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This article discusses an approach to relational ethics in contemporary systemic practice. It explores the possibilities offered by traditions of moral philosophy in attending to problems from a relational ethics perspective. This includes a focus on relationships as a crucial element in the development and maintenance of a moral self and how couples and families construct an ethical platform together, both consciously and unconsciously; and also how relational ethics may inform ideas about the values-driven problems people present in therapy. Finally, it suggests how ethical responsibility and accountability can be constructed as relational responsiveness. Despite our associations with morality as judgmental and rule driven, moral conduct and decision-making can involve imaginative, creative and aesthetic possibilities.
This is the second of two articles to map the landscape of practice theory in systemic family therapy. The first article gave a particular chronology of the development of family therapy practice theory, beginning with the frameworks that emerged in the 1960s-1970s and then tracing the transitional decade of the 1980s. The convergences of three sets of influences — ecosystemic epistemology, the feminist challenge and postmodernist ideas — led to the changed landscape of post-1990 practice theory. This second article picks up at this point, mapping four contemporary influential approaches in Australian family therapy — the Milan-systemic, narrative and solution-focused frameworks, and the dialogical perspective. Social constructionist and narrative ideas together constitute the dominant common theory influence in the post-1990 practice frameworks, although intersected and used in different ways in the different frameworks. Throughout the history of the development of practice theory, context and relationship remain the enduring parameters of the systemic family therapy field.
After birth the first thing we learn is becoming a participant in dialogue. We are born in relations and those relations become our structure. Intersubjectivity is the basis of human experience and dialogue the way we live it. In this paper the dilemma of looking at dialogue as either a way of life or a therapeutic method is described. The background is the open dialogue psychiatric system that was initiated in Finnish Western Lapland. The author was part of the team re-organizing psychiatry and afterwards became involved in many different types of projects in dialogical practices. Lately the focus has shifted from looking at speech to seeing the entire embodied human being in the present moment, especially in multifarious settings. Referring to studies on good outcomes in acute psychosis, the contribution of dialogical practice as a psychological resource will be clarified.
The bioethics movement has long promulgated a model of ‘principled decision-making’ in which ethical dilemmas and conflicts between various rights, interests, and ethical principles are central. In many respects this movement has had a laudatory impact on health care and on health professionals, but we will also argue that the bioethical model of ethical analysis has important limitations. The model's theoretical orientation is discontinuous with the training and skills of health professionals, the manner in which health professionals conceptualise and solve problems that arise in a clinical setting, and the time constraints inherent in most clinical situations. As such, the model is not readily applicable to much of the day-to-day work of clinicians and, in particular, to the routine ethical questions and situations that arise in caring for patients. What we suggest is that the bioethical model does not take into account that health care professionals, as part of their daily work, encounter and manage difficult, often conflictual situations and that they do so by bringing to bear conceptual frameworks and therapeutic techniques that have, embedded within them, the ethical values and goals of their own fields, as well as established ways of dealing with problems and addressing competing priorities. We further argue that from a systems perspective, the bioethical model and the pragmatic, problem-focused ethical decision-making of clinicians operate on different levels of complexity; whereas the former is especially appropriate for situations that resist consensus or that raise significant issues of public policy, the latter serves as an effective framework in less difficult or complex situations that can be moved effectively toward consensus and closure.
Teaching family therapy to clinical psychology trainees is not common practice in Australian clinical psychology training programs. There is sparse discussion in the literature. Family therapy is an evidence based intervention that complements a diversity of established theories and psychotherapies and would complement the intervention skills of trainee clinical psychologists. The aim of this paper is to illustrate how family therapy training may be integrated into a postgraduate clinical psychology course. The literature on core family therapy knowledge, skills and training methods will form the backdrop to a review of specific family therapy training courses for clinical psychology trainees. This will then be mapped against a consideration of accreditation requirements of clinical psychology courses in Australia and suggestions made for integrating family therapy into their training curriculum. Anecdotal feedback from students provides an initial step toward evaluation.
This article describes counselling practice as social action, reporting on a case of children witnessing community violence and its aftermath. Highlighted is the role of friends who made a stand of solidarity against such violence. Outsider witness practices helped recruit and grow a community of care for the client and his friends. This community of care was significantly enhanced by the involvement of a lawyer/musician/activist who composed a song with the three friends to take a stance against guns and violence in their society. Caring solidarity, generosity and doing hope together formed small but significant alliances against entrenched practices of violence.
This paper is the second part of a previous publication in this journal and is based on a plenary address at the 30th Australian Family Therapy Conference in 2009. It develops the idea of ethical practice in therapy for men and boys with a history of significant violence and abuse. This fosters a connection with resilience that resists or refuses to participate in historical narratives that support violence and its effects. In the paper, I provide several therapeutic examples of working with narratives of violence and present a theory of resilience and ethical practice drawing on the ideas of Deleuze. This helps to understand resilience as a process of ethical agency, creative renewal, and the production of expansive difference.
When multidisciplinary teams review their work, it is common for clinicians to hypothesise about their clients from the perspective of their role or theoretical model. The outcome of this review process may depend on the team's views. Here the epistemological position taken by team members about reality and objectivity can lead to starkly different pathways. There can either be a dialogue about different hypotheses, with the team jointly constructing new meanings; or, conversely, there can be a monologic exchange based on competition between different hypotheses. This paper explores why teams may struggle with coordinating different theoretical approaches and models. It suggests the dialogic nature of a reflecting team process offers one approach for helping teams to find ways of ‘putting their differences to work’. Ideas for implementing this process within multidisciplinary teams are illustrated with comments provided by teams who have begun to experiment with this approach.
How might we engage with the concept resilience in a world obsessed with the measurement and cataloguing of deficits and virtues alike; with predicting outcomes, producing certainty and the reification of stable identity? This article is based on a plenary address presented to the Australian Family Therapy Conference in 2009 and takes Deleuze's paraphrase of the 17th century philosopher, Spinoza as a point of departure from common sense views of identity. Can resilience be possessed by some as a personal quality enhancing their coping skills or might resilience be a vital aspect of living which passes through us? Perhaps resilience bounces back towards us and enables the unsettling of dogmatic beliefs and a stable sense of identity. Enquiry might then shift from the moral; What kind of person am I? How should I live? towards an ethical position of wonder; What else might there be? What might I be capable of? This article invites an ethical exploration of desire, its capture and of resistance and explores the politics of identity; illustrated with men's journeys of struggle with violence, sexuality and belonging and the discovery of ethics and generous forms of love in the face of adversity.
Many families come to treatment with concerns about attention-seeking children. This paper examines the dominant socio-cultural and biological influences on individual parent and child narratives about attention-seeking behaviour and explores the misalignment between the two. A case study illustrates the reconstruction of the dominant problem-saturated story through the hungry-for-attention metaphor. Finally, the author proposes an integrative approach to combining narrative practices with behavioural interventions for families and professional caregivers.
In this article we explore the role of differentiation of self in facilitating forgiveness in the context of couple and family relationships. Differentiation is defined from the Bowen perspective as the ability to connect with others without being excessively emotionally reactive to the ebb and flow inherent in all significant relationships (being able to connect to others yet also being able to self-regulate). Forgiveness is described as the releasing of an emotional injury via a complex psychological and relational process that is less an act of will than a discovery or possibility through understanding and empathy. Differentiation of self is related to emotional intelligence and empathy. The developmental and relational benefits of such are illustrated and discussed. A rationale for viewing differentiation and forgiveness in a contextual, historical, and relational attachment paradigm is suggested. Relevant clinical cases illustrate the dynamics of differentiation and forgiveness as discovery in the context of an understanding and empathic relational environment.
In this article I explore the use of Pearce and Pearce's' (1998) notion of ‘curating stories’ and ‘transcendent story-telling’ for teaching about models in family therapy. Taking a position of curator, the discussion invites students into inclusive and pluralist thinking about the many models in family therapy's collection. Two story-making frameworks of Stratigraphy and Australian Aboriginal ‘Dreaming’ are curated in a sequential way allowing a thick description and lived story of pluralism to emerge. Creative use of metaphors invites a context for transforming knowledge and abilities towards pluralism. I outline how family therapy can be taught using these metaphors as a way of freeing students to see its history as both interpretation and lived experience.
This paper reviews the diversity in parenting values and practices amongst Aboriginal peoples and Torres Strait Islanders. First, issues arising from the historical traumatic disruption of families' attachments are discussed. Then the contribution Indigenous parenting makes to the development of healthy and vulnerable individuals becomes the central focus. Family therapists can draw from a broad understanding of the diversity of parenting values and practices in the context of a strength-based approach.
This article describes the difficulties a mainstream family therapy service experienced in working with families from a refugee background. The experience of six therapists and five bicultural workers, who are also the referring agents, was captured in focus groups, and the reflections that emerged shaped a four-part approach for working with families from a refugee background. Live consultation, either by the family therapist or bicultural worker, is suggested as a way to marry the expertise of family therapists who are not cultural ‘insiders’ with the ‘lived experience’ and cultural expertise of bicultural support workers. The process of reflecting on therapeutic failure resulted in several principles for working therapeutically with families with a history of refugee trauma, unmet resettlement needs and family relationship challenges. These include maintaining a flexible approach to therapy, ascertaining a clear understanding of the referral context, defining an explicit therapeutic contract from the first session, being mindful of the important role that language plays and terminating therapy if it is contra-indicated.
When marriages and long-term relationships break down, parents may refer their children and adolescents to therapy for a variety of reasons. While the systemic therapist's preference may be to work with the family system/s, high conflict separation may prohibit such an approach. This article discusses family-focused child therapy that prioritises the needs of children while seeking to preserve a systemic approach. At a practice level this may involve: (a) individual child therapy, (b) engaging with smaller subsystems including siblings, (c) joint therapeutic work involving child/ren plus parent/s, and (d) any of these combinations; all while continuing to maintain a systemic understanding of the work. The article discusses the challenges of working with children from separated families, where there is restricted or no possibility of engaging with the broader family system.
This article is an exploration of family therapy in France by an Australian social worker and family therapist. It also reports on the 2010 European Family Therapy Conference and includes an interview with Dr Mony Elkaïm that provides an overview of his work. All this is discussed in terms of its relevance for family therapists in Australia. It is followed by a brief response from Dr Elkaïm.
This article concerns the use of language in both therapy and supervision, and how it contributes to the necessary risk-taking that will be a part of therapists' and supervisors' repertoires. The focus will be on my own examples in both roles, and will refer to both successes and failures, while questioning the usefulness of either concept. Within a postmodern paradigm, and influenced by thinkers including Foucault and Bakhtin as well as systemic clinicians, I will examine the use of language (including in cross-cultural settings where risks can sometimes be amplified) and of humour and self while exploring the meanings of identity. I contend that all relationships contain some element of risk and the ways in which we create a safe enough context, through the uses of language as well as nonlinguistic means, are the crucial elements in our endeavours as supervisors and therapists. I favour the idea that therapy is more of an art than a science and that this is most exemplified in the graceful use of language by which we strive to engage rather than alienate people. The article may be considered by some as being useful advice, and by others as a risk too far, such is the controversial nature of language, which highlights the importance of relationships and context.