PT25 Explain the rationale for systemic approaches

Overview

This standard describes how explaining the rationale for a programme of systemic psychotherapy is an intrinsic, ongoing part of the therapy. It involves helping the family and significant systems understand how systemic psychotherapy works and relating it to their own problems and experience so that they may give their valid consent. Establishing and maintaining an environment of respect, open communication and collaboration are essential contexts for this standard. 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 3.) 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:

Basic principles and rationale of systemic approaches

various systemic models and other related concepts and their limitations
theories of systemic change and clients’ theories of change
the assumptions contained in 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

Specific systemic techniques
the role of hypotheses to generate and guide formulations
theories underpinning the use of multiple perspectives of reflecting teams
how teams can be used in working directly with clients and the connections to theories of change

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 relationship

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

Treatment strategy
the general process of systemic therapy
the different phases of systemic therapy as a whole, and the phases within each therapeutic session

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

Performance Criteria

You must be able to do the following:

discuss the systemic approach with the client in a way that is likely to fit with their perspectives
discuss the beliefs and values underpinning the therapy
discuss the scope and limitations of the systemic approach including how issues of risk and safety will be addressed
provide a brief account of the efficacy data for treatment programmes for the specific problem if this is seen as helpful to the client
work collaboratively to help each individual, the family and their significant system find the potential relevance and utility of the systemic approach for their special difficulties
acknowledge the client’s and family’s strengths and successes
discuss with the client and the family the recursive relationship between situations, individuals, bodily sensations, thoughts, feelings and behaviour
help the client to realise that they and the system of which they are part have the resources to enable change
discuss with the client, family and wider system how changes in one part of the system is likely to result in changes in other parts of the system
model, through engagement and collaboration with all members of the significant system in the room, how the systemic approach works and how courtesy and consideration enable the system to work well
help the client to understand:

the role of the therapist
where appropriate the role of the team and how this will be negotiated
how members of the wider system will be involved in the systemic therapy
the different combinations and settings that may be pertinent to the therapy

explain the possibility of the usefulness of different therapeutic settings
use language, examples and a level of explanation that all clients are likely to understand and which are appropriate to the individual
discuss and explore each individual’s understanding of the systemic approach
encourage the client’s questions and feedback
elicit and discuss any concerns or queries any individual has regarding the systemic approach and their own situation
elicit and respect any individual’s ambiguities, questions or scepticism about the rationale, openly and non-defensively, inviting consideration of alternatives
create descriptive information for the client which offers a basic introduction to therapy and, where relevant, the team

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: Core 1 Communication