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
“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:
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
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 The problem of the
referring person.
Reder and Fredman (1996) The relationship to
help: interacting beliefs about the treatment
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?
To think about…
Time, context and relationship (interplay)
(The problem is the problem – the person is not the
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”

Pre session hypothesising