Integrated Family Therapy, with its fluid emphasis on different positions in theory and practice, considers change with families as a process of a unique combination of approaches depending on the needs of each family. How successful change occurs and its outcomes are co-constructed with each family. The foundations of change are driven also by unique aspects of the formulation that has been established, which in turn had become possible because of a carefully undertaken initial encounter with the family had established a successful orientation and completed assessment.
The Integrated model therefore takes the position, somewhat in juxtaposition to contemporary practice, that achieving change requires more than the content of carefully constructed therapeutic conversation alone, albeit that this remains a crucial aspect of a therapeutic encounter. Instead the Integrated model advocates that orientation, assessment, formulation, therapeutic alliance and therapeutic conversation combine in unique and varied ways to achieve change.
Furthermore, the wide variety of different family-based issues encountered differentially calls upon some components of the Integrated model much more than others. Achieving change for a wide range of complex family problems therefore often requires more than the type of manualisation that has stimulated the development, refinement, and implementation of non-systemic family therapies. In every case, reflective practice is important.
In this section, we refer to two case examples explored in depth elsewhere, where only one or two further sessions beyond assessment and formulation had been required; where ‘letting go’ – leaving the family on their journey – was heartfelt but unproblematic.
We separately provide examples of work of varying duration, from short-term and medium-term work (8 months) to an example of the type of case where long-term involvement is required (such commitment invariably associated with work where considerable acquired developmental trauma is present). Each case example has been illustrated to emphasise how achieving change so often requires more than therapeutic technique.
In the short-term case example, we explore the incisive use of the systemic therapeutic model shaping collaborative conversation and curiosity to achieve change in a resourceful family with complex family relationships.
In the medium-term case example, we explore change with the therapist as temporary secure base, using a systemic model but weaving in and out of different theoretical positions to help resolve early attachment problems and co-construct a hopeful future with the family; frequent reflections on their journey were an integral part of it.
The longer-term case example highlights the systemic therapeutic approach as including a container-function: to provide an ongoing temporary secure-base; to assist change through the developmental process; to help with trauma-processing; and without a definite end.
Journeys beyond the family life cycle: the BBC series ‘Who do you think you are?’ illustrates how understanding a family’s journey goes far beyond that of just their immediate family life cycle. John Byng-Hall, one of the UK’s earliest family therapists, was evidently profoundly influenced by the public disgrace of Admiral Byng, his illustrious 18th-century ancestor, as well no doubt as viewed through the lens of Byng-Hall’s own life-experience. Minuchin’s review of his family’s generational experience was embedded within its notably extended family culture, other therapists by their own family of origin’s displacement or loss (through 19th-century slavery, the Holocaust, refugee-seeking, or economic migration).
A family can be thought about as a semi-open system of relationships undergoing continuous transformation, under the influence of internal and external factors. The two of our case-examples who received least therapeutic contact had previously experienced some of the most major changes in even their recent journey (of which even then the therapists had only learned little).
First, the young woman who in childhood left neglect and an abusive family of origin to her final adoption in a family whose own family journey had been entirely different. Second, the family from a capital city who moved to a remote and rural part of Scotland with their youngest child after all the elder children had left home. These were complex family scenarios yet, as we describe elsewhere, neither of their post-assessment contact was more than a couple of sessions. The collaborative nature of the therapy (including liaison with the young man’s new school) allowed their onward therapeutic journey to continue far beyond their brief consultation.