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Finding the Way Forward in Professional Practice

2004; Johns Hopkins University Press; Volume: 11; Issue: 2 Linguagem: Inglês

10.1353/ppp.2004.0059

1086-3303

Richard Williams,

Child and Adolescent Psychosocial and Emotional Development

Finding the Way Forward in Professional Practice Richard Williams (bio) "But, Eeyore," said Pooh in distress, "what can we—I mean, how shall we—do you think if we . . ." "Yes" said Eeyore. "One of those would be just the thing. Thank you, Pooh." The House at Pooh Corner, A. A. Milne. Although a book for children,The House at Pooh Corner is also a book for adults to read to children thereby to mutually enjoy the commonality and perversity of life, and to explore differences and the challenges of communication. Apparently, it is also a suitable case for postmodern literary criticism (Crews 2003)! The fact that children like the book speaks volumes for their interest in narrative, relationships, and the ways in which students of developmental psychology have underestimated the maturity and intuitive grasp that quite young children can have of conceptual matters. Similarly, the worlds of mental health practice specifically and professional practice generally are riven with uncertainty, complexity, and misunderstanding. Sometimes, what is, apparently, a dilemma to someone else seems so obvious to us and vice versa. Thus, Fulford and Colombo (2004) cite Austin's (1956/1957) "blinding veil of ease and obviousness." So, when trying to help a person in distress, why can't others agree with us? Why do they persist in seeing different things in the same situation, think differently about it, and prioritize different matters? And, what do we do about it all? The truth is that different values and conceptual frameworks abound! Even when we may not realize it, the subtle assumptions we make are influenced by our beliefs and the conceptions that we hold dear. Added together, our values and the ideas we have been taught to favor add up to produce within us conceptual models for all things, including mental disorder and the task of assessing and intervening with service users, that we may recognize or which remain implicit. Sometimes seemingly subtle differences may produce substantial barriers that divide us when we least expect it. In such a setting, sometimes quasi-magically, we often feel ambivalent about striving for conceptual clarity; we crave resolution of uncertainty and misunderstandings but also fear that the very act of exploration could put at risk those delicate balances in our professional relationships we have worked hard to achieve through working together in situations that challenge us. Perhaps, this also illustrates Fulford and Colombo's claim that we are better at using high-level concepts than defining them. We need to achieve better mutual understandings between agencies, across services that are trying to work together, [End Page 151] and within teams, but also to explore this contentious territory in ways that allow us to feel safe enough. In their paper, Fulford and Colombo explore some of the conceptual differences that both reflect and describe our differing values and models, but they also present a method of exploration that can be invigorating, helpful, and safe. Why Achieving Conceptual Clarity Is Important Sometimes concepts may be in collision with each other and we may or may not realize that. For example, it is not uncommon for senior policymakers to ask for innovating services and then in the next sentence to require that they are of evidenced effectiveness. But, evidence of this kind of provenance takes skilled, rigorous research over some years. Thus, the challenges to be both innovating and evidence-based may be contradictory. Similarly, the kinds of evidence that may be valued by scientists may not answer the kinds of questions that service users and their families pose (Szatmari 1999). Thus, the goal of clear communication is not only important to practitioners but also to policymakers, strategic managers, and operational service managers as they all share the task of designing and delivering services that are well-orientated to the needs and wishes of the users of mental health services. I cite three illustrative circumstances relating to evidence-based policy making, the evidence required and provided by families and the evidence on which professionals appear to base their opinions. First, imagine a meeting of experienced professionals called to advise a government about its health policies. Such a hypothetical gathering, common in reality, is usually populated by senior folk...