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.     

Teaching and Learning Theory For Family Therapy Practice: On The Art and Craft of Balancing

As with all practice knowledges, family therapy theory sits in a complicated relationship to practice. This paper offers a set of reflections exploring challenges of teaching and learning theory for, and about, practice in family therapy. The importance of teaching particular frameworks of practice sits in tension and balance with the importance of the common factors of therapeutic change, and the inseparability of the use of self and the use of particular practice knowledge. Passion and commitment to particular ways of working is held in balance with the need for flexibility and the freedom to think independently. Discipline and focus is balanced with creativity and the room for integration. A number of balancing practices are identified in the art and craft of teaching, and the contextual issue of power and vulnerability in the teaching and learning relationship is acknowledged. Finally, the three ‘Rs’ in teaching and learning family therapy practice theory are drawn out – reflection, the recursiveness of theory and practice, and the reflexivity of self in relation to context and knowledge.     

Integrating Reflective Practice in Family Therapy Supervision

This paper discusses how to integrate reflective practice in the family therapy supervisory relationship. This enables family therapists to think creatively, be insightful, and develop a range of perspectives regarding systemic formulation and practice. It encourages review of the past and promotes understanding in the present with the aim to improve therapists work with families in the future. Reflective practice encourages independent thinking and learning and helps therapists to develop a systemic process of critical enquiry to investigate and critique their own practice. It encourages therapists to be self‐reflective and develop confidence to think hypothetically regarding change. This allows them to pose questions for exploration, construct a new lens to conceptualise therapy and the therapeutic relationship and develop awareness of the personal as well as the professional self.     

Applied Restorative Justice as a Complement to Systemic Family Therapy: Theory and Practice Implications for Families Experiencing Intra‐Familial Adolescent Sibling Incest

This article considers the impact on and therapeutic responses to families where there has been intra‐familial sexual assault (IFSA) by an adolescent member of the family against another younger member of the family. In doing so, the article will specifically highlight the nexus between systemic family therapy ideas and an applied restorative justice response in the form of Youth Justice Conferencing (YJC), as experienced through working as a family therapist in the area of adolescent sexual offending.     

Cut the Crap: Language — Risks and Relationships in Systemic Therapy and Supervision

This article concerns the use of language in both therapy and supervision, and how it contributes to the necessary risk‐taking that will be a part of therapists' and supervisors' repertoires. The focus will be on my own examples in both roles, and will refer to both successes and failures, while questioning the usefulness of either concept. Within a postmodern paradigm, and influenced by thinkers including Foucault and Bakhtin as well as systemic clinicians, I will examine the use of language (including in cross‐cultural settings where risks can sometimes be amplified) and of humour and self while exploring the meanings of identity. I contend that all relationships contain some element of risk and the ways in which we create a safe enough context, through the uses of language as well as nonlinguistic means, are the crucial elements in our endeavours as supervisors and therapists. I favour the idea that therapy is more of an art than a science and that this is most exemplified in the graceful use of language by which we strive to engage rather than alienate people. The article may be considered by some as being useful advice, and by others as a risk too far, such is the controversial nature of language, which highlights the importance of relationships and context.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

Theory and Practice of Systemic‐Dialogical Therapy

Systemic‐dialogical therapy originates from an evolution of Milan systemic therapy, through a reflection on Bakhtinian dialogue and on power and knowledge dynamics in therapeutic sessions. The model considers both emergent patterns in human interaction and the dialogical nature of human exchanges in which emotions play a relevant part. Such theoretical considerations prompted the creation of specific practices, such as emotional micro‐hypothesising, considering heteroglossia in the session, dialogue with the context, finding one's place in the relational network, and fostering relational responsibility in both therapist and clients. The practice of systemic‐dialogical therapy is illustrated by a clinical case study.     

Becoming Resilient: Overturning Common Sense — Part 1

How might we engage with the concept resilience in a world obsessed with the measurement and cataloguing of deficits and virtues alike; with predicting outcomes, producing certainty and the reification of stable identity? This article is based on a plenary address presented to the Australian Family Therapy Conference in 2009 and takes Deleuze's paraphrase of the 17th century philosopher, Spinoza as a point of departure from common sense views of identity. Can resilience be possessed by some as a personal quality enhancing their coping skills or might resilience be a vital aspect of living which passes through us? Perhaps resilience bounces back towards us and enables the unsettling of dogmatic beliefs and a stable sense of identity Enquiry might then shift from the moral; What kind of person am I? How should I live? towards an ethical position of wonder; What else might there be? What might I be capable of?This article invites an ethical exploration of desire, its capture and of resistance and explores the politics of identity; illustrated with men's journeys of struggle with violence, sexuality and belonging and the discovery of ethics and generous forms of love in the face of adversity.     

‘So I Feel Like I'm Getting It and Then Sometimes I Think OK,No I'm Not’: Couple and Family Therapists Learning an Evidence‐Based Practice

This research concerns itself with the experiences of couple and family therapists (CFTs) learning about and using an evidence‐based practice (EBP). The engagement with EBP is growing across many aspects of the mental health and health care systems. The EBP model is now being applied in a broad range of health and human service systems, including mental and behavioural health care, social work, education, and criminal justice (Hunsley, 2007). The dialogue about the role of evidence‐based approaches in the practice of CFT and research literature is also evolving (Sexton et al., 2011; Sprenkle 2012 ). Interestingly, while the research delves into what are the best approaches with different populations and presenting issues, little research has explored the experience of CFTs themselves, particularly while learning an EBP. Using a phenomenological approach called interpretive phenomenological analysis (Smith, Flowers & Larkin, 2009), this research explores the experiences of CFTs learning and using an EBP. The paper reports on key issues, challenges, and areas for CFTs, educators, and supervisors. As researchers, educators, administrators, policy makers, and CFTs struggle with what works best with which populations and how best to allocate resources, this research contributes to dialogues about how best to educate and support CFTs, and the complexity of doing research in real‐life settings.     

Introducing Evidence‐Based Family Assessment and Therapy in Child and Youth Mental Health Services: Applying Systemic Principles to Maintain,Sustain and Build Capacity

The purpose of this article is to overview the context of the mental health service in which we work, and family therapy's status prior to and after the impact of changes wrought by the introduction of the National Mental Health Policy. We then explore some key issues that we think contribute to the persistence of the occlusion of family therapy in child psychiatric services; and the strategies that we developed and are continuing to develop to support change. Finally, we describe the use of a family assessment instrument that we believe is central to our change strategy.     

Family Phone Therapy in University Counseling and Psychological Service Centers: A Family Systems Approach

Abstract

This paper offers family phone therapy as a method for student mental health practitioners to overcome the obstacle of geographic distance between students and their families when family therapy is the treatment of choice. The issues of confidentiality, triangulation, diversionary conversation, and mixed communication, which present unique concerns when engaging in family phone therapy, are introduced and strategies to deal with them are discussed. A case example is presented to demonstrate the utility of family phone therapy in dealing with problems that students who use university mental health services can typically experience. Finally, implications of dealing with students' developmental tasks from an individual or family systems perspective are discussed.     

Reflections and Learning From an Agency‐Wide Implementation of Single Session Work in Family Therapy

In November 2009, the Bouverie Centre, a centre for training, research, and clinical family therapy in Melbourne, Australia, embarked on a 12‐month trial involving the implementation of single session work as our main model of service provision for all new family appointments. We were interested in evaluating clients' and therapists' experiences of this change in our clinical service delivery. This article discusses some clinical dilemmas that arose for staff in this process, and how they were addressed. Clients' responses to single session work are outlined, followed by a discussion of outcomes of the implementation for our organisation.     

When Baby Brings the Blues: Family Therapy and Postnatal Depression

Postnatal depression impacts on a significant number of women and their families. As a topic it is attracting much interest from researchers as we become clearer about its impact on the long‐term mental health of both women and their partners, as well as on the couple's relationship and their children's mental health. This article will provide a brief overview of postnatal depression and the current research associated with it, and consider the usefulness of systemic family therapy interventions. Examples of these are included along with a clinical vignette.     

Differentiation of Self and the Process of Forgiveness: A Clinical Perspective for Couple and Family Therapy

In this article we explore the role of differentiation of self in facilitating forgiveness in the context of couple and family relationships. Differentiation is defined from the Bowen perspective as the ability to connect with others without being excessively emotionally reactive to the ebb and flow inherent in all significant relationships (being able to connect to others yet also being able to self‐regulate). Forgiveness is described as the releasing of an emotional injury via a complex psychological and relational process that is less an act of will than a discovery or possibility through understanding and empathy. Differentiation of self is related to emotional intelligence and empathy. The developmental and relational benefits of such are illustrated and discussed. A rationale for viewing differentiation and forgiveness in a contextual, historical, and relational attachment paradigm is suggested. Relevant clinical cases illustrate the dynamics of differentiation and forgiveness as discovery in the context of an understanding and empathic relational environment.     

Stemming the Tide of Trauma Systemically: The Role of Family Therapy

The initial section of this article describes the frequency with which people are exposed to various forms of traumatic stressors and the limitations of linear thinking in both assessing and treating the consequences of traumatic exposure as reported by the Institute of Medicine. The middle section of the article identifies the research and theory that supports the utility of systemic thinking and action in working with traumatised systems, especially families. The final section includes an outline of a protocol for family therapists and other systems‐informed practices to help traumatised families and other systems. A critical part of the protocol is that it meets the standards of trauma‐informed practice reflected by the Green Cross Academy of Traumatology and the International Society of Traumatic Stress Studies (ISTSS) guidelines, and the six criteria for evaluating treatment approaches. These criteria include do no harm, exposure titration control, reciprocal inhibition tuning, quantity and quantity of training, fit and fidelity and evidence of effectiveness.     

Perceived Family Functioning and Family Resources of Hong Kong Families: Implications for Social Work Practice

This article reports the results of a telephone survey (n = 1,015 respondents) that aims to identify the perceived general family functioning and family resources of Hong Kong Chinese families and their linkage to each other in a rapidly transforming society. The perceived general family functioning of the respondents was average, and the five types of family resources—time, income, human capital, psychological capital, and social capital—of the respondents ranged from average to good. The following family resource domains, in descending order, have accounted for significant variance in perceived general family functioning: income, time spent with family, stress coping efficacy, religion, and satisfaction with the living environment. Our findings provide empirical support for policy formulation and social work practice.     

The Paradoxical Effects of COVID‐19 in Italian Systemic Practice: Clinical and Teaching ‘Insights’

The COVID‐19 pandemic has impacted the personal and professional lives of all of us and has laid the bases for a social and cultural change. This article is written as a reflection on the paradoxical effects of the ‘viral phenomenon.’ We wish to highlight the opportunities and changes that have arisen from the emergency situation, especially through the use of the online setting, both in the clinical work and training activities of systemic therapists. This article is not intended to be a panegyric on the merits of digital sessions, but an appraisal, also through clinical examples, of the contributions that technology may give to our practices. We do not consider technology as a substitute, but as an integration and enrichment of the therapist's and trainer's tools. This tough experience may be transformed into an opportunity for learning new techniques and practices in which the screen becomes a useful support.