4/ Editorial introductions

It is exceptionally hard to negotiate with clients a view of their problems, equally hard to agree a treatment plan, without some degree of coercion by the clinician towards a particular outcome. The clinician has authority and will use it. Clearly, however, the practice of explicitly defining others' reality can be a recipe for much more overt abuse. A wide range of radical therapeutic approaches where 'reality' can be manipulated present ethical dilemmas. In chapter ten Sally Cameron describes her developing sense of abusing others by denying their reality in her work with the elderly. She writes about her experience of increasing alienation from reality orientation work. Sally describes how she managed to open a forum in which patients could talk about their lives and tell their stories, as well as detailing the interpersonal battles she had to face to do so. She underlines how unsettling it was for her to get in touch with her own fear of mortality and her inability to talk honestly about death. Finally, Sally emphasises the mutuality of the therapeutic process. She relates the struggle she underwent in allowing patients to share their life experience with her own growth, and the development of her subsequent work as a writer.

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