PT24 Undertake an assessment for family and systemic therapy

Overview

This standard is about systemic assessment. It is not a once-only event and may change as the therapeutic work proceeds. Systemic assessment is a therapeutic activity, in that what is asked of the client and how the questions are framed make a therapeutic difference. It has a role in keeping the client engaged in and encouraged about the work and provides an opportunity to find out holistic and relational information about the client, see how they respond to the approach and identify risks. In the systemic approach assessment, formulation and therapy are intricately linked. This standard describes therapeutic practice that has been shown to benefit families and other clients engaged in family and systemic therapy. (See reference in the additional information section on page 4.) To apply this standard, practitioners also need to take account of the multiple problems and complex co-morbidities that clients may bring to therapy. Family and systemic therapy should be offered as part of an explicit and structured approach agreed within the treatment team and with the client and the system. Users of this standard will need to ensure that practice reflects up to date information and policies. This standard should be understood in the context of the Digest of National Occupational Standards for Psychological Therapies. Version No 1

Knowledge and Understanding

You will need to know and understand:

Systemic assessment

the objectives of a systemic assessment from the perspective of the therapist and members of the system
how to use evidence based and formal assessment methods
the construction and applications of commonly used methods of system mapping
the indications and contra-indications to systemic treatment
how to carry out a multiple-perspective, systemic assessment
the potential negative consequences of the production of a formal assessment
how to write reports of an assessment for a range of audiences
the effects of mental illness in its acute, florid and less distinguishable forms on family life
the impact of social and behavioural problems on family life

Development and health
the physical, psychological, emotional and social development of a person through the life cycle
mental illness in all its acute, florid and less distinguishable forms as this affects family life

Risk
the assessment of risks to individuals and the risks they pose to others in a range of settings
current legislation and local guidelines and procedures about child and vulnerable adult safeguarding
the relevant professional systems of health care, social care, local authority and education applicable to safeguarding
how to balance the risk or safety and opportunity in therapeutic interventions
ethical issues of valid consent for all members of a system

Systemic approaches that enable therapeutic change
the role systems can play in psychological problems and health
how patterns of interaction and relationships within systems contribute to and maintain psychological, social, relational and cultural problems and health
explanations of how changes in any part of the system may have an impact on the rest of the system
how members of the system make use of resources that promote resilience and maintain change
psychological, social, relational and cultural problems that arise from lack of fit between attempted solutions and the current contexts
how systems develop helpful and unhelpful patterns of interaction and meaning systems and narratives
methods of utilising the members of the system and the system as a whole as a resource for the promotion and maintenance of change
how the therapist, colleagues and the broader professional system interact with, and form part of, the system with which they are working
the role of historical and trans-generational factors, stressful life events and their impact on family functioning in the development and maintenance of psychological disturbance, health and recovery

Systemic principles that inform the therapeutic approach
the range of contexts in which the client needs to be viewed
how the contexts manifest and constitute the system of significance
the personal, family and cultural factors and interactions between those factors that shape the individual
ways in which people understand themselves and the world around them
the influence of power relationships and different socio-cultural contexts on the development of meaning, relationships and behaviour for the client and the therapist
the influence of varied individual accounts of the same event on relationships and understanding in the system
the influence of recursive cycles of feedback on systems and individuals’ narratives, beliefs, emotions, feelings, actions, interactions and relationships

The therapeutic relationship
ethical, non-oppressive and anti-discriminatory practices
how to form and maintain collaborative relationships in age and culturally appropriate ways with everyone in the system
the impact of personal and professional narratives on the therapeutic process

Basic principles and rationale of systemic approaches
the various systemic models and other related concepts and their limitations
theories of systemic change and clients’ theories of change
the assumptions contained in the various systemic models
how to develop an account of patterns in relationships in families and wider systems
family based attachment theories across the life cycle from a systemic perspective

Performance Criteria

You must be able to do the following:

evaluate referral and contextual information obtained from relevant wider networks to determine:

whether and how to proceed with the assessment
who to consider involving
when and where to meet

take into account the context and history in which the problem developed and the referral emerged at this particular time
obtain the client’s consent to consult members of the wider system
where the client does not have the capacity to give consent, make a decision to consult the wider system on the basis of the best interests of the client or an individual in the client system
check with each client and explain to the client and relevant members of the wider system how you propose to work systemically
identify in conjunction with the client and, with permission, significant others:

perceived problem areas and the surrounding beliefs
information about the client’s family, schooling, work, interests, and other areas of life
relevant information about the social, emotional and physical development of the client
the potential strengths, skills and resources of the client and significant others that may support therapeutic change
the solutions that have proved to be helpful or have been thought about
the attempted solutions that have proved to be unhelpful or cannot be contemplated due to personal or cultural restraint

specifically obtain information about medication and explore it relationally
evaluate feedback from the client and significant others on the acceptability of the interventive aspects of the assessment process
assess and act on the risks that apply to the client, significant others and the wider community in line with your local guidelines
assess communication and interaction patterns within families and between family members, significant others and helping agencies
assess and map the family relationships and relationships with the wider system and significant others from your and the client’s understanding
communicate with the client in ways that are sensitive to:

individuals’ age and developmental stages
their culture and disability
the risk to each individual from new potentially harmful information

recognise and work with power differences affecting different members of the system’s rights to speak and contribute including those within the therapeutic relationship
help the client to articulate their situation and relationships in ways that enable them to appreciate and take both a close-up view and a wider perspective
share with the client and members of the system the outcome indicating whether systemic therapy is the right option for the client
describe alternatives to family and systemic therapy if jointly you consider it not to be an effective or best option

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard is derived from research reported in Roth, A., Pilling, S. and Stratton, P (2009) The competences required to deliver effective Systemic Therapies. Centre for Outcomes Research & Effectiveness (CORE) University College London. This standard has indicative links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB6 Assessment and treatment planning