ABSTRACT Family‐Based Treatment (FBT) is an evidence‐based treatment for young people with anorexia nervosa (AN). It utilises principles of family therapy, such as externalisation, to help separate the young person from their anorexic thoughts and behaviours using language and metaphor. As previous research highlighted some potential barriers to implementing FBT, this study explores the experience of FBT with young people themselves. Semi‐structured interviews were carried out with young people attending FBT for AN enquiring about their overall experience of FBT and externalisation. Interpretative Phenomenological Analysis (IPA) was used to analyse the data. Four main group experiential themes emerged: the insidious and deceptive development of eating disorders; grappling with the truth and surrendering control to treatment; reclaiming the self: the role of expert guidance and externalised narratives in recovery; and new perspectives from cognitive recovery. Externalisation was generally experienced as providing hope and agency in recovery and reduced feelings of guilt and blame among participants.
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Child sexual abuse (CSA) can lead to a host of adverse outcomes, and disclosing it can be an important part of the healing process. Most research in this area focuses on children who disclose, yet survivors often delay disclosure until adulthood, typically because of worries about parental responses. To strengthen awareness of perceived helpful and unhelpful parental reactions to adult child sexual abuse disclosure, this study presents results of a grounded theory investigation of adult survivors' (N = 15) perceptions of their parents' responses to CSA disclosure. Results centre on the survivors' views of parents' reactions, questions, behaviours, positionality and follow-up actions in response to the disclosure. Participants also shared how the familial context shaped responses and ongoing parent-child discussions following disclosure. The resultant grounded theory highlights relational processes that hindered or strengthened the parent-child relationship. Findings provide insights for family therapists and researchers.
In this paper we explore how a particular event-a genocidal war on Gaza-constitutes a rupture point, creating profound perturbations at many levels; for professional communities, as well as for citizens of the world. We argue that it requires systemic therapists to hold up to scrutiny some core conceptual frameworks and to rethink therapeutic responses. We address the question of how systemic frameworks can be utilised to analyse this unfolding catastrophe and the processes driving it, but we also argue that some are inadequate or evasive in grappling with the ethical questions which confront us. Given the scale of suffering, we raise questions about how to extend the parameters of our understandings of trauma and we explore what therapeutic approaches might possibly be of use. We share the ways in which colleagues in Gaza-through ongoing practices of psychological survival-continue to inform and enrich us. We explore the question of what responsibilities systemic therapists should assume and we give an example of work with a team in Gaza which includes witnessing, narrative and liberation psychology practices. We allude to how the war on Gaza impacts upon relationships with professional colleagues and within our agencies.
This qualitative study examined the lived experiences of Chinese parents with depression within a collectivist and interdependent cultural context. To recognise the underexplored relational and systemic dimensions, 14 parents diagnosed with depression were recruited via community mental health services in Hong Kong. Data were collected through parent-child dyadic (n = 8) and individual semi-structured interviews (n = 12). Thematic analysis was employed and two themes were generated: "Internal agent of cultural expectations in parenthood" and "External reinforcer of cultural norms in parenthood". The first highlighted how parents actively scrutinised their children's development and parental roles to meet societal standards. The second illustrated how external monitoring by family and community reinforced cultural expectations, often marginalising parents within the societal context. These findings emphasise the need to shift from a predominantly biomedical and individualistic approach toward a holistic perspective that incorporates the interplay between parents and their social environment into mental health research and practice.
This study employs a qualitative methodology to explore the relational dynamics influencing engagement with young people identified as hard to reach within a local authority youth offending service in East London. Grounded in critical realism and decolonial ontology, the study sought to uncover underlying social structures and power relations that shape engagement processes, whilst also valuing the lived experiences of both young people and practitioners. A Foucault and Quijano-informed thematic discourse analysis of ethnographic observations and semi-structured interviews revealed a complex interplay of micro-level relational dynamics and macro-level structural and systemic influences. Findings highlight the limitations of the HTR label and punctuate the need for systemic interventions that address power imbalances, cultural assumptions, and historical injustices.
While numerous studies examine the characteristics of families affected by psychoactive substance (PAS) use, less attention has been given to the broader impact of substance use on key aspects of family life. This study explores the effects of PAS consumption on four dimensions: family dynamics, work, emotional well-being, and leisure time. A 30-item instrument was developed and administered to 681 family members of individuals receiving treatment for PAS consumption at 17 specialised centres nationwide. Data were collected electronically with the assistance of trained therapists and analysed using the pandas library for data processing and matplotlib for data visualisation. Results indicate that all dimensions were negatively affected, with family dynamics showing the most significant deterioration, characterised by increased conflict and tension. Emotional well-being, leisure time and work productivity were also adversely impacted. This study offers initial insights into an under-researched area and highlights the need for targeted preventive and therapeutic interventions.
Many people place friendships at the centre of their lives, yet systemic therapists often focus exclusively on familial and romantic relationships. In this study, we explored how systemic therapists understand and approach working relationally with friends in therapy. We interviewed 17 UK-based systemic practitioners and analysed the data using reflexive thematic analysis. Although most participants were unfamiliar with friend therapy, they expressed curiosity, ambivalence, and thoughtful reflection on their personal and professional values. Participants recognised that practitioners could apply systemic skills to friendships, especially given social and cultural shifts that elevate the role of friends. At the same time, they identified barriers, including institutional norms, a lack of evidence, and concerns about applying therapeutic frameworks to these relationships. Our findings suggest that systemic therapists may be well-placed to work therapeutically with friends, but doing so could require shifts in training, tools, and ideology. Friend therapy challenges the field to reconsider which relationships deserve therapeutic attention.
Embedded systemic trainings have recently gained popularity in Doctorate in Clinical Psychology (DClinPsy) programmes due to increased recognition and government funding. However, limited evaluations have been completed to understand both student experience and the effectiveness of the embedded training. As part of piloting the new systemic pathway in the DClinPsy programme at Royal Holloway, University of London (RHUL), we recruited students from our 2023 cohort for the evaluation. We developed the Systemic Competence Survey (SCS) to evaluate the embedded Foundation Training in Systemic Practice (FTSP) quantitatively and qualitatively. The SCS demonstrated that participants improved their self-reported systemic knowledge, especially in applying the family life cycle framework. However, confidence in practical competencies showed minimal growth. Qualitative data highlighted the abstract nature of systemic ideas and a structural misalignment where compulsory FTSP precedes appropriate placement opportunities. This suggests the need to better align the timing of FTSP with practical application to enhance skill acquisition and meet key learning outcomes.
This paper discusses the changes brought to family therapy by the advent of postmodern philosophy. We examine the role of social constructionism in this context and distinguish its various versions based on their realist or anti-realist perspectives. We argue that contemporary family therapy should not be ontologically mute, as is currently the case in some approaches. Family therapy must incorporate both epistemology and ontology into a coherent philosophy of therapeutic practice. We highlight that the realism or anti-realism of the philosophy adopted by the therapist does not necessarily determine the authoritarian or non-authoritarian nature of his therapeutic practice. This is exemplified by new models of family therapy that are not ontologically mute but place significant emphasis on the therapeutic relationship. We suggest a therapeutic stance of collaborative or critical knowing, as we believe it can more effectively address the polarities inherent in the therapeutic process.
In this research methods article, it is argued that the issue of 'learning how to ask' is central to both ethnography and clinical practice. The paper describes ethnography and participant observation in qualitative research, arguing that ethnography is an ethical, political and disciplined approach. A short history of anthropology is provided, including the colonial setting of its origin. The article then describes what is involved in carrying out ethnography, how material, often referred to as data, is accessed, and how this material may be analysed. The close involvement of the person and the body of the researcher(s) in these processes is explained. The article makes a distinction between anthropology, ethnography and participant observation in relation to how these capture the processes of everyday life. In conclusion, the author argues for the need to recognise plurality, reflexivity and sustainability in relationships between researchers and systemic psychotherapists and their interlocutors.
This article presents a qualitative study exploring clients' experiences talking about their sexual relationships in couple therapy, and their wishes for how these conversations should unfold. Semi-structured interviews from 10 therapy processes were analysed through systematic text condensation. The findings are presented in the categories: The need to thematize sexual issues, Barriers to good thematization of sexual issues and Significance of thematization of sexual issues in the time afterward. All participants wanted sexuality to be thematised, yet this occurred in only half of the therapy processes. Due to the vulnerability associated with initiating such dialogues, clients wanted therapists to take the initiative, and address sexual issues in depth, with comfort and sensitivity. A thorough treatment of the topic helped the couple continue to manage discussions afterward. The study suggests that barriers to communication about sexuality lie with clients, the therapist, and how clients experience the skills of the therapist.
This paper presents two accounts of therapeutic work using Minecraft with families that include autistic children and children with ADHD. These accounts show how a popular videogame can be adapted to become the site for systemic interventions and a reflective space for families to explore strengths, difficulties, and relationships. With preparation, a range of systemic techniques and practices - including externalisation, sculpting, circular and reflexive questioning, and perspective-taking exercises - can be adapted for and implemented within the game. The paper outlines how these approaches were integrated into online systemic therapy, how practical and safety considerations were addressed, and how the families experienced the process. In both accounts, Minecraft provided an accessible, engaging, and flexible environment that supported therapeutic aims while also fostering moments of shared enjoyment, creativity, and bonding. The paper concludes by inviting practitioners to consider Minecraft as a medium for creating more inclusive and accessible services for families that include autistic children and children with ADHD.
Attachment ruptures, when children struggle to trust in parental availability and support, are linked to increased risk of psychopathology. Preventing or repairing these ruptures is important for fostering secure attachment and promoting family mental health. FamilieLink is a blended intervention that provides attachment-focused knowledge and parenting skills based on the dynamic model of the insecure cycle, with minimal professional involvement. This case study illustrates its application with Emma, a mother seeking support for her 10-year-old son’s anger outbursts and sibling conflicts. Using psychoeducation, reflective exercises, and emotion-coaching skills, Emma developed greater insight into her son’s emotional needs. She found the platform effective in raising awareness and offering practical guidance, though she noted a desire for more content on neurobiological underpinnings of attachment. Nevertheless, Emma recommended FamilieLink as a valuable resource for parents facing similar challenges. This case study highlights the potential of low-intensity, blended interventions to foster secure attachment within families.
Grounded in the Social-Emotional Ability Development (SEAD) framework, this study examined how social-emotional abilities are associated with romantic relationship quality, consisting of relationship satisfaction, positive interaction, and emotional bonds, with relationship commitment as a mediating factor. Structural equation modelling was conducted with data from 1268 married individuals to test direct and indirect effects. Findings revealed that social-emotional abilities were positively associated with romantic relationship quality, and commitment significantly mediated this association. Individuals with great emotional awareness, regulation, and empathy reported strong dedication to commitment, which in turn enhanced relationship outcomes. These findings underscore the importance of social-emotional development in sustaining healthy relationships. Because social-emotional abilities can be cultivated throughout the lifespan, they represent meaningful targets for prevention and intervention. Moreover, relationship quality has spillover effects on the psychological and relational well-being of couples and their children; the findings offer practical implications for marriage and family counselling, psychoeducation, and relational health programs.
This study examines the experiences of Israeli therapists in conditions of collective trauma following the devastating events of October 7, 2023. The study is based on eight in-depth interviews conducted with six therapists, a director, and a clinical supervisor at the Sdot Negev Resilience Centre in southern Israel, conducted during the period May to July 2024, 8-10 months after the start of the war between Israel and Hamas. The interviews focussed on (1) the challenges of providing mental health treatment after the October 7 terrorist attacks, (2) adapting professional interventions to the new reality, and (3) personal coping resources of the therapists. A thematic analysis of the interviews raised five main themes: the need for mental flexibility and creativity in therapeutic interventions in emergency situations; the challenge of maintaining professional involvement against the backdrop of the crisis of trust in the state's systems; the impact of strong identification between therapists and clients against the background of the shared traumatic experience; the increased importance of self-care for caregivers; the added value of systemic work with families and communities. The findings of the study indicate the need to develop a new treatment paradigm adapted to situations of collective trauma, while recognising the complexity of therapeutic work when the therapist is part of the affected community.
Transitioning between mental health services is a vulnerable process that can challenge treatment outcomes. This study explores the experience of moving from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) from the perspective of young people with anorexia nervosa. Qualitative interviews were conducted with three women undergoing this transition, focusing on their motivation, ambivalence and the changing role of the family. The data were analysed using interpretative phenomenological analysis. Four themes emerged: Sudden shift of responsibility; relational needs unmet during transitioning; the changing role of the family; and transitioning to treatment with peers. The findings highlight two novel aspects of this process: the lasting impact of family-based treatment on parental involvement and the dual role of peer treatment as both maintaining and motivating. Trial Registration: ClinicalTrials.gov identifier: NCT05956366
Competency-based training is thought to increase standards of therapist practice. The Systemic Practice Scale (SPS) has been developed to measure student competence in systemic therapy. Two studies were conducted to test the reliability and validity of this scale by using student data across three different UK training sites. Reliability was assessed by checking consistency in scoring across training sites and comparing data across year groups, with an expectation that competencies would improve over time. The factorial validity was assessed by examining the factor structure and internal consistency of the scale from data collected at one training site over seven years. The results of the studies indicate that the SPS holds construct validity, as student scores increased over time, and that the scale measures a single dominant construct. However, there was a difference in scoring across sites which linked to whether the SPS was used for assessment or feedback only.
This study examined the impact of the Tuning in to Kids (TIK) parenting programme for military fathers, their spouses and their children aged 4-6 years. TIK is designed for parents of children aged 4-12 and provides guidance on enhancing parental emotion socialisation. The programme uses an emotion-focused approach to improve parent emotional functioning, emotion coaching, parent-child relationships, and children's emotional, social and behavioural functioning. In this study, TIK was delivered separately to mothers and fathers in group settings. Participants included 12 military fathers, their spouses, and their children aged 4 and 6. An experimental design without a control condition was employed. Measures included the Children's Emotion Knowledge Test, Social Problem Solving Skills Scale, and parent report measures of Reactions to Children's Emotions and Coping with Children's Negative Emotions Scale. Findings indicated that TIK participation was associated with increases in parents' reported emotional socialisation behaviours. Children's also showed improvements in emotion understanding and social problem solving skills. These preliminary findings suggest the programme may benefit military families, highlighting the need for further evaluation with larger samples.
Dialogical and collaborative approaches for mental health crises have become increasingly popular worldwide. Although many of the ideas taken up in dialogical therapy, such as Tom Andersen's reflecting team, are widely practiced, little is known about how this practice supports relational reflexivity during dialogical meetings with families. This study used Systemic Functional Linguistics to explore reflecting team dialogues and the immediate responses of family members during 14 Open Dialogue network meetings. We found markers of reflective and dialogical interactions including the presence of mental processes expressed as spatial metaphors; epistemic modality to invite perspectives; and expressions that expand on themes in the families' talk. In the moments immediately after team reflections, network members took up these metaphors, moved into broader contextual reflections, and used language that acknowledged multiple viewpoints. These results offer insights into how dialogical therapies may support interpersonal reflection, recovery, and healing.
