All therapy, irrespective of model agree about one thing. If change is to happen someone, somewhere must do something different.
Therapists informed by systems thinking have traditionally focussed on changing the pattern of interaction that includes the symptom, by through changing what people do, what they feel, the interpretation they place on other’s behaviour, or the fundamental meanings drawn that make sense of their lives. Different schools of family therapy have emphasised one over another and used a range of techniques to achieve this outcome. For example, a structural family therapist may directly advise parents to stand together in the most practical and tangible way to insist a child co-operates as a way to restructure the family hierarchy. By contrast a Milan Systemic therapist may positively connote a symptom as solving another difficulty in the family, thus changing the meaning of the problem. Every school will have its own way of encouraging the client to ‘do something different’, through thought, feeling or action.
Intervention is not confined to end of session advice but is a process which is threaded through the episode. The end of session intervention may be a summary of material collected throughout the meeting which has revealed new information to the family or a very minor addition to that which has been discussed. Whether the intervention is a very new and different approach to that which has been discussed or a reiteration of the session, it needs to be delivered in a way that is heard by all family members and accepted as relevant.
bower(note) and Advice
bower(note) is the invariant protocols that guide all clinical practice at Bower Place including intervention. At the beginning of the first visit these are explained to clients and the format of a session outlined. The session is framed as a meeting where, hopefully the practitioner can contribute something of value in solving the family’s difficulty. As it is a meeting, minutes are taken in a way that is both transparent and inclusive of the client.. The agenda, activities that will be included in the session, is established and explained by the practitioner. The first item is the request made by the client for each individual session and for the whole episode of therapy. This forms the basis for service delivery, the contract between client and practitioner and creates boundaries around the process. It provides an opportunity to be clear about what can and cannot be offered and establishes appropriate ethical and expectation limits. This is done as a process of negotiation so both agree about the focus of the work, its viability and ethical acceptability. Advice which is delivered at the end of the session is the response to the client’s request and fulfills that part of the contract. The term ‘advice’ is used to include any request made and negotiated with the client and may include direction, opinion, or reflections about the situation. Delivered at the conclusion of the session and often after a break, Advice forms a recursive loop between the first item on the Agenda, request and the last. It will be revisited at the next session, often in the form of ‘Last session’s advice’ connecting each session to the next.
The art of Intervention
Having established the request the practitioner’s task is then to deliver advice to all parties that not only meets their request but is understood and accepted. This includes the content or what is said, who it is directed towards, how it is delivered and its location within the therapeutic relationship. Each of these will be explored further in the full-length versions of this paper available on bower(knowledge).
