British Psychological Society
Faculty for people with intellectual disabilities
Advancing Practice Conference: 26th March 2014
Sandra Baum and Henrik Lynggaard, Lead Clinical Psychologists
& Systemic Psychotherapists
Oxleas and Camden & Islington NHS Foundation Trusts
Overview
 What do we mean by the term ‘Systemic’
 Five areas of practice in ID services where the systemic
approach can be useful
 Illustrated by brief examples from practice
 The evidence base
 Workshop tomorrow to illustrate the systemic
approach in action with staff teams
Gregory Bateson (1904-80)
 Born and educated in UK
 Father: William Bateson
 Settled in the States after
2nd World War.
 Anthropology, biology,
social science, linguistics,
cybernetics, system theory,
(double bind)
Hear it again from Mary Mead Bateson
“Pathology is not in each individual person but it
is in the system, in the pattern of relationships
between them”.
“I was trying to attach it to an individual; that is
the way we are trained to think about
causation”.
What do we mean by Systemic?
 The word Systemic, like most other words, holds many
different meanings.
 From individual therapy  to family therapy (1950s)
 From family therapy  systemic therapy: (e.g. the
network of significant relationships of which each individual is a
part)
Iceberg
Visible
Invisible
The therapist’s talk
What informs our
talking, hearing and
seeing
What do we mean by Systemic?
 As we heard from Mary Mead Bateson the systemic approach
invites us to move away from pathologising individuals and
towards viewing concerns and problems as inter-personal. The
approach is particularly interested in what is happening between
people rather than within people; in other words it focuses on:
 Context
 Relationships
 Communication
 Interaction
What do we mean by Systemic?
Context
 Without context, words and actions have no meaning at
all.
 We always act from one context into another context
What do we mean by Systemic?
 Connected in relationship
 We live our lives in relationship with others.
 Our identities, and our resources for responding to
life events, are shaped and sustained by those we are
close to. When we experience a crisis, significant
people in our lives are affected too; and their responses
in turn, affect us.
What do we mean by Systemic?
 Communication
 Attention to communication is central to the systemic
approach. All forms of behaviour have a
communicative intent.
 People affected by intellectual disabilities often find
communication a challenge, so that their voices are
frequently subjugated, silenced or misunderstood.
9–2=7
6 + 5 = 11
11 + 1 = 13
3 + 14 = 17
Multiple perspectives
 A short exercise to demonstrate this key fundamental
systemic concept.
In systemic therapy we are concerned
to…
 create a context where we can open space for dialogue
 position ourselves as ‘facilitator’ or ‘conductor’ of
conversations.
 be mindful of how we invite people to be positioned as
resources to the problem (i.e. not to be blamed or
criticised).
 unpack problem saturated stories and to jointly cocreate and co-author new stories and meanings
together, and to find new ways of going forward.
Method
 A distinctive feature of the systemic approach is that
we often work with many people at the same time.
 We rarely work as single practitioner - as there is only
so much any one person can attend to at the same
time. We therefore, work in teams.
 An overall aim in the work is to create reflective
processes (people becoming observers to their
systems), by separating talking and listening
Five areas of practice where the systemic
approach has been particularly useful
 Working with families
 Working with individuals
 Working with staff teams
 Setting up and facilitating network
meetings
 Supervision
Working with families
The key themes include:
 life-long effects of having a son/daughter with ID.
 negotiating transitions, re-experiencing grief and loss,
and vulnerability and protection.
 relationship with the wider system of care and
support.
An example of family therapy
Mother
Father
Therapist
Jamie
19
Social
Worker
team
team
Working with individuals
 Putting people in the room - even in their physical
absence - through the questions we ask, in a way that
is accessible and meaningful to the person we are in
conversation with
 Therapeutic intention: to widen the perspective of
the problem
Example – “What might your Dad say…”
Point to or pull in an empty chair:
 “I know your Dad isn’t here, but could you imagine for a
moment that he is?”
 “I know it is an unusual question”
 “But could you imagine him sitting on this chair here?”
[touch the chair]
 “What do you think he might say?”
Working with staff teams
 Who needs to change?
 Bring staff together to provide a space for them to
think and reflect on their work with specific clients or
dilemmas
 Drawing out the expertise and knowledge of the staff
team
 We aim at an open, enquiring and reflexive approach
Network meetings: gathering a community
of concern around the person
 We bring together people who are involved, concerned and
connected around an
issue/problem/predicament/dilemma.
 Working with networks to create therapeutic opportunity.
 These network meetings create opportunities for
enhanced communication between the referred person,
their families and practitioners and facilitated coordinated
and collaborative future planning among the different
people involved.
Network meetings:
how are they facilitated?
 Themes and agenda not planned in advance but co-created
between the participants at the outset
 Separating talking from listening by creating reflective
processes
 We often start with asking the following questions to
everyone in turn: If you left at 4 p.m. and you said to
yourself; I am really glad that I came?
What would we have done together?
What would we have talked about?
What would you be clearer about?
What would you be able to do?
Process of network meeting further
explained
 From what participants say we identify some key
themes
In relation to each of these themes we then ask a series
of questions:
 What have you already done/understood/tried?
 What has been the effect?
 What have you been doing already to stop the situation
getting worse?
…
Supervision
 In supervision we can use a number of systemic
techniques to enhance our understanding (both
supervisee and supervisors) of a situation, or dilemma
or problem.
For example:
 “Could you sit in different chair and speak from the
position of the mother/care staff/brother…”
 Interview the supervisee as the client or as a significant
person in the system
 Intention: to create reflective processes
How can I show this is a useful
model?
 The Evidence Base of Systemic Family and Couples





Therapies by Prof. Peter Stratton, (AFT website, 2013)
SCORE-15 with videos (AFT website, 2014)
Archives of testimony – (AFT website, 2014)
Randomised control trials (Jones & Asen, 2000)
Descriptive accounts (see Baum & Lynggaard, 2006;
Context AFT: April, 2011; Clinical Psychology & LD, 2012)
Qualitative accounts (see Arkless, 2005; Baum & Walden,
2006; Pote, 2006; and Pote, Mazon, Clegg & King, 2011)
How to contact us
 sandra.baum@oxleas.nhs.uk
 henrik.lynggaard@islington.gov.
uk
Summary
 So, what we have done, we hope, is to give you a flavour of the many
different ways in our daily practice we can be informed by, draw on,
and use the systemic approach (e.g. with individuals, families, staff
teams, networks, teams, and supervision).
 Time has not allowed to go into any great detail about anything, and
you may well wonder where you go next in conversations, after the few
questions we have put up. Tomorrow, we are giving some more time to
look at one of the ways (working with staff teams), but there is of
course a lot published in this areas by now where people can seek
further information, guidance and inspiration.