With a robust attention to the ethics of
our practice, the refl exive positioning model has proven instrumental in guiding our thinking and our ongoing conversations about this organisational change. As my (Rob) familiarity with the model
has increased, I have found it easier to locate the position I am in in any given situation, and, particularly if I have a sense that the conversations are becoming stuck or if I have a sense that my conversational partner and I are positioning one another in incompatible ways, then I have a range of other positions to step into. It has been interesting to note how I have
been positioned by others through this process – often I have felt I am acting out of a relational position, but been experienced by the other as acting out of a production position. If there has been a way out of this, it has involved curiosity about the position of the other, and a certain attention to the aesthetics of our practice. A particularly useful aspect of the model
has been the emphasis both on refl exive awareness of positioning during ad hoc conversations, as well as the deliberate structuring of contexts for exploration within particular positions (such as the consultant position during deliberate practice meetings and the production position during quality and safety meetings). One unexpected consequence of this initiative has been how much I have learnt, both about the practice as well as the ethics of my colleagues, through the richness of the conversations that have ensued. There is a hazard in any write-up of a
project that the story can become too neat and deceptively coherent. There are as many stories that remain untold as there are that are told about this process of outcome measurement in our department, and hopefully the text boxes give some sense of this polyvocality. Our department is constantly changing
at every level – wider context, personnel, relationships within the team, the ongoing social construction of the department to the interactions going on within it (Campbell, 2000). This dynamic unfolding is never complete; our task in collecting meaningful feedback from clients about the eff ectiveness and the process of our work is likewise never fi nished. As Hersted and Gergen caution, “Organisations are always emerging or ‘becoming’ in ways that cannot be fully predicted” (2013, p. 100).
Context 170, August 2020
We are simultaneously inducting new stuff
to the spirit, purpose and practice of sessional measures, as well as continuing to try and connect their use to what established clinicians give value to in their work and trying to keep the collective enthusiasm going through sharing our own. Attending to the diff erent refl exive positions will continue to guide our work.
Acknowledgments We would both like to give sincere
thanks to Michael Rooney from IT for his work behind the scenes with the various iterations and complexities of the database. Thanks also to all our colleagues and clients who have, in their myriad ways, joined in the conversations and inspired our curiosity.
References Campbell, D. (2000) The Socially Constructed Organisation. London: Karnac. Campbell, D. & Groenbaek, M. (2006) Taking Positions in the Organisation. London: Karnac. Cotton, E. (2017) Surviving Work in Healthcare: Helpful Stuff for People on the Frontline. London: Routledge. Coventry, P., Lovell, K., Dickens, C. et al. (2015) Integrated primary care for patients with mental and physical multimorbidity. British Medical Journal, 350: h638. Duncan, B., Miller, S., Wampold, B. & Hubble, M.A. (2009) The Heart and Soul of Change: Delivering What Works in Therapy (2nd ed.) New York: American Psychological Association. Duncan, B.L., Miller, S.D., Sparks, J.A., Claud, D.A., Beach. P., Reynolds, L.R. & Johnson, L.D. (2003) The session rating scale: Preliminary psychometric properties of a working alliance measure. Journal of Brief Therapy, 3: 3-12. Goldberg S.B., Babins-Wagner, R. & Miller, S.D. (2017) Nurturing expertise at mental health agencies. Chapter 10 in T. Rousmaniere, R.K. Goodyear, S.D. Miller & B.E. Wampold The Cycle of Excellence: Using Deliberate Practice to Improve Supervision and Training. Wiley Blackwell, USA. Harré, R. & van Langenhove, L. (1991) Varieties of positioning. Journal for the Theory of Social Behaviour, 21(4): 393-407. Hersted, L. & Gergen, K. (2013) Relational Leading: Practices for Dialogically Based Collaboration. Chagrin Falls, Ohio: Taos Institute Publications. Hornstrup, C., Johansen, T. & Harre, R. (2008) Leadership as Refl exive Positioning. Available at:
https://www.taosinstitute.net/Websites/taos/fi les/ Content/5694373/Hornstrup-Leadershi_and_ Refl exive_Positioning.pdf (Accessed 19/7/19). Hornstrup, C., Loehr-Petersen, J., Madsen, J.G., Johansen, T. & Jensen, A.V. (2012) Developing Relational Leadership: Resources for Developing Refl exive Organizational Practices. Chagrin Falls, Ohio: Taos Institute Publications. Huffi ngton, C. & Armstrong, D. (eds.) (2004) Working Below the Surface: The Emotional Life of Contemporary Organisations. London: Karnac. Jackson, C. & Rizq, R. (2019) The Industrialisation of Care: Counselling, Psychotherapy and the Impact of IAPT. Monmouth, UK :PCCS Books. Knapp, M. (2012) Mental health in an age of austerity. Evidence-Based Mental Health, 15: 54-55. Lang, P., Little, M. & Cronen, V.M. (1990) The systemic professional domains of action and the question of neutrality. Human Systems: The Journal of Systemic Consultation and Management, 1: 39-55.
Marks, D.F. (2018) IAPT under the microscope. Journal of Health Psychology, 23(9): 1131-1135. McGrath, L., Walker, C. & Jones, C. (2016) Psychologists against austerity: Mobilising psychology for social change. Critical and Radical Social Work, 4(3): 409-413. Miller, S.D. (2015) The verdict is “In”: Feedback is NOT enough to Improve outcome. Blog post accessed 20/9/19 at:
https://www.scottdmiller.com/the- verdict-is-in-feedback-is-not-enough-to-improve- outcome/ Miller, P. & Rose, N. (2008) Governing the Present: Administering Economic Social and Personal Life. Cambridge, UK: Polity Press. Miller, S.D. & Duncan, B.L. (2000) The Outcome Rating Scale. Chicago, IL: Institute for the Study of Therapeutic Change. Minieri, A.M., Reese, R.J., Miserocchi, K.M. & Pascale- Haigh, D. (2015) Using client feedback in training of future counselling psychologists: An evidence- based and social justice practice. Counselling Psychology Quarterly, 28(3): 305-323. NHS England (2018) The Improving Access to Psychological Therapies (IAPT) Pathway for People with Long-term Physical Health Conditions and Medically Unexplained Symptoms at https://www.
england.nhs.uk/wp-content/uploads/2018/03/ improving-access-to-psychological-therapies-long- term-conditions-pathway.pdf (Accessed 19/7/19) NICE (2002) Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. NICE clinical guideline 1. London. Pearce, B. & Cronen, V. (1980) Communication Action and Meaning: The Creation of Social Realities. New York: Praeger. Public Health England (2018) Local Authority Health Profi le – Bradford 2018. Available at: https://fi ngertips.
phe.org.uk/profi le/health-profi les/area-search- results/E08000032?place_name=Bradford&search_ type=parent-area (Accessed 19/7/19). Reynolds, V. & polanco, m. (2012) An ethical stance for justice-doing in community work and therapy. Journal of Systemic Therapies, 31(4): 18-33. Rizq, R. (2012) The perversion of care: Psychological therapies in a time of IAPT. Psychodynamic Practice, 18: 7-24. Rose, N. (2019) Our Psychiatric Future: The Politics of Mental Health. Cambridge: Polity Press. Rousmaniere, T. (2017) Deliberate Practice for Psychotherapists: A Guide to Improving Clinical Eff ectiveness. New York: Routledge. Rousmaniere. T., Goodyear, R., Miller, S.D. & Wampold, B. (2017) The Cycle of Excellence: Using Deliberate Practice to Improve Supervision and Training. Hoboken USA: Wiley Blackwell. Simon, G. (2014) Systemic inquiry as a form of qualitative inquiry. In: G. Simon & A. Chard (eds.) Systemic Inquiry: Innovations in Refl exive Practice Research. Farnhill, UK: Everything is Connected Press. Sparks, J. & Duncan, B. (2018) The partners for change outcome management system: A both/and system for collaborative practice. Family Process, 57: 800-816. Steen, S. (2018) A cost-benefi t analysis of the Improving Access to Psychological Therapies programme using its key defi ning outcomes. Journal of Health Psychologies, Oct 4:1359105318803751. doi: 10.1177/ 1359105318803751. Tilsen, J. & McNamee, S. (2015) Feedback Informed treatment: Evidence-based practice meets social construction. Family Process, 54: 124-137. Wampold, B. & Imel, Z. (2015) The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. London: Routledge. White, M. (1997) Narratives of Therapists Lives. Adelaide, Australia: Dulwich Centre Publications. White, M. (2002) Addressing personal failure. International Journal of Narrative Therapy and Community Work, 3: 33-76.
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Refl exive positioning as a tool for organisational change: Systemic approaches to implementing outcome measurement
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