What is it?

This is the first step in a four-step 'ritual' called Thinking Together that is designed to help improve the quality of communication about our work, and thus to improve the quality of that work.

It is the "short-term" version of one of the Core Features of AMBIT practice, which is Active Planning.

Why do it?

Most clinical discussions (we argue) start with Stating the Case and move straight into generating solutions (Return to Purpose in our language) - missing out two key elements (Marking the Task and Mentalizing the Affect). Investing some time in developing a plan - either for something as 'simple' as a conversation with my team-mate, or for something as complex as trying to help a young person, is associated with better outcomes than relying on chance, 'inspiration', or intuition on the part of the helper in determining what would really be helpful to her colleague.

More than this, Marking the Task involves a deliberate attempt to kick start mentalizing in the worker who is asking for help - emphasising that in these conversations we ritually insist on mentalized explanations for behaviours - our own, as much as our clients'.

Using chat usefully

As practitioners, we all talk about our clients in all kinds of ways and in all kinds of places. Stories are often what draws us into this work, and this is both a positive and potentially a negative, as we can get lost in the stories, especially if they are very compelling or anxiety provoking.

Marking the task is about making the best use of these conversations - that are generally happening anyway.

There is a risk that one practitioner's capacity to mentalize about what his or her colleague is actually requesting may not always be accurate. One team member may be keen to "pass the time of day" whilst the other is actually requesting a very serious discussion about important clinical material.

KICK-STARTING MENTALIZING As mentioned above, in insisting that my colleague stops and asks their self (mentalizes their self): Why am I coming for help? What do I want out of this "help"? How would I know that I had been helped? we are setting the tone in a conversation that insists quite explicitly on mentalized explanations by all participants. By insisting that our colleague does not rush headlong into Stating the Case we invite them into a mentalizing frame of mind - "Help me understand what you think you need out of this conversation"

What is "Marking"?

We draw on the theory of Marked mirroring and Ostensive communication, that explains how mentalization develops through infancy, and which is also a helpful technique that practitioners can use in working with clients who are in distress. In "Marking" the KeyWorker takes responsibility for the clarity of his of her communication, and minimises the likelihood of misunderstanding about what is being asked for.

By explicitly MARKING a discussion we mean saying something that explicitly marks out what you want out of this conversation - that it is NOT just "passing the time of day" (although one could mark out that as the task, just as easily!):

"I want to talk about THIS client, in THIS particular way, for THIS amount of time..."

A core team task in AMBIT is to foster and sustain Mentalizing in team members. By using language very explicitly in this way this function is supported.

How to do it

These are simple steps, and the key is for team members to find their way into using these as one of the Rituals and Disciplines that define the team's culture.

1.Ritualised language:

Some shared "marker" that all team members will recognise is required. We have called these disciplines "Thinking Together", or "Passed-outwards Discussions" (or "PODs"), and any of these phrases might be enough to signal that a very specific kind of communicating is being requested right here, right now. Teams may wish to agree in their own rituals to mark the introduction of this disciplined way of communicating - a simple form of words that carry a shared meaning as part of the team culture. What is important is that these Rituals are EXPLICITLY agreed, rather than IMPLICITLY assumed to be in place.

2.Set boundaries

Agree how long we both have, and what is the outcome we want. This has been described as "turning the conversation upside down" and starting by defining what the ending might look like. The KeyWorker requesting this should have in mind:

"what would a satisfactory outcome of this discussion look like?"

Is there a key issue that needs a decision?
Is there an area of confusion that needs a better framework for understanding it?
Is there a crisis that needs an emergency management plan to ensure safety for the next few hours?
Is there a wish for some "ventilation" of feelings?
Is the task... to work out what the task is?
Etc...

3.A contract

By agreeing to take part in a Marked discussion of this particualr type, the colleague is effectively "contracting" to maintain the boundaries in the next steps - to keep the staff member on task and to help keep to these particular Boundaries.