The Questions
When do you start Tidal?
Ideally, we would begin to use Tidal as soon as a person entered
the service. If the person is unable (or unwilling) to
collaborate then we would support the person until they were in a
position to work, collaboratively, with the team members.
Are there certain people that we cannot use Tidal with?
As noted above, in a very few instances the person may be so distressed, or temporarily disabled, that they are unable to communicate. In such instances, we need to provide physical and emotional support until the person is able to respond.
The kind of person needed to provide this kind of sensitive, compassionate care should be highly skilled and highly experienced.
This should not be left to the novice.
How often do
we do the sessions?
The Tidal Model is pragmatic. We believe in working with the 'art of the possible'.
We do what can be done, when it can be done and as often as is necessary or appropriate.
For example, if a person is a threat to him(her)self (or others), considerable time and effort will be needed to ensure the person (and others) safety and security. Having helped the person construct a Personal Security Plan we might need to return, frequently, to review and, if necessary, revise this plan.
How often should we do this? As
often as is necessary!
Doesn’t the paperwork get in the
way of the conversation?
Imagine an 'ordinary conversation', where two people talk for 20 minutes. Afterwards, we ask the two people what, exactly, did they discuss? Most people are likely to find this difficult. They remember only the 'outstanding details' and forget the rest. In all likelihood, one or other person will forget important details that have 'slipped their mind'.
When people are distressed, or find it difficult to concentrate, their capacity for recall is limited even further. When that person is being 'interviewed' by a professional - who may wield great power and authority - the 'conversation' may became even more challenging.
We have studied these kind of situations and have found that most people remember very little. This is due mainly to the anxiety-provoking nature of such interviews, which are nothing like 'ordinary conversation'. In any 'clinical interview' the person who is the 'patient' is, by definition, at a great disadvantage: they are disempowered.
To address this problem of disempowerment we developed the idea of live recording of the conversation - either by the person or the professional, acting as scribe. Our aim is to make a record the key details of the conversation - in the person's own words (verbatim) - so that they could use this, later, to recall what (exactly) they were discussing.
We have found that many people later discuss these records with family or friends. This helps them further in relating to their problems in living - and what they might need to do to address them.
Our aim is simple: to re-empower the person; to reduce their sense of being at a disadvantage.
Does the 'paperwork get in the way'? No - quite the reverse!
Who in the team should do Tidal?
By definition a team is a group of individuals who work together to achieve a common goal. In any health or social care setting the goal must be to meet the person's needs. The team must - by definition - have a plan or model of care to help the individual members work towards the achievement of the team's goals.
If a team is using the Tidal Model as a framework for practice then all team members will need to work with the Model. If not, then the team's efforts will be fragmented at the very least. At worst, one team members efforts may be cancelled out by another. That said, different team members may fulfil different roles. It is the Team Leader's responsibility to decide who is 'best placed' to work with this or that person.
Does
the whole team need to be on board?
Where care is delivered by a team of professionals then the whole team should be agreed on the plan, model or strategy for delivering care. If not, there are bound to be conflicts, which may well affect the welfare of the person. However, in some teams only particular members have direct, sustained contact with the person: e.g. nurses or other 'direct care' staff. Doctors and other therapists may only have brief, occasional, or highly-focused contact with the person. It is desirable - but not essential - that these team members are 'on board'.
Where the professional
is working as an 'independent practitioner'- for example in a
community team - (s)he may work with
the Tidal Model independently - since (s)he is the only person
responsible for the delivery of care.
What do you do when someone says ‘there is
nothing wrong with me?‿/span>
In our experience many people believe - or at least claim - that there is 'nothing wrong', other than that they are being asked to talk about their 'problems'. This, in itself, should not present the professional with a problem.
There is no point in trying to convince such a person that they have a problem. This will only further jeopardise the relationship. Instead, we would accept what the person says: "OK, then how can we help you?"
If the person says, "there is nothing wrong with me, let me go home", we might say: "OK, let us talk about how I (we) could help you to go home".
The professional's aim is to be helpful, so the question must always be: "how can I help your to .......?"
What if the person says I
want to kill myself
We have met a lot of people who have said 'I need to harm/kill myself' - or someone else.
When people are distraught, frustrated, angry (or possessed by any other 'high emotion') they might 'want' to do all manner of things, which later they might regret.
Your responsibility is to help the person begin to feel more emotionally secure. You might begin by telling the person that you cannot HELP them carry out any action, which may be harmful or detrimental, to themselves or others.
Offer to talk about what kind of things that are important to the person that you COULD help them with.
Find another WAY to help the person.
How would we begin Tidal?
There is
no fixed rule regarding where to begin. Instead, this decision
is also pragmatic -
determined by the person or the circumstances of care itself.
‿If the person is distressed in any way the team
should consider beginning with the Personal Security Plan
‿If
the person appears be ‘safe and secure‿then the team might begin to
learn more about the person and their problems of living, through
the Holistic Assessment carrying this through to dedicated
One to
One Sessions.
‿If the team’s practice is focused primarily on
group work then they might choose to begin with one of the Tidal
Groups ‿using this as a lead in to more individual work later.
Often, this also is a choice made where the person is uncomfortable
(for whatever reason) with individual, one-to-one contact with
staff.
Does the Tidal Model pose a conflict with people who are on medication?
No.
All forms of medical treatment are focused on curing or ameliorating some illness or injury. The Tidal Model is NOT focused on illness or injury.
The Tidal Model is concerned only with the person and her/his relationship to specific 'problems in living'. (These may - or may not - be related to some illness or injury).
The 'treatment' that takes place in the Tidal Model involves the way the professional behaves towards the person - how the professional 'treats' the person - in an effort to help the person deal with a particular problem of living.
