Choice Variations
Choice Plus
Sometimes reaching a good Choice Point needs more than one Choice appointment. A key family member may have been absent or an individual session is needed with an adolescent. We call these appointments Choice Plus.
The challenges of working with choice
All CAMHS clinicians do the components of Choice at one time or another. However being curious about the families and young person’s view for a long time is often less familiar. We tend to be less curious when we are formulating our own ‘full assessment’ and when we are thinking about the challenges ahead in ongoing work (see Selecting Clinician for Partnership later in the book).
We find that the biggest challenge is how to be honest with our opinion. This is especially important when we identify risk. Saying what we think may make us anxious in case we are wrong or not seen as expert enough. Some clinicians may feel more comfortable being seen as the expert and then struggle to have a discussion with the family and young person about their ideas. It is also hard to say things that might be challenging or upsetting to a family or that we know they will disagree with. For example, we may avoid talking about our concerns about the attachment relationship between a parent and child when their view is that they want a diagnosis of ADHD.
What about offering advice?
This brings up an interesting issue about the meaning of neutrality- a construct that is important to many clinicians and we agree. However, we don’t we lose neutrality by offering our opinion or advice; it’s all about how we expect that advice to be listened to. If it is seen as something to be discussed, considered, amended and perhaps found useful: then it’s neutral. If we can’t share our opinion (we all have them) then we’re being secretive. If we want our users to believe every word and do what we tell them etc. then it clearly isn’t neutral! We are experts after all and we should use what we know to facilitate the family in their change.
However, we should hold our opinions lightly and not rush to them. There’s no doubt that too much opinion too early constrains the potential and curiosity. It can make the conversation more narrow or make the other feel less free with their thinking (we all struggle with this sometimes!).