Your client is not your client

At the most recent annual Division of Forensic and Family Psychology (University of Nottingham) lecture given by Lawrence Jones he spoke about trauma-related stress and how that is important for working with people who have been identified as struggling with personality difficulties. The focus of that discussion was really on the work of Lanius (2015) and others seeking to draw our attention to the impact of trauma in working with our clients. The language of this thinking refers to altered states of consciousness and Lawrence provided some examples of people that he had worked with who reported that during the time of their offence they could not remember their actions. It was at this point that my thinking went in a slightly different, but connected, direction and got me wondering about something that I think is important to consider, irrespective of working with personality or trauma.

 

Who’s in the room?

It is likely that all of us have had the experience of reading someone’s notes before our first meeting with them, maybe hearing tales of their behaviour from other professionals, and we see from their past that they have committed a range of offences, and we react. Maybe we experience fear, or doubt, we question if we have the skills to deal with this person, particularly if all of the evidence suggests that they can be violent and intimidating in some way. This is understandable. We also respond to headlines from The Sun. A recent, choice example;

“Mum, 32, lured boy, 14, to her home for sex after seeing him play football”

Headlines make us think things about the behaviours, the people, have reactions to it all, make judgements, and if we had a meeting with the mum or the boy the chances are that we would find our stance, our perceptions, our interactions, would be influenced by the judgements that we made. It turns out that this mum was not convicted as although she did have sex with a 14-year-old boy after seeing him play football, it was decided by a jury in under two hours that she reasonably believed that he was over 16. So that’s ok then.

The issue is that there is a good chance that the person described on the page is not the person in the room with you. First of all time will have passed so the person might have changed, they might have had time to think about their behaviour, they might present in a dishonest way, they may present differently because you are not a 14 year old boy. So, the person in the room is not the person who committed the offence, potentially, in really important ways. They are also not in the room because they committed their offence at time T, possibly with planning, possibly with days and weeks of mulling things over, maybe after committing prior offences, maybe having taken drugs or alcohol, or being angry or sad, and you are seeing them at time S, where none of that is true. There are altered (as in ‘different’) states of consciousness, emotion, thought, belief, knowledge, experience, and more.

So, who is in the room?

That’s a really good question. We don’t know. We can find out, as that is the role of assessment and formulation, so that can solve part of the puzzle, but what do we do about the chronological distance between the person who we get to know in the room with us (time S) and the person who committed the offence (time T)? Do they know who they were at time T? Will they tell us who they were at time T? There may be no answers to this dilemma – in which case this is simply a gentle warning of something to keep in mind – and I imagine that people will happily disagree with this view, how important it might be, and how it might be possible to circumvent it. I am not sure one can be definitive about what to do or how successful it might be. However, rather than present an issue and then run away, here are some ideas that I think might be worth considering. They are possibilities that I have used and may be of use to you, but just acknowledging that there might be an issue of concern will very likely make you come up with possibilities more creative than I can hope to think of.

 

Reinstating the past

Can we make use of one element of the Cognitive Interview, asking a person to place themselves back in the time and place of their behaviour, to reinstate the sensations and thoughts, to examine who they were in that past?

Metaphor and story telling

Kopp (1995, p.99) wrote, “Metaphor, does, in fact, point to a resemblance between two different things. The two things compared in a metaphor can be both different and similar because their difference and similarity involve different levels of comparison.” Could we use this idea, of comparison, asking someone to provide a comparison of them at T with them now at S, and look at the differences between the two? This could be a version of the idea of “Ideal Me vs Real Me”.

Empty Chair

If we ask someone to speak to themselves (or another part of themselves) at time T, would that conversation provide us with any insights that help us understand the person they were at the time of the offence? Here is an example.

 

References

Kopp, R. R. (1995) Metaphor therapy: Using client generated metaphors in psychotherapy. New York: Brunner/Mazel.

Lanius, R.A. (2015). Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research. Journal of Psychotraumatology, 6, 27905 DOI: 10.3402/ejpt.v6.27905

https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC4439425&blobtype=pdf

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