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BowerNote

The Practical Management of Inequality

Malcolm Robinson & Catherine Sanders

Bower Place

www.bowerplace.com.au

AAFT Conference - Adelaide - 19 October 2017

http://www.bowerplace.com.au/

Inequality as Praxis

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Inequality as Praxis

• Inequality is at the heart of social justice

• Helping & social assistance (including systemic

therapeutic practice) embodies inequality as praxis

• Inequality is the primary organizational constraint

that creates therapeutic praxis & power

• Constrains justice

• Constrains therapeutic practice

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Inequality - Constraint to Practice

• Greater inequality > greater constraint > more difficult for therapeutic practice to make a difference - with consumer/client, problem & its circumstances

• To change inequality is change therapeutic praxis

• Remove inequality - eliminates therapeutic praxis


Inequality - Reciprocity

• Good relationships, including therapeutic relationships, require a balance of give and take

• Greater the inequality the more one side ‘gives’ & the other ‘takes’

• Consumer/clients become locked into being recipients of advice, wisdom, knowledge & are expected to uncritically ‘take’

• Practitioners become responsible for change they do not have the power to effect

• Management of inequality leads to a better balance of responsibility for producing lasting change

© Copyright Bower Place Pty Ltd, Adelaide, South Australia 510/24/2017

Three Forms of Inequality


Political Inequality

• Consumer/client ≠ Practitioner/Agency

• Citizen ≠ Institution

• Manifest in power struggle over ownership

• Who has responsibility for the problem & who has authority to act or cease?

• Ownership = Responsibility/Authority

• Power struggle fuelled by inequality - compromises justice

• Common in complex matters - paralyses therapy

• Often driven by outside/socio-relational fracture


Problem Inequality

• Citizen requires a legitimate problem & disadvantage to become a consumer/client of an institution-regulated, state-funded, practitioner/agency

• Reveals inside & outside – practitioner not permitted

• Practitioner doesn’t need a problem - for the citizen to become a consumer/client

• Lived experience does not remediate inequality


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PsychologyCognition

Memory

Anxiety

Processing

Literacy

Language

Time

Psychological Inequality

© Copyright Bower Place Pty Ltd, Adelaide, South Australia

Psychological Inequality

• Consumer/client & practitioner differentials in

working memory, processing speed, language

• Skewed intellectual profiles constrain service delivery

& therapeutic practice

• Consumer/client anxiety amplifies other differentials

eg. learning, literacy, numeracy, education,

dementia, ABI, AOD, mental health, sleep deprivation

etc.


… if the consumer/client can’t

remember it or process it …


Clinical Practice is Choreographed


Clinical Practice is Choreographed

• All clinical practice has its own protocols & forms

• These include who attends, where people sit, how

notes are taken & how notes are managed

• Protocols & practices are assumed knowledge not

made explicit to the client

• More hidden & implicit these protocols - greater the

inequality

• Greater the inequality - more difficult it is to produce

change


Explicit Protocols Can be Changed

• Once protocols are made explicit - can be critiqued

• Impact on the consumer/client, practitioner & therapeutic process can be examined

• Alternative protocols which address inequality can be introduced


Notes - An Organising Protocol

• Way notes are taken creates a template for the

therapeutic encounter

• Changing note-taking process, storage, dissemination

+ ownership of notes speaks to the process

• Change note taking process - change inequality

• Notes - physical manifestation of making (poesis) &

doing (praxis) i.e. doing an Aristotle


BowerNote Protocol


BowerNote Protocol • Translate into invariant protocols to manage political,

problem & psychological inequality

• Process - not practitioner - dominated

• Concurrent communication in word & image

• Making & recording client memory

• Request & agenda driven - to manage contract & time

• Attend to size of the outside, relational fracture,

ownership, balance of responsibility & authority, identity

transformation & time future

© Copyright Bower Place Pty Ltd,

Adelaide, South Australia 1810/24/2017

Four Forms of Communication

• Verbal

• Written

• Diagram

• Physical



Communication

Verbal

Physical

Diagram

Written

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Australia

Pen Moves to the Client’s Hand

• Wherever possible the consumer/client is given the

pen & encouraged to take charge of the notes

• Includes the ecogram, time-line, recorded notes &

diagrams practitioner may devise with or for the

consumer/client

• A metaphor for the clinical process



Where To Sit

• Practitioner sits where the consumer/client can

easily read the notes & add commentary &

correction

• Often beside the consumer/client rather than

opposite - may sit on the floor

• Opposite can be experienced as dominance &

oppressive & anxiety provoking

• Sitting next to & lower may be more collaborative &

may offer less inequality - collaboration & shared

responsibility© Copyright Bower Place Pty Ltd, Adelaide, South Australia 2210/24/2017

Agenda

• Contract manages inequality in the citizen-institution relationship - at the heart of justice

• Contractual basis of service delivery reflected in protocol of agenda & request

• Transparent, co-created agenda established for each session - lists matters to be addressed, process & priority

• Specific agenda for the first consultation - request, village, timeline, problem, advice, follow-up & feedback



First Session Agenda

Agenda

Time-line

Request

Village

Problem

Advice

Follow-up

Feedback10/24/2017

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Australia 24

Subsequent Session Agenda

Agenda

Original Request

Follow-up tasks

New issues & requests

Changes made

Agenda items for next session10/24/2017 © Copyright Bower Place Pty Ltd, Adelaide, South Australia 25

Agenda & Time

• Explicit agenda - tells the consumer/client what will

happen & when - removes secrecy of practitioner

knowing how session will unfold

• As session unfolds - consumer/client is able to

remember what is happening

• Time a more shared decision

• Agenda is placed on the table in consumer/client’s

view - as items are completed they are ticked-off

• Dealing with time - another way to address

inequality


Follow-Up

• Follow-up sets a frame around the relationship & service delivery contract

• Practitioner talks about the work that must now be done - delineates responsibility - what, how & when.

• Agenda for the next session may be set - allows client time & space to process & prepare

• Manages anxiety


Feedback

• Consumer/client asked for feedback about process

• Addresses inequality - momentarily reversing hierarchy

• Client experience - informs future sessions

• More effective service

• Opportunity to correct misunderstandings or dissatisfaction with process etc.



In Summary

• How notes are taken in any therapeutic episode sets the

frame for the relationship between consumer/client,

practitioner, the wider system and that encounter

• It is the hidden yet enormously powerful template

protocol for the whole of service delivery

• Attention to protocol of note taking will have a profound

impact on the inequality between consumer/client &

practitioner & effectiveness of that service

• Management of inequality will enhance the effectiveness

of that service© Copyright Bower Place Pty Ltd, Adelaide, South Australia 2910/24/2017

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