Handbook of Systemic Approaches to Psychotherapy Manuals: Integrating Research, Practice, and Training (European Family Therapy Association Series)

Handbook of Systemic Approaches to Psychotherapy Manuals
	Preface and Dedication
	Acknowledgements
	Contents
	About the Contributors
	Chapter 1: Towards a Truly Systemic Account of the Current and Future of Manualisation
		1.1 The Origins of the Handbook of Systemic Approaches to Manualisation
		1.2 A Brief History of Manuals Related to the Wide Field of Systemic Therapies and Interventions
			1.2.1 But Proved with What and in Which Way?
			1.2.2 The Lack of Research and Operalisation Helps Systemic Psychotherapy to Lose Relevance
			1.2.3 Constraints and Resources: A Balance to Be Done with Positive Attitude
		1.3 What Is a Process?
		1.4 A Map of the Book
		References
	Part I: Issues and Experiences in the Creation of Manuals
	Chapter 2: Another Loop of the Spiral: A Re-examination of 18 Manualized Prescriptions from 1978
		2.1 Editors’ Prologue
		2.2 18 Systemic Practices in Couples Therapy: An Early Attempt Toward a Systemic Manualization
		2.3 Introduction
		2.4 The Need of Manualization
		2.5 The Root of a Manual
		2.6 18 Instructions
		2.7 Conclusion
		References
	Chapter 3: Six Different Approaches to Manualisation from the Leeds Family Therapy and Research Centre
		3.1 The Leeds Attributional Coding System Manual
			3.1.1 The Process
		3.2 An Attempt to Manualise the Recognition of Attachment Processes in Family Discourse
		3.3 Family Therapy: Training and Practice
		3.4 The Leeds Systemic Family Therapy Manual (LSFT Manual)
			3.4.1 Creation of the LFTRC Manual
				Why Was a Comprehensive Systemic Therapy Manual Needed in the UK?
		3.5 Outline of the LFTRC Manual
		3.6 Impact of the LSFT Manual
			3.6.1 Research Using the LSFT Manual
			3.6.2 Uses of the LSFT Manual in Training
		3.7 Reflections on the Development of an SFT Manual in the UK
		3.8 Using Manuals to Specify the Competences of Systemic Therapists
		3.9 Conclusion: Indications for Systemic Approaches to Manualisation from the LFTRC Experiences
		References
	Chapter 4: Co-creating ‘Fluid Manuals’ for Feedback-Informed Systemic Therapy and Collaborative Research
		4.1 Introduction
		4.2 ‘Fluid Manual’ as a Navigation Tool in Complex Systems
		4.3 Co-creating ‘Fluid Manuals’ for Feedback-Informed Systemic Therapy and Collaborative Research
			4.3.1 Co-creating a Collaborative Learning Community
			4.3.2 Co-creating a ‘Fluid Manual’, with Agreed-upon Steps in a Road Map
		4.4 Collaborative Research: Learning How to Learn, Making a Difference That Matters
		4.5 A Case: Working with ‘Fluid Manuals’ for Feedback-Informed Systemic Therapy and Collaborative Research
			4.5.1 Co-creating a Collaborative Community
			4.5.2 Co-creating a ‘Fluid Manual’, with Agreed-upon Steps in a Road Map
			4.5.3 Collaborative Practice-based Research: Creating a Culture of Feedback
		4.6 Manualisation Producing Practice Based Evidence Based Practice
		4.7 Conclusion
		References
	Chapter 5: Manualizing Human Systems Therapy Towards a Few-Sessions Therapy
		5.1 Introduction
			5.1.1 Manualized Family Therapies
		5.2 The Issue of Time and Effectiveness
		5.3 An Outline of the Development and Present State of Human Systems Therapy
			5.3.1 Some Steps of the Development of Human Systems Therapy
			5.3.2 Basic Principles of Human Systems Therapy
				A Definition of the Open System
				Epistemology of Human Systems: Use of First- and Second-Order Cybernetics
				An Outline of Human Systems Intelligence
					Interaction with the Environment Subsystem
					The Control Subsystem
					The Modelling Subsystem
					Some Other Important Components and Functions
				Increase of Order and Variety
		5.4 Steps and Content of Manualization
			5.4.1 History and Experiences of Manualization. Its Importance for Creating Effective Therapists
				The History of Main Steps Contributing to Manualization
		5.5 Steps of Manualization
			5.5.1 The First Step Is Joining
			5.5.2 The Second Step Is the Identification of the Goals of Therapy
			5.5.3 The Third Step Is the Categorization and the Formation of Hypotheses
				Categorization
				A Hypothesis That Cannot Be Falsified Is Useless to the Therapy
			5.5.4 The Fourth Step Is the Intervention
				Elaboration of Genogram on a Laptop
				Multilevel Intervention
					Intrapsychic Intervention
					Intervention in the Relationships of the Person with the Core Problem
					Intervention in Couples
					Family Intervention
				Use of Appropriate Techniques
				Two Examples of Techniques for General Use
			5.5.5 The Fifth Step Is Monitoring the Degree of the Achievement
			5.5.6 The Sixth Step Is a Circular Process if There Are Difficulties in Therapy
		5.6 Some Research Trials Before and After Manualization Using Human Systems Therapy
			5.6.1 Intervention in an Institution for the Reduction of Aggression in Their Residence
			5.6.2 Increased Discharge of Chronic Schizophrenics from a Psychiatric Hospital
			5.6.3 Reduction of Psychotic Symptoms in Schizophrenics
			5.6.4 Elimination of Hashish Use in Adolescents
			5.6.5 Reduction of Symptomatology in Cases by the Students in Their Final Examination
			5.6.6 Reduction of Symptomatology in Psychiatric Cases After 4 Sessions
		5.7 Discussion
		References
	Chapter 6: Manualizing the Therapeutic Process in Systemic Therapy: From the Construction of the Hypothesis to the Assessment of Change
		6.1 Introduction: Why Resume the Effort of Manualizing the Hypothesis and the Therapeutic Process Today?
		6.2 Methodology
			6.2.1 Phases of the Therapeutic Process
			6.2.2 Methods of Co-Construction of the Systemic Hypothesis, Their Pacing in the Therapeutic Process, and the Construction of a Relational Folder Suitable for Retrieving Useful Information
			6.2.3 Use of the “Systemic Quadrilateral” for the Construction of a Complete and Well-Done Systemic Hypothesis
			6.2.4 Coding and Timing of Interventions in the Therapeutic Process
			6.2.5 Efficacy Assessment
		6.3 Conclusion
		References
	Chapter 7: Manualising the Exeter Model: Couple Therapy for Depression – A Behavioural-Systemic Approach
		7.1 Introduction
		7.2 Background and Rationale
		7.3 Developing a Clinic
			7.3.1 Progression Toward the Exeter Model: Development Within a University
		7.4 The Model in Action
		7.5 The Model in Clinical Use
		7.6 Future Developments
			7.6.1 Cultural Genogram
		References
	Chapter 8: Systemic Approaches to Therapy Manuals: Family Situation Mapping and Systemic-Relational Assessment of Treatment for Families, Couples and Individuals
		8.1 Introduction
		8.2 The Manual
			8.2.1 Part One
			8.2.2 Part Two
			8.2.3 Part Three
		8.3 Dissemination and Study of the Manual
		8.4 Conclusions
		References
	Chapter 9: A Model of a Systemic Therapy Clinic
		9.1 Introduction
		9.2 The Context
		9.3 The Beginning
			9.3.1 The Building
		9.4 A Learning Hub
			9.4.1 Collaborative Relationships among Professionals
			9.4.2 Practice
			9.4.3 Training Students
			9.4.4 Assessment Strategy
			9.4.5 Supervision
		9.5 Research
		9.6 The Manual
			9.6.1 Progress Report
			9.6.2 Initiating the Project and Establishing Collaborative Relationships
			9.6.3 Financial Resources
		9.7 Discussion
		9.8 Conclusion
		References
	Chapter 10: The Map of Competences in Systemic Therapy: Targeting Associated Abnormal Psychosocial Situations in Axis 5
		10.1 Background
			10.1.1 Axis 5, Associated Abnormal Psychosocial Situations
		10.2 Context for the Research
		10.3 The Map of Competences as a Framework for Flexible Systemic Therapy
		10.4 Discussion
			10.4.1 A Multi-Epistemological Systemic Approach
			10.4.2 Using the Map of Competences
		10.5 Limitations of the Research
		10.6 Concluding Comments
		References
	Part II: Research Issues in the Use and Evaluation of Manuals
		1.1 Introduction
	Chapter 11: An Integrative Approach to Systemic Therapy
		11.1 Integrative Systemic Three-Column Framework
			11.1.1 Problem Formulation
			11.1.2 Exception Formulation
			11.1.3 Interventions
			11.1.4 Therapy Stages
		11.2 Case Example
			11.2.1 Assessment Contracting
			11.2.2 Problem Formulation
			11.2.3 Exception Formulation
			11.2.4 Treatment Contracting
			11.2.5 Therapy
				Interactional Reframing
				Externalizing the Problem
				Pinpointing Strengths
				Building on Exceptions
				Tom’s Challenge: Self-regulation
				Sue’s Challenge: Being Courageous
				Managing Resistance
				Parentings
				Building Support
				Disengagement
				Relapse Management
				Therapist Dilemmas
		11.3 Summary
		References
	Chapter 12: Research and Manualisation at ISCRA Institute: The DAN Model: Digital, Analogic, Narrative
		12.1 Introduction
		12.2 Research and Manualization at Iscra
		12.3 Format and Principles
			12.3.1 Axioms and Hypotheses
		12.4 DAN Synopsis
			12.4.1 Session Structure
		12.5 The DAN Manual in Practice
		12.6 Tools
			12.6.1 The Digital Section: The RSPc
				Data Interpretation
			12.6.2 The Analogical Section: The Tridimensional Genogram
			12.6.3 The Narrative Section: The Better Formed Tale
		12.7 The Final Version of the DAN Model
		12.8 Tools
			12.8.1 Genogram
				Use in Practice
				Purpose
			12.8.2 RSP, Photograph Choice and Role Reversal
				Dichotomies and the Relational Object
				Use in Practice
				Purpose
			12.8.3 Tridimensional Genogram and Object and Letter
				Use in Practice
				Purpose
			12.8.4 Systemic House Drawing
				Use in Practice
				Purpose
			12.8.5 Better Formed Tale and Fables
				Purpose
			12.8.6 Coat of Arms
				Use in Practice
				Purpose
		12.9 The Iscra Training and the DAN Manualization
		12.10 Conclusions
		References
	Chapter 13: The Digital Analogic Narrative (DAN) Model in Practice: Transformations and Enhancement of Resilience in a Non-clinical Parental Couple. A Case Report
		13.1 Introduction
		13.2 The Case
		13.3 Couple Description
		13.4 First Session: Presentation of the Programme, Gathering of Relational History, Genogram, Score 15
			13.4.1 Genogram
			13.4.2 Score-15
		13.5 Second Session: Relational Style Profile, Drawing of the House (Past and Present)
		13.6 Relational Style Profile
			13.6.1 Drawing of the House
			13.6.2 House of the Past
				Present House
		13.7 Third Session: Drawing of the House (Future), Feedback of the RSP, Homework (Role Exchange)
			13.7.1 RSP Feedback
			13.7.2 Homework: Role Reversal
		13.8 Fourth Session: Homework Feedback, 3D Genogram
			13.8.1 Homework Feedback
			13.8.2 3D Genogram
			13.8.3 3D Genograms of the Past
			13.8.4 3D Genogram of the Present
			13.8.5 3D Genogram of the Future
			13.8.6 Homework: Object and Letter
		13.9 Fifth Session: Restitution of the Homework, Score 15
			13.9.1 Restitution of the Homework
		13.10 Score-15
		13.11 Sixth Session: Better Formed Tale
		13.12 Seventh Session: Ritual of Discharge with the Heraldic Shield, Restitution of the Better Formed Tale Done at Home
		13.13 Eight Session: Follow-Up, Score-15
			13.13.1 Score 15
		13.14 General Thoughts on the Discharge Session
		13.15 Therapists’ Reflections
			13.15.1 Couples in the Mirror: Therapists and Spouses
		13.16 Did We Contribute to this Family’s Resilience?
			13.16.1 …and Then?
		13.17 Conclusion
		References
	Chapter 14: Taking Care of Adoption (TCA): Development of a Treatment Manual for Adoptive Families
		14.1 Introduction
		14.2 The Problems of Adoptive Families
			14.2.1 The Child’s Involvement in Dysfunctional Relational Patterns
		14.3 Theoretical Bases and Assumptions Underlying the TCA Model
			14.3.1 Goals of Therapy
			14.3.2 Tools and Techniques
		14.4 The Treatment Manual
		14.5 Conclusion
		References
	Chapter 15: Manualized Family Therapy in a Controlled Study on Childhood Depression: Therapists’ and Supervisors’ Reflections on the Use of the Manual
		15.1 Introduction
		15.2 The Research Project BIOMED “Psychotherapy for Childhood Depression”
		15.3 The Manual
		15.4 The Athens SIFT Team
			15.4.1 Main Issues Regarding the Therapeutic Process
			15.4.2 Supervision Main Issues
			15.4.3 Family Features
		15.5 Post-session Notes
		15.6 Further Reflections by Therapists and Supervisors
		15.7 From the Past to the Present: Further Usefulness of the SIFT Manual
		15.8 Concluding Remarks
		References
	Chapter 16: Working Alliance, Attachment, and Mentalization as Relational Indexes for a Systemic Manualization of Psychotherapy
		16.1 Effectiveness and Manualization of Psychotherapies
		16.2 Manualization in a Systemic Perspective
		16.3 Assessing Working Alliance and Attachment Matching Between Therapist and Patient
		16.4 Assessing Mentalization in a Systemic Perspective
		16.5 The Reflective Function in the Family (RFF)
		16.6 An Example of Systemic Family Treatment Assessed with RFF
		16.7 Conclusions
		References
	Chapter 17: A Manual Developed Through a Variety of Online Resources: The SCORE Index of Family Functioning and Change
		17.1 Introduction
			17.1.1 The SCORE: What It Is
			17.1.2 Processes of Development
			17.1.3 Content and Form at Different Stages/Locations
		17.2 A Guide to the SCORE Material
			17.2.1 Procedures for Translation
			17.2.2 Publications That Provide Guidance on Implementing SCORE
		17.3 Feedback from Surveys of Users
			17.3.1 A Sample of Specific Responses in the EFTA Survey
			17.3.2 UK Survey Responses
			17.3.3 Material on Google Groups, Q&As
			17.3.4 Feedback Offered by Users Individually, by Email and on Google Groups
			17.3.5 Examples of Specific Feedback from Users Shared Through Various Media
		17.4 Future Options
		17.5 Conclusion
		Appendix. The SCORE-15
		References
	Part III: Uses of Manuals in Clinical Practice
	Chapter 18: Intergenerational Couple Therapy
		18.1 Introduction
		18.2 Enlarging the Frame of Observation
		18.3 Presence of Families of Origin
		18.4 Presence of Children
		18.5 Presence of Friends
		18.6 Conclusion
		References
	Chapter 19: From Treatment Models to Manuals: Maudsley Single- and Multi-Family Therapy for Adolescent Eating Disorders
		19.1 The Development of Systemic Treatment Approaches for Young People with Eating Disorders
		19.2 Maudsley Family Therapy for Adolescent Eating Disorders
		19.3 Changes in the Model Over Time
			19.3.1 Changes in the Definition of the Phases of Treatment
			19.3.2 The Changing Nature of the Therapeutic Relationship Over the Course of Treatment
			19.3.3 Emphasising the Meaning of Parental Management of Eating as Caring Rather than Controlling
			19.3.4 Engaging the Adolescents and Siblings
			19.3.5 The Role of Parental Anxiety
			19.3.6 Broadening the Concept of Externalisation
			19.3.7 Use of the Family Meal Session
			19.3.8 Treatment Context and Intensity: Multi-family Therapy
			19.3.9 One Size Does Not Fit All: Differentiating (or Adding to Model) for Different Sub-Groups
				Families with High Levels of Criticism / Hostility
				Bulimia Nervosa and Young People Who Are Emotionally Dysregulated
				Highly Anxious and Demoralised Families
		19.4 From Models to Manuals
			19.4.1 The Development of Family and Multi-family Therapy Manuals for Eating Disorders
			19.4.2 The Role of Manuals in Delivering Effective Treatments
			19.4.3 Treatment Models Are Not Static, So Why Would a Manual Be?
			19.4.4 Formulation in Manuals
			19.4.5 Think Teams: No Clinician Is an Island
		19.5 Conclusions
		References
	Chapter 20: Suggestions for a Creative Manual: The “Intervention for Change” and the Therapeutic Relationship. The Floating Therapies and Working on the Self
		20.1 Introduction
		20.2 What Is Meant by Thinking Systemically to Act Systemically
		20.3 Part A. Working with the Courts
		20.4 Working with the Courts: An “Intervention for Change”
			20.4.1 The Use of the Methodology and the Manualization
		20.5 Part B. Therapies in a Clinical Setting
		20.6 Fluctuating Therapies
		20.7 Working on the Self
		20.8 The Therapeutic Relationship
		20.9 Examples
		20.10 The Access Routes to the Right Hemisphere: How to Talk to Emotions
		20.11 What Ways of Relating Are Successful with Each Family?
		References
	Chapter 21: “Triangular Mirroring” in Teaching, in the Clinic and in Research: A Procedure to Evaluate the Outcome of the First Session in Infant Systemic Psychotherapy
		21.1 Theoretical Premises
		21.2 Observational Experience for Research Purposes
		21.3 Triangular Mirroring: A Teaching, Clinical and Research Procedure
		21.4 Analytic Description of the Items
		21.5 The “Operative Protocol”
		21.6 Conclusions
		References
	Chapter 22: The Treatment of Mutual Demonization in Post-separative Conflict
		22.1 Introduction
		22.2 Differences Between Post-separation Conflicts and Intra-Family or Gender Violence
		22.3 Part One: The Phenomenon of Post-separative Conflict
			22.3.1 Separation as an Onset of Trauma
			22.3.2 The Schismogenetic Transacting Couple: Mutual Demonization
			22.3.3 The Macrosystemic Effect of Amplifying Schismogenesis
			22.3.4 The Semantic and Structural Homology Between the Couple System and the Legal System
			22.3.5 The Difficulties for the Parents
		22.4 Part Two: The Triggering Generativity Intervention
			22.4.1 The Intervention Context: Safeguarding the Clinical Space
			22.4.2 Implementation of Collaborative Practices and Setting Up a Working Party
			22.4.3 Methodology
		22.5 Work with the Macrosystem
			22.5.1 Meeting the Defence Lawyers
			22.5.2 The Initial Meeting with the Family
			22.5.3 Co-constructing the Rules of the Game: The Rules of Communication
			22.5.4 Meeting the Families of Origin, New Partners, and a Significant Friend
		22.6 Working with the Family
			22.6.1 Step 1: Presentification of the Conflict
			22.6.2 Step 2: Externalization of the Conflict
			22.6.3 Step 3: From Alienated Responsibility to Responsibility for the Conflict
			22.6.4 Step 4: Intervention to Break the Bond: Recovering the Past
		22.7 Conclusions
		References
	Chapter 23: Basic Model of a Couple’s Crisis: A Manual for Couples’ Therapy
		23.1 Working with Couples
		23.2 Relationship with the Therapist
		23.3 Couple in Crisis
		23.4 A Basic Model for Understanding a Couple’s Crisis
			23.4.1 Dysfunctional Communication Scheme and Difficulty of Transition
			23.4.2 Difficulty in Transition and Issues Around Organizing Adult Life
			23.4.3 Unfinished Story from the Couple’s History
			23.4.4 Unfinished Issues from a Partner’s Individual History
			23.4.5 Lack of Individual or Shared Plans
			23.4.6 Difficulty in Organizing Aspects of Adult Life
		23.5 Process of a Couple’s Therapy
		23.6 Autonomy–Intimacy
		23.7 Stages in the Couple’s Development
		23.8 Conclusion
		References
	Chapter 24: Marte Meo and Coordination Meetings: A Systemic, School-Based Intervention
		24.1 Introduction
		24.2 Starting Points
		24.3 Two Sets of Theories, Two Interventions, One System Perspective
			24.3.1 Marte Meo (MM)
			24.3.2 Coordination Meetings (CMs)
		24.4 Differences, Information, and Development
		24.5 Research Results
		24.6 Notes on Implementation
		24.7 Some Final Reflections
		References
	Part IV: Training as a Basis for Development of Manuals and a Context for Their Application
		1.1 Introduction
	Chapter 25: Image, Family, and Clinical Practice: Image and Family of Origin as Tools for Training the Family Therapist
		25.1 Introduction
		25.2 Rodolfo, EFTA, and the Need for Manuals
		25.3 Common Ground and the Importance of Training
		25.4 Training at Our Institutes
		25.5 Rodolfo—In His Own Words
		References
	Chapter 26: A Manualized Systemic Family Therapy Training Program
		26.1 The Manual
			26.1.1 Practical Learning
			26.1.2 Family Therapy Training Program
			26.1.3 Core Curriculum of the Four Years Training Program
			26.1.4 Learning Outcomes (LO)
			26.1.5 The Road Map
			26.1.6 The Theory
			26.7.1 Learning Outcomes Assessment
				Assessment Criteria
				The Questionnaire
		26.8 Some Preliminary Results
			26.8.1 Effects on the Students
			26.8.2 Effects on the Teachers
			26.8.3 Effects on the Training Program and Conclusion
		References
	Chapter 27: Healing Relationships: A Manualized Curriculum for Systemic Primary Care Physicians
		27.1 Introduction
		27.2 Evolution of Medicine in the United States
		27.3 Family Medicine
		27.4 UCSF SFGH Family and Community Medicine Residency
		27.5 Behavioral Sciences Curriculum
		27.6 Manuals, Epistemology, and Pedagogy
		27.7 Manuals and the Sacred
		27.8 The Manual
		27.9 Examples of Objectives from the Manual
		27.10 Value of Our Manualized Training
		27.11 Recurrent Challenges
			27.11.1 Reductionism
			27.11.2 Evidence-Based Treatment
			27.11.3 Desire to Fix
		27.12 Program Evaluation
		27.13 Dissemination of the Manualized Curriculum
		27.14 Manuals and the Pandemic
		27.15 Conclusion
		References
	Chapter 28: Changing the Trainees’ Epistemology in Systemic Family Training: The Manual as a Secure Base
		28.1 Introduction
		28.2 Significant Moments That Organised Us in the Development of Our Training Course
			28.2.1 Theoretical Input: Theoretical Narratives and the Training Social and Cultural Context
			28.2.2 The Application of Theory in Practice: The Formation of Therapeutic Teams
		28.3 Diversity of Therapeutic Experiences During the Course of Training
		28.4 Professional Development: The Journey from the Individual Perspective to Systems
		28.5 Mapping the Territory: A Guide for the First Session
		28.6 Witnessing the Family Drama: Containing Emotions
		28.7 The Experiential Median Group
		28.8 Changing the Trainees’ Epistemology
			28.8.1 The Relational Context of the Therapeutic Team and Group Supervision
		28.9 Encouraging Creativity – Integrating Diverse Theoretical Concepts
		28.10 Safe Uncertainty: Constructing a Secure Base in Training
		28.11 Deconstruction of the Meaning of Manual
		28.12 Conclusion
		References
	Chapter 29: Trainee-Focused Training: A Second-Order Approach in the Making of Therapists
		29.1 Introduction
		29.2 Why Speak About a Second-Order Cybernetics Approach in Therapy Training?
		29.3 My Background
		29.4 Theoretical Sensitivity
		29.5 Trainee-Focused Training (TFT)
		29.6 TFT in Romanian Context
			29.6.1 TFT in an International Context
		29.7 TFT Specifications
			29.7.1 General Specifications
			29.7.2 Theoretical Training Specifications
			29.7.3 Specifications for the Supervision Stage
			29.7.4 Specifications for the Personal Growth Stage
		29.8 The Present Stage of TFT Model
		References
	Chapter 30: Family Therapy Training in the Greek Public Sector: The Manualization of an Experiential Learning Process Through Personal and Professional Development
		30.1 Introduction to the Theoretical Context of the Training Program of the Family Therapy Unit
		30.2 The “Synthetic, Systemic-Experiential” Program
		30.3 Basic Topics as a Manual for the Development of a “Synthetic, Systemic-Experiential” Program
			30.3.1 The Goals and Objectives of the Training Program
			30.3.2 The Training Group Is Not a Therapeutic One
			30.3.3 The Role of the Team of Trainers and the Trainer-Trainee Relationship
			30.3.4 The Nuclear Philosophy
			30.3.5 The Therapist’s Therapy
			30.3.6 The Group Has the Potential to Integrate Different Idioms
		30.4 Epilogue
		References
	Chapter 31: “From Mind to Culture”: Developing a Treatment Plan Manual for the Enriched Systemic Psychotherapy Model SANE-System Attachment Narrative Encephalon®
		31.1 Introduction
		31.2 Theoretical Assumptions
			31.2.1 A Multiplicity of Perspectives
			31.2.2 Combining Perspectives
		31.3 Process of Therapy
			31.3.1 Therapy Setting
			31.3.2 Parallel Therapy Stages and Goals from Four Perspectives (Diagram 31.1)
		31.4 Case Conceptualization
			31.4.1 Teaching the SANE Model
			31.4.2 Asking Guiding Questions
			31.4.3 Using Skills and Techniques
		31.5 Role of Therapist
		31.6 Supporting Research
			31.6.1 Research on the Process and Experience of Therapy
				Macro-Level Studies
				Micro-Level Studies
			31.6.2 Research on the Progress of Therapy
				Coherence Enhanced
				Sensitive Stories Turn Less Sensitive
				Stories Assessed
		31.7 Epilogue
		References
	Chapter 32: Manualising – Personalising – Without Compromising (Either the Manual or the Systemic Approach) Except When …
		32.1 From Conflict to Cooperation: A Tale of Two Colleagues
		32.2 Problems-Possibilities and Resources-Restraints (PPRR)
		32.3 Level 1: Manualising: The Relationship of Each Team Member with Manualised Approaches
			32.3.1 Agency Context
				Framework of the Model
				Structure in Emotional and Therapeutic Containment
				Co-constructing Through Involvement and Language
				Contextual Influence and Influence on Context
				Flexibility/Ease of Integration
				Manualised Models as Rigid and Constraining
					Privileging and Subjugating Discourses and Ethical Positioning
				Structure Leading to Tensions and Pressures
				Integration of Approaches
				Using First-Order Methods in a Second-Order Way
				Creating a Relational Fit Through Collaboration
				Personally Informed Professional Practice
				Therapists Continuing Reference to Manuals
				Anchoring and Adaptation
		32.4 Approach-Method-Technique: Making Distinctions and Creating Connections
			32.4.1 Approach
			32.4.2 Method
				Example 1 (Approach)
				Example 2 (Method)
			32.4.3 Technique
		32.5 Level 2: Implementing a Manualised Approach Within a Single Unit (Eating Disorders)
			32.5.1 Beki’s Experience
			32.5.2 Refreshing Rigour Through Formal Training
			32.5.3 Connecting with Community
		32.6 Level 3: Process of Training the Staff Across All Three Units in the Service in Non-Violent Resistance (NVR)
			32.6.1 Transferring Excitement into Expertise
			32.6.2 Feedback from the Training
		32.7 Closing Remarks
		References
	Chapter 33: Implications of the Handbook for the Future of Manualization of Systemic Therapies
		33.1 Introduction
		33.2 Nine Issues of Systemic Manuals Generated by the Content of This Handbook
			33.2.1 The Status of the Manualization Issue
			33.2.2 Different Forms and Formats of Manual-Type Material Among the Chapters
			33.2.3 Variations in How Widely Applied Are Manuals Beyond the Originators’ Settings
			33.2.4 The Epistemological Bases Used for the Manuals
			33.2.5 Variations in the Forms That Manuals Are Taking
			33.2.6 The Process of Developing a Viable Manual
			33.2.7 Relationship Between Competence Specifications and Manuals
			33.2.8 The Prospects for Future Development of the Manuals
			33.2.9 Future Challenges
		33.3 Conclusion
			33.3.1 Our Guesses/wishes for the Future of Manualization
		References
	Correction to: Handbook of Systemic Approaches to Psychotherapy Manuals
		Correction to: M. Mariotti et al. (eds.), Handbook of Systemic Approaches to Psychotherapy Manuals, European Family Therapy Association Series, https://doi.org/10.1007/978-3-030-73640-8
	Index