This article was downloaded by: [University of Cambridge]

On: 27 December 2014, At: 04:32

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered
office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Child Care in Practice

Publication details, including instructions for authors and
subscription information:
http://www.tandfonline.com/loi/cccp20

The Applicability of Two Strengths-

based Systemic Psychotherapy Models
for Young People Following Type 1
Trauma
Stephen Coulter
Published online: 06 Feb 2014.

Click for updates

To cite this article: Stephen Coulter (2014) The Applicability of Two Strengths-based Systemic
Psychotherapy Models for Young People Following Type 1 Trauma, Child Care in Practice, 20:1,
48-63, DOI: 10.1080/13575279.2013.847057

To link to this article: http://dx.doi.org/10.1080/13575279.2013.847057

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the
“Content”) contained in the publications on our platform. However, Taylor & Francis,
our agents, and our licensors make no representations or warranties whatsoever as to
the accuracy, completeness, or suitability for any purpose of the Content. Any opinions
and views expressed in this publication are the opinions and views of the authors,
and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content
should not be relied upon and should be independently verified with primary sources
of information. Taylor and Francis shall not be liable for any losses, actions, claims,
proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or
howsoever caused arising directly or indirectly in connection with, in relation to or arising
out of the use of the Content.

This article may be used for research, teaching, and private study purposes. Any
substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,
systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
 Conditions of access and use can be found at http://www.tandfonline.com/page/terms-
and-conditions
Downloaded by [University of Cambridge] at 04:32 27 December 2014
 Child Care in Practice, 2014
Vol. 20, No. 1, pp. 48–63, http://dx.doi.org/10.1080/13575279.2013.847057

The Applicability of Two Strengths-based

Systemic Psychotherapy Models for
Young People Following Type 1 Trauma
Stephen Coulter
Downloaded by [University of Cambridge] at 04:32 27 December 2014

This paper will consider the inter-relationship of a number of overlapping disciplinary

theoretical concepts relevant to a strengths-based orientation, including well-being,
salutogenesis, sense of coherence, quality of life and resilience. Psychological trauma will
be referenced and the current evidence base for interventions with children and young
people outlined and critiqued. The relational impact of trauma on family relationships
is emphasised, providing a rationale for systemic psychotherapeutic interventions as
part of a holistic approach to managing the effects of trauma. The congruence between
second-order systemic psychotherapy models and a strengths-based philosophy is noted,
with particular reference to solution-focused brief therapy and narrative therapy, and
illustrated; via a description of the process of helping someone move from a victim
position to a survivor identity using solution-focused brief therapy, and through a case
example applying a narrative therapy approach to a teenage boy who suffered a serious
assault. The benefits of a strength-based approach to psychological trauma for the
clients and therapists will be summarised and a number of potential pitfalls articulated.

Keywords: Strengths-based practice; Systemic Psychotherapy; Psychological Trauma;

Solution-focused Brief Therapy; Narrative Therapy; Young People; Type 1 Trauma

Introduction
In recent years there has been a widespread shift in the focus of research and practice
in psychology (Seligman, 1991; Seligman & Csikszentmihalyi, 2000; Snyder & Lopez,
2005), mental health (Antonovsky, 1987; Petersen & Seligman, 2004), social work
(Saleebey, 2006; Weick, Rapp, Sullivan, & Kisthardt, 1989), community development
(Kretzmann & McKnight, 1993) and systemic psychotherapy (De Shazer, 1985;
Stratton, 2005; White, 1995) from an emphasis on disorder, dysfunction and deficits

Mr Stephen Coulter is a Lecturer at the School of Sociology, Social Policy and Social Work, Queen’s University
Belfast. Correspondence to: Stephen Coulter, Queen’s University Belfast, 6 College Park, Belfast BT7 1LP, UK.
Email: s.coulter@qub.ac.uk

© 2014 The Child Care in Practice Group

 Child Care in Practice 49
to a focus on well-being, resources, strengths and positive mental health. Different
disciplines tend to use their own jargon and this has produced a variety of
terminology referencing a range of overlapping and intersecting concepts. This
terminology is explored in the next section and consideration given as to how the
underlying concepts relate to one another. It pragmatically leads to a presentation of
Rapp, Saleeby, and Sullivan’s (2008) six standards for strengths-based practice as a
“yardstick” representing the essential characteristics of strengths-based work. This is
followed by a brief description of the concept of psychological trauma, the current
state of the evidence base for trauma interventions and the impact of trauma on close
interpersonal relationships, which provides the rationale for the use of systemic
psychotherapy (family therapy) with traumatised young people as part of the overall
treatment package. The epistemological congruence between second-order systemic
Downloaded by [University of Cambridge] at 04:32 27 December 2014

psychotherapy models and a strength-based orientation is noted, and the principles of

two of these models—solution-focused brief therapy (SFBT) and narrative therapy
(NT)—are briefly described. The first is then described at the level of process and the
second illustrated through application to a case example employing Beaudoin’s
(2005) four-quadrant “re-authoring map”.

Inter-disciplinary Terms
The highest level terms in this field appear to be well-being and salutogenesis.
Psychological well-being is about lives going well, operationally defined as a
combination of feeling good and functioning effectively. The concept does accom-
modate the “normal” range of life’s “ups and downs” but holds that well-being is
compromised when negative emotions are extreme or very long-lasting and interfere
with a person’s ability to function in his or her daily life (Huppert, 2009). Thus well-
being is not understood as a fixed state of the individual but as “a dynamic process,
emerging from the way in which people interact with the world around them”
(Michaelson, Abdallah, Steuer, Thompson, & Marks, 2009, p. 9).
In the field of health, the concept of salutogenesis emerged as a counter-current to
the prevailing disease model, almost a generation ahead of the recent general
embracing of strengths-based approaches (Antonovsky, 1985, 1987). Antonovsky and
colleagues turned their focus on to what made people well and came to believe that it
was largely associated with a good “sense of coherence” (SOC). At the core of the
SOC is the ability to perceive the world as predictable, manageable and meaningful
(Antonovsky, 1993). People with a strong SOC successfully engage in diverse
developmental tasks, apply healthy behaviours, possess the capacity to thrive despite
stressors in life, perceive good health, and experience a sense of wholeness in relation
to themselves, others and the community. Antonovsky, widely accepted as the
“father” of salutogenesis, defines SOC in the following way:
a global orientation that expresses the extent to which one has a pervasive,
enduring though dynamic feeling of confidence that (1) the stimuli deriving from
one’s internal and external environments in the course of living are structured,
predictable and explicable; (2) the resources are available to one to meet the
 50 S. Coulter
demands posed by these stimuli; and (3) these demands are challenges worthy of
investment and engagement. (1987, p. 19)

This appears to be very consistent with the idea of quality of life (Lindström, 1992,
1999), for which there is a sustained rich stream of research. It can be argued that the
promotion of the well-being /salutogenesis of the population should be a fundamental
goal of any society, and indeed are useful indicators of the functioning of a society
(Rees, Bradshaw, Gossami, & Keung, 2010).
Other well-known concepts that are closely related to well-being and salutogenesis
are hardiness (Kobasa, 1982), self-efficacy (Bandura, 1977) and flourishing (Keyes,
2002), but with limited space I will leave the reader to consider how these inter-relate
with the concepts above. However, like resilience, which will be considered in some
Downloaded by [University of Cambridge] at 04:32 27 December 2014

detail below, they may be thought of as second-level concepts; that is, those through
which well-being and salutogenesis may be achieved.
Resilience is a quality that, whether applied to materials, organisations, ideas or
people, indicates a capacity to resist stress, and cope with adverse conditions. Most
commonly in the social sciences, the term resilience has come to mean the ability to
resist, cope with or recover from serious physical and psychological difficulties. It
comes from the Latin word “resilio”, meaning to adapt and bounce back from a
disruptive event. It is a social construct that identifies both processes and outcomes
associated with well-being. Resilience was initially conceptualised as a trait of
individuals; for example, to explain how some children continued to achieve good
outcomes despite multiple risk factors (Anthony & Cohler, 1987). However, a 40-year
longitudinal study of resilient children conducted by Werner and Smith (2001)
provided rich evidence for a complex interactional view of resilience, involving
multiple internal and external protective influences over time. The role of a wide
variety of supportive relationships was been found to be crucial for children at every
age. Informed by this and other research (Rutter, 1990; Walsh, 2006), resilience has
come to be broadly conceived of as “a dynamic process encompassing positive
adaptation within the context of significant adversity” (Luthar, Cicchetti, & Becker,
2000, p. 543), or as Cyrulnik poetically puts it:
Resilience is a mesh, not a substance. We are forced to knit ourselves, using the
people and things we meet in our emotional and social environments. (2009, p. 51)

Resilience has been used in somewhat different ways. It can mean good outcomes
despite some “high-risk” status, ability to cope with a chronic stressor, and living well
after experiencing an extreme trauma (Masten, Best, & Garmezy, 1990). For the
purposes of this paper it will be used primarily in the third sense.
In sum, then, one can propose that strengths-based work be seen as a method of
intervention with the potential to increase service user’s resilience, leading to an
increased sense of well-being (and salutogenesis). Strengths-based approaches
concentrate on the inherent strengths of individuals, families, groups and organisa-
tions, deploying personal strengths to aid recovery and empowerment. The role of the
professional, then, is to engage in such a way that helps to uncover the service user’s
 Child Care in Practice 51
hitherto unrecognised or under-appreciated strengths and resources, so that they may
bring them to bear on their current challenges and difficulties.
These terminological differences, similarities and overlaps are interesting in terms
of disciplinary origins but can also lead people to believe that they are referring to the
same concept when there may be important differences, resulting in “talking at
professional cross-purposes”. Universally agreed terminology is unlikely to emerge
from such independent academic and disciplinary streams but it may be possible to
adopt standards for strengths-based practice that can provide a useful “yardstick” for
diverse practices claiming to be strengths-based. Rapp et al. (2008, p. 81–82) offer six
standards for strengths-based practice that, in this author’s judgement, could fit
the bill:
Downloaded by [University of Cambridge] at 04:32 27 December 2014

1. Goal orientation: strengths-based practice is goal oriented. The central and most
crucial element of any approach is the extent to which people themselves set goals
they would like to achieve in their lives.
2. Strengths assessment: the primary focus is not on problems or deficits, and the
individual is supported to recognise the inherent resources they have at their
disposal which they can use to counteract any difficulty or condition.
3. Resources from the environment: strengths proponents believe that in every
environment there are individuals, associations, groups and institutions who have
something to give, that others may find useful, and that it may be the
practitioner’s role to enable links to these resources.
4. Explicit methods are used for identifying client and environmental strengths for
goal attainment: these methods will be different for each of the strengths-based
approaches. For example, in solution-focused therapy, clients will be assisted to
set goals before the identification of strengths; whilst in strengths-based case
management, individuals will go through a specific “strengths assessment”.
5. The relationship is hope-inducing: a strengths-based approach aims to increase the
hopefulness of the client. Further, hope can be realised through strengthened
relationships with people, communities and culture.
6. Meaningful choice: strengths proponents highlight a collaborative stance where
people are experts in their own lives and the practitioner’s role is to increase and
explain choices and encourage people to make their own decisions and informed
choices.
Of course, “strength” is a culturally bound and context specific concept that cannot
be applied meaningfully in a universal way. Characteristics regarded as strengths in
one culture or sub-culture or setting may be considered as weaknesses in another.
Some writers have attempted to overcome this context-specific problem by referring
to strength as a person’s ability to “apply as many different resources and skills as
necessary to solve a problem or achieve a goal” (Smith, 2006, p. 26) in line with
evolutionary theory in which development of strengths is biologically driven in order
to increase survival chances (Watson & Ecken, 2003). A humanist perspective may
see the development of strengths as an inevitable dimension of the drive for self-
actualisation (Maslow, 1971), while others may see it as part of our desire to find or
 52 S. Coulter
create meaning in our lives, a need that does not appear to diminish when
experiencing adversity (Frankl, 1963). If we relate strengths to the theoretical frame
of resilience (above) then strengths can be operationalised as all those qualities and
processes that increase our ability to “bounce back” from or actively cope with
adverse circumstances.
It is important to acknowledge that elements of the strengths-based approach have
been present in aspects of many professional practices over the years. Nevertheless,
one can at the same time recognise the step-shift in terms of the widespread policy-
driven determination to refocus our orientation from “the past, deficits and
dysfunction” to “the future, resources and developing competencies” over the past
decade. This remains “a work in progress” for many professional groups and services,
Downloaded by [University of Cambridge] at 04:32 27 December 2014

and it can be useful for existing models and developing practices to be referenced
against a typology, such as the one suggested above (Rapp et al., 2008), to assess their
degree of “strength-based-ness”.

Psychological Trauma
Psychological trauma can occur when people are exposed to extreme stressors in
which they experience the threat of loss of life or bodily integrity of themselves or of a
loved one (American Psychiatric Association, 1994). This experience creates post-
traumatic stress in the individual, expressed in a variety of post-traumatic responses,
that needs to be resolved, and which for the majority of people can be managed in the
context of the person’s current physical, psychological and relational resources
(Coulter, 2010). Statistically, only a minority of people exposed to a trauma develop
post-traumatic stress disorder (PTSD) (Kessler, Sonnega, Bromet, Hughes, & Nelson,
1995). The rest may be less affected, suffer another post-traumatic response or indeed
over time experience post-traumatic growth (Joseph & Linley, 2008). Even extreme
traumatisation does not always lead to pathology. For example, a study of former
child soldiers in Uganda indicated that 28% were considered to have post-traumatic
resilience in that they did not show PTSD, depression or significant behaviour or
emotional problems (Klasen et al., 2010).

The Current Evidence Base

The creation of evidence for effective interventions for psychological trauma is still at a
relatively early stage. To date the research on psychological trauma has been focused
primarily on people classified as suffering PTSD. In respect of adults it is now
established that the most effective intervention for PTSD is trauma-focused cognitive
behaviour therapy (Bisson & Andrew, 2009; Cohen, Mannarino, & Deblinger, 2006;
Mahoney, Ford, Ko, & Siegfried, 2004; National Institute for Clinical Excellence
[NICE], 2005). This led Cahill, Rothbaum, Resick, and Follette (2009, p. 207) on behalf
of the International Society for Traumatic Stress Studies to state: “The evidence in
support of the effectiveness of individual CBT for the treatment of PTSD in adults is
now quite compelling”. In contrast there is a very limited evidence base for the
 Child Care in Practice 53
treatment of PTSD in children, other than that arising from the trauma of child sexual
abuse (NICE, 2005; Saunders, Berliner, & Hanson, 2003), although there is emerging
support for trauma-focused cognitive behaviour therapy (Silverman et al., 2008).
It is important to note that there is currently a reconsideration of the appropriate-
ness of the medically based approach to evidence creation in relation to complex
psycho-social activities such as psychotherapy. NICE has become the National
Institute for Health and Care Excellence and it is proposed that psychotherapies
should be evaluated more in line with the ways that this revised body will develop to
meet their new social care remit. For psychotherapy there is difficulty standardising
the design and delivery of interventions and there are long and complex causal chains
linking interventions to outcomes. Stratton (2013, p. 49. on behalf of The Association
Downloaded by [University of Cambridge] at 04:32 27 December 2014

for Family Therapy and Systemic Practice [AFT]) echoes the assessment of the
American Psychological Association (2012) that “the general or average effects of
psychotherapy are widely accepted to be significant and large and are quite constant
across most diagnostic conditions” and concludes in the light of this assessment the
appropriate approach is for “NICE to concentrate on identifying those interventions
that are demonstrably less effective”; that is, a process of exclusion on the basis of
evidence rather than the current one of inclusion mainly on the basis of evidence
appropriate primarily to drug and medical interventions.
In respect of the two systemic psychotherapeutic approaches that are central to this
paper, the stronger evidence of effectiveness is in relation to SFBT. A recent review
paper of 43 studies showed that 32 (74%) reported significant positive benefit from
SFBT, and an additional 10 (23%) reported positive trends. Only one study reported no
observable benefit from SFBT (Gingerich & Peterson, 2013). NT is a newer approach,
and while it has a number of supportive studies in relation to childhood stealing
(Seymour & Epston, 1989), parent–child conflicts (Besa, 1994), encopresis (Silver,
Williams, Worthington, & Phillips, 1998), and eating disorder and depression (Weber,
Davis, & McPhie, 2006), a comprehensive review of the evidence is still awaited. In
relation to trauma the most promising evidence is from a study showing that NT for
adults with a major depressive disorder showed comparable results on symptom
improvement to benchmark research outcomes (Vromans & Schweitzer, 2010).
As noted earlier, only a minority of people who experience trauma can be
diagnosed as suffering PTSD. When we widen our focus to include the broad range of
post-trauma responses we find numerous interventions recommended by researchers
and clinicians that have not been “demonstrated to be less effective”. Trauma
experienced by one person impacts on their family negatively impacting cohesiveness
(a balance between family separateness and connectedness) and flexibility (the
balance between change and stability) (Patterson, 2002). These relational and familial
consequences on couples (Catherall, 2004; Whiffen & Oliver, 2004), on the parent–
child interaction (Steinberg, Brymer, Decker, & Pynoos, 2004), and intergeneration-
ally (Daud, Skoglund, & Rydelius, 2005) of the individual’s suffering have the
potential to be the most long-lasting impacts of trauma. It is established that social
support is a key factor in ameliorating the impact of post-traumatic stress (Carlson &
 54 S. Coulter
Dalenberg, 2000; Ozer, Best, Lipsey, & Weiss, 2003) and that a reduction in parental
distress and more familial support mitigates the negative impact of trauma on
children (Briere & Scott, 2006; Cohen, Mannarino, & Deblinger, 2003; Pierce,
Sarason, Sarason, Joseph, & Henderson, 1996). The evidence indicates the importance
of involving family members generally and in respect of children and young people,
and thus systemic psychotherapy (family therapy) alongside other approaches in the
treatment of people seeking professional help following trauma is recognised best
practice (Coulter, 2011). A systemic approach to trauma focuses on how family
processes mediate stress, enable families to manage crises and cope with prolonged
stress, with the aim of reactivating social support and promoting resilience in the
family to enable the family to integrate the experience and regain a SOC and well-
being (Coulter, 2011; Walsh, 2006).
Downloaded by [University of Cambridge] at 04:32 27 December 2014

Systemic Psychotherapy
Systemic psychotherapy is a professional form of discourse and practice that emerged
in the 1950s. Its widespread adoption of a social constructionist epistemology and
collaborative ethic in the 1970s and 1980s led to a number of strengths-based models
of practice. A social construct can be defined as anything that exists by virtue of social
interactions, as opposed to objective reality (Berger & Luckmann, 2011; Gergen,
1999). A social constructionist will seek to identify ways in which individuals and
groups participate in the construction of their perceived social reality. This is an
ongoing, dynamic process, which is open to evolution and change. One implication is
that people who appear “stuck” with painful social realities may, through processes
of deconstruction and re-construction, move to less painful positions. In the domain
of psychotherapy, re-constructing realities is a common theme across a number of
models of practice within the systemic approach. In particular, SFBT and NT
epitomise this shift. Both models seek to ask: “… meaningful questions that will
combat the relentless pursuit of pathology, and ones that will help discover hidden
strengths that contain the seeds to construct solutions to otherwise unsolvable
problems” (Graybeal, 2001, p. 235). To these we now turn.

Solution-focused Brief Therapy

SFBT was developed in the USA in the early 1980s by DeShazer, Berg and colleagues
(De Shazer et al., 1986). They were interested in the inconsistencies in problem
behaviour and the fact that many clients attended for only one session of therapy and
they wanted to find a way to work effectively within these parameters. This lead to
the focus on “solution talk” rather than “problem talk”, facilitated by exploring
“exceptions” (i.e. times when the problem was not present or not present to the same
degree) that could hold the genesis of the person’s own solution, and/or obtaining a
detailed description of what the client would be doing differently if the problem was
solved. They hold that there is always something working in people’s lives, however
serious or chronic the problem, and so their focus is on “What’s right with you?”
 Child Care in Practice 55
rather than the more traditional professional concentration on “What’s wrong with
you?”. The solution-focused process frequently includes the following techniques:
goal clarification; pre-session change; scaling questions; miracle question; exceptions;
compliments; and tasks and problem-free talk (Hogg & Wheeler, 2004; Stalker,
Levene, & Coady, 1999)—some of which are described in the process below.

Application to Trauma
Glimmers of hope and optimism can arise through the interviewing process itself,
even following extreme trauma. A first step is to encourage clients to move from
relatively helpless victim position to that of a survivor, when a more active role
becomes possible. The following questions are ones that can begin to help move
Downloaded by [University of Cambridge] at 04:32 27 December 2014

someone away from a victim position (Bannink, 2008, p. 220):

. What helped in the past, even if only marginally?
. How do I succeed in getting from one moment to the next?
. Could it be worse than it is? Why is it not worse?
Once the client feels there is some emerging hope, some movement from a “struck”
position, then this process can be enhanced by inviting survivors to consider
questions such as:
. What will be the first sign that trauma is having less impact on your life?
. How much of your time is trauma in control of your life? How much time are you
in control? What are you doing differently at these times?
. What will (close supportive family member) see that will tell them that you are
continuing to make progress towards a more satisfying life?
. Imagine that in 10 or 15 years, when things are going better, you look back on
today, what will have helped you to improve things?
Minor exceptions and small changes in the desired direction are discussed in detail
using scaling questions, typically using a zero to 10 scale so as to elicit a focus on the
smallest noticeable change; that is, what would you need to do or what would need to
be happening more for you to move from 3.5 to 3.75? It would be unusual to use the
“miracle question”1 in situations for severe trauma because it is too big a conceptual
leap, but creative use can be made of the “not the miracle question”, devised by
Mason, to explore the beginnings of therapeutic change:
Suppose we were to work together for a number of sessions in a way that our
sessions were little or no use to you what would you and I each have to do to
contribute to getting it so wrong? (Hardham, 2006 p. 19)

Trauma has the potential to lead to major psychological pathology and one must
be particularly aware of avoiding adopting an inappropriately “sunny” or over-
optimistic disposition when engaging victims/survivors in a therapeutic process, as
this would probably be received by the client as disrespectful or minimising of their
experience. Indeed, this is true in all therapeutic work and such a stance would be a
 56 S. Coulter
naive misunderstanding of solution-focused work that is simply accentuated when
working with trauma.

Narrative Therapy
Narrative therapists believe that people give meaning to their lives and relationships
through the stories they tell and that an individual’s dominant stories have far-
reaching influences on their daily experience and ability to cope. People may be
labouring under socially constructed stories of failure, individual pathology, and/or
inadequacy, and NT can be described as a process of re-authoring lives (Myerhoff,
1982). Coombs and Freedman state:
Downloaded by [University of Cambridge] at 04:32 27 December 2014

We work to facilitate the development, telling, and retelling of stories from people’s
lives that speak of experiences and intentions that they prefer. Through these
tellings, we facilitate experience of possibilities not apparent in the problem story.
(2012, p.1033)

Narrative therapists hold that hidden inside any “problem” narrative is a story of
strength and resilience, and it is the job of the therapist to facilitate a conversation
that will bring forth these hidden stories. A key part of the narrative approach is
externalising the problem that people often believe is part of their character.
Externalisation helps people begin to define their problems as separate from their
identities (Epston & White, 1992) and is represented by the narrative motto “the
person is not the problem the problem is the problem”. Questioning inquires about
how the problem has been affecting the person’s life and relationships and a typical
sequence is usefully illustrated by Carr:
Can you tell me about a time when you prevented this problem from
oppressing you?
How did you manage to resist the influence of the problem on that occasion?
What does this success in resisting the influence of the problem tell us about you as
a person?
What effect does this success in resisting the influence of the problem have on your
relationship with your mother? (1998, p. 493)

Application to Trauma
The application of the narrative approach to trauma has some particular features.
The trauma event(s) occurs in the context of the person’s pre-existing narrative
framework, which is in a recursive relationship (both influencing and being influenced
by) the emerging trauma narrative. Thus, while therapists may affirm narrative
intentions they may struggle with how to implement these into clinical practice in the
context of trauma. Helpfully, Beaudoin (2005) has provided a four-quadrant matrix to
assist the narrative practitioner. This “re-authoring map” consists of the following:
 Child Care in Practice 57
. Actions taken and storied.
. Actions taken and not storied.
. Actions not taken and storied.
. Actions not taken and not storied.
These are now illustrated via the case of Mark, a 15-year-old boy who suffered a
serious assault in school. He was in physical education class playing football in the
school gymnasium with his year class. One of his classmates took exception to one of
Mark’s tackles and they “had words”. As Mark turned away the opponent attacked
him by jumping on his back, and with his left arm around Mark’s neck, punched him
repeatedly with his right fist. Mark fell to the ground and the attack was sustained
with repeated blows inflicted to his head and face. The assault ended when some of
Downloaded by [University of Cambridge] at 04:32 27 December 2014

Mark’s classmates pulled his attacker off him. Mark was taken to hospital and was
found to have multiple fractures to his jaw and severe bruising to his head and face.
Metal plates were required to repair Mark’s jaw and he was very conscious that his
jaw line had changed and was no longer symmetrical. The assault happened towards
the end of one school year and Mark presented with his parents for assessment at a
trauma centre five months later. He was dressed in his school uniform.
. Actions taken and storied: this quadrant deals with the story as initially narrated by
the traumatised person to get an overview of the client’s experience and the
obstacles to handling it differently. Through this process, some actions that are not
attributed much value or even defined as unhelpful can be re-considered as
meaningful or helpful. For Mark, thinking of the tackle in the context of the game
and his turning away after a few “words” helped him to appreciate that he had no
inkling of the violence to come and had not provoked the assault (congruent with
his values), while recognising that by turning away he had made himself more
vulnerable, thus giving it meaning in terms of his wider life story. This quadrant
was not the most significant in the re-authoring process for Mark, given the nature
of the traumatic incident.
. Actions taken and not storied: people inevitably try to protect themselves
(a survival mechanism), they will resist or try to minimise the suffering of trauma
by taking some action psychologically, emotionally or behaviourally. However,
these actions may not be recognised due to the overwhelming intensity of the
trauma. Mark initially responded with surprise when asked in what ways he had
resisted the assault, since he saw himself as simply the helpless victim of a vicious
and sustained torrent of blows. However, with persistence he was able to identify
certain actions including closing his eyes, turning his face as far as possible into
the floor, yelling out and (as the attack persisted) dissociation as ways in which he
sought to limit the impact of the assault.
Mark returned to the same school immediately after the summer break and
maintained full attendance. This action was one that we spent time on focusing on;
the strength of resolve required, the issue of how now to relate to different groups
within the school environment, and the feeling that people were talking about him
 58 S. Coulter
“behind his back”. Most challenging were Mark’s feelings related to the assault
being initially perceived as a fight and therefore a highly stimulating spectacle and
entertainment for a group of teenage boys, resulting in the apparent time delay
before his friends came to his aid. We discussed the mental and social skills he
employed in maintaining good relationships with his peer group in this context.
. Actions not taken and storied: this quadrant guides the therapist to focus on
deconstructing idealised narratives that may be hindering recovery. Why did Mark
not defend himself, turn the tables on his assailant and visit on him what he
intended to do to Mark? Our cultural media-fuelled narrative is replete with
superheroes who single-handedly face and overcome multiple attackers—the “self-
sufficient rugged individual” with the physical skills to defeat any enemy. This is
Downloaded by [University of Cambridge] at 04:32 27 December 2014

an idealised narrative of young men in particular (although not exclusively) that is

reinforced throughout much of popular culture. Mark’s parents may have been
unintentionally reinforcing this script by their (too) frequent reassurances to him
of “We don’t think any the less of you because of what happened”. The question is
why should Mark not think any less of himself in a culture where the myth of the
superhero reigns? We enacted the pattern of the assault; the comparative size of
the assailant, his advantage of surprise, the attack from behind, the arm round the
neck, how they fell to the floor with the assailant on top, the barrage of blows to
the face, the physical and emotional shock, and the inability to focus visually or
mentally. By thinking his way through these processes Mark could begin to
understand that it was impossible for him to have done more than he did and to
begin to understand in a “real” way how these make believe myths are indeed just
that—– unrealistic fantasies.
. Actions not taken and not storied: the aim is to focus on choices made during the
trauma (and subsequently) that have been taken for granted, so that they can be
appreciated and considered as congruent with the values of the individual. In
Mark’s case we discussed his choice not to seek revenge and to pursue a conviction
via the criminal justice system. This was a family value, inspired by Mark’s
parents, to respect and work within the system and not to go “looking for trouble”.
The parents reinforced this position even in the context of these serious injuries to
their son, and within the wider context of gendered scripts (noted above) it was
significant that his father had never espoused desires for revenge or unofficial
community action against the perpetrator. Acting in accordance with one’s
personal values is a profound aspect of “the self” that if recognised can enhance
one’s “sense of coherence” in the world. Beaudoin summarises the rationale of this
process as follows:
When clients are able to notice all the actions that they choose to engage in, despite
the challenge of the situation, and how congruent these actions were with their
values, they are more likely to experience themselves as competent and capable
individuals. The recognition and appreciation of these choices is more likely to lead
to a breakdown of the problem story of incompetent identity. (2005, p. 49)
 Child Care in Practice 59
To re-emphasise the style of NT, it is not a case of the therapist “pointing out”
important hidden aspects of the experience to the client; rather, the therapist adopts a
collaborative consultative position through which they help the client to thicken and
enrich their description and notice additional aspects of the experience, and their
responses to it, that may challenge their current (painful) way of story-ing it, thus
leading to a process of re-authoring (White, 1995).

Conclusion
We have seen that the concept of the “strength-based” approach as currently
constructed has deep roots in associated concepts with their own respected academic
literature within a range of cognate disciplines. The limited current evidence base was
Downloaded by [University of Cambridge] at 04:32 27 December 2014

presented and an emerging approach to evaluating evidence of effectiveness for

psychotherapies outlined and supported. It has been demonstrated that the “strength-
based” orientation is congruent with the earlier social constructionist epistemological
shift within the field of systemic psychotherapy resulting in the creation of a number
of second-order models of practice including SFBT and NT. It has been demonstrated
how these models can be applied to psychological trauma in young people and their
families in a way that the clients’ own resources are brought forth and thus lead to an
empowering experience.
Crucially these models of practice avoid repeating the client’s experience of
“helplessness”, which is a central defining feature of the experience of being
traumatised. SFBT and NT “seek out” the often discounted strategies and actions
employed by the victim/survivor to minimise and resist the impact of trauma and
how they have, perhaps in small unnoticed ways, already begun to reclaim their lives.
The strengths-based focus alters the person’s relationship to the trauma experience
and thus promotes adjustment, integration and recovery. It co-creates in a new self-
perception that includes elements of competence, coping and hardiness to counter the
helplessness experienced as part of the traumatic experience and perhaps most
importantly elicits hope of positive change.
A strengths-based approach to psychotherapy can be energising and enlivening for
the therapist, who believes that in every situation there is the potential for the
beginning of positive change already inherent, and their job is to find ways to bring
these forth to facilitate the process. Working in these ways can help to avoid burnout
and secondary traumatisation in psychotherapists as it avoids having the same
problem and deficit-saturated conversation over and over again, enabling them to
sustain conversation in the midst of tragic and often heart-rending situations. It
locates resources and responsibility for change in the client, and expertise and
responsibility for hosting conversations that reveal hidden resources and strengths
with the therapist. Therapists can view “all family members as ‘heroes on life
journeys’ who are challenged along the way” (Walsh, 2002, p. 133).
As with all approaches there are a number of potential pitfalls for the uninitiated.
The most obvious is the potential for therapists to move too quickly to “solution talk”
or more positive narratives and ignore many trauma victims/survivors need to tell
 60 S. Coulter
their story and the value of it to be respectfully “witnessed” (Weingarten, 2004). A
rush to uncover “hidden” aspects of the story can be disrespectful to this need, so it is
important that the therapist match their pace according to the needs of the victim/
survivor. An insensitive “What does not kill me makes me stronger” attitude
misjudged or mistimed can overlook that imminent phenomenological experience of
clients: “That which did not kill me has left me in debilitating physical and
psychological distress”. The need for active witnessing and validation of trauma
stories is not at odds with the assertion that unnecessary/redundant repetition of
problem-saturated stories may simply reinforce ideas of inadequacy, damage and
hopelessness. Similarly, an over-enthusiastic novice may, sensing the potential in
some hitherto unrecognised dimension of the experience that is being revealed
through their chosen strength-based approach, try too hard to encourage the client to
Downloaded by [University of Cambridge] at 04:32 27 December 2014

incorporate it in a particular way rather than simply explore these “new” aspects and
letting the process work through as new information is consciously available to the
clients. Old(er) core therapeutic skills should not be abandoned when new
approaches become available, and certainly the art of remaining congruent with the
client and introducing difference in a way and at a rate that continues to engage but
not overwhelm the client must remain at the heart of good practice.

Note
[1] “Suppose you go to sleep tonight and while you are asleep a miracle happens and all your
problems are solved. When you wake up, how will each of you be able to tell that this miracle
really took place? What would be different? How would your situation have changed?”

References
American Psychological Association. (2012). Resolution on the recognition of psychotherapy
effectiveness. Retrieved March, 15, 2013 from http://www.apa.org/news/press/releases/2012/
08/resolution-psychotherapy,aspx
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders
(4th ed.) Washington, DC: American Psychiatric Press.
Anthony, J. E., & Cohler, A. (Eds.). (1987). The invulnerable child. New York, NY: Guilford Press.
Antonovsky, A. (1985). Health, stress, and coping (1st ed.). San Francisco, CA: Jossey-Bass.
Antonovsky, A. (1987). Unravelling the mystery of health. How people manage stress and stay well.
San Francisco, CA: Jossey-Bass.
Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social Science
& Medicine, 36(6), 725–733.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioural change. Psychological
Review, 84, 191–215.
Bannink, F. P. (2008). Posttraumatic success: Solution-focused brief therapy. Brief Treatment and
Crisis Intervention, 8, 215–225.
Berger, P. L., & Luckmann, T. (2011). The social construction of reality: A treatise in the sociology of
knowledge. New York, NY: Open Road.
Beaudoin, M. (2005). Agency and choice in the face of trauma: A narrative therapy map. Journal of
Systemic Therapies, 24(4), 32–50.
Besa, D. (1994). Evaluating narrative family therapy using single-system research designs. Research
on Social Work Practice, 4(3), 309–325. doi:10.1177/104973159400400303
 Child Care in Practice 61
Bisson, J., & Andrew, M. (2009). Psychological treatment of post-traumatic stress disorder (PTSD).
Oxford: The Cochrane Collaboration.
Briere, J., & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms, evaluation, and
treatment. London: Sage.
Cahill, S. P., Rothbaum, B. O., Resick, P. A., & Follette, V. M. (2009). Cognitive-behavioural therapy
for adults. In E. B. Foa, T. M. Keane, M. J. Friedman, & J. A. Cohen (Eds.), Effective
treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress
Studies. New York, NY: Guilford Press.
Carlson, E., & Dalenberg, C. (2000). A conceptual framework for the impact of traumatic
experiences. Trauma, Violence, & Abuse, 1, 4–28.
Carr, A. (1998). Michael White’s narrative therapy. Contemporary Family Therapy, 20(4), 485–503.
Catherall, D. R. (Ed.). (2004). Handbook of stress, trauma, and the family. New York, NY: Brunner–
Routledge.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2003). Child and parent trauma-focused cognitive
Downloaded by [University of Cambridge] at 04:32 27 December 2014

behavioural therapy treatment manual. Philadelphia, PA: Drexel University College of

Medicine and Dentistry.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in
children and adolescents: A clinician’s guide. New York, NY: Guilford Press.
Coombs, G., & Freedman, J. (2012). Narrative, poststructuralism, and social justice: Current
practices in narrative therapy. The Counseling Psychologist, 40(7), 1033–1060.
Coulter, S. (2010). Systemic family therapy for families who have experienced trauma: A
randomised controlled trial. British Journal of Social Work, 41(3), 502–519.
Coulter, S. (2011). Systemic psychotherapy as an intervention for post-traumatic stress responses:
an introduction, theoretical rationale and overview of developments in an emerging field of
interest. Journal of Family Therapy, 34(4), 381–406. doi:10.1111/j.1467-6427.2011.00570.x
Cyrulnik, B. (2009). Resilience: How your inner strength can set you free from the past. New York,
NY: Tarcher/Penguin.
Daud, A., Skoglund, E., & Rydelius, P. (2005). Children in families of torture victims:
Transgenerational transmission of parents’ traumatic experiences to their children. Interna-
tional Journal of Social Welfare, 14, 23–32.
De Shazer, S. (1985). Keys to solution in brief therapy. New York, NY: W W Norton & Company.
De Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., Molnar, A., Gingerich, W., & Weiner-Davis, M.
(1986). Brief therapy: focused solution development. Family Process, 25, 207–221.
Epston, D., & White, M. (1992). Experience, contradiction, narrative and imagination: Selected
papers of David Epston and Michael White, 1989–1991. Adelaide, South Australia: Dulwich
Centre.
Frankl, V. E. (1963). Man’s search for meaning: An introduction to logotherapy. New York, NY:
Washington Square.
Gergen, K. G. (1999). An invitation to social construction. London: Sage.
Gingerich, W. T., & Peterson, L. T. (2013). Effectiveness of solution-focused brief therapy: A
systematic qualitative review of controlled outcome studies. Research on Social Work Practice,
23, 266–283.
Graybeal, C. (2001). Strengths-based social work assessment: Transforming the dominant paradigm,
Families in Society: The Journal of Contemporary Human Services, 82, 233–242.
Hardham, V. (2006). Bridges to safe uncertainty: An Interview with Barry Mason. Australian and
New Zealand Journal of Family Therapy, 27(1), 16–21.
Hogg, V., & Wheeler, J. (2004) Miracles R them: Solution-focused practice in a social services duty
team. Practice, 16(4), 299–314.
Huppert, F. A. (2009). Psychological wellbeing: Evidence regarding its causes and consequences.
Applied Psychology: Health and Well-Being, 1(2), 137–164.
 62 S. Coulter
Joseph, S., 7 Linley, P. A. (Eds.). (2008). Trauma, recovery, and growth: Positive psychological
perspectives on posttraumatic stress. Hoeboken, NJ: Wiley.
Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. (1995). PTSD in the National
Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.
Keyes, C. L. M. (2002). The mental health continuum: From languishing to flourishing in life.
Journal of Health and Social Behavior, 43(2), 207–222.
Klasen, F., Oettingen, G., Daniels, J., Post, M., Hoyer, C., & Adam, H. (2010). Posttraumatic
resilience in former Ugandan child soldiers. Child Development, 81, 1096–1113.
Kobasa, S. C. (1982). The hardy personality: Toward a social psychology of stress and health. In J. S.
Sanders & J. Suls (Eds.), Social psychology of stress and health and illness (pp. 3–32). Hillsdale,
NJ: Lawrence Erlbaum Associates.
Kretzmann, J. P., & McKnight, J. L. (1993). Building communities from the inside out: A path toward
finding and mobilizing a community’s assets. Evanston, IL: Kretzmann and McKnight.
Lindström, B. (1992). Quality of life: A model for evaluating health for all. Sozial &
Downloaded by [University of Cambridge] at 04:32 27 December 2014

Praventivmedizin, 37, 301–306.

Lindström, B. (1999). The salutogenic model as a tool for quality of life enhancement for children
with special needs. Exceptionality Education Canada, 9(1&2), 105–109.
Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and
guidelines for future work. Child Development, 71(3), 543–562.
Mahoney, K., Ford, J. D., Ko, S. J., & Siegfried, C. B. (2004). Trauma-focused interventions for youth
in the juvenile justice system. Los Angeles, CA & Durham, NC: National Child Traumatic
Stress Network.
Maslow, A. (1971). The farther reaches of human nature. New York, NY: Viking Press.
Masten, A. S., Best, K. M., & Garmezy, N. (1990). Resilience and development: Contributions from
the study of children who overcame adversity. Development and Pathology, 2, 425–444.
Michaelson J., Abdallah, S., Steuer N., Thompson, S., & Marks, N. (2009). National accounts of well-
being: Bringing real wealth onto the balance sheet. London: New Economics Foundation.
Myerhoff, B. (1982). Life history among the elderly: Performance, visibility and remembering.
In J. Ruby (Ed.), A crack in the mirror: Reflexive perspectives on anthropology (pp. 20–35).
Philadelphia: University of Pennsylvania Press.
National Institute for Clinical Excellence. (2005). Clinical Guideline 26. Post-traumatic stress
disorder: The management of PTSD in adults and children in primary and secondary care.
London: NICE.
Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress
disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129(1), 52–73.
Patterson, J. (2002) On understanding family resilience. Journal of Clinical Psychology, 58, 233–246.
Petersen, C., & Seligman, M. E. P. (2004). Character strengths and virtues: A handbook of
classification, Oxford: Oxford University Press.
Pierce, G. R., Sarason, B. R., Sarason, I. G., Joseph, H. J., & Henderson, C. A. (1996).
Conceptualizing and assessing social support in the context of the family. In G. R. Pierce,
B. R. Sarason, & I. G. Sarason (Eds.), Handbook of social support and the family (pp. 3–24).
New York, NY: Plenum.
Rapp, C., Saleebey, D., & Sullivan, P. W. (2008). The future of strengths-based social work practice.
In D. Saleebey (Ed.), The strengths perspective in social work practice (4th ed.). Boston, MA:
Pearson Education.
Rees, G., Bradshaw, J., Goswami, H., & Keung, A. (2010). Understanding children’s well-being: A
national survey of young people’s well-being. London: The Children’s Society.
Rutter, M. (1990). Psychological resilience and protective mechanisms. In J. Rolf, A. S. Masten, D.
Cicchetti, K. H. Nuechterlein, & S. Weintraub (Eds.), Risk and protective factors in the
development of psychopathology (pp. 181–214). Cambridge: Cambridge University Press.
 Child Care in Practice 63
Saleebey, D. (Ed.). (2006). The strengths perspective in social work practice (4th ed.). Boston, MA:
Pearson Education.
Saunders, B. E., Berliner, L., & Hanson, R. F. (Eds.). (2003). Child physical and sexual abuse;
Guidelines for treatment (final report: January 15, 2003). Charleston, SC: National Crime
Victims Research and Treatment Center.
Seligman, M. E. P. (1991). Learned optimism. New York, NY: Knopf.
Seligman, M. E. P., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American
Psychologist, 55, 5–14.
Seymour, F. W., & Epston, D. (1989). An approach to childhood stealing with evaluation of 45
cases. Australian & New Zealand Journal of Family Therapy, 10(3), 137–143.
Silver, E., Williams, A., Worthington, F., & Phillips, N. (1998). Family therapy and soiling: An audit
of externalizing and other approaches. Journal of Family Therapy, 20, 413–422.
Silverman, W. K., Ortiz, C. D., Viswesvaran, C., Burns, B. J., Kolko, D. J., Putnam, F. W., & Amaya-
Jackson, L. (2008). Psychosocial treatments for children and adolescents exposed to traumatic
Downloaded by [University of Cambridge] at 04:32 27 December 2014

stress. Journal of Clinical Child and Adolescent Psychology, 37, 156–183.

Smith, E. J. (2006). The strength-based counselling model. The Counseling Psychologist, 34, 13–79.
Snyder, C. R., & Lopez, S. J. (2005). Handbook of positive psychology. Oxford: Oxford University
Press.
Stalker, C., Levene, J., & Coady, N. (1999). Solution-focused brief therapy: One model fits all?
Families in Society, 80, 468–477.
Steinberg, A., Brymer, M., Decker, K., & Pynoos, R. (2004). The University of California at Los
Angeles Posttraumatic Stress Disorder Reaction Index. Current Psychiatry Reports, 6, 96–100.
Stratton, P. (2005). Report on the evidence base of systemic family therapy. Warrington: Association
for Family Therapy.
Stratton, P. (2013). Research update: A family therapy hope for NICE. Context, 125(February),
48–51.
Vromans, L. P., & Schweitzer, R. D. (2010). Narrative therapy with a major depressive disorder:
Improved symptom and interpersonal outcomes. Psychotherapy Research, 21, 4–15. doi:
10.1080/10503301003591792
Walsh, F. (2002). A family resilience framework: Innovative practice applications. Family Relations,
51(2), 130–137.
Walsh, F. (2006). Strengthing family resilience (2nd ed.). New York, NY: Guilford Press.
Watson, M., & Ecken, L. (2003). Learning to trust: Transforming difficult elementary classrooms
through developmental discipline. San Francisco, CA: Jossey-Bass.
Weber, M., Davis, K., & McPhie, L. (2006). Narrative therapy, eating disorders and groups:
Enhancing outcomes in rural NSW. Australian Social Work, 59(4), 391–405. doi:10.1080/
03124070600985970
Weick, A., Rapp, C., Sullivan, W. P., & Kisthardt, W. (1989). A strengths perspective for social work
practice. Social Work, 34(6), 350–354.
Weingarten, K. (2004). Witnessing, wonder, and hope. Family Process, 39(4), 389–402.
Werner, E. E., & Smith, R. S. (2001). Journeys from childhood to midlife: Risk, resilience, and
recovery. Ithaca, NY: Cornell University Press.
Whiffen, V. E., & Oliver, L. E. (2004). The relationship between traumatic stress and marital
intimacy. In D. R. Catherall (Ed.), Handbook of stress, trauma, and the family (pp. 139–159).
New York, NY: Brunner–Routledge.
White, M. (1995). Re-authoring lives: Interviews and essays. Adelaide, South Australia: Dulwich
Centre Publications.