As Ferndearle uses a Systemic approach throughout much of our thinking and practice, we have included a more detailed understanding of what it can mean for our client group.
What is systemic psychotherapy?
Systemic psychotherapy focuses on the relationships and interactions between people, as well as wider systems, whilst being mindful of the influences of different contexts and cultures. It seeks to improve communication and resolve conflict.
Systemic psychotherapy aims to identify unhelpful interactional patterns, sequences of behaviour and underlying narratives that determine how we operate in a family and social group. New and different ways of relating are explored. This can be short term work and often does not require long term interventions.
In addition to families and social groups, the systemic approach is increasingly being used to consult and supervise professionals in organisations.
Who is it for?
Below are examples of some areas in which Systemic psychotherapy is recommended:
Blended families with adjustment difficulties such as Foster Families, LAC children.
An individual needing to explore their interactional patterns without the complexities of others present.
Families with problems across generational boundaries.
Families where the identified patient's problems seem inextricably tied to problems with other family members.
Families where there is one or more member exhibiting an eating disorder.
Treatment of a family member with schizophrenia or multiple personality disorder (MPD). Therapy helps other family members understand their relative's.
Families that deviate from social norms that may be, for instance, troubled by outsiders' judgmental attitudes.
Families with members from a mixture of racial, cultural, or religious backgrounds.
Families who are scapegoating a member or undermining the treatment of a member in individual therapy.
In good circumstances, clients gain:
greater insight and reflexivity,
increased differentiation of individual family or group members,
improved communication with whom they spend more time,
loosening of previously reactive/destructive behaviour patterns,
resolution of the problem that led the individual, family or group to seek treatment.
Therapy can involve as few as one client because the focus of the ideology and, therefore, communication can still result in talking and reflecting about many others in the client’s system. For example, the attendance of carers may be more helpful in beginning the process of changing communication with an emotionally struggling teenager than the actual attendance of the person with the presenting problem. This is why Child Focused Groups are so key to our work.
Systemic Psychotherapy can lead to helping clients develop a greater level of understanding of each other and together with the therapist, create ways to maintain more positive interactions and understanding of each other after the completion of therapy.
How does this look in practice for us?
Within Ferndearle we use this approach across many structured features of our group living/working experience and in therapy. Some important structures (which are held as sacrosanct within our community) include:
Child Focus Groups
Child focus sessions take place once a month, for three hours, in our residential homes. The sessions bring together the whole care staff team and, where possible, a representative from school staff with the sessions chaired by Ferndearle’s Coordinator of Therapeutic Services, who is a Systemic Psychotherapist. Child focus sessions also take place in our school on a termly basis. A Director and the Operational Director also attend to ensure continuity of therapeutic understanding across the service.
The child focus sessions draw on systemic, attachment and psychodynamic thinking. We talk about the children in all contexts of their life, in conjunction with their current presentation, previous experiences and potential for future. We analyse how each child is benefitting from various adults in different ways; this may be in who they seek out to ascertain different needs or it may be how and who they communicate different aspects of their internal world to, if not verbally then either symbolically, or through acting out behaviours. The reflective nature of these monthly discussions enables us to be better informed as to the complexities of the emotional world of the child and allows us to implement effective therapeutic interventions.
A fundamental purpose for the residential sessions is to check 24-hour therapeutic care plans to see what is working well, whether interventions may need tweaking and whether there are any new developments that require new interventions. The sessions look at the diverse relationships of the child with the individual care staff and examine how these specific relationships may be used from moment to moment in specific circumstances, or during aspects of the child’s routines, to implement therapeutic interventions that affect change.
We always make use of in-depth genograms and date lines (a chronology of all-important events/experiences in the child’s history) to allow us to obtain insight into the intra-psychic and inter-personal world of the child. We frequently notice previous relationship interactions and experiences are being recreated within the interactional patterns of the children with their peers or staff members. This pattern of recreation is very important to understand as where the pattern is dysfunctional or unhealthy, it enables us to give an alternative experience either by the way we interact or by intervening to teach the child new relationship patterns. This might be with peers or with adults.
Systemic Group Therapy
Systemic group work takes place in the residential homes on a monthly basis and involves the whole child group, the care staff on duty and Ferndearle’s Co-ordinator of Therapeutic Services (Systemic Psychotherapist). These groups are primarily used to enhance positive interactions and social skills, understanding of each other, develop empathy and to enrich their individual feelings of self-worth and self-esteem.
There is currently a process in place called, ‘Pass the Hug’, which is increasingly becoming part of the culture of this systemic group. It encapsulates the above remit in a fun and child friendly approach.
The principal is that all participants think of and name positives they noticed in another person. One person begins and after saying their comment they then carry the green cuddly frog across the room to this person as a symbol of a ‘Hug’. Passing ‘The Hug’ is a therapeutically playful group technique to improve relationships and self-esteem because the positive narratives are witnessed and experienced by everyone present, having the effect of developing greater validation and positive meaning.
This group technique is also thought about across the months and reflections are made by staff and young people about positive changes they make. Any young people who struggle at any time to either speak or attend are still provided with positive comments as a continuation of validation that they have positive attributes that others have noticed.
This development of self-esteem is also developing relationships and social skills for our young people when they are in other situations.
Individual Child Therapy
Young people benefit hugely from systemic therapy because the focus is enabling them to think about themselves in relation to others. They have weekly sessions of 45 minutes in which they can communicate verbally and also with the opportunity to play if they desire. Being able to play helps interweave the high levels of intensity that discussions can create, allowing for a pause for example to focus on a chess move or the picking up of 4 cards in Uno. Play can also provide opportunities where the child may not have had positive role modelling of cooking, shopping and feeding.
Systemic therapy is not an interpretive therapy but instead provides reflective space, relationship discussions and a chance to rethink previously held narratives and belief systems. There is a high focus on the words that children use and helping them re-story their previous experiences of trauma which have contributed to their low self-esteem, poor social skills and understanding of social cues. Changing their scripts through constant life-story exploration plays a fundamental part in a child’s emotional development.
Staff Focus Groups
These sessions take place once a month for an hour and include the whole care staff group. They are run by Ferndearle’s Systemic Psychotherapist (Co-ordinator of Therapeutic Services) and provide an opportunity for group reflection in a similar way to family therapy. There is no set agenda and staff are encouraged to consider their interactions and their impact across all sub-systems of the organisation.
Staff Focus Groups
At times, this means that discussions may be about their specific staff group communication style, what needs developing and what is getting in the way of progress. On other occasions, this may link more succinctly with the presentation of a particular child in our care and the impact certain behaviours or needs have on some staff. Issues regarding power, race, culture, gender and ability are explored in relation to staff-staff and staff-child dynamics. This is also reflected with attending to the hierarchical system and how interactions across systems can impact on emotions and attitude for work.
The intention is that this has a therapeutic style approach with a moving through levels of intensity to then be brought back together with a beneficial route for positive progress.
Family therapy is an important systemic feature at Ferndearle and is used for various purposes, both with children who are returning home and also with children whose care plan is not to return home. Indeed, at Ferndearle we believe that providing family therapy in this latter context can still often be of considerable benefit in improving the quality of life for the child. The various forms of family therapy include:
Birth/adoptive family home reunification: in some cases family therapy is used to enable a child to return to their family. In this context attachment styles, relationship patterns and parenting styles are explored with a view to working together to make positive changes. The child’s coping strategies learned at Ferndearle are passed to the family through close discussion with parents, care staff and therapist. Our ethos is that in the majority of cases, parent’s intention is good, even if developing new interventions or parenting styles is difficult. We provide a range of opportunities for learning and changing of less helpful interactions/relationships through: couple therapy, parent and residential carer therapy, parental therapy and parent/child family therapy.
This is usually every two to three weeks in order for the development of shifting narratives to take place and the parents and child to ‘have a try at’ their new way of being together. DURING the therapy, it is also possible for the therapist to understand more fully what is maintaining a difficulty, at which point the approach is to intervene and enable the family to notice. This is a therapeutically safe place for these observations to be made.
Improving Significant Family Relationships as a Healing Process: at Ferndearle, where needed or possible, we believe that it is of vital importance to undertake family therapy with significant family members even when a child is not returning home. We have found that the experience for a young person of being told by a parent that they are for example “sorry” and “It was never your fault,” can serve as an extremely important healing process.
We have witnessed the emotional growth this can create for some young people as they hear the desired words from the person they most to need to hear it from.
Another element of this work is that sometimes it is possible to use family therapy to help the child to develop a clear narrative of their past. This includes talking about the painful as well as the fun or positive memories so that clarity is formed for the child. Formulating shared past stories leads to clearer communication in the present and future together. This can become very significant and often family life-story work books are completed:
Improving Quality of Interactions: again, even when the care plan is not for the child to return to family, Ferndearle believes that working with the family in family therapy can greatly improve the child’s quality of life now and in the future. Therefore, where it is deemed there is an opportunity in that family members are available, we will use family therapy to improve the quality of interactions between child and significant family members. This enables a greater quality of family contact and can change the sometimes disruptive and damaging forms of interaction that are initially present. In other circumstances, where for instance a family member is mentally ill or has a learning difficulty, it can help the child to understand and accept (instead of feeling let down and rejected) the limitations of their parent.
These types of family work are of particular benefit and of vital importance as the child gets older given that many LAC children do return to their family networks as young adults.
Releasing the child emotionally to invest in another family: in some cases family work is undertaken in order for a child to feel emotionally secure enough to accept another family; this is of key importance where children are anxious about the impact on a birth parent of them investing in another primary carer. They may feel guilty about liking another family and their loyalty and sense of belonging to their own family may feel threatened. This work is sometimes undertaken with a parent who with support from the therapist, is able to verbalise their acceptance to his/her child, of them living with another family; that he/she will always still be part of their birth family and can be members of both.
Working with new foster families: an important feature of family work at Ferndearle is that the systemic psychotherapist will undertake work with the new foster family and the child during the transition.
This is flexible with timing but invariably includes sessions before and after the move. This is to provide opportunities to discuss the evolving relationship and to create an experience of feeling emotionally supported and held.
In many instances, this includes practicalities such as discussions about the young person’s coping mechanisms, behavioural strategies and a sharing of responses expected and desired to various situations. It also provides a space to discuss anxieties around transitions and expectations of family living. The learning of any new family script is hard even if it is positive, so we endeavour to ensure that safety around this is created through open discussions.
Working with birth families and foster families together: where it is possible to get the relevant parties to participate in this form of family therapy, it is of considerable benefit to the quality of the child’s investment and happiness in their future placement. We are proud to say that we have managed to develop and evolve in this specific vital area of systemic therapy.
In this form of therapy, Ferndearle’s Systemic Psychotherapist meets with significant members of the birth family and the foster family with the child. This allows the child to experience both families working together; allows the child to feel emotionally free to invest in both families and gives reassurance from the foster family that they will support the child to remain a member of their own family. Hearing the whole group confirm that Contact will continue as is already expected is one such example of helping a child feel held in mind and secure.
Systemic Practice in the Integration of Therapy, Care and Education
At Ferndearle there is a very strong emphasis on a close integration of our Care, Education and Therapy services. To achieve this, weekly meetings are held by the Lead staff members from each of the three sectors. This ensures cohesive communication across all contexts of young people’s lives.
In addition, there are daily handovers between care/education staff; weekly handovers between therapist and care/educational staff and attendance at each other’s child focus groups. We believe that this practice of multi-disciplinary working together to maximise holistic development, is essential for the developmental outcomes for young people who have very complex needs.
Non-Violent Resistance (NVR)
NVR is a systemic therapeutic intervention that utilises as many significant relationships as is possible to affect change. This may include: care, education and therapy staff from Ferndearle or from outside schools where applicable; family members; Social Workers; IROs and even club leaders if deemed appropriate. At Ferndearle, this intervention is used occasionally to help to work on a specific extreme behavioural pattern such as persistent violence or absconding. Put very simply, it is a form of positive ‘group’ pressure where the child’s significant relationships constituting of the collective Ferndearle team and all other significant relationships around the child, raise their presence in a unified form to support the child to make changes.