Applying the Domains Framework to Family Processes

1. Applying the Domains Framework to Family Processes Jonathan Hill Derby November 2012

2. A Brief History • Thinking that families might be characterised by a dominant attachment style • The Adult Attachment Interview administered to the family in the present, e.g. What happens in the family when someone is sad? • Observation of families made clear that attachment interactions are a minority • There is an ecology of topics and processes

3. A Brief History • In addition to attachment – safety, discipline, and companionship/conversation/story telling/collaborative exploratory • The family navigates across these areas, moment by moment • Treatment modalities tend to emphasise one eg. Cognitive therapy collaborative-reflective, parent training discipline-expectation Hill, Fonagy, Safier, Sargent, ‘The Ecology of Attachment in the Family’, 2003, Family Process

4. A Brief History • Further elaboration of features of the domains for rating from the Family Domains Interview, and now from family therapy sessions • Elaboration supports development of a platform for clinical approaches Hill, Wren, Alderton, Burck, Kennedy, Senior, Aslam, Broyden Epub 2011 ‘The application of a domains-based analysis to family processes: implications for assessment and therapy.’ Journal of Family Therapy

5. Aims • To provide a systematic, patterned way of noticing and enquiring into family interactions • To provide a platform from which a range of established therapeutic approaches might be launched • To consider whether the framework suggests additional approaches – e.g. On-line, educational programmes

6. A Platform • Social domains are classes of interpersonal processes each with distinct procedural rules underpinning mutual understanding, emotion regulation and action. • We describe the features of three affect-action domains of family life – safety, attachment and discipline/expectation – and contrast them with exploratory processes in terms of the emotions expressed, the role of certainty versus uncertainty, and the degree of hierarchy in an interaction.

7. A Platform • Everything that people say and do in family life carries information about the type of interaction they are engaged in – that is, the domain. • Sometimes what they say or how they behave does not make the domain clear, or participants in the social interactions are not in he same domain (there is a domain mismatch). • This may result in misunderstandings, irresolvable arguments or distress.

8. Where does the Framework Come From? I – Philosophy of Mind • All biological systems, including social systems are rule bound • Events have intentionality, ‘aboutness’, e.g. Blood pressure, light intensity, distance and direction of nectar • In bees the rules of dance are species specific – genetic • In humans there are multiple rules for intentionality – domains provide constraints to underpin effective action (Bolton and Hill 2004)

9. Where does the Framework Come From? II – Developmental Processes • From birth parents ensure safety of the infant • From around 6 weeks parent and infant engage in face to face reciprocal, pleasurable interactions • From around 6 months distress and anger start to be distinguishable • 12 months the attachment sequence, distress and comfort is well established • 18 months oppositional behaviours requiring firm handling are seen, rules and expectations are set

10. Early Developmental Tasks of Parents • To identify accurately the signals of the infant – anger, fear, anxiety, sadness, discomfort, curiosity, joy • To identify accurately the reasons for the emotional state of the infant • To act appropriately to resolve the emotional state and attend to the reasons for it, or to engage the curiosity or share the joy • Bugental, D. B. (2000). Acquisition of the algorithms of social life: A domain-based approach. Psychological Bulletin, 126, 187–219

11. Where does the Framework Come From? III – Family Therapy • Bateson - All of what parents and children say, and show, metacommunicate the domain • Structural family therapy – emphasis on hierarchy and action, in the family AND the therapist with family • Systems therapies – emphasis on exploration, curiosity, and the collaborative nature of family processes AND the therapist with the family

12. Family Life as ‘Navigation’ • Parents responding to different negative emotions with different implications, requiring action • Parents responding to companionable, exploratory bids, requiring attention and interest • Similar processes between parents • Constant flux with each family member monitoring the kind of interaction that is occurring • Each process has its place and value • Parents and children navigate across domains in family life

13. Who Does What in the Domains?

14. Who Does What in the Domains?

15. http://www.youtube.com/watch?v=sMy0757byl4&feature=player_detailpagehttp://www.youtube.com/watch?v=sMy0757byl4&feature=player_detailpage

16. How is it at school darling? Could be exploratory. The question is does it convey clear interest in school? What does the shaking of the head imply – perhaps draws the focus on to the mother? I am not at school any more. Aren’t you? No I am at the sixth form college. Is that in a different place darling? This has many features of an exploratory exchange, although the humour comes from how out of touch the mother is with her daughter’s education, likely reflecting a lack of regular exploratory or discipline/expectation conversations. The humour also comes from the mother making herself the focus of attention. What is this project you are doing? (Shaking the model of DNA as she asks) Mother don’t get involved Written down this could sound like an interested exploratory question, but the tone does not convey genuine interest. Saffron responds as if something other than genuine interest is about to be shown!

17. I am involved, I am your mother, I want to know, I am interested The phrase ‘I am interested’ could belong in exploratory but does not have the tentativeness and uncertainty of exploratory. It is put quite forcefully, as if in safety or discipline. The phrase ‘I am your mother’ is ambiguous in that it could signal a hierarchical domain, such as discipline/expectation as in I need to know what is happening in your education, but in this relationship could bring the focus on the mother as in ‘you need to make me feel as if I am your mother’. You are not interested you are bored Saffron treats it as an exploratory bid from mother, which she does not believe. There could be an implied attachment need i.e. I might have hoped you would show interest as my mother and it hurts me that you do not. I want to know! So the facial expression, the tone, the insistence in spite of the daughters wishes all belong with discipline/expectation. However there is no accompanying clarification regarding the reason she wants to know, which would make the domain clearer It’s a DNA project which we present next week as part of our term work – alright? Saffron responds on the basis that it is discipline-expectation, angrily complying, typical of the way the domain works in adolescence. Open day, open day, at your sixth form college, is that what you are saying darling? Next week, what day darling? Now the domain is put into doubt radically. There is no longer the forceful, possible discipline/expectation, nor the interested tentativeness of exploration. You are not coming So now Saffron talks to her mother in reverse discipline/expectation, clear and unambiguous.

18. How do the Domains Become Unclear?

19. Topics for Discussion • Affect-action domains entail rapid inaccurate processing – the slower more accurate exploration buys time and understanding • Domains in equilibrium in the family – one domain may dominate (e.g. Discipline/expectation) at the expense of others • Domains processes identify therapeutic task, which may be behavioural, cognitive, narrative, psychodynamic...brief....longer term • The domains perspective can be applied to the therapist-family relationship

20. Questions Posed in Response to JFT Paper (I can supply) • Epistemology – do domains exist? • Are domains mutually exclusive? • How does domain functioning change with age – particularly in adolescence? • To what extent are domains universal – or open to cultural variations? Commentators; Paula Boston, Rudi Dallos, Carmel Flaskas, Brit Krause

21. Applications in Clinical Practice • Creating the platform • Observed interactions among family members • OR descriptions of events and who said and did what • Any setting, any time • How common in current family therapy practice?

22. Applications in Clinical Practice • Psychoeducational groups – provide parents with the tools, prior to description of the problem – RCT about to start in Manchester • Tell the family about the domains framework as a basis for discussion of family processes • Use the domains framework with the family to inform questioning, to open up discussion of alternative ways of seeing interactions

23. Examples from the Tapestry • Interface with behavioural activation for adolescent depression, clarify the place of attachment and discipline – with cognitive therapist • Expand ‘atrophied’ attachment where discipline dominates with oppositional child – with parent training clinician • Review the domains challenge of the adolescent who self harms repeatedly – with unit staff or parents • Consider the effect on other domains of the dominance of safety in treatment of childhood cancer – with nursing staff

24. Thank You