Structural, Strategic, Systemic (Milan) - all have similarities according to Heather Hayes (Re-Introduction to Family Therapy Clarification of The Schools) A.N.Z. Fam Ther 1991, Vol 12 No 1, pp 27-43.
All 'school's have similarities in how they view the emergence of a 'problem'. They see the problem emergence as synonymous with a transitional period in family life. They also see inflexibility, rigidity, old beliefs as informing a family's attempted solutions to problems, focus on present not the future, change rules/beliefs, use language to help change beliefs and pattern of interactions (e.g. relabelling or reframing), therapist adopts views of family, but with another alternative view.
Most interesting for me is that Heather Hayes suggests process is emphasised above content. This is certainly my current stance. In a service that encourage process shifts, I may be finding the observation of language (as per my current understanding of Collaborative) difficult to tap in to.
Am I then still a first order therapist? What needs to change for me to become more contemporary (second/third order)?
Firstly, I am excited at having noticed where I stand. I have alluded to hesitance to 'jump' over the many years in which FT tried to find it's feet and automatically become contemporary. Hoffman, beautifully describes her own path to being contemporary and how over time she rejected/built upon, traditional approaches to then help her own 'aha!' moments, and transition herself in to a new way of thinking.
Secondly, I have no idea if that will come for me! I am staunchly an interventionist, however I do enjoy exploring the language and beliefs of clients. Partly I am genuinely interested (nosey?) in peoples history, and partly introducing more exploration of language in to my practice. I've yet to offer an direct intervention nor be intentionally strategic.
Ok, a long way to go I know, but I'm eager to become that 'great' therapist that colleagues refer difficult cases to!
Sunday 29 January 2012
Saturday 28 January 2012
Post 9 - Feeling tired
Currently learning a new model in work which demands strict adherence to the model of the service. My role does not allow time for that so I've had to take some work home with me (including, space to digest sessions, new family's, observations, interactions, use of language etc and write up of notes, planning calendar, finding time for sessions and time for supervision etc).
So 7am-8am is taken up with work related travel, sessions and admin, yet I have MSc work that I then need to complete, think about, digest, plan, organise etc. Currently this is proving 'impossible' (used losely as I have history of invalidating other people's use of the word!).
So, starting annual leave in which I can concentrate on MSc work - I would much prefer time away or in a pub or watching DVD's, or playing football - but systemic thinking it is!!
So 7am-8am is taken up with work related travel, sessions and admin, yet I have MSc work that I then need to complete, think about, digest, plan, organise etc. Currently this is proving 'impossible' (used losely as I have history of invalidating other people's use of the word!).
So, starting annual leave in which I can concentrate on MSc work - I would much prefer time away or in a pub or watching DVD's, or playing football - but systemic thinking it is!!
Saturday 21 January 2012
Post 8: Harlene Anderson: Historical Influences
Harlene tracks some of the early influences to her post modern and collaborative way of working.
Some key points I take from this:
Some key points I take from this:
Ø Anderson practised at the Galveston group.
Ø MIT team (Multiple Impact Theory) - short term therapy in which member of the team conversed with various member of the family, sharing (never rejecting) differing opinions on illness, problem, aetiology etc.
Ø team principals around i) human creativity was boundless ii) understand differing points of view iii) team models communication
Ø Influenced by Bateson & Jackson & MRI research in to communication.
Ø interest in language was from a hermeneutic perspective and later a social constructionist perspective
Ø 'learn to speak the clients language'
o encourages therapist to be genuinely interested in clients stories
o families themselves did no have a language, no consensus was a resource
o listen differently and speak to one person at a time
o inter professional talk became language of the client
o mutual enquiry encourages clients to enquire, think about their own lives
o no longer needed intervention s ( but Anderson suggests the intervention ideas could be used as a resource)
o no longer stay behind mirror
Ø Onion Theory –
o No longer inflexible layers to systems, , therapists are part of system, not outside.
o one risk is therefore pathology is bumped up a level, pathology still encouraged.
o Systems now viewed as ecosystemic, flexible
o 'evolutionary systems' - non lineal, self-organising, self-recursive, constant state of change
o helps view process rather than change
o therapists cannot therefore have any unilateral control over a family
o System therefore seen as people convening over a relevance (i.e. a problem) which once the relevance dissolves so can the system.
How does Harlene experience collaborative as cost effective? For me, the idea of introducing first order change in a direct way, for some clients can introduce difference, or the sense of difference expediently.
Wednesday 18 January 2012
Post 7: Training
How can one begin to learn about contemporary approaches without prior rejection or accepting of other approaches? I want to remain cautious not to join in the cultural shift towards contemporary FT without practising more traditional approaches. Solution Focussed was once contemporary after all, I don;t want to reject it based on chronicity, but instead (if indeed I do) reject it based on experience of and personal application of it's core principals. Therefore, would MSc Trainees not therefore be better trained by purposely practicing all approaches? With issues of power, it feels rocky ground for me to practice approaches (say Strategic), but clinicians across time have practiced this, some felt less comfortable and therefore other new ways of thinking have emerged. I don't want to skip this transition of thinking, can I not squeeze 60 odd years of FT into 2 years?!
Post 6: Another case
Go the go ahead to case manage another case through 16-19 team. Mother and adolescent child. Initial consult (in which I have heard second hand), indicated they are in conflict in response to childs physical and social difficulties.
I don't like formulating at any stage, it feels like a game of guess who and takes for ever to pontificate about a truth that doesn't exist. If I was to humour myself, at this very very early stage (I haven't met them yet!!) then
1. Late adolescence, moving into adulthood
2. Quite restrictive disability
3. Client is disabled but able enough to function (often an usual category in which, in my experience, people are teased a little more rather than being protected due to an unfortunate disability)
4. Lifestyle decisions to be made
5. Independence, feeling the nest
I'm going to stop! I'm just commenting on every possible indicator of conflict - whats the point!
I'll save my judgements and listen to the family!
I don't like formulating at any stage, it feels like a game of guess who and takes for ever to pontificate about a truth that doesn't exist. If I was to humour myself, at this very very early stage (I haven't met them yet!!) then
1. Late adolescence, moving into adulthood
2. Quite restrictive disability
3. Client is disabled but able enough to function (often an usual category in which, in my experience, people are teased a little more rather than being protected due to an unfortunate disability)
4. Lifestyle decisions to be made
5. Independence, feeling the nest
I'm going to stop! I'm just commenting on every possible indicator of conflict - whats the point!
I'll save my judgements and listen to the family!
Post 5: Learning Models
I want to be a martyr for a moment. Having requested to case manage in a strict hierarchical service, the director has given a great opportunity and I am case managing. OK, no big deal, everyone reading this are likely to be case managing, but I perceive I have this 'junior' tag on me within my service - I run the risk this tag becomes permanent. Having worked with the senior staff for 10 years, I hope they are endeared to my development but I cannot help but think they are instead only ever viewing me as the 21 year old thrown in to the deep end of a Tier 4 fostering service. I faced it head on but rookie mistakes and a few mistakes made by inexperience and I wander how different they would view me if I walked through their door now as a 31 year old trainee FT.
Anyhow, I am now case managing one client in my service (whilst simultaneously case managing in FT clinic and having case managed in a local CAMHS setting). Part of clinican development is to learn about the 'model'. Having worked 10 years I assumed I knew it back to front and begrudgingly accepted my Outlook invite to 4 hours model training.
Through the training I was constantly introduced to new-ness. The different service provisions that the States have to offer their populations and model fidelity they expect of their clinicians. You work in a functional family therapy service as a clinician and there is no meandering off course. You assess just one population (say OCD), and assess only their OCD. You work with families and you are direct, work is time limited, phased, multi-model under same conceptual framework with a lot of weight placed on first order change.
This sounds great! It's a model that I experience having worked wanders with very stuck cases in Britain. Yet, I'm wading through mud and fumbling to excavate my own paths in family therapy and it's hard going. I need to keep the service director sweet and work just how the model depicts, and be kind to my own learning and not nail my colours to the mast too early and risk not learning contemporary models, approaches and techniques in favour of a very successful service model.
A reframe---? Perhaps I am in the ideal position to reflect, scrutinise and unpick what is your British child mental health service and what is your American model mental health service.
More to come on this!
Anyhow, I am now case managing one client in my service (whilst simultaneously case managing in FT clinic and having case managed in a local CAMHS setting). Part of clinican development is to learn about the 'model'. Having worked 10 years I assumed I knew it back to front and begrudgingly accepted my Outlook invite to 4 hours model training.
Through the training I was constantly introduced to new-ness. The different service provisions that the States have to offer their populations and model fidelity they expect of their clinicians. You work in a functional family therapy service as a clinician and there is no meandering off course. You assess just one population (say OCD), and assess only their OCD. You work with families and you are direct, work is time limited, phased, multi-model under same conceptual framework with a lot of weight placed on first order change.
This sounds great! It's a model that I experience having worked wanders with very stuck cases in Britain. Yet, I'm wading through mud and fumbling to excavate my own paths in family therapy and it's hard going. I need to keep the service director sweet and work just how the model depicts, and be kind to my own learning and not nail my colours to the mast too early and risk not learning contemporary models, approaches and techniques in favour of a very successful service model.
A reframe---? Perhaps I am in the ideal position to reflect, scrutinise and unpick what is your British child mental health service and what is your American model mental health service.
More to come on this!
Tuesday 10 January 2012
Post 4: The Milan Method - Quo vadi, Elsa Jones, Jour of Fam Ther 101: 325-338 (1988)
Notes from the article...
Ø Centro per lo Studia Della Famiglia – early publishings around 1978
Ø Group splits up (Pallazoli, Cecchin, Prata, Boscolo) circa 1984
Ø Centro Milanese per lo Studia della Famiglia – Boscolo & Cecchin teach
Ø The Nuovo Centro per lo Studia Della Famiglia
Ø Boscolo & Cechhin = co create new story through questions
Ø Stimulate a new way of thinking
Ø Palazzoli & Prata – more concerned with systemic functions that hold homeostasis. Searches for observable and classifiable patterns
Ø Schismogensis - ? something about change occurs when restraining elements are removed
Ø See Bateson 1958 – re Iatmul Tribe
Ø Original group maintain cohesion due to complimentary differences (Palazzoli energetic vs Boscolo coolness)
Ø Positive feedback which yielded more of the same behaviour created distance and change (instability, change in equilibrium) and therefore the team became further separated.
Ø Colapinto 1985 – Boscolo, Cecchin are too indifferent and will maintain status quo if remain this way
Ø Palazzoli and Prata – too authoritive, negatively connote families
Ø Exploration rather than research.
This is Elas Jones' take on the Milan team. I like the way she applies Batesonian ideas around schismogensis, complentarity, change, disequilibrium to explain how and possibly why the Milan team went different ways.
I'm not sure how others are to see the Milan team - is it assumed their differences led to a falling out? Are they in touch? Do they respect each others work? Are they in direct opposition? Either way, Elsa Jones views it in the perspective of systemic work being ever changing alla the ethos of systemic work and the team being one stepping stone amongst many.
Post 3: Cancelled Family session
These hours in clinic kills me. I'm all excited and feeling ready to go in to the systemic space and I get to hear my family have cancelled. Fair reason and a family I feel can be easily rearranged. I therefore have to find an exercise to do with my colleagues.
Last week the same happend. I used 4 descriptions of questions (Reflexive, Linear, Strategic and Circular) as proposed by Karl Tomm *. I asked my group to role play my family and spent approx 15 minutes thinking as a Lineal purist, a Reflexive purist etc. The exercise went down well, so this week how do I trump it??
In fact we did a new exercise. Polarise "Agree" & " Disagree" - using labels on the floor. Then pick out statements from a pack of cards e.g. "Arranged marriages have greater success" and place where on the scale you fit - Disagree, Agree or somewhere in between. Each discuss, differ, argue for/against and just introduce the sense that its good to thrash out differences. The exercise was done warm heartedly and it got the old grey matter working.
* Interventive Interviewing: Part 111. Intending to Ask Lineal, Circular, Strategic or Reflexive Questions? Fam Poc 27:1-15 1988
* The effect of Tomm's Therapeutic Questioning Styles on Therapeutic Alliance: A Clinical Analog Study. Fam Process 37: 189 -200, 1998. Dozier, Hicks, Cornille, Peterson
Last week the same happend. I used 4 descriptions of questions (Reflexive, Linear, Strategic and Circular) as proposed by Karl Tomm *. I asked my group to role play my family and spent approx 15 minutes thinking as a Lineal purist, a Reflexive purist etc. The exercise went down well, so this week how do I trump it??
In fact we did a new exercise. Polarise "Agree" & " Disagree" - using labels on the floor. Then pick out statements from a pack of cards e.g. "Arranged marriages have greater success" and place where on the scale you fit - Disagree, Agree or somewhere in between. Each discuss, differ, argue for/against and just introduce the sense that its good to thrash out differences. The exercise was done warm heartedly and it got the old grey matter working.
* Interventive Interviewing: Part 111. Intending to Ask Lineal, Circular, Strategic or Reflexive Questions? Fam Poc 27:1-15 1988
* The effect of Tomm's Therapeutic Questioning Styles on Therapeutic Alliance: A Clinical Analog Study. Fam Process 37: 189 -200, 1998. Dozier, Hicks, Cornille, Peterson
Saturday 7 January 2012
The cybernetics of physical illness. Barry Dym. Fam Proc 26: 35,48 1987
Based on General Systems Theory, Batesonian ideas of systems and feedback loops. I've just finished reading this paper as part of an online exam I have.
I understand the basis gist being - a medical model considering only causal and effects of a symptom is too linear, one must consider biopsychosocial impacts and recursive cycles.
However some points I wanted to explore
1. What does equipotentiality of functions mean? I understand it to mean, in the context of systemic thinking, that one action, say the behaviour of one person, can be replaced by the similar behaviour of someone else, thus maintain the status quo. An anxious Dad of a child with ME who gets distracted by his dying father, may then be replaced by an anxious Mum.
2. This paper made me think about 'symptoms'. Once we try and remove a physical symptom, according to Dym theory, then potentially a recursive pattern of family interaction remain. Having 'outcome measures' and specific symptom screening tools are perhaps only indicators of the symptom and by applying this theory, as family therapists how would we formulate or identify other areas of measurement? How would one know when the recursive pattern has ceased for an appropriate amount of time?
3. Some of the interventions Dym hints at seem quite strategic and paradoxical. The theory is a useful framework of which I will try and make use of, though unsure how strategic I will be with it. How about being strategic and open with this? A new way of introducing paradox and strategic work which has, in the past yielded great examples of success (see Hoffman, an Intimate Portrayal, page 13-14 where she gives examples from Erikson and Haley).
4. This is making me think about current cases I have now. I may be consciously focused on eradicating the symptom (albeit not physical in one case, and in another a physical symptom is present). So scanning the entire field may be of use in my practice.
5. Dym may have been talking about Externalisation to some extent when he talks about separating the symptom from the cycle in which it's embedded. At the same time he is careful not to give the impression that the symptom is then seen in isolation - the latter being different from my understanding of externalising.
I understand the basis gist being - a medical model considering only causal and effects of a symptom is too linear, one must consider biopsychosocial impacts and recursive cycles.
However some points I wanted to explore
1. What does equipotentiality of functions mean? I understand it to mean, in the context of systemic thinking, that one action, say the behaviour of one person, can be replaced by the similar behaviour of someone else, thus maintain the status quo. An anxious Dad of a child with ME who gets distracted by his dying father, may then be replaced by an anxious Mum.
2. This paper made me think about 'symptoms'. Once we try and remove a physical symptom, according to Dym theory, then potentially a recursive pattern of family interaction remain. Having 'outcome measures' and specific symptom screening tools are perhaps only indicators of the symptom and by applying this theory, as family therapists how would we formulate or identify other areas of measurement? How would one know when the recursive pattern has ceased for an appropriate amount of time?
3. Some of the interventions Dym hints at seem quite strategic and paradoxical. The theory is a useful framework of which I will try and make use of, though unsure how strategic I will be with it. How about being strategic and open with this? A new way of introducing paradox and strategic work which has, in the past yielded great examples of success (see Hoffman, an Intimate Portrayal, page 13-14 where she gives examples from Erikson and Haley).
4. This is making me think about current cases I have now. I may be consciously focused on eradicating the symptom (albeit not physical in one case, and in another a physical symptom is present). So scanning the entire field may be of use in my practice.
5. Dym may have been talking about Externalisation to some extent when he talks about separating the symptom from the cycle in which it's embedded. At the same time he is careful not to give the impression that the symptom is then seen in isolation - the latter being different from my understanding of externalising.
Friday 6 January 2012
first post
I'm four months in to training as a systemic family therapist. I'm studying at Leeds University, England. I wanted to share my experiences, the ups and the downs, the struggles and acheivements of training. I feel its one way to also get my thoughts and reflections down on 'paper', and hopefully chew the fat with other trainees across the globe.
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