‘Strangers in a Familiar Place’: The Evolution of a Family Therapy Clinic Within an In‐Patient Adolescent Unit

Abstract

This paper describes the evolution of a family therapy clinic within an inpatient adolescent unit. The dilemmas of such an enterprise are described in terms of the roles of its participants in relation to the ‘host’ unit. The authors propose that in order to maintain an appropriate boundary around the clinic, awareness of the ‘membership roles’ of the participants is essential. This concept, drawn from ethnographic research, refers to the differing perspectives that members of the multi‐disciplinary team bring into the family therapy clinic from their roles within the unit. The internal dynamics of the team are also described by reference to team members’ family of origin scripts which reflect their membership roles. The authors believe that adding a membership role perspective to family therapy clinics which operate within institutions may enable such teams to contain difference and thus achieve creativity.

‘Treating this place like home’: An exploration of the notions of home within an adolescent inpatient unit with subsequent implications for staff training

“…If this dynamic continues to be outside awareness, polarisation can continue and splits in the team emerge. The staff team discourse around care seemed to exemplify the dilemma and paradox associated with ‘covert coalitions’ and perceived parental failure that existed between parent, young person and the unit staff team (Rivett et al., 1997), as illustrated by staff debates about how homely the unit should be. There was anxiety and ambivalence exhibited within the focus groups about whether staff should care for young people and how the young people felt about their parents, oscillating between anger and protection.…”

“…The family and young person inevitably are in crisis at the point of admission, and paradoxically, the admission can appear to reinforce the idea that the family has failed in some way and the responsibility for the ‘problem’ is handed over to professionals and taken away from them (Rivett et al., 1997). For many parents, there is something utterly devastating about their child being admitted to an inpatient unit, which is often accompanied by a sense of failure as a parent (Frances, 2019).…”

Mindful of the Intersession Break in Family Therapy: The Time to Think Experiment

“…Taking this mid‐session break, even when working alone has been referred to as ‘team techniques without a team’ (Wetchler, Piercy, & Sprenkle, ) and has been recommended to therapists who do not work in a team. Some have recommended these methods to facilitate therapists taking an observer role (Rivett, Tomsett, Holmes, & Lumsdon, ).…”

Working systemically within an adolescent inpatient context

“…Delivering effective interventions, therefore, involves the application of parallel sets of knowledge and skills within a highly complex system, and reducing interventions to a collection of disaggregated tasks should be avoided. Clinicians and practitioners need to operate using their clinical judgement in combination with their professional skills, interweaving technique with a consistent regard for the relationship between themselves, the young person, their family and the wider team.Training staff to recognise the importance of family involvement also requires an attempt at least to address the 'paradox' that staff and families can find themselves in (Rivett et al, 1997): admission to an inpatient unit can appear to reinforce the idea that the family has failed and the responsibility for the 'problem' is handed over to professionals. Given that most young people are discharged back to their families who take on the role of care team on discharge, family…”

“…Training staff to recognise the importance of family involvement also requires an attempt at least to address the ‘paradox’ that staff and families can find themselves in (Rivett et al, 1997): admission to an inpatient unit can appear to reinforce the idea that the family has failed and the responsibility for the ‘problem’ is handed over to professionals. Given that most young people are discharged back to their families who take on the role of care team on discharge, family engagement is even more significant.…”