Questions as Therapy Using systemic ideas in a learning disability context Selma Rikberg Smyly Consultant Clinical Psychologist Formerly: Ridgeway Partnership Oxfordshire Learning Disability NHS Trust [email protected] Pre-session hypothesising To develop and maintain curiosity in therapist Help develop systemic questions. Cecchin: Not “falling in love” with ones hypothesis as a way of maintaining curiosity Systemic concept Life as storied; the problem saturated narratives of our clients (Lynggaard) “study of disability is the study of the disabeling society” (Hayden- Laureat) Nature of change/aim of therapy; Loosening the connection between the individual and the problem “The person is not the problem the problem is the problem” Questions as therapy; how to prioritise context and relationship questions over problem focused questions (using circular , questions reframes, punctuating alternative stories, seeing multiple stories as a resource : both and) Change happens at the level of meanings and beliefs by “creating new stories or new meanings to old stories” (Hoffman) Finding the “difference which makes the difference” (Bateson) When to use systemic approaches: 1. 2. 3. 4. 5. 6. Complex referrals/ front door assessments/ initial consultations Transitions e.g. form children’s to adult services When working with families and behavioural /cognitive approaches have not been helpful When other approaches have already been tried When feeling stuck and not knowing how to proceed When multiple views become a hindrance Asking about the relevant network Who are they What is their relationship to problem/client What is their expectation of /relationship to/ help Who invited the therapist, who is the referrer Prata, Selvini et.al.(1980) The problem of the referring person. Reder and Fredman (1996) The relationship to help: interacting beliefs about the treatment process. Social constructionist ideas(tool for hypothesising) Social constructionist models emphasise the creation of meanings around perceived problems, the way in which these are individually created in specific contexts and vary over time, hence multiple perspectives. The initial hypothesising orientates us towards a more systemic way of looking at what might be happening and is curious about what is seen as a problem for who and why? Services/networks involved How is the problem perceived? How has referral come about? GENOGRAM LIFE-EVENTS To think about… Ψ Time, context and relationship (interplay) (The problem is the problem – the person is not the problem) Why now? Context of the referral Family context? Transitions and Life -Cycle? Relationship to Help (Reader&Fredman) Co-ordinated management of meaning (Cronin&Pearce) Selma Rikberg Smyly October 2008 Position of the therapist/ Emotional stance of therapist GRACES (John Burnham) Gender, race, age, culture, education, sexuality/relationships Position of therapist /transparency /self reflexivity; who are we doing this work, what do we pay attention to/what do we miss out? (genogrammes, lifecycle stages, cultural context) Interest in referring person; why now, who’s idea was it? ( relationship to help; customer/visitor/ complainant) Pre session hypothesising; turning assessment on its head Multiple perspectives: multiple solutions, seeing difference as a resource/ opportunity for change (curiosity, inviting of difference, non blaiming stance, both /and) “ The person is not the problem the problem is the problem” ) .