuse of power I had experienced. This shook me. It was an ‘aha’ moment. I had long been puzzled about how I could become so disempowered and unable to respond effectively to some situations which could be described as an abuse of power by a man in the room. Once I had the conscious awareness of the connection with the childhood episode of abuse I have never felt immobilized in that way again.

However, the inquiry had happened before I had developed the conscious awareness of the abuse of power in that childhood experience. In the conversations with my friend, I made sense of the inability I experienced to speak in my defence in the inquiry as connected to the childhood sexual abuse. I made sense of the distress I experienced after my five minute zoom with the mental health act review panel as triggering a re-experiencing of the immobility I experienced at the inquiry. I did not become similarly immobilized in speaking to the MHA review panel or at the inquest but the speaking before the panel re-activated the older experience of being immobilized at the inquiry.

I now had my cognitively and experientially congruent narrative based in in my unique circumstances. I had made sense of the tumult of feelings I was caught in after the zoom with the mental health act review committee. The power completely went out of the ‘What’s the matter with me?’ story. My state of mind changed drastically. I was no longer irritable, picky and unpleasant, hating myself and feeling flawed. I felt pain and sadness.

I felt pain about the experience of the abuse, about the experience of the inquiry, about the loss of opportunities in the intervening decades in situations with controlling men. Most of these have been in clinical contexts where there has been a man in a family taking up a power position. I have not been as helpful to the family as I could now that I have made sense of the connection to my own abuse experience. I felt pain on behalf of all the people involved in abuse of power in our world, all the people who have been through sexual abuse and so much more. The experience which had affected me in these significant ways was minimal in comparison with what so many other people have been through. I also learned and reflected. I reflected on how I had dismissed the episode of sexual abuse from my childhood, and what a difference some small interventions had made. I was able to talk with my husband about the pain and sadness I was feeling which brought us back into connection with each other. I realised that this shift was an example of what Johnella described as the effect of building a narrative which is experientially and cognitively coherent created in a collaborative discovery conversation with my friend. In my experience of sadness and loss I was no longer alone, I was looking and moving forward.

Though my friend is a skilled therapist this was not a therapy conversation, it was a conversation between friends. We have a long history, finely honed in the process of writing our book together, of working through issues, valuing the connections and differences in our thinking processes and world views. The role she took up was of helping me to figure it out. She listened attentively, was present and responsive. Her responses were affirming and validating. She also brought forward ideas and asked challenging questions. In this context of our friendship we did not have the risks associated with the power dynamic in a therapeutic conversation of my experiencing her as an expert on my life. Where she raised and issue or asked a question which I did not experience as congruent I found it helpful in clarifying my thinking. Rather than prioritising what she was saying and trying to fit my thinking to hers the response which came to mind was, ‘no, it wasn’t like that, it was like this.’

Intimately as she knows and understands me, skilled and knowledgeable as she is, in making sense of human beings, I doubt she could have formulated it on my behalf. As I reflect on the narrative she helped me develop I can see how someone else may not find it congruent. There are other narratives which would also fit the details of my life and experience. But I had an experience of agency, of sorting out my thoughts, emotions and experiences. I knew she had helped me a lot, but on an experiential level I felt I had done it myself.

Key to the process in moving suffering into manageable pain is the collaborative development of an intellectually and experientially coherent personal narrative. Woven within this narrative is evidence confirming and producing a sense of personal agency. Placing the issue in context is the beginning of developing a more useful narrative to make sense of what is happening. I have another example from my own life.

…

I had been offered a five minute slot to speak to my written submission to the review committee overseeing the rewriting of the New Zealand Mental Health Act. I could have gone in person but the opportunity came up when I was away on my annual sailing holiday with my husband. On one level it seemed pointless to interrupt this precious time with a five minute slot but the Mental Health Act has such power over so many people’s lives I wanted to take up the opportunity of any influence I might have, however small. I made an appointment to speak over zoom. Making an appointment on a sailing holiday is challenging. Internet access is very variable. The major factor in the choices we make about where we sail when and where we anchor is the direction and strength of the wind. This is hard to predict.

I booked a slot at midday, hoping it would work out. The day the of appointment we had internet access but we also had the wind we needed to move to the next harbour, about 20 miles away. The wind tended to drop away at the end of the afternoon so it was frustrating to have to delay our departure to after 12.

I zoomed in and waited my turn. I was a little flustered but spoke clearly, and felt I made reasonable use of the limited time available. Despite this, I felt overwhelmed with distressing feelings I struggled to name. They were something like shame and incompetence. A family member, whose judgment I respect, had happened to watch and rang me, indicating support for what I had said. I appreciated the call but there was only a brief attenuation of the distress I was feeling. I rang a friend and vented briefly but she had limited time available and my husband was keen to set off. As we all know wind and tide wait for no one. We pulled up the anchor and set off.

I struggled with the afternoon. I was aware that I was being irritable, picky and fault finding but I didn’t seem able to stop it. This added to my distress. I knew it was to do with the hearing, but I couldn’t make sense of it. There were many aspects to the experience which, of course, I found challenging. It felt belittling to be given 5 minutes to speak to such an important issue when I had nearly 20 years’ experience in thoughtful, careful use of the existing Mental Health Act. Our unit had led the way in stopping use of seclusion. I knew my friend would understand completely. She had but as with the phone call from my family member it had made only a momentary dent in the distress I was feeling. My mind was building a story around, ‘What’s the matter with me?’
Through the afternoon and evening I festered over it and struggled to manage my behaviour. I was able to enjoy the remote, unspoiled beauty of the sail and our next anchorage but it was tempered. I apologised to my husband for the way I was behaving but the well oiled cooperation and shared joy which were usually part of these holiday activities were somewhat dampened.

After considerable self reflection and some collaborative discovery conversations with my friend I was able to make sense of the experience I was having and build an alternative story.
This was a process, rather than an ‘aha’ moment and quite long to describe. I have included it as this is an example I have permission to share. It is challenging to have meaningful consent to include anyone else’s story in this public space. I have removed detail about other people.

I figured out that speaking to the review committee for the MHA was triggering an experience I had had in an inquiry over a decade earlier. This inquiry was an important piece in the puzzle but just making that connection wasn’t enough to take the heat out of the effects of the ‘What’s the matter with me?’ narrative.

The patient involved had not died but there was some concern about the approach to care we had taken. This involved responsible risk taking, minimizing coercion and optimizing the patient’s autonomy. It was supported in the recovery movement and DBT approaches but was well ahead of standard practice. We did not use seclusion and avoided use of restraint even in the contexts such as her headbanging, or informing us of jagged objects inserted in body orifices. We had a locked area in the unit but minimized time young people spent there and supported escorted and unescorted leave even when there was risk of absconding.

The choices we made would not have been seen as particularly remarkable now, particularly in the context of risk to self in people with intense unstable emotions and ongoing risk. What is likely to make a difference to their risk is a shift in their ability to manage emotions and distress combined with hope of a life worth living. Undue restrictions on their autonomy can give a sense of containing risk but also has the potential to undermine recovery. The lead member of the inquiry team did not support the approach we took.

The flavour of the inquiry reminded me of cross examination of witnesses with the aim of discrediting them I have seen in televised courtroom dramas. There were two specific points where I remained silent when I should have spoken in my own defence. In one, a specific choice I made was represented in a misleading and negative way by one of the other witnesses. I could easily have given more context to explain the choice but didn’t. There was another point where I had completed a legal form inaccurately. I had explained my thinking in my clinical notes, which the inquiry team had access to. But the brief statement I had made on the legal form was not strictly accurate. This was brought forward in a way which made me look incompetent. Again, I could have spoken to the context, but didn’t.

The advice we had been given by the legal team was to say as little as possible in case we made things more difficult for ourselves. I am aware that in clinical work engaging in an argument is seldom constructive. But neither of these things accounted for my failure to speak up to give context where it was needed. I felt I had taken up a victim role of powerless passivity. My mind created a narrative around, ‘What’s the matter with me?’ which flooded me with feelings of shame and incompetence.

I had had to appear at an inquest for someone who had died the previous year. I was determined that I would not repeat the failure I remembered from the inquiry, to speak what I knew. This was partly fuelled by the experience of sitting at my sister’s bedside in ICU knowing that she might die, as she did. It was a great comfort to me that she was getting great care. I found it unbearable that the parents of this young person should suffer, not only the loss of their child but not be able to make sense of the care that she had been offered. I had actively prepared for the inquest and felt satisfaction in the way I had been able to answer the family’s concerns about their child’s care. I could not make sense of why this had not super-ceded the previous experience of my taking up a victim role.
It took the collaborative discovery conversations with my friend to make sense of my taking up the passive role in the earlier inquiry. Key to this was an episode of sexual abuse by a stranger I experienced as a child. Though I finally ran away, initially I went along without challenging the abuser despite uncomfortable feelings I could not name or process. I had lived most of my life not feeling it was particularly significant.

In the process of writing the book, Finding hope in the Lived Experience of Psychosis [link to our website] I described this episode and found it was more significant than I had realised. Doing some structured exposure with self-soothing and distraction took some heat out of the effects of the experience. But in a conversation about this exposure process with Johnella she named the abuse of power I had experienced. This shook me. It was an ‘aha’ moment. I had long been puzzled about how I could become disempowered and unable to respond effectively to some situations which could be described as an abuse of power by a man. Once I had the conscious awareness of the connection with the childhood episode of abuse I have never felt immobilized in that way again.

However, the inquiry had happened before I had developed the conscious awareness of the abuse of power in that childhood experience. I made sense of the inability I experienced in the inquiry as an effect of the childhood sexual abuse. I made sense of the distress I experienced after my five minute zoom with the mental health act review panel as triggered by this immobility I experience at the inquiry. I did not become similarly immobilized in speaking to the MHA review panel but the speaking before the panel re-activated the older experience of being immobilized at the inquiry. I am aware, re-reading this that it is not totally obvious how it all connects, but on an experiential level it feels congruent to me.

I now had my narrative based in in my unique circumstances. It was cognitively and experientially congruent. I had made sense of the tumult of feelings I was caught in after the   zoom with the mental health act review committee. The power completely went out of the ‘What’s the matter with me?’ story. My state of mind changed drastically.  I was no longer irritable, picky and unpleasant, hating myself and feeling flawed. I felt pain and sadness.

I felt pain about the experience of the abuse, about the experience of the inquiry, about the loss of opportunities in the intervening decades in situation with controlling men. Most of these have been in clinical contexts where there has been a man in a family taking up a power position. I have not been as helpful to the family as I could now I have made sense of the connection to the abuse experience. I felt pain on behalf of all the people involved in abuse of power in our world, all the people who have been through sexual abuse and so much more. The experience which had affected me in these significant ways seems so minimal when I think about what other people suffer. I also learned and reflected. I reflected on how I had dismissed the episode of sexual abuse from my childhood, and what a difference some small interventions had made. I was able to talk with my husband about the distress I was feeling which brought us back into connection with each other. I realised that this episode was an example of what Johnella described as the power of a narrative which is experientially and cognitively coherent created in a collaborative discovery conversation with my friend. In my experience of sadness and loss I was no longer alone, I was looking and moving forward.

Though my friend is a skilled therapist this was not a therapy conversation, it was a conversation between friends. We have a long history, finely honed in the process of writing our book together, of working through issues together, valuing the connections and differences in our thinking process and world views. The role she took up was of helping me to figure it out.  She listened attentively, was present and responsive. Her responses were affirming and validating. She also brought forward ideas and asked challenging questions. In this context of our friendship we did not have the risk associated with the power dynamic in a therapeutic conversation of my experiencing her as an expert on my life. Where she raised and issue or asked a question which I did not experience as congruent I found it helpful in clarifying my thinking. Rather than prioritising what she was saying and trying to fit my thinking to hers I would respond, ‘no, it wasn’t like that, it was like this.’

Intimately as she knows and understands me, skilled and knowledgeable as she is, in making sense of human beings, I doubt she could have formulated it on my behalf. As I reflect on the  narrative she helped me develop I can see how someone else may not find it congruent. There are other narratives which would also fit the details of my life and experience. But I had an experience of agency, of sorting out my thoughts, emotions and experiences.

If in the process of building a narrative with someone we find ourselves saying, ‘Does this make sense?’ this is a red flag that we are developing the narrative and checking that we are taking the person with us, rather than building it collaboratively.

🔈Listen to Full Audio

More Strands (from the previous website)

In revising this invitation to Johnella’s work I have tried to give it structure, divide it into bits, to look in on it from a different angles. This is, of course, limited at every point. When I began this project, almost 20 years ago, I worked with Tania Windelborn, who has now passed on. She was Maori and had quite different ways of constructing the world from what I do. This was much more relational, and it is no accident that she was so drawn to Johnella’s work. She used to speak of this work as like raranga or weaving. All the strands interconnected in many directions and the whole of the kete (kit or back) was deceptively strong, much stronger than any of the strands. You might use plaits for the handles or fastening, but the whole kete was much more complex, stronger and useful than a plait.

Anyone who is still reading here has an interest in Johnella’s work. This section brings together, with limited organisation, strands with more examples and some slightly different ways of saying things. I have been very keen to get this material up for feedback, but will continue to add further to this section.

I have also included some videos I made when I was beginning to explore Johnella’s work. They are not exemplars of what to do but have some interest to reflect on. They are all role plays made some time ago.

Spot the Difference

These are two sets of short videos that I (Josephine) made when I was beginning to learn from Johnella. They are home made. Number 1 is with my mother and number 2 with my sister. They are role plays where each of them took up a role of an imagined person and problem, informed by conversations with friends.

The first in each pair (1a and 2a) focuses on empathising and looking for solutions.

The second in each pair (1b and 2b) uses some strategies for exploration and focusing on agency I was beginning to learn from Johnella’s work. Neither is a particularly skilful example of the approach it is using.

1a Empathising and looking for solutions

1b Getting started using learning from Johnella

2a Empathising and looking for solutions

2b Getting started using learning from Johnella

Crafting Questions

When I began working with this approach one of the mistakes I made was just asking too many questions. Johnella does not use the phrase, ‘ask a question’, she is more likely to talk about making an inquiry. It takes care and thought to construct a useful question. I have noticed, in reading Johnella’s accounts of her work that her questions often have quite a lot of words. They use relational language and provide support for the person to put words to their thoughts, feelings and experiences.

Questions can have lots of different functions.

They can be for seeking information which is desired by the person asking the question for their own purposes.

“How much are the apples?”
“What is the best oil to use for my car?”
“Where do I find the Post Office?”

But what of a question like, ‘How do you do?’ or even the more informal ‘How are you?’ They are not seeking information at all.

‘What are you looking at?’ or ‘Who do you think you are?’ asked in a mildly hostile tone may be intended to intimidate.

When I went to a university in a new city many people asked me the same three questions: What school did you go to, what suburb does your family live in? and what does your father do? I did not experienced these questions as an interest in getting to know me, but in order categorise me on a social scale. Perhaps it was an attempt to figure out if I was worth getting to know.

When we go to the doctor with a physical health problem they ask us about troubling symptoms in order to gain information to make a diagnosis of a problem they can help with.

In a collaborative discovery process we are not so much asking a question to elicit information for us to process as to bring out into the open people’s knowledge, resources, intentions, values and experience, out into the open and provide a platform for movement. We are prioritising the experience of the question for the person receiving the question and what they learn from it. It is important that we are listening carefully and taking detailed notes so that we can gather the threads of what they are saying, feed it back to them in relational language and use what we are hearing to inform further exploration.

The intention is for people to experience the questions we ask as invitations

into a process of joint discovery, an indication of the respect we hold for them and value we place on the knowledge and resources they hold.

“Is the strength of the anger you feel when your daughter self-harms an indication of the depth of the love you feel for her and the commitment you have to her safety?”
[To a parent who is lecturing his son] “What are you hoping he will take from this conversation?”
“How did you make that decision?”

When we just encourage a person to talk freely they can feel some relief and may feel listened to but there is limited room for discovery because they are just telling us what they know, what is familiar to them. The purpose of discovery focused inquiry is to enable further exploration, to develop discoveries the person can own. An indication that a discovery process is happening is people coming out with thoughts like:

“I didn’t know I knew that.”
“I hadn’t thought of it that way”
“I didn’t remember that, isn’t that interesting?”

It takes considerable clinician focus and skill to construct a useful, easy to answer question. We often find, as we hear ourselves ask a question, that we need to rephrase it. This is not a fast paced process like banter. As clinicians we need to slow the conversation down to give

ourselves time to develop a helpful question and give the person time for processing.

Open questions give people a lot of space but take more mental effort to answer. A question like, “How are you finding this conversation?” requires a great deal more effort to answer than the question:

“I notice you are looking down and shifting in your seat. I am wondering if you are finding this conversation a bit uncomfortable.” “If you were starting to find it uncomfortable or uninteresting how easy would it be for you to let me know? Would it be really easy, middling, hard or more like impossible?”

Questions that are not too big are often more helpful. For example, compare: “What has changed?” with:

“Have there been any times when it has been a little bit easier to go out of the house?”

Small changes or steps are often not big enough to notice. If there are changes, there may be some agency and so we need to bring that forward:

“You notice the suicidal thoughts are not quite as strong at work? Do they start getting stronger as soon as you leave, what about lunchtime?”
“I noticed in the beginning of the conversation you seemed to be talking more freely than you are now. Has something I have said made it less easy to talk?” “Are you noticing some judgment or criticism?”

Bringing forward difference can be helpful. For example:

“Has parenting always been a struggle?”
“If you could take some of this memory with you what difference would that make?”
“I notice a difference between you and your mum in how much enthusiasm you each have for your going back to school? How do you understand the difference?”

Making questions particular and practical is helpful:

‘If I was watching from the side when the voices were getting stronger what would I see?”

Connecting the question with the person’s experience can help, specially when using relational language.

‘Last Wednesday, when you heard your mum say, no, to your request to go to the party, what thoughts and feelings did you notice?
“When you think of Kingseat (psychiatric hospital) as a place of shelter, can you tell me about the shelter it provided?”
“The strong anger you describe coming up when Johnny got into trouble at school, does that indicate something about the love you have for him and hopes you hold that he will do well?”

Offering alternatives can support the person in going into detail:

“I’m interested in how you made the decision to stop the medicine, if it happened all at once, or if you wondered about it over a few days.”

These are not naïve questions, we are using our knowledge to inform inquiry.

This is a longer example of focussed questions giving the person a lot of support to find a way to help us understand.

“Thank you for letting me know that you don’t want to talk about the things which have been troubling you. It is important to me that you are choosing what is OK for you to talk about. I would like to understand more about this decision. Would you be OK to help me understand the decision if we are clear there is no pressure to talk about the things that are troubling you?”
“If you started to feel pressure to talk about them what would I notice? Would you be able to let me know?”
“I could tell you some of the worries other young people have said make them reluctant to talk about tough stuff.” “Would you like to hear about them?”
“Some people worry about confidentiality, who else I might tell. Some people say that they cannot find the words to describe their experience. Some people worry that I might judge them or not understand. Some people say that keeping these things out of their mind helps them get through and if they talk to me about them that will bring them into their mind and they will experience feelings which will make them feel worse.’
‘That was a lot of ideas. Was there anything in there which might be a bit true for you? Any thoughts and feelings you noticed while I was talking?’

The young person has a lot better chance of forming an answer to a question like this than a simple inquiry, “why” or “How did you make that decision not to speak about what is troubling you?” If they endorse any or all of the alternatives this offers possibilities to explore.

Moving between ideas, feelings, values and practice.

We all have values and intentions which are an important personal resource and part of our personal identity.

“Given that you came here today because your mum wanted you to, does that mean that you give some value to her opinion?”
“What would you be doing if a bit more happiness/peace started to creep into your life?”
“How is love/respect shown in this family?”
“How does the concern you feel show itself?”

In resonse to, “I want her to show respect.”

“What sorts of things would she do which would let you know she was showing respect?” ” If she holds a different view from you, how can she express that in a way which shows respect?”

In response to ,“I’ve had enough. I am desperate.”

“Is this desperation meaning you are thinking about walking away, or does it give you more motivation to try and find a solution?”

A young person described arguing back to a teacher (action) because a punishment was not fair.

“Is fairness an important idea for you? (idea supporting action)’
‘How does your concern for fairness show in your life?” (actions supported by the idea).

From a conversation with a person contemplating suicide:

“One of the things that keeps you alive is your concern about the pain your death would bring your family. It sounds as if you place considerable importance on the well-being of your family. How does this concern for the well-being of your family you hold show in the day to day?”

Noticing and making explicit what we are noticing in the room.

Changes in expression, body position and ways of speaking may indicate an experience the person is not consciously aware of. Stopping and describing what we notice supports the person to attend to it and bring this into conscious awareness. It is important that this is tentative.

‘I am noticing you are talking more softly with longer spaces. Is something changing for you in the conversation?’
‘I am noticing you glancing at your mum/looking away when I asked about your dad working long hours. Do you have some concern about how this topic is for her?’
“I noticed you spoke quite quickly and strongly in response to what Mary said. Is that what it seemed like to you?”
“Were there some feelings you experienced?”
“Can you describe them?”

Attending to the experiences we are having.

This is not altogether straightforward as it is not always obvious what contribution experiences from our own lives are making. Usually we will not be able to process this in the context of the conversation without making space. One possibility is to stop the conversation and just ask for space:

‘A lot is happening in the conversation and I would just like to stop for a moment and gather my thoughts.’
“I’d like to stop the conversation for a moment. I just want to check how well this conversation is working for you.”
“I am wondering if there is a bit of a clash between us. Are you noticing anything like that?”

As described with judgment making an inquiry can be helpful. This could be any number of questions inviting reflection and exploration.

‘[with family] Is this happening a lot at home?
‘Help me understand, how did you make the decision to do x?’
‘What were you hoping for when you said y?’
‘Are you finding this conversation helpful?’

Summarising themes and asking also for input as to the content and focus of the conversation is another strategy which gives pause for everyone.

Attending to the response we are having may contribute to the conversation. We are noticing something. We also have knowledge and experiences which are not immediately available in our conscious awareness. Giving ourselves some opportunity to process may enable us to access this in a way it can be used to contribute to the conversation.

It may also protect the conversation. If the content of the conversation is triggering responses in us which do not belong in this conversation we may be less available to the conversation and need an opportunity to re-focus. There may be issues we need to take to supervision..

It is particularly important that we do not consider it a failure if we experience feelings of anger, irritation, frustration, boredom, being hopeless or useless or wanting people to never come back ever again. It is a failure of looking after the relationship if we do not take that to supervision or somewhere else and say, ‘this is what I experienced, let’s make sense of this’.

Feeling bored with a situation can mean we are making assumptions or are ahead of people, trying to get to a place that is safe and better rather than working with what is right now. It is important to check this out.

Focus on presence rather than absence

People often bring to us concern about absence of self esteem, confidence, motivation, respect to mention a few. The way our minds seem to work we are often drawn to the idea, ‘ Our professional training and literature also often focus on deficit.

Focus on presence rather than absence can lighten the conversation in a way which is more conducive to optimism and movement.

To experience concern about the absence requires some knowledge of presence. We can invite the person to use their imagination to bring forward the ideas they have about presence. For example:

“What is the conversation like when the fighting is not happening?’

“How would your life be different if you started to develop some self esteem?”
“If some self esteem started to develop, what would be the first sign?” “How would you tell?” “Who would notice first?”

In response to “No one ever listens to me”, one might inquire,

“What would let you know that listening was happening?”

For a young man who described young women looking straight through him,

“If they did see you what would you like them to see?”

“When I remember the way they talked about what happened, I am surprised I didn’t go mad.”
“When you remember that time, what supported you to hold on to the reality of your experience?”
“I sat through the inquiry with my partner squeezing my hand. It helped me to feel I existed. … his hand was marked from my fingernails. I just held on.”
“In the holding on, what were you holding on to?”

Making summaries

This is a powerful intervention and easy to neglect. Like much of Johnella’s work when done well it can seem very ordinary to me. I had an interesting experience when I was doing some small group teaching about this approach. We were a group of six. I was demonstrating doing a summary in a role play. The person in the role play found the summary very nurturing and helpful. The person sitting next to her agreed. The people across the room could not see the value.

How I made sense of this is that summaries don’t seem of value to clinicians, or someone at a distance. We are busy thinking about what is going on, what we should do next, etc. It is easy to miss what a summary adds to the process. Specially when done in relational language the person receiving the summary has an opportunity to experience what they are saying differently. At the very least they are hearing someone else speaking what they have said. But that is not necessarily apparent from across the room.

Summarizing slows the conversation down and gives everyone (including us) a chance to reflect. It is also a good opportunity to consult with the person about the direction of the conversation.

“Our conversation has ranged over several aspects of the life you are living. You have talked about the experience experiences of being bullied at work, of frustration with your partner, of wanting to spend more time with your older children. Which of these is most interesting to you for us to focus on?”

Summarizing highlights the formal nature of the conversation, distinct from a chat with a friend. Using the person’s own language also helps. We are unlikely fully to understand how they are choosing their words, but we are more likely to get it right using their language rather than substituting words. It supports the person to take up different positions, from being ‘in’ their experience, to the wide angle, or mountain top view, to listening to a person they respect (we hope) speaking their account of their experience.

This is an example of a summary with a young man experiencing persecutory delusions:

“It sounds as if you are experiencing intrusive thoughts about the gangs being after you, leaving you with a feeling that you are not safe anywhere. It sounds as if you have experienced a bit of a shift in that you have decided to get on with your life despite these thoughts and feelings. What you describe finding most helpful in “getting on” is keeping busy, to keep your mind off them. So, would you like us to look at how we can support you in keeping busy, finding activities you can engage in?”

This is an example with a young woman working to find other strategies to replace cutting:

“You describe through watching TV in the evening you were able to enjoy the programmes with little awareness of any feelings. Once the programmes were over you noticed the bad feeling coming in again. As the text fight began you remember noticing feelings of anger and sadness, but used the strategy of trying to pretend they weren’t real. Once the text fight was over you noticed the feelings gathering strength. Around the same time you noticed the thoughts about cutting coming up. You experienced some pleasure, maybe relief associated with those thoughts.”

A summary also provides an opportunity to bring together different strands of a conversation. This is the process of raranga or weaving to create a kete, a bag which has strength far in excess of that of any individual strand of flax from which it is made which Tania identified. We need to manage the risk for us of attending to the last thing the person said and for the person to remember only the last 10 minutes of the conversation. Throughout the whole conversation we need to be weaving the threads we are discovering together. We are setting out to build a narrative centralising their agency and resource. This narrative is located in context, time in history, experiences, family, social context and personal events in order to make sense of the person’s actions and create a platform for movement.

“We started the conversation with an intention to focus on the relationship between the two of you. We moved the focus to the concerns you both have about your daughter. Then we have started talking about the concerns you have about the school. I am wondering how the issues are connected or affect each other.”

What people are likely to take away from our work.

When we do this work well people will be more conscious of their agency, skills and resource than ours. What we are working towards is not for the person to leave the session thinking how clever and skilled we are and how lucky they are to have met us because they wouldn’t have managed without us. The focus is to bring into conscious awareness the skills, knowledge and resource they have. The intention is for them to own the discoveries and shifts in thinking and awareness we have made together. People are likely to find us helpful and feel listened to. They will often appreciate the conversations and what they get from them but won’t hear the skills we use to get there.

Many clinicians do not notice the skills we are using either. I had an example demonstrating this when I was asked to see a mother of two children with special needs who was experiencing and expressing anger and disappointment with our service. She had good reason and there had been some unhelpful conversations. I worked hard maintain my focus and presence. Focusing on agency and resource was straightforward. She showed a sophisticated understanding of her children’s needs and advocated for them with passion. She parented tirelessly and skilfully herself. I took careful notes and was able to gather threads in relational language using her words. Working in the present moment by noticing body changes enabled her to put words to some of the losses and grief she was experiencing in the context of the love she felt for these children for whom so little was being provided. Listening carefully and hearing some things which surprised me I found the conversation much more interesting than I had expected.

We reached a point where we were able to make an apology she could hear. We began a practical collaborative conversation about the limited ways in which our service might be able to provide something which would be useful for the family. I found the conversation very moving and felt drawn towards this woman in her challenges. She expressed appreciation for the conversation. After the interview the clinician who had been with me turned to me and said, ‘It wasn’t so hard, was it?’

People are more likely to talk about feeling listened to, feel a bit lighter and that we are nice, understanding people. They may feel increased energy and motivation. They may feel that their predicament is much less of a problem than they thought it was. This is important but does not take them far.

People need support to take their discoveries away, to take away the complexity of the narrative we have been building or it risks being lost. They need support hold the sense of the discoveries they have made to create a platform for movement. Options include: a piece of paper used during the conversation to record the threads as they come up, a clinical note they have a copy of, a voice recording, a clinical letter or a specific ‘therapeutic’ letter.

Explicitly negotiating safety in the therapeutic relationship

We are inclined to think of trustworthiness as being a property of a person. In ordinary language we talk of trust as if it were a binary, black or white. Someone is trustworthy or not. Trust is there or it is lost.

It makes more sense to think of trust as an aspect of a relationship, to talk of levels of trust, types of trust. There might be beginning trust, fragile trust, or we can talk about the process of developing trust. There may be someone I would trust with my bank account but I would not trust with my car or my child. Trust is built in a relationship in a context. A therapist or clinician cannot create trust alone.

Engaging the person as an active partner in the discovery process around managing safety and building trust can be therapeutic in itself. It gives an opportunity for the person to experience someone holding power in the relationship asking about and listening carefully to their experiences. Carefully constructed collaborative discovery process can enable them to take up agency in the context of this power relation.

“You have described some experiences you have had in therapy where you ended up feeling an increase in sadness. I am wondering if it will be possible for you to let me know if we were starting to move into talk where that might happen. What would be the first sign you might notice?”
“What would I see you do if that was starting to happen?”
“Would you be able to let me know, give me a sign?”
“If I thought I noticed something and asked you, would you give me an honest answer or might you pretend things were OK?”

There are so many places this conversation can go. It is not uncommon for me to be talking with a young person who is clear that they would not let me know if they were hating the conversation and longing for it to end. This is a strategy they use in much of their lives which does not serve them well. An interesting aside on how invisible the skills we use are happened after one of these conversations.

I was talking with a young woman who had had many unpleasant conversations with people like me. She was adamant she would not even know herself, at the time, if the conversation was not working for her. In the process of exploring around this I asked her if she would clean my car if I asked her. She said she would. I realised I don’t have a car but I have a bicycle. I asked her if she would know at the time she was cleaning my bicycle that she didn’t like it. Initially, she said, ‘no’, then laughed and said, yes she probably would. We managed to inch forward with some progress which is another story. But afterwards, I heard a trainee who was with me telling another staff member, in an astonished voice, that I had asked this young woman to clean my bicycle. She could see that it had been helpful in building some engagement but clearly seemed a very odd strategy to her.

Levels and forms of safety and trust are present in every relationship. Explicit negotiation in this relationship has the potential to bring knowledge and experience the person has into their conscious cognitive awareness. The explicit awareness of this knowledge increases the possibility it will be available to them in any relationship they engage in.

For example:

“I notice you looking down and away. I am wondering if you are feeling some discomfort in the conversation.”
If yes, “I am wondering if you would have been able to let me know if I had not asked directly.”
‘What would have influenced the decision you would have made about whether to tell me or not?”

Identifying strategies we call ‘avoiding’ or ‘people pleasing’ can be made explicit in this context. In exploring how widely the person uses them it may become clear that they were used in a context of fear. Safety is dynamic, a relational construct, in a context. When people experience lack of safety in a moment the risk is that they experience this as evidence of a deficit in themselves, eg too sensitive, unable to connect to people, no good at talking or so damaged or incompetent they cannot be helped. If we notice a drop in tone, change in body posture, struggle to speak or change in emotional presence we need to check this out. We need to look for a way to move forward and return to the concern later to check out if we are making progress.

“What were we doing when this happened?”
“How can I support you now?”
“If we were to increase the sense of safety in this room what would we need to do?”

More on carefully negotiating meaning

Any use of language involves assumptions. What any of us says about our lives is as close as we can get to the experience, it is not the experience. When I tell you about sadness I

am experiencing you make sense of it in terms of experiences you have of what you call sadness, what you have heard from others and other sorts of knowledge you have of sadness. All of this may bring you somewhere near getting an understanding of what I am experiencing but we cannot afford to take it for granted.

In the context of the power relation we risk losing access to the meaning the person makes because they are likely to see our knowledge and understanding as superior to theirs. When we pick up meaning in a way they do not intend there is a risk that they will value our knowledge over theirs and conclude that what we say ‘must be true’. They are at risk of discounting their experience in favour of what they perceive as ours.

A simple example comes from a situation when a young woman described herself as having been ‘spoiled’. When asked what she meant by that she turned to the clinician as an authority and asked: “What does ‘spoiled’ mean?” An understanding of wider societal understanding of ‘spoiled’ is of no usefulness to the conversation. What is needed is the understanding of ‘spoiled’ she used.

As with many approaches to therapy and lots of other life activities, the devil is in the detail.

Making an inquiry in relational language about what a person is experiencing in the present moment is an opportunity for more specific understanding of meaning in context. This has a much better chance of bringing forward more understanding.

“This jealousy that you were experiencing as Mary said this and this, could you put words to this jealousy.”

A question like this is more likely to generate new discovery than asking about jealousy. What is important in this conversation is not some sort of general jealousy, it is this jealousy in this moment in relationship to this person. Given that much of our professional knowledge is based on collapsing and grouping people’s experiences it is useful to ask oneself:

“How much do I understand about how living with this is for this person?”

Talk That Heals

Discovery Oriented Conversational Process

5 strategies to experiment with – a toe in the water.

Strategy 1

Consciously remind yourself that this person/family negotiates a life we have little understanding of and uses skills, knowledge and resources we want to learn about.

Strategy 2

Replace telling with inquiry.

Strategy 3

Ask for feedback as you go along.

Strategy 4

Focus on Agency

Strategy 5

When noticing judgment coming up in ourselves, explore.

Six key points of difference in Johnella’s Approach

Point of Difference 1

1. Profound respectfulness – People have important resources we and they may not be able to name. Central to this work is bringing forward those resources.

Point of Difference 2

2. Do no harm – Address the power relation in the therapeutic relationship

Point of Difference 3

Recognize and make effective use of the power we hold.

Point of Difference 4

Listen for opportunities for exploration of each person’s unique experience within their social and environmental context.

Point of Difference 5

Conceptualising and describing in relational terms.

Point of Difference 6

Collaborative development of a personal narrative

More Strands (from the previous website)

Crafting Questions

Moving between ideas, feelings, values and practice.

Noticing and making explicit what we are noticing in the room.

Attending to the experiences we are having.

Focus on presence rather than absence

Making summaries

What people are likely to take away from our work.

Explicitly negotiating safety in the therapeutic relationship

More on carefully negotiating meaning

5 strategies to experiment with – a toe in the water.

Talk That Heals

Discovery Oriented Conversational Process

5 strategies to experiment with – a toe in the water.

Strategy 1

Consciously remind yourself that this person/family negotiates a life we have little understanding of and uses skills, knowledge and resources we want to learn about.

Strategy 2

Replace telling with inquiry.

Strategy 3

Ask for feedback as you go along.

Strategy 4

Focus on Agency

Strategy 5

When noticing judgment coming up in ourselves, explore.

Six key points of difference in Johnella’s Approach

Point of Difference 1

1. Profound respectfulness – People have important resources we and they may not be able to name. Central to this work is bringing forward those resources.

Point of Difference 2

2. Do no harm – Address the power relation in the therapeutic relationship

Point of Difference 3

Recognize and make effective use of the power we hold.

Point of Difference 4

Listen for opportunities for exploration of each person’s unique experience within their social and environmental context.

Point of Difference 5

Conceptualising and describing in relational terms.

Point of Difference 6

Collaborative development of a personal narrative

More Strands (from the previous website)

Crafting Questions

Moving between ideas, feelings, values and practice.

Noticing and making explicit what we are noticing in the room.

Attending to the experiences we are having.

Focus on presence rather than absence

Making summaries

What people are likely to take away from our work.

Explicitly negotiating safety in the therapeutic relationship

More on carefully negotiating meaning

5 strategies to experiment with – a toe in the water.

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