AFT CONFERENCE 2013
Think Family Systemic and Psychodynamic
Safeguarding Practices
Gary Robinson
Karen Johnson
Steve Edgeley
Aims 1
•
•
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•
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Share Thinking and Practice
Introduce Think Family Pilot project
Include the voices of families we work with
Learn from each other
Stimulate ideas and creativity
Embrace/Observe Confidentiality and Respect
It’s a very remarkable thing that the
unconscious of one person can act upon the
other without passing through the conscious
Freud 1916
Aims 2
Share ideas about: Exploring, Managing and
Utilising Therapists Differences:
• Conscious and Unconscious Processes
• Splitting, Mirroring, Projection
• Parallel Processes
• Relational Reflexivity
• Gender
• Style/Theory: Now or Tomorrow
Plans
1.30 Introductions and Sculpt
1.45 Context: Drivers
1.55 Strategy
2.10 Theory & Practice
2.20 J’s Family & Team: DVD’s
2.45 Discussion & Feedback
3.00 End
Introductions and Sculpt
Co-ordinated Management of
Meaning: Safety and Risk
Safeguarding
Systemic
Psychodynamic
Context
Think Family
Munro and Hackney
Serious Case Reviews
Political and Economic Drivers
Strategic Direction
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•
•
•
Organisational commitment
Approved Therapies
Partnership in education
Meeting the needs of complex
families – multi agency
intervention
• Think family and safeguarding
children and adults
• Supervision in practice
Systemic
Training
Programme
Clinical
Quality
Committee
Safeguarding
Board and
Groups
Tuesday Family
Therapy Team
Think
Family
Training
DAFT
Systemic
Supervision
Training
Couples
Project
Model of Containment
Mirroring
Predictability
Reliability
Boundary and Space
Donald Winnicott:1964
Supervision
Boundary and Space
The Maturational
Process and the
Facilitating environment
Multi agency Consultation
and Supervision
Family Therapy Team
Individual or
Family
Towards Positions of Safe Certainty
Safe
Safe
Uncertainty
Safe
Certainty
Certainty
Uncertainty
Unsafe
Certainty
Unsafe
Uncertainty
Unsafe
(Mason 1993)
The team aims to offer Safe Uncertainty
in relation to practice, supervision,
consultation and training. We aim to
safely challenge unhelpful defensive
practices and premature certainty in
promoting manoeuvrability and
collaboration
James’s Genogram
2012
2002
J
14
J
11
11
A
H
M
Family Referral
•
•
•
•
•
Safeguarding Concerns
ADHD and ASD Assessment
Physical Health Issues
Bereavement
Child & Adult Mental Health Issues
Events
Psychodynamic
Systemic
1: Mum and son
together, mum
unwell, physically
sick, including as J
speaks
Defence
Milan: Neutrality,
Projective Identification Curiosity,
Hypothesising.
Reflecting Teams
Safeguarding
Child protection in place,
therapy meeting with
child in attendance.
2: Arguments
Conscious and
between mum and J Unconscious processes
and J and siblings
Structural ideas
regarding hierarchy
and parentification
Child in Need
Section 47
3: Meetings with
Consultant
Psychiatrist & Care
Coordinator
Transference and
Counter-transference
Post Milan: Social
Constructionism &
Domain of Aesthetics
and Production
Working Together:
Mending
workforce/network splits
4: Finding voices:
Team. Family &
Professionals
Parallel Process and
Synchronicity
Self and relational
Reflexivity
Supervision &
Safeguarding Policy &
Procedures
5: J finds his voice
Processing and
Differentiation
Structural and
Strategic. Child
Focused
Every Child Matters
6: Networking,
Formulation &
Supervision
Formulation and
Interpretation,
Reparation
Safe Uncertainty and
CMM: Formulation
Risk Assessment,
Diagnosis, Perpetrator,
Victim
Event
Psychodynamic
Systemic
Safeguarding
1: Mum and
son together,
mum physically
sick, including
as J speaks
Defence, projective
identification
Milan: Neutrality,
Curiosity,
Hypothesising.
Reflecting Teams
Child protection in
place, therapy
meeting with child
in attendance
Exploration of the
nature of the
physical illness and
how this may be
affected by
emotions, anxiety
and distress. How
does J experiences
this. Collaborative
sharing of ideas
and possibilities.
Are J’s emotional
and physical need
being met needs
being met? Is it
helpful to meet
together and or
separately with
mum?
Psychodynamic
hypothesis : does J
represent something
unbearable
(unconscious) for
mum, leading to
unconscious intersubjective
communication. The
expelling (ridding) of
unwanted and/or
disavowed (denied)
content of one mind
into another, too
painful to bring to
mind.
Event
Psychodynamic
2: Argument
Conscious and Unconscious
between mum processes
and son
Mum and son differ in the
perception of events and
communication.
Countertransference and
transference responses to
interaction. Therapists hold
different thoughts in mind
and hypothesises in live
feedback.
Reflection, some thoughts
occur following sleep or
during following days.
Unconscious connections
between child and therapist.
Systemic
Safeguarding
Structural ideas
regarding
hierarchy and
parentification
Child in Need
Section 47
Recognising
position
As eldest sibling
whilst
considering life
cycle and child
development
issues. Inviting
mum to take
different
positions.
Enabling the
child’s voice to
heard and
validated.
Containment
or escalation.
Safeguarding
registration
issues and
parenting
assessment.
Event
Psychodynamic
Systemic
3: Meetings with
Consultant
Psychiatrist &
Care
Coordinator
Transference and Post Milan: Social
CounterConstructionism &
transference
Domain of
Aesthetics and
Holding,
Production
Containment and
Reparation.
Exploring and
addressing
Mum is able to
Safeguarding
express strong
concerns, taking a
emotions of hurt both-and positions.
and then reWorking with and
engages with the alongside.
psychiatrist.
Embracing the
notion of Problem
dissolving systems.
Safeguarding
Working Together:
Mending
workforce/network
splits
Network meeting,
consultation,
operational and
clinical supervision.
Live co-working.
Systemic
Psychodynamic
Safeguarding
Medical
Event
Psychodynamic
Systemic
Safeguarding
4: Finding voices:
Team. Family &
Professionals
Parallel Process and
Synchronicity
Self and relational
Reflexivity
Team worked with
transference and
countertransference
on behalf of family
and simultaneously
within the team
itself.
Sharing of
genograms,
personal and
professional stories
and emotional
triggers.
Supervision seeing the whole
picture . Munro:
Systemic
perspectives
Exploring
Opening out layers of differences and
feelings. Equality of
similarities.
therapist voices.
Use of SCORE
Analysis and
interpretation of
splits, informed by
Safeguarding Policy
& Procedures.
Not working in Silo’s
(in isolation) or
individually with
complexity and risk.
Event
Psychodynamic
Systemic
Safeguarding
5: J puts his
feelings into
words
Processing and
Differentiation
Structural and
Strategic. Child
Focused
Every Child Matters
Use of
countertransference
both empathic and
hostile in service of
both mum and son.
Therapist
anxiety/fear of
damage to cotherapy alliance.
Doubling, empty
chairs and
externalising.
Moving around the
room. Interrupting
and modelling.
Intensification and
manoeuvrability.
Importance of the
post and post-post
space.
Ensuring the child’s
voice is heard and
represented.
Connecting up the
individual work.
Event
Psychodynamic
Systemic
Safeguarding
6: Networking,
Formulation &
Supervision.
Report writing
and letters
Formulation and
Interpretation
Safe Uncertainty
and CMM:
Formulation
Risk Assessment
and Diagnosis.
Perpetrator and
Victim
Shared formulation,
using concepts from
object relations and
analytic theories. Use
of information from
family and from
team as
felt/experienced, in
order to connect
with experiences of
others in the
network.
Emphasis upon
engagement and
the “so what”
question.
Addressing risk and
safety
collaboratively and
as a shared
experience.
Movement towards
partnership working
and development of
new narratives.
Focus upon
strengths and
resources rather
than deficits.
Exploration of wider
contexts e.g.
benefit system and
AMH resources.
DVD 1: Meeting Family Sept 2013
Whilst watching the excerpt consider:
• What are you noticing about, systemic,
psychodynamic and safeguarding issues?
• What might you be noticing about the key
issues?
• What might you consider doing in the session
or in the space between, or next time?
DVD 2: Post session Sept 2013
Talk with you partner:
• How are your ideas being affirmed and
challenged?
• What new ideas are emerging?
• What feedback might you be able to offer
the family and/or team?
Super
vision
Seeing the whole
picture
Rejected psychiatrist
NHS
Rejected CAMHS practitioner
Rejected social worker
Local Authority
Therapist
NHS
Working alliance
NHS psychiatrist
CAMHS Practitioner
SW – Working alliance
Good therapist(s)
Feedback for Mum J: Experiences
Positives
Negatives
Reliability
Trust
Regard
Listening
Advising
Neutrality
Interest/ Curiosity
Inconsistency
Mistrust
Shaming
Confronting
Instructing
Blaming
Judgement
Exercise in Pairs
Discuss a current, recent or past
safeguarding or risk issue where you
experienced tensions, stress or
polarisation between colleagues or
professionals. Explore the primacy of
thinking and practice in relation to
systemic, psychodynamic and
safeguarding ideas.
Feedback and Discussion
Revisit Sculpt
Co-ordinated Management of
Meaning: Safety and Risk
Safeguarding
Systemic
Psychodynamic
So What & Project Blue Print
• So what……What has this workshop
offered you which you may use?
• What elements need to be included
and described within a model blue
print or manual? Key questions for
teams?
References Psychodynamic
Giacomo Rizzolatti and Maadelena Fabbri Destro (2008) Mirror
Neurons. Scolarpedia, 3(1): 2055
Donald Winnicott, (1965) The Child the Family and the Outside World
Brodie, F., & Wright, J. (2002) Minding the gap not bridging the gap:
Family therapy from a psychoanalytic perspective. Journal of Family
Therapy, 24, pp. 205-221
Donald Winnicott, (1965) The Maturaltional Process and the Facilitating
Environment
Donald Winnicott, (1965) Home is where we start from
Sue Gerhardt, (2004) Why Love Matters, How Affection Shapes a Babies
Brain
Ed Tronick, (2007) Neurobehavioural and Social Emotional Development
of Infants and Children
Donald Kalsched (1996) The Inner World of Trauma
References Safeguarding
Every Child Matters (2003) HM Government
Working Together (2006) HM Government
Munro Review (2011) Department for
Education
Beyond Blame (1993) Peter Reder and Syvia
Duncan
References Systemic
Anderson, H. Goolishian (1992). The Client as the Expert: a Not knowing Approach to
Family Therapy. In McNamee,s. and Gergen,K. (eds) Therepy as Social Construction. Sage.
London.
Berg, Insoo Kim. (1999) Family Preservation: A Brief Therapy Workbook. BT Press, London.
Cade, B. (2009) Some further bits and pieces about double bind. Context (2009) 102:15-16.
Cecchin, G. (1987).Hypothesizing, circularity and neutrality revisited: an invitation to
curiosity. Family Process, Vol 26, p405-413.
Cronen, V. E. and Pearce, W. B. (1985) Toward an explanation of how the Milan method
works: an invitation to a systemic epistemology and the evolution of family systems. In:
Campbell, D. and Draper, R. (eds), Applications of Systemic Family Therapy: The Milan
Approach. London: Grune and Stratton.
Cullin, J. (2009) Double bind: much more than just a step toward a theory of schizophrenia.
Context (2009) 102:8-13.
Goldner, V. Penn, P. Sheinberg, M. Walker, G. (1990) Love and Violence: Gender Paradoxes
in Volatile Attachments. Family Process: 29, p. 343-364.
Hoffman Lynn (1990)Constructing realities: An Art of lenses. Family Process 29:pp1-12,
References Systemic
Jones, E. (1993) Family Systems Therapy: Developments in the Milan Systemic Therapies,
Chapter 1 Family Systems Therapy. Chichester, Wiley.
Kelly, A. McKillop, K. (1996). Consequences of Revealing Personal Secrets. Psychological
Bulletin. 120. 3: 450-465.
Lang, W. Little, M. Cronen, V. (1990) The Systemic Professional: Domains of Action and the
Question of Neutrality. Human Systems. 1.1 pp 34-49.
Mason, B. (1993). Towards Positions of Safe Uncertainty. Human Systems. 4: 189-200.
Mason, B. (2005). Relational risk taking and the therapeutic relationship. In C.Flaskas,
B.Mason, and A.Perlesz (eds) The Space Between: Experience, Context and Process.
Reimers,S. (2006). Family Therapy by default: developing useful fall-back positions for
therapists. Journal of family Therapy. 28: 229-245.
Roberts, J. (2005). Transparency and Self-Disclosure in Family Therapy: Dangers and
Possibilities. Family Process. 44.1: 45-63.
Robinson, G. Whitney, L. (1999). Working Systemically Following Abuse: Exploring Safe
Uncertainty. Child Abuse Review Vol 8. 264-274.
Selvini, M. Boscolo, L. Cecchin, G. Prata, G. (1980). Hypothesizing, circularity, neutrality:
three guidelines for the conductor of the session. Family Process, Vol 19, p3-12.
Stratton, P., Bland, J., Janes, E. and Lask, J. (2010), Developing an indicator of family
function and a practicable outcome measure for systemic family and couple therapy: the
SCORE. Journal of Family Therapy, 32: 232–258.
Please contact us
gary.robinson@derbyshcft.nhs.uk
01332 623700 Ext 33261
karen.johnson@derbyshcft.nhs.uk
01332 888080
Stephen.Edgeley@derbyshcft.nhs.uk
01332 623776