Masters research dissertations
Titles and abstracts of systemic masters research dissertations from UK family therapy training institutes that were awarded distinctions or merits and from non-UK family therapy training institutes.
Chris Manning. The factors which affect fathers’ relationships with their children following relationship breakdown.
In recent years, the impact of parental separation on children has become a subject of wide-ranging research. Within this, and given that in the British context 90% of children of separated parents continue to reside with the mother, there has been a growth in interest about the continued involvement of fathers in the lives of children who have experienced separation. This has tended to dwell on practical issues such as the importance of financial contribution to care of the children in maintaining father-child relationship, as well as the extent of contact in ensuring positive outcomes for children. Recent years have witnessed a greater interest in the quality of the relationship between father and child, rather than a straightforward focus on financial contribution and the extent of contact, as indicative of continuing involvement and positive outcomes.
Research has tended to use mothers’ accounts of fathers’ involvement, with a growing importance attached to children’s views on the involvement of fathers in their care. With a few exceptions, the views of fathers on all aspects of this process have been under-reported.
This study attempts to learn about paternal points of view of the relationship with their children following separation through interviews with four fathers who have separated and attempted to maintain relationships with their children. Attention is given to what they consider important in maintaining that relationship and also what constrains its development. Some consideration of fathers who bring up children alone is also given. Interpretative Phenomenological Analysis (IPA) is the method used to analyse the transcripts. The focus on unearthing the subjective experience of phenomena by the respondents, and on the attention paid to the researcher’s own prejudices in IPA made it particularly relevant to this kind of study.
Leyla Prince. Parenting after an acquired brain injury: a mixed methods research synthesis
Background: The impact of acquired brain injury (ABI) on the individual and family is well documented. Several studies have reported difficulties experienced in the couple relationships, family functioning and an adverse impact on children. There is little documented about parenting after ABI, particularly from the perspective of the parent with ABI.
Objective: The aim of this review was to explore the research on parenting after ABI, from the perspective of the parent with ABI in order to further insights into the parenting experience.
Methods: A literature search of several databases was carried from 1908 to the present (March 2019). Selected search terms were replicated in each of the databases. Preferred Reporting Items for Systemic Reviews and Meta Analyses guidelines were followed. This review conducted a Mixed Methods Research Synthesis to analyse data from studies implementing quantitative, qualitative and mixed methodologies. All quantitative data was therefore converted to qualitative data and subjected to a thematic synthesis.
Results: Six hundred and sixty-nine articles were identified through the database searches. After removing duplicates, title/abstract review and full text review, six studies were included. Five core themes emerged from the data – consequences of ABI, parental role, parental distress, relationship change and loss. From these two higher order themes emerged, namely identity change and perceptions of parenting with ABI.
Conclusion: Parents with ABI have negative perceptions of their parenting abilities and this is strongly linked to the limitations inferred by the consequences of the brain injury. The parenting experience appears to be one facet of the larger view of the family experience of ABI, with identity change due to loss at the core of this. Parents with ABI would welcome support and guidance. Further research is needed to inform practice.
Tom Reid. UK birth parents’ experiences of the court-ordered removal of their children: a thematic synthesis
This review aims to synthesise research in the UK on birth parents’ experiences of the court-ordered removal of their children. This is a relatively under-researched field, though there has been recent interest. A research question is developed: What are the experiences of birth parents of the process and aftermath of the removal of their children? Reports of studies are systematically retrieved and quality-assessed and a thematic synthesis methodology is used to draw out descriptive themes from the papers reviewed: impact of child removal, relationships, responding to and coping with child removal and situation before removal, each of which are broken down into sub-themes. Descriptive themes are used to develop three analytical themes in answer to the research question: parents managed identity stories to maintain dignity, parents’ emotional experiences were complicated by the social context and the experience was so powerful that future relationships are ‘haunted’ by the removal of a child (Broadhurst et al., 2017, p.80). Implications for research and practice are discussed.
Fiona Kennon. Parenting a child with diabulimia: An Interpretative Phenomenological Analysis
Background: The literature tells us that more than a quarter of people with Type 1 diabetes also have an eating disorder; a statistic higher than that of the non-diabetic population. Standard eating disorder treatments for this population offer disappointing results. Complications associated with poorly-managed diabetes are wide-ranging and can be life-limiting, even fatal. Existing literature suggests that the support of families is crucial in management and recovery from this complex illness.
Aim: To explore the lived experience of parents whose child lived with Type 1 diabetes and an eating disorder.
Method: Semi-structured interviews were carried out with three participants, all mothers. The interviews were transcribed verbatim and analysed for meaning using Interpretative Phenomenological Analysis.
Results: Four themes emerged from the data: battling, blaming, surviving and loss. These were then interpreted through the lens of ideas from systemic theory.
Conclusion: The results of this study highlight that a formal recognition of this illness is invaluable in helping families be able to access appropriate support more quickly. This study reinforces existing literature, which found that support should be offered by a team which understands both eating disorders and Type 1 diabetes. Previous studies conclude that the use of current interventions for the T1ED population, is not effective; this study recommends the development of family therapy programmes, evidenced as treatment for Type 1 diabetes and for eating disorders, be developed with this population specifically in mind.
Marta Costa Caballero. Exploring the use of language as a contextual marker in working with families: a focus on the parents’ experience
Before the 1980s many studies constructed a negative view of bilingualism. However, these have since started to be challenged. Recently there has been an interest in understanding the meaning of language for bilingual and multilingual families in systemic psychotherapy. This new perspective, rather than considering cultural beliefs from a medical model or a stereotyped view of certain cultural groups, represents a shift towards understanding what it means for families to live across languages and cultures.
This exploratory qualitative study is based on interviewing five bilingual couples (a non-native English speaker and a native-speaker English) in relation to their parenting across cultures (i.e. their respective cultures of origin and the culture of the context where they currently live). Data was analysed using Interpretative Phenomenological Analysis (IPA) as a research method from a social constructionist stance. This study is particularly interested in the participants’ understanding about how they make decisions about which language to parent in and how language impacts the relationships in their families. There is also a specific emphasis on the relationship between language and the cultural identity of the family from a developmental and changeable perspective rather than being static. The overarching intention of the study is to present language as a contextual marker to discuss family relationships, cultural identity, beliefs and emotions. The study enhances previous research by highlighting the importance of discussing the meaning of language with multi cultural families in therapeutic settings, particularly at transitional periods when entering parenthood or as a child starts to attend school. This study concludes that further research to understand the needs of bilingual families and their experiences is necessary in order to address some of the discourses embedded in the educational field.
Family and clinician persepectives
Katarzyna Smithson. Exploration of influences on systemic therapists’ and trainees’ thinking and use of client feedback: discourse analysis. 2023. IFT/University of Bedfordshire.
The concept of client feedback is fundamental in systemic theory and practice. This study explores discourses organising systemic therapists’ and trainees’ constructions of client feedback and the research question is “What are the influences on systemic therapists’ and trainees’ thinking and use of client feedback?”. This is a small-scale qualitative study which used semi-structured interviews with a group of systemic therapists and practitioners and Foucauldian Discourse Analysis (FDA) was used to analyse them. Several new insights emerge from the analysis: the connection between the degree of collaboration and use of client feedback; the significance of social factors organising possibilities for feedback; and the dimension of compatibility between the individual and context-related values and purposes of feedback use. A simple model of personal, professional and context-related aspects of therapy is offered to organise the complex picture of influencing discourses and implications for practice are explored.
Roxy Stoneman. What are Trainee Systemic Psychotherapists’ experiences of endings with families within the trainee family clinic? (2021)
This study aimed to understand Trainee Systemic Psychotherapists’ (TSP’s) experiences of therapeutic endings within trainee family therapy clinics. A literature review was conducted on therapeutic endings. Due to the research being conducted during the COVID-19 pandemic, online therapy is also considered. Participants (N =4) were Trainee Systemic Psychotherapy students in their final year of training at the Tavistock and Portman NHS Trust. Semi-Structured interviews were conducted to understand TSPs’ experiences of the end of therapy with families within trainee family clinics. Interpretative Phenomenological Analysis (IPA) was the chosen data analysis method. The findings identified several themes for TSPs when ending therapy within a trainee family clinic, including: how the power that families, TSPs and supervisors hold influences the end of therapy; the impact of online therapy on endings and how TSPs’ relationships to endings influences the end of therapy (including their feelings of relief; hope for endings to be collaborative and experiencing endings as bittersweet). Two ending rituals were also identified: noticing the changes the family have made and the recognition of family strengths. Lastly, the limited attention to endings within the MA Systemic Psychotherapy Tavistock and Portman NHS Trust Systemic Psychotherapy course was identified. A Trainee Systemic Psychotherapists’ Experiences of Endings Model (TSPEEM) is proposed as a reflexive tool to understand TSPs’ experiences of endings and to support future training.
Robin Ewart-Biggs. Family Therapy, Torture and Exile: Three Family Narratives
The impositions of torture and exile seek to break family and social systems. Little has been written from the perspective of refugee families who have attended family therapy in the UK following torture. This qualitative study seeks to prioritise their voices. Eleven family members, from three families, were interviewed about their experiences of family therapy at a systemically oriented clinical service. A narrative analysis was carried out. The participants emphasised social aspects of their experience, the processes of finding agency in their lives and the intricacies of communication and trust-building. The families each constructed different meanings from the experience of therapy; these were enacted in the research process. The dramatic narrative forms of the interviews illustrated parallels between the power imbalances in the families’ relationships with researcher, therapist, host society and persecutor. Process research methods are suggested for further research.
Emma Dunton. What Are Systemic Trainees’ Experiences Of Personal Development While Studying To Become A Family And Systemic Psychotherapist?
This study can be used to reignite further interest into future generations of trainees’ experiences while undertaking systemic training, an area of research that has historically been neglected. This qualitative study used a thematic analysis method exploring data collected via 4 semi-structured interviews with trainees on the 2018-2020 cohort of an MSc programme at a London training institution. It explored their experiences of personal development while training to become family and systemic psychotherapists. Analysis of data identified five themes: experiences of the course; experiences of core requirements of the course; position of being a trainee, changing relationships with family and evolving identify. The research identified that training is often a complex and sometimes difficult journey for trainees to navigate. Resulting, in development of reflexive skills, changes in identity, impacting on family relationships and systemic thinking becoming a ‘way of being’ in all aspects of life for some. The study makes recommendations for training providers to consider how more support can be provided to trainees in terms of emotional and academic demands that may arise from the course, which will undoubtedly result in changes to self and close relationships. A strength of this study is that respondent validation was attained twice to ensure the voices of participants were accurately represented.
“Well it’ll be pretty strange if they came out as the same person as they went in. I think that’s almost impossible!” Chris
Melanie Shepherd ‘Thinking family’ in primary care and exploration of the ways in which primary care psychological therapists think about families and use their thinking in their clinical work.
This pilot study investigated the experiences of primary care psychological therapists regarding the place of families in their clinical work with adults. There is no published research into this issue. Anecdotal and audit data demonstrate that couple and family work is unusual in adult primary care mental health services although clients frequently seek help for interpersonal problems.
Semi-structured interviews were conducted with seven psychologists. Qualitative data were analysed using Interpretative Phenomenological Analysis. Two superordinate themes emerged: ‘thinking family’ and ‘seeing family’ with various sub themes. These were translated into two narrative accounts: ‘congruent’ and ‘conflicted’ with the wider context.
Some participants had an individual/problem and others a family/context focus. All participants considered clients families, including those who claimed not to do so. Although seeing family members together in primary care is feasible, this rarely happens. Facilitating factors identified include training, supervision, exposure to research evidence demonstrating the effectiveness of family therapy, and opportunities to collaborate with family oriented colleagues. Participants described external barriers to seeing family members together, including aspects of the primary care setting and lack of support, and internal barriers including negative beliefs about family work and perceived lack of confidence.
Some participants question the family/context focus and whether ‘thinking family’ or seeing family members together would be deemed appropriate in the eyes of colleagues these ideas were justified with reference to the evidence base supporting cognitive behavioural therapy. The possibility of internalised constraints is discussed in the light of White’s (1992) ideas about power. The significance of the political context and the current dominance of CBT and NHS psychological therapy services for adults are explored.
Recommendations are made regarding changing perceptions about family therapy, and offering team training and ongoing support systems to psychological therapists. The particular challenges of doing so in primary care discussed.
Publication: Shepherd, M. (2014) Do primary-care psychological therapists think family? Challenges and opportunities for couple and family therapy in the context of Improving Access to Psychological Therapies (IAPT) Services, Journal of Family Therapy, Volume 36, Issue 1, 39 to 61.
Sedef Oral. Reciprocal Impact between Couple Therapists’ Beliefs about Coupledom, Experiences in Romantic Relationships and Experiences in Couple Therapy: A Qualitative Study
Although conducting couple therapy is a professional practice, it also involves very deeply personal processes that a therapist might pass through. The present study aimed to discover the experience of being a couple therapist considering how personal and professional beliefs and experiences of the couple therapists have reciprocal impact on each other. For the purposes of this study, couple therapists who are (a) currently working with couples in their caseloads, and (b) in a romantic relationship themselves were interviewed. Seventeen in-depth, semi structured interviews were conducted. The data was analysed in MAXQDA 2018.1 using grounded theory’s constant-comparative method. The emergent model revealed three categories including sub-categories for each other: Endeavouring to repair relationships, creating the presence of a therapist working with couples, and developing the presence of a person and a couple therapist, respectively. The findings suggest that being aware of person of the therapist and learning how to use themselves for relating, assessing, and intervening the couple clients create a more secure therapeutic presence. These results contribute to the literature by filling the practical and theoretical gap in couple therapy implications. Thus, findings are thought to be useful for the frameworks of couple therapy training programs and couple therapy supervisions.
Sally Fraser. Transparency in Clinical Documents. Family therapists’ experiences of copying letters to families. A qualitative study
Sharing written information is a core practice in Systemic Family Therapy (Carr, 2010), based on the principles that therapeutic engagement can be enhanced and power differentials can be minimised. The practice of copying letters to families is supported by legislation in NHS England, but not in Scotland.
This study used Interpretive Phenomenological Analysis to explore the experiences of 4 family therapists who work in CAMHS in Scotland, who routinely copy letters to families.
Themes across 4 interviews were identified, including positive impact on therapeutic engagement, addressing power issues, the value of multiple perspectives and the role of language.
Analysis revealed that despite some challenges, transparency in letter writing practices is an integral part of therapeutic processes and has clear benefits for clinicians and families.
Bruce Kissell. What are the experiences and perceptions of Systemic Family Therapists/Systemic Practitioners at Great Ormond Street Hospital of the concept of resilience?
There is an extensive body of literature on resilience encompassing 50 years of existing work. Nevertheless, most research has focussed on individual traits of resilience, therefore a systemic approach which takes into account the relational context of resilience is needed. There is also a lack of research that explores the experiences of practitioners around the concept of resilience. This study design will be a Qualitative Research study using semi-structured interviews following an IPA methodology (Interpretative Phenomenological Analysis). This research methodology fits with the question as the aim will be to explore insights into how a given person (family therapists/systemic practitioners), in a given context (GOSH – Great Ormond Street Hospital), makes sense of a given phenomenon of lived experience (resilience). The use of IPA allows for an exploration of a systemic conceptualisation of resilience from a practitioner’s perspective.
Results showed that there were three superordinate themes that participants articulated when exploring their perceptions and experiences of the concept of resilience: relationship with the self; relationship with uncertainty; and relationship with adversity. From the research study results (based in the participants specific context), resilience can be understood as a resource generating and co-ordinating process that emerges in a relational context.
In conclusion, the research project highlighted the importance of resilience for these Systemic practitioners/family therapists and how resilience can be a helpful concept when thinking about the therapeutic relationship with families. In the context of the therapeutic relationship the process of resilience allows resources to emerge, alongside the acknowledgment of the adverse experience. This could have implications for systemic practice as the very act of exploring resilience creates space for resources to emerge. The results led to proposed suggestions regarding future research specifically regarding: what fosters team resilience; and also the potential benefits of a therapeutic space to explore team self-reflexivity.
Donna Wright. Reflecting Teams: An exploratory study with clinicians.
This is an exploratory study with clinicians who took part in a Reflecting Team (RT) as part of a Family Therapy Clinic investigating clinicians’ experiences, thoughts and understanding. A literature review was completed to understand the development of Reflecting Teams and the advantages and disadvantages of its use in Family Therapy. A qualitative approach was adopted and data gathered via a focus group of eight participants.
Thematic analysis was used to interpret the data and generated five global themes:
- Theme 1 – Change in Clinicians’ Perspectives.
- Theme 2 – Clinicians’ Perspectives on the client experience of Reflecting Teams.
- Theme 3 – Finding a Fit for the Family.
- Theme 4 – Clinicians’ Experience of Reflecting Teams.
- Theme 5 – Guidelines and Considerations for an Effective Team
The study found similar themes in the literature emerged in the data. There was a mirroring, a shared experience for clinicians and families related to exposure to being in and experiencing a Reflecting Team. There is some discussion around how ethical the Reflecting Team is when families describe it as ‘shocking’ and suggestion of using a video clip to prepare families and new members of the team to the concepts and nature of the Reflecting Team. As well as the importance of asking families for feedback about their experience of the Reflecting Team. Clinicians found it more helpful being in the room with families rather than behind a screen in order to be able to respond and feel the emotions more fully in the room and develop as therapists.
Reflecting Teams continue to offer multi-perspectives, richness and diversity to families and are useful and beneficial for both families and clinicians. Further areas of research are suggested.
Andrew Edge. How Ideas about Emotion form part of Systemic Psychotherapy: An Exploratory Study of Systemic Psychotherapists’ Understandings of how Theoretical and General Beliefs about Emotion Inform Practice.
There has been little focus in the literature about the possible relationships between therapy practice and beliefs about emotion held by systemic psychotherapists. In this research, five qualified systemic psychotherapists working in England were interviewed as part of an exploratory study. The participants seemed able to reflect on both their theoretical and wider beliefs about emotionality, discussing how they felt these might influence their practice. The data is discussed primarily from a social constructionist position using broader literature on emotion, including theories from both the ‘modern’ and ‘post modern’ traditions. Findings suggest this is an area systemic psychotherapists would like to consider further, including developing increased understanding of the ‘reflexive’ processes involved. Implications for practice and further research, indicated by the findings, are also highlighted.
Sonia Kalia. How do professionals deconstruct letters of instructions (LOIs)?
This qualitative study highlights some of the tensions of working as an independent professional within the child protection and court systems. It captures and evaluates the perspectives of six experienced professionals on the use and impact of LOIs, within complex social processes of conducting assessments with children and families. A structure of Thematic Analysis and Coordinated Management of Meaning’s Hierarchy model is used to collect and analyse data. The emerging themes were: Taking Positions, Use of Power, Context, Multiple Perspectives, Interactional Processes, Professional Guidance and Supervision. It draws out two main findings: the conflicted position of the IP and significance of collaborative approaches and systemic practices within assessment processes. Lastly, it suggests a further evaluating study into measuring LOIs.
Diane Charles. From the Supervisee perspectives: How is the context of live supervision used in ‘learning’ about family therapy?
Supervision, within the therapy domain, constitutes a process whereby a more aptly qualified therapist oversees and guides the supervisee through stages of learning. It is often the medium used to promote the trainee therapist’s clinical skills, theoretical and personal development.
Whilst indirect supervisory practices involves the retrospect inspection of trainee accounts, records or videotapes, live supervision provides a real-time account of the processes occurring between client and therapist, and involves a more immediate approach to supervision with the supervisor directly involved in the process.
Live supervision, often comprising of supervisor, client and reflecting team, entails an obligation for the trainee to demonstrate the integration of theory into practice conjointly with an ability to negotiate the interplay and reciprocal activity of multiple relationships ‘in action’ whilst keeping in mind the use and positioning of ‘self.’
This premise calls into focus how the context of live supervision is used ‘to learn’, and thus, has led to my interest to seek out and examine existing research and literature surrounding this topic of interest.
‘Race’ and culture in systemic psychotherapy
Shaila Sheikh . How has Black Lives Matter influenced systemic psychotherapists relational risk-taking in their clinical practice? MA dissertation. 2021 London: Tavistock and Portman National Health Service Foundation Trust.
A small scale, qualitative study, exploring how Black Lives Matter (BLM) has influenced systemic psychotherapistsrelational risk taking (Mason, 2005) in their clinical work. Systemic psychotherapists professionally known to each other, were invited to have reflective conversations, in pairs, on this subject. This aligned the research methods with relational and systemic ideas. Their conversations were examined through Foucault’s lens (1982) to identify the discourses and consider notions of power indicative of relational risk taking in their systemic practice.
The findings do not intend to theorise racism. The hope is to support all systemic psychotherapists working interculturally, and in recognition of the BLM ‘call to action’ (BLM, 2020).
The process, learning and findings have been highly relevant to my personhood, self as a therapist and clinical practice.
Joe Cottrell- Boyce How do family therapists address white privilege in clinical practice? MA dissertation. 2019 London: Tavistock and Portman National Health Service Foundation Trust.
For this qualitative study, four family therapists were interviewed about the significance of White privilege to their therapeutic practice. The interview data were ana- lysed using Foucauldian discourse analysis. The study highlights the relevance of White privilege to systemic family therapy as a historically contextualised social re- ality, manifested in unequal experiences, outcomes and relationships. Constraints to addressing White privilege are identified in the form of alternative discourses, such as ‘colour blindness’, which problematise the naming of race and contribute to ‘race anxiety’. ‘Talk- about- talk- about-r ace’, acknowledging the contradictions and un- certainty inherent to dialogue around race, may help overcome the mutually negating imperatives of these discourses. Acknowledging White privilege requires ‘re- lational risk- taking’ (Mason 2018); to neglect this task risks complicity with the maintenance of White privilege, which, “depends for its power on silence” (Berndt 2008: 190).
Now published: Cottrell-Boyce, J. (2022) “Addressing White privilege in family therapy: A discourse analysis”. Journal of Family Therapy, 44(1), 142– 156. https://doi.org/10.1111/1467-6427.12363
Natasha Nascimento. Discourse Analysis Exploring Therapists’ Use of Self Iin Cross-cultural Systemic Therapy
The aim of this research study was to explore how therapists’ account for their use-of-self in cross-cultural Systemic Therapy; which positions and discourses are professionally and culturally available to Systemic Therapists and the impact these have on therapy. As we are “products of our social and cultural milieu” (Pakes and Roy-Chowdhury, 2007, p.267), therapists share assumptions with members of society, so the greatest challenge is to be aware of our own biases. A Discourse Analytic approach was used to analyze five qualified Systemic Therapists’ discourses obtained through semi-structured interviewing. I am interested in what informs Systemic Therapists’ use-of-self in cross-cultural practice and how therapists move themselves when working cross-culturally. Three dominant discourses emerged: postmodernist discourse in reference to self-reflexivity as therapists’ main tool (‘use- of-self’) and ‘not-knowing’ in relation to cross-cultural therapy; in contrast with modernist discourse of ‘obligation’ or ‘good-practice’; and lastly a discourse of possibilities and constraints in intra-cultural and cross-cultural services. These results highlight how therapists’ use-of-self is constructed rationally; how principles of ‘good practice’ with diverse clients might be taken into account, but not necessarily addressed, and, moreover, how therapists’ use-of-self might be constructed differently in cross-cultural therapy services and intra-cultural services, and how this might have an impact on therapists’ and colleagues’ effectiveness. Possible implications for training and clinical practice are discussed.
Sreety Das. Multilingual matrix: exploring the process of language switching by family therapists working with multilingual families
This research explores the phenomenon of language switching in clinical practice in the systemic psychotherapy field. I consider multilingual therapists’ experiences of switching from use of one language to another in the therapeutic context, the therapists’ awareness of this, and the intentions or possible meanings they attribute to these experiences. The interpretative phenomenological approach was used to analyse the experiences of four female family therapists based in London and from a range of cultures and communities.
It was found that the therapists construed their multilingual position as both challenging and advantageous. Suggestions are made to explore the language switching phenomenon in supervision and training, as well as to think more widely with monolingual and multilingual colleagues and supervisors about the meaning and the use of language switching in therapeutic practice. Existing research in this area can be developed further to provide a framework that could benefit practitioners in the systemic field.
Das, S. (2020) Multilingual matrix: exploring the process of language switching by family therapists working with multilingual families. Journal of Family Therapy, 42: 39-53. doi:10.1111/1467-6427.12249
Lizette Nolte. The Influence of Migration on the Cultural Self of Therapists and their Therapeutic Work
Due to an increase in global mobility and displacement there is a growing cultural diversity within therapeutic encounters between therapists and clients. Literature on cross-cultural therapy traditionally focuses on the culture of the client. However, due to recent theoretical shifts in the field, writers are now emphasising the importance of including the culture of the therapist in the discourse about cross-cultural therapy. This study explores the cultural identity of therapists.
Six qualified family therapists from different cultural backgrounds who have migrated to Britain were interviewed. Their experiences and the impact on their clinical work were explored. Grounded theory was used to analyse the data. Themes were identified within three areas, namely the experience of migration, reflections on the self of the therapist and reflections on cross-cultural therapy.
The findings include: Migration is described by participants as a multi-layered experience that continues to influence their lives on different levels over time, including ongoing negotiation of their cultural identities within a host culture. “Othering” and racism in different contexts, including their relationships with colleagues, influence this process. In their clinical work participants describe a position of moving between curiosity and connection, both when working with culturally similar and different clients. Participants warn against tokenism within the field of family therapy and argue for representation of minority cultures at all levels of the profession.
The findings of this study pose important challenges to the family therapy field in terms of training, supervision and addressing issues of discrimination amongst colleagues. It is viewed as important to attend to the cultures of all therapists within family therapy training and supervision. The potential of accessing the personal life experiences of therapists as a safe, non-challenging and meaningful way to do this is discussed. Further research is suggested.
Christine Eidler. To explore how family therapists from a UK charity working with victims of torture, identify individual and family resilience in their work with refugee populations.
This qualitative study examines the ways specialist family therapists at a UK charity working with victims of torture identify individual and family resilience in their work with refugee populations. A thematic analysis discovered the following themes as significant in this process: hope, cultural competency, attachment, past experiences of resilience, spirituality and religion, as well as the need for professionals to adopt an anti-oppressive and strength-based approach to look after themselves when confronted with the extremity of refugee people’s narratives. The data suggests that both individual and family resilience is described as multifactorial changing over time at an individual and cultural level. Again, while the process of identifying resilience is mostly collaborative, it requires a high level of commitment by the therapist to discovering it. The study explores and highlights the need for further research into the effective clinical application of individual and systemic resilience in therapeutic work with refugee populations.
Mala McFarlane. An exploration of Black and Minority Ethnic Inter Racial Couples experiences of Race and Ethnicity constructs: their experiences of being a Multi Ethnic Family.
In study explores Black and Ethnic Minority (BAME) inter racial couple’s experience. I seek to understand their lives as a multi ethnic family; that is how they negotiate racial and ethnic differences, identify themselves racially and ethnically as a family and how they are by others. I interview 6 participants and ask them to tell me their story of how they make sense of race and ethnicity and their experiences of being a multi ethnic family. I used a qualitative methodology; interpretative phenomenological analysis (IPA) to draw out divergences and convergences from the data.
Research with implications for therapy / systemic practice
Naureen Whittinger. Community discourses about recovery from disaster A Foucauldian discourse analysis of perspectives on recovery voiced by community members four and five years after the Grenfell fire. (2023)
This study sought to explore what discourses about recovery were constructed by community members who were directly and indirectly impacted by the Grenfell Tower fire in 2017 and the implications of these discourses. A Foucauldian discourse analysis was used to analyse transcribed film and speeches streamed on social media on the fourth and fifth anniversaries of the Grenfell tower fire. It revealed that community members adopted three main discourses around recovery: a relational discourse, action discourse and community discourse. These findings suggest social connectedness, being active participants in change-making, and community unity enable people to adopt positions helpful for recovery. It is important for systemic therapists to attend to language and issues connected with power as well as the implications of social and political injustice for people affected by disaster. The limitations of the study and implications for practice are discussed.
Claudia Livesey. Exploring the conditions of possibility for the development of systemic social work: a Foucauldian Discourse Analysis of Ofsted’s annual summaries of social care inspections, as a context for child protection practice
The Munro Review of Child Protetion advocated for a paradigm shift in the child protection social work carried out in Local Authority children’s services’ departments across the UK. Munro’s review called on Local Authorities to develop systemic, relationship-based cultures and practices. In this theoretical dissertation I will use Foucauldian Discourse Analysis to explore how far annual summaries of Ofsted’s children’s social care inspections from 2007-08 to 2016 facilitate, limit, enable, or constrain, the conditions of possibility for the development of systemic child protection social work. I argue here that the competing realities being negotiated post-Munro in complex social, cultural, political and economic contexts, exist as primary and secondary injunctions in a double bind. I critique the discourse that produces ‘leadership’ as an emergent subjectivity and set of practices, suggesting that it functions to limit the power of Local Authority children’s services to create societal change. Systemic social work is more likely to be possible where there is the capacity for recursive influence between and across social worlds.
Jonathan Buhagiar. The construction of ‘psychosis’ in a UK Parliamentary debate: A Foucauldian Discourse Analysis
The literature about ‘psychosis’ has been predominantly informed by a positivist epistemology and quantitative methodologies. However, a growing body of qualitative literature explores how ‘psychosis’ is talked about by different groups in society. The current study extends the field by analysing how ‘psychosis’ is constructed in a 2016 UK Parliamentary debate that followed the introduction of the two-week access and waiting-time standard in early intervention in psychosis services in England. I draw on a social constructionist epistemology and use a Foucauldian Discourse Analysis. The analysis outlines different discourses, including biomedical, moral, economic, and gendered and racialised constructions of ‘psychosis’, and the subject positions made available to individuals, families and Government. I discuss the implications of these results for systemic psychotherapy and the value of attention to the political context in clinical practice, research and training.
Lydia Guthrie. How do Syrian refugees resettling in Oxford under the Syrian Vulnerable Person’s Resettlement scheme make sense of their resettlement experiences, and how does it affect their construction of identity?
This qualitative study examines the ways in which Syrian refugees experience their resettlement in Oxford, having moved to the UK under the Syrian Vulnerable Persons’ Refugee Scheme. It is based upon three semi-structured interviews, supported by an Arabic/English interpreter, with five participants across three family groups. Data was analysed using Reflexive Thematic Analysis, within a social constructionist epistemology.
Three themes were found: “Lives interrupted – war as punctuation”; “Constructing identity – who am I here?” and “The practices of resettling”. These themes capture both the ambiguous losses and the hopes experienced by the participants, as they construct a life in a new socio-cultural context while looking backwards to a past which they cannot physically revisit, nor psychologically leave behind.
This study demonstrates that the participants are constructing a sense of coherence by developing ways of preserving essential themes of faith, culture and language, while learning to adopt new practices and to negotiate across social difference. These processes are located within a social context characterised by racism, oppression and dominant social stories which position them as vulnerable.
Kate Meredith. Exploring the process of coping in partners of people with communication disorders resulting from acquired brain injury in the early phase of neuro-rehabilitation – experiences and reflections of a focus group. A Qualitative Study.
Communication disorders following acquired brain injuries (ABIs) affect individuals, couples and families. However, there is a lack of research into the way that partners cope in these circumstances, particularly during in-patient rehabilitation, and family involvement in rehabilitation varies greatly across services. The purpose of this study is to explore the effects of communication disorders and ABIs on the couple relationship, and what partners felt helped them to cope at this time or could help other partners in the future.
A focus group was conducted with male and female partners of people with communication disorders (PCDs) resulting from ABIs who were in-patients on a rehabilitation unit. The group discussion was transcribed verbatim and thematic analysis was used to analyse the data qualitatively.
Four super-ordinate themes and 24 sub-ordinate themes were identified. These illustrate how partners of PCDs experience a range of emotions and changes in their relationships and roles, the different levels of formal and informal support they can access, and how they utilise previous experience when adjusting to a communication disorder after an ABI.
Findings from the study give an understanding of the experiences of partners of PCDs. Increased support to this group of people is recommended, including opportunities to gain relevant information, share experiences and tell stories in order to construct meaningful narratives. A range of ways in which support could be provided is discussed. Further investigation into partners’ experiences and the changes in the support that they require and receive along the rehabilitation journey is required.
Lorraine Davies-Smith. Identification of common themes for distressed women at increased risk of familial breast cancer. 1998
Ten women at increased risk for breast cancer, based on generational family cancer history, routinely presenting at a familial breast cancer clinic (FBCC) and who in the clinical opinion of a Consultant Cancer Geneticist and a Clinical Nurse Specialist were ‘distressed’, were invited to complete a series of questionnaires and participate in a semi structured interview.
Two measures of anxiety (State Trait Anxiety Inventory, Spielberger et al 1977); a measure of negative attitudes (pessimism) about the future (Beck Hopelessness Scale, Beck & Steer 1978) and three health belief measures (Multi Dimensional Health Locus of Control Scales, Wallston et al 1978) were obtained. Analysis of these measures indicated that this group of women are reporting a high degree of State and Trait anxiety, have less belief in either their own ability (internality) or health professionals (powerful others) to ensure good health and believe more strongly that good health is a matter of chance, and are indicating a higher degree of hopelessness about the future than the general population. The only correlation between measures which reached statistical significance was that between State / Trait anxiety.
Seven commonalties (vulnerability classes), associated with cancer family legacies and life stage development were identified. Genogram information confirmed each of the women in the study encompassed several of these commonalties.
Qualitative analysis of the interviews discriminated six major categories which developed participants perceptions regarding the source and family impact of their distress. They confirmed the identified commonalties as pertinent and indicate these women think about breast cancer and its impact multi – generationally, linking their memories and experience of breast cancer in previous generations through themselves and into their children’s generation
Further research may be needed to inform what help, if any, should be made available and to whom.
Susan Tristram. Single Women and their Friendships: Stories of Attachment
Single women’s friendships offer an alternative story to the dominant discourse of the couple relationship. These friendships are seldom focussed on and have received little attention in the systemic therapy literature. This paper explores the historic and current cultural and ideological trends surrounding single women and friendship between women in an attempt to explain and understand this invisibility. Focussing in particular on close and enduring friendship between single women, connections are made between these friendships and attachment relationships. Five single women tell their stories of life-long friendship and emergent themes are observed. These include security, reciprocity, growth, enduring relationships and irreplaceable relationships. These attachment themes are used to illustrate the significance of these friendships.
The paper includes implications for the theory and practice o f systemic psychotherapy throughout. These include the consideration of the needs of single women within systemic therapy, with commitment to a non-pathologising approach. This is described as working with an emphasis on the network of relationships surrounding these women, and in particular focussing on their friendships as the main source of connection and intimacy. This is suggestive of different ways of working systemically, including incorporating friendships onto genograms and inviting friends into sessions. The therapeutic implication of promoting enduring friendship between women to attachment relationship status is also described as significant. This would place close friendship alongside the couple relationship in importance and challenge the traditional meaning of the “family”. Whilst this paper celebrates systemic psychotherapy in its ability to deconstruct social myths and move closer to lived experience, it is noted that single women and their close friendships have yet remained largely overlooked. It is hoped that by opting for including single women in systemic theory and practice and giving rightful significance to their close friendships as attachment relationships that the shift away from oppressive gendered constructions might be encouraged and maintained.
Harriet O’Brien. Brotherly love: What are the stories and descriptions men aged 30-60 tell about their relationship with their brother or sister who is closest in age to them?
This paper uses narrative thematic analysis to analyse interviews with four adult male volunteers from the local community. Subjects were invited to reflect on their relationship over time with their sibling closest in age. The analysis uses the frame of time to highlight development and changes in the relationship. Findings support those in the literature that stress the significance of adult sibling relationships. The use of time as a frame is helpful in providing a coherent narrative, not broken by the artificial divide of childhood and adulthood. Findings regarding the resilience of sibling bonds and the influence of the sibling relationship on later parenting may be of particular use in the systemic field.
David Cuthbert. Part way down the road – an evaluation of the impact on staff, including staff’s perception of the impact on service users, of the introduction of systemic / relational concepts and practices in a voluntary sector residential substance misuse treatment service.
The aim of this research was to evaluate the impact of introducing systemic concepts and ideas to a residential substance misuse treatment center, with the purpose of assessing the validity of continuing to develop a relational approach to the treatment of substance misuse.
The aim was addressed using a qualitative research approach by employing the focus group method to obtain data. Two focus groups were conducted with the relevant teams within Carlisle House. The discussions in the focus groups were guided by six general and open questions to stimulate conversations about their experience of the research topic, and allow for new information to emerge.
I used a thematic analysis approach to analyse the data, and the technique of triangulation (Bryman, 2008) to cross check data from both focus groups and the literature review, to ensure greater reliability and validity.
The introduction of these concepts were generally welcomed as being both empowering for service users and staff. They were viewed as presenting a significant challenge to the Centre’s beliefs about substance misuse and their accepted treatment methods, as well as a personal challenge to staff.
The evidence to support the continued development of a relational approach for the treatment of substance misuse emerged and recommendations made for the continuation of this journey.
Mona-Karina Theodosius. The Exeter Model for Couples’ Therapy and Depression. Considering the interplay between empathic and behavioural manoeuvres within the Exeter Model for couple therapy with depression: observing and describing frequency and sequencing.
NICE guidance recommends Behavioural Couples’ Therapy for the treatment of depression, because of its Randomised Control Trial-led evidence base. Desiring to build the evidence base for systemic therapy in the treatment of couples and depression, the Exeter Model proposes a bi-modal systemic-behavioural and systemic-empathic approach. Five couples that had undergone treatment in the Exeter Model Clinic at Exeter University’s Mood Disorder Centre, were coded according to a baseline measure of relational estrangement. The frequency of therapist use of behavioural and empathic manoeuvres, and their sequencing was tracked across therapy. No singular pattern emerged, not least due to the small sample size of the participant group and its variance. Trends in the findings suggest links between initial levels of couple estrangement and the sequencing of specific interventions. This descriptive investigation serves to better inform use of the Exeter Model, and is a preliminary step toward future evaluative research.