Tavistock Systemic Doctoral Research Theses.
Titles and abstracts of doctoral systemic and family therapy research carried out on the Professional Doctorate in Systemic Psychotherapy at the Tavistock.
An action research project to explore and develop family therapists’ experiences of using systemic art and music techniques in a CAMHS setting
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2014
This study explores family therapists’ experiences of using systemic art and music techniques in a CAMHS setting and charts how these techniques were developed through an action research process. As a music therapist and family and systemic psychotherapist, I have used techniques in my practice that combine ideas from the Arts therapies with systemic therapy. This study was born from my curiosity to explore if these ideas and techniques could be expanded into the field of family therapy as a useful adjunct to our work with words.
The study involved recruiting participants from three NHS family therapy teams, with each team becoming a participant set. Through an action learning process, in which each set was convened consecutively, given opportunities to learn music and art techniques, try them out in their practice and report back via focus groups and consultation, feedback was gained which influenced the input for the next set. Through this process techniques were explored in depth, ideas were developed and new insights gained which not only highlighted the difference music and art can bring, but also bought attention to family therapy creativity and identity, and how change is realised and embedded within teams.
The research was analysed using thematic analysis, paying particular attention to Braun and Clark’s (2006) phases of thematic analysis. I also used Massey’s (2011) model of clarifying the kinds of data that emerge in focus group research to help the initial analysis, and paid attention to context and process throughout the analysis, as outlined by Vicesk (2010).
Adult Mental Health
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2014
Despite wide agreement in the systemic field that therapists should take a non-blaming stance, historically there has been little exploration of how this stance is achieved in practice. The difficulty in knowing how to put ‘non-blaming’ into practice is further heightened by competing models of intervention with families affected by psychosis. This study contributes to a body of literature that is concerned with how complex issues of morality are achieved dialogically by considering how family therapists manage the tension of intervening to promote change whilst maintaining a multi-partial, non-blaming stance.
Two therapies carried out with families affected by psychosis are analysed using the methods of Conversation Analysis (CA) and Membership Categorization Analysis (MCA). In both therapies the sequences examined are drawn from the second session of therapy where explicit blaming events occur. By examining blaming events chronologically through the course of a session the study shows how the rules about the way blame is talked about are achieved interactionally.
The analysis demonstrates that systemic theory’s emphasis on the importance of being non-blaming is grounded in a sophisticated understanding of the threat blame poses to co-operation and agreement. In both therapies, the delicacy and ambiguity with which blame is treated serves to enable the conversation to continue without withdrawal. However the cost of ambiguity is a possible misunderstanding of the intent of the speaker. The resulting misalignment, where it continues over several turns and sequences, leads to explicit blame becoming relevant as a solution to a redundant pattern of interaction.
The findings indicate that the management of blame requires both the exploration of blame and its interruption when emotions and conflict run high. The former enables understanding and movement towards therapeutic goals while the latter is necessary to promote therapeutic and family alliances. An unintended consequence of the injunction to be non- blaming might be the premature closing down of topics, militating against problem resolution.
The study concludes that CA and MCA offer a wealth of knowledge about mundane conversational practices that can be applied fruitfully to systemic therapy process research, teaching and supervision.
Parental mental health and the family: exploring parents' concerns about their children. grappling with inter-generational shadows
Doctorate in Systemic Psychotherapy. Doctorate thesis. Tavistock/UEL. 2005.
This qualitative research project examines family members' conceptualisation of parental mental health problems from a child mental health context. Different constructions of these problems held within the family, and the connections that these may have to parents' concerns about their children, are explored through an interpretative phenomenological analysis of seventeen semi-structured interviews with family members from eight families. Multiple perspectives are brought to this systemic exploration through examination of three inter-related points of view within the family (parent-patient, other-adults and young people) and across two services' cultures through four Focus Group discussions held with professionals in both adult and child services.
This thesis argues that family members' ideas about the causes of parental mental health problems are significantly influenced by the ways in which different constructions of the problems relate to powerful emotional states, such as guilt, blame, fear and shame. This is implicated in parents' ideas about children's problems, which are primarily attributed to the effects on them of parents' difficulties and to fears about the inter-generational transferability of mental health problems. The role that professional approaches play in enhancing these fears are highlighted and discussed in relation to practice. A dissonance is noted between the meanings that participants hold about their experiences and the medical discourse of explanation. Findings point to the over-arching importance of keeping the whole family in mind highlighting indications for practice in both adult and child services and at their interface. This research underscores the value of listening to service users' views and points to further research in this important field.
Behind closed doors: a grounded theory of the social processes that describe how parents talk to their children about parental mental health difficulties
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis
Since the government commissioned the Crossing Bridges programme in 1998 (Falcov, 1998) and through legislation and a number of government policies and initiatives since, there has been emphasis on addressing the needs of families where there are parental mental health problems. Furthermore, there is a fast-growing body of research pointing to the needs of these families. However, service structures, development and provision have lagged behind. Most often parents with mental health difficulties have access to services addressing their individual mental health needs while their needs as parents and the needs of their children remain largely invisible. One such need that has been highlighted repeatedly in the literature is the need for children to have information about and make sense of their parent’s mental health difficulties. Given the lack of services to respond to this need, it is most often left to the parent to make decisions about and respond to their child’s search for understanding.
This study is a qualitative study that explores parents’ experiences of decision-making and responding to this need, and the social processes and dominant discourses that impact on these experiences. Fifteen parents with mental health difficulties were interviewed, using semi-structured individual interviews, which were transcribed, and interpretive Grounded Theory was employed to analyse and interpret the data.
The grounded theory that was constructed suggest two main social processes that impact on parents’ talking with their children about parental mental health issues. Firstly, within a relational context, parents were Negotiating mutuality between themselves and their children. Secondly, within an identity context, parents had to navigate Holding on to self, holding on to life. These social processes indicate that both parents’ relationships with their children and also their own sense of themselves within the context of their mental distress powerfully shape telling, talking and keeping silent. Implications of these findings both in relation to clinical interventions and future research are considered. In particular, the importance of positioning the parent as active role-player in the healing of their child, and positioning the child as active role-payer in their own meaning-making, are highlighted. Furthermore, developing ‘double-stories’ beyond the mental health story and beyond ‘information’ is emphasised and the importance of a sense of continuity of self and identity over time for parent and child is accentuated. Finally, the importance of allowing for complex and ever-evolving understandings of mental distress is indicated, and the role of both talking and remaining silent in this process is stressed.
Also see publication
Nolte, L. & Wren, B. (2016) Talking or keeping silent about parental mental health problems – a grounded theory of parents’ decision-making about whether or not to talk to their children about parental mental health difficulties, Journal of Marital and Family Therapy, 42(4): 731–744. doi: 10.1111/jmft.12177.
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2005.
This thesis is a qualitative study of child protection cases that the responsible caseworkers have found difficult to handle and in which the professional interventions to date have not been judged sufficient or effective. The study is a rhetorical Discourse analysis and the data analysed is transcriptions of internal case conferences in three different Norwegian child protection groups.
My research focus has been on how the cases are constructed or constituted by the professionals who are responsible for the cases at the time of the discussions and how the versions about the cases are developed through the discussions among the group members. Focus has been on features of the talk and argumentation, how versions are established through description and on the specific terms and categories that are used in these descriptions.
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2008.
This thesis explores associations that could have an impact on the experience of a parental death in childhood. It suggests a methodology for establishing the prevalence of parental bereavement that helps the author to explore quantitatively any associated links between parental death in childhood and delinquency rates in 16-year-olds. As well as helping to establish the prevalence of parental death in childhood, the methodology also enables the author to explore possible contributing factors that could increase a child's vulnerability to the experience of parental death such as social class, age and gender of child and dead parent these are presented as a set of risk variables in which the data shows an increase in a parentally bereaved child's susceptibility to delinquent behaviour. It also compares themes within essays written by parentally bereaved children and none parentally bereaved children. The exploration used the Thematic Apparition Test coding as a framework from which to identify differences in the stories told about the future by each comparison group.
Doctorate in Systemic Psychotherapy. Doctorate thesis. Tavistock/UEL 2016.
This multi-perspectival Interpretive Phenomenological Analysis (IPA) study explored how people in the ‘networks of concern’ talked about how they tried to make sense of the challenging behaviours of four children with severe learning disabilities. The study also aimed to explore what affected relationships between people.
The study focussed on 4 children through interviewing their mothers, their teachers and the Camhs Learning Disability team members who were working with them. Two fathers also joined part of the interviews. All interviews were conducted separately using a semi-structured approach. IPA allowed both a consideration of the participant’s lived experiences and ‘objects of concern’ and a deconstruction of the multiple contexts of people’s lives, with a particular focus on disability. The analysis rendered five themes: the importance of love and affection, the difficulties, and the differences of living with a challenging child, the importance of being able to make sense of the challenges and the value of good relationships between people. Findings were interpreted through the lens of CMM (Coordinated Management of Meaning), which facilitated a systemic deconstruction and reconstruction of the findings. The research found that making sense of the challenges was a key concern for parents. Sharing meanings were important for people’s relationships with each other, including employing diagnostic and behavioural narratives. The importance of context is also highlighted including a consideration of how societal views of disability have an influence on people in the ‘network of concern’ around the child.
A range of systemic approaches, methods and techniques are suggested as one way of improving services to these children and their families. It is suggested that adopting a ‘both/and’ position is important in such work - both applying evidence based approaches and being alert to and exploring the different ways people try and make sense of the children’s challenges. Implications for practice included helping professionals be alert to their constructions and professional narratives, slowing the pace with families, staying close to the concerns of families and addressing network issues.
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2014.
Theory development and research within the sphere of family therapy is an expression of who we are, where we are, and where our next horizon may lead us. The dialogical perspective introduces a new horizon to the systemic paradigm, a shift that supports new ways of observing practice. This project explored therapist stuckness, one aspect of the impasse phenomena, through this new lens. In response, the project introduced an alternative consultation model. The task of the model is to support a therapist when they encounter a stuck phase in therapy. Thus, the principal aim of this qualitative project was to ascertain if a consultation model influenced by the aforementioned perspective supports a therapist who is experiencing a stuck phase and if the stuck phenomenon is of value to the therapeutic process. Action Research methodology directed this inquiry. The research followed an action/reflexive cyclical trajectory with a marked responsiveness to the participant’s ideas and experiences as they engaged in the consultation and the participant/researcher dialogue. Hence, the primary method of data gathering entailed the engagement of family therapists in a consultation lead by the model. Each participant engaged in one consultation and one post consultation review. The analysis was directed through a synergy of lenses, namely: Interpretative Phenomenology Analysis, a dialogical lens and a Gadamerian Hermeneutic reflexive framework. The outcome of the analysis was translated through the Action Research lens with the outcome modifying the model format as required. The findings revealed that therapist stuckness could be described as a multi-positioned, responsive process. This description demonstrates the complex relationship between the therapist and client group. The description points towards the need to address stuckness in a way that observes how the therapist and client group connect and participate in the therapeutic trajectory. The developed Dialogical Consultation Model attempts to address this task. From this research, it is envisaged that the developed consultation model will provide a platform to develop a more advanced reflexive supervisory tool for use in systemic training and general systemic practice.
A phenomenological study into the place of consultation in the work of staff in children’s homes. How much is it an organisational construction?
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2012.
Residential work with young people is a complex and difficult job. CAMHS practitioners provide consultation support to staff teams in children’s homes. The study investigated the phenomenon of CAMHS consultation to residential staff within the context of a local authority setting. Focus groups were convened to gather data regarding how staff members understood consultation in the context of a local authority setting from four hierarchical levels within residential services. Interpretative Phenomenological Analysis was utilised to analyse the data into themes. A number of significant contextual themes emerged: the importance that staff members attach to maintaining and preserving relationships with their colleagues; the unclear and complex context of the work; and the sense of powerlessness that they experience. It is argued that these themes represent a culture that makes it difficult for members of staff to engage in the process of consultation, especially when focussed on staff relationships. The likely impact on the consultation process is discussed and some considerations for the clinical implications are suggested.
Exclusion of black boys of african heritage in the British education system – can systemic consultations make a difference?
Doctorate in Systemic Psychotherapy. Tavistock / UEL Doctoral thesis.
There is a wealth of literature and statistics documenting the fact that Black boys of African, African-Caribbean and Mixed-Race heritage are disproportionately represented in the exclusion figures in schools in England. The literature, predominately, directs our attention to sociological, psychological and intellectual theories that seek to explain this phenomenon. Consequently schools have developed a wide range of intervention strategies that fit with these explanations. One example of this is the provision of mentoring projects for black boys which seeks to address the issue from psychological and sociological perspectives.
These theories and explanations encourage schools and policy makers to focus on individuals ie the children, the parents, the teachers but not necessarily what informs their perceptions of each other and how these perceptions influence the patterns of relationships that give rise to ways of interacting that are labeled as problematic.
This study sets out to examine how a Relational Consultation Model could be a resource for primary schools. The Model comprises a questionnaire called an Appreciative Relational Inquiry Map (the ‘Map’). It uses Milan and Post-Milan Interviewing techniques (Palazzolli et al 1980, Penn 1982, Tomm 1985, 1988(a), 1988(b) and a Reflecting Team conversation (Andersen 1987, 1992) to gather data which is analysed using an interpersonal communication theory called Co-ordinated Management of Meaning (CMM) (Cronen & Pearce 1985, Cronen et al 1982, Oliver 1992, Oliver et al 2003, Pearce 1999).
It provides a structure that facilitates family therapists in the exploration of the experiences of black boys excluded from school; their parents and teachers with the aim of promoting a working partnership between the three that would lead to a reduction in the kind of behaviours that resulting in exclusion.
The research was carried out in two schools in an inner city London borough. It tells the story of two boys who were the subject of a number of fixed term exclusions, their mother and their teacher. The data is presented in the form of two case studies.
A major implication of the findings is the need to address the barriers of silence in which talk about race and colour is enveloped and the nature of conversations that make this an area of both visibility and invisibility.
Some call it love: exploring Norwegian systemic couple therapists' discourses of love, intimacy and sexuality
Anne Kyong Sook Øfsti
Doctorate in Systemic Psychotherapy. Doctorate thesis. Tavistock/University of East London. 2008
This thesis is a qualitative study based on interviews and video material, of five therapists conducting couple therapy. Norwegian systemic couple therapists’ discourses about love and intimate relationships have been explored with the aim of shedding light on couple therapy as a professional field in which discourses about love, sexuality and intimate relationship are drawn on, exchanged and negotiated.
The method of analysis is discourse analysis, and poststructuralist theory has informed the design and underpinned my epistemological stance. A main issue has been to explore how systemic couple therapists occupy a position of power as clients’ expectations of them as professionals are linked to notions of objective knowledge. This is simultaneously a challenge because most couple therapy issues are discursive. I have looked specifically at how a discursive dynamic has unfolded in couple therapy and how dominant discourses of love, as for instance ‘the romantic’, stabilize and reproduce heteronormativity. This analysis is intended to provide new insight into the field of systemic couple therapy practice in relation to the importance of self-reflexivity.
The limitations of the study are discussed, reflexivity issues are explored and ideas for further research are proposed. The implications of the study for therapeutic work with couples and training of couple therapists has been elaborated.
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2007
This thesis explores expectations of marriage before marriage, their origin, and their development in the first year of marriage among Maltese Catholic couples marrying in the Church. Nine couples were purposely selected from a sample of marriage preparation course participants to attend two semi-structured interviews; one before marrying and another one approximately one year into marriage. The first interviews consisted of questions around the origin of expectations of marriage and on expectations of marriage before marriage. The second interviews focused on the development of expectations within the first year of marriage. Interpretative Phenomenological Analysis was used to analyse the data.
The various themes that emerged are highly indicative of the shifting constructions about the family and the transitory nature of gender roles in Malta with current couples finding themselves ensnared between traditional and post-traditional constructions. Expectations before marriage continue to persist into the first year of marriage as do various tensions between partners. While women generally expressed expectations concerning togetherness, connectedness, and increased emotional intimacy, men generally expressed expectations regarding independence and separateness. Women were also generally more inclined to voice expectations of romanticism than their male counterparts. In spite of the relatively long courtship and high level of perceived romanticism before the wedding, disappointed expectations, particularly of the romantic expectations held by women, were immediately experienced after the wedding as partners realise that the map is not the territory. Marriage invokes a psychological shift which needs to be further explored. All the emerging themes are embraced within an over-arching theme of an evolving relationship narrative, involving the co-construction of a collaborative dance between individuality and relatedness within a rapidly changing context.
Culture in therapy
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2008.
In this study, I explored the under-researched areas of constructions of 'the family' and the process of change in intercultural and intracultural systemic psychotherapy. The participants, drawn from two different clinics, were five clinicians - two South Asian and three White British - and seven families with whom they worked, of which four were South Asian and three were White British. The data comprised transcripts of eleven videotaped clinical sessions and sixteen audio-taped research interviews with both clinicians and families. My research questions were:
1. How is 'the family' constructed and talked about in systemic intercultural and intracultural clinical sessions?
2. a. How do discourses about 'the family' shift change over the course of intercultural and intracultural work?
2. b. What are the discourses about 'change' drawn on by clinicians and families in intercultural and intracultural systemic psychotherapy?
3. What are clinicians and families' experiences of intercultural and intracultural systemic psychotherapy?
From a Social Constructionist epistemological position, I used the qualitative methods of Discourse Analysis and Interpretative Phenomenological Analysis to analyse the material. The main findings of the study were: Firstly, although 'the family' was constructed differently by South Asian and White British families, clinicians - regardless of whether they were working interculturally or intraculturally - privileged a discourse of 'the family' as a two generation, two parent, biological, intact unit. Secondly, the families minimised racial and cultural differences which sometimes constrained the clinicians from taking the risk of addressing difference. Thirdly, the families associated a positive outcome in therapy with a good relationship with their clinicians and viewed cultural similarity or difference as only one determinant of engagement. The study points to the value of a close study of discursive practice in intercultural and intracultural family work and has significant implications for clinicians, trainers, service providers and policy makers.
Cultural Identities and Stepfamilies
Ways in which the cultural identities of mixed heritage individuals are maintained in mixed ethnic stepfamilies.
Doctorate in Systemic Psychotherapy. Tavistock / UEL 2017
There has been an increasing amount of research into mixed heritage individuals, both adults and adolescents. More recently, some research has emerged on mixed heritage families but there is hardly any research on mixed ethnicity stepfamilies. As a systemic clinician of mixed heritage my research interest has stemmed from my personal experience of living in a stepfamily with visible differences, where my father’s Nigerian culture was not discussed. In my clinical work I work with families from culturally mixed backgrounds and have developed a keen interest in their experiences of maintaining the different cultures. Discourse analysis was employed to examine the various ways in which stepfamilies talked about their differences. Five stepfamilies were recruited. The biological parents (all mothers), their partners and children, participated in the study. Findings revealed considerable variation in the talking and maintenance of cultural heritages within the stepfamilies but four main findings emerged. In some stepfamilies, there was little or no talking whilst in others talking about the process of becoming a stepfamily occurred. The stepfamilies had various experiences of living with their visible differences which included ideas of not having any differences or minimisation of differences. The role of the extended family also played an important part which changed over time. The ‘presence’ of the biological father was of particular significance for the children, most of whom maintained contact with their fathers. The study has revealed the complexities of stepfamily life and the numerous ways in which the mixed heritage children/stepchildren navigated the different households in order to maintain their cultural heritages.
In the margins: Black, Asian and Minority Ethnic women’s narratives of recovering from an eating disorder
Kamala Jeanette Persaud
Doctorate in Systemic Psychotherapy. Tavistock / UEL.2017.
Eating disorders are associated with white Euro/American women and were initially thought of as a ‘culture bound’ condition; that is specific to a particular culture. However, research and clinical experience shows that Black, Asian and Minority Ethnic (BAME) women in the United Kingdom and globally, experience the distress of disordered eating. There remains a debate about transferring diagnostic categories across cultures and how similar or different the experience of eating disorders is for BAME women compared with white women from the United Kingdom. This inquiry is a small scale qualitative inquiry asking questions of race and culture, of idioms of distress and intercultural meaning making explored through narratives of nine racially diverse women recovering from an eating disorder, drawing on a dialogical approach to narrative analysis. Recovering narratives are explored both to bring forth untold appreciative stories where personal stories of recovering is under researched, and to make transparent that research addressing BAME women and eating disorders is limited and where studies are undertaken, they remain invisible in mainstream clinical texts or journal articles.
Individual/cultural and collective stories are identified through the analytic process drawing on creative non fiction writing techniques, weaving both traditional and dialogical methods of narrative analysis. The dialogical method centres on ‘voice, embodiment and emotional volitional tone’ of the storytellers, every voice contains multiple voices. The researcher is ready and attuned to listen to the emotional volitional tone, an active, embodied talk that invites reflexivity of the researcher who embodies and emotionally engages with the material creatively, contributing to the co construction of dialogical stories. In foregrounding storytellers’ strengths, capabilities and talking back to the orthodoxy of biomedical narratives is a position or resistance.
Dominant discourses of eating disorders marginalise BAME women, and represent a challenge to clinicians and services. The lack of attention to diversity is shown to impede access to timely assessment and treatment. The ethnocentric narrative is further emboldened because racially diverse families are concerned about seeking help where services are seen as constructed for white persons leading to concerns about confidentiality and fear of stigma.
Key findings are summarised below: The first two findings concur with current, though marginalised knowledge; the remainder of the findings are unique to this inquiry.
Eating disorders occur amongst BAME women and cause distress
Help seeking remains problematic; when help is sought there are access to treatment issues
Clinicians require training to challenge assumptions regarding BAME women and eating disorders
Eating disorder experiences may appear similar to white females though clinicians should not presume the pathway to the condition is the same
Migration, racism, colonisation, slavery, trauma, loss, bereavement, famine, war, starvation, the role of food, gender roles, family understanding of mental ill health and social change need to be taken into account in assessment and treatment
BAME women are positive about their recovering from eating disorders
BAME women co exist in individualistic and collectivist cultures and this may assist in recovering
Culturally informed practice/training guides are produced to support clinicians in identification, assessment, treatment and training
In concluding, this inquiry interrogates the dialectic between mainstream and subjugated narratives, contesting assumptions that it is only white women who experience eating disorders and brings forth marginalised narratives that resist, stand up and talk back to dominant narratives. BAME women experience the distress of eating disorders often without adequate support in our communities. As clinicians we are positioned now to consider our ethical responsibilities towards this visible/invisible heterogeneous group.
Palatable differences: an exploration of the development of anorexia nervosa within the context of the twin relationship experience
Doctorate in Systemic Psychotherapy. Tavistock / UEL. 2004
Background and Aims:
The study explores the experience of female monozygotic twins and how these experiences may be related to the development of anorexia nervosa. The study presents the stories of the twins, from the twin perspective, the mothers perspective and where relevant the clinician perspective. The qualitative analysis of Interpretative Phenomenological Analysis (Smith et al) used was adapted to suit the needs of the study, which was to present, and interpret the voice of each of the twins, within a systemic frame work.
Design and Participants:
This study was a case series design with each case study including a set of twins, their mother and where relevant a clinician. This included a set of twins where both had a diagnosis of anorexia nervosa; a set of twins where one had a diagnosis of anorexia nervosa and one had a diagnosis of depression; a set of twins where one had a diagnosis of depression and one had no diagnosis; and a set of twins where both twins had no diagnosis.
The measures used were the ‘Telephone Zygosity Questionnaire’ (TZQ) developed by Peeters et al; the ‘Sibling Inventory of Differential Experience’ (SIDE) developed by Daniels & Plomin; self designed semi structured interview schedule. The interviews were transcribed and analyzed using Interpretive Phenomenological Analysis (IPA) using some Grounded Theory techniques.
The main themes that emerged were around the issues of comparison, the twin relationship, enforced togetherness or separation of the twin pair, and how much of an “issue” being a twin was for the twins themselves. Jealousy and competitiveness seems to be more destructive when it originates from within the twinship. The twin relationship does not seem to be understood in the treatment setting.
These findings suggest that a better understanding is required of the twin relationship for the twin who is seen on their own within treatment settings. In addition treatment/therapy training establishments need to address issues around relationships for treatment directed at twins.
Fostering and adoption
Constructing realities – constitutive factors of culture and context in stories of substitute mothers to girls whose biological mothers have died of AIDS in Zimbabwe
Doctorate in Systemic Psychotherapy. Tavistock / UEL. Doctorate Thesis. 2005
Eight Shona women, aged between twelve and fifty-five years old, and from different social contexts in Zimbabwe, were asked to tell their stories about mothering girls whose biological mothers have died of AIDS.
Their narratives are situated in a context of constant and unprecedented change, and in which the women have also lost children, siblings, parents and other relatives. They describe how they are redefining themselves with their remaining family members, and communities, in a context of extreme economic and social collapse.
Any conversations about AIDS are severely constrained by stigma and taboo and the women are faced with the dilemmas of re-storying family life, fraught with danger of distressing themselves and those they talk with. Their narratives focus on strategies for survival, managing newly created families, and preparing the girls for adulthood in the context in which sex is dangerously associated with death.
Interview contexts had to be selected carefully, so that participants felt safe and empowered. The challenge for the researcher, who was of a different culture, social status and language base, was to attend to intellectual and emotional processes which influenced the way in which she witnessed, heard and represented the stories.
Interpreters were coached in interviewing, and their interpretations were examined with a view to minimizing linguistic and semantic misunderstandings.
Whilst dimensions of language, culture and context influenced the presenting and hearing of the narratives, this study highlighted the importance of attending to the process of data collection in research, as much as the analysis and interpretation of findings.
Doctorate in Systemic Psychotherapy. Doctorate Thesis. 2004.
This research shows how kinship care is a small but significant way of caring for children in British society today, a safety net family response to the needs of children to be looked after following the absence or inability of their birth parents. I explore through discourse and rhetorical analysis of interviews and therapy sessions with carers and their families, the process of negotiating entitlements in kinship care, recognising the dilemmas with which families can struggle as they draw on conflicting understandings of family relationships, family ties and parental authority in making decisions about the children they care for. I make use of the Co-ordinated Management of Meaning framework to consider how families draw on these discourses from personal, family and cultural levels of meaning as they work through the family changes involved in setting up and day-to-day experience of kinship care. I show that justificatory discourses of mothering and fathering, at times increase the likelihood of discord unless families are able to hold a complementary rather than conflictual perception of the multiple attachments, authorities and relationships involved in kinship care.
The centrality of such discourses in carers’ accounts contrasts with the marginalisation of discourses of loss and protest, the latter being more audible in the analysis of therapy sessions where I was able to hear the voices of the children and young people present. In systemic therapy contested meanings of family members’ experiences and resulting dilemmas of how to act are analysed, showing how their exploration and deconstruction in therapy can enable families to hear each others’ accounts and to consider how to move on with their lives together.
See also publication
Ziminski, J. (2007) Systemic practice with kinship care families. Journal of Social Work Practice 21, 2, 239–250.
Patterns of thinking and communication in families where an adolescent has atypical gender identity development
Doctorate in Systemic Psychotherapy. Doctorate Thesis. Tavistock / UEL. 2000.
In this thesis I describe a study of a small group of transgendered adolescents and their parents, referred to a specialist NHS service. This was a qualitative study based on interviews with seven adolescents, all with a diagnosis of gender dysphoria of childhood, and on separate interviews with thirteen parents. I looked specifically at how the adolescents and parents build an intelligible account of the young person’s gender identity development, how their accounts interact with their coping behaviour, how they manage communication about the gender issues, and how they believe that these issues have impacted on relationships within the family.
person reports were analysed using Grounded Theory methodology. Into this methodology I incorporated a
concern with researcher reflexivity and a commitment to a
narrative/constructionist approach. There were several suggestive findings in a
number of domains: how communication is
managed with great care in the interview families, with people tending to build
their accounts in solitary ways; how the young people and their parents
recognise that their response to the transgenderism is a deeply moral issue
concerned with their worth as people, and involving them in providing accounts
that attempt to explicate the young person’s departure from ‘normal’
development; how an active approach to coping by parents is associated with
greater acceptance of the child’s cross-gender identification; how a biological
explanation of the cause of transgenderism prevailed amongst the adolescents
and the more accepting parents; how the young people are preoccupied with
changing the body, and reject self-reflexivity around their gender identity
development. The limitations of the study are discussed, reflexivity issues are
explored and ideas for further research are proposed. The implications of the study for
therapeutic work with transgendered adolescents and their parents are
See also publication.
(2012) Researching the moral dimension of first-person narratives.
Qualitative Research in Psychology, 9
Wren, Bernadette (2014) Thinking postmodern and practising in the enlightenment: Managing uncertainty in the treatment of children and adolescents. Feminism & Psychology 24(2):271-291
Infant mental health
Doctorate in Systemic Psychotherapy. Doctorate Thesis. Tavistock/UEL 2005
This qualitative research explores the process of change in parent-infant psychotherapy. Two mothers suffering from emotional breakdowns in the perinatal period agreed for their therapy to be analysed. The treatment model involved the use of video-observation (Beebe, 2003). In many of the therapy sessions the mothers were filmed interacting with their babies for five minutes. In the following session the mother watched the video. From this observer position, the mothers were invited to comment freely on what they observed. The research question investigated how occupying this observer position influenced the therapeutic process.
The data consisted of fifty transcribed psychotherapy sessions; the method of analysis chosen was a form of theme analysis. The findings suggest that parent-infant psychotherapy enhanced the parents’ reflective functioning (Fonagy, Steele, Steele, Leigh, Kennedy, & Mattoon, 1995; Slade, 2002), and the use of video facilitated the process. At the start of therapy both mothers were vulnerable and heavily defended and their defensive processes impacted upon their babies. The findings illustrate that the therapy helped modify their defensive responses and this brought relief for their babies. The mothers’ reflexive capacities grew and their relationships with their babies became more rewarding.
The efficacy of the video occurred within a structured, trustworthy therapeutic relationship which was theoretically informed by systemic and psychoanalytic understandings. The research concluded that unless such a relationship is in place, the use of video in the way described should be considered with caution.
Also see publication
Jones, A. (2006) Levels of change in parent-infant psychotherapy. Journal of Child Psychotherapy, 32/3: 295-311.
Constructions of older people of relationships between their mental illness, aging and family relationships
Joanne Challis Smith
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2013
The genesis of this study came from a wish to contribute to the evidence base of systemic and narrative therapies with the cohort with whom I work clinically, that is elders suffering with mental health difficulties. Its subject matter and methodology were influenced by recognition of the paucity in the literature of both subjective experiences and narrative research studies with this client group. In this study nine elders with mental health problems narrated experience of mental health, their family relationships and ageing. Identification of themes around these three areas of interest were made and analysis of narrative variables such as influence of past, present, local and wider cultural narratives, narratives of time, coherence, performance of preferred narrative selves and influence of audience were made. Service implications for Narrative and Systemic therapy with elders and wider service planning were considered in light of findings. Throughout, reflexive consideration was made by the researcher and this is included, particularly in the conclusion, in the write up.
Doctorate in Systemic Psychotherapy. Doctorate Thesis. Tavistock/UEL 2016.
An increasing number of people with terminal cancer are being cared for at home, often by their partner. This study explores the identity, experiences and relationships of people caring for their partner at the end of life and how they construct their experience through personal and couple narratives. It draws upon dialogical approaches to narrative analysis to focus on caring partners and the care relationship. Six participants were recruited for the study. Two methods of data collection are used: narrative interviews and journals. Following individual case analysis, two methods of cross-narrative analysis are used: an analysis of narrative themes and an identification of narrative types.
The key findings can be summarised as follows. First, in the period since their partner's terminal prognosis, participants sustained and reconstructed self and couple relationship narratives. These narratives aided the construction of meaning and coherence at a time of major biographical disruption: the anticipated loss of a partner. Second, the study highlights the complexity of spoken and unspoken narratives in terminal cancer and how these relate to individual and couple identities. Third, a typology of archetypal narratives based upon the data is identified. The blow-by-blow narratives illustrate how participants sought to construct coherence and meaning in the illness story, while champion and resilience narratives demonstrate how participants utilised positive self and relational narratives to manage a time of biographical disruption. The study highlights how this narrative approach can enhance understanding of the experiences and identities of people caring for a terminally ill partner.
See also article.
Anthias, Louise (2016) Constructing personal and couple narratives in late-stage cancer: can a typology illuminate the caring partner perspective? Australian & New Zealand Journal of Family Therapy, 37 (3). pp. 418-430. ISSN 1467-8438
The development of a relational approach to the understanding, treatment and management of chronic pain
Doctorate in Systemic Psychotherapy. Doctorate Thesis. Tavistock / UEL
This study explored a systemic relational perspective towards the understanding, treatment and management of chronic pain.
The study was in three connected parts:
- a content analysis of video-tape of two clinical interviews, (a couple and a family) where one partner suffered from chronic pain;
- a focus group of five men in chronic pain;
- semi-structured couple interviews with each of the five men and their female partners.
In the latter, Interpretative Phenomenological Analysis (IPA) was used to explore the transcribed data.
- The definition of the relationship with pain, both from the perspective of the patient and significant others can influence how the pain is managed. A distinction between primary and secondary relationships with pain is identified.
- A lack of fit between patient and significant other beliefs concerning the management of pain may decrease or accentuate the difficulties in managing the condition.
- Family of origin and newer emerging scripts around coping with adversity, both for the person in pain and significant others may aid or constrain the effective management of the pain.
- Pain can be perceived as relational as well as an individual issue and good management of the pain can be helped by good teamwork and having a pro-active stance around engagement with social support systems.
- Uncertainty and concerns about the future and the condition exist both for the person with the condition and significant others.
An increased emphasis on a relational perspective to pain may help in the understanding, treatment and management of the pain. Arising out of the results, a new addition to existing perspectives on pain management is suggested for health professionals: that of primary and secondary relationships with pain. Helping patients and significant others reclaim a primary relationship with each other and have a secondary relationship with the pain may be a useful way forward in pain management and its treatment.
It is further suggested that these results have implications for the training of professionals involved in working with people in chronic pain and their significant others. Some potential implications are highlighted and discussed.
Professional Doctorate in Systemic Psychotherapy. Tavistock-UEL. Doctoral Thesis. 2007
There is growing evidence that the way patients and families relate to healthcare professionals influences their experience of illness and healthcare, and may affect their psychological and physical wellbeing. Relationships between professional groups may also have a significant impact on healthcare provision to children and families.
Previous research has focused on dyadic relationships within paediatric healthcare (mother and child, nurse and parents, doctors and nurses), but little has been published concerning the complex inter-relationships and roles of family members, doctors and nurses.
The aim of this research was to undertake a systemic analysis of the roles and relationships of nurses and doctors with children, adolescents and families. A qualitative methodology was used to explore how the three groups (nurses, doctors and families) understand their respective roles and relationships in the care of ill children within a tertiary paediatric hospital.
While systemic and social constructionist theory informed the overall conception of the study, grounded theory was the method used for structuring data collection and analysis. Data collection involved semi-structured interviews with doctors, nurses and families. These were audio-taped and each set of transcripts analysed according to grounded theory principles. Theoretical coding then allowed comparisons to be made across each set of data.
Two theoretical categories describing key processes involved in the care of ill children emerged from the analysis. These were: “Building emotional connections and focusing on medical goals: complementary or contradictory relationship discourses for families and staff?” and “Shifting relationships around expertise and power: the gains and losses associated with new positionings”
The first category highlights that both professionals and families appear to draw on particular societal discourses to inform their roles and relationships. These discourses (about the therapeutic value of emotional connections between staff and families and the need for ‘medical professionalism’) can appear at odds with each other. creating tensions and dilemmas for each group.
The second theoretical category highlights that power relationships between nurses, doctors and families are in a process of change. Fundamental change may be hard to achieve however, as each group may experience losses and well as gains in their emerging positions.
It is further argued that changes in government policy relating to these core processes creates challenges for each participant group as they struggle to balance positive working relationships, the medical care of the child and status and power issues. Change in any one aspect of these professional and family roles and relationships may have both adverse and beneficial effects, which need to be recognised. These findings raise important questions about the feasibility and desirability of family centred care.
The implications of this research for training, consultation and future research are explored.
The research adds to a small but growing body of literature focusing on the interface between professionals, patients and families in healthcare settings.
See also publication:
Down, G. (2010) 'Relationships between Healthcare Staff and Families in a Paediatric Hospital: a Grounded Theory Study', Human Systems 21(2), 237–69.
I know you can't see it but it hurts : a research study into the experiences of young people, their parents and healthcare professionals, who live and work with medically unexplained physical symptoms
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2014
In this study I have explored first-person stories of young people, parents and healthcare professionals about their experiences of living and working with medically unexplained physical symptoms (MUPS). MUPS claims large amounts of healthcare professionals’ time and technological resources in primary and secondary healthcare. As a consequence there has been an increasing amount of research interest in MUPS sufferers in recent years. However, few studies have explored the experience of MUPS sufferers from a social constructionist, dialogical and narrative epistemological standpoint. A cross-disciplinary review of the literature on MUPS revealed the experiences of young people and their families to be similar to those with a diagnosis of chronic illness and their families. A dearth of qualitative studies have explored the first-person accounts of young people, their parents, and healthcare professionals who live and work with the condition. Research aims were generated following the review of the literature: To explore the meanings that young people, their parents and healthcare professionals attach to their experience of MUPS in the absence of a medical diagnosis To explore stories constructed from these experiences by young people, their parents, and healthcare professionals about the impact of MUPS upon identity and significant relationships To discover the discourses and narrative templates that inform healthcare professionals’ practice with young people and their families who live with MUPS To identify cultural and institutional discourses and narrative templates from focus group members’ stories of experience; that position or marginalise MUPS sufferers and their families. The focus group method was chosen for data collection. Seven focus groups were held in a Paediatric Liaison Department (PLS) in a Regional Hospital in the East Midlands, U.K. Young people and parents were recruited to the focus groups from historical casework of the PLS Department. Healthcare professionals were recruited from the hospital paediatric and PLS teams. The focus groups involved two groups for adolescents with MUPS and two groups of parents of adolescents with MUPS. Three other focus groups involved healthcare professionals who work with adolescents and their families with MUPS. The focus group discussions were videotaped and transcribed by the researcher and two forms of analysis were employed: Thematic Analysis (TA) and Dialogical Narrative Analysis (DNA). The two forms of analysis produced multiple literal themes and implicit stories abstracted from focus group members’ accounts. A major theme for young people and parents was their feelings of anger and frustration following the initial medical interview with their doctors. Young people and parents reported they were not only disbelieved by the doctor about the existence and severity of the symptoms, but the doctor attributed negative attributions about their presentation such as ‘You’re lazy’, ‘It’s psychosomatic’, ‘All in your head’, ‘Fussy parent’. Without a diagnosis concerns of the young people and their parents were not legitimised. Young people and parents lost confidence in medical institutions. Young people responded by withdrawal and increasing social isolation. Many parents took on the role of advocacy in an attempt to restore their child’s credibility and the family’s integrity. Some of the doctors interviewed spoke about the dearth of training in MUPS in both paediatrics and psychiatry. They suggest that managing MUPS patients can be very time-consuming for hard-pressed clinicians. Within the medical encounter they sometimes feel pressured or ambivalent about whether to continue to investigate despite previous negative results. Doctors also stated that MUPS patients can generate anxiety and uncertainty in clinicians. More main themes emerged including recognising MUPS as primarily ‘an idiom of distress’ and the shortcomings of the biomedical paradigm in addressing the problems and dilemmas of MUPS sufferers, their parents and healthcare professionals. In the Discussion Chapter I propose a model of training and CPD for healthcare professionals. The model proposes introducing a hermeneutic approach and open emotional postures to compliment the deductive role of the diagnosing physician. It is proposed that by accessing concepts from both the scientific and phenomenological paradigms healthcare professionals will reduce the possibility of incongruence and potential for impasse within the physicianpatient relationship. In the conclusion of the report a number of recommendations are given based upon the outcomes of the study to introduce the benefits for professionals in adding theoretical concepts from systemic family psychotherapy, dialogical and narrative theory to inform and promote a hermeneutic discursive centred practice with MUPS sufferers and their families.
Power and Social Care
An examination of the ways in which power arises, and is managed, between systemic psychotherapists and parents working together in a social care context
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesi. 2017.
This study aims to understand and describe some of the ways in which power arises, and is managed, between clinicians who are systemic psychotherapists and the parents they are working with in a social care context. Examining their interactions in detail, particularly their talk, aims to do this. Interest in the questions arose from my own practice as a systemic psychotherapist working in children's social care, with a focus on complex neglect, where I identified challenges to ef[ective practice that were related to that context. My initial ideas were about power being a particularly salient issue in each of these challenges in one way or another, and I wanted to examine and extend this area of interest using qualitative research methods. Conversation Analysis (CA) is used here to examine the power dynamics at the heart of therapeutic work in this social care context. The primary overall objective of the study is to understand how power dynamics are managed to enable interventions aimed at reducing risk in families to be effective, by answering the following questions: L What is happening in moment-by-moment interactions between parents and systemic psychotherapists talking together, when the talk is taking place because of issues regarding risk to children? How are power dynamics being spoken about, negotiated, or managed in this high-risk context? 2. What is happening in moment-by-moment interactions between parents and systemic psychotherapists when talk that may lead to change, and reduce the risk to children, can be identified and seems to be being mutually created, understood and agreed between them? How are power dynamics being spoken about, negotiated, or managed in this particular high risk context? I examine 3 sessions, with 3 different sets of parents and systemic psychotherapists, in detail. I argue that power can be made useful when it is arising as authority that is jointly created between parents and therapists. I contend that the findings show how systemic approaches and practice can uniquely contribute to safeguarding work in contexts where issues of power prevail. I consider how the systemic practitioners in the study show their ability to deal with the power differentials arising, and develop relationships, that lead to effective and ethical working. I show how combining systemic and CA frameworks allow these abilities to be seen, and identified. These abilities are reflective of the systemic theoretical base, and systemic techniques enable these theories to be put to use. I show how these elements of practice enable complex processes between people to be negotiated. I argue how systemic approaches could contribute to mentalization-based approaches more than they do presently, and specifically when working with 'hard to reach' families. I argue that other therapeutic approaches such as these would benefit from dealing with the concept of power more explicitly, and benefit from understanding and utilising systemic approaches and practices in more depth to do so. I also use this understanding of what is happening in the relational systemic approach to examine the often-used concept of 'disguised compliance'. I make an argument for a more relational use of the term than is sometimes suggested. All of the above areas have implications for practice, and for the training and supervision of systemic psychotherapists, and other practitioners working in a social care context.
Rachel Watson, Jointly created authority: a conversation
analysis of how power is managed by parents and systemic
psychotherapists in children's social care. Journal of Family Therapy, 2018
The interface between systemic psychotherapy and the family courts, especially in relation to expert reports
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2014.
This qualitative research set out to explore how far understanding is shared between systemic psychotherapists who write expert reports for family courts and the judges who receive them, with particular reference to various concepts involved in the process such as truth, objectivity and expertise itself. Data obtained from semi-structured interviews with systemic “experts” and family judges was analysed using Grounded Theory. In response to ideas emerging from initial interviews, the focus broadened to consider how, despite the potential advantages of a relational approach to this working context, the possibility of these benefits being delivered by the involvement of systemic psychotherapists remained “invisible” to judges. Different beliefs were identified around the idea of being able to assess openness to change without actually introducing change. The complexity of cases and the responsibility of making hugely significant decisions about children and families were seen to require family judges to be more “interventive” than judges in other areas of law, and systemic experts to be more “certain” than in other contexts. The values, beliefs and sources of knowledge which inform the ways in which experts and judges reconcile those challenges and tensions within the context of a rapidly changing family justice system were compared. Some ideas were generated both about ways of supporting and enhancing these professional roles, and about implications for practice.
See also publication
Hickman, S. (2017) Systemic psychotherapists as expert witnesses in the family court: ‘visitors to another world’?. Journal of Family Therapy, 39: 437–453.
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2009.
The thesis describes a detailed investigation into the quality of meetings between Swedish therapists and refugee families, and how this is affected by language and culture differences. In a series of books and papers under the heading, "OpenDialogue", the Finnish psychologist Jaakko Seikkula and his colleague have written about the importance ofdialogical quality in meetings with psychiatric patients. This Open Dialogue perspective was adopted in the research, particularly by using Dialogical Sequence Analysis (DSA), the method of text analysis as developed by Seikkula and his colleagues. The Thesis examines the first two or three meetings (but in one case, the eighth) between six refugee families from different homelands and three sets of experienced therapists, asking whether the talk was dialogical and led to some form of new understanding. It also asks whether DSA is an appropriate method of text analysis for such meetings, and by extension, how far the Open Dialogue (OD) approach is appropriate. A multi-perspective methodology was used, combining DSA, video-reflections - the interactive use of video-recordings, and interviews with the families concerned. Graphic display of DSA outputs turned out to be a valuable method for comparing meeting quality. The display showed that "new understanding" developed in these meetings under similar conditions predicted by DSA for psychotic patients. Statistical analysis also showed substantial agreement between DSA assessments of meeting quality and those made by the participating therapists. Thematic analysis of the video-reflections complemented the DSA by revealing more about the non-verbal aspects of the meetings, embodying the feelings of the participants. Interviews with the families gave their feedback on the meetings. The conclusions of the research are that the OD approach is highly appropriate, although therapists sometimes need to use more initiative than OD would suggest. The cross-cultural obstacles to dialogue were seldom the obvious ones of misunderstanding, but inhibitions on both sides and difficulties of achieving spontaneity through an interpreter. Given these obstacles, the dialogical quality turned out to be high though uneven, whether assessed by DSA or by the therapists concerned. Most families were also positive about the meetings. Guidelines emerge from the research that should improve the quality of meetings with refugee families, and strengthen the development of a therapeutic alliance. Keywords: refugee, trauma, dialogue, open dialogue, interpreter, therapeutic alliance
See also publication
Guregård, S & Seikkula, J. (2014) Establishing therapeutic dialogue with refugee families. Contemporary Family Therapy. 36: 1.
Discovering a ritual of oblivion: systemic perspectives on adolescence, self harm and the Zimbabwean context, with particular attention to the usefulness of postcolonial theory
Doctorate in Systemic Psychotherapy. Tavistock / UEL. Doctorate Thesis. 2003.
This is a qualitative and exploratory study, from a systemic therapeutic point of view, of the links between public and private discourses in the explanations young people in Harare, Zimbabwe, give of their deliberate self harm. The study is concerned with establishing the variety of forms in which relationships may be perceived between individual adolescent narratives of despair (and consequently self harm) and a broader social and cultural context. In regard to this study postcolonial theory in relation to southern Africa is used as a privileged explanatory construct, not because young people themselves find such theoretical models to be useful therapeutically, but because as the researcher I have found it a useful means with which to connect private and public discourses. Colonial process in relation to Zimbabwe is described and explored. The theoretical work of Achille Mbembe is foregrounded in this. The eleven young people who participated in the study are described, as are the transcript and research narratives they provided. Methodologies used were a theoretical analysis, Interpretative Phenomenological Analysis and Narrative Analysis. These analysises show a textured picture of young people struggling to voice painful emotion in elational contexts which are also heavily impacted by colonial history and traumatic process, and suggest self harm moving from expression to coping mechanism. These descriptions are related to systemic theory and practice, as well as to the Zimbabwean crisis.
Family therapists’ experiences of working with adolescents who self-harm and their families: a grounded theory study
Doctorate in Systemic Psychotherapy. Tavistock / UEL. Doctoral Thesis. 2014
This study is a qualitative enquiry into family therapists’ experiences of working with young people who self-harm and their families. To date, in spite of self-harm being a serious public health concern, there is relatively little exploration of the subject in family therapy literature. The study attempts to describe, understand and illuminate family therapists’ experiences: the therapeutic issues encountered, the stances adopted in response to the issues encountered, and the emotional impact on the therapist of working with this client group.
A total of nine experienced family therapists participated in semi-structured interviews. The study employed a grounded theory method for data analysis. The analysis yielded a theory of therapists’ experiences that included a Core Category and three Main Categories.
The Core Category that emerged was:
the Practice of Hope – Withstanding the Pull to Hopelessness.
The three Main Categories were:
the Situation Safe
Therapeutically – The Practice of Hope
and Organisational Processes: Supporting Therapists.
The Core Category is the central feature of this theory. It proposes that the central concern for the therapist is how to stay engaged with the family and the young person in the context of serious risk of self-harm and in situations where change is difficult to achieve and hopelessness can pervade. The therapist has to try to understand and make sense of family members’ distress, and be touched by and open to their feelings of despair and hopelessness without becoming overwhelmed and despairing themselves. The therapist response to this dilemma is the stance of hopefulness. It is both a therapeutic stance and orientation, and is enacted in practice through finding ways to cultivate hope in the therapeutic encounter.
While the Core Category is the central ‘story’ the three Main Categories are linked to the Core Category.
The Main Category, Making the Situation Safe describes the initial stage of the work, with its focus on ensuring the safety of the young person.
The Main Category, Conversing Therapeutically – the Practice of Hope describes how the therapists enacted the ‘practice of hope’.
The Main Category, Team and Organisational Processes: Supporting Therapists describes how the context in which the therapists work, the nature of relationships, the team and organisational structures, play a critical role in supporting therapist hope, so that they can withstand the pull to hopelessness.
This study aims to make a contribution towards articulating a framework for family therapy with adolescents who self-harm and introduces a new vocabulary – the language of hope and hopelessness.
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2012
Research on intimate partner violence and abuse in same-sex couple’s relationships is still a relatively new area of interest. Given the silence surrounding this form of abuse within the field, there is much to be learned by research focusing on its meaning. This research study examined violence and abuse in the couple’s relationships of gay men from a British perspective. The study is located within a phenomenological approach, designed to capture the essence of the individual’s experience. The choice of a grounded theory approach for the analysis of the data rested on it being particularly helpful in generating theory in areas where this is lacking. However, the challenge of recruiting participants to the study limited the utility of the method, highlighting the ongoing difficulty of gaining access to sexual minority participants for studies involving sensitive issues. Eight participants, all gay men, were recruited and semi-structured interviews administered as a basis for generating data. A focus group discussion also formed part of the study and considered the question of whether same-sex partner abuse is the same or different from that seen in heterosexual couple’s relationships. Findings suggest that love for one’s partner, hope for change and quality of sex, accounted for the ongoing investment made by these men in their violent and abusive relationships. The emphasis on physical abuse diminished the importance of other forms of abuse, i.e. emotional, psychological and financial abuse. The direction of the abuse was in contrast to that seen in heterosexual relationships, i.e. the partner with most instrumental power, was the one most at risk of abuse. There was little 5 recognition of the impact of homophobia or internalized homophobia as possible contributory factors in the development of violence and abuse. Participants tended to rely on their own resources rather than seeking outside help and the clinical implications of this were considered.
Narratives of sexual orientation: Towards an understanding of how individual women come to know themselves as lesbian, heterosexual, bisexual, asexual and/ or in other ways
Doctorate of Systemic Psychotherapy. Tavistock & University of East London. Dec 2006
This study examines the factors and processes by which individual women identify their sexual orientation. The subject of women’s sexuality and sexual orientation development is analysed from different theoretical perspectives in the literature review, with particular focus being placed on contributions made by Systemic Psychotherapy.
Using the Interpretative Phenomenological Approach and principles derived from Grounded Theory and Memory Work, the research study analyses the views of women across the sexual orientation range, which have been obtained through interviews. It also examines ideas derived from critical discussions with different practitioners and clinicians on the subject. While the study focuses on the women’s individual ideas and thoughts, it adopts a broader perspective on the role played by wider systemic factors such as relevant historical events, the socio - political milieu, the question of the influence of biological factors on sexual orientation development, as well as the role played by the family, the wider community, work and friendship networks.
The study is qualitative in nature. It is aimed at trying to reach an understanding of how these women experience their sexual development, how they negotiate related changes within their lives and the meanings made of these events. Writers within the Systemic psychotherapy field have called attention to the fact that Systemic Psychotherapy has been slow to address issues to do with sex and sexuality issues.
The study is aimed at opening up theoretical and clinical practice discussions on the subject of women’s sexuality, rather than make generalisations about women. It is hoped that the issues raised in the study, as well as the debates and dilemmas highlighted, will be used as a platform from which to continue the enquiry with the hope of encouraging further research and theory development.
The map of competencies in systemic therapy: A qualitative study of the systemic competencies in child and adolescent mental health that target the associated abnormal psychosocial situations.
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2016.
The overarching aim of this research project is to identify a comprehensive and detailed outline of the systemic therapist competences in the Norwegian child and adolescent mental health (BUP) that target the psychosocial difficulties that are categorized as associated abnormal psychosocial situations in the multiaxial classification of child and adolescent psychiatric disorders/axis 5 (ICD-10). The project is based on twelve qualitative in-depth interviews with six experienced systemic family therapists, fieldwork observations of the therapists (participants) in practice and an analysis of the Norwegian Directorate of Health’s guidelines for child and adolescent mental health institutions. The specific research questions for this research project are: 1. In the context of child and adolescent mental health, what are the different competences in a systemic family therapy approach that address the associated abnormal psychosocial situations? 2. What are the legally binding requirements in the Norwegian Directorate of Health’s (2008) guidelines for child and adolescent mental health? 3. How does systemic family therapy interconnect with the Norwegian Directorate of Health`s (2008) guidelines for child and adolescent mental health? Grounded theory (GT) was chosen as the main methodology for this study. During the analysis, the following six overarching categories were identified: (1): legally binding requirements; (2) the importance of ethical and contextual awareness in systemic therapy; (3) the systemic therapist’s stance; (4) therapeutic processes; (5) therapeutic practices; and (6) session-specific features. Challenges, such as limiting the systemic approach to six overarching competences, are discussed alongside this study’s strengths and limitations, and suggestions for future research are presented. The detailed outline of the systemic therapist competences and the legally binding requirements in the Norwegian Directorate of Health’s guidelines was compiled into a “map of competences”. The findings show that the legally binding requirements interconnect and overlap with the identified systemic competences, although their wording and their inclusion of diagnosis can challenge the systemic ideas of using a non-pathologizing language. The map of competences is intended to be applied as a tool for clinical supervision, clinical practice, education and training in family therapy. This research may also facilitate a “bridge-building process” between mental health and postmodern systemic ideas.
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2018.
In this study I explore how ethnicity, gender and class are implicated in the construction and performance of authority in the supervisory relationship. Authority is a concept that is used as one of the competences and stances to take as a systemic psychotherapist and systemic supervisor but its meaning has not been enough explained nor deconstructed in the systemic literature. Twelve participants were recruited for the study. The chosen methodology was Grounded Theory. The key findings can be summarised as follows. First, authority is constructed by systemic supervisors upon dominant social constructions in a hierarchical relationship that is gendered, classed and racialised. Second, this study highlights that gender, class and ethnicity are intersectionally implicated in the constructions and performance of authority, rather than operating separately. Third, supervisors use theoretical concepts such as the domains of action in their conceptualization of authority, in order to manage the nuances between holding multiple perspectives and the assertion of their authority. In conclusion, Authority is a gendered, racialised and classed-based construct and thus shapes the influence of how knowledge and expertise is conveyed and received in the supervisory relationship. This construction of authority is embedded in power relationships, which privilege those supervisors that belong to the most hegemonic groups of society: white male middle class; and discriminate minority supervisors accordingly to their intersectionality.
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2009.
This research study has enquired into the circumstances as to when it is appropriate for systemic therapists to use self-disclosure of personal information to their clients as a clinical intervention.
Eight experienced systemic therapists were interviewed and the interviews analysed using grounded theory analysis. A wide range in the readiness to self-disclose was found amongst the research participants.
This thesis discusses how family/systemic therapy practice and theory have evolved and how this process has affected the development of systemic interventions such as therapist self-disclosure. The systemic literature on the topic of therapist self-disclosure is sparse and generally does not differentiate between its uses in different clinical scenarios. It shows that systemic therapy theory has concentrated on the teaching of models and technique while neglecting the development of the therapeutic relationship and interventions such as therapist self-disclosure. The research, supported by the literature, identifies a systemic professional culture that encourages caution in using therapist self-disclosure which has its origins in a number of areas including being overly influenced by Freudian thought and theory.
The thesis builds on work by Rowan & Jacobs (2002). Their model identified distinct ways of being a therapist which help the therapist to determine the type of therapeutic inventions that are appropriate to be used or not. Three therapist positions were found the instrumental, the fluid and the relational and these are discussed. They are related to four different self-disclosure types that have been identified in the research. Other variables that emerged from the research, in relation to self-disclosure and systemic therapy, are also discussed. The systemic ‘self-disclosure framework’ has been devised identifying the place of these variables in systemic therapy, with the aim of informing the systemic therapist of their options in their use of self-disclosure.
Recommendations are made for systemic clinical practice and theoretical development.
The narratives which connect… a qualitative research approach to the narratives which connect therapists’ personal and private lives to their family therapy practices
Doctorate In Systemic Psychotherapy. Tavistock/UEL. Doctoral Thesis 2008.
The major aim of this research project is to look into some meaningful and important connections between Norwegian family therapists’ personal and private lives and how their clinical practice may be created and constructed. These questions are asked: How do we understand that so little research has been done on the links between the psychotherapist’s own personal and private life and her/his clinical practice? How does the therapist's own life history and personal and private experiences influence the way he/she understands and practises systemic family therapy? What are the influences of being a systemic family therapist on the therapist's own life and how she/he thinks about the way she/he lives it?
I have used Grounded Theory as the framework for this research and have interviewed seven family therapists using semi-structured interviews. In addition, Thematic Analyses are used to analyse the videos of the first family therapy session of my first four research participants. , the research shows that both the practice of family therapy and the therapist’s personal life may be influenced. Family therapy education in Norway is challenged by these findings of how personal and private influences may affect clinical practice. I suggest that it is time to make personal and professional development programmes compulsory in Norwegian family therapy training.
In summing up the project, I have developed a middle range theory named “The map of resonance” where I use the concept resonance to understand both the relationship between the therapist’s personal ideas and professional practice and between the therapist and the clientI develop some ideas about pitfalls for therapist, and suggest how PPD-work and supervision can ensure professional development both in education and in general practice. The perspectives from a supervisors angle are also included. The project shows that personal and private experiences sometimes form a main framework for understanding sequences of family therapy practice. This realization should not be overlooked in the future and calls for further development.
Also see publication
Jensen, P. (2012) The Map of Relational Resonance in Professional Practice. Human Systems, 23: 119-138.
Jensen, P. (2016) Mind the Map: Circular processes between the therapist, the client, and the therapist’s personal life. In A. Vetere and P. Stratton (eds)The Interacting Selves. Routledge.