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PT30 Intervene in patterns within and across systems

Overview

This standard shows the factors a systemic psychotherapist maintains awareness of, in order to address problematic patterns and promote positive ones. A therapist engages with the system in order to help change the patterns. 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:

    Systemic approaches that enable therapeutic change
  1. the role systems can play in psychological problems and health
  2. how patterns of interaction and relationships within systems contribute to and maintain psychological, social, relational and cultural problems and health
  3. explanations of how changes in any part of the system may have an impact on the rest of the system
  4. how members of the system make use of resources that promote resilience and maintain change
  5. psychological, social, relational and cultural problems that arise from lack of fit between attempted solutions and the current contexts
  6. how systems develop helpful and unhelpful patterns of interaction and meaning systems and narratives
  7. how to use the members of the system and the system as a whole as a resource for the promotion and maintenance of change
  8. how the therapist, colleagues and the broader professional system interact with, and form part of, the system with which they are working
  9. 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
  10. how families responds to presenting problems and become organised by them
  11. the relationship of responses and subsequent organisation to historical and current pattern of relationships
  12. the development, maintenance and resolution of psychological disturbance within patterns of relationships

    Specific systemic techniques
  13. the theory and use of circular questioning techniques and skills
  14. the construction of various methods of system mapping
  15. how to reframe problem descriptions and externalising problems
  16. how and when to use enactment techniques
  17. how and when to use problem solving techniques
  18. how and when to adopt a challenging perspective

    The therapeutic relationship
  19. ethical, non-oppressive and anti-discriminatory practices
  20. how to form and maintain collaborative relationships in age and culturally appropriate ways with everyone in the system
  21. how to make use of self and relational reflexivity to enhance therapeutic relationships
  22. the impact of personal and professional narratives on the therapeutic process

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

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

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

Performance Criteria

You must be able to do the following:

  1. establish the client’s definition and hierarchy of problems
  2. identify the client’s successful and unsuccessful attempted solutions
  3. identify the client’s openness to changing their situation for the better
  4. identify and respectfully highlight repetitive, unhelpful or stuck interactions and patterns of communication
  5. identify historical and trans-generational factors that constrain, promote or maintain change
  6. review and pause unhelpful or stuck interactions and patterns of communication and develop new, helpful ones
  7. enable the client and wider system to talk together when you consider there to be an opportunity for therapeutic gain
  8. practice new alternatives to unhelpful and stuck interactions and patterns of communication that:
    1. fit with individuals’ negotiated outcomes
    2. offer a positive balance of costs and gains
  9. amplify and promote positive patterns and communication that can impact on the rest of the system
  10. seek feedback from the client about the effects and impact of the challenge and their part in it and modify your approach accordingly
  11. consider, live and retrospectively,  the impact of your involvement in the client’s patterns via self-reflexivity and the use of a team and your supervisor

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 2 Personal and people development
PT30 Intervene in patterns within and across systems
Final version approved June 2010 © copyright Skills For Health,
For competence management tools visit tools.skillsforhealth.org.uk