Therapeutic tact: being-with as having the right touch
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The archetypical picture of a person in the midst in the midst of a mental health crisis is perhaps curled up in fetal position, doing nothing. Daniel Sutton explored the transition from such a doing nothing phase towards recovering. In his doctoral study he asked the question “what is the meaning of doing for people in recovery from mental illness?” His findings revealed a sense of the generic heart of practice. To support someone through their journey of recovery is not so much about problem solving, nor following a set pattern of therapeutic strategies. Rather, it involves providing opportunities and experiences and letting things ‘play out’ through a particular mode of engagement. Therapeutic tact is the art of getting-in touch and making sense of what is present. Sometimes it requires taking hold of the situation but most often it means holding back. The play of tactful being-with first requires an attunement towards other, a mood of openness. The willingness of the carer to get-in-touch with the other brings an embodied attunement experienced by both at an emotional level. Yet, tactful practice also requires a safe distance between one’s self and the person who is ‘undone’. This may simply call for a quiet presence, allowing the other to reach out when they are ready. However, too much distance can leave the person feeling the other does not care. Tactful being-with is inextricably tied with care. Both caring and careless encounters leave an indelible visceral impression. Tact involves opening one’s being to the other’s real and potential pain or losses. Presence is not merely a matter of being physically available but is the gift of ‘being there’. Care also shows itself in deficit modes: ‘hands off’ indifference and ‘heavy handed’ obtrusiveness. The challenge for the carer is to get the play space between with just the right amount of freedom to move. In such a space vulnerability is not avoided but embraced. For the recovering person, having someone there to share the space makes all the difference. Having another person understand, sometimes more than one understands oneself, is incredibly powerful. Creating such understanding involves a back and forth process of dialogue where an embodied attunement allows each to ‘just know’. The ‘how are you?’ of an attuned carer is very different to the token question of anybody. If the call is there, the carer may need to ‘hold’ the other to create bounds to the play space, to bring a sense of security and keep the other grounded. Tact thus requires strength and honesty, being ‘straight up’. Yet at the same time there still needs to be room for the other to move. Thus maintaining the play space involves holding steady while also holding it open enough so play can develop and boundaries can shift. The carer offers tactful invitations to call the other to actively make a choice. While tactful practice requires getting in touch with and holding the play-space, the question of what occurs within the play-space to make it therapeutic remains. Because the dynamics of therapeutic interaction cannot be predetermined, having tact is more important than tactics or a pre-conceived game plan. Ultimately, carers need to withdraw from the space, leaving room for free play and for the other to truly shine.