Relationship to help

29th March 2018

Key points of theory:

How this fits with AMBIT

  • Within this general framework, there is also interest in the specific processes and experiences of people seeking professional help for their difficulties:
    • One of the assumptions of the AMBIT model is that many of the young people will have had negative previous experiences with professional helping systems and/or will have negative beliefs and feelings about such help.
    • Many AMBIT practices are designed to find ways of working with clients who may have many reasons for not wanting to work with professional services.

A universal 'Primary Outcome' for AMBIT-influenced teams?

  • There are few if any generalisable treatment Aims and Goals in AMBIT-influenced teams - but "developing a more adaptive relationship to help" is probably one of them.

Mentalizing the relationship to help

There are many ways that clients might perceive the help that we offer, and these may be influenced by early experiences (see Internal Working Model for an Attachment-based explanation of this.)
Our perception of what help is will trigger emotional reactions to this, and these will influence our behaviour. AMBIT takes a view that there are many different ways in which our clients might experience our help (however authentically we might feel we are offering it). The point is that understanding how young people see our help might in itself help us with broadcasting our intentions in a clearer way for this young person - to enable them to accept (or "enter") help, despite their concerns or objections. In this way we are offering opportunities for them to develop new perspectives on help.


This diagram (animated below) is not an attempt to define reality (which would be Psychic equivalence on our part!) but is more a "thought experiment" that tries to describe some of the commonest barriers to help that may be worth considering.

A young person may (mis)perceive help in different ways at different times. Getting to be helped requires a "Therapeutic Bargain - in which the client "takes a chance" and "enters anyway". Although she may enter through many different "doors", she may leave understanding rather more accurately the perspectives of a helper that may have been misunderstood from "outside the door". There may commonly be "comings and goings" in and out of relationship with help, rather than a "coming to stay".

  • Consider "different kinds of Help" as being available "inside" the diagrammatic "house".
  • There are four doors in and out of this house (though in reality of course there are many more)
  • The three "Blocks" that stand in each doorway are as follows (from the outside going in):
1. The Response to Help in terms of the affective/behavioural response to what they "see" standing between them and real help ...e.g. hopeless, fearful, denying, angry.
2. The Response to Help in terms of the young person’s own perception/construction/imagination of the state of mind of the worker who stands between them and help ...e.g. helpless, useless, refusing, accusing.
3. The Offer of Help: A selection of potential states of mind that the worker might actually offer the young person e.g. interested and committed, holding hope that things will change over time even though ways forwards now are difficult to see, authentic and truthful (expressing confidence in the young person's self-agency, unafraid to "tell it as it is" in terms of diagnoses or reflections.

If the worker can properly mentalize the young person's authentic feelings and beliefs, right here, right now, and can show (in her eyes, and her manner of speech, etc) that this has been sensitively understood, then Epistemic Trust may be established, and help or learning may quite suddenly be accessible - like a door opening. There may be learning, that "help may look unhelpful sometimes, and this can be explored..."

The point of this thought experiment is that if we, as workers can more accurately mentalize our clients' experience of (or relationship to) this "Help" we are offering, then we may be more successful at adapting the way that we are offering it, in order to make it less indigestible than unfortunately our well-intentioned offers of help too often appear.

Of course, the shift towards greater mutual understanding is the work of Engagement, and a key skill is how the worker can find ways of Broadcasting Intentions.


Welcome the Coming and Speed the Going

(With thanks to Dr Paul Caviston for this quote)
Note that the end point is not the young person "taking up residence" in the help centre, but taking what is on offer there to set off on the next stage of her journey. This echoes the ancient "code of conduct" described in Homer's Odyssey which all dwellers in the Greek islands held:
"Welcome the coming, speed the going"

This code dictated how islanders were obliged to behave towards sailors who were shipwrecked on their shores (which must have been a pretty commonplace event back then.) The duty was to provide hospitality, repairs, and to stock the ship for the onwards journey. See also In my beginning is my end for how this approach might be used clinically.