Effective Client/Therapist Collaboration
For over a decade, a research group at the Centre for Mental Health and Substance Abuse at University of Southeastern Norway has conducted a series of qualitative studies into the experience of client-therapist collaboration in different mental health settings. In two recent papers, the findings of this programme of research has been synthesised into a set of themes (Sundet et al, 2020a) and a model of practice (Sundet et al., 2020b). This body of work comprises the most comprehensive investigation of therapeutic collaboration anywhere in the world so far. In addition, it is based on an understanding of the client as a person existing in a social context who actively brings their own ideas and life experience into the process of making therapy happen. This stands in contrast with the prevailing conceptualisation of collaboration within the mainstream psychotherapy literature, which views tends to view collaboration as consisting only of client participation with a set of therapeutic ideas and procedures defined by the therapist. The Sundet et al. (2020, a,b) papers are densely written, because they represent the condensation of many years of work. However, they provide a unique opportunity for pluralistic practitioners to reflect systematically on how we approach the crucial collaborative dimension of all of our work. For example, they highlight two themes that are highly recognisable but which perhaps do not receive enough attention:
Seizing the present moment. “Critical elements of seizing the moment are spontaneity, unexpectedness, and informal and off-the-course happenings. Although possibly challenging…spontaneity [opens up] opportunities and possibilities for building collaboration and relationships… Spontaneity involves grasping what is present at a given moment such as the pleasure of managing small tasks of everyday life as a cue to move toward recovery and change seemed valuable even if such a cue may lead to a detour…. recovery should not be viewed as a planned, rational, and stepwise process”. (Sundet et al., 2020a, p.9).
The balance between being helped and being controlled. “There is a fine breaking point between being helped and being controlled. In being helped one also shows one’s dependence on the other, creating the situation of the possibility of control. [For example] attaining the balance between help and control was shown in a study of the program for therapist–user pairs through the application of a “control-free zone” through which the participants were able to let go of controls, work together for a goal, and participate in activities together (Karlsson et al., 2013)”. (Sundet et al, 2020a, p.11).
Sundet, R., Kim, H. S., Karlsson, B. E., Borg, M., Sælør, K. T., & Ness, O. (2020a). A heuristic model for collaborative practice–Part 1: a meta-synthesis of empirical findings on collaborative strategies in community mental health and substance abuse practice. International Journal of Mental Health Systems, 14(1), 1-16.
Sundet, R., Kim, H. S., Karlsson, B. E., Borg, M., Sælør, K. T., & Ness, O. (2020b). A heuristic model for collaborative practice—part 2: development of the collaborative, dialogue-based clinical practice model for community mental health and substance abuse care. International Journal of Mental Health Systems, 14(1), 1-12.
Karlsson, B., Borg, M., Revheim, T., & Jonassen, R. (2013). ‘To see each other more like human beings… from both sides.’Patients and therapists going to a study course together. International Practice Development Journal, 3(1).
[the Sundet papers are published in an open access journal; the Karlsson paper can be accessed through Google Scholar]
Keywords: collaboration, community, mental health, substance abuse