Making sense of the lives of our service users: systemic training for staff

I’m a systemic psychotherapist working (unusually for this modality) in Adult Mental Health. As you all know, the basis of systemic thinking is that you can’t understand what people do, think and feel, if you don’t understand their context – familial, social, professional and cultural.

And my own professional context is one of the things I most value about my role, in that though I rarely work with other systemic psychotherapists (there are only two of us in AMH in my Trust) consequently, I get to work with all other professional groups in a whole realm of clinical contexts.

The reason I value it, is partly because I worry about the tendency of professional groups to cluster together and consequently either see themselves, or be seen, as separate, different and sometimes excluding of other professional groups. It can create a kind of homogeneity of thinking and approach, that I don’t see as helpful.

Also, I believe it can reinforce the NHS ‘hierarchies’ of profession, whether acknowledged or not. Individual psychological therapists may be very good at embedding themselves within services, at working on a ‘level playing field’ with all disciplines, but – and of course this is a generalisation – psychological therapists are often felt by other professional groups, to see themselves as ‘special’, as equipped to do ‘special things’ with clients.

Nothing could irritate me more. Consequently, when I went to the European Family Therapy Association conference in Naples with colleagues (great city, great coffee, the conference was good too) and saw a workshop given by Laura Fruggeri, Professor at the University of Parma, on systemic working for non-systemic therapists, I was inspired at the idea of sharing this with non-psychological therapy colleagues. Which makes me sound like some kind of ghastly evangelist, compelled to do good. Not so.

Sadly, I’m much more keen on the slash and burn approach; questioning and sometimes seeking to disrupt embedded structures and hierarchies. Which isn’t necessarily a wholly adult approach; sometimes it’s just irritating and childish, but equally, it’s probably a necessary role from time to time.

Back to the training; I decided that I’d like to invite Laura to come and give that workshop for non-psychological therapists in my own Trust. After a lot of angst, a pandemic, the usual delays and hassle, it happened. Fifty people from a whole range of professional groups – ward clerks to OT’s to doctors to health care assistants to nurses to social workers. No space to describe the content, but – for anyone who’s trained systemically, you’ll know it’s jargon, and obscurity-heavy – yet Laura and Gwyn Daniel, her co-trainer, were able to convey deeply complex concepts (Coordinated Management of Meaning, anyone?) in completely understandable ways.

And really, that’s the point. Our psychotherapeutic and psychological modalities aren’t rocket science. Much of our task should be in seeing if they make sense to our clients, or seem useful or usable in their context. If they do, people are more likely to engage in the often scary, boring or just tiring, task of trying to do things differently.

I remember when I did the Nye Bevan training at the NHS Leadership Academy, what I liked most about it, was that it focused on ideas and commentary from outside the NHS – other countries, other sectors, other priorities, many of whom illustrated how insular and fragmented the NHS can be, and how important it was to think more widely.

One of the Nye Bevan exercises was to try and convince a constituency MP (a real MP, incidentally) that they wanted to have a new psychiatric hospital built in their constituency, when patently, many of their constituents were SO not keen on that idea.

Appealing to the greater good, or how helpful it would be for society generally, went down like a lead balloon and had absolutely no traction. It was a helpful illustration that if we don’t address people’s priorities as they see them, or that take account of their particular context, we won’t get anywhere. Salutory lesson which applies to clinicians and to our clients.

In terms of thinking across specialisms, this isn’t to say that we’ll all have the same knowledge-base or will choose to inhabit each other’s specialities, but understanding the foundation and contexts of each other’s practice and even dipping toes in the water of each other’s learning, has got to be helpful to us, our colleagues and our clients. And making our work seem less ‘special’ and less ‘magic’ might be hard on our egos, but that’s probably not the worst thing either.