PT33 Explore differences across and within cultures in family and systemic therapy

Overview

This standard is about inclusive practice: recognising and working with difference in ways that promote understanding and respect, making family and systemic psychotherapy meaningful for all parties in the system. It requires a range of reflexive approaches on the part of the therapist and the therapy team and the ability to recognise when extra consultation is required to support client wellbeing. Practitioners may also address discriminatory and oppressive behaviour within the client system and encourage changes to this dynamic. 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:

Culturally sensitive practice

1. dominant and alternative constructions of identity
2. how cultures construct different world views and experiences
3. the character of your own cultural assumptions and habits
4. the significance of your own cultural assumptions, prejudices and stereotypes
5. how to discuss cultural assumptions, habits and prejudices transparently and be open to alternative world views
6. how to engage with the client where there is potential for distance due to different world views between you and the client
7. how to identify cultural themes and explore different meaning and perspectives within the clients’ cultural framework
8. how to use interpreters and others in facilitating the contribution of family members with special needs and those whose first or spoken language is different from that in which the therapist works
   
   The therapeutic relationship
   
9. ethical, non-oppressive and anti-discriminatory practices
10. how to form and maintain collaborative relationships in age and culturally appropriate ways with everyone in the system
11. how to make use of self and relational reflexivity to enhance therapeutic relationships
12. the impact of personal and professional narratives on the therapeutic process
    
    Risk
    
13. the assessment of risks to individuals and the risks they pose to others and in a range of settings
14. current legislation and procedures about child and vulnerable adult safeguarding
15. the relevant professional systems of health care, social care, local authority and education applicable to safeguarding
16. how to balance the risk or safety and opportunity in therapeutic interventions
17. ethical issues of valid consent for all members of a system
    
    Systemic principles that inform the therapeutic approach
    
18. the range of contexts in which the client needs to be viewed
19. how the contexts manifest and constitute the system of significance
20. the personal, family and cultural factors and interactions between those factors that shape the individual
21. ways in which people understand themselves and the world around them
22. the influence of power relationships and different socio-cultural contexts on the development of meaning, relationships and behaviour for the client and the therapist
    
    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. family based attachment theories across the life cycle from a systemic perspective

Performance Criteria

You must be able to do the following:

1. seek cultural consultation or advocacy when your understanding or provision of support is insufficient
2. identify the markers of diversity that are pertinent to work with the client
3. take into account in your work with the client:
1. the ways in which the markers of diversity may intersect and shape sense of self, relationships and social positioning
2. the contexts in which markers are embedded and the levels at which interventions should take place
3. the ways in which positioning within social and cultural discourses shapes sense of self, relationships and social positioning
4. manage in therapeutic ways the similarities and differences between the location of the client within social and cultural discourses and your own location
5. find ways of engaging and connecting effectively across differences within the client and its significant systems and between yourself and the client
6. engage with the client’s cultural beliefs through questions that are meaningful within the client’s cultural framework
7. identify the implications for the therapeutic relationship of differences that are intertwined with and signified through power relationships
8. explore the challenges of working across different cultural context for you and the client and negotiate ways of ensuring that the therapy remains useful
9. adapt your approach or suggest alternatives if a systemic psychotherapy is found to be based upon assumptions of helpfulness that are not culturally congruent.
10. identify and check out assumptions about and practices of similarities and differences
11. create a safe containing environment in which issues of difference can be named, discussed and explored respectfully in an ongoing way
12. respond sensitively to tensions that arise between members of the therapy system because of socio-political and personal beliefs
13. promote and embody respectful and collaborative relationships which fit with the client and ensure anti-discriminatory practice
14. understand and explore transition issues for the client and their impact on the presenting problem and ways forward
15. respectfully challenge beliefs, behaviours and practices within the logic of the cultural system and 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: Core 6 Equality and diversity