Why is a Family Therapy Strategy Not Implemented in the UK?

We are here at the ISPS Conference in Liverpool discussing the evidence of the effectivity of Family work in the form of BFT which has been researched since the early 1980's supported by the Cochrane Review and the NICE guidelines. Open Dialogue also has a huge body of evidence supporting its effectivity based on numerous research papers published outside the UK. In both approaches there is an emphasis on the importance of family interventions reducing medication and admissions to hospital, and increasing wellbeing and successful outcomes. Despite the evidence the implementation of these approaches has been a huge challenge as psychological and social interventions have less status than the medical model.

One has to wonder why this is it still not happening and why neither Peer Supported Open Dialogue nor BFT are routinely available even in Early Intervention Services?There is currently a system overload which certainly contributes. Family therapy because of the desirability of including all family members often takes place in the evening which creates difficulties for staff with family commitments. In addition individuals have their own agendas and there is a focus on structures rather than activities. We need to ask ourselves what is effective in bringing change and it is neither evidence nor policies. We need a small number of enthusiasts who are politically involved and energised to champion family interventions and drive their delivery forward.

In addition supervision is important as is the structure of services, and training. We need to explore why some practitioners feel challenged by family work, but the personal exploration in the form of genograms and examination of the family of origin work practitioners in Open Dialogue training put in place seems to support the Open Dialogue work. Supervision needs to explore the impact of transferential issues on both Behavioural Family Therapy clinicians and the Open Dialogue practitioners. Professionals should be able to explore transferential difficulties and what resonates for them in the work. I think a further reason is that the Open Dialogue team manages any psychological distress and the impact of holding and containing the sessions is the bond between the team members. The Open Dialogue teams are considerably more knowledgable about their colleagues and closer through their intimate awareness of one another and their personal histories, they also socialise together and spend more time in one another's company than the average team. There is in addition an almost evangelical enthusiasm for the approach. Individuals have chosen to complete the Open Dialogue training at considerable cost to themselves through additional work and study, they believe strongly in the ethos and desperately want the research to be sucessful.

Author Bio: Jane Hetherington, Principal Psychotherapist at KMPT and an employee at Early Intervention Services in Kent, has completed Open Dialogue course and will be a part of the new Open Dialogue Course. She is trained as an integrative psychotherapist and has experience working in primary care, substance misuse, and psychosis services. Here, she writes about a few psychotherapeutic theories.