Family Therapy in the Real World: Dialogical Practice in a Regional Australian Public Mental Health Service

Abstract

This paper describes the development of a family therapy service in a regional Australian public mental health service for children and adolescents, using a service model of therapy in the family home which draws on the 'dialogical' and 'collaborative' principles of Seikkula, Anderson and others. The implementation of this service has incorporated training, peer supervision and reflective practice, which has been congruent with dialogical and collaborative principles. Clinicians from a wide range of backgrounds and levels of experience have had a positive experience of learning to work in a dialogical framework. The 'Mobile Family Therapy Team' consists of around 20 clinicians (nurses, allied health clinicians, consultant psychiatrists and trainee psychiatrists) who work in teams of two or three, and who work with one to four families each. Most therapy is conducted in the family home, and clinicians experience this as rewarding but also challenging. This service model is seen as acceptable and accessible to families. Our experience has been that this form of family therapy has been a useful and effective component of treatment for families with complex, severe and high risk problems who have not benefited from previous interventions. Many of these families would not have accessed traditional clinic-based family therapy. We see supervision and reflective practice as essential to the sustainability of this service.Keywords: child and adolescent, family, systemic, dialogical, collaborative, therapy Key Points1 Delivering therapy in the family home provides a rich context for understanding and engaging with families. 2 Core elements of a dialogically informed family therapy include therapists working within a 'not-knowing' stance, management of strong emotions in the session and utilising practices of public reflecting conversations within the co-therapy team. 3 This is an effective use of resources in a public sector mental health setting as it is useful for families who are 'stuck' with complex and severe problems, which have not responded to simpler interventions. 4 A congruent dialogical approach to supervision and reflective practice is an appropriate and helpful way for clinicians to learn and become confident in the practice of collaborative and dialogically informed family therapy.

The Systemic Assessment Clinic, a Novel Method for Assessing Patients in General Adult Psychiatry: Presentation and Preliminary Service Evaluation

“…The literature shows that early family involvement in mental health treatment has a number of advantages such as clarifying the problem, defining it in the language of the patient and family and mobilising their psychological resources so that they can increase engagement and agency in the process of recovery (Garavan 2013 ; Hartman and De Courcey 2015 ; Seikkula and Alakare 2014 ; Ulland et al 2014 ). For instance one study showed that involvement of the family at first contact with psychiatric services significantly reduced rates of unnatural-cause mortality in patients with schizophrenia compared to those with no family involvement (Reininghaus et al 2015).…”

“…Systemic family therapy is a discipline which has historically been very dynamic in expanding its theoretical ground and adapting its practices to the pressures and constraints of specific health settings (Flaskas 2010 ; Hartman and De Courcey 2015 ). Within acute and secondary mental health services, such as those where this research project was carried out, systemic clinics are not uncommonly staffed by practitioners who, having an interest in family therapy but no formal qualification, work under supervision of consultant family therapists (Hartman and De Courcey 2015 ). Such adapted practice provides for the training of non-family therapists in system and family based approaches, while allowing for the running of additional clinics by a specialist service which is often restricted to a small number of highly qualified family therapists.…”

The community mental health team fidelity scale: A measure of program fidelity of social networks interventions for severe mental illness

“…The development of an integrated OD approach to the provision of mental health services offers the possibility of an alternative to the current 'functional team' model of care in the United Kingdom (Hopfenbeck, 2015;Razzaque and Stockmann, 2016). Preliminary evidence suggests that OD may be more effective than standard care in reducing relapse and the use of antipsychotic medication (Seikkula et al, 2001bHartman and De Courcey, 2015;Bergström et al, 2018). Additionally, OD might help equip mental health staff with additional skills necessary to engage service users and their families across the broad spectrum of care needs (Holmesland et al, 2014).…”

Social constructionism in couple and family therapy: Narrative, solution-focused, and related approaches.

“…OD approaches are being applied to other couple and family problems as well (Guregård & Seikkula, 2014;Hartman & De Courcey, 2015;Lidbom, Bøe, Kristoffersen, Ulland, & Seikkula, 2015;Seikkula, Aaltonen, Kalla, Saarinen, & Tolvanen, 2013;Vail, Grafsgaard, Wiggins, Lester, & Boyer, 2014). As with several of the other approaches, it has a global reach, including in the United States, where its dissemination has been spearheaded by Mary Olson (Olson, 2015;Olson, Laitila, Rober, & Seikkula, 2012).…”