Reenee Singh

Detecting therapeutic improvement early in therapy: Validation of the SCORE-15 index of family functioning and change

The SCORE index of family functioning and change is an established measure, with strong psychometric properties, of the quality of family life. We report the sensitivity to therapeutic change of the short form, the SCORE-15. Data are reported from 584 participants aged above 11 years, representing 239 families. All couples and families had been referred for systemic couples and family therapy, completing the form at start of the first session and close to the fourth. The SCORE-15 is shown to be acceptable with strong consistency and reliability. Change over only three sessions was highly statistically significant. Further validation is provided by improvements in quantified scores correlating significantly with independent measures provided by family members and by their therapists. The SCORE-15 is a proven measure of therapy and of therapeutic change in family functioning. It is therefore a routinely usable tool applicable to service evaluation, quality improvement, and to support clinical practice. Practitioner Points •The SCORE provides practitioners with brief descriptions of varied aspects of family interaction that have proven significance for many families who present for therapy. •SCORE-15 can be used with confidence to monitor and report proven indicators of progress in systemic therapy. •Because SCORE identifies clinically significant issues of family interaction it has many potential uses in therapy. •There are many new possibilities for therapists to undertake collaborative research.

The uses of emotion maps in research and clinical practice with families and couples: Methodological innovation and critical inquiry

We explore how “emotion maps” can be productively used in clinical assessment and clinical practice with families and couples. This graphic participatory method was developed in sociological studies to examine everyday family relationships. Emotion maps enable us to effectively “see” the dynamic experience and emotional repertoires of family life. Through the use of a case example, in this article we illustrate how emotion maps can add to the systemic clinicians’ repertoire of visual methods. For clinicians working with families, couples, and young people, the importance of gaining insight into how lives are lived, at home, cannot be understated. Producing emotion maps can encourage critical personal reflection and expedite change in family practice. Hot spots in the household become visualized, facilitating dialogue on prevailing issues and how these events may be perceived differently by different family members. As emotion maps are not reliant on literacy or language skills they can be equally completed by parents and children alike, enabling childrens perspective to be heard. Emotion maps can be used as assessment tools, to demonstrate the process of change within families. Furthermore, emotion maps can be extended to use through technology and hence are well suited particularly to working with young people. We end the article with a wider discussion of the place of emotions and emotion maps within systemic psychotherapy.

Reflections on the challenges of understanding racial, cultural and sexual differences in couple relationship research.

In the field of systemic psychotherapy there has been much recent interest in the areas of culture and reflexivity, and in working with couples. In this article we reflect on the process of conducting research in these areas. Drawing on findings from a large, national, empirical mixed-methods study on long-term relationships, we use two examples from the data to illustrate the complexity of researching across racial, cultural and sexual differences, in terms of research design and sampling, fieldwork and research practice, and making sense of multidimensional data. We point to findings that suggest that notions of coupledom are culturally constructed and thus challenge straightforward ideas of the procreative, sexually active couple dyad, separate from intergenerational extended families. The clinical significance of the findings for both lesbian, gay, bisexual or queer and culturally diverse couples and families are discussed. Practitioner points Cultural or racial matching is not a sufficient condition for engagement and empathy with couples and families. Critical reflexivity about similarity and difference is essential in cross-cultural systemic practice. ‘The couple’ and its distance from the extended family may be defined differently in different cultures. One research tool used in this project, the emotion map, appears to have utility in clinical practice with couples and families.

Power and Parenting Assessments: The Intersecting Levels of Culture, Race, Class and Gender

This article uses a case example to highlight some of the complexities of working with minority ethnic families. It addresses the dilemmas that exist for therapists and other professionals when carrying out cross-cultural assessments of parenting. In this article, we will examine how professionals’ constructions impacted on the assessment process with regard to family life, culture and mental health. We will draw out implications for clinical practice in this area.

Co‐constructing family therapy in the Asian Chinese family diasporas of mainland China, Malaysia, Macau, Singapore and Taiwan

Asian Chinese families are experiencing constant changes. While commonly known cultural themes such as ‘face’, ‘hierarchy’, ‘harmony’ and ‘filial piety’ are useful references and important caveats in clinical settings, they are most useful when the context of larger socio-economic and political developments of recent decades is taken into account. This article is co-authored by seven experienced Asian therapists from China, Hong Kong, Macau, Malaysia, Singapore, Taiwan and the United Kingdom. They share their insights into working with Chinese families in Asia. In addition to considering cultural dimensions, the authors attempt to consolidate the understanding of Asian Chinese families by focusing on the effects of socio-economic and political development. Other than focusing on the unique characteristics and challenges of working with Chinese families in their region, they highlight the most useful therapeutic stances and approaches when working with Asian Chinese families. Practitioner points Be mindful that changing family structures affect family dynamics, childcentric values and work-life balance. Chinese families expect to receive advice and instruction. Therapists need to be direct and authoritative where appropriate to avoid causing dissatisfaction Chinese families can be helped to negotiate their emerging needs for the differentiation of self A possible therapeutic option is use of self and the ability to embrace uncertainty

Why who we are makes a difference

On a recent holiday in India, I (R.S.) took my 10-year-old son to visit the Taj Mahal. We were accompanied by two of my friends – one a middle-aged gay Asian man and the other an older Asian, heterosexual woman. We were followed around by a photographer, who insisted on taking a ‘family photograph’. He was convinced that my gay friend and I were a couple and that my female friend was an aunty or grandma. Although we could easily have been mistaken for a three generational family anywhere in the world, I was curious about the photographer’s readiness to cast us in those roles. He was focusing on interdependence and relatedness and thus constructing only familial relationships. He was assuming that platonic relationships between men and women did not exist and that everybody is heterosexual and has children. We all carry templates, based on our cultural, societal and idiosyncratic experiences of what it means to be a family. When these assumptions are unchecked, we run the risk of imposing our world views on the clients we work with. Recently, when working with an English, middle-class family, I (R.S.) was surprised by the way in which the daughter-in-law spoke to her mother-in-law, which I experienced as disrespectful. It was only through examining my own culturally based ideas about relationships with extended family that I was able (more helpfully) to reframe the daughterin-law’s anger as ‘speaking up courageously on behalf of the rest of the family’. It is a difficult time to belong to a minority ethnic group, and as a South Asian migrant, I (R.S.) am keenly aware of recent attitudes towards migrants, of Islamophobia, racism and prejudice. How does one live and work in London’s multicultural society when multiculturalism has become a bad word? How can we provide robust clinical services that cater to the different levels of difference that our clients present? How can we hold the different levels of difference, and their intersectionality in mind, so that we are not merely paying lip service to the social GRRAAACCEEESSS 1 (Burnham, 2012) but are prepared to embrace the complexity of difference? Eileen Munro (2010) has critiqued a ‘technocratic’ view of practice that has become prevalent in public services according to which we make use of techniques we have learnt to analyse and solve problems, rather than it being ‘the individuals involved and how they work together’ (p. 16) and the relationships involved in this that are important. An ‘evidence base’ has developed of models of working which seems to suggest that such techniques will work for all clinicians, with all populations and in all contexts, providing that we remain ‘model compliant’, that is, we are doing it right! While we have found some of these models and the techniques attached to them profoundly helpful in helping us to stay focused and purposeful in our work with families, this picture of what is involved in the work has always seemed to us to be partial and limited, not giving sufficient weight or importance to the relationship between ourselves and our client families, and the context in which we meet together. As an older White, middle-class man working in a largely working class 658596