BowerNote
The Practical Management of Inequality
Malcolm Robinson & Catherine Sanders
Bower Place
www.bowerplace.com.au
AAFT Conference - Adelaide - 19 October 2017
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
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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
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Three Forms of Inequality
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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
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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
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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.
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… if the consumer/client can’t
remember it or process it …
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Clinical Practice is Choreographed
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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
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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
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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
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BowerNote Protocol
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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
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Four Forms of Communication
• Verbal
• Written
• Diagram
• Physical
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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
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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
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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
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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
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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.
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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