PT28 Promote the engagement of children and adolescents in family and systemic therapy

Overview

This standard involves the therapist in developing a relationship with children and adolescents in the family in a way that addresses anxieties and confusions about the therapeutic work and creates a context in which they feel willing and able to participate. The work may include meeting with individuals, subsystems and the larger family unit, creating a safe context for a discussion about the sharing of information.  It involves effective, often playful, communication at their level and by means they understand, ensuring that the child or adolescent has the opportunity to have a voice in the work. 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:

The therapeutic relationship

1. ethical, non-oppressive and anti-discriminatory practices
2. how to form and maintain collaborative relationships in age and culturally appropriate ways with everyone in the system
3. how to make use of self and relational reflexivity to enhance therapeutic relationships
4. the impact of personal and professional narratives on the therapeutic process
   
   Systemic principles that inform the therapeutic approach
   
5. the range of contexts in which the client needs to be viewed
6. how the contexts manifest and constitute the system of significance
7. the personal, family and cultural factors and interactions between those factors that shape the individual
8. ways in which people understand themselves and the world around them
9. the influence of power relationships and different socio-cultural contexts on the development of meaning, relationships and behaviour for the client and the therapist
10. the influence of varied individual accounts of the same event on relationships and understanding in the system
11. the influence of recursive cycles of feedback on systems and individuals’ narratives, beliefs, emotions, feelings, actions, interactions and relationships
    
    Culturally sensitive practice
    
12. dominant and alternative constructions of identity
13. the character of your own cultural assumptions and habits
14. the significance of your own cultural assumptions, prejudices and stereotypes
15. how to explore differences across and within cultures
16. how to engage with the client where there is potential for distance due to different world views between the therapist and client
17. how to identify cultural themes and explore different meaning and perspectives within the clients’ cultural framework
    
    Systemic approaches that enable therapeutic change
    
18. how members of the system have, and can make use of, resources that can promote resilience and maintain change
19. methods of utilising the members of the system and the system as a whole as a resource for the promotion and maintenance of change
20. how the therapist, colleagues and the broader professional system interact with, and form part of, the system with which they are working
21. 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
    
    Basic principles and rationale of systemic approaches
    
22. various systemic models and other related concepts and their limitations
23. theories of systemic change and clients’ theories of change
24. the assumptions contained in the various systemic models
25. how to develop an account of patterns in relationships in families and wider systems
26. family based attachment theories across the life cycle from a systemic perspective
    
    Development and health
    
27. the physical, psychological, emotional and social development of a person through the life cycle
28. mental illness in all its acute, florid and less distinguishable forms as this affects family life
    
    Risk
    
29. the assessment of risks to individuals and the risks they pose to others in a range of settings
30. current legislation and local guidelines and procedures about child and vulnerable adult safeguarding
31. the relevant professional systems of health care, social care, local authority and education applicable to safeguarding
32. how to balance the risk or safety and opportunity in therapeutic interventions
33. ethical issues of valid consent for all members of a system
    
    Specific systemic techniques
    
34. how to reframe problem descriptions and externalising problems
35. play and other creative verbal and nonverbal techniques for working with children
36. how and when to use enactment techniques
37. how and when to use problem solving techniques
38. how and when to adopt a challenging perspective

Performance Criteria

You must be able to do the following:

1. discuss with parents and carers how best to prepare children and adolescents for the systemic work and setting
2. use language and other forms of communication that are appropriate to a child’s or adolescent’s developmental level
3. work at a pace appropriate for the age and capacity of the child
4. attend to what the child or adolescent wants to say whether or not it is relevant to the presenting problem
5. elicit the child’s or adolescent’s strengths, interests, competences and  world view
6. hold space for the child’s or adolescent’s voice in a family in a way that does not violate parents’ beliefs about hierarchy between children and parents
7. highlight and validate strengths and solutions provided by the child or adolescent
8. judge when the child or adolescent needs safeguarding from being part of or witnessing adult interactions in a session
9. safeguard the child or adolescent in a session from repeated negative interactions from others and highlight positive interactions
10. acknowledge and challenge the position and roles a child or adolescent may habitually have in the system where it is likely to have an adverse impact on them
11. track and use your therapist responses for continued engagement
12. evaluate any impulse to align with any one member of the system for its effects on the work, therapeutic alliance and family relationships
13. explore and address anxieties about therapy and the therapeutic setting
14. facilitate the articulation of fears, anxieties, hopes and dreams
15. use individual sessions with the child or adolescent when it allows them greater comfort in expressing themselves
16. discuss with the child or adolescent what information to transfer back into the conjoint family sessions

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