Abstract
M.Cur.
Family therapy is practiced by advanced psychiatric nurse practitioners to assist families in the promotion
of their mental health as integral part of health. The most important purpose of family therapy is assisting
families to bring about change in their lives and relationships in their attempt to re-author their lives.
Although many models for family therapy have been developed and used over the years by family
therapists, it remains a fact that the most important factor in bringing about change is the family themselves
and their beliefs and perceptions about therapy as well as the world around us. Yet it often happens that
families come to family therapy and are not ever asked what their experience of family therapy has been
and what in fact has been useful and what has not.
It was observed by the therapeutic team of a specific family therapy unit in Gauteng that many families
who came for therapy would only attend one or two sessions of family therapy and would then not return
to therapy. Frequently the team was only given an insubstantial reason as to why the family left therapy.
After much discussion and debate about this observation within the team we could still not come up with
any answers for our questions.
In an attempt to answer some of these questions the following research questions were asked: What are the experiences of the family, therapists and the reflecting team of the first and or second
session of family therapy?
What guidelines can be described for advanced psychiatric nurse practitioners to use when conducting
family therapy to assist families in the promotion, maintenance and restoration of their mental health as
integral part of health?
This research followed a qualitative, descriptive, exploratory and contextual design, using the strategy of a
multiple case study.
This research took place in two phases.The first phase was concerned with the description of the experiences of the family, therapists and the
reflecting team of the first and or second session of family therapy when the family has left therapy after
the first and or second session. To this end two families who left therapy after one or two sessions, two sets of therapists and two reflecting teams were asked by means of in depth semi-structured interviews
what their experience of the first and or second session of family therapy was. Field notes were also taken.
After the results of the interviews and the multiple case studies were described a cross case analysis
between the two cases was undertaken, where the results of the first case study were interpreted in the
light of the results of the second case study.
The results of the interviews and the cross case analysis were presented following the phases in which
therapy happened, namely the joining phase, the working phase and the termination phase.
In the joining phase of family therapy it was found that most of the research participants experienced a
feeling of disconnection in the therapy room. This prevented them from really becoming engaged in the
process of therapy. In the working phase of family therapy, the research participants experienced a lack of safety in the therapy
room. This resulted in the families not feeling safe enough to really share their stories, difficulties and
problems which they had come to therapy for assistance with. Both families experienced feeling attacked
and undermined either by the therapists or by the members of the reflecting team.
The families experienced feeling disempowered in the context of the own therapy. They did not feel that
they were in control or could determine in any way what happened in the room. Even when they knew that
the direction taken by the therapists was not one which was helpful for them, they felt powerless to say so.
As the therapy progressed it seemed that the therapists and members of the reflecting team battled to
reflect inwardly on their own internal process. This served to create a distance between them and the
families they were seeing and they battled to connect with the families as a result.
The experience of the way in which the reflecting team worked was mixed. On one hand the multiple
perspectives offered were experienced as useful, but at times the presence of the team was experienced as
intrusive and disruptive. Moving into the termination phase of family therapy it became apparent that the families experienced
therapy as not being helpful and they did not feel that their problems had been addressed. The therapists
and reflecting team members on the other hand felt that therapy had been quite effective. This finding
highlighted the need for us as therapists to ask families of their experiences of therapy in order for therapy
to become more effective. In the second phase of this research guidelines were described for advanced psychiatric nurse practitioners
to use when conducting family therapy to assist families in the promotion, maintenance and restoration of
their mental health.