PT35 Monitor and review progress in family and systemic therapy

Overview

This standard shows how the therapist involves the client in monitoring or measuring the progress of the work. Between them, therapist and client highlight progress and backward steps, impasses and the moments when goals, direction or methods of working may need to change. They may identify that alternative models of therapy may be more useful or that there needs to be referral to other services. A therapist is also expected to draw on the process of review for the development of their own practice. 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:

Progress review and measurement

formal methods of evaluation of progress
reflexive processes for evaluating progress
interpretation of the meanings and implications of client progress

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

Systemic principles that inform the therapeutic approach
the range of contexts in which the client needs to be viewed
how the contexts manifest and constitute the system of significance
the personal, family and cultural factors and interactions between those factors that shape the individual
ways in which people understand themselves and the world around them through a process of personal and social construction
the influence of power relationships and different socio-cultural contexts on the development of meaning, relationships and behaviour for the client and the therapist
the influence of varied individual accounts of the same event on relationships and understanding in the system
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
explanations of how changes in any part of the system may have an impact on the rest of the system
how members of the system make use of resources that promote resilience and maintain change
psychological, social, relational and cultural problems that arise from lack of fit between attempted solutions and the current contexts
how to use the members of the system and the system as a whole as a resource for the promotion and maintenance of change
how the therapist, colleagues and the broader professional system interact with, and form part of, the system with which they are working
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
the various systemic models and other related concepts and their limitations
theories of systemic change and clients’ theories of change
the assumptions contained in the various systemic models
how to develop an account of patterns in relationships in families and wider systems
family based attachment theories across the life cycle from a systemic perspective

Performance Criteria

You must be able to do the following:

identify with the client and significant others whether the client finds the changing patterns of beliefs, emotions, relationships, narratives, behaviours and perceptions beneficial
enable relationally reflexive processes through which you and the client comment on the process and outcomes of the work through
measure changes with standardised instruments where this reduces uncertainty about progress and is acceptable to the client
explore how change is being sustained outside the therapeutic setting
evaluate the effects of the work in progress for the client and you by using supervision and your team self reflexively
evaluate any impulse to align with any one member of the system for its effects on the work, therapeutic alliance and family relationships
explore the possible meanings of any decrease in progress and potential limitation in therapy
identify the need for other explanatory models, interventions, onward referral or alternative or additional therapy
reformulate goals through discussion with the client and colleagues
monitor your own performance in relation to the client’s goals for therapy with team, colleagues and via ongoing clinical audit
identify what you may learn or contribute to research or evaluation from the process of review

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: HWB6 Assessment and treatment planning