What is engagement?
Engagement is a process of making (and sustaining) a therapeutic
Attachment Relationship with your client. One of the
Core Features of AMBIT is its stress on the
Individual Keyworker Relationship as the means by which we help to restore, stimulate or sustain more accurate
Mentalizing in the young person, and their family. It is therefore intimately about the client's
Relationship to help.
When do I do this?
Naturally enough, engagement tends to be the focus at the beginning of treatment, but it continues as a theme throughout the work. There are a lot of
Engagement techniques described in this manual.
Some theory:
- Engagement describes the process whereby a young person (or any patient) becomes invested in the co-construction of a therapeutic relationship, and in taking up shared work, with the therapist or team.
- We assume that such a move is made, inspired by a belief that these actions will help suggest a way forward out of mental anguish.
- However, we also know that many young people or families have different, and much less 'optimistic', Internal Working Models of how relationships with 'authority-figures-who-offer-help' tend to work (see Relationship to help).
- So engagement relates to the extent to which the young person is able accurately to Mentalize my 'good intentions' as a therapist .
- We know from empirical research that from very early in life infants are preferentially drawn to pay attention (a very rudimentary form of engagement!) to activities that are perceived as being influenced by intentions. In later years, this same propensity to be 'drawn in' by perceived intentions (ones perceived as authentically helpful) can be built on by the worker's efforts to 'mentalize aloud' - and as much as possible to make explicit his or her thinking, beliefs, hypotheses, concerns and intentions. This accounts for the emphasis in AMBIT (especially in Active Planning) on the notion of Broadcasting Intentions:
How do I do this?
See:
Engagement (or Joining) is the process of "
accommodation" between the
KeyWorker, the young person and the family, the search for a "fit" that will be good enough to allow the
difference (new ways of looking at things, new ways of doing things) that will be introduced by the keyworker to be explored in a context of safety.
It can be described as the "formation of a therapeutic alliance", the "development of rapport" - it is the "
non-specific but essential ingredient of all therapy".
While a
KeyWorker may be more conscious of using joining techniques initially, joining is an ongoing process which needs to be maintained throughout therapy and aims both at establishing engagement and facilitating change. Joining is established through the use of technique integrated with the KW's presentation of self. This is also explored one of the
Core Features of AMBIT, which is
Active Planning - where the balancing-act of (a)
joining and (b)
"going somewhere useful together" is described.
From the point of view of the therapist,
Engagement techniques seek to reduce the activation of certain
Attachment behaviours (see
Secure Base), and can do so only in the context of very clear
Boundaries, including those boundaries that dictate the nature and limits of the relationship between patient and keyworker (
Patient-Worker Boundaries).
Specific Engagement problems:
A variety of factors can make engagement more difficult, and call for specific awareness and techniques to work around these problems. For instance:
Click the
Show references and info panel to reveal sub-topics under this heading, suggesting ways of achieving or enhancing engagement.