Over the years I’ve come across many situations that have always involved adapting to the circumstances. This is true for when I use what’s called therapeutic use of self. Basically, this is the space where your own strengths and qualities are used as a therapeutic tool and we all have this ability, regardless of stage in our own careers. Another way that I like to view this is by pointing out that you can have all the knowledge and life experience in the world. But if you cannot connect with someone on a therapeutic level, then all of that knowledge and experience is wasted, as the client isn’t going to benefit from that knowledge due to the lack of connection, or therapeutic use of self.
To give an example of this, I once worked with an indigenous person that had a whole range of traumas that included intergenerational violence which was still impacting upon him, only this was being masked over through the use of substances and a detailed delusional system that would come to the front of his presentations when feeling the need to protect himself. As a result, this person was having to work with me as an involuntary consumer under the Mental Health Act, and subsequently, I was faced with constant verbal aggression and also threats of physical violence. The easiest (and less optimistic) option with this would be to maintain the mandated level of treatment under the Mental Health Act and put in the usual measures such as two persons visiting to increase safety etc. However, on my first meeting with this person, I couldn’t even introduce myself before being faced with a barrage of insults and threats, and this told me two things from the beginning. The first was that this person hated the situation he was in, and the second was that if we want his behaviour to change, then we as clinicians also have to change.
From here, I began with a simple change of routine, it was clearly the forced treatment which this person was disliking, so I decided to visit in between usual treatment weeks for a casual ten-minute introduction, obviously still with someone else, but the focus would be to attend and listen, rather than arriving to inform him of what we would like him to do. This routine continued for several months, to the point where I learnt a great deal about this person and even began to recognize that some of his behaviors in the community reflected his indigenous background. We even managed to begin addressing some of his other health needs and would spend much more time together. But the greatest achievement with this, was that one I began listening to him and acknowledging his frustrations, the anger disappeared and he eventually became a voluntary client along with his treatment being changed as a consequence to an approach which was much less intrusive. Although this process took quite some time, the key intervention here was the therapeutic use of self. I didn’t go in with some fancy assessment or empirically tested treatment. I just went in and listened, followed by acknowledging his experience and seeing how things could change.
Another noticeable event with this is that one day when completing a home visit, he accidently hit his knee on a coffee table and his reaction was exactly the same as the earlier days when seeing clinicians, he did not like. There was lots of swearing, threats, and throwing of objects. I had to leave on that occasions for obvious safety reasons, but I was able to return the following day and discuss what happened, and he was also able to reflect that this is the same way he reacts to most things. So again, the way in which his aggression was worked on, was by listening and not letting it be a deterrent.
Although this person will continue to approach stressors in a particular way, it highlights how the therapeutic self can influence change and be very containing for both client and clinician as neither person is engaging with a competing agenda, they are just being present in the moment and seeing what unfolds.