MAIN POINTS
1. From the start, we consider who's
involved in the presenting picture?
"The people involved" are the "system" concerned.
Often and in the first place this is just the immediate family
- characteristically, a "Family Therapist" might always
make this assumption. The invitation to an appointment is then
to "all those living at home" because it "helps
to get a full picture and plan for the best".
Often the individuals in the family are already working hard at solving something. If no one's bothered, the presenting problem is likely to be a protest of cry for help, in itself drawing in someone else or raising the level of concern; and/or the problem may be a solution for the sadness [e.g stealing, overdose, alcohol].
2. At the appointment, we consider who
we may need to work with next time?
Perhaps the father has not come - or the granny or a helper from
another agency - but they are obviously important and we need
to explore involving them. Or we can suggest seeing just the [parent[s]
next time - if only because the young children were so noisy they
were distracting from sorting something out, as they may well
be doing at home too!
3. We find that the combination of individuals'
solutions may be what's keeping the problem going.
This "circle" of solutions and problems is another part
of what we mean by a "system". An example: 8 year old
Donna feels neglected and sad; Donna gets grumpy and misbehaves;
Dad sees Donna as needing understanding; Mum thinks she's playing
it up, both sure they're right [as they both may be]; the softer
Dad gets, the harder Mum gets to balance things and vice versa;
Mum and Dad fall out with each other; Mum and Dad feel defeated
and resentful; they don't have time for Donna; so ...... Donna
feels neglected and sad and so on. Of course, there may be a whole
complicated story behind this which may need exploring before
things can change.
4. They're supposed to be weak, but clients
usually have great strengths.
Individuals and families usually have good reasons for what they're
doing. Great strength and even heroism will be found in those
who have often had to face grave challenges in their lives.
5. Seeing the family together allows
us and them to see what could change soon
Meeting together allows a full picture to actually happen "here
and now". We also see when and where it isn't happening,
showing the family's strengths. The family and the worker open
up ideas and options [e.g deciding loyalties, needing to talk
to each other before dealing with the children, or sharing different
upbringings, feelings or secrets]. Perhaps plans will emerge for
meaningful things to do as homework between sessions.
6. This whole process can be very complex,
so live team help is needed for the worker
Live team work is of positive use in many ways as it frees and
supports the worker. It helps pick up or "mirror" what's
happening and focus it most helpfully for the family. Taking a
break for a team consultation [while the family have theirs!]
makes one interview worth more than two as a live creative process
takes shape. It seems appropriate to have one "system"
[the team] to work with another [the family etc.]
7. Other helping agencies are often involved
so we work hard at liaising with them.
Another aspect of a "systems" approach is that, over
particular cases or in general, the agencies in a district need
to work together to form a broad "team".
8. This approach may be intensive but
often brief
Even one or two family meetings may be enough, but 4-8 would be
average, and occasionally longer is needed. Sessions are usually
several weeks apart.
OTHER QUESTIONS
Why meet a family all together?
This gives a vivid full picture. It values and include's everyone's
contributions and ideas equally. If they're not included, then
they may not be able to support change. You can avoid suggestions
that someone has already tried. It's much quicker, and it's fun!
Won't seeing them together inhibit important
secrets from being told?
The most striking demonstration that a family has an important
secret is in a family interview, where the worker can comment
openly for all and explore the problematic effects of having a
secret, without needing to know what it is at first. Seeing an
individual and discovering the secret secretly may only add to
the problem of what you and the individual do next. However, sometimes
it is necessary to arrange to see an individual, for example,
in suspected child sexual abuse.
What kind of problems get referred?
This kind of agency gets referred children aged 0-16 plus [and
their families. Presenting problems include the following : Worrying
feelings [sad, phobias, nightmares], behaviour in or out of the
home [aggression, not doing what they're told, stealing, lying,
running away], school difficulties [truancy or not attending,
poor work] medical things [physical symptoms with or without physical
causes, diet, soiling, wetting, attempted suicide], and open family
conflict [around divorce, fostering and adoption,family violence
and sexual abuse, and child care questions]. We also offer consultation
to other agencies work with children and families.
Why don't you call what you do "Family
Therapy"
We are not set up as a "Family Therapy" service. Families
do not come here saying "We have a family problem; give us
a Family Therapy", they usually say "We're worried that
our child has a problem". A "systems approach"
needs to go wider [and narrower] than just "the family",
especially since there are many varied forms of family in our
modern society. The word "therapy" is too mystifying,
unclear and medical for our liking. We [and the local culture]
prefer to call a spade a spade. So, if we have to call it anything,
we call ours a "Family Systems Approach" within which
we may have to consider all kinds of ways of helping, one of which
may be "family work". However, Family Therapists might
call most of what we do Family Therapy.
August 1991
nick.child@virgin.net