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PT34 Promote change through tasks between family and systemic therapy sessions

Overview

This standard shows how the systemic psychotherapist invites the client to work with tasks, experiments and rituals that have evolved as an extension of in-session work. Any task, experiment, or ritual is tailored to the particular client and each individual in the context of their culture, the stage of the work, and their relationship with the therapist and the therapy team. The client needs to be an informed participant in the planning and in the feedback on how the tasks went. 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:

    Out of session tasks
  1. a range of common out of session tasks, their use and the evidence for their effectiveness
  2. rationales for the use of tasks and techniques for presenting them to the client

    Specific systemic techniques
  3. the theory and use of circular questioning techniques and skills
  4. the construction of various methods of system mapping
  5. how to reframe problem descriptions and externalising problems
  6. how and when to use enactment techniques
  7. how and when to use problem solving techniques
  8. how and when to adopt a challenging perspective

    Risk
  9. the assessment of risks to individuals and the risks they pose to others in a range of settings
  10. current legislation and local guidelines and procedures about child and vulnerable adult safeguarding
  11. how to balance the risk or safety and opportunity in therapeutic interventions
  12. ethical issues of valid consent for all members of a system

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

    Systemic approaches that enable therapeutic change
  20. the role systems can play in psychological problems and health
  21. how patterns of interaction and relationships within systems contribute to and maintain psychological, social, relational and cultural problems and health
  22. explanations of how changes in any part of the system may have an impact on the rest of the system
  23. how members of the system make use of resources that promote resilience and maintain change
  24. psychological, social, relational and cultural problems that arise from lack of fit between attempted solutions and the current contexts
  25. how systems develop helpful and unhelpful patterns of interaction and meaning systems and narratives
  26. how to use the members of the system and the system as a whole as a resource for the promotion and maintenance of change
  27. how the therapist, colleagues and the broader professional system interact with, and form part of, the system with which they are working
  28. 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

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

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

Performance Criteria

You must be able to do the following:

  1. develop tasks, experiments or rituals that the client can carry out outside the therapeutic setting and that:
    1. are relevant to the ideas generated in the session
    2. are likely to be effective
    3. are co-evolved with the client and agreed by them
    4. have a clear intention
    5. transfer therapeutic work from the session to other settings
    6. build on experience with previous tasks and their outcomes
    7. allow space for practice, playfulness, experimenting and hypothetical scenarios that are ethically informed
    8. have low or manageable risks
    9. have value in being set even if they are not completed
    10. involve each individual in a way that matches the intention
  2. explain and check that the client understands your rationale for suggesting the tasks
  3. explore difficulties you, the team or the client anticipate
  4. elicit detailed feedback on carrying out tasks
  5. explore non-judgmentally the reasons for the client not carrying out a task and use the understanding gained in future task construction
  6. agree and manage between session contact about the tasks
  7. adjust the pace and direction of therapy in response to progress in the tasks
  8. review the choice of tasks and methods and their impact with your team or colleagues

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: HWB4   Enablement to address health and wellbeing needs
PT34 Promote change through tasks between family and systemic therapy sessions
Final version approved June 2010 © copyright Skills For Health,
For competence management tools visit tools.skillsforhealth.org.uk