Despite wide agreement in the systemic field that therapists should take a non-blaming stance, historically there has been little exploration of how this stance is achieved in practice. The difficulty in knowing how to put ‘non-blaming’ into practice is further heightened by competing models of intervention with families affected by psychosis. This study contributes to a body of literature that is concerned with how complex issues of morality are achieved dialogically by considering how family therapists manage the tension of intervening to promote change whilst maintaining a multi-partial, non-blaming stance. Two therapies carried out with families affected by psychosis are analysed using the methods of Conversation Analysis (CA) and Membership Categorization Analysis (MCA). In both therapies the sequences examined are drawn from the second session of therapy where explicit blaming events occur. By examining blaming events chronologically through the course of a session the study shows how the rules about the way blame is talked about are achieved interactionally. The analysis demonstrates that systemic theory’s emphasis on the importance of being non-blaming is grounded in a sophisticated understanding of the threat blame poses to co-operation and agreement. In both therapies, the delicacy and ambiguity with which blame is treated serves to enable the conversation to continue without withdrawal. However the cost of ambiguity is a possible misunderstanding of the intent of the speaker. The resulting misalignment, where it continues over several turns and sequences, leads to explicit blame becoming relevant as a solution to a redundant pattern of interaction. The findings indicate that the management of blame requires both the exploration of blame and its interruption when emotions and conflict run high. The former enables understanding and movement towards therapeutic goals while the latter is necessary to promote therapeutic and family alliances. An unintended consequence of the injunction to be non- blaming might be the premature closing down of topics, militating against problem resolution. The study concludes that CA and MCA offer a wealth of knowledge about mundane conversational practices that can be applied fruitfully to systemic therapy process research, teaching and supervision.

This study investigated the application of six techniques from systemic family therapy. A review of the history of family therapy identified the major contributions from general psychiatry, communications theory and cybernetics which had combined to form the therapies known collectively as systemic family therapy. The theory was outlined and examined and the major assumptions which are the basis for specific techniques of therapy within this model were identified. Six of these techniques were examined and demonstrated in therapy. The outcome of each technique was assessed. A family was seen from initial contact to termination, using a two member team approach (Viaro and Leonardi, 1983) in which-one therapist observed the other through a one way video arrangement. The presenting problem was a suicide attempt by an adolescent, culminating in admission to hospital. Therapy using the model was concluded in four sessions. Follow-up at six months disclosed no further admissions to hospital and a report from the family that they were satisfied with the outcome of therapy. Distinctions between first and second order cybernetic therapy were made and the therapists were found to adhere to a first order model. Successful and unsuccessful use of the techniques is identified and discussed. Using as a measure the absence of further suicide attempts and the family's self reported reduction in the number of arguments between the parents and the identified patient, it was concluded that the use of the nominated techniques from systemic family therapy had enabled successful intervention.

Since the government commissioned the Crossing Bridges programme in 1998 (Falcov, 1998) and through legislation and a number of government policies and initiatives since, there has been emphasis on addressing the needs of families where there are parental mental health problems. Furthermore, there is a fast-growing body of research pointing to the needs of these families. However, service structures, development and provision have lagged behind. Most often parents with mental health difficulties have access to services addressing their individual mental health needs while their needs as parents and the needs of their children remain largely invisible. One such need that has been highlighted repeatedly in the literature is the need for children to have information about and make sense of their parent’s mental health difficulties. Given the lack of services to respond to this need, it is most often left to the parent to make decisions about and respond to their child’s search for understanding. This study is a qualitative study that explores parents’ experiences of decision-making and responding to this need, and the social processes and dominant discourses that impact on these experiences. Fifteen parents with mental health difficulties were interviewed, using semi-structured individual interviews, which were transcribed, and interpretive Grounded Theory was employed to analyse and interpret the data. The grounded theory that was constructed suggest two main social processes that impact on parents’ talking with their children about parental mental health issues. Firstly, within a relational context, parents were Negotiating mutuality between themselves and their children. Secondly, within an identity context, parents had to navigate Holding on to self, holding on to life. These social processes indicate that both parents’ relationships with their children and also their own sense of themselves within the context of their mental distress powerfully shape telling, talking and keeping silent. Implications of these findings both in relation to clinical interventions and future research are considered. In particular, the importance of positioning the parent as active role-player in the healing of their child, and positioning the child as active role-payer in their own meaning-making, are highlighted. Furthermore, developing ‘double-stories’ beyond the mental health story and beyond ‘information’ is emphasised and the importance of a sense of continuity of self and identity over time for parent and child is accentuated. Finally, the importance of allowing for complex and ever-evolving understandings of mental distress is indicated, and the role of both talking and remaining silent in this process is stressed.

This study is a qualitative enquiry into family therapists’ experiences of working with young people who self-harm and their families. To date, in spite of self-harm being a serious public health concern, there is relatively little exploration of the subject in family therapy literature. The study attempts to describe, understand and illuminate family therapists’ experiences: the therapeutic issues encountered, the stances adopted in response to the issues encountered, and the emotional impact on the therapist of working with this client group. A total of nine experienced family therapists participated in semi-structured interviews. The study employed a grounded theory method for data analysis. The analysis yielded a theory of therapists’ experiences that included a Core Category and three Main Categories. The Core Category that emerged was: •Cultivating the Practice of Hope – Withstanding the Pull to Hopelessness. The three Main Categories were: •Making the Situation Safe •Conversing Therapeutically – The Practice of Hope •Team and Organisational Processes: Supporting Therapists. The Core Category is the central feature of this theory. It proposes that the central concern for the therapist is how to stay engaged with the family and the young person in the context of serious risk of self-harm and in situations where change is difficult to achieve and hopelessness can pervade. The therapist has to try to understand and make sense of family members’ distress, and be touched by and open to their feelings of despair and hopelessness without becoming overwhelmed and despairing themselves. The therapist response to this dilemma is the stance of hopefulness. It is both a therapeutic stance and orientation, and is enacted in practice through finding ways to cultivate hope in the therapeutic encounter. While the Core Category is the central ‘story’ the three Main Categories are linked to the Core Category. The Main Category, Making the Situation Safe describes the initial stage of the work, with its focus on ensuring the safety of the young person. The Main Category, Conversing Therapeutically – the Practice of Hope describes how the therapists enacted the ‘practice of hope’. The Main Category, Team and Organisational Processes: Supporting Therapists describes how the context in which the therapists work, the nature of relationships, the team and organisational structures, play a critical role in supporting therapist hope, so that they can withstand the pull to hopelessness. This study aims to make a contribution towards articulating a framework for family therapy with adolescents who self-harm and introduces a new vocabulary – the language of hope and hopelessness.

There has been relatively little robust research investigating the experience of family therapy from a client’s perspective. Much of the literature fails to make clear their methods for analysing the data, and takes an ‘either or’ approach to family and individual perspectives. Thus, either whole family perspectives, or the perspectives of a particular group are sought, making it difficult to understand the impact of the family context on individual perspectives or vice versa. The present research seeks to understand the family therapy experiences of individuals within their familial context. Two families of three were interviewed using a semi-structured interview guide and interviews were analysed using Interpretative Phenomenological Analysis. Results are presented as two family case studies. One over-arching theme of ‘the safety of the therapeutic relationship’ emerged from the accounts of both families. The therapeutic relationship provided the safety to talk and explore problems and relationships. This was described as cathartic and helped family members to see themselves and each other differently. Varying degrees of exploration of individuals was associated with differing levels of engagement with therapy. Being able to explore relationships for both families allowed them to develop new understandings of each other. Gender also emerged as an important theme and this is discussed in relation to issues of power and gender. Some key methodological limitations of the research including the small number of participants and the impact of an overly detailed interview schedule on the data are discussed. As this study involves two case studies of three family members each, it is not easily transferable, but points to some key themes and processes which have implications for practice and future research.

The current models that we use in systemic family therapy came out of office/clinic-based practice. To date, there is no model specifically orientated to systemic family therapy in the home. As a systemic family therapist, I argue that non-traditional approaches may need to be considered; and that systemic family therapy models should come closer to reflecting discourses that have shades of global influences. My interest in the area emerged from a position of ignorance – making assumptions that the tools used in the clinic could easily be colonised into a family’s home – but I found that the models often used in the clinic do not necessarily transfer easily into the home. an adaptation of a systematic review was conducted that undermined the notion that therapists are ‘knowing’ with particular skill and competency to work in the home. I ask the question: How do I improve upon my systemic family therapy practice to work in families’ homes? African oral traditional ideas (AOTI) are broadly explored to consider the notion of self and bodily feelings as a source of knowledge. Through the use of AOTI I created an approach known as Seselelame, foregrounding a new practice stemming from ideas that are not home grown within the systemic family therapy perspectives, to support my practice within the home. the inquiry offers the following contribution of new knowledge to family systemic therapy: conceptualization of a method (Seselelame) that incorporates the idea of self in the context of awareness of feelings in the body; a method that incorporates African oral traditional ideas and thus expanded the traditional Western view of family/systemic therapy; contextualization of the significance of home as a source of knowledge; the Seselelame model was used as an analytical tool alongside a systemic constructionist analytical model to compare and contrast the data produced. The findings conclude that the inquiry has implications for the practice and teaching of systemic family therapy, which will eventually be published once the thesis is completed.

O campo da terapia familiar tem se desenvolvido a partir de diferentes contribuições teóricas e epistemológicas. Um dos desenvolvimentos recentes da terapia familiar tem se dado a partir da emergência do movimento construcionista social em ciência, levando, dentre outras mudanças, a uma maior ênfase nos processos de comunicação no contexto terapêutico. Considerando a crescente utilização das contribuições do construcionismo social pelos profissionais brasileiros envolvidos na prática clínica, consideramos relevante compreender como tem se dado essa transmissão de conhecimentos do campo teórico para o campo clínico. Assim, o objetivo deste estudo qualitativo é investigar a difusão do discurso construcionista social entre um grupo de terapeutas familiares brasileiros, focando em como este se constitui em um aporte útil para sua prática clínica. Foram entrevistados 14 terapeutas familiares, do sexo masculino e feminino, psicólogos, cuja atividade profissional atual envolve o trabalho com famílias, e possuem responsabilidade docente em institutos de formação em terapia familiar. As entrevistas foram gravadas em áudio e transcritas literalmente e na íntegra. A análise das informações foi realizada a partir das propostas construcionistas sociais em ciência. Parte do processo de análise e discussão dos resultados foi realizada em conjunto com a Profa. Sheila McNamee, Ph.D., durante um estágio de pesquisa na Universidade de New Hampshire. Na análise das entrevistas, focamos em dois eixos de discussão. Primeiramente, discutimos o que os participantes descrevem como sendo o construcionismo social, evidenciando as principais ideias e conceitos do construcionismo que norteiam sua prática e seu posicionamento como terapeutas. No segundo eixo, discutimos de forma crítica e reflexiva três maneiras distintas pelas quais os participantes aplicam as ideias construcionistas na prática, enfatizando implicações, possibilidades e limites que advêm deste uso. Ao longo de toda discussão dos resultados, articulamos a análise proposta com aspectos da difusão do construcionismo entre os participantes. Concluímos, a partir deste estudo, que a difusão do construcionismo social está atrelada às formas pelas quais os terapeutas atribuem utilidade aos conceitos teóricos descritos na literatura. Além disso, a sensibilidade ao construcionismo social é um aspecto da prática clínica que oferece diferentes formas dos terapeutas relacionarem-se com as abordagens do campo da terapia familiar, trazendo convites à prática da auto-reflexividade por parte dos terapeutas. (FAPESP) / The field of family therapy has been developed based on different theoretical and epistemological contributions. One of the recently developments of family therapy has taken place based on the contributions of the social constructionist movement in science, leading to an emphasis on the communication processes in the therapeutic context. Considering this increasingly expansion of social constructionists ideas among professionals involved in clinical practice, it is important to know how theoretical knowledge has been incorporated into professional midst. The aim of this study is to investigate dissemination forms of social constructionist discourse among a group of family therapists, focusing on how these ideas are a useful contribution for their clinical practice. We interviewed 14 family therapists, men and women, psychologists, who work with family counseling, and are responsible for teaching social constructionism in family therapy training institutes. All interviews were recorded and literally transcribed. The analysis was carried out based on social constructionisms contributions for research practice. Part of this analysis process was developed in partnership with Professor Sheila McNamee, Ph.D., at the University of New Hampshire, during a research internship. We have divided the meanings made with our participants in two major pillars: Firstly, we discuss the participants definition of social construction, highlighting its main ideas and concepts that guide their clinical practice. Secondly, we critically and reflexively discuss three forms by which our participants apply social constructionism in their practice, emphasizing implications, possibilities and constraints that emerge as a consequence. Throughout these discussions, we articulate our analysis with aspects of dissemination of social constructionisms ideas among the participants. We conclude that the propagation of social constructionists ideas is tied to the utility that family therapists attach to the theoretical contributions of social constructionism. Also, the sensitivity to social constructionisms ideas offers the professionals specific forms by which they can relate to other approaches in family therapy practice. In this sense, this study enhances the importance of self-reflexivity as a quotidian practice of the family therapist. (FAPESP)

I denna undersökning utforskas betydelsen av intersubjektiv kontakt och delad förståelse som en väg att samskapa en förståelseorienterad vägledning i den terapeutiska processen och det dagliga familjelivet. Undersökningens syfte är att utforska båda parters upplevelse av delad förståelse och dess betydelse i systemisk familjeterapi. Frågeställningarna fokuseras på vad som kännetecknar tillstånd av närvaro respektive frånvaro av intersubjektiv kontakt och förståelse. Samt vilken betydelse och vilka konsekvenser denna närvaro/ frånvaro har för terapeut och familj. Undersökningen baseras på fyra kliniska fallbeskrivningar återgivna ur båda parters perspektiv. Genom oberoende intervjuer utforskas båda parters terapierfarenheter efter avslutad terapi. Resultat av studien visar att intersubjektiv närvaro och förståelse i terapin är en nödvändig och avgörande faktor för att utvidga och öka den intersubjektiva kompetensen i systemet. Resultaten visar även på hur denna närvaro i den gemensamma terapeutiska processen blir en sorts modellerande kraft som bär vidare i familjernas vardag. Detta ökar förmågan att ta den andres perspektiv och svara på varandras inre livsvärld. En förståelseorienterad vägledning utvecklas. Resultaten visar god överensstämmelse med teori och forskning inom området. Resultaten har även kliniska implikationer och visar på vikten av att i såväl utbildning som handledning av psykoterapeuter uppmärksamma förståelsens centrala betydelse i det professionella mötet och i klinisk praktik. / This study explores the impact of mutual and shared understanding as a way to create an understanding-oriented guidance in family-therapy and in daily family life. The intention is to investigate the reciprocal experience of shared understanding and it ́s significance in family therapi. The questions focus on what charactarizes the states of prescence or abscence of intersubjective contact and understanding as well as what impact these states will have on the therapist and the family. The survey is based on four clinical case-histories reproduced from the therapists and the families ́ perspectives. Independent interviews explore both parties ́ experiences of the therapy after it was completed.Results of the study show that intersubjective presence and understanding during therapy is an essential and vital factor to extend and increase the intersubjective competence in the system. The results also show how the mutual therapeutic process presence is a kind of modeling force that carries on in families' everyday lives. This process developes the ability to take the other ́s perspective and respond to each other ́s inner world. An understanding-oriented guidance evolves. The results show good accordance with theory and research in the actual science field. They also have clinical implications and emphasizes the importance in both training and supervision of psychotherapists to payattention to the central importance of understanding in the professional meeting and in clinical practice.

A dissertação analisa a utilização de rituais terapêuticos na Terapia familiar sistêmica, promovendo a resiliência em situações de sofrimento e crise.A primeira parte aborda os ritos dentro de uma perspectiva antropológica e psicossocial, enfocando a finalidade dos rituais na humanidade, como processo de reconhecimento e inserção do ser humano no grupo social. Aborda, também, os ritos familiares, suas funções e de que maneira os mitos construídos na família influenciam o surgimento do sofrimento.Ainda neste capítulo, é apresentada a terapia familiar sistêmica, a fim de compreender a utilização dos ritos terapêuticos, como técnica utilizada na terapia, principalmente para possibilitar a mudança no sistema terapêutico. A terapia familiar contribui com os estudos sobre o ciclo vital familiar, ajudando a conhecer e identificar as etapas do desenvolvimento, a fim de restaurar vínculos, rupturas e paralisações, que ocasionam surgimento de sintomas na família.A segunda parte analisa a resiliência familiar, tentando compreender como algumas pessoas, apesar de sofrerem enormes adversidades e traumas, adquirem força para vencer a crise, saindo mais fortalecidas.A fim de compreender em que contexto os ritos terapêuticos são aplicados, esta parte, ainda, nos apresenta quem é o terapeuta familiar sistêmico, suas crenças, convicções, seu universo pessoal e profissional.A terceira parte apresenta a pesquisa, realizada com terapeutas de família, onde foram investigadas as suas práticas, com rituais na terapia, assim como objetivo, avaliação e análise dos resultados terapêuticos.Foi analisado em quais etapas do ciclo vital, precisa-se de maior intervenção terapêutica através dos rituais, auxiliando a família a ultrapassar a fase cristalizada, proporcionando vivenciar um rito de passagem. Finaliza com análise dos rituais estudados, sob a perspectiva antropológica, compreendendo os três momentos de um rito: margem, separação e agregação.Os rituais são essenciais no desenvolvimento do ser humano, através deles, a sociedade reafirma seus valores, crenças e sua identidade, oferecendo oportunidade para expressão do individual e coletivo. / The dissertation analyses the use of therapeutic rites in systemic family therapy, promoting resilience in situations of suffering and crises. The first part approaches these rites from an anthropologic and psychosocial perspective, focusing in the finality of the rites in mankind as a process of recognition and insertion of the human being in the social cycle. Likewise, it approaches family rites; its functions and how the myths built in the family environment influence the appearance of suffering. Moreover, it is presented the systemic family therapy, in order to understand the use of therapeutic rites as a technique used in therapy, mainly to make a change possible in the therapeutic system. Family therapy contributes with the studies of the family vital cycle, helping to be aware of and to identify the development stages, in order to restore bonds, ruptures and stops, which cause the appearance of symptoms in the family. The second part analyses family resilience, trying to understand how some people, besides suffering enormous adversities and traumas, find power to beat the crises, ending stronger than they were before. In order to comprehend in which context the therapeutic rites are applied, this part also presents to us who is the systemic family therapist, his/her beliefs, his/her convictions, his/her personal and professional universe. The third part presents the research performed with family therapists, where their procedures with rites in therapy were investigated as well as the objective, evaluation and analysis of the therapeutic results. It was analyzed in which stages of the vital cycle more therapeutic intervention is needed with the help of the rites, assisting the family to pass the crystallized stage, providing the experience of a rite of passage. It ends with the analyses of the rites studied from an anthropologic perspective, including the three stages of a rite: margin, dissociation and aggregation. The rites are essential in the development of the human being. By these, society reaffirms its values, beliefs and identity, offering an opportunity to the individual and the collective to express them.

O campo da terapia familiar tem se desenvolvido a partir de diferentes contribuições teóricas e epistemológicas. Um dos desenvolvimentos recentes da terapia familiar tem se dado a partir da emergência do movimento construcionista social em ciência, levando, dentre outras mudanças, a uma maior ênfase nos processos de comunicação no contexto terapêutico. Considerando a crescente utilização das contribuições do construcionismo social pelos profissionais brasileiros envolvidos na prática clínica, consideramos relevante compreender como tem se dado essa transmissão de conhecimentos do campo teórico para o campo clínico. Assim, o objetivo deste estudo qualitativo é investigar a difusão do discurso construcionista social entre um grupo de terapeutas familiares brasileiros, focando em como este se constitui em um aporte útil para sua prática clínica. Foram entrevistados 14 terapeutas familiares, do sexo masculino e feminino, psicólogos, cuja atividade profissional atual envolve o trabalho com famílias, e possuem responsabilidade docente em institutos de formação em terapia familiar. As entrevistas foram gravadas em áudio e transcritas literalmente e na íntegra. A análise das informações foi realizada a partir das propostas construcionistas sociais em ciência. Parte do processo de análise e discussão dos resultados foi realizada em conjunto com a Profa. Sheila McNamee, Ph.D., durante um estágio de pesquisa na Universidade de New Hampshire. Na análise das entrevistas, focamos em dois eixos de discussão. Primeiramente, discutimos o que os participantes descrevem como sendo o construcionismo social, evidenciando as principais ideias e conceitos do construcionismo que norteiam sua prática e seu posicionamento como terapeutas. No segundo eixo, discutimos de forma crítica e reflexiva três maneiras distintas pelas quais os participantes aplicam as ideias construcionistas na prática, enfatizando implicações, possibilidades e limites que advêm deste uso. Ao longo de toda discussão dos resultados, articulamos a análise proposta com aspectos da difusão do construcionismo entre os participantes. Concluímos, a partir deste estudo, que a difusão do construcionismo social está atrelada às formas pelas quais os terapeutas atribuem utilidade aos conceitos teóricos descritos na literatura. Além disso, a sensibilidade ao construcionismo social é um aspecto da prática clínica que oferece diferentes formas dos terapeutas relacionarem-se com as abordagens do campo da terapia familiar, trazendo convites à prática da auto-reflexividade por parte dos terapeutas. (FAPESP) / The field of family therapy has been developed based on different theoretical and epistemological contributions. One of the recently developments of family therapy has taken place based on the contributions of the social constructionist movement in science, leading to an emphasis on the communication processes in the therapeutic context. Considering this increasingly expansion of social constructionists ideas among professionals involved in clinical practice, it is important to know how theoretical knowledge has been incorporated into professional midst. The aim of this study is to investigate dissemination forms of social constructionist discourse among a group of family therapists, focusing on how these ideas are a useful contribution for their clinical practice. We interviewed 14 family therapists, men and women, psychologists, who work with family counseling, and are responsible for teaching social constructionism in family therapy training institutes. All interviews were recorded and literally transcribed. The analysis was carried out based on social constructionisms contributions for research practice. Part of this analysis process was developed in partnership with Professor Sheila McNamee, Ph.D., at the University of New Hampshire, during a research internship. We have divided the meanings made with our participants in two major pillars: Firstly, we discuss the participants definition of social construction, highlighting its main ideas and concepts that guide their clinical practice. Secondly, we critically and reflexively discuss three forms by which our participants apply social constructionism in their practice, emphasizing implications, possibilities and constraints that emerge as a consequence. Throughout these discussions, we articulate our analysis with aspects of dissemination of social constructionisms ideas among the participants. We conclude that the propagation of social constructionists ideas is tied to the utility that family therapists attach to the theoretical contributions of social constructionism. Also, the sensitivity to social constructionisms ideas offers the professionals specific forms by which they can relate to other approaches in family therapy practice. In this sense, this study enhances the importance of self-reflexivity as a quotidian practice of the family therapist. (FAPESP)