New Zealand Rehabilitation Association, Inc.

So, the first question is: What is Family Therapy?

There’s a difference between family therapy and the family work I would do as part of a rehabilitation team.  Family therapy developed over the 70’s, 80’s and 90’s in response to the traditional approach to working with children and adolescents that viewed the child or the adolescent in isolation.  Family therapy developed as a way of looking at the child’s problem in the context of the family dynamics and interactions.  Working as a family therapist in, say a Child and Family Unit, you would generally work with whole families, and you would often have a co-therapist and work as a team.

In terms of the work that I do – although I’m employed as a family therapist for Capital Coast Rehab - I actually work as a family worker and counsellor.   That’s partially because I’m a psychotherapist, and that word is quite frightening to people, and what we want to do is to normalise it and to say that having difficulty with relationships and in families, when you’ve got an illness, had a stroke, or had an injury, is normal.  We don’t want to make it sound like some kind of extreme mental health condition so I describe myself as the family worker or the counsellor. 

What sort of work do you do for Capital Coast Rehab?

Most of the work that I do is with couples.  Family work is about – and this is what I teach in REHX709 (the university paper) - thinking systemically, thinking of the person as part of a set of relationships and part of a family – but that doesn’t mean you need to have all those people in the room all the time.  So I tend to work with couples or individuals.  That might be the person with the injury or illness, or it might be the partner -  it might be seeing them together and separately as well.  Sometimes parents are keen to include their adult children as well, as illness & injury has a ripple effect on the whole family.

In the rehab setting I don’t usually involve younger children. I generally believe its more helpful to assist parents to talk to their own children about what is happening in the family, than for me to see the children themselves.  So if one of the parents has had a stroke or had an injury and they’re worried about how they’re managing their children – then I will work with the parents about the children’s needs and what might help.

The key worker of a client in Capital and Coast Rehabilitation will refer to me when they think there are issues in the family which may hold up the client’s progress in their rehab.  I tend to see people who have had a stroke, where either the person with the stroke or the partner has become quite depressed. They may be quite stuck in grief and the relationship is suffering. There is a lot of evidence now of the impact that illnesses like a stroke can have on a relationship – it may for example, necessitate a complete change in roles.

I also see people where the team feels that the client or the client’s partner or  older  children have expectations for recovery that are different from those held by the multidisciplinary team– and they haven’t been able somehow to establish mutual goals. Facilitating family members to talk to each other about their hopes and fears often shifts peoples’ perceptions and enables them to communicate more effectively with the rehab team.

I am also involved with people with degenerative conditions like MS or early onset Alzheimer’s where there’s a lot of grief for both client and partner and family. Inevitably family members are at different stages of adjustment at different times.

And I sometimes just work with the multidisciplinary team as a consultant – where we talk and decide whether there is a role for me or not.

Who could become a family therapist?

In the past in NZ it was difficult to acquire a formal qualification as a family therapist although there were great ways of learning on the job in a number of agencies in the major cities.  We now have a psychotherapy programme and qualification in Auckland, and family therapy is one model of psychotherapy.  Recently, in the Wellington School of Medicine also, the Public Health Department is starting some family therapy training, which I think is mainly for mental health and child and adolescent professionals.

Where did you train as a family therapist?

Well, I trained like an apprentice really – I worked at child, adolescent and family services.  I did a post-graduate social work qualification.  Then over the next five to six years I trained as a psychotherapist, and I had to go backwards and forwards to various places in NZ and even Australia to do that.   Child and Adolescent Services brought experts from all around the world to teach us family therapy – and about seven or eight of us trained together… and then we taught it from about ’88 to ’93.  I taught family therapy to psychology and social work students at Victoria University, and to mental health staff working here in the psychiatric unit.  We used one-way screens both for practice and training and learned by observation and supervision.

Is there any regulation of the profession?

Well no, because it is not recognised as a profession on its own but there’s regulation of psychotherapy and family therapy is a model of psychotherapy.  If you are trained as a psychotherapist you can apply to be a member of the NZ Association of Psychotherapists. Psychotherapy  is about to be set up for registration by the government – this should come into law by the end of this year. And so you will be able to be a registered practitioner.

Does ACC pay for family therapy?

ACC in Wellington used to occasionally pay for it when they had a Serious Injury Unit, and case managers became very skilled working with serious injury - mostly with people who had traumatic brain injuries. The case manager worked as part of the multidisciplinary team – and they realised that the impact of the injury on the person’s relationships was fundamental to their quality of life.  So they would then involve the family worker as part of the multidisciplinary team, and pay for maybe up to ten sessions for the couple and/or family of the client.  I am not aware of them doing this now (although they may). I have taken it up with Ministers at times and they do agree that family relationships are essential to your quality of life… (laughs) which is my hobby horse!

Ah!  So tell me about your hobby horse.   What is your ‘soap box’ issue for the NZRA audience?

Well I’ve been to a lot of presentations – in DHB’s and in ACC – where people ask what is rehab about?  How are we trying to make a difference to our clients?  And fundamentally it boils down to maximising peoples’ choices in life, maximising their options, and improving their quality of life.  Then, when we are talking about quality of life everybody agrees that it’s not just about being able to make a cup of tea or walk to the front door. Having more independence is very important but if your most important relationship is falling apart – or if you feel the whole family is not coping with what’s happened to you that’s fundamentally important too. Yet we don’t seem to be willing to fund work to help people’s relationships survive the impact of a major injury or an ongoing debilitating illness.

Even in situations where there are known relationship consequences from the injury or illness – traumatic brain injury for instance.

And stroke, depression… we don’t invest in it.  And so what Capital Coast Rehab has done by employing a family therapist – although I am very part time - is to acknowledge that in addition to helping people regain their mobility and focusing on their ADLs, you can’t ignore their relationships and that’s very innovative of them.

Thank you for your time.

Post-script, 21 August 2008: Ginny has since resigned from teaching REHX709 (after 8 years), but continues her work with Capital & Coast Rehabilitation and her own private practice.