A systematic review and meta‐synthesis exploring client experience of reflecting teams in clinical practice

Abstract

There is a dearth of readily available evidence on the impact of reflecting teams in family therapy. A synthesis of the literature was needed to provide clarity and insight into client experience of the process. A systematic search of the reflecting team literature was conducted and 11 papers using qualitative methodologies were identified. The findings of these studies were synthesised using meta‐ethnography. Three themes were identified; ‘unusual and strange’; ‘unique conversations’ and ‘therapeutic environment’. The reflecting team process was unanticipated and unique, but it could be helpful where people were made to feel safe and understood. Reflecting teams, while initially received as an odd and unusual experience, are typically found to be an effective and helpful approach within family and couples therapy. Extra considerations should be taken to ensure that clients feel able to engage with the process, avoiding it becoming overwhelming and unhelpful.Practitioner points Higher levels of self‐awareness and uncertainty are present for the family when first presented with the reflecting team. A strong rapport with the lead therapist can support family engagement with the team. Reflecting teams were experienced as more effective when they represent a diverse group of professional, ethnic and cultural backgrounds. Hope and validation are vital parts of creating a therapeutic space which is effective in introducing difference to a family.

Reflecting Team Practices outside the therapy room: A thematic analysis of a Child and Adolescent Mental Health Service (CAMHS) away‐day process with a team undergoing change

“…There is little empirical research on the effectiveness of reflecting conversations with families (Brownlee et al, 2009; Harris & Crossley, 2021; Hicks et al, 2021; Stinchfield & Pender, 2012; Willott et al, 2012). Most of the existing research is qualitative, enquiring about the experiences of therapists and families.…”

“…These aspects appeared to be (1) the multiverse of ideas within the reflecting team enabled families to respect differing ideas (Armstrong et al, 2019), (2) focus on family strengths enabled more open talk and possibility of change (Smith et al, 1993, Armstrong et al, 2019; Brownlee et al, 2009; Mitchell et al, 2013; Stinchfield & Pender, 2012) and (3) the non‐judgemental conversations within the reflecting teams enabled families to talk more openly (Hoger et al, 1994). Furthermore, Harris and Crossley (2021) found that despite reflecting teams initially being perceived as 'unanticipated and unique' they were found to be a helpful and effective approach. Good engagement with the lead therapist and a diverse group of members of the reflecting team (professional, ethnic and cultural backgrounds) led to more effective outcomes in therapy.…”

A Critique of Coordinated Management of Meaning and Circularity in Relation to Countering Oppressive Practice: Reflections from a Trainee Therapist

“…Some consensus statements included shifting between talking and listening, keeping a curious and neutral stance, encouraging self-reflection, and being mindful to keep the reflections to under 10 minutes so as not to overload families. Harris and Crossley (2021) used meta-ethnography and synthesised 11 studies on families' experiences of the RT. Whilst it could be seen as an 'unusual and strange' experience (someone watching you, and at times it could be confusing and overwhelming), other themes included 'unique conversations' (multiple voices, offering new ideas) and 'therapeutic environment' (creating safety, reflecting hope for change).…”

“…To attend to the perception of the RT experience as 'unusual and strange' and potentially 'overwhelming,' as discussed by Harris and Crossley (2021), it is important to explain the rationale behind having many people in the room. A useful metaphor I learnt from other systemic therapists is the football match metaphor, where the family members are players in the field and the RT are spectators.…”

Reflections on reflecting teams

“…This edition begins with an innovative study of what goes on in Reflecting Teams (RTs) by Chloe Constable and her colleagues in the UK. As the authors describe, this method of offering multiple perspectives to family members has been widely used in UK settings, particularly in training contexts, though it has been comparatively little studied – two recent studies in this journal by Harris and Crossley (2021) and Hicks et al (2021) are honourable exceptions. These authors here analyse the key categories of utterances used in RTs, thus developing a ‘Reflecting Team Utterances Framework’.…”