Lessons from Systemic Theory and Practice

1. Lessons from Systemic Theory and Practice British Psychological Society Faculty for people with intellectual disabilities Advancing Practice Conference: 26th March 2014 Sandra Baum and Henrik Lynggaard, Lead Clinical Psychologists & Systemic Psychotherapists Oxleas and Camden & Islington NHS Foundation Trusts

2. Overview • What do we mean by the term ‘Systemic’ • Five areas of practice in ID services where the systemic approach can be useful • Illustrated by brief examples from practice • The evidence base • Workshop tomorrow to illustrate the systemic approach in action with staff teams

3. Gregory Bateson (1904-80) • Born and educated in UK • Father: William Bateson • Settled in the States after 2nd World War. • Anthropology, biology, social science, linguistics, cybernetics, system theory, (double bind)

4. Hear it again from Mary Mead Bateson “Pathology is not in each individual person but it is in the system, in the pattern of relationships between them”. “I was trying to attach it to an individual; that is the way we are trained to think about causation”.

5. What do we mean by Systemic? • The word Systemic, like most other words, holds many different meanings. • From individual therapy  to family therapy (1950s) • From family therapy  systemic therapy: (e.g. the network of significant relationships of which each individual is a part)

6. Iceberg Visible The therapist’s talk What informs our talking, hearing and seeing Invisible

7. What do we mean by Systemic? • As we heard from Mary Mead Bateson the systemic approach invites us to move away from pathologising individuals and towards viewing concerns and problems as inter-personal. The approach is particularly interested in what is happening between people rather than within people; in other words it focuses on: • Context • Relationships • Communication • Interaction

8. What do we mean by Systemic? • Context • Without context, words and actions have no meaning at all.   • We always act from one context into another context

9. What do we mean by Systemic? • Connected in relationship • We live our lives in relationship with others. • Our identities, and our resources for responding to life events, are shaped and sustained by those we are close to. When we experience a crisis, significant people in our lives are affected too; and their responses in turn, affect us.

10. What do we mean by Systemic? • Communication • Attention to communication is central to the systemic approach. All forms of behaviour have a communicative intent. • People affected by intellectual disabilities often find communication a challenge, so that their voices are frequently subjugated, silenced or misunderstood.

11. 9 – 2 = 7 6 + 5 = 11 11 + 1 = 13 3 + 14 = 17

12. Multiple perspectives • A short exercise to demonstrate this key fundamental systemic concept.

13. In systemic therapy we are concerned to… • create a context where we can open space for dialogue • position ourselves as ‘facilitator’ or ‘conductor’ of conversations. • be mindful of how we invite people to be positioned as resources to the problem (i.e. not to be blamed or criticised). • unpack problem saturated stories and to jointly co-create and co-author new stories and meanings together, and to find new ways of going forward.

14. Method • A distinctive feature of the systemic approach is that we often work with many people at the same time. • We rarely work as single practitioner - as there is only so much any one person can attend to at the same time. We therefore, work in teams. • An overall aim in the work is to create reflective processes (people becoming observers to their systems), by separating talking and listening

15. Five areas of practice where the systemic approach has been particularly useful • Working with families • Working with individuals • Working with staff teams • Setting up and facilitating network meetings • Supervision

16. Working with families The key themes include: • life-long effects of having a son/daughter with ID. • negotiating transitions, re-experiencing grief and loss, and vulnerability and protection. • relationship with the wider system of care and support.

17. An example of family therapy Mother Father Therapist Jamie 19 Social Worker team team

18. Working with individuals • Putting people in the room - even in their physical absence - through the questions we ask, in a way that is accessible and meaningful to the person we are in conversation with • Therapeutic intention: to widen the perspective of the problem

19. Example – “What might your Dad say…” Point to or pull in an empty chair: • “I know your Dad isn’t here, but could you imagine for a moment that he is?” • “I know it is an unusual question” • “But could you imagine him sitting on this chair here?” [touch the chair] • “What do you think he might say?”

20. Working with staff teams • Who needs to change? • Bring staff together to provide a space for them to think and reflect on their work with specific clients or dilemmas • Drawing out the expertise and knowledge of the staff team • We aim at an open, enquiring and reflexive approach

21. Network meetings: gathering a community of concern around the person • We bring together people who are involved, concerned and connected around an issue/problem/predicament/dilemma. • Working with networks to create therapeutic opportunity. •  These network meetings create opportunities for enhanced communication between the referred person, their families and practitioners and facilitated coordinated and collaborative future planning among the different people involved.

22. Network meetings: how are they facilitated? • Themes and agenda not planned in advance but co-created between the participants at the outset • Separating talking from listening by creating reflective processes • We often start with asking the following questions to everyone in turn: If you left at 4 p.m. and you said to yourself; I am really glad that I came? What would we have done together? What would we have talked about? What would you be clearer about? What would you be able to do?

23. Process of network meeting further explained • From what participants say we identify some key themes In relation to each of these themes we then ask a series of questions: • What have you already done/understood/tried? • What has been the effect? • What have you been doing already to stop the situation getting worse? • …

24. Supervision • In supervision we can use a number of systemic techniques to enhance our understanding (both supervisee and supervisors) of a situation, or dilemma or problem. For example: • “Could you sit in different chair and speak from the position of the mother/care staff/brother…” • Interview the supervisee as the client or as a significant person in the system • Intention: to create reflective processes

25. How can I show this is a useful model? • The Evidence Base of Systemic Family and Couples Therapies by Prof. Peter Stratton, (AFT website, 2013) • SCORE-15 with videos (AFT website, 2014) • Archives of testimony – (AFT website, 2014) • Randomised control trials (Jones & Asen, 2000) • Descriptive accounts (see Baum & Lynggaard, 2006; Context AFT: April, 2011; Clinical Psychology & LD, 2012) • Qualitative accounts (see Arkless, 2005; Baum & Walden, 2006; Pote, 2006; and Pote, Mazon, Clegg & King, 2011)

26. How to contact us • sandra.baum@oxleas.nhs.uk • henrik.lynggaard@islington.gov.uk

27. Summary • So, what we have done, we hope, is to give you a flavour of the many different ways in our daily practice we can be informed by, draw on, and use the systemic approach (e.g. with individuals, families, staff teams, networks, teams, and supervision). • Time has not allowed to go into any great detail about anything, and you may well wonder where you go next in conversations, after the few questions we have put up. Tomorrow, we are giving some more time to look at one of the ways (working with staff teams), but there is of course a lot published in this areas by now where people can seek further information, guidance and inspiration.