Creating a safe space
Those of us who are clinicians may have heard ourselves asking our patients/clients, “Why did you lie?” I cannot help you when you lie. Just tell me the truth?” Of course, we already know why the child and the patient/client lied to us. They did not want to be punished or chastised for their behavior. They may not be ready to change their behavior and, yet, are not ready to let go of the relationship with the parent or the clinician. They may feel embarrassed or ashamed.
Seldom do we then ask the patient/client “How can I make it safer for you to tell me the truth.” Of course, this assumes that we really are ready to focus on making the space safer for truth telling. There are, of course, certain actions or behavior we cannot tolerate. We cannot, for example:
It is thus within this context that everything possible must be done to create an atmosphere of openness and trust. This can be very difficult some of the time and impossible at other times. Both clients/patients and clinicians come into this relationship with a history. Although clinicians may be very intentional about identifying and guarding against their history and consequent prejudices affecting the relationship with the patient/clients said history will affect the relationship to a greater or lesser extent. The patient/client may be very fearful of trusting the clinician or very fearful of letting go of some self-administered medication or other treatment for fear of not being able to function in some way.
At times, it may not be possible to create a safe place. Something about the clinician may trigger a very acute fear. In that case, on will want to help the person find a safe person with whom to talk. A healthy clinician will not take the need to do this as a personal affront. The goal is for the patient/client to get what they need. It does not matter who is able to provide the safe space.
The reader will now be aware that the goal is to problem solve and not to punish, rebuke, make the child or patient/client or the clinician feel bad. There is no reason to blame one person in the dynamic. At times one may realize that a certain approach is not working to create a safe place. That is fine. One can try another approach.
We live in a culture which may make it seem that it is necessary to assign blame or punish someone when an approach to any situation is not working. This is not to say that any of us quits learning. One may be doing something which is not helpful or even destructive. I worked for/with a clinician who would scream at parents and children when they did not behave as he thought they should behave. Clearly that was not appropriate or effective therapeutic behavior. I have also worked with teachers who really did not like the students with whom they were working. Clearly, one either needs to resolve the issues which lead to this attitude or decide that one is better suited for another profession. If one is using a problem solving approach one will do one’s best to identify the problem/issue and then explore various solutions which honors the dignity of all people involved.
I recall a story of a school counselor who had advised a student to ask her mother if it would be okay if she came to live with her. The father with whom the girl had been living was very angry and came in to see the counselor. The counselor did not berate the parent but merely said to him, ‘You must love your daughter a lot.” The father immediately began to weep. They then were able to talk about the fact that dad was so worried about his daughter that he would get very angry if she was doing something which he feared would have negative consequences. The father also did not realize that the daughter needed some pieces she could only get from the same sex parent. The counselor could have berated the father for his anger, but he clearly recognized the pain beneath the anger. By not getting sucked into the angry space and not responding with anger, the counselor was able to create a space which was safe for the father to express what he was really feeling.
It is not always easy to take a problem solving approach. When one is tired, it is easy to react with “Why did you lie?” or “I am tired of your lying.” It is always helpful to take a moment to access one’s energy level. The 12 step program talks about HALT – hungry, angry, lonely, tired. When one is in HALT one is much more likely to just react. If one recognized that one is in HALT one can sometime postpone dealing with a situation.
If I hear myself asking a why question or being negative I know that I am not in a problem solving space. I am just reacting. That is when I need to take a break and, when possible, let the other person know that I need to deal with this situation later. The goal is to find out how to make it safe to tell the truth or to find another space which is safe.
Written September 22, 2017
Those of us who are clinicians may have heard ourselves asking our patients/clients, “Why did you lie?” I cannot help you when you lie. Just tell me the truth?” Of course, we already know why the child and the patient/client lied to us. They did not want to be punished or chastised for their behavior. They may not be ready to change their behavior and, yet, are not ready to let go of the relationship with the parent or the clinician. They may feel embarrassed or ashamed.
Seldom do we then ask the patient/client “How can I make it safer for you to tell me the truth.” Of course, this assumes that we really are ready to focus on making the space safer for truth telling. There are, of course, certain actions or behavior we cannot tolerate. We cannot, for example:
- Keep prescribing certain medications if the patient is taking something which had a negative and possibly life threatening interaction with the prescribed medication.
- Condone or allow behavior which endangers self or others
- Keep secret any known or strongly suspected threat or other danger to a child.
- Allow use of illegal drugs on premises of office/facility or home.
- Engage in behavior with the client or patient which would seriously blur the roles of clinician and patient/client and, thus, result in the clinician being less objective.
It is thus within this context that everything possible must be done to create an atmosphere of openness and trust. This can be very difficult some of the time and impossible at other times. Both clients/patients and clinicians come into this relationship with a history. Although clinicians may be very intentional about identifying and guarding against their history and consequent prejudices affecting the relationship with the patient/clients said history will affect the relationship to a greater or lesser extent. The patient/client may be very fearful of trusting the clinician or very fearful of letting go of some self-administered medication or other treatment for fear of not being able to function in some way.
At times, it may not be possible to create a safe place. Something about the clinician may trigger a very acute fear. In that case, on will want to help the person find a safe person with whom to talk. A healthy clinician will not take the need to do this as a personal affront. The goal is for the patient/client to get what they need. It does not matter who is able to provide the safe space.
The reader will now be aware that the goal is to problem solve and not to punish, rebuke, make the child or patient/client or the clinician feel bad. There is no reason to blame one person in the dynamic. At times one may realize that a certain approach is not working to create a safe place. That is fine. One can try another approach.
We live in a culture which may make it seem that it is necessary to assign blame or punish someone when an approach to any situation is not working. This is not to say that any of us quits learning. One may be doing something which is not helpful or even destructive. I worked for/with a clinician who would scream at parents and children when they did not behave as he thought they should behave. Clearly that was not appropriate or effective therapeutic behavior. I have also worked with teachers who really did not like the students with whom they were working. Clearly, one either needs to resolve the issues which lead to this attitude or decide that one is better suited for another profession. If one is using a problem solving approach one will do one’s best to identify the problem/issue and then explore various solutions which honors the dignity of all people involved.
I recall a story of a school counselor who had advised a student to ask her mother if it would be okay if she came to live with her. The father with whom the girl had been living was very angry and came in to see the counselor. The counselor did not berate the parent but merely said to him, ‘You must love your daughter a lot.” The father immediately began to weep. They then were able to talk about the fact that dad was so worried about his daughter that he would get very angry if she was doing something which he feared would have negative consequences. The father also did not realize that the daughter needed some pieces she could only get from the same sex parent. The counselor could have berated the father for his anger, but he clearly recognized the pain beneath the anger. By not getting sucked into the angry space and not responding with anger, the counselor was able to create a space which was safe for the father to express what he was really feeling.
It is not always easy to take a problem solving approach. When one is tired, it is easy to react with “Why did you lie?” or “I am tired of your lying.” It is always helpful to take a moment to access one’s energy level. The 12 step program talks about HALT – hungry, angry, lonely, tired. When one is in HALT one is much more likely to just react. If one recognized that one is in HALT one can sometime postpone dealing with a situation.
If I hear myself asking a why question or being negative I know that I am not in a problem solving space. I am just reacting. That is when I need to take a break and, when possible, let the other person know that I need to deal with this situation later. The goal is to find out how to make it safe to tell the truth or to find another space which is safe.
Written September 22, 2017
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