A SYSTEMIC PERSPECTIVE
The Foundations of Systemic Practice
Evidence
Practice ‐ Storyboarding
Julie Burgess‐Manning (University of Otago in Wellington)
Ruth Gammon (Massey University in Wellington)
Wayne Ferguson (Key Assets Fostering)
Family Therapy Association of Aotearoa New Zealand ‐ FTAANZ
General Systems Theory
 Karl Ludwig von Bertalanffy (1901 ‐1972) ‐
known as one of the founders of general systems theory
 Gregory Bateson (1904 – 1980) ‐ an English anthropologist, social scientist, linguist, visual anthropologist, and cyberneticist helped extend systems theory and cybernetics to the social/ behavioural sciences
 Cybernetics – is where action by the system generates some change in its environment and that change is reflected in that system in some manner (feedback) that triggers a system change
Systems Theory
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Individuals can only be understood within their social context
The “patient” is the entire system, not the identified patient (IP)
General Systems Theory & cybernetics are the intellectual inspirations for systemic therapy Systems = parts of an organization + relationships among those parts
Family Therapy ‐ A Historic Perspective
 Generally trace back to the 1950’s, however there was work done with families earlier
 Nathan Ackerman – often consider the ‘Father of Family Therapy’  Early Family Therapy based on Psychoanalytic models and theories of therapy.
 Systems Theory and the Cybernetics major influences on development of Family Therapy along with the Child Guidance Movement, social work practices, the etiology of schizophrenia, marriage counselling and group therapy.  More recently there has been a movement from Modern to Post Modern Family Therapies
What is a system?
 A group of inter‐related parts, functioning together in a particular way
 All systems are embedded in layers of “ecology” or “context” or “environment” or “culture”.
 Instead of reducing systems to analyse each part, we look at how the whole works together.
 The whole is greater than the sum of its parts.
 Whilst remaining inextricably related, the parts and the system have lives of their own.
General Systems Theory
“The systems perspective would have us see each member of a family in relation to other family members, as each affects and is affected by the other persons. “To understand each person in a family, one must study how each is in relation to every other family member. To study a single member apart from the others, is to know that person relative to the new context (the context in which she or he is studied) but not in the context of his or her family.”
Becvar and Becvar (1999) Systems theory and Family therapy, pg 6
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Homeostasis
 Homeostasis or balance explains how living systems control steady state – as one part of a system tries to change, the other parts or the system try to restore it back to its original state.  Feedback loops are the important control mechanisms
 Not linear cause & effect, but rather reciprocal effect
 Positive feedback loops set up runaway situations that drive systems beyond their limits
 Negative feedback loops decrease deviations from system rules
Evidence for Family Therapy
Large Body of Literature supporting the use of Family Therapy for a variety of mental health problems – A 2010 review of Family Therapy Journals by Alan Carr (Journal of Family Therapy)
 US –controlled trial of interventions for psychically abused young adolescent and their families – found MST was more effective than routine outpatient treatment – reducing out home placement, adolescent and parent distress and parenting behaviour associated with child abuse. (Swenson et al., 2010)
 Controlled trial of adolescents at risk of suicide found that 3 months of Attachment Based Family Therapy (ABFT) was more effective than routine treatment in reducing suicidal ideation and depressive symptoms (Diamond et al., 2010)
Evidence for Family Therapy (Continued)
 Adult‐focused problems – there are a number of studies that demonstrate the use of systemic therapy in a variety outcome studies for adult mental health problems .  Family Process published a systematic review of studies published in a variety of languages, that showed in the 38 studies reviewed 34, systemic therapy alone or as part of multimodal programmes was more effective than treatment as usual or other conditions in treatment of schizophrenia, mood disorders, eating disorders, substance abuse disorders, or adjustment to physical disorders in adulthood. There was also evidence that it may be useful in anxiety disorders. Improvement with systemic therapy was stable for follow up periods up to 5 yrs. (Von Sydow et al. 2010)  Substance Abuse, a variety of family therapies have found to be effective in the treatment of substance use across the lifespan (Ruff et al, 2010; Henderson et al., 2010: Feaster et al., 2010)
What Does Research Say About Family Therapy?
Ruth Gammon, PhD, MSW
Massey University Psychology Clinic Wellington
[email protected]
Evidence for Family Therapy (Continued)
 Functional Family Therapy (FFT) was more effective, a year after treatment, than routine probation/youth justice services in reducing recidivism and behaviour problems in delinquent adolescent. (Sexton and Turner, 2010)
 Other areas:
 Couples Therapy
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Sexual problems
Infidelity
 Diversity
 LGBT family members – substance abuse (Senreich, 2010), when a youth comes out Willoughby and Doty, 2010), and the Australian and New Zealand Journal of Family Therapy had a special issue on gay and lesbian parented families, with a range of research (Carr, 2010) Evidence for Family Therapy (Continued)
 Cost Effectiveness‐
 A review of 8 cost effectiveness studies for treatment of substance abuse, concluded family based interventions can be cost effective and deserve inclusion in the health care delivery system
 In a 13.7 yr follow up on re‐arrests in juvenile offenders compared the outcome for youth treated with MST and individual therapy. They estimated that every dollar spent on MST provided about $10 ‐$24 in savings to taxpayers and crime victims ( Klietz et al., 2010)
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Acknowledgements
 The work of Susie Essex, Colin Luger, Margaret Hiles and Dr Amanda Fox.  My colleagues in the Family Therapy Team of Southmead North Bristol Trust, CAMHS, UK.
 Andrew Turnell and Susie Essex (2006) Working with Wayne Ferguson Werry Centre Training Day – Skills for working with Children Wellington, December 2012
‘Denied’ Child Abuse: The Resolutions Approach, Open University Press Outline for the session
The words and pictures storyboard
 Discuss the context and development of the approach
“In ‘words and pictures’ the emphasis is upon parents and therapists co‐constructing a narrative that uses the family’s own words often juxtaposed with professionals’ descriptions and explanations, to create a firm context for the future through the medium of a shared story”
Hiles,et al (2008)  Make some links to family therapy literature and theory
 Provide an outline of the process  Exercise – construct a storyboard Storyboarding
 A term borrowed from the advertising and movie making worlds
 the flow of the story to be told is represented by a series of uncomplicated pictures
 highlight the main ideas and turning points
Finding the Words
 Somebody in the family always knows something. The issue is, often, not everybody knows the same thing and there is little shared understanding  The same event will have a range of meanings for different people in the system (and they may use different words)  Some things are just so terrible we can’t find the words to describe what has happened  Professional paralysis
 Whose words are privileged?  If we as family therapists have ideas about what to say, how do we take family members /carers worries into account?
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Why? We can be over or under organised by topics that emotionally overwhelm, so the question becomes how do we find a way that includes children and children’s voices?
Over organised = pathologising, over anxious, hysterical, enmeshed, over protective, re ‐traumatising.
Under organised = minimising, denial, neglecting, unable to protect.  Children are often not asked what they make of what is happening.
 Children are often left out of discussions about what is happening and why.
 A chance for adults to re‐think or re position themselves in relation to difficult events through the eyes of the child
 The process of creating the storyboard helps families talk about and communicate difficult information
Co‐construction is key
 It provides a focus for those involved, encouraging them to think about the child’s need for a coherent narrative  Statutory agencies can endorse the narrative because it captures and reinforces the concerns and a meaningful safety plan can be developed  The story is cohesive, is easily understood and shared by all participants. It creates openness – supporting the development of solid safety planning
A wide range of family therapy and systemic skills are used
 Who to convene, when and in what combinations
 The ability to hold different positions simultaneously
 Maintaining a ‘both/and’ rather than ‘either/or’ positioning
 Context as foreground  Working within the family’s frame of reference to support and enhance understanding
Links to FT theory and literature  John Byng‐Hall – Rewriting Family Scripts, family  Cronen and Pearce – levels of context and meaning
secrets and myths  Lynn Hoffman – collaborative approaches to Family Therapy, non expert positioning
 Michael White and David Epston ‐ Narrative Therapy – dominant and subjugated stories, thick and thin descriptions, thickening the counterplot
 Jim Wilson – child focused practice
 John Burnham – warming the context
 Paul Gibney ‐ context, interactivity, difference and form 4
Children Key Messages for the Child
 Need a story that makes sense
 What have people been worried about?
 Enough detail so they are clear and understand what is  Events: things that went right as well as those that happening
 Children sense/pick up what is happening  Listen to half conversations – on the stairs, behind doors, phone conversations etc.
 Fill in the gaps – become confused, scared and anxious went wrong
 Who’s helping things to get better?
 It’s OK to tell people about your worries
 People are looking out for you and working hard to keep you safe in the future Key Steps in the Process Components of storyboards
 Explain the process to parents and professionals
 The words
 The co construction of a joint narrative is central
 Use short sentences, plain language and use the words of the family
 This could mean including an alternative construction of mental illness, for example alongside the professional discourse. (Dad calls it ‘the alone times’ but the doctors call it depression)
 Be clear about what people are worried about  Say just enough to represent the whole  Meet with family members and professionals in different combinations – gather their story (timelines are usefull)  Drafting and amendment  Agreement ‐ participating adults agree formally to the content. (May have to agree to disagree and include both versions in the story)  Share with children and family members.
Components of storyboards
Components contd.
 The Pictures  An integral part of the story – illustrating the narrative and bringing the text alive
 Show relationships, emotions and context
 Do not usually depict traumatic events
 Show how people reacted, how they tried to help, what they might have been feeling or had wanted to say
 Identify who was involved and their role
 Structure and Sequence
 The starting point has to represent a logical and contextual introduction to events from the child’s point of view
 Difficult episodes are interspersed with positive events in the child’s life that fit and add balance to the overall story
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Storyboards ‐ Basic Structure 
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Clear title stating what this is about
First picture sets the context, neutral not too worrying
Who is worried
What they are worried about
Be clear about what the worries are ‐ this might be the only chance to let everyone in the system know the concerns Who is trying to help and move things forward
End with a number of people all working together. A positive picture with a future focus
Developing the storyboard
Maintain a clear focus on:‐
1. What are the concerns?
2. Who needs to know about them?
3. What do they need to know?
4. Why do they need to know it? (Who wants them to know and what is the purpose of their knowing?)
5. What do people know (or think they know) already?
Hints  Stick to facts rather than opinion
 Comment on what people may be thinking, feeling and doing  Include positive and neutral elements of the story to weave between difficult and positive aspects of the wider experience
 Leave some contextual aspects out so the children can add in for themselves
 Aim the story towards the edges of the youngest child’s frame of reference.
 Focus on key turning points and events  The pictures need to be simple – not cartoons
 Make multiple copies
 Children often want to read their storyboard a number of times.  This is not life story work – but a particular event in time Case Example
In 2008, Adam was 7 and Chloe was 4. We all lived in the house with the big tree. It was Number ___ Tamaki Ave. Nanna Sandy and Pops Mike lived in the units just down the street by the park. 6
Nanna and Pops started visiting our house lots. They helped tidy the house and Nanna
cooked us dinner. Mummy stayed in bed and she didn’t want to speak that much. Sometimes she cried. Daddy was all stressed out and shouted at everyone. Everyone was very worried about Mummy. The doctor could not help her stop crying so Mummy had to go to a special hospital called a psychiatric hospital. Daddy would not go to this hospital to see Mummy. He did not like it. We did not like it too, but Grandma Veronica and Granddad Ray took us to visit. Mummy just cried more and more. She didn’t want to speak to anyone. Pops and Nanna said it would be OK but Daddy was very worried so he called the doctor to ask for help.
Case Example
Tyrone now aged 9, lived with his mother Janice until he was 5 years. Janice has a serious problem with alcohol abuse. He then went to live with his paternal grandmother, Irene and has been living there for the past 4 years. Tyrone has had frequent irregular contact with Janice while living with Irene. Janice has decided to move to the South Island to try and have a fresh start and get away from the influences of her drinking friends. She feels she needs to have a clean break and will no longer be able to visit Tyrone. Irene feels she can’t cope on her own with Tyrone any longer as his behaviour has become more challenging over the past 4 years. CYF are involved and the plan is for Tyrone to move to a non‐kin foster placement. Exercise Gather the story
 What might Janice’s story be? ( to Tyrone)
Contact Wayne Ferguson Acting Director – Key Assets  What might Irene’s story be?
 What might the CYFS Social Worker story be?
 What may Tyrone be thinking and feeling?
 Who else may have a story to contribute?
Create the storyboard
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