Systemic Psychotherapy

This paper will explore the work of members of community learning Disability
Services in attempting to support care organisations to work effectively with
those they serve. Systemic practice has been increasingly recognised as
potentially useful in working with the systems of relationships that from the
context of the lives of men and women with learning disabilities. (See for
example Baum & Lynggaard (eds.), (2006); Jenkins & Parry (2006); Haydon, M.
& Elliott, N. (2004) as well as consulting with organisations more generally
(Campbell, 2000, Cecchin & Stratton, 1991). We will begin by exploring the term
‘systemic’ and what it might mean to work systemically.

In this paper we describe some of the systemic practices used in our Community Learning Disability Teams (CLDT’s). Systemic, social constructionist approaches guide practice away from the imposition of clinician-led professional knowledge toward the valuing of the complexity of local contexts and to practices of collaboration with those seeking the assistance of specialist learning disability services. We describe a plurality of practices that are at once highly valued for their brevity, effectiveness and client satisfaction and also create space for political challenges, namely, to internalising, disabling understandings of people with learning disabilities and their relational networks.

I shall present training as a nomadic experience. In the first part I shall develop some issues coming from Heinz von Foerster (1972), Humberto Maturana and Francisco Varela (1980). In particular, ideas concerning education and instruction, questioning whether to abandon the concept of information, using, instead of it, the word perturbation, or a denotative-extensive versus connotative-intensive approach to learning. Later, I analyze the Loman family (in Arthur Miller's play Death of a Salesman) to give the reader an idea of what I mean by intensive analysis. In the final part I shall write about Nomadism in the usual context of training abroad; when the trainers go to teach new techniques of therapy with no regard and respect to the soil on which they walk, the historical context, ways of living, and the competences they discover there; in other words, colonialism.

La presente investigación tuvo como propósito caracterizar la práctica clínica sistémica de trabajadores/as sociales y psicólogos/as que ejercen en contextos públicos de salud mental y programas psicosociales vigentes en el país. La finalidad del estudio radicó en conocer las tensiones micropolíticas del sistema público y las alternativas de resistencia por parte de los/as profesionales, explorando los eventos poéticos que los humanizan y sensibilizan en su relación terapéutica en estos dispositivos de intervención. Para llevar a cabo estos planteamientos se realizó entrevistas en profundidad a profesionales adscritos a una práctica clínica sistémica crítica y que se encontraban ejerciendo en dichos contextos laborales. Lo central fue conocer su experiencia clínica sistémica y sus subjetividades encarnadas a dichos escenarios de intervención con sistemas humanos. Se llevó a cabo un análisis interpretativo del texto de las entrevistas y de los insumos estéticos-literarios vinculados a la imaginación reflexiva personal, intentando triangular las voces de los/as entrevistados/as con las teorías y opinión del investigador, visualizando los aspectos favorables y los nudos problemáticos del contexto clínico de intervención. La necesidad de realizar dicho estudio reflejó la posibilidad de iniciar un diálogo teórico-práctico que permitió vislumbrar proposiciones y conceptualizaciones para una práctica clínica sistémica acorde a los requerimientos del sistema público en contextos de salud mental y programas psicosociales, para posteriormente proponer consideraciones teórico-metodológicas que contribuyan a dichos escenarios vinculados mayoritariamente al trabajo con población en situación de vulnerabilidad y exclusión social.

This paper troubles the concept of single autism spectrum. We discuss how the ideology from early medical theory has influenced the conceptualisation of autistic people, professional diagnostic practice and an aspiration to “cure” people of their autistic selves. We critique the idea of a single spectrum and propose alternative appreciations of autistic people as having diverse identities and community memberships, as people who are living fluid, intersectional lives over many axes and different contexts. Multi-Spectra Living problematises the story of autistic people as primarily or only autistic and proposes autistic people are fluid, contextually influenced and contextually responsive.
We offer an elaboration on intersectionality by explaining how the practice of splintersectionality foregrounds one characteristic over another to reinforce existing professional and everyday prejudice resulting in social and statutory failures to autistic people. We extend the work of Pillow (2019) to discuss how lenticularity, decolonial attitude and epistemic witnessing can support the development of decolonial practice of Multi-Spectra Living.

L'articolo contiene la proposta di un modello di lettura dell’agire terapeutico che cerca di essere congruente con i principi epistemologici della psicoterapia sistemica secondo il "Milan Model" (sviluppato da Luigi Boscolo e Gianfranco Cecchin).

Mind Alone For many years psychoanalysis and psychoanalytic psychotherapy was singularly centered on the unconscious mind and conscious mind. There was only mind and the mind could become aware of its own self and its own representational realm. The self itself was representational and the emphasis on the mind was in the light of analytic thinking and analytic observation. There was an emphasis on objectification of mental phenomena and subjectivity itself. Knowing was knowledge by association, by reflection and mediation by linguistic signifiers. Knowing was neither non-conceptual nor pre-reflective, nor was there a place for direct experiential knowingness. Knowing was associated as mind alone and singular mind functions such as thinking, feeling, sensation, memory and imagination. Transitional Space as Space of Awareness With the presentation of the work of Donald Winnicott there was a shift in the psychoanalytic understanding of knowingness. A similar change in psychoanalytic thinking about knowing was also taking place in the Jungian and archetypal analytic schools. In psychotherapy Winnicott emphasizes a focus on the suspension of mind and in the process of suspension of mind, awareness was freed to focus within awareness, free to focus itself on itself. In the suspension of mind (a Winnicottian form of the phenomenological reduction,) the patient relocates themselves. The patient relocates from being located in mind alone or even located in a particular function of mind alone such as: feeling function or thinking function or sensation function or memory function; the patient enters or relocates themselves into the intermediate area of experience. This intermediate area of experience or this in-between space of experience is also described as the transitional area of experience and relatedness. Sometime this place is also described as the place of potential space. The sense of self shifts from being located in the mind or mental function of the mind into the more embodied sense of spacious awareness or as the place of potential space. Winnicott would described this knowing

The main aim of this study is to explore the breadth of the inference field and the type of etiopathogenetic contents of symptom explanations provided by the client and therapist in the first two psychotherapy sessions conducted using a systemic approach. Does the therapist use triadic explanations of psychopathology as suggested by her approach? And do clients resort almost exclusively to monadic and dyadic explanations as did the university students in our previous study? What kind of explanations do they propose? The coding system "1 to 3: from the monad to the triad" was applied to the transcripts of 25 individual systemic therapies conducted by the same therapist. This manual allows coding of the inference field of symptom explanations according to three categories: monadic, dyadic, and triadic. These three broad categories are also used to analyze the etiopathogenetic content of each explanation: traumatic, intrapersonal, and interpersonal. Our findings showed that clients and their therapist actually used different inference fields: clients resorted almost exclusively to monadic and dyadic explanations, whereas their therapist included the triadic explanatory level. Moreover, the therapist provided more interpersonal explanations than her clients. Hence, the dissonance between client and therapist about the inference fields-a crucial premise of one of the most accepted ideas of therapeutic change according to systemic therapies-is proven, at least among our participants. Thanks to this dissonance, clients and therapists can create a new story, potentially able to change clients' feelings, without disconfirming their emotions.

Background: People coming to therapy as part of their recovery from torture may choose not to speak or write about their experiences, yet the process of seeking asylum requires that they must hand over their life stories for a true–false adjudication with potentially life and death consequences. When people have been silenced and speaking has become dangerous, there are major ethical challenges for the activist practitioner who, along with the person who has experienced torture, sees the importance of stories not only being understood and shared in ways which are factual but which contain truth. Methods: I share my experiments with writing as a form of inquiry, specifically ghostwriting and ventriloquation. Findings: These have the effects of (1) moving the therapeutic process into a collaborative inquiry between the client, an asylum seeker, and me as both counsellor and expert witness; (2) letting fictionalised tellings of 'real life' reveal the hidden and complex life stories of clients and counsellors and (3) sharing stories which would otherwise remain hidden and risk perpetuating oppressive practices. Implications for practice: Ghostwriting and ventriloquation offer the practitioner-researcher ways of speaking from a first-person position, from 'within' experience rather than a distanced 'about-ness' position. In this dialogical writing, I use actual and imagined inner and outer voices to enable the sound of talk and thought to be reflexively and empathically heard and felt by readers. Relational ethics are considered in how to imagine the other and manage ownership of stories without reproducing oppressive practices.

Blaming events in therapy were used as a focus for discussions with family therapists in order to examine their construal of the therapeutic process when working with families who blame. Interview transcripts were used as data which were analysed using a qualitative methodology, with a view to building a theoretical model. We present an exploratory model that allows therapists to position their therapy within a broader framework of psychological approaches. When prompted by a video-clip of blaming from the therapy setting, therapists tended to categorize current difficulties in terms of fear and control issues from past relationships and consequent underlying beliefs, and they also described the resultant negative outlook as a direct challenge to therapist idealism. Interestingly, the two themes that emerged from the interview data with the most categories and quotes were ‘unhealthy allocation of responsibility for problems’, which is arguably the main source of overt blaming, and ‘family identity and cohesion’, so often a point of contention during therapy.

The aim of this study was to further understanding of blame in systemic therapy. Five families were chosen by their therapeutic team as engaging in blaming of a kind that the therapists found difficult to work with. Couples from each of the five families participated. A video extract from therapy identified by therapists as typifying blaming within the family was used as a focus for semistructured interviews with each parent. Transcripts were analyzed according to the procedures of grounded theory. On the basis of this inductive qualitative analysis, a framework of understanding emerged from the data consisting of the core category, “dialectical understanding,” and an accompanying set of overarching themes. These themes capture the way in which participants oscillated among 13 dialecics in their discussion of blame within their family and within family therapy. The model provides a framework for analyzing the style and content of therapy conversations with a view to helping therapists facilitate therapeutic change in this difficult client group.

Abstract
This paper investigates a new application of the Internalised-Other Interview (Tomm, 1993). Internalised-Other Interviews have been used for increasing empathy (Burnham, 2000), for creating dialogue (Lysack, 2002), as a way of entering the culture of a person (Pare, 2001) and from within an object relations framework (Hurley, 2006). This paper explores the use of the Internalised-Other Interview for conversations where the referred person is not present. Such people may be at risk of being understood by family members, staff, and others in the community in narrow, monological and problem-saturated ways. Such people may include those with severe intellectual disabilities (ID); those with challenging behaviours; and those with high communicative support needs. The paper discusses an illustrative vignette based on using the Internalised-Other Interview with residential staff supporting people with ID. We have found that Internalised-Other Interview can be powerful in supporting people, family members, support staff, professionals and others in a person’s network to help them into the experience of a person who they might otherwise be struggling to understand. Internalised-other interviews invite attention to the voices of, and positions occupied by, people at risk of being either unheard or understood only in superficial, clinical, problem-saturated and ‘othered’ ways. The Internalised-Other Interview is particularly useful when working with referrals for individuals where proxies may be required to provide communication support.

Current evidence suggests that up to 20% of Irish adolescents have significant behavioural problems, a figure consistent with results of epidemiological studies of youth mental health problems in other countries. Functional Family Therapy (FFT) has consistently been identified in authoritative international reviews as a family-therapy programme for treating adolescents at risk for juvenile delinquency with a particularly strong evidence-base including many controlled trials, and a well developed training and monitoring system for implementing FFT in new community-based sites. Between 2010 and 2014, a research programme to evaluate the effectiveness and implementation of FFT at Archways Families First was conducted by a research team at University College Dublin, in collaboration with Indiana University, and the team of FFT therapists at Archways Families First. The results of this programme, described in this summary report, provide strong support for the effectiveness of FFT as practiced at Archways Families First in reducing behaviour problems and the risk of juvenile delinquency.

This paper contends that the systemic approach can be useful in working with adults
with intellectual disabilities and their relational network, including paid care services.
A practice example using a systemic approach with a man with intellectual
disabilities and his paid supporters showed a movement from an internal description
of the problem as existing in the man with intellectual disabilities to a focus on
coordinating the relationship between the man and his paid supporters. The authors
argue for the utility of the systemic approach in working with those who live and workin services for people with intellectual disabilities and who may not have had access
to these kinds of conversation in the past.

This article tells a dialogical story and describes a process of mutual learning and embodiment over the course of a long therapeutic relationship. The article maps the development of relationship, between my inner voices, my supervisors and those of my client, where stories of self and other are articulated, elaborated and externalised using the metaphor of a "bundle of treasures". A self-reflexive process of personal and professional mapping, using the hierarchical model of the Coordinated Management of Meaning, is described. In a recursive and isomorphic process, supervisory and therapeutic conversations further elaborate these stories, and through joint action, enable the creation of a liminal, reflexive space, a Fifth Province position, a cauldron of creativity where practice-based theory can develop. This process will be illustrated as it arises in the story of relationship and the process of therapy, so this narrative invites the reader to become an active participant in a never-ending process where theory becomes a live metaphor in the quest for being human.

"I work a part of my week in a number of community learning disability teams. I undertake family therapy and systemic practice of
various kinds including with the staff and management of support services. Th e remainder of my week, I work as a lecturer at the
University of Portsmouth. Th is paper explores some ideas about disablement and some of my experiences of working systemically
in services for adults with learning disabilities."

Riassunto
La formazione in psicoterapia è intrinsecamente modellata dal nostro modo di pensare all’essere umano. Che cosa, nell'esistenza umana, ci espone alla (psico)patologia? Cosa può essere considerato benefico e trasformativo nello scambio terapeutico? E analogamente quale atteggiamento nella formazione, così come nella terapia, potrebbe essere più umano?
Facendo riferimento al pensiero fenomenologico, gli autori esaminano lo statuto singolare attorno al quale ruotano la psicopatologia e la terapia: il fenomeno patico. Il "patico" si riferisce alla multiforme vulnerabilità che contraddistingue la nostra condizione umana e che segna anche la nostra apertura, la nostra fondamentale sensibilità a ciò che accade nell'incontro. La dimensione patica della malattia – più che i sintomi – costituisce la realtà immediata e pregnante per il paziente.
La terapia può essere definita come un movimento intersoggettivo di incontro, di comune cammino e di scambio, dove il terapeuta mette le sue conoscenze teoriche, il suo saper fare e la sua presenza al servizio della persona in cura, per tendere ad uno stare meglio con se stesso, con gli altri e nel mondo.
Allo stesso modo, la formazione è chiamata a realizzare un incontro trasformativo tra formatori e studenti. La formazione in psicoterapia si baserebbe su questa iniziazione viva e pensante alla condizione umana: alla sua fondamentale natura “patica”, segnata dalla possibilità sia della perdizione e dell'annientamento, che della fiducia e del compimento.
Nel suo cammino, l’allievo deve poter contare non solo sull’esperienza, ma anche sulla relazione con formatori impegnati che lo sostengono e lo guidano, e sulla solidarietà attiva, sullo spirito cooperativo del gruppo dei compagni per affrontare il ‘meraviglioso’ e lo ‘sconcertante’ dell'incontro con il pathos.

The main aim of this study is to explore the breadth of the inference field and the type of etiopathogenetic contents of symptom explanations provided by the client and therapist in the first two psychotherapy sessions conducted using a systemic approach. Does the therapist use triadic explanations of psychopathology as suggested by her approach? And do clients resort almost exclusively to monadic and dyadic explanations as did the university students in our previous study? What kind of explanations do they propose? The coding system "1 to 3: from the monad to the triad" was applied to the transcripts of 25 individual systemic therapies conducted by the same therapist. This manual allows coding of the inference field of symptom explanations according to three categories: monadic, dyadic, and triadic. These three broad categories are also used to analyze the etiopathogenetic content of each explanation: traumatic, intrapersonal, and interpersonal. Our findings showed that clients and their therapist actually used different inference fields: clients resorted almost exclusively to monadic and dyadic explanations, whereas their therapist included the triadic explanatory level. Moreover, the therapist provided more interpersonal explanations than her clients. Hence, the dissonance between client and therapist about the inference fields-a crucial premise of one of the most accepted ideas of therapeutic change according to systemic therapies-is proven, at least among our participants. Thanks to this dissonance, clients and therapists can create a new story, potentially able to change clients' feelings, without disconfirming their emotions.

Psychotherapy has never been under such scrutiny. NHS and voluntary agencies have changed what they offer to tick the criteria of ‘evidence-based practice’ as conceptualised through the NICE Guidelines and ‘Skills for Health’ to win funding and ensure survival. Ideas of ‘illness’ and ‘cure’ provide impossible goals, forcing organisations to constantly reinvent what they offer to mask their lack. Training programmes shape themselves to fit what the HPCP appears to demand of them, skewing the perspective of new generations of shrinks. In reaction to this, we must be careful not to retreat to the ghetto of private practice, glorifying an ideal of what once was. For, despite the odd low cost or outreach scheme, psychotherapy as a discipline has failed to deconstruct some of the societal ideas and material realities which have kept it a space for the liberal and middle classes. I will argue that the need to teach new generations the ability to deconstruct ideas of ‘evidence base’, ‘illness’ and ‘cure’ allows us a great opportunity to trouble ideas and practices which have long operated at a societal and organisational level. Further, the ability to confidently ward off colonising discourses is an attractive one to services and practitioners who soon realise the latest configuration of what to offer is necessarily lacking.