Family Therapy Skills and Techniques in Action

Mark Rivett, Joanne Buchmüller

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317542247
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Please watch the following short video advertisement for the book, featuring the Editors: https://www.youtube.com/watch?v=N1ApHAQIMzQ&feature=youtu.be

Relationships are a resource for healing a range of psychological difficulties. This is the fundamental principle of family therapy, an increasingly influential form of psychotherapy that is building up a strong evidence base in a range of psychological problems across the life cycle. Family T herapy Skills and Techniques in Action is both a guide to a variety of family therapy techniques and a review of their history. It provides a thorough explanation of the techniques, explaining their origins and use in contemporary family practice, whilst guiding readers in learning new skills. The authors provide film examples and transcripts of the techniques in action so that readers can develop their skills in a practical way.

The book is divided into sections that describe and demonstrate skills such as:

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• Assessing a family;

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• Building a therapeutic relationship with multiple family members;

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• Enactment;

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• Reframing;

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• Using circular questions;

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• 'Externalising' the problem;

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• Using family therapy skills in individual work;

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• Understanding and utilising systemic supervision.

Family Therapy Skills and Techniques in Action will be an essential practical manual for a range of family therapy skills which can be used in family work by family practitioners from a variety of backgrounds: counsellors, support workers, social workers, psychologists, generic therapists and nurses.

Chapter 1

Introduction

Setting the scene

Psychotherapy and counselling have always had a private, if not secretive, aura about them. This may be in part because they have some historical connection to the act of religious confession, where only the priest and God know what is divulged. However, in an era of professional accountability, democratic openness and the widening of access to psychological therapies, such secretive patterns seem somewhat outdated. Historically, family therapy has ‘bucked’ this secretive trend with various pioneers demonstrating their work by conducting ‘live’ sessions with families. However, although family therapists were once happy to show how they worked by showing film clips of their therapy sessions, rules about confidentiality and respect for the privacy of families have curtailed this activity. Thus, if counsellors, social workers, mental health nurses, clinical psychologists and even beginning family therapists want to learn about ‘what family therapy looks in practice’, they have to fall back on verbatim transcripts or theory laden papers.

This book is a response to this context. We aim to show readers what family therapy looks like so that they can learn how to put it into practice. The written text is only half of the product: Chapters 3 to 10 are presented with a film that demonstrates a skill and method outlined in the text. In our experience, this is what practitioners want. The film and the text are two sides of one coin. Because of this emphasis, the book is a practical resource for all those who work with families.

On a broader level, the book highlights and examines the skills and techniques that family therapy has brought into the world of psychotherapy. What we have chosen to do is to take a defining ‘technique’ from a number of family therapy schools and demonstrate it both in print (including film transcripts) and in film. We have therefore dissected the range of family therapies and the techniques from those schools into isolated, bite-sized examples. We are well aware that this way of presenting the skills could be seen as reductionist. It seems to presume that ‘all’ each school provided was the one skill we choose to emphasise in the film. This is obviously not what we want to achieve. We hope the more rounded description in the chapters will go some way towards reducing this risk. We also hope that our zeal for these schools of family therapy transmits itself to the reader, and the music of family therapy guides him or her back to the original ideas and thus see how complex and innovative the approaches are.

Despite these reservations, there are a number of reasons why we feel it is important to return to these skills in the contemporary world. Some of these are to do with the external context within which all the psychotherapies function. Other reasons are connected to internal contexts.

An external reason is that these skills are all around us: adopted by other psychotherapies (and sometimes forgotten by family therapists). But such adoption often misses the context, or the deeper skill implicit in the initial description of the technique. For instance, ‘reframing’ was originally developed within Strategic Family Therapy (Chapter 6) but has been adapted by many other psychotherapies. In its original version, it included the idea of gradual reframing – this has been lost within these other adaptations. We use the film to demonstrate an example of this gradual reframing.

Another external reason for such a pragmatic approach to teaching family therapy skills is that evidence-based practice has introduced an integrative model of family therapy, which we discuss in Chapter 4. This model embeds family therapy techniques in such a way that it can be difficult to extract them, to discern them and to emphasise them. Students learning these models therefore need help in seeing these techniques in action so that they can themselves develop those skills and apply them in practice.

A last reason is that psychological therapies have been undergoing something of a renaissance with various attempts to widen access to them in populations that have traditionally been excluded. Family therapy has been central in this development especially within children’s services because of its established evidence base. There is, therefore, a hunger for the transmission of family therapy skills within parenting programmes, cognitive behavioural training and in children and young persons’ mental health (e.g. www.minded.org.uk/). These new students want practical skills rather than elite trainings for the select few.

There are a number of internal reasons for a pragmatic approach to teaching and learning family therapy skills. One is to challenge the traditionally complex theories with which family therapists are so enamoured, which may be fascinating but rarely contribute to accessibility for trainees or newcomers. For instance, the more obscure aspects of social constructionism (see Chapters 2 and 7) do not help a family-based support worker faced with an angry parent, where reframing (Chapter 6) or enactment (Chapter 5) might. An equally potent reason for this book’s emphasis is the way that family therapists are trained in the contemporary world. Family therapists used to train their students by supervising them in a live context. This involved a number of ways in which the supervisor could guide the therapist in vivo during a session. One of the authors (Mark Rivett), for instance, worked with an ear bug in his ear so that he could hear a running commentary on the therapy session from his supervisor who was observing from behind a one-way screen. This traditional way of training has declined because of the influence of collaborative approaches and ‘reflective teamwork’ (see Chapter 10). Thus, it is rare for family therapists to examine their own skills in this ‘dissected’ way.

Fact box

In vivo relates to an event, which takes place in real time, in real world conditions. Here it refers to a supervisee being supervised whilst they work with a family.

Despite these valuable reasons for presenting family therapy skills in this way, we also recognise there are some major pitfalls. The first is that often a film comes to represent something that it is not necessarily intended to represent. As therapists, we have had to come to terms with our anxiety about how the films will be received both within the family therapy world and within the broader counselling or psychotherapy world. We need therefore to presage our ‘embodied’ work with a caveat of humility. These films of family therapy practice are offerings that aim to stimulate discussion, practice and constructive analysis. They are not meant to be perfect examples of ‘how to do it’ but are rather catalysts for ‘how could I have done it better?’ The films, in this sense, are a challenge to the reader or watcher. They are not meant to be a finished product despite a process that implies that they are. It is, after all, the great reward of a teacher to have a student who surpasses his or her own competency.

In this context, it is important to explain how the films were made. Over a period of two days, a group of actors met the authors of this volume and created families for us to work with. Each scenario had a basic script to orientate actors and therapists, but very quickly the sessions came to rely on improvised dialogue. Such a way of producing clinical films obviously does not fully re-create clinical practice. For instance, ‘in real life’ the therapists would not be so persistent, nor would they ‘only’ work with one technique at a time. Equally, all clinical practice needs to attend robustly to questions about risk, safety and duty of care, which is not demonstrated in these films. However, at times, as the sessions proceeded, a quality of reality did descend in the room, which shows that these are valuable and applicable skills in the everyday reality of clinical work with families.

This book is designed with students and clinicians who have not experienced a ‘mentoring’ or ‘apprenticeship’ in family therapy. It is designed for use in social work training, counselling courses and the recent Children and Young People’s Increasing Access to Psychological Therapies (CYP-IAPT) courses. However, we are aware that students who have already completed some family therapy training will notice a gap. There is little representation from the social constructionist or dialogical forms of family therapy. Although the influence of these schools of family therapy is strong in Chapter 7 and Chapter 10, we have not given them a stand-alone chapter. There are at least two reasons for this. One is that these schools of family therapy (which are particularly popular in Europe and the UK) have purposefully not emphasised ‘techniques’ because such an approach is ­contradictory to their philosophy. This makes them very difficult to demonstrate in a short 15 to 20 minute film. The second reason is that the evidence-based integrative models rarely explicitly refer to these more philosophical, amorphous and hard to encapsulate approaches. Because this book has a pragmatic focus – we want to help readers develop their clinical skills – we have chosen not to elaborate these ideas. We do, however, hope that this book will stimulate enthusiasm that will encourage readers to explore the world of family therapy, and lead them to other approaches that are not foregrounded in this book.

Orientation to the book and films

As we have said, the text of the book needs to be read while accessing the accompanying film. Transcripts of the films are included chapter by chapter, but we would recommend watching the session, if possible. Each film can be accessed using the eResources tab on the webpage for the book, which can be found on the Routledge website: www.routledge.com/9781138831438. Like real-life clinical practice, the book takes the reader through a series of encounters with two different families. Details of the families are provided at the end of this chapter. Chapter 2 establishes the underlying metaphor for family therapy. Although this is a short chapter, it is probably the most important one in the book. Chapter 3 gives a thorough description of how assessment works in family therapy. The film that accompanies it provides one example of how the therapist (Mark Rivett) expanded the assessment with the family. Chapter 4 explores integrative family therapy practice with an emphasis on the therapeutic alliance in family therapy and on how to engage family members in a joint endeavour to improve family life. The film that accompanies it shows the therapist (Mark Rivett) ‘talking about talking’ with the family. This chapter is crucial because, paradoxically, the rest of the book unpicks the contributions of specific models to help the reader learn them. The paradox is that Chapter 4 more closely represents contemporary family therapy practice rather than the more numerous other chapters. Chapters 5, 6, 7 and 8 concentrate on particular schools of family therapy and their films show (usually) one of the techniques that have been bequeathed by that school. Chapter 9 takes the techniques already discussed into work with individuals. The last chapter (Chapter 10) expands on how a systemic understanding can be used in supervision and reflective clinical practice. Each chapter has a quality of being independent from the others; although in a truly systemic way, ‘the whole is greater than the sum of its parts’. Readers can choose to develop their skills chapter by chapter. Each chapter begins with a summary of the key points of theory to help the reader locate subject areas of interest. Throughout the chapters you will find ‘Fact’ boxes and ‘Task’ boxes. Fact boxes explain the context of key parts of the text – our aim is that they will conveniently inform the reader as they progress through each chapter. Task boxes direct the reader to expand their learning experientiall...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Dedication
• Contents
• Acknowledgements
• Preface
• 1 Introduction
• 2 Family therapy: Listening to the orchestra
• 3 Assessment: Finding out what we need to know
• 4 Integrative family therapy: A contemporary practice
• 5 Structural family therapy: Creating a new dance with families
• 6 Strategic family therapy: Making language therapeutic
• 7 The Milan and Post-Milan approach: Changing rules and meanings in family life
• 8 Narrative therapy Interpreting the story
• 9 Working systemically with individuals: Opening up a different view
• 10 Systemic supervision: Reflective practice to enhance outcomes
• Epilogue: destination or starting point?
• Index