PT31 Promote constructive patterns in relationships within and across systems

Overview

This standard is about change that the client wants: facilitating the client in systemic therapy to change patterns of beliefs, emotions, attitudes and behaviour within and across contexts in order to improve the relationship the different people have with each other. It is a collaborative process and involves facilitating open communication and the engagement of the relevant people within a therapeutic alliance in order to find ways of promoting effective interaction 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 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 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. help the client and the wider system to reflect and map:
1. their thoughts, feelings, beliefs, attitudes and patterns of interaction behaviour and stories related to the problem
2. how the meanings given to these may prevent change
2. identify with the client:
1. dominant and subordinate narratives that constrain or enable change
2. disruptions that may have occurred
3. openings, resources and exceptions that have been obscure or not been acknowledged and permit new possibilities
3. enable the client to:
1. identify historical and trans-generational factors that constrain, promote or maintain change
2. reframe their constraining ideas and re-label ideas and descriptions of the problem in a positive way
3. give the problem a positive external identity
4. co-construct new ideas and narratives with the client that can accommodate contradictions and uncertainties
5. encourage the client to draw on their resources and views from the wider system and transfer knowledge and skills from their successes and solutions to other problems
6. explore with the client the potential implications of changes in beliefs and or behaviours for their life and the individuals in it
7. identify and amplify change in a way that focuses on the client’s actions, resources and their impact in their own lives as well as within the wider system
8. encourage the client and wider system to talk together at times with less reliance on you as facilitator when you consider there to be an opportunity for therapeutic gain
9. enhance the client’s agency within their situation in a way that strengthens the client’s ability to influence their own life and their relationships in a direction they prefer
10. generate and strengthen alternative narratives which maintain preferred changes in the emotions, beliefs and relationships of the client’s life
11. elicit and attend to feedback from the client to maintain interventions that are acceptable and useful
12. recognise self reflexively the impact of your own ideas, thoughts and feelings about solutions

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