Deconstructing Mason’s (un)safe (un)certainty

Barry Manson’s safe uncertainty framework has had a significant influence on the fields of systemic psychotherapy and systemic social work. His original 1993 paper has been cited more than 300 times, and a range of interpretations offered and applications proffered. I offer a deconstructive reading of Mason’s 1993 paper, in order to better understand this phenomenon. I focus on issues of style, rhetoric, expositional emphasis, and word choice – why does Mason choose ‘safe’ rather than ‘secure’? Using analysis by Boholm and colleagues, I set out the semantic pros and cons of using ‘safe’ and ‘secure,’ arguing that, on balance, ‘secure’ is the more appropriate word for Mason’s purposes. I then explore Mason’s reporting of practice, in particular the shift over time from indirect to direct reporting of speech. I argue this shift underpins efforts by Mason to clarify his use of safe uncertainty. Mason’s changing use of voice strongly supports the claim that his framework should not be applied to the analysis of, or responses to safeguarding, risk and protection dilemmas, for which more appropriate frameworks are available.

Η Θεραπευτική σχέση στη συστημική ψυχοθεραπεία οικογένειας και ζεύγους: απόψεις σε εξέλιξη

The relationship between therapist and client plays a central role in the quality and effectiveness of psychotherapy, independently from the therapeutic approach adopted by the therapist. The therapeutic relationship in the frame of Systemic Family and Couple Psychotherapy (SFCP), presents several peculiarities, especially when displayed in the "classical" therapeutic context of systemic psychotherapy, where complex and multifaceted relationships develop between therapists and family members, in front and through the one-way mirror, forming a network of "multiple bonds". Modern views on therapeutic relationship in SFCP have been influenced by the development of the "second order cybernetic", since the late 1980s, and the subsequent "linguistic shift", according to which the therapist, as a part of the therapeutic system, dialogues with family members, contributing to co-constructs new realities, as a therapeutic change cannot result from a didactic / guiding relationship. In this context, the emotions and feelings of the members of the therapeutic system come to the fore, whilst the issue of clients’ resistance to the treatment process is completely redefined. The research regarding the therapeutic relationship in the systemic approach, using both quantitative and qualitative methods, focused on a variety of dimensions, e.g., the impact of the session context and the used techniques, the degree of empathy between therapists and clients, and the therapeutic alliance that develops between them. In more recent years, the provision of mental health services using digital practices raised new challenges and concerns regarding the development of the therapeutic relationship in the new conditions of cooperation between therapist(s) and client(s) in online settings.

Recognizing oneself in the encounter with others: Meaningful moments in systemic therapy for social anxiety disorder in the eyes of patients and their therapists after the end of therapy

There is evidence that systemic therapy is effective, but there is little evidence about meaningful moments in systemic therapy in general, and none at all in systemic therapy for social anxiety disorders. Meaningful moments are one of the relevant research objects in change process research, as they contribute to a better understanding of therapeutic change. Objective The objective of this study is to characterize and describe meaningful moments in the context of systemic psychotherapy, from the point of view of patients and their therapists, after the end of therapy. The therapy studied is a manualized, monitored systemic therapy for social anxiety disorder. Method Semi-structured follow-up interviews were conducted separately with five patients and their therapists (N = 10). Methodological triangulation was used: Grounded theory was used to code the transcripts as described by Charmaz. Then the passages of the selected code “meaningful moment” were evaluated using thematic comparison, in line with Meuser & Nagel. Findings Three categories involving meaningful moments were identified: (1) meeting other patients in group therapy session, (2) therapeutic resource orientation and (3) recognizing oneself in a diagnosis or pattern of behaviour. These categories emerged as contexts related to the occurrence of meaningful moments from a subjective perspective. Discussion Meaningful moments seem to be consistently related to the therapist input and to specific interventions or settings, both from the perspective of the patients and the therapists. Two tandems each described a coincident moment. One central aspect of all 14 moments is that the patients and therapists described patients being able to acquire another outlook on themselves.

Qualitative Analysis of Psychological Intervention in Intensive Care Unit in Greece: A Case Study of An Adult Woman with Septic Shock

We report a case study of a woman with Septic Shock who attended Psychological Intervention after medical treatment in the Intensive Care Unit of a Greek Teaching Hospital in Athens. Qualitative analysis of data was collected from Focused Interview, Genogram as a family history tool and Psychological Intervention based on Short/ Systemic Psychotherapy. The study focuses on the deep understanding of the patient’s changes in terms of thoughts, emotions and behaviors after the invasion of a serious disease, like Septic Shock.

Qualitative Analysis of Psychological Intervention in Intensive Care Unit in Greece: A Case Study of An Adult Woman with Septic Shock

We report a case study of a woman with Septic Shock who attended Psychological Intervention after medical treatment in the Intensive Care Unit of a Greek Teaching Hospital in Athens. Qualitative analysis of data was collected from Focused Interview, Genogram as a family history tool and Psychological Intervention based on Short/ Systemic Psychotherapy. The study focuses on the deep understanding of the patient’s changes in terms of thoughts, emotions and behaviors after the invasion of a serious disease, like Septic Shock

Madness, Mythopoetry and Medicine

This chapter draws on a detailed transgenerational case study, the story of ‘Masimbo’, which involves migration, to highlight the conceptualisation and journey of mental illness within an African cultural perspective. In Masimbo’s story, African understandings of mental disorder are side-lined by Western approaches with untoward consequences for him and his family. The implication that is drawn from this, however, is not that African perspectives should replace Western approaches but rather that they should be used together. Thus, Masimbo’s story is illuminated with comments woven in from both an African (Yoruba traditional conceptualisation) and a systemic psychotherapy perspective. This shows how respecting both perspectives is possible and preferable from a person-centred point of view as different narratives/understandings are foregrounded and backgrounded like a tapestry, promoting an approach in which mental illness and the nuances that culture brings, is appreciated and worked with. We conclude with a reflection on the nature of storytelling as mythopoetry within African culture and its role in bridging between perspectives in mental health.

Doing remote systemic psychotherapy during a pandemic

This paper describes some findings from a rapid quality improvement project exploring clinician views about the delivery of remote systemic psychotherapy since the Covid-19 induced UK lockdown. Remote systemic psychotherapy is a practice response based on the need to remain physically distant from people and involves "meeting" via video link rather than in person. Written responses were gathered from early-adopter clinicians in one UK NHS trust, reflecting on their experiences of convening remote systemic psychotherapy sessions during March and April 2020. Overall, findings suggest that that remote systemic psychotherapy has been acceptable, effective and indeed welcomed by clinicians, within the pandemic context. Using a diffractive thematic analysis, four themes were constructed from clinician responses: practical and boundary issues need careful attention; the conversational flow of remote systemic psychotherapy sessions is different to that during in-person sessions; it is necessary to do things differently with words and bodies; the practice of creating meaningful dialogical communication when separated by screens is hard. Tentative practice recommendations are provided.

Review of the Volume “Trăind cu schizofrenia” [Living with Schizophrenia], Authors: Eliza Geanina Cogian, Adina Nicoleta Karner Huţuleac, Lumen Publishing House, 2020

The analysis of social discourses on schizophrenia, in terms of its causal aspects, effects but also forms of therapeutic intervention show a wide diversity of opinions, ranging from empathic to attitudes of total rejection. The book “Trăind cu schizofrenia” [Living with schizophrenia], published by Lumen Publishing House in 2020, is written by two practicing psychologists, Eliza Gianina Cogian, who has been training in family and couple systemic psychotherapy, and also as a therapist for people diagnosed with schizophrenia, and Adina Nicoleta Karner Huţuleac, who is a doctor of psychology and trainer of family and couple systemic psychotherapy. There are many misconceptions and myths about schizophrenia. We must recognize that these myths contribute to maintaining a global pessimism regarding the knowledge related to this disease and at the same time can reduce the patient's chances to improve their condition or to recover. In this sense, the book has the great merit of comparatively analyzing different theoretical concepts, including that of Jung or Bleuler, but also some forms of therapeutic intervention.

Ethical Issues in Systemic Psychotherapy

Ethical codes in systemic therapy are discussed drawing on cultural, professional, legal, and complexity-oriented perspectives. First, a cultural framework is established to describe systemic perspectives on ethics following cultural codes in systemic science. Legal issues are discussed as are professional ethical formulas, which function as mandatory sets of rules for systemic practice. The description of a European systemic association’s ethical code serves as an example of systemic practice and is supplemented by medical sources. The adoption of systems science and complexity model perspectives demonstrates similarities of ethical discussion within various systemic approaches. A detailed outline of ethical guidelines in concrete systemic practice is provided, drawing on ideas of neighboring systemic models in natural and social sciences.