disunited (among themselves or with me) I often use metaphors that they can agree on. These can be used as a way of re-joining and summarising. One useful one is that of a road. It may be smooth and easy to walk on or it may have uncomfortable pebbles, irritants to our feet. It may have rocks that we can notice and avoid or it may have boulders, problems that seem insurmountable. Maybe at this stage in therapy the family feel devastated by the size of their ‘boulder problem’ they have struggled with; maybe they are worn out, feel they have failed. I believe the task of the therapist is to be curious about each of their perceptions, to explore together their solutions and hopefully over time, as their relationship with the problem changes, the ‘boulder’ will diminish or vanish. The way we communicate can set the tone for the session. As Fran Hedges (2005) describes the process, “In a systemic orientation we work with the idea that every action is a communication and every communication is an invitation to other people to respond in some way”. I felt I could not write about ‘engagement
without a passing nod to Salvador Minuchin (Minuchin & Fishman, 1981). He was interested to know what style would be useful to families. Although the ideas of nearly 40 years ago may seem dated and maybe too contrived, he introduced some original thinking. He believed that, “joining a family is more an attitude than a technique and is the umbrella under which all therapeutic transactions occur”. Engagement is letting the family know that the therapist understands them and is working with and for them. Minuchin uses Harry Stack Sullivan’s phrase, that the therapist must be “more human than otherwise”. Minuchin honours the idea that the therapist’s use of self is a “powerful tool” in engaging with families. These ideas accord with earlier and later research into what makes therapy successful, from Truax and Carkhuff (1967) in the 60s to Fonagy in 2006. Consistently, researchers found that the style of the therapist, rather than the model, was the more eff ective variable in off ering benefi cial therapy and subsequent client satisfaction. Minuchin describes how therapists can be close to the family by affi rming them and may intensify their experience. A therapist taking a “median position”, he thought, was able to show neutrality and track the family process (rather than the content). A disengaged therapist was thought of as adopting an expert position. Developments in our understanding of the process of communication have led us to believe that a more equable dialogic
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position is the path towards respectful therapeutic relationships. Angus and Kagan (2009) in a Rogerian tradition, researching the eff ectiveness of therapist’s empathy, found that, “the therapists’ capacity to empathetically attune with clients on a moment- to-moment basis in therapy sessions may be a key mechanism of change across a range of approaches and clinical disorders”. Recent scientifi c research is being applied
to clinical contexts to enable us to understand more about engaging and interacting with families. Trust is probably the most important part of the family members’ relationship with us. Without trust in the therapist and the therapeutic process, engagement and therapy are not possible. Most people come to therapy with some trepidation and (to use de Shazer’s words), some are “visitors”. Whatever fears people bring with them, our task is the same, to off er a safe, secure base in a calm and welcoming environment. Safety is a key element in enabling our clients to be able to relax and grow in trust. The research scientist Steven Porges has asserted that, “Safety is the treatment”. He has studied the workings of the vagal nerve. His research has revealed that this nerve plays a crucial role in our state of mind and body. Our autonomic nervous system is constantly revising our environment in order to keep us safe. This is mostly happening automatically at an almost unconscious level. When we or our clients feel anxious, angry or fearful and we feel unsafe, this is detected by neuroreceptors in the vagal nerve which, in concert with the sympathetic nervous system, will activate our ‘fi ght, fl ight, freeze’ response or a protective state of collapse. This temporarily inhibits our ability to think and refl ect. When we are calm and feeling safe, we are able to relax and trust. We can listen, concentrate, evaluate, focus and hear what is being said. We can move from moment to moment with an open awareness of all that is happening around us. As therapists, we can really be present to our clients, fully absorbed and alert to their responses. We are frequently witnesses to confl ict and the high escalation of feelings in the families and couples we see. Our skills are challenged to engage and re-engage with these distressed clients. Deb Dana is a psychotherapist who has
studied the clinical applications of the research into the workings of the vagal nerve. She advocates that, when engaging with clients who are experiencing a state of high escalation, it is important that the therapist remains in a state of calmness and safety. The therapist’s physiological state communicates
itself to the clients and can off er them the containment and safety that will enable them to accept these cues of safety and allow themselves to de-escalate. It is only in this resumed calm state that refl ection, negotiation, learning and co-operation can happen. Keltner (2012) has called the vagal nerve the “compassion nerve”. He says that, “through the actions of the ventral vagus we are wired to care”. Dana off ers us breathing techniques, which can be used to help clients to move from the highly aroused or dissociated state of response to threat, to the experience of a calmness and stillness. This is a moment when clients can experience the integration of themselves, as they, even momentarily, let go of their fears and recover hope that trusting connections can be rediscovered. This can be a moment of reconnection with themselves, their families and the therapist. It can also be a moment of vulnerability that calls for the presence of safety, which the therapist can off er through affi rmation, validation and containment. Fredman (2007) commented that, “Our intention is to enter a meeting and join the relationship in a position of ‘tranquility’”. Inviting the client into a relationship marked by “curiosity, mutual listening and respect where touching each other with words and actions is mutually enjoyable and attention is focused on refl ecting and musing”. As I waved goodbye to my friend, my
footsteps were lighter, my heart was warmer. We had laughed together over memories and hopes. We had grieved together over the future of the planet, the rise of violence and corrupt political systems. Our hearts and minds had joined in happiness and sadness and I felt better for it. I was a stronger, more confi dent person after my affi rming visit. I hope that my clients can fi nd the strength to go home with similar hope in their hearts, as a result of the generosity, forgiveness, and care they can off er to one another and the joy of their increased connections. To borrow some lines from the poet Lemn
Sissay: Let there be peace, Let tears evaporate to form clouds, cleanse themselves, And fall into reservoirs of drinking water. Let harsh memories burst into fi reworks that melt,
in the dark pupils of a child’s eyes And disappear like shoals of darting silver fi sh,
And let the waves reach the shore with a Shhhhhhhhhhhh shhhhhhhhhh shhhhhhhhhhh.
Context 169, June 2020
Engaging and being
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