Department of Psychiatry and Health
Medical College of Georgia
Augusta, Georgia 30904
DATE: April 1, 1987
EDITION: Volume II, Number 1
CONTENTS
---Thanks to Gunnar Forsberg, who sent me his translation of the Table of Contents and Introduction to NATVERKSTERAPI. I am typing up his manuscript of the translation, and will send it out with the next issue. I'm still hoping to hear from one or some of you with suggestions/linkages for an English language publisher.
---Gunnar and his colleagues are working on a final report of their project, using network strategies for child protective work in the Stockholm area. I have information on obtaining their preliminary report, below in the RESOURCE EXCHANGE section. I am hoping that Gunnar and his colleagues will be able to present their work at Ortho next year.
---It is time once again to prepare proposals for the next Ortho conference, to be convened in San Francisco March 27-31. I will propose a course with a format similar to our last gathering, listing the faculty from that Chicago Ortho course. Please let me know if you want to be added or removed from the faculty list.
---My apologies to Ross Speck, who sent me an application form to present at the Annual Meeting of the Canadian Psychiatric Association. I'm afraid the deadline passed before I could get out this issue.
---Anne Coppard tells me that COTA is setting up a Toronto-based association for exchange of skills and information about network intervention. Their activities will include a newsletter.
---Please send me news of your activities, to pass along to others.
---This section of NETLETTER is for exchange of opinions on topics of interest to readers and contributors. I will start off with a couple of pieces which I hope will stimulate some productive discussion, and hope to be hearing from you on these or other topics.
---For some time, I have wanted to address an issue raised in the FAMILY PROCESS article written by the Mount Tom group (Halevy-Martini, J., Hemley van der Velden, E., Ruhf, L., and Schoenfeld, P.(1984). Process and strategy in network therapy. Family Process,23, 521-534). Julia Halevy and her colleagues made the point that network therapy is a form of ecosystemic intervention, stating that, "network therapy as an ecosystemic intervention is indeed reflective of an antihumanistic philosophy." Noting that assemblies are sometimes conducted in the absence of the index patient, Halevy et. al. noted that the client's "behavior shifts in response to, and by virtue of, the structural systemic change." In choosing the term "antihumanistic" to characterize the network approach, they cited Gerald Erickson's Family Process article (Erickson, G.(1984) A menu note on the cybernetic network. Family Process, 23, 200-204). Erickson's piece made the case that "orthodox" structuralism is antihumanistic in that it is strictly constrained to patterns of relations, excluding considering of individual persons as actors. Gerry however stated that his own and other writings on network therapy represent "genetic" rather than "orthodox" structuralism, because they include both people and products as well as patterns of relations. His piece was in favor of saving the person as a social actor; "the problem remains of how to integrate 'orthodox' and 'genetic' and save the persons and the wider social context in family therapy."
I will not try to present a theoretical integration of persons and the patterns of their relations, although I do assert that such a theoretical integration will be more productive than orthodox structuralism in addressing clinical issues. What I want to argue for is a clinical stance that is flexible enough to take more than one theoretical frame of reference into account when addressing problems in the real world. Certainly, when I formulate, plan, or desribe clinical problem-solving, I have to use an ecosystemic approach. Its utility is apparent in the example that Halevy et al. use, that of opening up a relatively "closed" homeostatic family system by increasing its connections with its wider social network. I find it just as useful and necessary to use individual and psychological concepts in addressing network problems. For example, one of the most compelling phenomena I have encountered in conducting network assemblies is the tremendous power of network members' motivation to give help and support. The followup study Network Consultants conducted of an assembly for a suicidal adolescent (Trimble, D., Kliman, J., Villapiano, A., and Beckett, W.(1984). Follow-up of a full-scale network assembly. Family Process, 6, 102-113) demonstrated significant individual transformations in individuals' experiences of depression, understanding of how to cope with depression in themselves and the people they loved, and substantial actions in their own networks, generated by the personal transformations they experienced in the assembly process. Substantial relief of distress and resolution of psychopathology on the part of the index patient are not uncommon outcomes of assemblies. I often find that psychodynamic or other psychological models of group psychotherapy are very useful tools in comprehending these individual changes. I know that I lack a theoretical model which can incorporate the systemic and psychological perspectives, but I also know that a clinical stance which can utilize these different perspectives is most productive for me.
---To my knowledge, the most productive centers for practical use of the full-scale assembly are Family Networks in Minneapolis and the network therapy team at Mount Tom Institute for Human Services in Holyoke, Mass. Conversations with folks from both centers reveal a common historical pattern. Early in the history of each program, they were more likely to assemble large full-scale assemblies (more than 20 people). As time went on, they found themselves to be working with smaller assembled groups, although they continued to use the full-scale format (e.g. use of an intervention team). All of us have learned that most situations are best managed with smaller-scale techniques; Gunnar Forsberg's group reported this in their preliminary report (see RESOURCE EXCHANGE, below). Nonetheless, there are some situations for which the larger full-scale assembly is suited. Why is it that an operating program tends over time to conduct full-scale assemblies with smaller groups? Perhaps the small proportion of cases in the program's population suited for large gatherings is treated in the early phase of the program's operation, leaving only cases for which smaller gatherings are appropriate. More likely, I think, is the tendency to move to more economical mode of operation after the staff's curiosity about the full-scale assembly has been satisfied, and they have become exhausted with the tremendous demand on the team's time and emotional resources. I began to notice this attitude shift in myself after several years practicing network therapy in community mental health.
If, in fact, a network therapy team will tend to drift toward smaller assemblies over the course of time, then I think we will be losing some valuable experience. The full-scale assembly is very valuable in making the invisible structure of the personal network observable. I think the full-scale assembly generates some powerful psychological and spiritual phenomena for the network and for the team members; these phenomena are not generated in the smaller scale assemblies. Speck and Attneave's concept of "critical mass" appears to be relevant to these very powerful large group phenomena. From the perspective of community mental health, the larger full-scale assembly affects many more people as a preventive intervention. Do you agree with these observations and/or the implications drawn from them? If so, can you suggest strategies for maintaining the viability of the full-scale assembly in a service program?
---Received from Anne Coppard (COTA, Toronto): Gottlieb, Benjamin and Coppard, Anne. "Using social network therapy to create support systems for the chronically mentally ill." Submitted to the Canadian Journal of Community Psychiatry, for a special October, 1987, issue on chronic mental patients in the community.
The article describes the first year of the COTA social network therapy team project with chronic mental patients in Toronto, including details of the program's development and difficulties, a literature review, program objectives and methods. I was particularly impressed by the account of COTA's extremely detailed assessment methods, both initial and ongoing. Program workers are supported by a carefully established support network at work. Interventions take the network as the client, and client encounters usually involve more than the index patient (sometimes, the worker will meet with network members without the index patient). The program aims to increase the "structural solidarity" of client networks; to increase more stable, flexible, and satisfying support systems for chronic patients. Specific goals include the following: Increase the size of the non-kin sector. Create at least two, and preferably more, clusters. Minimize encapsulation of the patient's social network in someone else's network. Increase symmetry or reciprocity of supportive exchanges. Remove or insulate the patient from noxious or dependency-incurring ties. Reinforce existing supportive ties while increasing the range of supportive provisions exchanged therein (e.g. expand from loans of cigarettes and money to information, emotional support, and companionate support). The main strategies utilized include network construction (usually utilizing minimally demanding settings such as patient social clubs), network coaching, and network sessions (small-scale convening of network members).
The COTA program is well-described, and a good illustration of designing a program based on current literature on networks, social support, and mental health. I am looking forward to seeing their outcome data.
---Received from Anne Coppard: Wayslenki, Donald, Lancee, William, and Coppard, Anne. "The clinical use of social networks." Paper presented at the Annual Meeting of the Ontario Psychiatric Association, Toronto, January 22, 1987.
This briefer paper again describes the COTA program, and includes some of the data from initial and ongoing assessments of the first 30 clients in the first year. There are no formal outcome data, although they note that 20 of 24 respondents reported more positive than negative changes in their networks. There are lots of intriguing bits of information, much of it confirming common wisdom about the networks of chronic patients. Networks were small, with 50% relatives. Nonkin clusters were small and relatively useless. There were few reciprocal relationships. Clients with affective disorder were less likely to have nonkin clusters. Clients with thought disorders reported no confidants. Illustrating the COTA stance that the network is the client, and their indirect intervention strategies, is the fact that 40% of their contacts were not directly with the patient.
---I received a letter from a British psychologist and family therapist who hopes to spend this summer on sabbatical in North America getting training in social network therapy. I gave him the Mount Tom and Family Networks (Minneapolis) addresses, and promised to notify people through the NETLETTER. If you have a training opportunity to offer, please get in touch with Peter B. Farrell, M.Sc., Muvern Cottage, Wells Road, Latcham, Wedmore, SOMERSET, ENGLAND, BS28 4SB.
---Anne Coppard suggests that Don Lugtig may be interested in a paper by Dr. Eilene L.G. McIntyre, Professor of Social Work, University of Toronto, 246 Bloor Street W., Toronto, Ontario, M5S 1A1, entitled "The child case network project." I haven't seen it myself; it occurs to me that it might also interest Gunnar Forsberg and others working in child welfare.
---The position of Executive Director at Family Networks is open; see the enclosed announcement. Note that the deadline for application is May 15.
---The next NETLETTER will include Gunnar Forsberg's translation of the Table of Contents and Introduction to NATVERKSTERAPI. Again, I am asking colleagues with the connections to help link me with a publisher who might be interested in publishing an English translation.
---NETWORK WORK WITH MULTIPLE PROBLEM FAMILIES IN CRISIS is the preliminary report on child protective work using network strategies conducted near Stockholm by a group including Gunnar Forsberg. I reviewed the report in an earlier issue of NETLETTER. The cost is 49 Swedish Crowns per issue, approximately $8. U.S. I have some copies of the report. You can order single copies from me @ $8 apiece while they last. Larger orders should be addressed to Gunnar Bergvall, Information Councellor, Botkyrka Kommun, Box 510, 147 00 TUMBA, SWEDEN.
---As you can see, the letter is getting a little more formalized and organized. Sometime this year, I will work out a cost estimate and ask for subscriptions. I will also send out a Directory questionnaire, so we will have an annually updated listing of subscribers, their addresses, and current interests and activities. Please keep sending me your news, views, information about resources, and writings. I will pass them along. Major papers will be reviewed; shorter pieces will be printed in the NETLETTER. I welcome reviews of network literature by readers.
---The current mailing list is made up of those who attended or were invited to the network course at Ortho in Chicago in 1986. It includes most of the people I know about who are involved in the use of social network intervention in clinical practice. I welcome suggestions for additions. With this issue, I am adding Mansell Pattison to the list.
E. Mansell Pattison, M.D.
Department of Psychiatry and Health
Medical College of Georgia
Augusta, Georgia 30904
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