Applying the Domains Framework to Family Processes

Jonathan Hill

Derby

November 2012

A Brief History

Thinking that families might be characterised by a dominant attachment style

The Adult Attachment Interview administered to the family in the present, e.g. What happens in the family when someone is sad?

Observation of families made clear that attachment interactions are a minority

There is an ecology of topics and processes

A Brief History

In addition to attachment – safety, discipline, and companionship/conversation/story telling/collaborative exploratory

The family navigates across these areas, moment by moment

Treatment modalities tend to emphasise one eg. Cognitive therapy collaborative-reflective, parent training discipline-expectation

Hill, Fonagy, Safier, Sargent, ‘The Ecology of Attachment in the Family’, 2003, Family Process

A Brief History

Further elaboration of features of the domains for rating from the Family Domains Interview, and now from family therapy sessions

Elaboration supports development of a platform for clinical approaches

Hill, Wren, Alderton, Burck, Kennedy, Senior, Aslam, Broyden Epub 2011 ‘The application of a domains-based analysis to family processes: implications for assessment and therapy.’ Journal of Family Therapy

Aims

To provide a systematic, patterned way of noticing and enquiring into family interactions

To provide a platform from which a range of established therapeutic approaches might be launched

To consider whether the framework suggests additional approaches – e.g. On-line, educational programmes

A Platform

Social domains are classes of interpersonal processes each with distinct procedural rules underpinning mutual understanding, emotion regulation and action.

We describe the features of three affect-action domains of family life – safety, attachment and discipline/expectation – and contrast them with

exploratory processes in terms of the emotions expressed, the role of certainty versus uncertainty, and the degree of hierarchy in an interaction.

A Platform

Everything that people say and do in family life carries information about the type of interaction they are engaged in – that is, the domain.

Sometimes what they say or how they behave does not make the domain clear, or participants in the social interactions are not in he same domain (there is a domain mismatch).

This may result in misunderstandings, irresolvable arguments or distress.

Where does the Framework Come From? I – Philosophy of Mind

All biological systems, including social systems are rule bound

Events have intentionality, ‘aboutness’, e.g. Blood pressure, light intensity, distance and direction of nectar

In bees the rules of dance are species specific – genetic

In humans there are multiple rules for intentionality – domains provide constraints to underpin effective action (Bolton and Hill 2004)

Where does the Framework Come From? II – Developmental Processes

From birth parents ensure safety of the infant From around 6 weeks parent and infant engage in face

to face reciprocal, pleasurable interactions From around 6 months distress and anger start to be

distinguishable 12 months the attachment sequence, distress and

comfort is well established 18 months oppositional behaviours requiring firm

handling are seen, rules and expectations are set

Early Developmental Tasks of Parents

To identify accurately the signals of the infant – anger, fear, anxiety, sadness, discomfort, curiosity, joy

To identify accurately the reasons for the emotional state of the infant

To act appropriately to resolve the emotional state and attend to the reasons for it, or to engage the curiosity or share the joy

Bugental, D. B. (2000). Acquisition of the algorithms of social life: A domain-based approach. Psychological Bulletin, 126, 187–219

Where does the Framework Come From? III – Family Therapy

Bateson - All of what parents and children say, and show, metacommunicate the domain

Structural family therapy – emphasis on hierarchy and action, in the family AND the therapist with family

Systems therapies – emphasis on exploration, curiosity, and the collaborative nature of family processes AND the therapist with the family

Family Life as ‘Navigation’

Parents responding to different negative emotions with different implications, requiring action

Parents responding to companionable, exploratory bids, requiring attention and interest

Similar processes between parents Constant flux with each family member monitoring the

kind of interaction that is occurring Each process has its place and value Parents and children navigate across domains in family

life

Who Does What in the Domains?

Exploratory Safety Attachment Discipline

Is there something to solve? Completion?

Whose job is it?

Who is in charge?

Who is leading?

Who is the focus?

Are you responsive to your child’s emotions?

How do you look?

How you sound?

What does your child gain?

Who Does What in the Domains?Exploratory Safety Attachmnt Discipline

Is there something to solve? Completion?

NO YES YES YES

Whose job is it? SHARED PARENT PARENT PARENT

Who is in charge? ALL PARENT PARENT PARENT

Who is leading? CHILD PARENT CHILD PARENT

Who is the focus? BOTH CHILD CHILD CHILD

Responsive to child’s emotions?

YES NO YES NO

How do you look? INTERESTED DEFINITE TENDER DETERMINED

How do you sound? UNCERTAIN DEFINITE WARM CROSS

What does child gain? CONFIDENCECREATIVITY

SAFETYCERTAINTY

SECURITYCOMFORT

SELF DISCIPLINE

http://www.youtube.com/watch?v=sMy0757byl4&feature=player_detailpage

How is it at school darling?Could be exploratory. The question is does it convey clear interest in

school? What does the shaking of the head imply – perhaps draws the focus on to the mother?

I am not at school any more.Aren’t you?No I am at the sixth form college. Is that in a different place darling?This has many features of an exploratory exchange, although the

humour comes from how out of touch the mother is with her daughter’s education, likely reflecting a lack of regular exploratory or discipline/expectation conversations. The humour also comes from the mother making herself the focus of attention.

What is this project you are doing? (Shaking the model of DNA as she asks)

Mother don’t get involvedWritten down this could sound like an interested exploratory question,

but the tone does not convey genuine interest. Saffron responds as if something other than genuine interest is about to be shown!

I am involved, I am your mother, I want to know, I am interestedThe phrase ‘I am interested’ could belong in exploratory but does not have the

tentativeness and uncertainty of exploratory. It is put quite forcefully, as if in safety or discipline. The phrase ‘I am your mother’ is ambiguous in that it could signal a hierarchical domain, such as discipline/expectation as in I need to know what is happening in your education, but in this relationship could bring the focus on the mother as in ‘you need to make me feel as if I am your mother’.

You are not interested you are boredSaffron treats it as an exploratory bid from mother, which she does not believe. There

could be an implied attachment need i.e. I might have hoped you would show interest as my mother and it hurts me that you do not.

I want to know!So the facial expression, the tone, the insistence in spite of the daughters wishes all

belong with discipline/expectation. However there is no accompanying clarification regarding the reason she wants to know, which would make the domain clearer

It’s a DNA project which we present next week as part of our term work – alright?Saffron responds on the basis that it is discipline-expectation, angrily complying,

typical of the way the domain works in adolescence. Open day, open day, at your sixth form college, is that what you are saying darling?

Next week, what day darling?Now the domain is put into doubt radically. There is no longer the forceful, possible

discipline/expectation, nor the interested tentativeness of exploration. You are not comingSo now Saffron talks to her mother in reverse discipline/expectation, clear and

unambiguous.

How do the Domains Become Unclear?

Exploratory Safety Attachmnt Discipline

Is there something to solve? Completion?

NO YES YES YES

Whose job is it? SHARED PARENT PARENT PARENT

Who is in charge? ALL PARENT PARENT PARENT

Who is leading? CHILD PARENT CHILD PARENT

Who is the focus? BOTH CHILD CHILD CHILD

Responsive to child’s wishes?

NO YES NO YES

How do you look? INTERESTED DEFINITE TENDER DETERMINED

How do you sound? UNCERTAIN DEFINITE WARM CROSS

What does child gain? CONFIDENCECREATIVITY

SAFETYCERTAINTY

SECURITYCOMFORT

SELF DISCIPLINE

Topics for Discussion

Affect-action domains entail rapid inaccurate processing – the slower more accurate exploration buys time and understanding

Domains in equilibrium in the family – one domain may dominate (e.g. Discipline/expectation) at the expense of others

Domains processes identify therapeutic task, which may be behavioural, cognitive, narrative, psychodynamic...brief....longer term

The domains perspective can be applied to the therapist-family relationship

Questions Posed in Response to JFT Paper (I can supply)

Epistemology – do domains exist? Are domains mutually exclusive? How does domain functioning change with age

– particularly in adolescence? To what extent are domains universal – or

open to cultural variations?Commentators; Paula Boston, Rudi Dallos, Carmel Flaskas, Brit

Krause

Applications in Clinical Practice

Creating the platform Observed interactions among family members OR descriptions of events and who said and

did what Any setting, any time How common in current family therapy

practice?

Applications in Clinical Practice

Psychoeducational groups – provide parents with the tools, prior to description of the problem – RCT about to start in Manchester

Tell the family about the domains framework as a basis for discussion of family processes

Use the domains framework with the family to inform questioning, to open up discussion of alternative ways of seeing interactions

Examples from the Tapestry

Interface with behavioural activation for adolescent depression, clarify the place of attachment and discipline – with cognitive therapist

Expand ‘atrophied’ attachment where discipline dominates with oppositional child – with parent training clinician

Review the domains challenge of the adolescent who self harms repeatedly – with unit staff or parents

Consider the effect on other domains of the dominance of safety in treatment of childhood cancer – with nursing staff

Thank You