ABSTRACT This In Practice article describes the implementation of Open Dialogue, a dialogic, network‐based approach to mental health, within Youth and Family Services at the Counseling Service of Addison County, a community mental health agency in rural Vermont, USA. It outlines how Open Dialogue network meetings were integrated into everyday clinical practice and reports service activity between 2022 and 2025, during which the team facilitated 880 meetings with 232 families. The article explores the relevance of Open Dialogue for youth and families, including its attention to complex family dynamics and the voices of children and adolescents, and reflects on practical challenges such as staffing, documentation and regulatory pressures within community‐based mental health services. Drawing on this experience, the paper offers practice‐based reflections on how Open Dialogue may be implemented and sustained in youth mental health settings.
ABSTRACT This paper describes the development and early implementation of a culturally grounded practice approach, the SEWB Yarning Cards 2021 , designed to operationalise cultural frameworks within routine service delivery. Utilising the Social and Emotional Wellbeing (SEWB) Framework (Gee et al., 2014), the SEWB Yarning Cards aim to bridge conversations between human service professionals and Aboriginal and Torres Strait Islander people, using culturally relevant language. The SEWB Yarning Cards strive to stimulate the exploration of the seven SEWB inner domains, through facilitating culturally sensitive yarning, in an effort to bring culture to the forefront of service provision for Aboriginal and Torres Strait Islander people. By emphasising the interconnectedness of the self and well‐being, the cards have the potential to disrupt Western service delivery models, challenge entrenched practices and broaden access to Indigenous methodologies for non‐Indigenous human service providers, supporting transformative practice. By promoting culturally responsive interactions, the SEWB Yarning Cards aim to centre the voice of Aboriginal and Torres Strait Islander individuals, families and community in ways that have the potential to inform decision‐making, therapeutic interventions, referral pathways and the development of personalised culturally grounded understandings. This paper focuses on the methodological design and implementation of the approach rather than on evaluation outcomes.
ABSTRACT The contemporary language‐centric paradigm in family therapy provides a mature systemic framework for intervention, yet faces limits in conveying non‐codable, embodied familial lived experiences. Although codifiable, linear language is the primary meaning‐making tool; it often cannot fully capture latent emotional tensions, embodied experiences and power dynamics inherent in family interactions. When therapeutic practice encounters situations resistant to linguistic penetration, artistic interventions are often reductively construed as mere ‘emotional outlets’ or ‘ice‐breaking techniques’, thereby significantly diminishing their ontological value in reconstructing family interaction systems. Grounded in the non‐verbal turn of systemic theory and informed by a poststructuralist critique of discourse, this paper advances the central proposition of ‘art as a relational language’, moving beyond instrumentalist conceptions. It argues that artistic interventions are not supplementary to verbal therapy; rather, through the presence and interactive engagement of non‐verbal symbols, they restructure the mechanisms of family meaning‐making, dissolve discursive hegemony and externalise tacit relational rules. By analysing the deep operational logic of art in relational externalisation, power redistribution and co‐construction of meaning, the study delineates therapists' reflexive ethical boundaries in artistic practice and, through illustrative cases of symbolic transformation of implicit interaction rules, constructs an integrated ‘art–relation–system’ analytical framework. Ultimately, this framework demonstrates how art‐based interventions facilitate a shift in family therapy from ‘discourse‐dominated meaning construction’ towards ‘multimodal relational reconstruction’, providing theoretically robust and practice‐oriented tools for addressing complex family dynamics.
ABSTRACT The use of family group conferences (FGCs) in the Norwegian child welfare service (CWS) is introduced as a promising approach, inspired by Māori people's traditions. However, how the FGCs work is experienced by one of its main contributors, the Family Group Conference Coordinators (FGCC), has undergone limited exploration. The present study examines FGCCs' experiences. Data include a representative group of practising, experienced FGCCs from the entire region of Northern Norway in the CWS ( N = 12). Based on semi‐structured interviews through three focus groups, they were asked about their subjective experiences of doing FGCC work. Data were qualitatively analysed according to systematic text condensation. Primarily, the FGCCs advanced FGCs as process facilitators. This entailed concrete initiatives to optimise processes among those involved. First, initiate a fast beginning, encourage participation and successive rather than single meetings. Second, place the child in the centre position, making FGC ‘the child's meeting’, ensuring the child's understanding and participation. Third, apply a neutral, humane stance by asking open questions and inviting curiosity towards differences among those involved. Fourth, advance an early introduction of the FGC approach, follow‐ups and FGCCs as initiators of follow‐ups to augment FGCs' potential. All reported high job satisfaction and sense of mastery by contributing towards turning children's and family networks' attention away from personal deficits and conflicts into shared responsibility for challenges and contribution towards the child. To optimise job satisfaction and sensitivity, they advocated frequent practice. Based on Māori inspiration, practising Norwegian FGCCs experience being process facilitators as the main ingredient of their FGCC work. To build favourable processes, they cultivate detailed initiatives, while placing the child in the centre. Their experience‐based practice as process facilitators sends suggestions to the general family therapy field and CWS about concrete initiatives to facilitate processes among children and family network at conflicts. Further research on family inclusion and participants' experiences is needed.
ABSTRACT When difference in oneself is rejected by oneself and others, malaise appears as a sign of openness to new possibilities. This article presents a clinical reflection on the concept of difference, but with special attention to difference in the relationship of the self with oneself. It describes the therapeutic work carried out by a clinical team from the University of Chile, using the one‐way mirror as a space for hospitality toward the difference in an adolescent migrant patient, making visible the tension between the mandate of sameness and the need to recognise otherness in himself. Closely following the work of Michel Foucault, therapy becomes an ethical and aesthetic path to concern others in pursuit of new relationships with themselves.
ABSTRACT Brain injuries can put marriages and partnerships under considerable strain. One contributor to this is narratives about the relationship focused on discontinuity, rupture and loss, in which life after the injury is compared unfavourably to life before. Similar narratives about rupture and loss also affect the self‐identity and well‐being of both partners. Aims were to develop structured guidance about applying narrative therapy with couples following brain injury and to explore its usefulness for this purpose. The therapy focused on helping couples identify continuities in their life (including values and strengths) and develop richer narratives about their life together. The general principles of narrative therapy with couples are outlined, and a session‐by‐session plan is described that translates these principles into specific practice. Individual and couple trees of life were also used as part of the therapy. Three couples received the therapy. To evaluate its usefulness, couples were asked to provide feedback about their experience of it and to complete questionnaires about their relationship and individual well‐being before and after therapy. A description is given of the therapy's application for each of the three couples and their response to it. All three couples described how they had benefited from the therapy, and all showed some statistically reliable improvements on the questionnaires. Narrative family therapy, with its emphasis on empowerment and the value of richer narratives, may be particularly useful in a brain injury context where couples often feel helpless and their experience is dominated by narratives of rupture and loss. Structured guidance for its application also has the potential to enable its delivery by clinicians working in rehabilitation settings who do not have highly specialist training in relationship therapies. Further refinements of the guidance are needed, and the approach needs to be evaluated in more diverse contexts.
ABSTRACT The impact of acquired brain injury (ABI) on families is well documented, and there are long‐standing calls for a family focus in treatment. The purpose of this enquiry was to explore clinicians' perspectives on family‐inclusive practices in ABI care. We conducted a semi‐structured focus group with six clinicians working in ABI care within and across acute, rehabilitation and community settings in Melbourne, Australia. Focus group data were subject to qualitative content analysis using a deductive, predetermined coding system. We identified six themes that characterised clinicians' practice with individuals and their families post‐ABI. Themes summarise the complexity of providing care that acknowledges not only the individual's needs but also the familial and relational context that should inform recovery and rehabilitation post‐ABI. Clinicians reported on the importance of responding to the impact of ABI on the whole family, particularly the effects of trauma, and the benefits of maintaining hope and actively resourcing effective family programs and social support systems. Increasing the workforce capacity for family engagement, including training and other related activities, such as organisational and implementation support, would promote these aims.
ABSTRACT Walk‐in single‐session models have the potential to provide timely access to family mental health support, while addressing service system resource constraints. Single‐session therapy models have demonstrated effectiveness across various contexts internationally, yet few studies have examined their impact on family and relational outcomes. This study aimed to compare the effectiveness of two family therapy interventions within the same service setting for families facing complex challenges, such as mental illness, substance use and trauma. One offered immediate access to a single online session; the other provided multiple sessions of therapy following a full intake assessment and a variable wait time. Sixty family members (30 per intervention) participated in the 12‐month follow‐up. Using a mixed‐methods design, measures of confidence, satisfaction and relational outcomes were collected, and in‐depth qualitative interviews conducted. At the 1‐year follow‐up for both interventions, sustained improvement in relational and family functioning outcomes was noted and did not differ significantly between groups. Similar confidence levels were reported about the continued effective management of the original concerns. Families in the single‐session group universally valued rapid access to whole‐of‐family care, and this appears to be a central contributor to positive outcomes. Although most family members reported positive outcomes from just one session, the benefit of longer‐term support pathways for some families was also evident. The findings of this relatively small study support the potential of single‐session, rapid‐access interventions to provide effective support for distressed families dealing with complex challenges. Timeliness and a well‐defined single‐session focus may create conditions of support that enable change at levels similar to traditional multi‐session family therapy. Further studies with larger sample sizes across different service contexts appear warranted.
In this article, I consider the role 'theory' has played in my professional life against the background of social science, particularly social anthropology, and of systemic psychotherapy. I offer three events in which I had to respond to the use of theory directly, showing how this use was contingent on particular contexts, questions and what I wanted to achieve. I look back to acknowledge that in these events I stayed within a modernist fold according to which ideas should be tested in terms of pre-established criteria. At the same time, I point out that in much research this is not actually what is done. Rather, 'theory' is often seen as upholding a status quo, while differences are uncovered in experimentation. Such tensions between similarities and differences have comfortably stayed within what we have called 'the human' or 'humanity'. The paper moves on to interrogate the assumption of 'the human' inspired by post-qualitative and decolonising research approaches. In this, it takes cues from Haraway's notion of 'god trick', from Wynter's critique of Man, from Barad's work on quantum physics and Lugones' idea of the 'streetwalker', arguing that theory and orientations have localised origins. This local ground is where theory and practice are entangled, where the subject is not unified, and where we as systemic psychotherapists are 'in the middle'. I provide an example from my own therapy practice suggesting that theory is ethics. In order to pursue ethical knowledge/practice, we may therefore do well to turn to 'the local' and to situated knowledges. Here, there is no dichotomy: Theory is practice and practice is theory.
Within family therapy training, genograms are taught as a core part of understanding and working with family relationships. Trainees also construct their own families of origin as a method of understanding the mechanics of the process and, more importantly, as a direct method of exploring the relational nature of psychological resources and psychological distress. This paper examines the cultural assumptions embedded in the conventional Western genogram and describes efforts to develop a culturally meaningful approach for First Nations family therapy students in Australia. Standardised genogram symbols may inadequately represent kinship systems that integrate Country, community, spirituality and postcolonial histories. We propose a reimagined genogram that incorporates context, story and artwork, moving beyond low-context symbolic conventions towards culturally resonant representations. In doing so, the genogram is not merely adapted but transformed-honouring Indigenous ways of knowing whilst retaining its systemic foundations. Underpinning this work is an ethic of two-way listening and learning between Indigenous and non-Indigenous students and teachers.
This paper is a decolonising, Indigenous qualitative inquiry that integrates elements of critical autoethnography, narrative methods and conceptual analysis to explore how Peruvian Andean cosmology can inform contemporary systems thinking and family therapy practice. Writing as a mestiza, a Peruvian migrant in Australia, the author traces the lived experience of cultural erosion within Western, individualistic contexts and her reconnection with ancestral Andean teachings. These teachings-rooted in reciprocity, ecological attachment, collective responsibility and relational balance-are presented as living epistemologies that offer timely contributions to working therapeutically. The author examines core Andean concepts including ayll (kinship-based community), ayni (sacred reciprocity), Yachay (aprenderes Spanish) (embodied ancestral knowledge, through experiential learning), the Chakana (Andean cross) and the cosmological trilogy of Hanan Pacha, Kay Pacha and Ukhu Pacha. These relational ontologies predate and enrich systems thinking and practice, challenging anthropocentric assumptions embedded in Western perspectives and offering timeless frameworks for understanding identity, belonging, ecological distress and intergenerational trauma. Ecological attachment-connection to land, place and the more-than-human world-is proposed as foundational to wellbeing and particularly relevant for Indigenous and migrant families. Applications for systemic practice include recentring relational ontology; integrating ecological and ancestral systems into assessment and formulation; adopting ayni as a relational ethic of humility and accountability; applying yanantin (complementary dualism) to reframe conflict and difference; and incorporating ritual, symbol and embodied practice to support healing. The paper concludes by advocating for a decolonising therapeutic stance that honours Indigenous therapeutic sovereignty, resists cultural imperialism and positions systemic thinkers and practitioners as agents of relational, ecological and cultural reconnection.
Hoarding disorder is a chronic and disabling disorder that impacts not only the person experiencing the disorder but also their family members. This qualitative study explored the impacts of clinical levels of hoarding on adult children and partners of individuals with hoarding disorder. Of the 34 participating family members, 20 completed semi-structured telephone interviews and 14 participated in two focus groups. Participants completed questionnaires assessing sociodemographic and clinical characteristics and hoarding severity. Transcribed interviews were analysed using thematic analysis. Three overarching themes were identified: (1) 'Self-Concept and Meaning Making', capturing how participants' internal experience had been negatively affected by the person with hoarding disorder; (2) 'The Relational Experience', reflecting the negative ways in which participants' interpersonal relationship with the person with hoarding disorder and others had been impacted; and (3) 'Unmet Needs', depicting the information and support needs of family members, and recommendations for future family-centred interventions for hoarding disorder. The majority of participants appeared to draw on unhelpful coping strategies and reported unmet information and support needs. The findings elucidate substantial, wide-reaching and enduring impacts of hoarding on family members, including disruptions to daily functioning, mental health, self-esteem, relationships and overall quality of life. Family members often represent the forgotten client within healthcare settings, pointing to a pressing need to recognise and support them throughout the recovery process.
When difference in oneself is rejected by oneself and others, malaise appears as a sign of openness to new possibilities. This article presents a clinical reflection on the concept of difference, but with special attention to difference in the relationship of the self with oneself. It describes the therapeutic work carried out by a clinical team from the University of Chile, using the one-way mirror as a space for hospitality toward the difference in an adolescent migrant patient, making visible the tension between the mandate of sameness and the need to recognise otherness in himself. Closely following the work of Michel Foucault, therapy becomes an ethical and aesthetic path to concern others in pursuit of new relationships with themselves. Cuando la diferencia en s & iacute; mismo es rechazada por uno y por los dem & aacute;s, el malestar aparece como signo de apertura a nuevas posibilidades. Este art & iacute;culo presenta una reflexi & oacute;n cl & iacute;nica en torno al concepto de diferencia, pero colocando una especial atenci & oacute;n a la diferencia en la relaci & oacute;n consigo mismo. Se describe el trabajo terap & eacute;utico realizado por un equipo cl & iacute;nico de la Universidad de Chile, utilizando el espejo unidireccional como espacio para la hospitalidad con la diferencia de un paciente adolescente migrante, visibilizando la tensi & oacute;n entre el mandato de igualdad y la necesidad de reconocer la alteridad en uno mismo. Siguiendo de cerca la obra de Michel Foucault, la terapia se convierte en una v & iacute;a & eacute;tica y est & eacute;tica para inquietar a otros en pos de nuevas relaciones consigo mismo.
This paper is in two parts. The first part describes the 'Mirrors of Possibilities' approach, a novel decolonised systemic psychotherapy ceremony-like method containing our Indigenous Celtic perspective and consideration of our collective ancient indigenous neurobiological roots. This therapeutic model uses metaphorical mirrors to help clients reflect on their strengths, struggles, emotions, identities and interconnections with the aim of fostering healing, belonging and relational growth. The 'Mirrors of Possibilities' process is structured into six distinct phases, and its adaptability is demonstrated with client examples. The paper's second part outlines how, using the 'Mirrors of Possibilities', therapists can decolonise themselves and systemic psychotherapy by integrating aspects of systemic family therapy and narrative therapy, compassion-focused therapy, the symbolism of Jungian psychology, the Kinship Indigenous Worldview, the Evolved Nest and feminist decolonial intersectionality. This approach aligns with the Indigenous Celtic concept of 'Duthchas'-a deep sense of belonging and responsibility that reconnects us to our shared humanity and to our Sacred reciprocal relationship with Nature.
Family therapy, like any other theory within the helping professions, is as moulded by the systems of colonisation. This paper, which explores how this occurred, utilises client material to explore just how we might recognise, challenge and decolonise the ideas that have shaped our profession. Although presented through the lens of individual psychotherapy work, the author recognises that family therapy is well-positioned in this regard and encourages readers to use their undoubted talents to challenge the structures that inhibit us as we work with clients from other varying cultures.
The history of the mental health sciences includes numerous instances where parents were unjustly blamed for their children's psychological distress. From its inception, family therapy moved away from linear causal, intrapsychic explanations to emphasise complex family dynamics. However, systemic perspectives may still have unintentionally sustained a culture of blame. In contemporary Western society, high expectations around 'good parenting' place considerable pressure on parents to create ideal conditions for their children's development, often leaving them feeling insecure and inadequate. While guilt can motivate reparative actions, it becomes counterproductive when internalised as a fixed parental identity. This article explores how transgenerational family scripts provide a contextual lens for reflecting on difficult family interactions, while aiming to minimise the reinforcement of negative self-perceptions. It highlights the importance of acknowledging societal pressures in therapy to help parents navigate personal and social expectations. A case study illustrates the ongoing relevance of family scripts in systemic practice.
In this paper, I use Location, Dislocation and Relocation (LDR) as a narrative and social constructionist approach from which I explore storytelling and meaning-making. It describes LDR as a method to enable the reader to familiarise themselves with this narrative construct. It enables the reader through a clinical description to orientate to the process of LDR in the action of clinical endeavour. I then go on to explore my own stories of LDR and to bring different Indigenous understandings to the process, what location is as a place, what stories are and what type of knowing there is. I explore colonisation and acts of resistance we can use to support something other to emerge. In the process, I introduce descriptions of decolonising as a practice and what that looks like in the clinical example I give. The paper concludes with an invitation to continue to use LDR with each other as a form of story that is full of action and intent.
