Los Desafíos: transitoriedad, fiscalización ciudadana, paridad en los partidos

My findings show that context can be worked with actively and is meaningful and influential in therapeutic work with individuals. Whilst integrative psychotherapy and counselling psychology advocate the importance of working with a client’s context and books about genograms say they can be used with individuals as well as families, no previous research has been conducted about their use within the therapeutic relationship and process with a single client rather than a family or couple. My research shows that using a genogram can help build the working alliance and facilitate therapeutic change, but it also has potential drawbacks and needs to be used sensitively and skilfully by the therapist. Therefore, I think there are the implications regarding the use of genograms and our consideration of (family) context as a whole.

My project provides practical answers to inform and challenge what we do, not just what we say we do. Hage (2003; p.561) states that:

125 “it is the social developmental, contextual perspective... that we must embrace if we are to remain true to our roots and unique identity as counselling psychologists”.

However, I am confused about how counselling psychology and integrative psychotherapy engage with context or more systemic ways of working.

Within counselling psychology literature, I can find two main articles concerning counselling psychology and systems, both of which were written over fifteen years ago. Whilst Bor et al. (1996; p.240) state that systems is “both a school of therapy in counselling psychology as well as a meta-theory”, neither they nor Street (1996) elucidate how counselling psychology integrates, criticises or engages with systems theory more specifically from a theoretical or clinical perspective.

In other articles, such as Alilovic & Yassine (2010), the focus is on how counselling psychologists can work with families. But it is not clear if a systemic perspective is recommended in this regard or how/if counselling psychologists should be trained with specific skills in this area. Alilovic & Yassine (2010; p.340) convey uncertainty by saying:

“it is not the intention of the authors to imply that specialist training in family is not appropriate or necessary...rather, it is our intention to broaden the scope of counselling psychologists and perhaps encourage the profession to adopt a view that working with families is not synonymous with ‘family therapy’ and an absolute requirement to complete an additional specialist training”.

In my opinion, it seems strange that counselling psychologists are required to ‘operate safely in a range of modalities’ including families (BPS, 2010), but systemic working is not always covered as thoroughly as other paradigms in all training programmes. Indeed, systemic theory is not consistently included alongside psychodynamic, humanistic and cognitive- behavioural traditions in the discussion of theoretical integration in counselling psychology. For example, it is given a chapter in Woolfe & Dryden (1996) and then mentioned briefly in

126 the opening chapter of Woolfe et al. (2010) as ‘strongly emerging’ with constructionist and narrative approaches.

I think that, in order for systemic thinking and the use of genograms to be fully integrated into clinical practices, it would be important to include theory and techniques as an essential element within counselling psychology and integrative psychotherapy training programmes. This could include each trainee collating their own genogram, so they can begin to explore their wider social context and how their family structure and history has influenced their identity. If this is done with a peer, this can also give a sense of working collaboratively on a genogram, where the other person reflects on what is revealed and helps them understand its meaning.

My sense is that this would provide a good foundation for starting to develop a systemic perspective on clients, which could be enhanced by teaching specific techniques and theory. In order to encourage reflective practice, I think it would be crucial to get trainees’ feedback on how they might use genograms in their clinical work and include systems theory and ideas about context within their developing integrative frameworks.

Overall, my sense is that counselling psychology and integrative psychotherapy both need to review and re-establish their relationships with context and systemic working, both theoretically and clinically, so that they have a place alongside established ways of thinking and working. I have concentrated on counselling psychology here because it specifically “places importance on the context of the individual” (Alilovic & Yassine, 2010; p.333). I am surprised that it has not found more common ground with a systemic perspective, given that systemic approaches focus on the creativity and resourcefulness of clients in a way that is consistent with the values of counselling psychology (Strawbridge & Woolfe, 2003). From a theoretical point of view, I would have thought that, as integrative and reflexive psychological therapists with the ability to hold different polarities, integrating systemic thinking entails a (necessary) paradigm shift towards:

127 “conceptualising human behaviour in a fashion that integrates intraindividual, interpersonal, environmental and macrosystemic elements” (Kaslow et al., 2005; p.339).

In terms of clinical practice, whilst I would call for more research to specify the skills required by therapists to use genograms adeptly and the potential effects associated with working with a wider unconscious, my findings demonstrate the beneficial use of a holistic and relational tool that has the potential for quicker work by understanding the background underlying the client’s distress. It builds on aforementioned research by Pinsof et al. (2008) to show the advantages of focussing on a client’s relationships and their internal processes to facilitate therapeutic change. This may provoke the exploration of integrated approaches within research investigating what factors promote change in therapeutic work.

In addition, my findings are relevant within the current professional context of counselling psychology and integrative psychotherapy within statutory services, as highlighted in my Introduction. In my mind, whilst cognitive-behavioural therapy (CBT) aims to collect evidence to describe and challenge a client’s current ‘disordered’ thinking patterns, using a genogram and systemic working can re-frame and actively address a presenting issue within a wider context in a way that is more empowering for the client. This represents an important philosophical difference where there is a focus on a holistic view of the person within their relational context rather than the treatment of symptoms that are seen as arising within individuals. Therefore, this approach is more in line with the humanistic values of integrative psychotherapy and counselling psychology.

I also believe that genograms can be used successfully in both short and longer term work in statutory services such as the NHS. Norcross (2011), in his research about what works in psychotherapy, recommends that practice and treatment guidelines should explicitly address therapeutic behaviours and qualities that promote a facilitative therapeutic relationship. My findings show that, even though a certain level of working alliance is required before

128 introducing a genogram, its subsequent use can help build the therapeutic relationship. As long as the therapist pays attention to the timing of the introduction so that some trust has been established, using a genogram in shorter-term work could further strengthen the relationship quickly. Additionally, in a similar way to CBT, the outcomes from a genogram are immediate. So, with the therapist appropriately pacing the work and monitoring the client’s verbal and non-verbal responses, it is possible to understand the meaning of the client’s presenting issues and thus focus the treatment direction accordingly. In longer term but perhaps still time limited work, a genogram can be used to deepen the client’s process and level of exploration when the groundwork in the therapy and relationship has been fully established.

Therefore, using a genogram therapeutically is relational, collaborative and potentially successful in short-term work in the same way as CBT, but is also holistic and non- pathologising. My belief is that both are required within a responsive and pluralistic approach by psychological therapists in statutory services to ensure that therapy is adapted to the needs and specific characteristics of clients.