The Purpose of Practice
The Tidal Model is, fundamentally, existential in character. Our interest is in the person's experience of her or himself. This focus becomes the basis for all the decisions made regarding what 'needs to be done' to address the person's particular problems in living.
In keeping with this philosophical outlook we assume that the person is free to choose, and is ultimately responsible for their actions.
The role of the professional helper is to support the person in making decisions about what 'needs to be done' and then in carrying these out in everyday life.
The Tidal Focus
Our motto is borrowed from the work of Shoma Morita: "First, know your purpose...then...do what needs to be done".
Our purpose is simple - although its attainment may be difficult. It is to help the person to return to everyday life as soon as possible.
Having established our purpose we must support the person in identifying 'what needs to be done' to realise this.
In the Tidal Model the first steps in recovery are taken as soon as the person enters the care setting. No time should be wasted. The aim is to help establish the conditions needed to return the person to everyday life as soon as possible.
All aspects of the practice of Tidal serve as a rehearsal for everyday living. At every stage of practice the helper tries to strengthen the person's autonomy - encouraging the person to take 'the driving seat'.
The practice of the Tidal Model is based on four key questions.
1. How might the person be helped to feel safe and secure and what needs to be done for this to be realised?
The Personal Security Plan is designed to address this issue.
2. Who is the person and what are their problems of living?
The Holistic Assessment is designed to address this issue.
3. How might we help the person begin to develop their own way of living, constructively, with their problems?
The One to One Sessions are designed to address this issue.
4. What might the person learn about themselves and their problems through discussion with others?
The three Tidal Groups are designed to address this issue.
Do What Needs to Be Done
The practice of the Tidal Model is pragmatic. It emphasises working directly with the person’s problems in living; doing whatever appears to be appropriate; doing what works for the person ‿ceasing to do anything that seems not to work.
Tidal practice is created afresh each time the helper and the person meet. At these meetings they work out what ‿em>needs to be done‿and then decide how this might be enacted each and every day.
The Key Tidal Processes
There are four key processes in the Tidal Model. These are used to learn more about the person and to work out ‘what needs to be done‿to address their problems in living.
1. The Personal Security Plan
Care settings are expected to ensure that the person is kept ‘safe‿- not exposed to any obvious hazards or any other risk of coming to harm. However, although a person might be safe in a physical sense, they might still feel very insecure. Unlike physical problems ‿e.g. a broken limb or high fever ‿ problems in living exhibit no ‘signs‿ Instead, all such problems are abstract: they are experienced only within the person ‿ in the form of specific thoughts and feelings. If we are to help the person to be both safe and secure we need to establish what needs to be done to help increase that sense of personal and private ‘security‿
The Personal Security Plan was developed with the support of people with experience of distressing or disabling problems of living: those who had attempted suicide, self-harmed or felt threatened by ‘voices‿or ‘thoughts‿
The aim is to help the person identify what they can do for themselves and what others might do for or with the person that might increase the sense of personal security.
This is the most common starting point for Tidal. If people do not feel emotionally secure, they are unlikely to be willing to explore the nature and meaning of their problems in living.
2. The Holistic Assessment
In traditional health and social care a ‘patient‿or ‘client‿is ‘admitted‿to the care setting. Usually this ‘admission‿is arranged through referral from a psychiatrist or another health or social care professional. The ‘history‿that accompanies the admission focuses on the ‘patient/client’s‿illness or disorder, medical history and family history.
However useful the history might be it represents only a professional account of the situation. This is similar to a description of a shipwreck by bystanders on the beach. In the Tidal Model we are interested in a personal account. We want to hear the story from the person who 'survived the shipwreck'.
What, exactly, happened to the person? How did this affect them? How have they coped with this? Who helped them? In what way?What do they think, feel and believe about this event in their life?
We want to develop a more complete picture of the person ‿framed in their words, rather than ours.
The Holistic Assessment was developed with the support of a wide range of people with personal experience of psychiatric care, sometimes with repeated ‘admissions‿over many years. This large group helped us appreciate what was missing from traditional psychiatric or psychotherapeutic ‘assessment‿ They also helped us refine the wording and format of the Holistic Assessment, making it ‘user-friendly‿
3.The One-To-One Session
The Holistic Assessment identifies the problems which brought the person into care. In the One to One Sessions the person is helped to begin to address these problems.
However, time does not stand still. What was a major problem yesterday may have been displaced by a ‘new‿problem. Instead of using a ‘fixed‿problem list each One to One Session begins by asking the person what they wish to talk about. What is troubling them now?
It is only respectful to allow the person a little time to talk about the ‘problem‿ how it begun or affected the person etc. However, the real starting point of the session involves asking the person how they would like things to be. What would they want to be different? This will represent the person's ultimate ‘aim‿‿however distant.
The rest of the session focuses on discussing, in practical detail, how the person might begin to move towards this aim.
- What does the person do at present that is helpful or constructive?
- How might they do more of this?
- What else might they do?
- What help might they get from others to deal with the problem and begin to move towards the aim?
These sessions focus on helping the person take charge of their situation; begin to think about what ‿em>needs to be done‿ develop a structured plan for doing this in everyday life. This is the beginnings of what might be called ‿em>self-management‿
In the Tidal Model our
aim is to help the person understand better the resources they
already possess, what they have learned afresh about themselves
over the time in care, so that they will have something to draw upon
when confronted by new problems in living ‿or perhaps a return of
the old ones.
The Records of Practice
All the written records of conversations within the Personal Security Plan, Holistic Assessment and One to One Sessions are made ‘in situ‿/em> ‿ along with the person. Wherever appropriate, the person will be encouraged to make the record in their own hand. If this is not possible, the professional will act as ‘secretary‿ recording only what the person wishes recorded, exactly as they wish it recorded. The person is always provided with copies of each session’s recordings for their own reference, which they may share with family/friends or keep private.
At the end of each session the helper will make a copy for the person and place the original in the person’s records.
This is only appropriate. The story that is documented, drawn upon, or further developed in these records belongs to the person. It would be inappropriate to make a professional record ‿which will be filed and maintained for years ‿ without providing a copy of this for the person’s reference.
These records not only help to remind the person what has been discussed but serves as a ‘memory aid‿ reminding the person what ‘needs to be done‿in specific situations in everyday life.
4. Group Work
Group work is a very important part of the Tidal Model. All people learn about life and themselves through group experience. Reading books, schooling and other forms of formal education help the individual acquire knowledge or information. However, we learn about human relations ‿and life itself ‿in the family home, the school playground and through membership of formal and informal social groups across the lifespan.
Most care settings offer some kind of group activity. This is either a formal ‘therapy‿group or serves as a distraction from the person’s everyday worries. The three groups within the Tidal Model are designed to serve as rehearsals for the kind of group activity found in everyday life. In many settings the team may introduce the person to one of the groups as a first step into the Tidal Model. The group may serve as an important ‘warm up‿for the individual work, helping the person become more comfortable in talking about themselves and their personal experience.
The Discovery Group focuses on helping the person meet and share with others their experience of things that matter, are meaningful or significant.. Originally named the ‘recovery group‿this group was re-named by people in a high security unit in New Zealand . They said that after a very long time in care they had ‿em>finally learned important things about one another and about themselves‿ In this group two staff members also participate. By sharing details from their personal lives they act as important role models for the people in care.
The Information Sharing Group focuses on providing information on any personal, health or social issue that might concern individual members.
- People may be confused about the different treatments on offer; may have problems with money, housing or family; or need legal advice. They may need information either to help make a decision or simply to be better-informed.
Given Tidal's person-centred nature all topics are chosen by group members themselves. Someone with expert knowledge of a particular topic is invited in to answer the group’s questions. This format puts all the group members ‘in the driving seat‿
The Solutions Group focuses on group discussion of specific problems in living. What is the individual members‿experience of such problems? How have they been affected by this problem? How do they cope with, manage or otherwise live with this particular difficulty or issue?
The group is facilitated by a staff member but offers no advice or direction. Instead, the group members are encouraged to share experiences, learn from one another and, perhaps, begin to see problems from a slightly different perspective.
The Tidal Model Manual
You can learn more about the practice of
the Tidal Model by reading our 120 page manual.
This describes, in detail, the use of the four processes, along with examples. You can order a FREE COPY here. To order your copy click here (Order the Tidal Manual)