Holding onto the ‘mystery’ within online family and systemic therapy

Abstract

Covid‐19 has led to a shift towards online therapy. This paper focuses on therapists’ experiences of translating systemic practice online with families. A range of UK services are represented, including community, inpatient, adult and children services. A social construction theory, coordinated management of meaning, is used to understand online family and systemic therapy. The new context of online therapy influenced all other levels of the therapeutic encounter including content and structure of sessions, therapeutic relationship, therapists’ identity and culture of therapy. The relationship between ‘doing’ online therapy and reflecting on practice has been central in co‐constructing new ways of interacting. There were many similarities across services, where there were differences these were client and context specific. As better ways of engaging emerged, therapists became more confident, creativity in therapy increased and attitudes about online therapy became more positive. Practitioner points Online systemic therapy is possible across adult and children services at different tiers within community and inpatient settings. CMM provides a framework to understand communication in online therapy. Online therapy requires reconsiderations at all levels of the therapeutic encounter. Increased confidence and competence correlates with positive attitudes about online therapy. Online therapy is impacting on the overall evolving culture of therapy.

The impact of COVID-19 on people with intellectual disabilities

“…Recent evidence suggests that there are therapeutic benefits to working online, particularly in the arena of LD. Cronin et al (2021) noted that through interviews with staff who were working systemically in an LD service, there were several main benefits to this mode of working. Creativity was nurtured, and greater attention was paid to language used in sessions.…”

Some Ontological and Epistemological Consequences of the Development of Online Family Therapy and What This Could Mean for Practice

“…Even the best constructed therapy suites ‘leak’ sound and light via the mirrored screen. Online, practicing via a computer, muting the microphone and turning off the camera means no limit to the noise one can make – you will not be heard ‘down the line.’ In the first author's supervisory practice in a training context, everyone keeps cameras on, so that the lead therapist, O/R team, and family can all see each other, unless we agree otherwise with the family for a specific therapeutic reason (see Cronin et al., 2021 for a contrasting method) 4 . One of the differences between in‐person ‘team and screen’ therapy and its online equivalent when cameras remain on is that the O/R team are seen to be listening to the conversation between family and lead therapist.…”

“…We have focused our discussion here on the differences between in‐person and online ‘team and screen’ practice. While some teams have adopted an O/R team cameras off practice (Cronin et al., 2021), anecdotally we know that some others negotiate and agree cameras on or off with families (see also Sherbersky, Ziminski, & Pote, 2021 for a discussion of training issues). Both approaches may be examples of good practice, privileging collaboration with families, putting families at ease so that they experience the process as less ‘performative’ (Cronin et al., 2021, p. 307).…”

“…While some teams have adopted an O/R team cameras off practice (Cronin et al., 2021), anecdotally we know that some others negotiate and agree cameras on or off with families (see also Sherbersky, Ziminski, & Pote, 2021 for a discussion of training issues). Both approaches may be examples of good practice, privileging collaboration with families, putting families at ease so that they experience the process as less ‘performative’ (Cronin et al., 2021, p. 307). We think that whatever the practice a team establishes with families, there are particular epistemological and ontological consequences which may have significance for the therapy families receive.…”

‘When it comes to relational trauma, you need people at the table’

“…The impact of the pandemic is expected to be significant for victims of sexual abuse, as access to professional help for families with a disclosure of sexual abuse prior to the pandemic was suddenly interrupted at the time of the lockdowns. Organisations searched for effective ways to re‐organise their services for clients and switched from in‐person therapies to online therapy (Aafjes‐van Doorn et al, 2021 ; Cronin et al, 2021 ; Lange et al, 2021 ; Lebow, 2020 ; Mc Kenny et al, 2021 ; Wilke et al, 2020 ). Janine, 1 a girl who had been abused by male family members, was in therapy when the Covid‐19 lockdown took place in the Netherlands in March 2020.…”