Research project

Language games

As described above, some time ago, a company manager asked my colleague Bruno Hillewaere and me to implement standardised evidence-based systemic therapy. We deliberated to ascertain whether we could commit to a singular model or treatment manual before deciding that we could not. Instead, we developed, described and researched our own family therapy practice. We (Van Hennik & Hillewaere, 2017) co-created a ‘fluid’ manual of FITS (Feedback-informed Integrative Therapy within Systems). Since evidence-based models are usually presented as abbreviations (MST, FFT, MBT-F, ABFT, EFFT), we decided we needed our own abbreviation or acronym. We started out fully intending to play the ‘language game’, seeking to find the right words that highlighted our preferred approach (integrative,

improvisational and feedback-informed). This worked better than expected. Systemic therapy (a fifty-year tradition) was regarded with suspicion. FITS (a fictional method (at that time), an act of poetic disobedience (Hoffman, 2017), was accepted as a contemporary approach to therapy. Indeed, the company for which we were working at the time promoted and advertised FITS.

What started as a language game soon became a more serious project. We co- created a ‘fluid’ manual, under permanent review and construction, distilled from what we learned from feedback in response to our practice and new theoretical input. I decided to research FITS and gradually developed it as a Practice Based Evidence Based Practice. ‘FITS as PBEBP’ produces accountability, validity from within, in local and singular cases. In the following pages I shall discuss the validity and viability of ‘FITS as PBEBP’ as a generative alternative to standardisation in the field of systemic therapy.

FITS as PBEBP

FITS is an approach that is guided in part by method but primarily by questions. While using a manual and a time frame, the therapist also co-creates a fitting configuration of theory and procedures with family members. The FITS therapist needs to be

knowledgeable regarding a wide range of well-known theories, practices and skills relating to family therapy. It is the therapist’s responsibility to determine the relevance of a specific technique to the family by organising feedback and dialogues about

outcomes, developments, and collaboration. Transparency and accountability are provided by means of outcome measurement, practice-based evidence, and qualitative inquiry. A practice based evidence based approach means that therapy is at no time provided without measuring its effects, and that no research is done outside of the practice itself. Therapist and family members examine the effects of their cooperation in collaborative research. The output of research is input for therapy and for the ongoing revision of the fluid manual.

The research project

From January 2015 to August 2016, I provided manualised FITS therapy and PBEBP research to fifteen families at two different mental health care facilities. In each case, I sought the consent of family members to use information arising from the treatment and research in my doctoral research project. I gave them an informative pamphlet and an additional sheet of data for those who wanted it (appendices 2&3). Eight families consented to the use of the information as requested. I gathered quantitative data and audio recordings of sessions in which we (that is, therapist and family members) evaluated the developments and our collaboration. I analysed the transcripts in

accordance with my research design (C.5). The findings generated input for therapy and answers to my research question about ways of navigating systemic therapy (C.5.).

In the process of writing my thesis, I had the sense of being accompanied by ‘textual friends’ (Shotter, 1993), as I read the works of John Shotter, Gilles Deleuze, Rosi

reading group, took part in a five-day summer school with Rosi Braidotti, and greatly benefited from the support and wisdom provided by my peers and supervisors Gail Simon and Ravi Kohli.

Key concerns in my Professional Doctorate in Systemic Practice

I have a number of key concerns in this doctoral thesis in Systemic Practice:

- To construct a socio-political and philosophical context for methodology and theory (Leppington, 1991). This is the socially constructed response space that makes my practices and speech possible.

- To describe FITS as a temporary and constantly developing ‘fluid’ manual. - To develop FITS as a Practice Based Evidence Based Practice.

- To design a systemic research methodology.

- To conduct research and to learn how to navigate on the basis of ‘coordinated improvisation’ and ‘collaborative learning’ in Feedback-informed Systemic Therapy. I use a mixed-methods approach to research: quantitative research seeking to produce reliable data regarding outcomes, developments and collaboration in therapy, and qualitative research, that seeks to illuminate the ways in which a family therapist can navigate Feedback-informed Systemic Therapy on the basis of coordinated improvisation and collaborative learning. - To learn from learning, to write reflexive narratives about findings, affirmations

and surprises. This third-order learning can help me to expand my response- ability in navigating and re-describing the fluid manual of FITS as a temporary result in the process of becoming.

- To discuss the potential for PBEBP to serve as an alternative to the standardisation of therapy manuals.

The key aim in my research project

The key aim in my research project is to design and conduct research on ways of

navigating on the basis of coordinated improvisation, collaborative learning, and mixed- methods research in Feedback-informed Systemic Therapy.

To this end, I work as follows:

• I describe and analyse the ways in which I coordinate improvisation and enhance collaborative learning in my work as a therapist, as a result of dialogue and feedback in FITS.

• I describe the place of transparency and accountability as part of the practice of coordinated improvisation and collaborative learning in FITS. This is done

through outcome measurement, practice-based evidence, and qualitative inquiry. • I learn from the descriptions and research outcomes to improve coordinated

improvisation and collaborative learning in FITS family therapy.

Research questions

The key question in my research project:

• How can a family therapist navigate on the basis of coordinated improvisation, collaborative learning and mixed-methods research in Feedback-informed Systemic Therapy?

Secondary questions:

• How does a FITS therapist navigate on the basis of coordinated improvisation? • How does a FITS therapist navigate on the basis of systemic feedback?

• How does a FITS therapist navigate on the basis of collaborative learning? • How does a FITS therapist navigate on the basis of mixed-methods research? • Can we produce accountability in the transparent process of co-creating ‘validity

from within’, conducting FITS as a Practice Based Evidence Based Practice? • Could Practice Based Evidence Based Practice serve as an alternative to

standardisation in the field of systemic therapy?

Target group or sample

Eight families gave their consent for the use of treatment and research data in my research project. All of them were undergoing therapy at one of the two mental

healthcare facilities (De Viersprong & Intermetzo) to which I was attached in this period. We recommended FITS therapy (one to fifteen sessions) for families with children aged

children displayed severe emotional, social, and behavioural problems, such as

aggression, depression, or chronic truancy. Complex family problems are often related to trauma, divorce, or the parents’ mental health problems. The parents frequently feel helpless and react with anger and aggression or alternatively by withdrawal. Family members feel caught in undesirable, unproductive, self-reinforcing vicious circles of behaviour.

Ethics

Informed consent: All family members requesting therapy at either De Viersprong or Intermetzo mental health facility are informed orally and in writing about the ways in which information arising from the therapy sessions may potentially be used. All information related to therapy is kept in secure files. Family members sign a document (appendix 3) in which they either consent to the use of routine outcome measurements of therapeutic outcomes, and their generalised anonymised use in scientific studies, or indicate that they refuse to grant such consent.

The decision to refer clients to FITS Family Therapy is taken after an initial assessment. The family members receive an explanatory pamphlet about FITS. In my first session with a group of family members, I ask them whether they would like to join in my research project. I hand them an information and consent form (appendix 2, 3)

explaining how the research is conducted. I also explain that I would like to make audio recordings of two sessions in which we evaluate the collaboration and developments in therapy. All transcripts and deliberations will be returned to the families after these have been processed for research purposes.

Family members taking part in FITS, including children aged twelve or older, decide whether or not to participate in my research project. In the case of those aged twelve to fifteen, parental consent is obligatory (appendix 3). It is made clear to all family

members that their decision as to grant or withhold participation in the research project has no effect whatsoever on the therapy, that all their personal information will be protected, and that they are free to terminate their participation at any time during the therapy.

Confidentiality and data access: I am a professionally-trained systemic therapist and adhere to a strict professional code governing confidentiality. All therapy provided at one of the mental healthcare facilities to which I was attached (De Viersprong,

Intermetzo) takes place under the overall responsibility of a senior psychotherapist. All personal information is stored in personal files, which clients may examine whenever they wish. The audio recordings that are used in the course of my research are encoded, with each family member receiving a unique code. All the information incorporated into written reports or publications is encoded and anonymous.

Data after completion of the project: All outcome measurements (ROM, CDOI, FGRL) are stored in the personal files of the facility concerned (De Viersprong, Intermetzo). All audio recordings will be erased three months after recording. The transcripts will be encoded and published anonymously as part of my thesis.