The Relational Brain in Counselling & Psychotherapy

Recent developments in neurotherapy point to the importance for practitioners of awareness of the biological underpinnings of mind and behaviour. Neurobiological studies indicate that talking therapies have their effect at least partly by supporting changes to clients’ brain structure and function. Furthermore, they also indicate the critical importance of creating a safe therapeutic space to support such change: an experience of safety is critical as a basis for effective learning and cognitive change. A psychotherapeutic context generated by a warm, skilled therapist in a safe environment assists with down-regulation of neural stress responses and up-regulation of neural patterns that enhance change, neural growth and solution-focussed thinking. Establishing good therapeutic alliance creates a safe positive environment for clients to explore new strategies and behavioural change – establishing new neural pathways. Practitioners who are interested to further explore ideas around emotional attunement and its impact on the therapist-client relationship might wish to read Susan Hart’s (2011) The Impact of Attachment, part of the Norton series on Interpersonal Neurobiology.

Personality Disorders & Parenting

Managing a child's development where parents guide and provide, can be a challenging yet rewarding feat with many ups and downs, with its path impacting on both parties. Where a parent has a personality disorder the challenges of parenting and successful therapy are even greater. A study conducted by Weiss, Zelkowitz, Feldman, Vogel, Heyman, and Paris (1996) compared children with a parent with a diagnosis of personality disorder, compared to those without a personality disordered parent. They reported that children in the former group had a significantly higher number of psychiatric diagnoses and scored higher on a global rating of impairment, compared to children in the latter group. A more recent study has reported that certain parenting qualities appear to be more predictive of this outcome, and that having a parent with a personality disorder in itself is not predictive of a childs’ psychiatric health during adulthood (Johnson JG, Cohen P, Chen H, Kasen S, Brook JS. 2006). Does our biology guide our nature or does our nurturing guide our biology?

Johnson JG, Cohen P, Chen H, Kasen S, Brook JS. (2006) Parenting behaviours associated with risk for offspring personality disorder during adulthood Arch Gen Psychiatry. May;63(5):579-87

Weiss, M., Zelkowitz, P., Feldman, R. B., Vogel, J., Heyman, M., Paris, J. (1996). Psychopathology in offspring of mothers with borderline personality disorder: A pilot study. Canadian Journal of Psychiatry, 41, 285-290

Young Adult Women with an Eating Disorder

For those of us who work with sufferers of eating disorders, the transitory acceptance of the reality of the illness can be frustrating and confusing. A retrospective study by Schoen (2012) et al is the basis for the development a preliminary model of help seeking behaviour which provides some practical guidelines for practitioners, friends and family. The authors make three recommendations. First, the woman's awareness of cost and severity of her disorder should be a key component in encouraging her to seek help, preferably by someone close to her who can put a focus on the need for immediate action. Second, family and friends should be educated in 'caring confrontation', particualrly when the woman encounters a defining moment in the illness as a result of physical symptoms, relationship issues or a tragedy. Finally, practitioners should overtly acknowledge the client's ambivalence and uncertainty about treatment. As a clinician it is valuable to have such clear guidelines in such a challenging area of practice.

Eva G. Schoen, Sharon Lee, Christine Skow, Stefanie T. Greenberg, Allison S. Bell, Joanna E. Wiese & Jessica Kelly Martens (2012): A Retrospective Look at the Internal Help-Seeking Process in Young Women With Eating Disorders, Eating Disorders: The Journal of Treatment &Prevention, 20:1, 14-30

Siblings, Parenting & Marriages; How Do they Intersect?

Anyone with a brother or sister would know how central these relationships are to our lives, both as children and adults. What is less clear is the influence of other family dynamics on the sibling relationship. This is the question addressed by researchers Jeong Jin Yu & Wendy Gamble, who explored the connection between marital quality and sibling relationships, marital quality and parenting style and parenting styles and sibling relationships.Their results showed that warmer and more co-operative marital relationships were associated with warmer and more harmonious sibling relationships. They conclude by saying; 'In keeping with the family systems theory, whereby chains of causality are complex and interchangeable among subsystems, this study shows significant bidirectional relations between sibling relationships and parenting styles.'

Jeong Jin Yu & Wendy C. Gamble (2008) Pathways of Influence: Marital Relationships and Their Association with Parenting Styles and Sibling Relationship Quality J Child Fam Stud 17:757–778

The Father - Son Relationship

A study by Matta et al (2010) reports that men who experienced a good relationship with their father during childhood were more likely to be less emotional in response to stressful events in daily life than those who had a poor relationship, a finding which did not apply to women. The primary place of fathers in the home has shifted from moral leader and breadwinner to that of nurturer and includes degree of involvement and relational nurturing capacities. The modern father is much more able to be involved in the day to day activities of care of children which requires a certain level of engagement, accessibility and responsibility. Fathering patterns of preindustrial society indicated that paternal affection and engagement with routine child care was positively associated with greater equality between men and women, suggesting that this type of fathering transforms the male. Responsibility of a man to the demands of fatherhood arises as a critical feature in this transformation.

Mallers, M.H., Charles, S.T., Neupert, S.D., Almeida, D.M. (2010) Father Responsivity: Couple Processes and the Co-construction of Fatherhood

Matta, D.S. and Knudson-Martin, C. (2006) Perceptions of Childhood Relationships with Mother and Father: Daily Emotional and Stressor Experiences in Adulthood.

It Just Happened 6/4/12

What do we know about adolescent girls' desire and how do we conceptualize it? This is the question raised by Deborah Tolman in her book Dilemnas of Desire (2002) based on in depth interviews with 29 girls from an urban and suburban high school. Tolman argues that young women continue to struggle with the madonna-whore split and that ' developing a strong sense of self and engaging in authentic, meaningful and joyful intimate relationships requires an acknowledgement and acceptance of ones own bodily feelings.' Desire must become a fundemantal part of a young woman's sense of self and a body that acts and is not just acted upon; intimacy shouldn't 'just happen' to a girl. However there is a choice to be made. Do girls 'feel and act on their desire and risk the negative, even puitive, possibly disastrous consequences, or do they deny, discount or distract others from their desire and suffer profound disconnection from themselves? The research is now 10 years old. Is it still the same and what has it meant for those women now in their twenties and their mothers?

Redefining Incompetence

Young adults who fail to leave home may attract a range of diagnoses including social phobia, obsessive compulsive disorder (OCD), depression, conduct disorder, attention deficit hyperactivity disorder (ADHD) and learning disabilities. Varied as these are, parents complaints are similiar; avoiding school and work, demands services and money, excessive use of their computer, and inversion of the night–day cycle. A team of five psychologists in Israel have been applying principles of nonviolent resistance to these situations and in their paper Parent Training in Nonviolent Resistance for Adult Entitled Dependence report on their work with 27 families. The focus is on resistance rather than control, anti-eascalation training and creating a network of support. The authors report this approach was 'effective in reducing the most challenging aspects of adult entitled dependence.' Parents effectively reduced the services they offered and a third of the adult children who had been unemployed at the beginning of the study were in at least part time work and some were living independently. A reduction in hostility and conflict resulting in a more pleasant home environment and greater well being was also reported.

Lebowitz,E., Dolberger,D., Nortov,E . & Omar, H.(2012) Parent Training in Nonviolent Resistance for Adult Entitled Dependence Family Process Vol. 51:90–106

Never Leaving Home

Call them “NEET” (not in employment,education, or training) , “Kippers” (kids in parents pockets eroding retirement savings) or “Boomerang Children” (these are a growing cohort of low functioning adult children who are highly dependent on their parents). For them 'the transition to fully autonomous functioning does not occur or is reversed after an abortive attempt at independence leading to chronic dependence on parental support.' Authors Lebowitz et. al (2012) have coined the term adult entitled dependence which is characterized by parents who continue to provide for their children at a level that is beyond the norms of their culture and offspring with impaired functioning. It is a 'chronic condition involving a dysfunctional adult offspring and at least one parent who accommodates to the pattern of dependence by providing age-inappropriate services.' A vicious cycle develops whereby the attempts of both parties to alleviate the problem exacerbate it.Watch this space for the approach these authors recommend for this situation.

Understanding and Intervening in Family Interaction

A central idea of family therapy is that problematic behaviours are generated in relationship, maintained in relationship and hence their resolution can also be found in relationship. Tracking the 'patterns which connect' symptoms and family patterns of interaction; behaviourally, affectively and cognitively is central to therapy. While this is a compelling idea it is interesting to read research which maps patterns between families which present with a symptom and those which don't. Suman,L. & Nagalakshmi (1995) studied the nature of family interaction in alcoholic and non-alcoholic families. Their results demonstrated clear differences, with alcoholic families 'characterized by poor communication patterns, lack of mutual warmth and support, spouse abuse and poor role functioning, 'as compared to non-alcoholic families who were 'characterized by by free and open communication, mutual warmth and satisfaction and sharing of responsibilities.' Such studies attest to the value of understanding pattern as a means of targeting effective intervention.

Learning Disabilities & Behaviour Problems

The relationship between learning disabilities and behaviour problems in adolescents has been well documented. However, the pathway from the former to the latter is not well understood. Recently, three studies from around the world have investigated the impact of learning disabilities on serious behaviour problems in adolescents.

Fyson and Yates (2011), in the UK, have determined that young people with learning difficulties are disproportionately represented amongst youth who are subject to Anti-Social Behaviour Orders (ASBOs – a non-custodial criminal justice order which binds the subject to behavioural conditions over a period of time).

Maniadaki and Kakouros (2011), investigating the educational histories of young offenders in Greek Correctional Centres, found that between 25-45% showed symptoms of ADHD (compared with a population prevalence estimate of 6%), and noted that adolescents with ADHD often show behavioural profiles similar to juvenile offenders, including impulsivity, lack of future orientation, lack of consequential thinking, inability to delay gratification, difficulty regulating emotion, need for stimulation, and low frustration tolerance.

Finally, Rucklidge, McLean and Bateup (2009) investigated incarcerated young offenders from New Zealand, finding that over 90% demonstrated learning difficulties in at least one area, and noting that reading comprehension predicted recidivism after release.

It seems that adolescents with undiagnosed learning difficulties are at greater danger of becoming involved in the criminal justice system. The authors’ suggestions, including universal screening for learning difficulties in primary school, better learning support for children with these difficulties, and accurate identification of young offenders with learning difficulties, will no doubt be helpful; but will also be expensive to implement. Until such time as they are widely available, it will be important for therapists and educators faced with difficult children to keep asking ourselves the question: “what might be underlying this behaviour?”.  

A Broken Heart can Kill

It's true, a broken heart can kill you. A study published in the Journal of the American Heart Association reports one is 21 times more likely to suffer a heart attack in the days after the death of a loved person. One explanation is that following such a bereavement people tend to neglect their own health and fail to take medication. This is especially important where the survivor has their own health issues which predispose them to heart attack. It's a time when family and friends should be especially vigilant of those closest to the deceased and ensure they are caring for themselves.The last thing anyone needs at times like this is to be planning a double funeral.  

What do I do Next?

Congratulations to Hugh Crago, former editor of the Australian & New Zealand Journal of Family Therapy and his collegue at the University of Western Sydney, Penny Gardener, on the publication of their book "A Safe Place to Change: Skills & Capacities for Counselling & Therapy". The book is intended for those in their first year of counselling training and aims to describe capacities & skills that are central to the art of therapy across a range of widely practiced approaches. The authors highlight skills 'every competent helper needs when dealing with people in distress' including those of holding, exploring, encounter & coaching.The wisdom, warmth & experience of these authors will make this a text that even the most experienced practitioner will find valuable.Crago,H. & Gardener, P. (2012) A Safe Place for Change:Skills & Capacities for Counselling & Therapy IP Communications 

CYBER- Relationships, Intimacy & Risk

Terms like “personal computer” or “laptop computer” and “touch screens” are indicative of the increasingly intimate relationships humans are developing with these technologies. Email, texting, instant messaging, web chat and webcams all provide convenient on-the-go take away virtual conversations and relationships. An exploratory study of sex and relationship seeking online revealed that 75% of men and 41% of women had engaged in such activity. Only 2% of these respondents meet the criteria of compulsive use. What is the impact of this on the intimacy traditionally generated in human to human relationships? Partners may either move closer to one another, discovering aspects of one another not discussed before, or sometimes partners may move away from one another, with secrecy and deception emerging in the relationship. Respondents to the survey indicated many negative consequences including body image problems, decreased sexual desire and lower satisfaction in partners and sexual relationships.  

The Sibling Relationship & Couple Conflict

Working with conflicting couples can be challenging for therapists who may find themselves as imobilized as their clients by endless dispute. Mones, A. in the paper Exploring Themes of Sibling Experience to Help Resolve Couples Conflict suggests that the sibling relationship may provide an alternative route into resolution of couple difficulties. 'Processes of power, gender identity, competition, cooperation, affection, proximity-distance, communication, and empathy are regularly negotiated between and among brothers and sisters. These same skills and competencies are those that are critical in our marital interactions.' The author suggests that exploring key themes in each person's sibling relationships and comparing these understandings, can transform the relationship from 'one of disillusionment and conflict to one of acceptance and empathy.'

Mones, A. (2001) Exploring Themes of Sibling Experience to Help Resolve Couples Conflict. The Family Journal 9: 455  

Separation, Gender & Children

Staying together for the sake of the children has been a well recognized motivation for unhappy couples to continue their marriage. But for those who do decide to separate, what do we know about who makes this decision? Belinda Hewitt from the University of Queensland analysed 9,118 first marriages to explore the role of gender in separations by exploring the role of children. While the results do show that children deter separation there was only inconsistent evidence that the cost of separation with children was more likely for mothers than fathers or vice versa. While emotional and financial costs of ending a marriage are important considerations to both husbands and wives, these may be secondary to other factors like the impact of remaining in an unhappy partnership.

Hewitt, B. (2009) Which Spouse Initiates Marital Separation WhenThere Are Children Involved? Journal of Marriage and Family 71 (May 2009): 362–372 

    Problem Solving & Strategy  

In 1987 Jay Haley, famously said 'If therapy is to end properly, it must begin properly.' Fourteen years later Amini & Woolley have taken this maxim and applied it to the first session of brief strategic therapy. Their paper presents the Brief Strategic Therapy Scale-1 (BSTS-1), a supervisory observation tool which allows for analysis of the performance and competence of therapists. The scale identifies six interactional core skills needed in the first session of brief strategic therapy; flexibility of position, persuasiveness, technique/strategy, goal directedness, use of language and therapist-client relationship. The scale provides the beginning strategic therapist with the continual evaluation and specific feedback that increases therapeutic skill.

Rachelle L. Amini and Scott R. Woolley (2011) FIRST-SESSION COMPETENCY: THE BRIEF STRATEGIC THERAPY SCALE-1 Journal of Marital and Family Therapy Vol. 37, No. 2, 209–222  

Six Practical Tips for Keeping New Year Resolutions

This is the time of year when most of us think about making New Year’s Resolutions with the aim of improving our lives. However, many people struggle to change their behaviour in line with their resolutions, even though they want to. With this in mind, here are 6 practical tips and techniques that might make it easier to make the changes you’ve been wanting to make in 2012!!

1 – Get a little concrete. Plan your resolutions to include small, measurable actions instead of huge or vague hopes: “go for a 30 minute walk three times a week” is more likely to succeed in increasing your frequency of exercise than “get fit again” or “go to the gym for an hour every day”. “Borrow a new book from the library every fortnight” is more achievable for most people than “become a well-read person” or “read for an hour before bed”. Forming a new habit is easier when it’s linked to a repeated, practical action.

2 – Track your progress and stay accountable. There are many ways to track your progress in keeping your resolution: a daily chart, online tools like www.lifetick.com, speaking to family and friends about your new plans, having a “resolution buddy”, keeping a diary or journal, or even using Twitter or Facebook to note your progress, can help maintain your motivation to keep up the resolution when you’re not feeling good about it. Just writing down your resolutions and sticking them up somewhere obvious has a positive effect on your likelihood of keeping up with your plans for change.

3 – Focus on the positive. Often, resolving to add something enjoyable to your life can give you strength and energy to tackle some of the tougher things. So, go ahead and consider resolving to “call a friend for a chat twice a week” or “take someone out to coffee every Monday” or “book half an hour of novel reading time every second day” – you might find that you end up with the energy to tackle that messy spare room, go to the gym, or fix your finances.

4 – Review your resolutions regularly. We know that the more often we hear a message, the more likely we are to believe it’s true – it’s why advertising works so well, and why the messages we send to children are so important. But it can also work to change your behaviour – by taking 2 minutes each day to review your resolutions, you are keeping them fresh in your mind. Some online tools can assist with this, by sending emails each day or each week to remind you of your plans for change. Whether it’s morning or night, a daily refresher of your plans will keep them “top of mind” each day.

5 – Think about “why” as well as “what”. When framing a resolution, consider why you want to make this change. Do you want to increase your fitness so you can run around with your kids more? Do you want to clean out the spare room so your cousin can visit more? Do you want to increase your social contact to help keep your mood positive? Then, put a reminder of the “why” somewhere prominent in your life – the bathroom mirror, in your wallet, inside your car, on the fridge – so as well as the reminder about what you want to do, you also have a reminder about why it is worth doing.

6 – Don’t try to do too much at once. Most people’s lives are already full of commitments to family, work, friends, volunteering, housework, and hobbies. Resolving to make five big changes is likely to be overwhelming for anyone! Instead, choose one resolution to throw all your energy at, and focus on this for 2012. When fulfil a single resolution, you are likely to feel a greater sense of self-efficacy and success than if you do a half-hearted job at several resolutions.

All the best for 2012, and enjoy your summer! 

Congratulations to Catherine Sanders

Congratulations to Catherine Sanders, the 2011 recipient of the Australian and New Zealand Journal of Family Therapy Special Award for Distinguished Contributions to Family Therapy which was presented at the recent Australian Family Therapy Conference held in Melbourne. The awards is made to individuals who, on the assessment of their peers, have made an outstanding contribution to the field of family Therapy.

Catherine has more than thirty years public and private sector clinical experience as both teacher and therapist and in this time has practiced as a family therapist with a diverse range of clients and difficulties. She has particular interst and expertise in working with children their family, friends and world.

Catherine is past president of The Family Therapy Association of South Australia and the Australian and New Zealand Journal of Family Therapy and from 1984 to 1998 was associate editor of the journal. Catherine is a well-known presenter in both family therapy and psychology and has published in excess of a dozen papers both locally and overseas in refereed journals and books.

Catherine’s most recent work was also launched at the Family Therapy Conference in Melbourne; A Practical Guide to Family Therapy edited by Paul Rhodes and Andrew Wallis. This book draws together the expertise of a group of Australian family therapists who each contributed a chapter outlining their knowledge and skill in working with families. Catherine authored the seventh chapter “Including children in Family Therapy”. The book is published by IP Communications (www.ipcommunications.com.au )

To find out more about Catherine and the workshops she will be conducting in 2012, visit www.bowerplace.com.au

Gifts and Relationships - the good and the bad

With Christmas just around the corner, psychologist Marten Johns has some wise words for us about the value of gift giving. Perhaps we ought to thank those who receive our gifts for this exchange creates and reinforces an emotional bond.  Research by E. Dunn et al (2011) suggests people who spend money on others are often happier than those who spent money on themselves. These researchers suggest that it is the way we spend money rather than how much we spend.  They suggests that we “buy more experiences and fewer material goods; use their money to benefit others rather than themselves and buy many small pleasures rather than fewer large ones.”  When it comes to giving gifts it there appears to be some truth in the adage that  “it’s the thought that counts.”

As consumer spending goes into overdrive over Christmas, we tend towards impulse purchases, often getting more for less and  buying something the purchaser want, rather than something the receiver would appreciate.  With giving activating areas of the brain generally associated with rewards, the best reward is seeing a genuine appreciation from a receiver. 

When choosing, the better we know a person the more appropriate gift we are likely to purchase.  Giving a gift is an indication of the state of the relationship and choosing correctly is crucial.  E. Dunn (2008) looked at reactions to good and bad gifts and how this impacted on relationships.  “In Experiment 1, men viewed themselves as less similar to their new acquaintance after receiving a bad versus good gift from her, whereas women’s perceived similarity ratings were unaffected by  gift quality. In Experiment 2, men reported decreased similarity to their romantic partner after receiving a bad gift, whereas women responded to the bad gift more positively; perceived similarity, in turn, had an impact on participants’ evaluations of the relationship’s future potential.”  Avoid toasters I say!!

Elizabeth W. Dunn, Jeff Huntsinger, Janetta Lun and Stacey Sinclair (2008) The Gift of Similarity:

How Good and Bad Gifts Influence Relationships. Social Cognition, Vol. 26, No. 4, pp. 469–481

Elizabeth W. Dunn, Daniel T. Gilbert, Timothy D. Wilson (2011) If money doesn't make you happy, then you probably aren't spending it right. Journal of Consumer Psychology, 21, pp. 115–125 

ADHD-What Role Medication

The National Health and Research Council have drafted controversial guidelines  in relation to children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). These include a recommendation that  a failure by parents to medicate their children be treated as a child protection concern. This has, understandably, raised significant concern in parents and professionals who view ADHD stimulant medication as a less desirable treatment and one that can potentially be avoided with family based interventions. A diagnosis of  ADHD is based on the child’s behaviour and the difficulty parents and others, like teachers, experience in managing those behaviours.  

A study by Gregor Lange and colleagues identified that families with children diagnosed with ADHD have higher levels of stress, lack of support, low parental quality of life, family functioning difficulties, low parental satisfaction and parental psychological health problems (Lange et al., 2005). This suggests that family factors may act as both predisposing and maintaining factors and the importantance of  assessing the family and wider system with the understanding that the most effective interventions may be with those in the child’s world rather than the child. The proposed move closer to mandatory medicating children with ADHD increases the likelihood of neglecting the other factors that may potentially be more impactful. In addressing these factors and the common presentation of non-compliant/undesirable behaviours it is important to focus on interventions, other than medications, that address environmental and behavioural factors.

Lange, G., Sherrin, D., et al. (2005). Family factors associated with ADHD and emotional disorders in children. Journal of Family Therapy, 27, 1, 76-96.

Interested in reading more about Bradley Lange, the author of this newsletter? Then scroll down.

Bradley is a fully registered psychologist with the Psychiology Board of Australia and member of the Australian Psychological Socity having completed his training with a Master of Clinical Psychology.

Bradley has received training in a number of areas of psychotherapy, with specialised training in the child behavioural and developmental problems. Bradley’s experience,  has also been significantly focused on adult psychological problems, including depression, anxiety, anger, substance dependence, psychosis and attachment related problems.  Prior to working at Bower Place, Bradley has worked in ; child protection, adult acute mental health, drug and alcohol services, child behaviour therapy, adult therapy and family therapy.

Bradley takes an eclectic approach to psychotherapy with a focus on family systems, attachment issues, interpersonal therapy as well as cognitive and behavioural therapy, with the clients presenting concerns and view on therapy informing treatment direction.  

Bradley will be conducting the following workshops in 2012:

2nd March: Incompletely Fractured Couple Relationship

17th August: Depression and the Couple Relationship

16th Novemeber: Complex Co-Morbid Wider System Matters

7th December: Child Behaviour Problems: School & Family

Couples & Cancer

 A diagnosis of cancer is a frightening experience and most of us would assume that the presence of a supportive partner through the journey would be a valuable asset. Researchers  Baik,M. & Adams,K have reviewed literature evaluating couples interventions where one person is facing cancer. The results from fourteen studies showed that eight demonstrated improvement for patients, eight reported overall improvement for partners, five studies showed partial improvement for patients and three demonstrated partial improvements for partners.The authors conclude that 'although couples-based interventions may facilitate emotional support and dyadic coping, how these psychosocial interventions should be delivered, at what point in the illness and treatment they should be delivered, and how long they should continue remain as future challenges.'

 Baik,M. & Adams,K.(2011) IMPROVING THE WELL-BEING OF COUPLES FACING CANCER: A REVIEW OF COUPLES-BASED
PSYCHOSOCIAL INTERVENTIONS Journal of Marital & Family Therapy Vol 37,2 p250-256

Carol Manning, who will be presenting two workshops in the Bower Place 2012 workshop series, has developed expertise in working with women dealing with breast cancer.

Carol is a clinical psychologist registered with the Psychology Board Of Australia and member of the Clinical College of the Australian Psychological Society.She has trained in both cognitive behavioural therapy and family therapy and aims to provide a collaborative environment in which to help clients move toward helpful changes in their lives.

Carol has extensive experience in both the public and private health sectors. She enjoys working with adults with a wide range of issues including anxiety, depression, grief, eating disorders/body image issues and illness.  

Carol will be presenting two workshops in 2012:

8th June: Young Adult Women & an Eating Disorder

25th July: Women with Breast Cancer  

What is Family Therapy for?

When we hear the term Family Therapy most of us think of a practitioner sitting in a room consulting individuals, couples and families whose practice is informed by systemic thinking. This view is challenged by the editor of the Journal of Family Therapy, Mark Rivett in an editorial, Looking Beyond the Clinic (2010) 32: 1–3, which introduces papers that 'explore the boundaries of systemic practice in a number of innovative contexts'. These include narrative practices with refugee women, systemic work in learning disability services, systemic practice in a war-torn country and trauma response teams who travel  the globe. He raises the challenge, ‘What is family therapy for?’

One practitioner who has addressed this question in her professional life is Michele Banks who will be co-presenting in the Bower College Workshop series in 2012. 

Michele trained as a social worker at Flinders University and in family therapy at Oxford House in Adelaide in the 1980’s. She holds a UK qualification of MSc from the Institute of Family Therapy, London.

Michele worked in CAMHS  in SA to the  mid 1990’s in management and clinical leadership roles, focusing on work with adolescents, cross cultural practice and reaching out to underserved communities.

She went to the UK to develop these interests and worked in a range of settings in inner London, including inpatient and community settings with adolescents and their families with severe and complex mental health difficulties, in the South London and Maudsley NHS Trust; with the Tavistock Clinic in their first child and family outreach team; with refugees at the Medical Foundation for the Care of Victims of Torture; and most recently supervising family therapists and social workers in child protection in the London Borough of Hackney.

Michele has worked as a social work educator in Ghana, West Africa and has been a trainer and consultant to NGOs there and in other developing countries. She also has post graduate qualifications in health services management, dramatherapy and medical anthropology 

This Thing Called Change

Change is the central activity of therapy, yet how much do we really know about this mysterious process?  Researchers, MOLINARI,L., EVERRI, M., & FRUGGERI,L have taken up the challenge in a study aimed at understanding how families organize and regulate  interactions when discussing family change during children's adolescents. Studying  the coregulation of family members' interactions during transitions, periods of destabilization and uncertainty, can offer indications on how families face life challenges. A family's capacity to manage episodes of change can predict its members’ adjustment and better understanding of transitional processes in ‘‘normal’’ families, can support the design of prevention programs and intervention for parents’ and adolescents’ counselling.

MOLINARI,L.,EVERRI, M., & FRUGGERI,L (2010) Family Microtransitions: Observing the Process of Change in Families with Adolescent Children . Fam Proc 49:236–250, 2010  

 The Price of a Flutter

 Our propensity towards gambling is one aspect of our national identity. Whether it is traditional Two-Up on ANZAC day or a national public holiday for the Melbourne Cup there is no denying that gambling is part of our culture. It is therefore not unexpected that an attempt by the government to place restrictions on the use of pokie machines is being met with vocal opposition. Psychological factors that are identified as being related to problem gambling, once socio-demographic variables have been controlled for, include anxiety, loneliness and stress (Dowling & Brown, 2010). Further studies have identified problem gambling as having a higher prevalence in people with Major Depressive Disorder (12.5%) and Bipolar Disorder (12.3%) when compared to community based populations (Kennedy et al. 2010). With such prominent correlates between problem gambling and other recognised serious psychological problems, it begs the question how healthy our national identity is and how protective of it we should be when attempts are made to regulate it.

Dowling, N. & Brown, M. Commonalities in the psychological factors associated with problem gambling and internet dependence. Cyberpsychology, Behaviour and Social Networking, 2010. 13, 4.

Kennedy, S., et al. Frequency and correlates of gambling problems in outpatients with major depressive disorder and bipolar disorder. Canadian Journal of Psychiatry, 2010, 55, 9. 

NVR- A Guide for Parents & Professionals

Haim Omer's 2004 book Non-violent Resistance: A New Approach to Violent and Self-Destructive Children has proved a valuable resource to practitioners working with aggressive, out of control children and their families. Now authors Avraham-Krehwinkel,C. and Aldridge,D. have published a guide book for practitioners and parents.The book provides both theoretical explanation and case studies and  is based on an eco-systemic perspective which recognises the central role of relationship patterns which influence how we perceive others' behaviour and the judgements and actions which follow. A key theme is that rebalancing of power in the parent-child relationship will only happen with commitment, consistency and a willingness to remain steadfast. For entrenched behaviour this could take at least three months!
 

Omer,H. (2004) Non-violent Resistance: A New Approach to Violent and Self-Destructive Children Translated from
the Hebrew by Shoshannah London-Sapir and Haim Omer. Cambridge, UK: Cambridge University Press

Avraham-Krehwinkel,C. and Aldridge,D. (2010) A non-violent resistance approach with children in distress: a guide for parents
and professionals,  London and Philadelphia, Jessica Kingsley Publishers 

It's a Mental Health Week

October 9^th to 15^th is Mental Health Week 2011, a time to raise awareness of mental health issues in the community and explore and ways forward for sufferers. In the next year, 1 in 5 South Australian will experience a mental health problem and key to good recovery is freedom from stigma and discrimination. Mental Health Week opened with the presentation of the Margaret Tobin awards, established in 2004 in recognition of her contribution to mental health reform in South Australia and designed to  ‘recognise and celebrate the achievements of people or organisations that have made an outstanding contribution to mental health in South Australia.’ Other activities include the Stress Less in the Workforce Project, an initiative to encourage  businesses to recognise and address work related stress and an increase in funding of Rural Grants from $7000 to $22,000 to support rural Mental Health Week activities.

What Becomes of the Bully and the Bullied?

Two teenagers from Murray Bridge High School were recently charged with aggravated assault following an episode of bullying. Among studies which have increased our understanding of bullying is that of O'Brennan, Bradshaw and Sawyer (2008) which identified that victims of bullying and bully/victims were more likely to present with internalising symptoms, such as depression and anxiety, than their peers who were not involved in bullying. They suggested this linked to Major Depression and Anxiety Disorders later in life. The impact of bullying on peer relationships on both victims and bullies appears to change depending on age. However, bully/victims report a low level of perceived importance of peer relationships across age ranges which relate to poor social skills and negatively impacts ability to develop pro-social bonds in life.  

O'Brennan, L. L., Bradshaw, C. P & Sawyer, A. L. (2009). Examining developmental differences in the social-emotional problems among frequent bullies, victims, and bully/victims. Psychology in the Schools, 46(2), 100-115

 Recipe for Resilience 

Recently it has been announced that Dr Martin Seligman, a leader in the field of positive psychology, will be coming to Adelaide to strengthen the state's approach to resilience in our young people. Research into childhood resilience has identified parental and environmental factors, such as maternal warmth, positive parental and sibling relationships as well as a calm and well structured home environment as playing crucial roles in a child's emotional and behavioural resilience to bully victimisation (Bowes, et al. 2010). Other research had also identified the quality of the parenting and the parent's personal wellbeing as contributing to a child's resilience and that positive social support can impact on these parental factors (Armstrong, Birnie-Lefcovitch & Ungar, 2005). Being aware of what factors contribute to resilience and how they can be strengthened in our young people is important as we work to our future.

Armstrong, Birnie-Lefcovitch, and Ungar, (2005). Journal of Child and Family Studies, Vol. 14, No. 2.

Bowes, L., Maughan, B., Caspi, A., Moffitt, T. E. & Arseneault, L. (2010). Journal of Child Psychology and Psychiatry Vol. 51, No. 7.

Whats So Funny?

Is laughter the best medicine? University of NSW, researcher Dr Lee-Fay Low, asked this question in relation to nursing home residents suffering from dementia. 400 residents from 36 nursing homes took part in the SMILE study which compared mood, agitation levels, behaviour and social engagement of those exposed to a "humour therapist" as compared to 200 control residents who had no extra fun in their lives."Humour therapist" Jean-Paul Bell dressed as a lift operator and entertained residents for 3 months. He 'raised a smile or two by chatting away to imaginary people on the end of an old-style telephone handset and waved a magic wand about, asking residents what they wished for.' Those who received humour therapy showed a 20 per cent reduction in agitated behaviour including aggression, wandering, screaming and repetitive behaviour. Such results point to the need for care facilities to address the emotional needs of residents as well as clinical and practical care. 

Are we Ageist?

Does the clients' age and clinical training of the therapist relate to the evaluation of couples who present for conjoint therapy? This was the question researchers Ivey, D.,Wieling,E. & Harris,S (2000) explored by presenting clinical vignettes describing a younger and older couple. Each was described as experiencing an 'absence of sexual intimacy, increased frequency of arguments, and increased use of alcohol'. The vignettes were evaluated by practicing marriage and family therapists, therapists-in-training, and individuals with no clinical background. And the results............'relational and mental health concerns experienced by elder couples are not perceived as seriously as are identical concerns experienced by younger couples. However these perceptions were not influenced by levels of training or experiences suggesting that training did not mitigate against ageist attitudes.'

 IVEY,D.,WIELING, E. & HARRIS, S, (2000) Save the Young—The Elderly Have Lived Their Lives: Ageism in Marriage and Family Therapy Family Process, Vol. 39, No. 2

 More Complexity, more abuse

National Child Protection week is upon us (September 4th - 11th) and child abuse and neglect issues are on the national stage. Professor Patrick Parkinson from Sydney Law school released a report to Parliament this week outlining the increasing problem of child abuse and neglect across Australia. His report identified that over the past decade the cases of child abuse and the number of children in care has nearly doubled, resulting in a strained government system that is struggling to deal with the demand. One of the proposed reasons for this rise is an  level of complexity of issues in the family of origin. Once a child had been removed from the home the family continues to struggle to resolve  issues and make the home safe for their child to return, resulting in the child remaining in alternative care longer............

Click here to read psychologist, Bradley Lange's full response to this report./print/bower-place-blog/more-complexity-,-more-abuse 

Smart parenting, for safer kids

Congratulations to Emiritus Professor of Child Development at the University of South Australia, Freda Briggs on the launch of her 18th book 'Smart Parenting for Safer Kids'. Professor Briggs, AO is well known in academic circles for her research and publications in child sex abuse and her latest book is a response to parents' pleas for a 'book for them'. Professor Briggs who was interviewed by Ian Henschke on ABC radio 891 spoke of her belief that currently there are more hazards for children and that 'helicopter parenting', where parents hover over their offspring does not enhance protection but rather prevents children developing the skills and knowledge that will keep them safe.The book addresses the dangers chiuldren are exposed to in modern Western society, how to choose safe, high quality childcare and child minders, ways to protect  children from the dangers of bullying, cyberspace and the internets and protection of children from sex offenders and sexual abuse. 

Click on the link to hear the interview with Professor Briggs. http://blogs.abc.net.au/sa/2011/08/creating-a-safe-world-for-your-kids.html

Briggs, F. (2011) Smart Parenting for Safer Kids Jojo Publishing, Melbourne

The London Rioters - What were they thinking

Listening to the Law Report on Radio National this week I was fascinated to hear London defence lawyer Bruce Reid reflect on those he is defending as a result of the London riots."What's been strange about it is the fact that a large number of them have no convictions. At this kind of riot you  expect your regular clients, career criminals, to be arrested. What's been surprising is we've had a lot of first-timers. I've had a 20 year-old mother, two months pregnant, looting an electronics store and coming out with a vacuum cleaner. I've had a university student stealing clothes and electronics, and he received a 12-month sentence. Comes from a middle-class family, no need to steal. I don't understand why he did it".

Psychologist, Clifford Stott researches crowd reactions to policing and triggers to violence and has suggested that while people don’t become irrational and do continue to think for themselves, the crowd reacts in response to the behaviour of other groups. When threatened, he suggests that a make-shift social identity is formed and individuals begin to work together for the benefit of all. It is less a case of loosing an identity, than gaining a new one in reaction to a threat.

This explains violent reactions to police but does it explain the looting?

Click here for more information on Clifford Stott:

http://www.liv.ac.uk/psychology/staff/CStott/HMIC%20Report%20Crowd%20Psychology%20-%20Final%20Submission%20Draft%20%2814-9%29.pdf