PT26 Develop a formulation in family and systemic therapy

Overview

This standard shows the various factors that are taken into account in developing a systemic formulation and the way in which that formulation is recorded, presented and shared. A formulation continues to evolve during the progress of therapy and, in this respect, it is always tentative and emerging. Central to developing a formulation is the process of collaboration and sharing understanding with the client and family that also draws on theories of change. 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:

Specific systemic techniques

the role of hypotheses to generate and test formulations
how to generate and test formulations
the construction and applications of commonly used methods of system mapping
how to reframe problem descriptions and externalising problems

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

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

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
how to make use of self and relational reflexivity to enhance therapeutic relationships
the impact of personal and professional narratives on the therapeutic process

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

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

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

Culturally sensitive practice
dominant and alternative constructions of identity
the character of your cultural assumptions and habits
the significance of your own cultural assumptions, prejudices and stereotypes
how to explore differences across and within cultures
how to engage with the client where there is potential for distance due to different world views between you and the client
how to identify cultural themes and explore different meaning and perspectives within the client’s cultural framework

Performance Criteria

You must be able to do the following:

develop a formulation of the presenting problem including all members of the system that takes into account:

the different contexts of significance
the power differentials in the system
the factors involved in the development and maintenance of the problem(s)
the resources that promote change and constraints that limit change
the client’s understanding of their difficulties and attempted solutions
the wider system and their understanding of the client’s difficulties and their attempted solutions
the relationship between the therapist, therapy team, the system of concern and the wider professional system
the similarities and differences between the client’s and therapist’s explanation
information and evidence from the continually evolving assessment and other sources
the particular perspectives that the therapist brings to the work

emphasise the provisional nature of the formulation
ensure that blaming or pathologising descriptions and explanations are avoided
share the formulation with the client to elicit their feedback in ways that creates a shared understanding and promotes a mutual engagement in the work together
revise the formulation on the basis of new information and feedback that emerges during the course of the therapy from the client and significant others
develop goals for the therapy collaboratively with the client
record the formulation in a way that informs further development of the therapy
communicate the formulation in a way that is respectful to the client, their significant system and your team
evaluate any impulse or invitation to align with any one member of the system for its effects on the work, therapeutic alliance and family relationships

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