Is There a Place for Biopsychosocial Formulation in a Systemic Practice?

There is a long history of literature concerning integrative practice and how a systemic practice can fit with other models of therapy Much of this literature has focused on establishing a space for systemic therapy within the dominant medical paradigm, and exploring how the medical model can be enhanced by systemic ideas. The outcome has been better practice, especially in child and adolescent mental health. Interestingly, however, there has been less discussion of the converse: the family therapy literature has rarely considered whether or not systemic practice itself can be enhanced by ideas from the dominant medical model. This article proposes that a biopsychosocial formulation can enhance systemic practice by: (I) holding clinicians accountable for their thinking; (2) facilitating a rigour and attention to detail that may prove useful when therapy falters; (3) opening up other possibilities for intervention; and (4) providing a way to engage with the dominant medical paradigm and support clients in negotiating their way through this system. Potential problems nevertheless arise when integrating a biopsychosocial formulation into a systemic framework. This article identifies these problems and presents ideas for how they can be managed in practice.     

On the Project of Using Psychoanalytic Ideas in Systemic Therapy: A Discussion Paper*

Recently in Australian and New Zealand systemic therapy forums, there has been a tentative renewal of interest in psychoanalytic thinking. These local discussions have tended to reference psychoanalytic ideas as part of the struggle to understand emotional experience, and the therapy relationship. This paper reviews the patterns in these discussions, and then considers the wider context of the appearance of this interest in terms of the history and development of systemic theory. Some tentative comments are made about the project of using psychoanalytic ideas in systemic theory and practice.     

Transitions to Systemic Practice for a Clinical Psychology Trainee

This article provides an individual perspective on encounters with systemic and family therapy ideas during the transition from university training to professional practice as a Clinical Psychology Registrar. Clinical psychology training provides a solid grounding in individually focussed, cognitive and behavioural models of psychotherapy. What may be less developed on entry to practice are the knowledge, procedural skills and reflective competencies needed to understand and respond to challenges in family‐based therapy and in working within complex caregiving systems. Systemic ideas can provide important resources for facilitating these transitions. Trainees may need support not only in gaining knowledge of family therapy models, but also in making a challenging ‘epistemological shift’ (Cullin, 2014) from internalised models of psychopathology to systemic ways of thinking about problems and change. Systemic concepts and support in developing a position of ‘hospitality’ (Larner, 2003) towards competing therapeutic models can also help the trainee be more effective in complex caregiving environments. This article provides examples from my learning as well as reflections on what may help trainees make the transition to professional practice and make use of systemic ideas.     

Object Relations Family Therapy: Articulating the Inchoate

In recent years there has been a renewed interest in psychodynamic ideas within the family therapy literature. While some authors have explored the usefulness of psychodynamic concepts in the systemic context (Byng-Hall, 1995; Flaskas, 1993, 1996; Luepnitz, 1988, 1997), others have argued that psychodynamic models of family therapy should be given more credence in systemic work with families (Guttman, 1991). This paper describes Object Relations Family Therapy (ORFT), a psychoanalytic model of family therapy, in plain English in order to minimise the obscurity of some of the existing terminology and to emphasise the utility of more contemporary formulations. ORFT addresses the interface between psychoanalytic and systemic theories. It offers a way of conceptualising complex family dynamics at both the interpersonal and intrapsychic levels. It also integrates an understanding of nonverbal, unstated and often implicit processes in its formulation of problem development. The unique contribution of ORFT is elaborated using a clinical example.     

Key Systemic Ideas as Seen Through the Eyes of First‐Year Trainees

This article offers an introduction to key systemic ideas as seen through the eyes of first‐year trainees in a postgraduate systemic therapy course. Our aim is to present these ideas in user‐friendly, accessible language, with examples to illustrate their use. The article is organised around three main themes: how a family system gets organised; how systemic work helps to effect change in families; and how a systemic therapist creates a context for change. Ideas covered include circular patterns, processes and questions, feedback loops, the importance of context, the interdependence of meaning and action, taking a meta‐perspective, systemic hypothesising, neutrality, curiosity, second‐order change, use of language and the position of the therapist. The article may be of particular interest to those who are new to systemic ideas, as well as for those involved in providing training in systemic practice.     

How and Why Do Family and Systemic Therapies Work?

My reviews of the evidence base for family therapy conducted over the past 15 years have been guided by four key questions. Does systemic therapy work? What sorts of systemic therapy work for specific problems? What processes occur in effective systemic therapy? Is systemic therapy cost‐effective? In this paper answers to these questions are given. Systemic interventions are effective for about two out of three cases. Specific models of effective systemic therapy have been developed for most common mental health problems. There are many processes shared by evidence‐based models of practice that can be incorporated into the routine practice of research‐informed family therapy. Systemic therapy is cost‐effective and in many cases leads to medical cost‐offsets. Available evidence indicates that family therapy can make a very significant contribution to alleviating suffering and making the world a better place to be.     

Time and environmental crisis: An exploration with special reference to pollution

The present environmental crisis is gaining prominence on the sociopolitical and scientific agenda. There is widespread consensus about what constitutes the crisis but little agreement about its causes and potential solutions: what is a solution for one person is often considered a source of the problem by another. Focusing on aspects that are normally ignored allows us to sidestep these hardening oppositions and gives us a new access to environmental issues and their analyses. While the spatial dimension has been brought to the fore in a number of disciplines, the temporal equivalent has stayed implicit. Explication of what remains invisible in conventional analyses can shed light on the familiar, agreed upon and disputed.     

Behavioral science and energy conservation: Conceptualizations, strategies, outcomes, energy policy applications

While economic, physical design, and legal disciplines have been the dominant approaches in energy conservation policies, each perspective has limitations with regard to effectively being able to modify energy-related behaviors of consumers. A behavioral science approach which integrates knowledge bases from a number of disciplines and levels of analysis has had relatively little input into energy policy, even though conceptually and technically the approach is well developed, and has recently demonstrated its applicability to energy policy through many field experiments. These studies, which have used combinations of antecedent and consequence strategies, are critically reviewed with regard to energy savings attributable to these strategies and the potential for large-scale applicability. Based on this review, a sophisticated, media-based approach, developed from a detailed marketing plan, is described as the foundation of a basic program. However, such a program would be experimental in nature and contain subparts to carefully evaluate other strategies (e.g., diffusion, feedback). Thus, the behavioral sciences, while by no means offering a panacea, can make important contributions to energy policy when working in concert with other disciplines.     

Anticipating needs and designing new items rapidly - a case study for the design of postural aid equipment

In this case study, designers proactively proposed new product ideas to a client by using an ergonomic approach. This approach differs from a more traditional approach where one works within a specific, clientdefined project. The methodology used included basic ergonomic techniques such as task analysis and information gathering sessions conducted with users. It was adapted so that these enriched user sessions could be conducted within a short time period. After meeting with five users in seven days, designers identified 20 problems that could be tackled and eight design ideas that could be implemented over the short, medium and long term. The ideas encompassed a wide range of potential projects, including physical product improvements, new product lines, Web-site and software improvements and longer term research. Problems identified and ideas generated involved many disciplines including occupational therapy, mechanical engineering, graphical design, software engineering, sales and manufacturing know-how. This wide range was possible because designers were not constrained to specific project scopes and timelines. The client was involved in the idea evaluation process. As a result of this study two new projects were initiated so far.     

Gregory Bateson at 100

Gregory Bateson (1904–1980) was a founding figure of family therapy. The centenary of his birth offers a chance to look again at his life and work for ‘the patterns that connect’. Family therapy may have turned out to be a receding part of that pattern, but it remains important to place Bateson and his thinking in the larger contexts of knowledge; the 19th century history of Darwin and evolution, and 20th century developments in genetics, anthropology, cybernetics and psychotherapy. Bateson swam in all these vast currents, moving towards new aesthetic, holistic and contextual forms of systemic wisdom. His ideas are still very relevant to therapists, but even more, they may be vital to our very survival as a planet in this new century.     

The social practice of sustainable agriculture under audit discipline: Initial insights from the ARGOS project in New Zealand

One of the most interesting recent developments in global agri-food systems has been the rapid emergence and elaboration of market audit systems claiming environmental qualities or sustainability. In New Zealand, as a strongly export-oriented, high-value food producer, these environmental market audit systems have emerged as an important pathway for producers to potentially move towards more sustainable production. There have, however, been only sporadic and fractured attempts to study the emerging social practice of sustainable agriculture - particularly in terms of the emergence of new audit disciplines in farming. The ARGOS project in New Zealand was established in 2003 as a longitudinal matched panel study of over 100 farms and orchards using different market audit systems (e.g., organic, integrated or GLOBALG.A.P.). This article reports on the results of social research into the social practice of sustainable agriculture in farm households within the ARGOS projects between 2003 and 2009. Results drawn from multiple social research instruments deployed over six years provide an unparalleled level of empirical data on the social practice of sustainable agriculture under audit disciplines. Using 12 criteria identified in prior literature as contributing a significant social dynamic around sustainable agriculture practices in other contexts, the analysis demonstrated that 9 of these 12 dimensions did demonstrate differences in social practices emerging between (or co-constituting) organic, integrated, or conventional audit disciplines. These differences clustered into three main areas: 1) social and learning/knowledge networks and expertise, 2) key elements of farmer subjectivity - particularly in relation to subjective positioning towards the environment and nature, and 3) the role and importance of environmental dynamics within farm management practices and systems. The findings of the project provide a strong challenge to some older framings of the social practice of sustainable agriculture: particularly those that rely on paradigm-driven evaluation of social motivations, strong determinism of sustainable practice driven by coherent farmer identity, or deploying overly categorical interpretations of what it means to be ’organic’ or ’conventional’. The complex patterning of the ARGOS data can only be understood if the social practice of organic, integrated or (even more loosely) conventional production is understood as being co-produced by four dynamics: subjectivity/identity, audit disciplines, industry cultures/structure and time. This reframing of how we might research the social practice of sustainable agriculture opens up important new opportunities for understanding the emergence and impact of new audit disciplines in agriculture.     

Environmental Discourse and Social Movement Organizations: A Historical and Rhetorical Perspective on the Development of U.S. Environmental Organizations

Environmental organizations in the United States are key actors in the process of social change. A rhetorical and historical perspective expands the understanding of different types of environmental organizations, and the actions that they follow. In the first section of this article, the role of language in constructing social movements is reviewed. This perspective is then applied in a second section to the environmental movement in the United States. Through a detailed reading of the philosophical and historical literature on environmental discourses, and an examination of the founding documents of leading environmental organizations, six environmental discourses are identified, and the incorporation of these discourses into environmental organizations is described. A close look at forty-four environmental organizations in the United States in a third section shows three distinct historical periods (Conservationist/Preservationist; Ecocentrist; and Political/Deep Ecology) through which the U.S. environmental movement has developed. The article concludes with some suggestions for further research.     

The challenge of interdisciplinary collaboration in addressing the social determinants

The importance of professional disciplines working together to address the critical social and health issues facing society today cannot be overstated. Policy makers, service providers and researchers have long been calling for greater interdisciplinary collaboration. Despite this there has been little systemic analysis of the constraints involved in such collaboration. Far too often disciplines continue to work in silos. This paper aims to analyse the barriers to interdisciplinary collaboration through a case study of the relationship between social work and public health. These two disciplines have a lot more in common than might first appear. There is real potential for social work and public health to work together and enhance each other's efforts to address their common goal of greater social equality. However, this will require a genuine commitment from both disciplines to develop a shared political analysis, common language and a framework for action, which utilises their respective strengths.     

Frameworks for Practice in the Systemic Field: Part 2 — Contemporary Frameworks in Family Therapy

This is the second of two articles to map the landscape of practice theory in systemic family therapy. The first article gave a particular chronology of the development of family therapy practice theory, beginning with the frameworks that emerged in the 1960s‐1970s and then tracing the transitional decade of the 1980s. The convergences of three sets of influences — ecosystemic epistemology, the feminist challenge and postmodernist ideas — led to the changed landscape of post‐1990 practice theory. This second article picks up at this point, mapping four contemporary influential approaches in Australian family therapy — the Milan‐systemic, narrative and solution‐focused frameworks, and the dialogical perspective. Social constructionist and narrative ideas together constitute the dominant common theory influence in the post‐1990 practice frameworks, although intersected and used in different ways in the different frameworks. Throughout the history of the development of practice theory, context and relationship remain the enduring parameters of the systemic family therapy field.     

Power and Knowledge: The Case of the New Epistemology

This paper is in part a critique of the new epistemology. However, its focus is not the content of the new epistemology, but rather the process of the generation and legitimisation of knowledge which is represented by the new epistemology. It is argued that the new epistemology has been embedded in foundationalism, or a framework that poses epistemology as the (legitimate) base of thinking, knowledge and practice. This is a very conservative process of knowledge, as it allows the censorship of other ideas and knowledges in family therapy. My critique is part of a wider project of exploring the relationship of knowledge and power. To this extent, the new epistemology can be used as a case to illustrate the powerful effects of knowledge, and to remind us of the importance of allowing the space for differences in knowledge to enrich the field of family therapy.     

I,we, and she: An ecological note on Etzioni's I & we paradigm

Ecology and environmental issues are almost completely lacking in socioeconomics. Results of environmental sciences demonstrate that nature plays an important role in the life of individuals and collectivities. Etzioni's I & We paradigm can be enlarged to include Mother Nature.     

Exploring the Therapeutic Relationship A Case Study

This paper is focused on the topic of the therapeutic relationship in systemic therapy. It is structured around the discussion of my experience of work with a particular family where the engagement issues were complex, and where there was the potential for a negative therapy sequence. The psychoanalytic concepts of transference, countertransference and projective identification are chosen to discuss my dilemmas — however, the differences between the analytic and systemic contexts of work are noted. Through the discussion of this case study, the potential benefits of using these analytic ideas to understand the therapeutic relationship in specific situations in systemic therapy are identified.     

Feminist In(ter)ventions in Family Therapy†

Family therapy is often receptive to new ideas but so far it has only engaged with the second wave of feminisms in a restrained and conditional way. In this article we map the influence of feminisms on the life of family therapy and conclude that its dominant conceptual frameworks have so far resisted feminist revision. Ironically, while feminist post-modernist thought has helped to loosen the modernist grip on family therapy, family therapy's embrace of post-modernism synthesizes and displaces rather than centres feminist concerns. Since post-modernism is not post-patriarchal, the result may be exclusion of feminist perspectives that offer a principled and liberating way through current dilemmas in family therapy. Feminist perspectives are not mere voices among others; they hold promise for the development of a more inclusive theory and practice based on a valuing of inter-connectedness and an ethics of care and responsibilty.     

THE INTEGRATIVE PSYCHOTHERAPY ALLIANCE: FAMILY,COUPLE AND INDIVIDUAL THERAPY SCALES*

The therapeutic alliance concept has been confined primarily to the literature on individual psychotherapy. This paper formally introduces the concept into the family and marital therapy domain and presents various clinical hypotheses about the nature of the alliance and its role in familyand marital therapy. A systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework. The implications of this integrative-alliance concept for family, couple and individual therapy research are examined. Three new system-ically oriented scales to measure the alliance in individual, couple and family therapy are presented along with some preliminary data on their methodological characteristics.