‘Many pieces one family’: An elaboration of one family’s bereavement experiences

There has been considerable research on bereavement and the concept of continuing bonds. However, there is a distinct absence of research considering bereavement, continuing bonds and family dynamics post-bereavement. The paper reports on a study utilising a family systems approach combined with narrative methods, tools of conversation analysis and systemic theory. This integration of approaches is used to consider how one family offers an account of their experience of bereavement. An exploration of their conversation along with visual presentation in the form of button sculpts is employed. The findings support the suggestion that it is useful to consider bereavement experiences as part of a family system. Clinical implications of the research are outlined to consider how best to support bereaved families.

The child with developmental disabilities: The effects on the whole family. What do the families really need from the ‘early intervention’ professional system?

This paper is based on the premise that the current services delivered to children with developmental disabilities and their families in Wales are in need of revision in order to fully support the families to then be able to support their children. Currently services use a medically dominated approach in trying to ‘fix’ these disabled children and are lacking regard for the emotional and psychological impact on the families. The author comes from a position of having worked with these families as a clinical psychologist for over 20 years and shares with the reader things that her lived experiences tell her matter to these families and what families have said matters. There are ‘extra’ demands of looking after a child with developmental needs and in managing oneself in relation to a complex set of professional demands (services). In relation to this, there are a complex array of emotional experiences and dilemmas that parents are often fluctuating between. Six key themes have been developed which potentially form a model to think about some of the dynamics for families in these situations; Denial v acceptance, Guilt v forgiveness, isolation v support, fear v courage and anxious thinking v reimagining the family story. This paper provides the reader with a practical and strength-based model for service delivery to support children with developmental disabilities and their families. The new model of care is about helping families ‘to come to terms with’ a condition that cannot be cured. The new vision is about adaptation, re-framing or seeing from a different perspective, that is, a ‘fulfillment in new dreaming’. Families must adjust physically, psychologically and practically to living with limitations which can be severe and uncertain at times and may not be resolved. Two main principles that should be followed: 1. Caring about what matters. That is to say addressing a child’s developmental disabilities within the broad context of the child and family’s lives. Parents need space to acknowledge and process their feelings without judgement, with professionals and peers who have ‘good’ understanding and empathy. 2. We the people. Health care should become the work of we the people not we the professionals serving the rest of the people. At the heart of it is the orientating ideal that captures what the work is about – well-being of families. The principles of the model being to engage a resource that is largely untapped in our strained healthcare system: the knowledge, wisdom and energy of individuals, families and communities who have a child with developmental disabilities/learning disabilities in their everyday lives. These families are no longer simply consumers of services who respond to requests to ‘fix’ disabled children. The author describes what she is doing to develop services including the development of Early Positive Approaches to support (EPAtS). The author also considers some issues that get in the way of developing this new practice smoothly. Summary A new way of looking at and considering what is important in the professional system supporting children with developmental disabilities and their families.

Fostering therapeutic security in insecure times: Populism and the new rise of nationalism

A sense of security is a key issue in attachment theory and its derivation, attachment narrative therapy. This article focuses on an analysis of threats to security that result from the socio-cultural context in which psychotherapy and supervision are conducted. Europe is perceived as a relatively safe place. However, growing populism and nationalism are affecting the context in which psychotherapy is being carried out, by reducing the sense of security of patients, therapists and supervisors alike. The article explores this phenomenon. An example of supervision will be provided, carried out by Arlene Vetere shortly after the brutal murder of a prominent Polish politician. Consideration will be given to the agreement of views between the supervisee and the supervisor, as well as its significance to the supervision. The manner in which security is built within supervision rooted in attachment narrative therapy will also be analysed. The thesis posited is that a sense of security is not an innate personal characteristic but results from actively working towards it and a description of such actions is also offered in the article.

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.

Narrative therapy and the autism spectrum: A model for clinicians

Narrative therapy practices have a long history of application to a wide range of mental health conditions. This paper discusses a novel narrative approach specific to autism and the application of narrative therapy constructs for clinicians working with families who have a member with a diagnosis of autism spectrum brain style differences. The author introduces a visual framework and descriptive language as a reference point to think and talk about autism within the context of narrative family therapy. This framework guides clinicians toward supporting an individualized narrative of the pattern of strengths and differences that are part of the autism spectrum brain style. The narrative approach outlined in this paper provides the entry point for clinicians to guide families toward the development of strength-based narratives that foster connections and resiliency within the family. A narrative therapy model is introduced with three key features highlighted: structuring the session to accommodate for autism spectrum brain style differences, using descriptive language to support the development of alternative narratives, and highlighting key narrative shifts taken from family therapy sessions. Readers are provided with a case study that illustrates the use of narrative therapy structures when working with this unique population of families.

The first 30 years of the story of the Journal of Human Systems

We are writing this story of Human Systems with excitement and an eye to the future. Rudi Dallas and Becky Stancer took on the editing of the Journal but also joined with Peter Stratton and Helga Hanks in looking for a new base for the Journal. They succeeded in having Sage Publications include the Journal in their publications in internet form with Rudi Dallas and Becky Stancer as editors. This is a fantastic new beginning, in a contemporary format and with a new orientation of Therapy, Culture and Attachment. Peter Stratton and Helga Hanks have undertaken to give context to this new beginning by writing about the previous thirty-year history of Human Systems.

A narrative approach for a client with irritable bowel syndrome

This article aimed to illustrate a new narrative approach that transformed a client’s story of suffering by differentiating the meaning construction of a particular speech act of other people. The new narrative approach has fundamental roots in coordinated management of meaning theory. The authors reformed this as “modified coordinated management of meaning” (MCMM), and called the refined model the refined MCMM (RMCMM). The client was a 21-year-old woman who was diagnosed with irritable bowel syndrome (IBS) in high school. Her story of suffering concerned odors related to her IBS-diarrhea symptoms, which resulted in her experiencing difficulties in college life. The social worker intervened the client’s meaning construction of the locutionary act of another person’s speech act “something really stinks.” The client acquired the skills for generating new meaning constructions and speech act selections to transform her story of suffering. The RMCMM was an efficacious narrative approach that allowed the client with IBS to transform her story of suffering over a short period.

Feeling ‘like you’re on … a prison ship’ – Understanding the caregiving and attachment narratives of parents of autistic children

This study explored the caregiving and attachment relationships of parents of autistic children, analysing 16 Parent Development Interviews conducted as part of a larger project. The interviews were analysed using attachment theory–driven discourse analysis, namely, the Adult Attachment Interview and Meaning of the Child Interview methods of evaluating relational discourse for transformations of meaning with a self-protective function. A multiple case-study approach was used to build an explanatory model of the caregiving and parent–child relationships of the whole sample. The study found a high level of trauma in the parents’ early childhood that shaped the way they interpreted their child and the parent–child relationship, often undermining these parents’ intentions to form more positive relationships with their own children. An interpersonal understanding of the problems of these families is suggested, seeing difficulties as residing in relationships, maintained by a circular process of ruptures, as parent and child seek to protect themselves from the pain and shame inherent in the experience of ‘disconnection’, and the apparent failure of the parents’ hope for a better relationship with their children than they experienced as children. This may be exacerbated by commonly available autism narratives, which tend to essentialise problems, mechanise parental understanding of their children and encourage parents to experience their child as fundamentally separate, challenging the caregiving system. Clinicians supporting families with autistic children may be assisted by attending to this meaning-making process, seeking creative alternatives to help these parents realise their positive intentions that do not support a shame-based cycle.

Responsibility inoculation: Constructing ‘good parent’ accounts when accessing child mental health services

With the prevalence of child mental health conditions rising, the role of the initial mental health assessment is crucial in determining need. Utilising a critical discursive analytic framework, we explored the ways in which parents during these mental health assessments constructed the child’s difficulties as medicalised and doctorable as opposed to systemic and familial. Through this discursive positioning, we examined the ways in which parents mitigated blame and accounted for the child’s behaviours and emotions. Parents engaged in three accounting practices to construct the child’s problems as dispositional and to mitigate against an alternative familial system interpretation. First, they drew upon normative cultural repertoires of parenting. Second, they mediated ways whereby normative practices were deviated from in the best interest of the child. Third, they rhetorically positioned overcoming systemic difficulties by illustrating cooperative parenting in separated families. Our findings have implications for how parents build a case for the need for medical intervention in assessment settings.