• Practice based evidence based practice: navigating complexity in feedback-informed systemic therapy

      Van Hennik, Robert (University of BedfordshireUniversity of Bedfordshire, 2018-03)
      In this thesis I present a research-based account of designing and practising manualised systemic family therapy and doing practice-based, collaborative work. Some time ago my colleague Bruno Hillewaere and I were asked to start providing standardised, evidence-based systemic therapy. In reviewing the range of standardised approaches that were available at the time, we decided we could not commit to a single model or treatment manual. Our experience suggested to us that in times when therapy derives its legitimacy from control, standardised protocols and benchmarking, little attention is paid to the therapist’s improvisations and those small, unpredictable and non-replicable differences that can make the difference for family members. Accordingly, we decided to develop, describe and research our own family therapy practice that was full of improvisations in response to the exchanges that take place, from one moment to the next, in the context of family therapy. In this thesis I present this work. I refer to it as Practice Based Evidence Based Practice (PBEBP). This thesis traces the ways in which I co-developed, applied and used a fluid manual of Feedback-informed Integrative Therapy within Systems (FITS) as a Practice Based Evidence Based Practice (PBEBP) within the bio-cultural matrix that embeds. I present a theoretical framework, inspired by Neo-Materialism, that integrates cybernetics and social-constructionism in contemporary systemic thinking. The question I ask is how to navigate complexity and offer accountability about the process of systemic learning, without getting drawn into the paradoxical spiral of control. I suggest ways in which therapists may become systemic nomads and describe how to produce ‘validity from within’, remaining open to the unpredictable process of becoming in multi-actor networks of human and non-human generators. I show how the fluid manual of FITS corresponds to the locality and complexity of social and cultural life. FITS as PBEBP is substantiated by collaborative practice-based and generative research. The therapist is both practitioner and researcher and involves clients as co-researchers. Therapist and clients examine the effects of their collaboration. The output of research is input for therapy in the ‘collaborative learning community’ constituted together. I have analysed eight cases of completed FITS therapies with families. I promote collaborative learning through coordinated improvisation, organised feedback and mixed-methods research. Accountability and transparency are provided by the quantitative measurement of developments and collaboration in therapy and the qualitative inquiry of therapist’s navigating practice and collaborative learning. I use quantitative measurements as a prelude to evaluative conversation. I analyse critical moments in the transcripts of those conversations. I discover how therapy practice and research effectively intertwine. I hope to inspire systemic practitioners to manualise and research their own practices as a Practice Based Evidence Based Practice. FITS as PBEBP provides ‘validity from within’ in local and singular cases. This approach is an affirmative and transparent alternative to standardisation of protocols and methods in the field of mental healthcare generally and family therapy specifically.