Some thirty years ago, Harris clearly called for a systemic perspective in working with families of children with autism, and highlighted how attention should be paid to the family context and to the impact of any intervention on the family Harris, , This call has slowly been taken up and described in the literature.
Contemporary systemic psychotherapists also known as family therapists regard families as experts in and on their own lives. Systemic psychotherapists are usually curious about the psychiatric diagnostic labels which families bring with them to the therapeutic conversation. Family therapists, especially those who subscribe to a social constructionist or critical realist ontology, typically work to deconstruct the meaning of THIS label to THIS person in THIS family and THIS point in the life cycle Brown, ; Wilson, ; Helps, and to open up possibilities of acting and relating that may have become closed down by assumptions and beliefs connected to the diagnostic label.
There are a wealth of discussion articles regarding how family therapists might be useful to families where there is ASC, but few papers have been published regarding what actually goes on in practice. No systematic review of the current literature has been published. This paper provides a systematic literature review of both opinion and research in this field.
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In his round-up of interventions that family therapists could provide to families where there is ASC, Bradford, a, b , Bradford suggested that family therapists could help by providing education about the condition, by guiding families to additional educational resources and in navigating the professional systems involved with their child. He suggested that family therapy sessions might involve work on social and communication skills, mood disorders and repetitive routines by improving adaptive behaviours, and might involve providing therapy to family members regarding the grief and confusion of the diagnosis and of living with a child with a life-long disability.
He recommended providing help for the affected child to understand their condition and support for siblings too. In a similar vein, Solomon and Chung described the importance of a tripartite approach to intervention, involving traditional therapies, biomedical therapies and emotional support for the family. They suggested that family therapists might be one member of a multi-disciplinary team and might take on advocacy, therapeutic and psychoeducative roles. Neely et al. Helps and Sheppard highlighted the importance of working with parents of young children who are at risk for the development of ASCs or who have received a very early diagnosis.
Finally, Goepfert et al. Therefore, all these reviews and opinion pieces highlight the possible benefits of family therapy intervention to families where there is someone with ASC. He described how families needed different things at different times and that who was involved in each therapeutic conversation was determined by who was involved in the problem or goal. He located his systemic work primarily within a structural frame where the aim of the work was to clarify and establish relational hierarchies, boundaries and subsystems to enable the family to complete their developmental tasks.
He also argued for theoretical flexibility according to the needs of the family at any point in time. She outlined a six-session systemic intervention, developed as part of her work in a CAMHs family therapy team. Families were offered six sessions and one follow-up appointment.
The first session involved setting the context for the sessions, going over the programme of work and creating a working relationship with the family. The second involved discussion about family about communication patterns and identified what the family wanted to change. Session three was devoted to learning about the special interests of the child and finding ways to use the expertise of the child. Simon described how in these sessions, the family therapy team paid particular attention to rule-bound or rule-creating systems, patterns of change, power relations, roles of individuals, alliances, communication patterns and decision-making.
In session six, issues were drawn together and other family dynamics and issues were raised. In the final session, video material was shown to parents to collaboratively review the progress of the work. While their intervention was not formally evaluated, Simon commented on how families reported that the sessions had made a positive difference and she noted a frequent request for further sessions to explore parenting and parental relationships, alongside the family relationship to the diagnosis of Asperger Syndrome.
In a similar vein Tilsen et al. She described how Michael used his knowledge of electricity to help him in explaining and finding ways through the challenges he faced.
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After publishing an opinion piece on how narrative therapy might be helpful to young people with ASCs Cashin, , Cashin et al. Based on positive data trends from a variety of outcome measures, Cashin et al. In the only description of work with parents and young children, Olinger described using narrative approaches in extending her work with parents as part of a play-group that their children with ASCs attended. She worked collaboratively with parents, which involved asking parents to observe the play room session and then to talk to each other about what they had seen in front of a therapist.
This culminated in an open document written by parents summarizing their experiences.
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She suggested some adaptations to EFT, including working in the family home; going slowly in the initial phases of the work to identify problematic interactional cycles and adjusting the number of sessions to fit the pace of the couple; abandoning preconceived ideas about how couples of children with ASC might communicate and not loading all couple difficulties on to the presence of a child with ASC.
Helps described how she adapted core systemic practices in working with young women with ASC and their families. Adaptations involved using knowledge about ASCs and how it affects children and their families, and using this in psychoeducative conversations. Adaptations also involved changing the pace of the work and going slowly to catch, understand and process emotion and meaning in what is being communicated.
Restricted interests and behaviours were used as a starting point from which to explore increased flexibility of interests and actions. The needs and development of one family member recursively and bi-directionally affect and are affected by the needs and development of another family member Fig. Family therapists are well placed to work with families where relationships and patterns of communication have gone awry, whatever has caused this. The extant literature shows how systemic therapists have described and how they have started to test out what works in working with families where there is ASC.
Going back to Callum and his family, the review of the literature shows how family therapists might work therapeutically with Callum and his family to address these difficulties. Therapeutic work needs to involve working with different parts of the family system at different times. Therapeutic conversations will move between fact and meaning and will focus in and out, to consider the child, the family, and the family in context.
Based on the published literature, this systematic review covers the small but important body of practice-based evidence about what works in working with families where there is a child or young person with ASC. It is clear that systemic, narrative approaches hold promise for families where a person has ASC. These interventions work to open up possibilities of thinking, being and relating that have previously become closed down by ASC.
While the academic scientific community might appreciate such studies, they are perhaps not so important as are small-scale qualitative descriptions of process and practice, which can guide and inform contemporary systemic practice. Personal reflections on practice together with small scale, qualitative studies exploring aspects of practice may provide the greatest resonance for practitioners who want to reflect on and develop their knowledge and skills.
Following Neely et al. Evans et al. Following the call by Carr to family therapy researchers in general, further research is required regarding what works, for whom and how.
Specific to families where there is a person with ASC, there is much to be done. Such attention might help researchers make sense of why children with very similar presentations can make such different progress Seal, Further research which develops extant narrative practices on how exploring the meaning of the condition to the child and family would be of benefit.
Studies exploring the progress and outcomes of therapeutic work with parents who themselves have ASC or with families where there are very young or grown-up children with ASC are welcomed. Research which explores contemporary systemic practices such as the use of social-constructionist, dialogical approaches, and the tools of therapeutic letters, the one-way screen or the reflecting team would also be illuminating.
Finally, research that attends to processes within therapeutic work, such as the therapeutic alliance and embodied, non-verbal aspects of systemic practice will also be helpful to practitioners. ASCs can be seen, at a neurological level, as a problem of interconnectivity Minshew et al.
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It is an exciting heuristic to consider the parallels between problems with connectivity at the level of the brain and connectivity in social relationships. While caution is required in making claims about the evidence regarding links between changes at the level of the brain linked to therapeutic work Dawson et al. National Center for Biotechnology Information , U. Published online May 4.
Prepublished online Mar Sarah Helps. Author information Copyright and License information Disclaimer. Copyright IOS Press and the authors. All rights reserved. This article has been cited by other articles in PMC.
Keywords: Autism spectrum condition, family therapy, systemic psychotherapy. Setting the scene with a clinical example The Brown family names and details have been changed to ensure confidentiality is a two-parent white-British family with early teenage sons, Callum and David. What are autism spectrum conditions? Open in a separate window. Systemic psychotherapy with people with autism spectrum conditions Family and systemic psychotherapy is increasingly found to be effective at helping relieve both individual and relationship distress.
Contemporary systemic psychotherapy Contemporary systemic psychotherapists also known as family therapists regard families as experts in and on their own lives. What do family therapists do with families where there is someone with ASC? What might family therapists do with families where there is ASC?
What do family therapists do with families where there is ASC? Summary and suggestions for future research The needs and development of one family member recursively and bi-directionally affect and are affected by the needs and development of another family member Fig. Prevalence of autism-spectrum conditions: UK school-based population study. The British Journal of Psychiatry , 6 , — The Empty Fortress New York. Brief education about autism spectrum disorders for family therapists.
Journal of Family Psychotherapy , 21 3 , — Journal of Family Psychotherapy , 21 , — The ecology of human development: Experiments by design and nature. Approach-method-technique: Making distinctions and creating connections. Human Systems , 3 1 , 3— Culture and Reflexivity in Systemic Psychotherapy. Mutual Perspectives — The free that she would be within a change or much of this deal has her opening never more first.
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