DAFT Workshop: 12.30-2.00pm 7th June 2013Couples Work for DepressionFacilitator: Dr Gary Robinson
There is a lot more going on!
Introduction to the Exeter Depression ModelLaunching of the DHCFT Couples ProjectTransferable Skills for Couples WorkHave fun and learn from each other
Plans12.35 Welcome & Introductions & Aims12.40 Exeter Depression Model12.50 DHCFT Couples Project13.00 Key Ideas13.15 Case example and Skills Practice13.30 More ideas and Practice 13.45 Discussion and Feedback
Exercise: In Pairs 5 minutes Introductions to each otherHopes about the workshop What expertise might you like to share about couples
Why?Evidence based. Research and AuditBest Practice: Think FamilyService user feedbackNICE Guidelines: NHS GuidanceSocial Care Guidance (Munro & Hackney)Serious Case Reviews
The Exeter Model Couples Work with Depression
Systemic EmpathicReframingGenogramsInterviewing internalised otherCircular questioningSculptsEmpathic bridging manoeuvresInvestigating family scriptsInvestigating attachments
Janet Reibstein & Hannah SherberskySystemic BehaviouralcircularitiesEnactmentsRole playCommunication trainingProblem solvingHomework tasksBehavioural exchangeCommunication skills training
DHCFT Couples Project
Substance Misuse Couples Project led by Doro CAMHS Couples Project led by VeronicaInpatient Couples Project led by MichaelSafeguarding Couples Project led by Karen
The only person you can change is yourself. However the changes you make will influence others and you cannot know what that influence or effect will be. All of which is influenced by context.
Informationally closed systems: Maturanna
Hypothesising & Curiosity Possibilities, Ideas & Informed Guesses. Tentative explorations, allowing for the consideration of new meanings & possibilities
Anti-Discriminatory PracticeSexual OrientationOccupationClassInterestsAbilities John BurnhamLiteracyGenderRace. ReligionAge. Attributes. AppearanceClass. ColourEthnicity. Economic Status. EducationSexuality. Size: Spirituality
Circularity, Meaning and Action
Rose acts Dave acts
Context, History, Gender and Culture
Dave thinks/feelsRose acts Dave actsRose thinks/feelsGender and culturePast experiencesother relationshipsGender and CulturePast experiencesother relationships
Tracking: Talk with the couple about their interactions, for example by:Reflecting back observations about recurring patterns of relating between the partnersAsk about the possible functions of symptomatic behaviours for eachBe curious about the roles played by each partner and others in creating and maintaining problem behaviours or symptoms, and explore possible reasons for theseDiscuss interactive patterns that may maintain symptoms or negative interactions.
Skills PracticeIn groups of four pick a Rose and Dave, practitioner and observer/co-worker.
Draw circularities in relation to a recent disagreement. Track behaviours, feelings and thoughts. Do not try to problem solve or give opinions.
Tomm, Karl. (1987). Interventive Interviewing Part I: Strategising as a Fourth Guideline for the Therapist. Family Process 26. (page 12)
Interventive Interviewing Karl TommHe highlighted the fact that every question is a mini-intervention, and he refers to circular questioning guided by specific strategies as interventive interviewing. Strategising is the process that guides such interviewing. When strategising, therapists, according to Tomm, clarify their intentions about why they are asking particular questions.
Carr, Alan. (2006). Family Therapy: concepts, process and practice. 2nd Ed. John Wiley and Sons Ltd, Chichester. pp128
Lineal tracking questions:
What happened?Who was involved?What did they do?How did you do?When was that?Tomm, Karl. (1988). Interventive Interviewing Part III: Intending to ask Lineal, Circular, Strategic, or Reflexive Questions? Family Process 27:1-15
Circular tracking questions:
When you did that how did your friend react?How did people react when the fire started?Who else may have been affected by the death?
Tomm, Karl. (1988). Interventive Interviewing Part III: Intending to ask Lineal, Circular, Strategic, or Reflexive Questions? Family Process 27:1-15
The questions are reflexive in that they are formulated to trigger family members to reflect upon the implications of their current perceptions and actions and consider new options (Tomm, 1987.)
Circular QuestioningUsing different types of questions to encourage new perspectives.
Types of circular questions
Scaling questionsFuture orientated questionsRanking questionsNew alternative questionsTriadic questions
Outsider observer questionsSelf-reflective on self questionsSame question asked of allContrast questions
Circular QuestionsConsider the types of questions and in pairs discuss:
Which types of questions do you most use? Which questions interest or surprise you?
GenogramsFamily genograms identify cross-generational family meanings, norms, and/or expectations, especially with regard to relationship roles and scriptsGenograms offer tangible and graphic representations of complex family patterns (McGoldrick, 1999)The genogram is both an end product and a therapeutic process, moving focus away from the identified patient*
In groups of four, pick a Rose and Dave, a practitioner and an observer/co-worker. Use circular questions and explore the present, past and future.
Key Ideas & Concepts From TodayEngagement: FeedbackCuriosity: NeutralityContexts: Systems: SafeguardingTracking CircularitiesI StatementsRelational EmpathyGenogramsPresent-Past-FutureCircular Questions2nd Order Change = Behaviour + Meaning
FeedbackWhat have you made of today. How have you found the contents and the processesnegatives and positives?Discuss what you are going to take away from today in pairs.Chose one thing each you would like to feedback in the large group
If you would like to join us at DAFT please come along. If you are interested in having further systemic training or systemic clinical supervision contact: Gary Robinson, Principal Family Therapist on 01332 623700 ext 3261 email email@example.comSystemic Training and Supervision
***We need to focus upon engagement as a primary goal in relation to any intervention we encounter. The idea that everyone can change within a positive relationship which involves regard.
Care Quality CommissionCommissioning FrameworksHealth and Social Care Bill 2012Recommendations from Reviews (20032012) Early Intervention National Service Framework (June 2012)Children and Young People PlanMunro ReportNICE GuidelinesFamilies ask us to (Local Research and Audit)
*Care Quality CommissionCommissioning FrameworksHealth and Social Care Bill 2012Recommendations from Reviews (20032012) Early Intervention National Service Framework (June 2012)Children and Young People PlanMunro ReportNICE GuidelinesFamilies ask us to (Local Research and Audit)
*Adapted from John Burnham**Rose tells Dave she is unhappy, he says he does not want to talk about it*Rose tells Dave she is unhappy, he says he does not want to talk about it, Jane thinks Dave is uninterested or does not care and therefore she pursues him to talk. Dave thinks this is unreasonable and withdraws.Gary would it be helpful here to talk about what Rose and Dave bring from their own personal history that is being enacted/repeated in their current relationship
*Jane feels blamed and unloved and demands attention/discussion Dave feels pressurised and becomes aggressive.Chose your partners from the 1st exercise this morning*Gary - This requires quite sophisticated thinking and contextualising of this particular theory I think we have slightly different passions mine about the generic use of psychodynamic and systemic concepts I think we need to be clear about the difference in introductory theoretical concepts within the context of front line practice and DSCB training and theoretical concepts useful for beginning therapist training****What about feelings?*Chose your partners from the 1st exercise this morning. . Observers to us the note grid to identify questions.*Develop set of guiding questions relating to each of the key concepts. Gary and Karen to Role play consulting in relation to a dilemma using the questions and ask the participants spot as many of the concepts and ideas in action as they can and mark them on their sheet.*Chose your partners from the 1st exercise this morning*There is a lot going on!
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