The therapist should consider inviting all members of the household and any other important family members mentioned by the referral source. Recent life events should be taken into account when deciding attendance. Further information may be needed from the referral source to help determine who to invite. Safety and individual well-being should be prioritized.
This document provides an overview of family therapy. It begins by defining family therapy as a therapeutic modality focused on interactions within a nuclear or extended family system with the goal of alleviating problems initially presented by individual members or the family as a whole. It then discusses key aspects of family therapy including that it typically involves 10-20 sessions, can be conducted in various settings, and works to change family interactions and structure. The document also summarizes different types of family therapy models including family systems therapy, structural family therapy, and functional family therapy. It provides details on functional family therapy including its goals, techniques, phases of intervention, and focus on risk and protective factors. Finally, it outlines the key concepts and goals of structural family therapy
The document provides an overview of family therapy. It discusses the origins of family therapy after World War II to address issues arising from loss. Several types of family therapy are mentioned, including systems theory developed by Murray Bowen, structural family therapy by Salvador Minuchin, and strategic family therapy by Jay Haley. Common reasons for seeking family therapy include child issues, trauma, divorce, and domestic violence. Key concepts in systems and structural family therapy are also outlined such as feedback loops, homeostasis, family structure, subsystems, and boundaries.
System theory views social systems like families as interconnected groups that influence each other. It was developed in the 1950s and challenged individual explanations for problems by looking at relationship dynamics within families. Family therapy uses systems theory to understand how changing one part of a family impacts others. There are different approaches like structural and strategic family therapy. The family lifecycle identifies developmental tasks at each stage, and transitions between stages can cause stress. Systems theory informs social work practices like family assessments and decisions about child welfare. It also emphasizes understanding each family's cultural context rather than stereotypes.
This document provides an overview of family therapy. It discusses key concepts in family systems theory such as viewing problems in their interpersonal context and treating the family relationship system rather than individuals. The goals of family therapy are described as exploring family dynamics and psychopathology, mobilizing family strengths, restructuring interactions, and strengthening problem-solving. Several models of family therapy are summarized, including structural family therapy, strategic family therapy, and systemic family therapy. Techniques used in different models like enactment, joining, and reframing are also outlined.
Family therapy views psychological disturbances in their family context. The goals are to explore family interaction dynamics, mobilize family strengths, restructure maladaptive styles, and strengthen problem-solving. Family therapy emerged in the 1950s as therapists explored family dynamics and found that some patients regressed after individual treatment returned home. Structural family therapy, developed by Salvador Minuchin, analyzes relationships within a family system. It aims to transform dysfunctional homeostasis by restructuring boundaries, alliances, and hierarchies through techniques like enactment and intensity regulation.
The Milan approach focuses on viewing problems systemically and seeing how symptoms maintain family homeostasis. The therapist aims to help the family recognize how problems serve certain functions for the family system through circular questioning and other indirect interventions. Key techniques include hypothesizing family dynamics based on initial information, maintaining neutrality, and reframing problems and behaviors in a positive light to facilitate change in how the family views and interacts with each other. The goal is for the whole family to change their patterns rather than blaming individuals.
The Milan school of family therapy developed an approach based on systems theory and complexity. Key aspects included circular questioning to challenge problem maintaining beliefs, end of session interventions like paradoxes and rituals, and a team approach with co-therapists. The goal was to alter family interaction patterns and beliefs supporting problems like schizophrenia. Over time the Milan school split into more strategic and non-directive branches but both retained a focus on flexibility, feedback and challenging existing family constructs.
This document outlines several schools of family therapy, including psychodynamic, behavioral, strategic, Milan's systemic, and solution-focused approaches. It describes key concepts and therapeutic techniques for each approach. For example, behavioral family therapy applies principles of behaviorism to change family interactions, while strategic family therapy uses indirect techniques like reframing and paradoxical interventions. The document also discusses integrative approaches that combine concepts and strategies from different schools of family therapy.
This document provides an overview of family therapy. It begins by defining family therapy as a therapeutic modality focused on interactions within a nuclear or extended family system with the goal of alleviating problems initially presented by individual members or the family as a whole. It then discusses key aspects of family therapy including that it typically involves 10-20 sessions, can be conducted in various settings, and works to change family interactions and structure. The document also summarizes different types of family therapy models including family systems therapy, structural family therapy, and functional family therapy. It provides details on functional family therapy including its goals, techniques, phases of intervention, and focus on risk and protective factors. Finally, it outlines the key concepts and goals of structural family therapy
The document provides an overview of family therapy. It discusses the origins of family therapy after World War II to address issues arising from loss. Several types of family therapy are mentioned, including systems theory developed by Murray Bowen, structural family therapy by Salvador Minuchin, and strategic family therapy by Jay Haley. Common reasons for seeking family therapy include child issues, trauma, divorce, and domestic violence. Key concepts in systems and structural family therapy are also outlined such as feedback loops, homeostasis, family structure, subsystems, and boundaries.
System theory views social systems like families as interconnected groups that influence each other. It was developed in the 1950s and challenged individual explanations for problems by looking at relationship dynamics within families. Family therapy uses systems theory to understand how changing one part of a family impacts others. There are different approaches like structural and strategic family therapy. The family lifecycle identifies developmental tasks at each stage, and transitions between stages can cause stress. Systems theory informs social work practices like family assessments and decisions about child welfare. It also emphasizes understanding each family's cultural context rather than stereotypes.
This document provides an overview of family therapy. It discusses key concepts in family systems theory such as viewing problems in their interpersonal context and treating the family relationship system rather than individuals. The goals of family therapy are described as exploring family dynamics and psychopathology, mobilizing family strengths, restructuring interactions, and strengthening problem-solving. Several models of family therapy are summarized, including structural family therapy, strategic family therapy, and systemic family therapy. Techniques used in different models like enactment, joining, and reframing are also outlined.
Family therapy views psychological disturbances in their family context. The goals are to explore family interaction dynamics, mobilize family strengths, restructure maladaptive styles, and strengthen problem-solving. Family therapy emerged in the 1950s as therapists explored family dynamics and found that some patients regressed after individual treatment returned home. Structural family therapy, developed by Salvador Minuchin, analyzes relationships within a family system. It aims to transform dysfunctional homeostasis by restructuring boundaries, alliances, and hierarchies through techniques like enactment and intensity regulation.
The Milan approach focuses on viewing problems systemically and seeing how symptoms maintain family homeostasis. The therapist aims to help the family recognize how problems serve certain functions for the family system through circular questioning and other indirect interventions. Key techniques include hypothesizing family dynamics based on initial information, maintaining neutrality, and reframing problems and behaviors in a positive light to facilitate change in how the family views and interacts with each other. The goal is for the whole family to change their patterns rather than blaming individuals.
The Milan school of family therapy developed an approach based on systems theory and complexity. Key aspects included circular questioning to challenge problem maintaining beliefs, end of session interventions like paradoxes and rituals, and a team approach with co-therapists. The goal was to alter family interaction patterns and beliefs supporting problems like schizophrenia. Over time the Milan school split into more strategic and non-directive branches but both retained a focus on flexibility, feedback and challenging existing family constructs.
This document outlines several schools of family therapy, including psychodynamic, behavioral, strategic, Milan's systemic, and solution-focused approaches. It describes key concepts and therapeutic techniques for each approach. For example, behavioral family therapy applies principles of behaviorism to change family interactions, while strategic family therapy uses indirect techniques like reframing and paradoxical interventions. The document also discusses integrative approaches that combine concepts and strategies from different schools of family therapy.
Structural family therapy aims to change problematic family dynamics by altering the family structure. The therapist maps the family structure, including subsystems, boundaries, and hierarchy. Therapeutic interventions include enactments to observe family interactions and restructure boundaries and power dynamics within sessions. The goals are to establish clear generational and social roles and balance enmeshed or disengaged relationships. As the family structure changes through new interaction patterns, individual symptoms are expected to reduce. The therapist takes a directive role to transform the family structure through action-oriented strategies.
1 family system therapy powerpoint presentation christine moranchristinemoran54
Family systems therapy views individuals as best understood through their interactions within the entire family. Symptoms are seen as expressions of family dysfunction, and problematic behaviors often serve purposes for the family system. The goals of family systems therapy are to change interactional patterns within the family and between generations to reduce distress and initiate family reorientation.
Dorothy Johnson's theory defined Nursing as “an external regulatory force which acts to preserve the organization and integration of the patient's behaviors at an optimum level under those conditions in which the behavior constitutes a threat to the physical or social health, or in which illness is found.
Nursing theory provides a framework for nurses by defining concepts, describing relationships between variables, and guiding practice, research, education and communication. There are four levels of theory from metatheory to practice theory. Common nursing theories were developed to explain phenomena like human caring, adaptation to illness, and achieving self-care. Theories influence assessment, intervention, and evaluation in nursing and help define the profession.
Sister Callista Roy is a prominent nurse theorist born in 1939. She developed the Roy Adaptation Model (RAM) in the 1960s-1970s and published it in 1976. The RAM views people as adaptive systems who use coping mechanisms to respond to stimuli. It focuses on four modes of adaptation: physiological, self-concept, role function, and interdependence. Roy spent her career developing and refining the RAM and advocating for its use in nursing education and research. She has influenced over 100,000 nursing students.
Orem's Self-Care Deficit Nursing Theory has three related theories: self-care, self-care deficit, and nursing systems. The self-care theory focuses on an individual's ability to care for themselves, while the self-care deficit theory examines when people require nursing assistance. The nursing systems theory describes the relationships needed to provide nursing care. Orem identified universal, developmental, and health deviation self-care requisites and defined a self-care deficit as the inability to meet one's therapeutic self-care demand.
This document provides an overview of key concepts in systemic therapy, including social constructionism and its influence on understanding the self and emotions. It discusses how social constructionism views reality as co-constructed through language and relationships. The self is seen as developed through interactions with others from a young age. Emotions are also viewed as socially and culturally constructed. Context is emphasized as central to meaning, and the document outlines changes to traditional Milan principles like curiosity replacing neutrality. Circular questioning is introduced as a way to explore relationships.
This document provides an overview of several organizational theories including system theory, Weick's theory of organizing, Luhmann's social systems theory, and evolutionary psychology. It discusses key concepts in system theory like wholeness, hierarchy, openness, and feedback. Weick's theory focuses on equivocality reduction and sensemaking. Luhmann examines social systems as communication and the role of episodes, stability, and change. Evolutionary psychology proposes that human behavior is influenced by innate mechanisms adapted through evolution.
Family systems theory views the family as an interconnected system where each member and part influences the others. It focuses on relationships and interactions rather than individuals. Key concepts include family roles that members take on, rules that regulate the system, and homeostasis that resists change to maintain equilibrium. When one part of the system changes, all other parts must adapt to maintain balance.
This document provides information on two nursing theorists: Sister Callista Roy and Dorothy Johnson. It summarizes Roy's Adaptation Model, which views the person as an adaptive system interacting with the environment. The goal of nursing within this model is to promote adaptation. It also summarizes Dorothy Johnson's Behavioral Systems Model, which views the person as a system of organized subsystems that work to maintain stability. Johnson identified 7 subsystems that help the person maintain a steady state through adjusting to internal and external forces.
unit2-Impact of organizations in workplace counselling.pptxShambhavi Sahstry
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The psychodynamic approach views organizations similarly to how psychoanalysis views individual development, believing organizations have collective unconscious drives that motivate them and can exhibit defenses like splitting, projection, and transference. When using this approach, counselors should listen for symbolic messages, assess defense mechanisms, and monitor their own countertransference reactions.
The systemic approach views problems as context-specific rather than individual, and believes interactions automatically create systems within organizations. When using this approach, counselors should understand issues from multiple perspectives, recognize emerging patterns, and perceive the meanings ascribed to problems within the organizational
General Family Systems Theory & Structural Family TherapyJane Gilgun
Ever wondered what general system theory has to do with circular causality and structural family therapy? These slides represent the most clarity I could come up with regarding these important ideas.
Family therapy theories used in family health care Arun Madanan
1. Structural family therapy focuses on transactional patterns, adaptation, subsystems and boundaries within families. The goal is to change problematic family structures through in-session manipulation of family interactions.
2. Family systems therapy emphasizes differentiation of self, multigenerational processes, triangles and emotional cutoff. The long-term focus is on gaining insight into past influences and freely choosing present behaviors.
3. Family interactional therapy examines self-worth, communication, rules and societal links. The assessment and problem-solving aim to improve family members' ability to understand each other's feelings and needs through open communication.
Strategic family therapy developed from combining elements of several theories including those of Erickson, the MRI group, Minuchin, Bateson, and Jackson. The therapist takes an active, directive role in planning interventions to change problematic feedback loops and achieve second-order change by modifying family rules. Core concepts include viewing problems as maintained through misguided solutions, conceptualizing symptoms as voluntary, and using techniques like tasks, paradoxes, and reframing. The goal is to motivate families to alter signature behavioral patterns associated with identified problems.
Structural family therapy developed by Salvador Minuchin focuses on changing relationships and interactions within families. Minuchin believes families have hierarchical structures with subsystems like parent-child and marital. He uses techniques like mapping family structures and boundaries, enactments to observe interactions, and changing distances between family members. The goals are to establish clear boundaries between subsystems and alter dysfunctional coalitions and alliances to improve family functioning.
This document summarizes two nursing theories - Human Caring Theory and Role Theory - and their application to clinical practice. Human Caring Theory, developed by Jean Watson, focuses on compassionate care, dignity, and healing relationships between nurses and patients. Role Theory examines how individuals behave in social and work situations. The document compares the key concepts of each theory and provides examples of how they inform nursing assessments, diagnoses, and interventions. It also discusses areas where further research is needed, such as boundaries in caring relationships.
Chapter 12 theories focused on interpersonal relationshipsstanbridge
The document summarizes several theories focused on interpersonal relationships in nursing. It discusses early theories like Peplau's that emphasized the nurse-patient relationship and its phases. Later theories incorporated humanistic approaches and focused on existential experiences and expanding consciousness. Theories continued evolving to emphasize patient strengths, preferences, and recovery. Philosophical changes in nursing, from positivism to postmodernism, influenced theoretical development.
This presentation is an overview of multisystemic family therapy which is an approach to work with children and families where the system in which families live their lives is the target of intervention. Thus, professionals operate within the various ecologies in which families live their lives. There are multiple evaluations of this approach, and in general when implemented accurately has good outcomes.
Cognitive therapy attempts to change problematic thoughts and behaviors by addressing faulty or unhelpful thinking patterns. Therapists help clients identify irrational beliefs and replace them with more realistic perspectives. Cognitive therapy aims to correct automatic negative thoughts that perpetuate issues like depression. It uses tactics like challenging assumptions, evaluating evidence, and discussing alternative solutions. Rational emotive therapy similarly seeks to transform irrational beliefs that cause strong emotions by teaching clients to recognize and dispute unhelpful "should" statements. Cognitive behavioral therapy combines cognitive and behavioral methods, emphasizing the discovery and modification of thinking that leads to dysfunctional behaviors.
The document discusses several principles for developing therapeutic alliances in couple counseling, including maintaining multiple alliances with each partner and the couple as a unit, adopting frameworks that account for interactions within therapeutic triangles, and creating dialogical space that allows both partners to feel heard while managing tension and conflict in the relationship.
This document provides an overview of key concepts in family therapy. It discusses systems theory perspectives, including circular causality, reciprocal relationships, and holistic views of families. Specific models of family therapy are outlined such as structural family therapy and strategic therapy. Key concepts explored include boundaries, feedback loops, narratives, and the social construction of reality. The document emphasizes strengths-based, solution-focused approaches and the importance of self-reflection for therapists.
This document presents the findings of a realist evidence synthesis that developed a logic model for Multispecialty Community Providers (MCPs) in the English NHS. The initial programme theory for MCPs contained 13 components with 28 connections. A review of 116 studies identified equivalents of MCP components. The evidence supported some connections but not others. A revised logic model was developed with 17 well-evidenced connections and contextual qualifications for implementation. Further research is needed to test the model.
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Structural family therapy aims to change problematic family dynamics by altering the family structure. The therapist maps the family structure, including subsystems, boundaries, and hierarchy. Therapeutic interventions include enactments to observe family interactions and restructure boundaries and power dynamics within sessions. The goals are to establish clear generational and social roles and balance enmeshed or disengaged relationships. As the family structure changes through new interaction patterns, individual symptoms are expected to reduce. The therapist takes a directive role to transform the family structure through action-oriented strategies.
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Orem's Self-Care Deficit Nursing Theory has three related theories: self-care, self-care deficit, and nursing systems. The self-care theory focuses on an individual's ability to care for themselves, while the self-care deficit theory examines when people require nursing assistance. The nursing systems theory describes the relationships needed to provide nursing care. Orem identified universal, developmental, and health deviation self-care requisites and defined a self-care deficit as the inability to meet one's therapeutic self-care demand.
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Family systems theory views the family as an interconnected system where each member and part influences the others. It focuses on relationships and interactions rather than individuals. Key concepts include family roles that members take on, rules that regulate the system, and homeostasis that resists change to maintain equilibrium. When one part of the system changes, all other parts must adapt to maintain balance.
This document provides information on two nursing theorists: Sister Callista Roy and Dorothy Johnson. It summarizes Roy's Adaptation Model, which views the person as an adaptive system interacting with the environment. The goal of nursing within this model is to promote adaptation. It also summarizes Dorothy Johnson's Behavioral Systems Model, which views the person as a system of organized subsystems that work to maintain stability. Johnson identified 7 subsystems that help the person maintain a steady state through adjusting to internal and external forces.
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This document discusses two major approaches to understanding the impact of organizations on workplace counselling: the psychodynamic approach and the systemic approach.
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Communicating effectively and consistently with students can help them feel at ease during their learning experience and provide the instructor with a communication trail to track the course's progress. This workshop will take you through constructing an engaging course container to facilitate effective communication.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
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Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
2. Family Therapy Concepts 1
• This four hour workshop is meet to
introduce to participants some of the basic
ideas and components that are associated
with a body of knowledge referred to as
Family therapy
• In order to present a more congruently it
will be following the Leeds Systemic Family
Therapy Model as laid out in the Leeds
Systemic c Family Therapy Manual, Ms
Helen Pote et al 2000
3. Basic concepts of System
theory
• In the world of systems therapy, linear
causality does not exist. Instead we find
an emphasis on reciprocity, recursion,
and shared responsibility
• A and B exist in the context of a
relationship in which each influences
the other and both are equally cause
and effect of each other behaviour
4. Basic concepts of System
theory
• Over time, A and b establish patterns
characteristic of their particular relationship
• Our perspective is holistic, and our focus is on
the process, or context, that gives meaning to
events instead of only on the individual or the
events in isolation. Our focus is also present
centred, we examine here-and now interactions
rather than look to history for antecedents
causes.” (Leeds Systemic c Family Therapy
Manual, Ms Helen Pote et al 2000)
5. Models of Family Therapy
1. What is marriage and family therapy?
• Marriage and family therapists practice a unique
profession. Family therapy began as a breakaway
movement from psychiatry in the 1950's
• Marriage and family therapists may see individuals,
couples, families, and/or groups, yet they retain their
interactional perspective regardless of the configuration
of clients
• Marriage and family therapists take an interactional
perspective, and build on client strengths, rather than
assumed pathology
6. What is the philosophy of
family therapy?
• Each family operates on the basis of predictable
patterns of interactions
• patterns of behaviour being passed and
replicated from generation to generation
• Family members are always affected by one
another's issues. 91): “
• (Distant Education for Family Therapy
Counselling and Supervising
-http://www.dmrtk.jgytf.u-
szeged.hu/phare/eng/main.htm)
7. Some classifications of family
therapy
• Behavioural Family Therapy
• Bowen theory
• Brief Therapy: MRI
• Contextual Therapy
• Eriscksonian Family Therapy
• Focal Family Therapy
• Milan Systemic Therapy
• Family Psychoeducational Therapy
• Strategic Therapy
• Structural Therapy
8. Types of Family Therapy
• Structural Family Therapy (Minuchin, 1974,
Colapinto, 1991)
• Conjoint Family Therapy (Satir, 1967)
• Contextual Therapy (Boszormenyi-Nagy,
1991)
• Strategic Therapy (Madanes, 1981)
• Brief Therapy
• Milan Systemic Therapy (Boscolo et al,
1987)
• Narrative Therapy (Freedman, Combs,
1996)
9. • “It is important to note that Family therapy is
probably a misnomer. When family therapy is
built on the assumption of systems theory,
amore appropriate label would probably be
relationship therapy.”
• Family Therapy a systemic integration 3rd
edition Dorthy Becvar and Raphael Becvar, 1988
p12
• *Another alternative is the term systemic
therapy
10. Contrasting individual and
family Therapy
• Individual therapy Family Therapy
• Asks why Asks what
• Linear Cause and effect Reciprocal causality
• Subjective/objective Dualism Holistic
• Either/or Dichotomies Dialectical
• Value-free Science Subjective/Perceptual
• Deterministic/Reactive Freedom of
Choice/Proactive
• Laws & Law like External reality Patterns
• Historical Focus Here-and now focus
• Individualistic Relational
• Reductionistic Contextual
• Absolutistic Relativistic
11. CyberneticEpistemology/Systems
Epistemology
• Metaphors of pattern Metaphors
of Material
• Cybernetics Physics
• Mind Body
• Communication Energy
• Biological World Physical
• Organization of whole Ingredients
of whole
• Qualitative analysis Quantitative
Analysis
• Mechanistic Explanation Vitalistic
Explanation
12. Systems Focus
• In working systemically the central focus
should be upon the system rather than the
individual
• The system may usefully be thought of as
the household or a wider family system,
and may include friends, people in
institutions (school, work, church)
• A consistent view is that these difficulties
do not arise within individuals but in the
relationships, interactions and language
that develop between individuals
13. Systems Focus
• Rock and dog
• Definition of a system
• Environment-systems-subsystems
• Open and closed system
• Wholeness
• Boundary
The interface between the system and its
environment is called the boundary of the
system
15. Circularity
• Patterns of behaviour develop within systems, which are
repetitive and circular in nature and also constantly
evolving. Behaviour and beliefs that are perceived as
difficulties will also therefore develop in a circular
fashion
18. Connections and Patterns
• In understanding relationships and difficulties
within systems it will be important for the
therapist to consider the connections between
circular patterns of behaviour
• The process of therapy should enable family
members to consider these connections from
new and/or different perspectives
• All communication provides direct access to
world views and world views reflect processed
structure.
19. Connections and Patterns
• Structure is like a snap shot of process
• Process is like making a movie basic on the
structure
• Structure and process seen as communication
reflect world view
20. Symmetrical and
complementary interaction
• Symmetrical interaction is characterised by
equality and the minimization of difference
• complementary interaction is based on the
maximization of difference
• Rigid symmetrical or complementary patterns
may be problematic
• Meta- complementary – A lets or forces B to be
in charge
• Pseudo-symmetry – A lets or forces B to be
symmetrical
• Triangulation
22. Narratives and Language
• Behaviours and beliefs form the basis of stories
or narratives
• The language that is used to describe these
narratives and the interactions between
individuals constructs the reality of their
everyday lives
• At times when stories lived and stories told are
incongruous change
23. Constructivism
• This is the idea that people form autonomous
meaning systems and will interpret and make
sense of information from this frame of
reference
• People cannot make assumptions about what
meaning will be attributed to the information
they offer/contribute to others
• Thus there is only the possibility of perturbing
other people’s meaning systems
28. Social Constructionism
• Relevant is the idea that meaning is created in
the social interactions that take place
between people and is thus context dependent
and constantly changing
• this takes precedence over the concept of a
single external reality
29. Cultural Context
• The therapist should consider the importance
of context, in relation to the cultural meanings
and narratives
• The relationship between these narratives, the
therapeutic relationship and its context
• The family should be an important
consideration at the point of referral and
throughout the therapy
30. Power
• The therapist should take a reflexive stance in
relation to the power differentials that exist within
the therapeutic relationship, and within the family
relationships
• No powerlessness
• No Power in a (Batesonian sense)
• Victim in oppressor, oppressor in victim
31. Co-constructed therapy
• In therapeutic interactions reality is co-
constructed between the therapist (and
team) and the people with whom they
meet
• They form part of the same system, and
share responsibility for change and the
process of therapy
• Particular attention should thus be paid to
the contributions that all members of the
therapeutic system make in the process of
change
32. Self-reflexivity
• The therapist should aim to apply systemic
thinking to themselves and thus reject any
thinking about families and their processes that
does not also apply to therapists and therapy
• Self-reflexivity focuses especially on the effect
of the therapy process on the therapist
• In order to use self-reflexivity it will be
necessary for the therapist to be alert to their
own constructions, functioning and prejudices so
that they can use their self effectively with the
family
33. Strengths and solutions
• The therapist should take a non-pathologising, positive
view of the family system
• A family system that enters the therapeutic system
should be considered as a system that owns a wealth of
strengths and solutions in the face of difficult situations
• It is important for the therapist to recognise that there
is a multi-versa of possibilities available for each family
in the process of change
• The therapist can facilitate this process by attending to
the strengths and solutions in the stories that the family
system brings to therapy
34. Models of therapeutic change
Feed back - System
• In a system where a transformation occurs, there
are inputs and outputs. The inputs are the result
of the environment influence on the system, and
the outputs are the influence of the system on
the environment. Input and output are separated
by duration of time, as in before and after. Or
past and present
35. Feed back loop
• In every feedback loop, as the name suggests,
information about the result of the transformation or an
action is sent back to the input of the system in the
form of input data
• If these new data facilitate and accelerate the
transformation in the same direction as the proceeding
results, they are positive feedback
• If the new data produce a result in the opposite
direction to previous results, they are negative feedback
36. “An appropriate Fiction for
behavioural Science”
• Some one needs to provide a fiction for the
behavioural sciences that would work like the
elegant fiction upon which physics was built-its
Newtonian Particle. The idea of a recursive
network with feedback structure provides a
useful fiction behavioural science. (The
Aesthetics of change Bradford Keeny the
Guildford press New York London 1983)
38. Positive and negative feedback
• positive feedback loop left to itself can lead
only to the destruction of the system, through
explosion or through the blocking of all its
functions
• Negative feedback leads to adaptive, or goal-
seeking behaviour: sustaining the same level,
temperature, concentration, speed, direction
39. • In a negative loop every variation toward a plus
triggers a correction toward the minus, and vice
versa. There is tight control; the system
oscillates around an ideal equilibrium that it
never attains. A thermostat or a water tank
equipped with a float are simple examples of
regulation by negative feedback
40. Deviation amplifying feed back
(positive feed back)
• If the family system is to function effectively; it
must be able to encourage desirable changes in
behaviour and to adapt to changes in the family
members as they grow older. The positive feed
back loop provides the necessary mechanism
• Difference that makes a difference
• News of difference
• Sameness and difference - stability and change
41.
42. Prescribed practices as in line
with the Leeds model
• The prescribed practices described below are things that
would not be included in a routine therapy session. It
may be that on one or two occasions it is appropriate to
use one of these approaches; however they must be
used within a systemic framework that is, using the
guiding principles outlined at the start of this manual
43. Advice
• As a systemic therapist you would not
usually offer direct advice to the family
about their interactions or the difficulties
they are experiencing
• advice may be appropriate in helping the
family work towards their goals, advice
may be offered in a non-directive or
reflexive manner. Options should be
presented as choices about which the
family can make their own decisions
44. Interpretation
• Psychodynamic interpretations about the
meaning of symptoms or interactions in
relation to individual or trauma would not be
usual for systemic therapists
• Rather, meanings are explored in relational
and interactional terms between members of
the system
45. Un-transparent/closed practice
• Therapists should not remain closed about their
working practices, ways of thinking and
understanding the difficulties
• They should try to remain transparent by
explaining their practices at the beginning of
therapy, and during therapy as appropriate
46. Therapist monologues
• In the co-created process of therapy therapists
should not find themselves lecturing or using
long monologues in their interactions with the
family
• The process should be more like a sharing of
ideas between therapist and family, and
between family members
47. Consistently siding with one
person
• In taking a neutral stance therapists should not find
themselves consistently siding with one person in the
family
Working in the transference
• Therapists should be paying attention to the relational
and engagement issues between themselves and the
family with which they are working but they should not
use the relational aspects between themselves and the
family
48. Inattention to use of language
• Therapists should not be inattentive to
the use of language used by the family
• They should pay attention to the both
the words and phrases used, and the
meanings attributed to these
49. Reflections
• Therapist’s simple reflections of the points or phrases
that are used by the family should be kept to a
minimum. Reflections may be used to enhance
engagement and to develop the family’s sense of being
listened to and understood, but when used, reflections
should be followed by questions, and increased curiosity
about the issues presented
50. Polarised position
• Therapists should avoid taking a position which is
polarised from that of the family, or a position which is
likely to escalate to a polarised position
• The therapeutic team can enable the therapist to
achieve this by presenting the multiple perspectives
from which the family situation can be understood
Sticking in one time frame
• Therapists should not stick in one time frame, but move
the focus of their questions and discussion between the
past, present and future
51. Agreeing/not challenging ideas
• Therapists should not be in a continual state of
agreement with the family’s ideas
• They should remain curious and challenging
about the nature and content of these ideas,
in order to introduce new unexplored
possibilities and ideas
52. Ignoring information that
contradicts hypothesis
• Therapists should not ignore, or minimise
information presented by the family which
contradicts their own ideas and hypotheses
Dismissing ideas
• The ideas presented by the family about the
difficulties with which they are struggling, or
the process of therapy itself should not be
dismissed by the therapist
53. Inappropriate affect
• The therapist’s affect should match that of
the family, and would be considered
inappropriate if it remained dissimilar from
family for an extended period of time
• One example might be if the family were
feeling optimistic about change and the
progress they were making, and the
therapist remained pessimistic
54. Ignoring family affect
• Therapists should pay attention to the affect that
the family is showing in the session, and not ignore
strong expressions of affect during the sessions
• This may be particularly relevant when a member
of the family shows distress during the meeting,
either by sad or angry behaviour
Ignoring difference
• Therapists should not ignore issues of difference
between themselves and the family or within the
family
56. Plan of development
• Assessment
• Overview of specific goals
• Pre-therapy
• Initial sessions
• Middle-sessions
• End- sessions
57. Assessment Performa family
• Demographic Information
• Genogram / Ecogram /timeline
• Migration and trauma history
• Referral information
• Needs assessment
• Family Structure/process
• Change
• Cultural formulation
58. 6. Family Structure/Process
• The way in which activities within the home are organized
along gender, generational lines and roles
• The connections which partners maintain with their network of
friends and relatives
• Partners attitudes towards their children
• The way in which the family members perceive the connection
between the individual and the world (e.g. Autonomy of the
individual or the individual in relation to family and
generations/ in relation to culture - dominant/non-dominant)
• Coalitions, alliances, boundaries, hierarchy within the nuclear
and extended families)
• Communication and behavior patterns
• Role and relationships clarity
• Strengths (eg., coping mechanisms)
59. Convening Sessions
In deciding whom to invite to the firsts session
• Who is living in the household?
• Who else is mentioned as important members of the family
system?
• Recent family life events, that may affect attendance e.g.
childbirth / separation.
• Is further information required from referrers before
therapy can commence?
60. Convening Sessions
• What professional systems are involved with
the family? In relation to:
• i. The presenting issues.
• ii. Other issues, such as child protection.
• Would it be helpful to initiate a professional
/ network meeting prior to the therapy
commencing?
61. Before the initial session
discuss the therapy.
• Team working
• Attendance issues, who will be coming, how
to get there, and
• ambivalence about attending.
• Therapist’s interest in hearing everyone’s
ideas
• Confidentiality
62. Pre-therapy preparation
• Construct a genogram and ecogram from
referral information
• Summarize the main themes from the
referral
• Consider the recent life events of the family
• Consider difficulties which may arise around
engagement and how to address these
63. Pre-therapy preparation
• Consider broader system issues, and define
who is in the network
• Brainstorm
themes/hypotheses/formulations which
may be relevant to the family
64. Genograms
• All members of the family system, including
adopted/fostered members
• Delineation of the household
• All members of the wider system
• Dates of birth
• Deaths, with dates
65. Genograms
• Partnerships and marriages, with dates
• Separations and divorces, with dates
• Pregnancies, miscarriages, and
terminations, with dates
• Occupations / Schooling
• Any information that is missing from the
referral information should be noted and
enquired about during the initial session of
therapy.
66. The Ecomap
• 1) includes the major systems that are a part
of the family's life;
• 1) includes the major systems that are a part
of the family's life;
• 3) portrays an overview of the family in their
situation by, picturing the important nurturant
or conflict connections between the family
and their world;
67. The Ecomap
• 4) demonstrates the flow of resources or the
lack and deprivations;
• 5) highlights the nature of the interfaces and
indicates conflict for mediation and resources
to be identified and mobilized.
68. Goals during initial session
• Outline Therapy Boundaries & Structure
• Engage and Involve all family members
• Gather and Clarify Information
• Establish Goals and Objectives of Therapy
69. Goals during middle sessions
• Develop and Monitor Engagement
• Gather Information and Focus Discussion
• Identify & Explore Beliefs
• Work towards change at the level of beliefs
and behaviors
• Return to Objectives and Goals of Therapy
70. Goals during ending sessions
• 1.Gather Information and Focus Discussion
• 2. Continue to work towards change at the
level of behaviors and beliefs
• 3. Develop family understanding about behaviors and beliefs
• 4. Secure Collaborative Decision re: Ending
• 5. Review the process of therapy
71. Pre-therapy preparation
• Construct a genogram from referral
information
• Summarise the main themes from the referral
• Consider the recent life events of the family
• Consider difficulties which may arise around
engagement and how to address these
• Consider broader system issues, and define
who is in the network
• Brainstorm themes/hypotheses/formulations
which may be relevant to the family
72. Pre & Post Session Preparation
• Summary of the main themes from previous session
• Information which requires clarification from previous session
• Between session contact the therapist has had with the
family/wider system
• The current formulation/themes/hypothesis of the issues with
which the family are bringing
• Ways forward for the current session which are being
considered
• Any team – therapist issues which need to be addressed
• Any family – family/team issues which need to be addressed
• CONSIDER THE 6. FAMILY STRUCTURE/PROCESS
73. Goals during initial session
• Outline Therapy Boundaries & Structure
• Engage and Involve all family members
• Gather and Clarify Information
• Establish Goals and Objectives of Therapy
74. Outline Therapy Boundaries &
Structure
• Introductions
The therapist should introduce himself or
herself as a team member and explain the
role and context within which they work
(the team and the centre).
• Team working
The therapist should explain that they work
as part of a team, and that the team’s role
is to generate ideas and help the therapist
understand the family / system.
75. • The confidentiality of any information discussed in
the session should be outlined. Specific statements
about the boundaries of confidentiality should be
made in relation to other systems.
• Structure of the session Information should be given
on the length of the meeting, the breaks, and the use
of team feedback through messages or reflecting
teams. Explain that during the break,
Confidentiality
76. • Structure of therapy Explain that if the family/team
decide to meet again, that the meetings will be
decided together by the family / team in accordance
with their needs and wishes.
• Questions Time should then be spent giving the
family an opportunity to ask questions and meet the
team. Agreement to proceed with videoing should be
confirmed, and the family informed that the video
will now be switched on.
77. Engage and Involve all family
members
•Supportive environment Initially it is
very important for the therapist to
provide a warm, supportive and empathic
environment, to increase trust and
rapport and to build the therapeutic
relationship
78. • Hear from everyone: Therapists should try to hear from
all members of the system/family, initially connecting
with them all at an individual level, and assessing the
level of contribution they feel they are able to make to
the discussion
• Neutrality: The therapist is trying not only to hear
everyone’s views but also to establish their interest in
different perspectives that may be held within the
system.
79. Gather and Clarify Information
• The concept of therapy
• The system
• The presenting difficulties or issues
• Solutions and successes to date
Attention should be paid to collecting
information in a circular manner. Although it
will be appropriate to ask linear questions in
collecting information, especially at this early
stage of therapy, circularity can be maintained
by linking multiple linear questions between
family members in a circular way.
80. Establish Goals and Objectives
of Therapy
• The therapist should consider with the system
what are their goals and objectives for therapy
• The establishment of goals should be achieved
in a way which expresses the Possibility of
Change, and should convey the expectation
that change is possible, and likely to occur
81. Post-session
• Review of main interventions and family’s
response
• Ideas for future sessions, themes/issues to follow
up,
• E.g. narrative prompts, unexplored areas, facts
to check
• Feedback to therapist of team observations
• Therapist’s reflections on issues evoked for them
by the session
• Review of important information shared, e.g. life
events, elements of genogram
• CONSIDER THE 6. FAMILY STRUCTURE/PROCESS
82. Case notes
• All written records should be non-pejorative, legible,
dated, signed, with no abbreviations. Alterations and
Corrections should be clearly marked and signed. Case
notes should include:
• Family information sheet & Genogram/ecogram-
ecomap
• Referral information/letter
• All other written communications to and from the
centre
• Record of attendance
• Sessions notes
• Notes on telephone contacts to and from the centre
83. Session notes
Session notes should include :
• Date and number of session
• Who attended therapy
• Therapist/Team member names
• Main themes of the session – including key
language used by family
• Team observations – clearly labelled as
impressions
• Record of interventions
• Key points/ideas/decisions to follow up in
later sessions
85. Goals during middle sessions
• beliefs and behaviors Develop and Monitor
Engagement
• Gather Information and Focus Discussion
• Identify & Explore Beliefs
• Work towards change at the level of
• Return to Objectives and Goals of Therapy
86. Develop engagement
• The therapist should pay particular attention to
developing a co-constructed therapeutic
relationship. In addition to attending to the three
aspects of engagement from the initial meeting
(supportive environment/hearing from
everyone/neutrality), attention should be paid to:
• Creating and offering choices about the process of
therapy
• Resolving issues in the family-therapist-team system
as they arise. This will require therapists to allow
sufficient time for team discussions pre and post
sessions and time within sessions to discuss the
process of therapy with families and any concerns
or questions they have in relation to this.
87. Gather information & focus
discussion
The therapist plays a role in developing this discussion to
develop themes and keep the discussion focused.
Information may often focus on the following topics:
• The presenting difficulties or issues: Therapists’
should be collecting this information in a manner that
enables circular descriptions of behavior to develop
• The family and wider system: The therapist will still
gather information about the family and wider system
as is necessary to understand the information and
stories being presented by the family
• Solutions & Successes: The focus on the successes
and solutions available to the family should be
steadily increasing throughout therapy
88. Identify & explore beliefs
• The therapist should identify and explore the
family’s thoughts, beliefs, myths or attitudes,
which may be contributing to their dilemmas
and difficulties
• Circular questions which build up circular
descriptions of behavior can also be used to
explore the beliefs and assumptions which lie
behind those behaviors
89. Identify & explore beliefs
Therapists should explore the family’s beliefs in relation to:
The presenting difficulties.
• E.g. What ideas has your wife come up with to explain the
behavior John is showing?
Relationships within the family and with the wider system.
• E.g. Who feels it is most important to keep liaising with the
school over this issue?
Solutions that have been tried or hypothesized
• E.g. What gave you the confidence to keep going with this
new idea?
90. Identify & explore beliefs
Successes in all areas of family life and relationships to
the wider system
• E.g. Would that be judged as a success in your family?
Therapy process, beliefs about therapy
• E.g. What led to your decision not to bring the
children to today’s meeting?
Family behavior during therapy
• E.g. Jill is looking distressed, what do you think was
so upsetting for her in talking about the difficulties
you are experiencing?
91. Work towards change at the
level of beliefs and behaviours
Challenge existing patterns and assumptions:
• To move with the family to a position where they
are able to query their own beliefs, perceptions and
feelings
• Th: How would your Nan explain the times when
you and your mum do get on well together?
• John: Well she says we are alright when we stop
and listen, sometimes we can just bite off each
other’s heads you see, over nothing, when no-one
has really done anything wrong
92. Work towards change at the
level of beliefs and behaviours
Provide distance between the family and the problem:
• Providing distance to try and free the family from the pressure
of the difficulties, so that they are more able to consider and
reflect upon them. Alternative perspective circular questions
and those aimed at looking at possible futures can often be
helpful in achieving this
Externalize
• That is to give the problem an external, objective reality
outside of the person. This can be useful in mobilizing the
family’s resources to unite in working towards solutions and new
ways of thinking which challenge the difficulties.
• Externalization means to put something outside of its original
borders, especially to put a human function outside of the
human body. The opposite of externalization is internalization
93. Reframing – Virginia Satir
• Reframing is altering the meaning or value
of something, by altering its context or
description
• Reframing is a powerful change stratagem.
It changes our perceptions, and this may
then affect our actions. But does changing
our symbolic representation of the real
world actually change anything in the real
world itself?
94. Reframing – Virginia Satir
• A classic example of a reframe by Virginia Satir
concerns a father who complains at the
stubbornness of his daughter.
• There are situations where she will need
stubbornness, to protect herself or achieve
something. Reframing switches to a context that
makes the stubbornness relevant.
• It is from the father himself that she has learned
to be stubborn. By forcing the father to equate
his own stubbornness with hers, this creates a
context in which he either has to recognize the
value of her stubbornness, or deny the value of
his own
95. Open up new
stories/explanations
Either by facilitating the family’s evolution of new ideas
and narratives, or by the introduction of these ideas
by the therapist. All family members will have
stories about their lives, the lives of other family
members, and the life of the family. Exploration of
neglected information may open up the development
of stories which are more helpful to the family in
coping with their concerns. Information which is
neglected often concerns:
• Successes
• Solutions
• Exceptions
• Alternative views from the network
• Other strengths
96. Elicit solutions
• It will be helpful to gather information from
the family about solutions for the difficulties
that they have tried or would consider useful
• Ideas generated by them are usually most
helpful and linear questions are often used to
develop an overview of solutions that the
family have tried or thought of
97. • Amplify change: In order to maximize the
change or potential change that is occurring
throughout the course of therapy it will be
important for the therapist to focus on
statements the family present about progress
• Enhance mastery: To encourage the family to
gain a sense of mastery or control over their
situation, their thoughts, feelings and
behaviors. This should enable the family
members to take responsibility for their own
roles and actions, and for the process of
change
98. Introduce therapist/team ideas
• May include the therapist sharing their ideas
and hypothesis about the family, individual,
or difficulties, for a variety of reasons.
Including:
• Normalize difficulties
• Move the family to new ideas
• Connect family’s ideas
• Suggest ways to organize the discussion,
e.g. Enactments
99. Linear questioning
• Direct linear questions can often be useful in
gathering information from the system and
clarifying information given, especially at the
beginning of therapy
Circular Questions
Circular questions are aimed at looking at
difference and therefore are a way of
introducing new information into the system.
They are effective at illuminating the
interconnectedness of the family sub-systems
and ideas
100. Statements
Statements are used by the therapist for 3 main
functions:
• To clarify and acknowledge a communication from
the family
• To comment on the position or emotional state of a
member of the family
• To introduce therapist/team ideas, directly or in
the form of a reflecting team.
• In using statements therapists should ensure that
they are not of long duration, and do not become
therapist monologues
101. Positive connotation
• From the Milan systemic group, a complex paradoxical
reframing technique which includes all family members
and the system itself
• Each family member's contribution to the problem is
reframed as an effort to solve problems and help meet
the family's needs
102. Metaphor
• A figure of speech in which a word or phrase that
ordinarily designates one thing is used to designate
another, thus making an implicit comparison, as in “a
sea of troubles” or “All the world's a stage”
(Shakespeare)
103. Narrative description
• Utilizing the interactional dynamics of family
therapy, people can deconstruct oppressive
and debilitating perspectives, replace them
with liberating and legitimizing stories, and
develop a framework of meaning and direction
104. THE MIRACLE QUESTION Steve
De Shazer
• "If you go to bed tonight and when you awake in
the morning a miracle has occurred overnight and
everything is going well in your marriage, then how
would you know (or indeed how would any on else
know, like a relative or a friend?......Note: because
your are asleep you won't know that there has
been a miracle) ...what will be different?...What
will you see? What will you be hearing, doing,
feeling? What are you going to notice if the
problem is no longer there, what is it that is
different about the situation that demonstrates to
you that the problems has been replaced by
solutions?....what else?....
105. Tasks
• Noticing tasks
• Between now and next time we meet, we would like you to observe
, so that you can describe to us next time what happens in your
family that you want to continue to have happen (De Shazer and
Molnar 1984)
• Writing tasks
• Counting tasks
• Using a piece of string, count the ( to tie knots in) number of time
that you compliment someone in your family between now and the
next time we meet.
• Playing tasks
• Hugs without warning
• E.G. Given to each participate secretly the job to give a family
member a hug without warning.
• Turn taking tasks
• E.G. Planning a family activity
106. • Naming the dilemma
• Change pattern
• Proscribe problem
• Counter paradoxes:
• Therapeutic double binds.
• For example the family was warned against
• premature change. The family feels more
acceptable and un-blamed for how
• they are while at the same time challenged to
change.
• The belief is that you can’t give a direct
prescription
108. Return to objectives and goals
of Therapy
The therapist should return to the issues of goals for
therapy as therapy progresses:
• If goals seemed unclear during the initial stages
of therapy, it may take some time and thought
with the family for them to consider the areas
they want to change in therapy, or to find
priorities for change.
• If goals are achieved, so that goals can be
renegotiated, perhaps for change at a wider
system level, or a decision to move towards
the end of therapy is made
• If goals change due to changing circumstances
for the family
109. Goals during end sessions
• Gather Information and Focus Discussion
• Continue to work towards change at the level
of behaviors and beliefs
• Develop family understanding about behaviors
and beliefs
• Secure Collaborative Decision re: Ending
• Review the process of therapy
110. Gather information & focus
discussion
• The Presenting difficulties or issues
• Solutions and Successes to date
• The System / Wider system
111. Continue to work towards change at
the level of behaviour and beliefs
It is more common in end sessions for the focus to be on
the following methods:
• Amplifying change: In order to maximize the change or
potential change that is occurring throughout the course
of therapy it will be important for the therapist to focus
on statements the family present about progress
• Enhancing mastery: To encourage the family to gain a
sense of mastery or control over their situation, their
thoughts, feelings and behaviors
• Challenging existing patterns and assumptions: To
move with the family to a position where they are able
to query their own beliefs, perceptions and feelings
• Reframing: Reframe some of the constraining ideas
presented by the family. Relabelling in a positive way,
ideas and descriptions given by family members, in a
manner which is consistent with their realities
112. Developing new stories and
explanations
• Successes & Solutions
• Strengths
• Exceptions
• Alternative views from the network
113. Develop family understanding
about behaviours and beliefs
As therapy ends it will be important for the
therapist to work with the family to develop
and encourage their understanding of the
process of the development of difficulties.
Underlying family interactional patterns.
• Motivations for assumptions, behaviors and
feelings.
• Understanding of a family member’s reactions
to other’s behaviors
114. Collaborative ending decision
The timing of ending is not always obvious and in aiming to make
the ending process a collaborative process the therapist and
therapy team should be alert to a number of signals in sessions:
• Positive feedback from the family: the family situation or the
issues they presented are reported as improved or improving
• Negative feedback from the therapy: The family report
dissatisfaction about the therapy, or the progress they are making
• Therapist notices changes: Missed sessions by the family.
Changes in the level of engagement in therapy. Therapist notices
positive changes in the way the family are interacting during
sessions
115. The team should consider the following issues and then
gather the family’s views on these:
• Whether the family might feel it was appropriate to end
therapy, do they feel they have achieved what they set
out to achieve?
• How might the family prefer to end therapy, would they
like a follow up appointment or would they like to re-
contact the team if necessary?
• Might the family feel it would be important to engineer
systems of support, before therapy ends?
• With whom should the team share information about the
therapy and what has been achieved, e.g. referrer,
school.
• A useful and engaging way of saying goodbye to the
family
116. Once this information has been shared decisions should be
reached about:
• When therapy will end.
• What follow up arrangements will be made.
• What the family might do if difficulties should arise
again.
• Who will be contacted post therapy
117. Review the process of therapy
• It will be helpful for the therapist to invite the
family to review the process of therapy.
• What has been gained/lost for the family
through therapy?
• Any misunderstandings not addressed during
therapy should be clarified and addressed.
• Reasons for therapist’s behaviors and
procedures used.
• What might the family do differently if future
difficulties arise?