Meeting The Professional Network
The professionals are professionals

By network we mean everyone who is involved in the clients life. Parents, siblings, husbands, wives, children and grandchildren, colleagues and employers, relatives and friends, social workers, probation officers etc.

With professional network we mean the people who are involved in the clients life on a professional basis. When the client doesn't need them anymore they will withdraw and devote their time and energy to other people that need their help.

It's not uncommon for a social worker to be one of the most important persons in the life of an elderly alcoholic and sometimes the probation officer can be one of very few "normal" people in a criminal addict's life. For psychotic addicts the most important social contact can well be staff in a day-care-center or in a mental-health-institution.

Important people should participate in the process of change. We humans see ourselves as we think others see us. When other people describe that we did something good, this description can make the difference it takes for us to see it as something we did ourselves and therefor owns. When families can’t participate in therapy for one reason or another it can therefor be worth while to examine if someone from the professional network could participate instead. It is of course best if this person has known the client for a long time. Changes such a person observes will have greater credibility for the client than observations coming from a person who only knew the client for a short time.

Sometimes clients come by themselves and sometimes accompanied by family members to the first session. Co-operation with the professional network is than needed only if you (the family, the client and lastly you) think that treatment isn't developing the way it should, or if the family thinks that they and the professionals are pulling in different directions. It may be productive to see differences of this sort as an expression of the fact that clients tell different things to the professionals and the family, as a result of these people asking for different things. Clarifying this in a meeting with the people involved is often enough to avoid a potentially destructive development. Such a development may for instance be the client being seen as manipulative.

When the life-situation is developing in the "right" direction there is no need for the professionals to meet. Most helpers are perfectly happy when things go well for their clients and are grateful when they can stop working on a case. They don't have to come to your sessions for this to become clear to them. Most often it is enough that the client informs them that their help is no longer needed.

In the out-patient-contexts where we work a professional (the referrer) frequently accompanies the client to the first session. We know that it is not so in most other contexts, but we want to recommend it.

Social workers and probation officers are good at making clients come to therapy. As many clients don't have much hope that treatment can be of any use to them, they often do not come entirely out of their own free will. Usually the referring agent contacts us and we discuss if he or she can bring the client in for the first session. We explain that the chances of the client showing up increases dramatically when someone who has known him for a while comes along, or even picks him up before the session and drives him to us.

In these sessions it is useful for the people involved to clarify questions of responsibility and decide how the contact with the referring agent is to look like. Is the referrer to participate in all sessions, or in some? How is the referring agent to be informed about the result or no-result of treatment? What about the contact between the client and the referring agent?

Why co-operate?

Frequently family members and particularly parents, think that "alone is strong" or "we got what we deserved" and out of consideration for other family members and for the addict they hold back important information to other people who are concerned and who care. "He has so much at work right now". "I can't put more weight on her with this trouble." "If I tell him this, he'll get a heart-attack, anxiety-attack, kill himself or kill the boy."

It is also common that one doesn't want to involve others: "We deal with our own problems." "One should be able to deal with problems without involvement from the outside." Or: "We won't get any help anyway; they’ll say that it is our own fault, that we did something wrong, that we failed to raise him properly."

Participating in treatment with the professionals can therefor be a very important experience for family members.

Another reason for meeting is that in the ensuing conservation one helps each other clarify different roles. Family members and professionals have different roles and functions and contribute with different things. By meeting, talking and listening, one supports each other and, above all, shares new perspectives with the client and the family members.

Differences in the encounter with professionals compared to the family

There are differences in how you meet professionals compared to how you meet family members. When you see families you point out how they are helping their family member towards a life without drugs, and in particular you are emphasizing their emotional support.

When meeting the professionals you emphasize more how the professionals are or have been supportive and/or coercive in a way that is helpful to the client and you avoid emotional overtones.

Phrase your questions so they fit the relationship you are asking about, and with increasing skill you can also use your questions to clarify who is responsible for what.

You ask the client: "What does your father need to see to be proud of you?"

A question in the same vein to the social worker will be: "What do you as a social-worker have to see to leave Nils alone?" or you ask Nils: "What does your social worker have to see to think you are doing all right?"

You ask the employer: "What does Nils have to do so you can let him keep his job?"

Desire for co-operation and collaboration is most often expressed by someone in the professional network, or by a family member other than the client.

Occasionally a wish to collaborate is expressed by a client himself. Most often these clients either have a particular wish (wants a special treatment, wants to go to a particular institution, etc) or feel they need a stable structure with clear limits to stop their problematic behavior.

Make sure the client, the family or the professional network expressed a purpose with the meeting. (This can include a purpose expressed by you, but it is always wise to avoid becoming ones own customer). Of course the expressed purpose may be one of many, but if someone has been clear with what they hope to achieve it makes things easier for everyone.

In what follows we sketch a few situations where the client, the family or the professional network may confirm that they want to meet with other people in the network.

None of these situations is ever pure in the every day world of practical clinical reality, and they can always be defined in some other way. We have arranged them in the following order; wishes expressed by the clients come first, than the families and lastly the professionals. We feel that this is the prioritizing that is best to use when we decide to ask questions that may lead to someone expressing that they need to meet other people in the network.

Collaborating - the addict’s view-point

When we try to help clients feel that they have some control over their life, we want to help them experience that it is they themselves who decide something of their future. It is then important that we use our privilege to ask questions in such a way that the client feels that it is what he thinks that determines what the co-operation with the professional network is to look like.

A situation that is not uncommon is that clients come to therapy because a social worker or probation officer thinks the client needs treatment. If the client doesn't want to go into treatment the children will be taken away from the home, the welfare money will not be paid, or the client will have to go back to prison. Your treatment (or any treatment) then becomes the client's alibi, and "getting treatment" is more important than the content of treatment.

One usually notices very quickly when a client is in this dilemma, even if some clients won't tell you spontaneously. Sometimes the referring agent has informed you about the situation, but many professionals don't feel that they are "forcing" the client into treatment. They feel that they have been straight and fair and clear about how they see the client’s situation. They made it clear to the client that they think he needs treatment and; "he agreed".

Frequently the client expresses that he has no problem and he is moderately (or not at all) interested in the conversation. When asked the miracle question or other future oriented questions the answer may be that the social worker would leave him alone and then there would be no problem. It quickly becomes clear that the client is in a situation where some authority is expecting something from him, and he doesn't agree with the authority about the goal or is not clear about what it is. Useful questions can be:

"What do you think N.N. hopes you can get out of coming here?"

"What do you think N.N. needs to see you do/you can handle/ happen in your life, for him to leave you alone afterwards?"

"When good things happen in your life, how will N.N. notice that they have happened? What will you notice on N.N. when you talk to him, after he has noticed the difference?"

Notice that as usually the form of the question is not if, but when. This is not banal or trivial!!!

"What do you think about us asking N.N. to join us next time we meet, so we can find out what he hopes for you to get out of coming here?"

"On a scale where 10 stands for N.N's involvement in your life being a huge problem, and 0 stands for the opposite, where are you at today?"

We want to emphasize that this is not necessarily a bad situation. We don't see coercion as an impediment to treatment. At times it seems as if coercion and firm demands from a relatively non-understanding surrounding, is something that clients can experience as something that helps them get a direction in their life. A social worker can with his presence and a realistic list with demands, bring about considerable improvement in the life of a client and his family.

To some extent it will depend on how much hold the professionals have on the client. A good many clients are often very interested in not going into treatment - at least not because someone else told them to - and can look very seriously into what they have to do so they won't have to come anymore. With these cases we inquire carefully with the client and the 'referrer' what needs to happen for the addict to be ‘off the hook’. In this way it will be apparent for everyone involved why the client has come and what is expected of him.

So called 'unmotivated clients' are often surprisingly co-operative when it comes to what they need to do, in order not to be forced to do something else. By accident it may even happen that they do something that is good for them in the process.

It is advantageous if the person who 'forced' the client to come is present. It is both easier to talk openly and get realistic goals that can build both on what the professional thinks the client needs to do and on what the client wants to change. It is sometimes surprising both for the referring persons and us how much 'insight' these clients have in their situation.

Addicts sometimes get into the situation of having improved their life so much that they are able to use the help authorities can provide. The problem is that the concerned persons in authority, knows your client as someone who has exploited them, broken contracts, not kept promises, or a number of other things that has led to the persons in authority no longer wanting to, or being permitted to help (by their bosses).

It will not always be easy to get these persons in authority to join in meetings with the client/family, as they have decided that they can not be of help.

Jonte has gambled for many years and has huge debts. He has nice manners, good academic training in computer- and office-work, and is generally a very nice person. The problem is that he has the habit of quitting jobs after a while, by simply failing to show up. Jonte blames this on his gambling problem and staff at the employment agency have decided that he is "not capable of holding a job" before he is "cured". In sessions with HK, Jonte thinks that he can neither be – nor know if he is – "cured" before he gets a job and he feels he is in a catch-22-situation in relation to the employment agency.

At a meeting with the professional network the employment agency agent clarifies what he needs to see to start believing that it is possible for Jonte to keep a job. Jonte has to handle no matter what job for three months, and after this time he will receive appropriate help from the agency.

After this session Jonte stops therapy with HK. He finds a cleaning-job, keeps it for three months, and then resigns. He then contacts the employment agency and demands that they fulfill their promise which they do.

A similar situation can arise when you are interested in helping an addict come to a special institution of his own choice.

In the future it will probably become more and more difficult to make placements in institutions based on client’s own wishes. Making this clear to clients, and making it clear that social authorities are prepared to pay only for not so expensive out-patient treatments can be one of the purposes of network meetings.

Collaboration - the families view-point

A need to collaborate with others arises in families who think their own effort is inadequate or doesn't yield enough result.

Magnus' mother is involved, interested and does what she can. Magnus is having a very difficult time. He uses so much drugs and alcohol that he gets new bruises every day, and two to three times a week he ends up in the hospital. Magnus' mother rightly thinks that not enough things are happening in the right direction.

"Can’t anyone help me with this? He’ll kill himself and I’ll blame myself for the rest of my life for not having done enough."

Magnus has stopped coming to sessions, but mother has continued on her own. The social workers are not aware of the seriousness of Magnus situation.

"It's insane what he is doing. Can't he be put away for a while so he gets a chance to pull himself together and not kill himself?" she asks. We answer: "Do you think it would be a good idea if we invited his social worker here to inform him about how you see Magnus situation, and to hear what they have to offer?"

For the family, the purpose of meeting in this and similar situations can be that they want the authorities to act forcefully to stop the abuse. Sometimes the purpose of situations more or less clearly related can be defined as a need for clarification. Mother and father stopped giving money to the addict and are angry because welfare is continuing to pay money that is used for drugs and alcohol.

How a situation is defined has great importance for how it is handled. Conflict and disagreement doesn't always have to be addressed directly.

Anton 35 years old, moderately developmentally retarded, has lived for many years in an institution. In therapy with his family he develops an interest in sports, and starts socializing with members of the local fan club. He makes rapid progress and stops smoking hashish and drinking alcohol. His older sister in particular insists that he should get an apartment of his own, learn to take care of his economy, and become more independent towards the institution. She helps him get an apartment and the institution is faced with a development they didn't plan and are not entirely positive about. In family sessions the sister in particular describes how the staff is doing their best to sabotage her trying to help Anton become more independent. She, the mother and probably Anton are worried that the staff may withdraw their support, which most probably would lead to Anton failing to mend for him and would force him back into the institution.

In the meeting defined as "a meeting to discuss and reach an agreement so that everyone pulls in the same direction", Anton’s present situation is described as a result of great progress, and everyone present is "blamed" for this progress. The therapist makes it credible that the staff has "laid the foundation" and the sister has helped with the "final steps" towards independence. Everyone expresses that they are concerned and wants to help Anton towards even more independence, and the staff clearly expresses that they intend to continue working with Anton. The sisters impression of the staff working against what she feels is Anton’s best interest, is never brought up.

When the meeting is over, everyone seems happy, contented and proud. Everyone leaves with what seems to be optimism for Anton’s future.

Our experience is that many clients have many professional helpers involved in their life, and they can handle it too. For parents and professionals though, it can be quite overwhelming and confusing with a lot of different persons. A wish to coordinate the efforts is sometimes expressed by the clients, though more often by their parents. This coordination however is frequently most needed by the professional network.

Collaboration - the professionals view-point

When many professionals are involved in a client, a wish for collaboration often arises. The purpose of these meetings is mostly to inform each other about what is being done so that the efforts can be coordinated. To avoid hidden agendas it is almost always wise if the clients and families are present at these meetings. This is particularly true if anyone suggests they shouldn’t.

Professionals participate in meetings for different reasons. This means that a meeting can develop very differently, depending on the setting, the participants and the goal.

· Professionals express a wish for a joint attitude and direction.

· Professionals need to discuss and solve conflicts and problems in the network.

For most of our clients it is not a big problem when different professionals have different opinions. They adjust easily. They talk to their social worker about money, they talk to their therapist about how they feel, and they talk to their probation officer about drugs and crime. On a general level this is not a problem for anyone, unless the different perspectives (and maybe directions) collide and conflicts arise, or if the clients gets confused (which sometimes happens).

One useful principle for these meetings is that "ideas are more important than people". The important is what is said, not who said it. Professionals and family members all have good and useful ideas, but it is seldom possible to carry all of them through at the same time. Conflicts easily arise when one has to choose.

It is important that the therapist focuses on how the meeting can lead to something constructive. The therapist's job is to lead the discussion into future possibilities – not looking for faults in the past. With angry and upset people this may be difficult, and the session should be led in such a way that the risk of eruptions is minimized. Focusing on how each person wants things to become, and how each one can contribute to a solution, increases the chances of developing a constructive conversation and cooperation (see for instance Valeria page *).

Best is if the meeting is initiated from desires or wishes the family has expressed. Second best is if the meeting is initiated from the professional network and third best is if it is the therapist who summoned the meeting. It is wise to give some thought as to who is the customer, and you should be careful so you don’t become your own (and perhaps the only). Meetings initiated from desires or wishes expressed by therapists tend to lead nowhere.

Best is if the client calls for the meeting himself. Paricularly if he never did anything similar before, this situation can be used in a way that enhances growth. Work through concretely what he needs to do and how he can make the people come that could be of help to him.

"Who do you think can be of help to you?"

"Do you think the easiest way to get them in, is you calling them or is it better to write them a letter?"

Some people find it very humiliating to ask for help. They tend to believe that ‘alone is strong’, and they are often governed by ‘cowboy-mentality’. It’s no use trying to persuade them. Instead point out to them that the ability to ask for help when one needs it, is a sign of real maturity. You can often get these clients to agree to a meeting but it may be to much to ask that they should do the inviting too. Volunteer to be the one calling to invite the network.

Scrutinize carefully who can be of help. Merely discussing and thinking about who can be of help leads to thoughts that have to do with solutions and positive development.

Introduce yourself and ask about the names of the people present. Ask each one where they work, their professional role and for how long they have known the client. Be as respectful if it’s been ten years once a week or one week since they had the first and perhaps only meeting with the client.

If there are many people present, name-tags can be useful and even fun while people fill them out.

It is important that it is clearly said where everyone comes from so that everyone knows that everyone else got their role and position correctly. It can be very unpleasant for an old social worker to be perceived as the client's mother, and it may even be offending. Even if you personally don’t have any problems with personal and professional roles, many people is not that lucky. Make it easy on them. Those who don’t have any difficulties with this won’t be offended by it being clearly said that they are there as professional helpers. It is your job to see to that everyone goes home without loosing self-esteem or face.

Talk to everyone about how long they have known the client or known about the situation. Pay close attention if someone starts talking about things having gotten better, but save it until you’ve clarified the purpose of the meeting.

Clarify the purpose

Every situation can be described and defined in many different ways. When you decided the purpose for a meeting, at the same time you took a stand towards, and described a situation. Reflect in advance on what kind of descriptions can be made and how they can be useful.

Clarify who has taken the initiative and called for the meeting and why. Remind those who are there, and yourself, about the overall purpose, by expressing that everyone is there because they want to do something that can help the client do something to change his situation.

"Nisse has tried for a long time to stop doing drugs and on previous occasions he was help by ... What ideas do we have here today that we think could be useful for him?"

"Nisse and his parents don’t see the kind of progress they were hoping for and wanted us to meet and discuss together what can be done."

"We are a lot of people here who are involved in Nisse and wants to help. The social-worker thought it would be a good idea if we all got together and figured out how to proceed from here."

Set up goals for the meeting

One of the best ways to initiate a meeting is to make some kind of agenda based on the idea: "Imagine that this will be a useful meeting and everyone is satisfied afterwards. What will we have done here today?"

Another way is to start with: "Imagine we meet here in three years time and Nisse is doing fine. How do you think that happened? What do you think Nisse did? What do you think we did that was helpful?

A third variant is that everyone is given the opportunity to discuss what they think is important and depending on what is said and the time available, an agenda is done for the meeting.

A fourth way is that the person responsible for the meeting asks everyone, one by one, what he or she thinks the client will have gotten from the meeting if it will be a useful one.

All these ways to initiate meetings aim at creating descriptions of goals. It is amazingly easy to create an atmosphere of hopefulness but the therapist needs to be active and goal-oriented for this to happen .

The deepening part of these sessions will be very similar to family sessions with one big difference. Avoid questions around closeness/ distance and emotions. Apart from this, follow the plan we proposed for the first session with the family. Give the network, particularly those who have known the client for some time, the opportunity to talk about the changes they have seen or see now. Alternatively talk about the steps the client or someone else in the network is planning.

How the rest of the meeting will develop largely depends on how and why it came about in the first place. Isn’t treatment making any difference and are people pulling in different directions? Will there be a difference if everyone starts pulling in the same direction – and what direction?

Is this a situation with a sparse network around an isolated schizophrenic who is drinking himself to death and where one may have to use forced custody, or is the purpose of the meeting to help the client get started in a day-care-unit?

Many other factors are of course important, for instance; how many people are present and if there have been conflicts in the network.

When we coordinate meetings with more than 10 people it is impossible to ask each one for every detail. We then divide people into groups to work on different issues and bring their work back into the main group.

The goal is that the meeting is closed in such a way that it makes everyone feel satisfied. Loose ends, unanswered questions and other unfinished business should not be left hanging in the air.

When the purpose of the meeting was that people should get answers to a number of questions, one can finish the meeting by asking each person to sum up if and how their questions were answered.

When the purpose of the meeting was to make a common action-plan for how to be of help, one can repeat together what the plan is, eventually write it down and give each one a copy.

When the purpose was to sort out conflicts, one can finish with a short discussion about how far one got.

Other ways we’ve found useful are:

• The therapist writes a protocol that is distributed to the persons present. The protocol can also be sent to persons who were unable to attend the meeting.
• The therapists takes a break, sums up the meeting in the same form as after a conversation with a client or a family, and then reads the summary to everyone present.

The co-operation that never really started

Kim is 14 years old and feels uncomfortable at home with her parents and her 2 siblings. Her tempers lead to violent conflicts, particularly with her mother. She comes home later and later, and when her parents question her she gets into rages and throws things. She goes to school every day, but skips classes and the teachers don’t know what she is up to. One day she is involved in a fight and after this she disappears from school. She returns the day after, running around with a penknife looking for the adversary from the day before. The police arrives and in the afternoon the same day the whole family ends up in child psychiatry.

When the therapist (MS) comes into the room where the family is sitting, Kim looks at him defiantly, turns her chair so she has her back against everyone else and pulls her sweater up over her head. During the course of the conversation her many positive sides are highlighted, but the therapist doesn’t succeed in establishing any contact with her.

The therapists sees Kim in another session and her parents twice and the parents report having dealt with some difficult situations in a new way and also some progress with Kim’s behavior. Kim says to her parents that she stopped smoking hashish but as there is very little progress in school, the parents don’t believe her.

More and more people around Kim get involved, social worker, school-nurse, teachers, friends, parents of her friends, some relatives and friends of the family. The parents receive a lot of different ideas from different people and the therapist starts worrying that they may become confused by all the good ideas, which are sometimes quite contradictory. He suggests to the parents that a meeting with the network could be useful to find a way to deal with Kim and her situation. At about the same time the social worker becomes increasingly worried. She gets telephone-calls from the school, urging her to do something about the situation. She starts considering putting Kim in an institution for delinquent children.

The therapist and the social worker meet once. For the rest the collaboration in the professional network is done over the telephone.

The meeting never takes place. Kim is eventually taken by the authorities and placed in an institution.

Why was there no meeting?

There are no definite answers, but what do the people involved say?

The parents:

"First we thought it was a good idea, but then when there couldn’t be any meeting before the ‘Social’ had made their decision, it sort of became to late. The meeting would then only be some kind of parenthesis. When we started thinking about who we wanted to invite, there were quite some people – but what if no one would come and we would sit there all by ourselves. Besides everyone knew about the problems."

The social-worker:

"I thought that at least the most important people could attend a meeting, if it was to difficult for the parents that everyone was there. On the other hand the situation was so critical that we had to make a decision and act – that had to be prioritized."

Previous therapist (whom the parents consulted):

"I believe an institution is the best for Kim."

The therapist:

"The idea about a network-meeting was mine from the start, but I didn’t succeed in making the purpose of the meeting clear to the people involved. I could see a scenario where no-one could reach Kim, everyone would continue to give the parents good ideas and they would become more and more confused. The purpose as I saw it, would have been to coordinate all the efforts and in some way make sure the parents were running the ship.

I can understand that parents and professional's do not always want to have big meetings where there is a big risk that one feels exposed and looses face. I didn’t see the taking her into custody as a hindrance for the network meeting – on the contrary. I think it would have been a good idea to gather everyone who cared about Kim to talk about the seriousness of the situation and discuss how to help Kim avoid being taken into custody, or eventually making the stay in an institution something helpful."

Valeria

Valeria is slightly developmentally retarded and the crèche has asked for a meeting with her social worker who in turn asked the therapist (HK) to participate. The social worker has been concerned about the children's situation and has tried to help Valeria so the children could stay with her. Valeria has seen the therapist three times, and her goals have been to find more effective limit setting towards her 5-year-old daughter.

It is the administrator who opens the meeting and she does so by turning to Valeria. She explains that her staff is very worried about the children. They don’t seem to feel well. She continues: "It is important that you understand that we want to help you." Valeria looks at her with a numb look on her face, and the administrators voice turns a little strained. "It is difficult in the mornings when you leave the children and you stand here talking to the staff and you forget the children, but you must understand that we are here to help you. You forget the children, and the children are sad when you are leaving, and it goes on and on, and we see how badly Johanna feels and also the small one."

The administrator takes a brief pause, fidgeting in face of Valerias dumb staring. One of the staff goes on describing the difficult interplay when Valeria leaves and picks her children up, and how bad the children feel about it all and how sad they are. She also turns towards Valeria, who is now crying and holding on as in a cramp to her 8-month old, sitting on her lap. Another one of the staff takes on, telling her they want to help, and that actually Valeria smelled of alcohol once in the afternoon when she came to pick up her children.

It’s been about 15 minutes and HK asks "I have only met Valeria a couple of times and I think she made great progress in her limit-setting with Johanna, but it has been only a short while and I understand if there is no change here yet. I wonder how you (the staff) will notice when things will be getting a little bit better?"

One of the nursery school teachers immediately answers: "It will be much calmer and the children won’t cry as much when Valeria leaves."

"Valeria will be on time," the administrator says and one of the teachers who hasn’t said anything yet quietly fills in: "She will be more strict with the children when she picks them up and there will be no more fuss with coats and shoes."

Through a series of questions on the same theme to the staff and the social worker, concrete behavioral descriptions of what will be different are filled with more and more details. When HK thinks that the depictions are concrete enough for everyone to see if and when they occur, he turns towards Valeria:

"What do you think about all this? How will you notice on them (HK makes a sweeping gesture towards the staff) when they notice that you have changed?"

"They will meet us when we get here in the morning and they will help me undress the children so that the children feel that they are welcome."

"How will they be different towards you?" wonders HK as he raises one hand with the palm towards one of the nursery school teachers, who is trying to say something, and adds towards her: "One moment."

"They will tell me more about how things are going with the children in the nursery school, not only the bad things that happened, but also if something good happened."

"How will that affect you?"

"I’ll be happier and it will be easier to talk to them."

HK turns toward the staff again: "Have any of these things happened during let’s say the last two weeks?"

"Yes," one of the staff answers, "the other day Valeria seemed to be entirely ok and the children were ok all day."

"Oh," says HK, "so it makes such a big difference. How was Valeria different?"

"She seemed harmonious and there was no fuss with the children."

The other nursery school teacher now suddenly remembers that there was another day when things were better too and when the staff collects one observation after the other, a picture of big changes the last two weeks slowly emerges. Valeria also starts describing things that the staff is doing differently towards her.

"So if you pick a scale from 1 to 10 where 10 stands for what we imagined it would be when the problem is solved – what has this last week been like?"

Valeria looks nervously at the staff who seems to be consulting each other with their eyes. Finally one of them answers "7," and another nods in confirmation.

"Wow," says HK, rises and shakes Valerias’ hand. "Congratulations! How did you do that?"

Valeria smiles proudly and generously blames him: "It’s because I’ve been seeing you."

"Maybe so," answers HK, "but what have you done that has been so different so that they (a sweeping gesture towards the staff) have noticed the difference?"

The rest of the meeting deals with these descriptions and how the staff and Valeria have collaborated in a change-process. From this point on it becomes a positive and hopeful meeting and plans are made jointly around what each person can continue to do that will enhance the chances of procedures around leaving and picking up children continue to function without complications.

Our experience is that there are two types of situations that can be particularly difficult for therapists. One is when someone wants the authorities to force a relative into treatment, and they are the only ones who feel that the situation is so serious that this is necessary. One example is Mrs. Anderson who comes to the Alcohol-clinic very concerned and worried because her husband drinks one light-bear with his dinner every day.

It is important not to ignore Mrs. Anderson. It is not because we don’t understand how one light-beer a day can be a problem that it is not a problem. One way to relate is to examine how Mrs. Anderson will notice the difference when her husband's problem is solved.

The other situation is when social workers are extremely oriented towards a particular method of treatment. We think this will be as common in the future as it has been in the past. The difference will be in the preferred theoretical orientation. In the past every addict was to be treated in an institution. In the future maybe everyone is to be treated with 30 days in an AA-institution, or maybe everyone is to have brief solution focused therapy.

It’s wise to keep in mind that social workers, as well as therapists, are bound by the ideology that dominates their unit. A meeting, focusing on the client’s and the family’s goal and their ideas on method, can sometimes lead to a social worker fighting for these against her own institution.