AFT CONFERENCE 2013 Think Family Systemic and Psychodynamic Safeguarding Practices Gary Robinson Karen Johnson Steve Edgeley.

AFT CONFERENCE 2013

Think Family Systemic and Psychodynamic Safeguarding Practices

Gary RobinsonKaren JohnsonSteve Edgeley

Aims 1

• Share Thinking and Practice • Introduce Think Family Pilot project• Include the voices of families we work with• Learn from each other• Stimulate ideas and creativity• Embrace/Observe Confidentiality and Respect

It’s a very remarkable thing that the unconscious of one person can act upon the other without passing through the conscious

Freud 1916

Aims 2

Share ideas about: Exploring, Managing and Utilising Therapists Differences:•Conscious and Unconscious Processes•Splitting, Mirroring, Projection•Parallel Processes•Relational Reflexivity•Gender•Style/Theory: Now or Tomorrow

Plans

1.30 Introductions and Sculpt1.45 Context: Drivers1.55 Strategy2.10 Theory & Practice2.20 J’s Family & Team: DVD’s2.45 Discussion & Feedback3.00 End

Introductions and Sculpt

Co-ordinated Management of Meaning: Safety and Risk

Safeguarding

Systemic Psychodynamic

Context

Think FamilyMunro and HackneySerious Case ReviewsPolitical and Economic Drivers

Strategic Direction• Organisational commitment• Approved Therapies• Partnership in education• Meeting the needs of complex

families – multi agency intervention

• Think family and safeguarding children and adults

• Supervision in practice

Tuesday Family Therapy Team

ClinicalQuality Committee Safeguarding

Board and Groups

Think Family Training

Couples Project

Systemic Supervision Training

DAFT

Systemic Training Programme

Model of Containment

MirroringPredictabilityReliability

Boundary and SpaceDonald Winnicott:1964

Supervision

Boundary and SpaceThe Maturational Process and the Facilitating environment

Family Therapy Team

Individual or Family

Multi agency Consultation and Supervision

Safe

Safe Certainty

Certainty

Unsafe Certainty

Safe Uncertainty

Uncertainty

Unsafe Uncertainty

Unsafe

(Mason 1993)

Towards Positions of Safe Certainty

The team aims to offer Safe Uncertainty in relation to practice, supervision, consultation and training. We aim to safely challenge unhelpful defensive practices and premature certainty in promoting manoeuvrability and collaboration

2012

MJ2002

14 11 11

J A H

James’s Genogram

Family Referral

• Safeguarding Concerns• ADHD and ASD Assessment• Physical Health Issues• Bereavement• Child & Adult Mental Health Issues

Events Psychodynamic Systemic Safeguarding

1: Mum and son together, mum unwell, physically sick, including as J speaks

DefenceProjective Identification

Milan: Neutrality, Curiosity, Hypothesising.Reflecting Teams

Child protection in place, therapy meeting with child in attendance.

2: Arguments between mum and J and J and siblings

Conscious and Unconscious processes

Structural ideas regarding hierarchy and parentification

Child in Need Section 47

3: Meetings with Consultant Psychiatrist & Care Coordinator

Transference and Counter-transference

Post Milan: Social Constructionism & Domain of Aesthetics and Production

Working Together: Mending workforce/network splits

4: Finding voices: Team. Family & Professionals

Parallel Process and Synchronicity

Self and relational Reflexivity

Supervision & Safeguarding Policy & Procedures

5: J finds his voice Processing and Differentiation

Structural and Strategic. Child Focused

Every Child Matters

6: Networking, Formulation & Supervision

Formulation and Interpretation, Reparation

Safe Uncertainty and CMM: Formulation

Risk Assessment, Diagnosis, Perpetrator, Victim

Event Psychodynamic Systemic Safeguarding

1: Mum and son together, mum physically sick, including as J speaks

Defence, projective identification

Psychodynamic hypothesis : does J represent something unbearable (unconscious) for mum, leading to unconscious inter-subjective communication. The expelling (ridding) of unwanted and/or disavowed (denied) content of one mind into another, too painful to bring to mind.

Milan: Neutrality, Curiosity, Hypothesising.Reflecting Teams

Exploration of the nature of the physical illness and how this may be affected by emotions, anxiety and distress. How does J experiences this. Collaborative sharing of ideas and possibilities.

Child protection in place, therapy meeting with child in attendance

Are J’s emotional and physical need being met needs being met? Is it helpful to meet together and or separately with mum?

Event Psychodynamic Systemic Safeguarding

2: Argument between mum and son

Conscious and Unconscious processes

Mum and son differ in the perception of events and communication. Countertransference and transference responses to interaction. Therapists hold different thoughts in mind and hypothesises in live feedback. Reflection, some thoughts occur following sleep or during following days. Unconscious connections between child and therapist.

Structural ideas regarding hierarchy and parentification

Recognising positionAs eldest sibling whilst considering life cycle and child development issues. Inviting mum to take different positions.

Child in Need Section 47

Enabling the child’s voice to heard and validated. Containment or escalation. Safeguarding registration issues and parenting assessment.

Event Psychodynamic Systemic Safeguarding

3: Meetings with Consultant Psychiatrist & Care Coordinator

Transference and Counter-transference

Holding, Containment and Reparation.

Mum is able to express strong emotions of hurt and then re-engages with the psychiatrist.

Post Milan: Social Constructionism & Domain of Aesthetics and Production

Exploring and addressing Safeguarding concerns, taking a both-and positions. Working with and alongside. Embracing the notion of Problem dissolving systems.

Working Together: Mending workforce/network splits

Network meeting, consultation, operational and clinical supervision. Live co-working.

Psychodynamic Systemic

Medical

Safeguarding

Event Psychodynamic Systemic Safeguarding

4: Finding voices: Team. Family & Professionals

Parallel Process and Synchronicity

Team worked with transference and countertransference on behalf of family and simultaneously within the team itself.

Opening out layers of feelings. Equality of therapist voices.

Self and relational Reflexivity

Sharing of genograms, personal and professional stories and emotional triggers.

Exploring differences and similarities.

Use of SCORE

Supervision - seeing the whole picture . Munro: Systemic perspectives

Analysis and interpretation of splits, informed by Safeguarding Policy & Procedures.Not working in Silo’s (in isolation) or individually with complexity and risk.

Event Psychodynamic Systemic Safeguarding

5: J puts his feelings into words

Processing and Differentiation

Use of countertransference both empathic and hostile in service of both mum and son.

Therapist anxiety/fear of damage to co-therapy alliance.

Structural and Strategic. Child Focused

Doubling, empty chairs and externalising. Moving around the room. Interrupting and modelling. Intensification and manoeuvrability.

Importance of the post and post-post space.

Every Child Matters

Ensuring the child’s voice is heard and represented.

Connecting up the individual work.

Event Psychodynamic Systemic Safeguarding

6: Networking, Formulation & Supervision. Report writing and letters

Formulation and Interpretation

Shared formulation, using concepts from object relations and analytic theories. Use of information from family and from team as felt/experienced, in order to connect with experiences of others in the network.

Safe Uncertainty and CMM: Formulation

Emphasis upon engagement and the “so what” question. Addressing risk and safety collaboratively and as a shared experience.

Risk Assessment and Diagnosis. Perpetrator and Victim

Movement towards partnership working and development of new narratives. Focus upon strengths and resources rather than deficits. Exploration of wider contexts e.g. benefit system and AMH resources.

DVD 1: Meeting Family Sept 2013

Whilst watching the excerpt consider:•What are you noticing about, systemic, psychodynamic and safeguarding issues?•What might you be noticing about the key issues?•What might you consider doing in the session or in the space between, or next time?

DVD 2: Post session Sept 2013

Talk with you partner:•How are your ideas being affirmed and challenged?•What new ideas are emerging?•What feedback might you be able to offer the family and/or team?

Super vision

Seeing the whole picture

Rejected psychiatristNHS

Rejected social workerLocal Authority

TherapistNHS

Rejected CAMHS practitioner

Working alliance NHS psychiatrist

CAMHS Practitioner

SW – Working alliance Good therapist(s)

Feedback for Mum J: Experiences

Positives NegativesReliability Inconsistency Trust MistrustRegard ShamingListening ConfrontingAdvising InstructingNeutrality BlamingInterest/ Curiosity Judgement

Exercise in Pairs

Discuss a current, recent or past safeguarding or risk issue where you experienced tensions, stress or polarisation between colleagues or professionals. Explore the primacy of thinking and practice in relation to systemic, psychodynamic and safeguarding ideas.

Feedback and DiscussionRevisit Sculpt

Co-ordinated Management of Meaning: Safety and Risk

Safeguarding

Systemic Psychodynamic

So What & Project Blue Print

• So what……What has this workshop offered you which you may use?

• What elements need to be included and described within a model blue print or manual? Key questions for teams?

References PsychodynamicGiacomo Rizzolatti and Maadelena Fabbri Destro (2008) Mirror Neurons. Scolarpedia, 3(1): 2055Donald Winnicott, (1965) The Child the Family and the Outside WorldBrodie, F., & Wright, J. (2002) Minding the gap not bridging the gap: Family therapy from a psychoanalytic perspective. Journal of Family Therapy, 24, pp. 205-221 Donald Winnicott, (1965) The Maturaltional Process and the Facilitating EnvironmentDonald Winnicott, (1965) Home is where we start fromSue Gerhardt, (2004) Why Love Matters, How Affection Shapes a Babies BrainEd Tronick, (2007) Neurobehavioural and Social Emotional Development of Infants and ChildrenDonald Kalsched (1996) The Inner World of Trauma

References Safeguarding

Every Child Matters (2003) HM GovernmentWorking Together (2006) HM GovernmentMunro Review (2011) Department for EducationBeyond Blame (1993) Peter Reder and Syvia Duncan

References SystemicAnderson, H. Goolishian (1992). The Client as the Expert: a Not knowing Approach to Family Therapy. In McNamee,s. and Gergen,K. (eds) Therepy as Social Construction. Sage. London.Berg, Insoo Kim. (1999) Family Preservation: A Brief Therapy Workbook. BT Press, London.Cade, B. (2009) Some further bits and pieces about double bind. Context (2009) 102:15-16.Cecchin, G. (1987).Hypothesizing, circularity and neutrality revisited: an invitation to curiosity. Family Process, Vol 26, p405 413.‑Cronen, V. E. and Pearce, W. B. (1985) Toward an explanation of how the Milan method works: an invitation to a systemic epistemology and the evolution of family systems. In: Campbell, D. and Draper, R. (eds), Applications of Systemic Family Therapy: The Milan Approach. London: Grune and Stratton.Cullin, J. (2009) Double bind: much more than just a step toward a theory of schizophrenia. Context (2009) 102:8-13.Goldner, V. Penn, P. Sheinberg, M. Walker, G. (1990) Love and Violence: Gender Paradoxes in Volatile Attachments. Family Process: 29, p. 343-364. Hoffman Lynn (1990)Constructing realities: An Art of lenses. Family Process 29:pp1-12,

References SystemicJones, E. (1993) Family Systems Therapy: Developments in the Milan Systemic Therapies, Chapter 1 Family Systems Therapy. Chichester, Wiley.Kelly, A. McKillop, K. (1996). Consequences of Revealing Personal Secrets. Psychological Bulletin. 120. 3: 450-465.Lang, W. Little, M. Cronen, V. (1990) The Systemic Professional: Domains of Action and the Question of Neutrality. Human Systems. 1.1 pp 34-49. Mason, B. (1993). Towards Positions of Safe Uncertainty. Human Systems. 4: 189-200. Mason, B. (2005). Relational risk taking and the therapeutic relationship. In C.Flaskas, B.Mason, and A.Perlesz (eds) The Space Between: Experience, Context and Process. Reimers,S. (2006). Family Therapy by default: developing useful fall-back positions for therapists. Journal of family Therapy. 28: 229-245.Roberts, J. (2005). Transparency and Self-Disclosure in Family Therapy: Dangers and Possibilities. Family Process. 44.1: 45-63. Robinson, G. Whitney, L. (1999). Working Systemically Following Abuse: Exploring Safe Uncertainty. Child Abuse Review Vol 8. 264-274.Selvini, M. Boscolo, L. Cecchin, G. Prata, G. (1980). Hypothesizing, circularity, neutrality: three guidelines for the conductor of the session. Family Process, Vol 19, p3-12.Stratton, P., Bland, J., Janes, E. and Lask, J. (2010), Developing an indicator of family function and a practicable outcome measure for systemic family and couple therapy: the SCORE. Journal of Family Therapy, 32: 232–258.

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