DAFT Workshop: 12.30-2.00pm 7th June 2013
Couples Work for Depression
Facilitator: Dr Gary Robinson
There is a lot more going on!
http://derbyshireaft.wordpress.com/
http://www.aft.org.uk/view/index.html?tzcheck=1
http://www.derby.ac.uk/search/?q=systemic%20courses
Aims
•
•
•
•
Introduction to the Exeter Depression Model
Launching of the DHCFT Couples Project
Transferable Skills for Couples Work
Have fun and learn from each other
Plans
12.35 Welcome & Introductions & Aims
12.40 Exeter Depression Model
12.50 DHCFT Couples Project
13.00 Key Ideas
13.15 Case example and Skills Practice
13.30 More ideas and Practice
13.45 Discussion and Feedback
Exercise: In Pairs 5 minutes
• Introductions to each other
• Hopes about the workshop
• What expertise might you like
to share about couples
Why?
•
•
•
•
•
•
Evidence based. Research and Audit
Best Practice: Think Family
Service user feedback
NICE Guidelines: NHS Guidance
Social Care Guidance (Munro & Hackney)
Serious Case Reviews
Systemic-behavioural/systemic-empathic:
The Exeter Model
Couples Work with Depression
•
•
•
•
•
•
•
•
•
Systemic Empathic
Reframing
Genograms
Interviewing internalised other
Circular questioning
Sculpts
Empathic bridging manoeuvres
Investigating family scripts
Investigating attachments
Janet Reibstein & Hannah
Sherbersky
•
•
•
•
•
•
•
•
•
Systemic Behavioural
circularities
Enactments
Role play
Communication training
Problem solving
Homework tasks
Behavioural exchange
Communication skills training
DHCFT Couples Project
Substance Misuse Couples Project led by Doro
CAMHS Couples Project led by Veronica
Inpatient Couples Project led by Michael
Safeguarding Couples Project led by Karen
Self Reflexivity
The only person you can change is yourself.
However the changes you make will
influence others and you cannot know what
that influence or effect will be. All of which
is influenced by context.
Informationally closed systems: Maturanna
Hypothesising & Curiosity
Possibilities, Ideas & Informed Guesses.
Tentative explorations, allowing for the
consideration of new meanings & possibilities
Anti-Discriminatory Practice
Sexual Orientation
Occupation
Class
Interests
Abilities
John Burnham
Literacy
Gender
Race. Religion
Age. Attributes. Appearance
Class. Colour
Ethnicity. Economic Status. Education
Sexuality. Size: Spirituality
Circularity
Dave acts
Rose acts
Circularity, Meaning and Action
Dave thinks
Rose acts
Dave acts
Rose thinks
Context, History, Gender and Culture
Past
experiences
Dave thinks/feels
Rose acts
Dave acts
Rose thinks/feels
Past experiences
Circularities
Tracking: Talk with the couple about their interactions, for
example by:
• Reflecting back observations about recurring patterns of
relating between the partners
• Ask about the possible functions of symptomatic
behaviours for each
• Be curious about the roles played by each partner and
others in creating and maintaining problem behaviours or
symptoms, and explore possible reasons for these
• Discuss interactive patterns that may maintain symptoms
or negative interactions.
Skills Practice
In groups of four pick a Rose and Dave,
practitioner and observer/co-worker.
Draw circularities in relation to a recent
disagreement. Track behaviours, feelings and
thoughts. Do not try to problem solve or give
opinions.
Circularity
(Notice new information)
Hypothesising
(Consider, reflect,
discuss ideas)
Neutrality
(Open and curious
To new information)
Strategise
(Consider and choose)
Tomm, Karl. (1987). Interventive Interviewing Part I: Strategising as a Fourth Guideline
for the Therapist. Family Process 26. (page 12)
Interventive Interviewing
Karl Tomm
“He highlighted the fact that every question is a mini-intervention,
and he refers to circular questioning guided by specific strategies
as ‘interventive interviewing’. Strategising is the process that
guides such interviewing. When strategising, therapists, according
to Tomm, clarify their intentions about why they are asking
particular questions.”
Carr, Alan. (2006). Family Therapy: concepts, process and practice. 2nd
Ed. John Wiley and Sons Ltd, Chichester. pp128
Lineal tracking questions:
What happened?
Who was involved?
What did they do?
How did you do?
When was that?
Tomm, Karl. (1988). Interventive Interviewing Part III: Intending to ask Lineal,
Circular, Strategic, or Reflexive Questions? Family Process 27:1-15
Circular tracking questions:
• When you did that how did your friend react?
• How did people react when the fire started?
• Who else may have been affected by the death?
Tomm, Karl. (1988). Interventive Interviewing Part III: Intending to ask Lineal,
Circular, Strategic, or Reflexive Questions? Family Process 27:1-15
Reflexive Questions
“The questions are reflexive in that they are
formulated to trigger family members to reflect upon
the implications of their current perceptions and
actions and consider new options” (Tomm, 1987.)
Circular Questioning
Using different types of questions to
encourage new perspectives.
Types of circular questions
•Scaling questions
•Future orientated
questions
•Ranking questions
•New alternative
questions
•Triadic questions
•Outsider observer questions
•Self-reflective on self
questions
•Same question asked of all
•Contrast questions
Circular Questions
Consider the types of questions and in
pairs discuss:
Which types of questions do you most
use? Which questions interest or
surprise you?
Genograms
• Family genograms identify cross-generational family
meanings, norms, and/or expectations, especially with
regard to relationship roles and scripts
• Genograms offer tangible and graphic representations
of complex family patterns (McGoldrick, 1999)
• The genogram is both an end product and a therapeutic
process, moving focus away from the identified patient
24
B
Past
A
Present
3. Agree what the aims
or goals are for the
future and how the
family will be supported
in achieving them, over
what period.
Resisting premature knowing, or
offering solutions. Inviting families
to consider the influences of the
past before moving to the future
C
Future
2. Move to what is in the
past; the history that may
be impacting upon the
present and potential
future.
1. Start with here and
now. Who is important in
the child’s life, what are
the current presenting
difficulties. How do family
members understand this
and who might be
involved in the
assessment, treatment
and support?
Skills Practice
In groups of four, pick a Rose and
Dave, a practitioner and an
observer/co-worker. Use circular
questions and explore the present,
past and future.
Key Ideas & Concepts From Today
•
•
•
•
•
•
•
•
•
•
Engagement: Feedback
Curiosity: Neutrality
Contexts: Systems: Safeguarding
Tracking Circularities
I Statements
Relational Empathy
Genograms
Present-Past-Future
Circular Questions
2nd Order Change = Behaviour + Meaning
Feedback
1. What have you made of today. How have you
found the contents and the processes…negatives
and positives?
2. Discuss what you are going to take away from
today in pairs.
3. Chose one thing each you would like to feedback
in the large group
•
Supervision
Consultation
DAFT
& AFT
University
Training
Programme
Research & Audit
Pilot Projects
Systemic
Network
Experts by
Experience
Systemic Training and Supervision
If you would like to join us at DAFT please
come along. If you are interested in having
further systemic training or systemic clinical
supervision contact: Gary Robinson, Principal
Family Therapist on 01332 623700 ext 3261
email gary.robinson@derbyshcft.nhs.uk
31