Australian and New Zealand Journal of Family Therapy 2018, 39, 90–102

doi: 10.1002/anzf.1279

A Network Therapy Clinic for Clients with

Intellectual Disability
Lorren Krilich1, Laura Van Vorst2, Stuart Koski3, Alana Winn4 and
Paul Rhodes5
1
Real Therapy Solutions, Campbelltown, NSW
2
Casula High School, Casula, NSW
3
The Benevolent Society, Liverpool, NSW
4
Anala Programs and Services, Mittagong, NSW
5
University of Sydney, Sydney, NSW

Over the past 30 years a systemic approach has been applied to complex cases involving intellectual disability
and behaviours of concern. This paper describes a model that draws on systemic family therapy and network
therapy as well as the use of a reflective team. A single session intervention was provided for families of people
with intellectual disability. A systemic consultation was used as a pre-session meeting for professionals working
with the family. The systemic consultation and single session therapy allowed the family and the professional net-
work to gain insight. Involving the professionals in the therapy session also enhanced the alliance between profes-
sionals and family. This approach assists everyone involved in the case to find a way to progress.

Keywords: family therapy, intellectual disability, network therapy, reflective team, single session, systemic
consultation

Key Points

1 The literature supports the use of systemic family therapy with clients with disability.
2 A single session systemic family therapy clinic shows promising outcomes for families and networks of peo-
ple with intellectual disability.
3 A systemic consultation can help the professionals working with the family to see the issues in a new light.
4 A reflective team can be a powerful tool in making changes in stuck systems.
5 Including the extended network in a therapy session can enhance the alliance between the family and pro-
fessionals involved, which supports the family to make lasting changes.

In recent years, a systemic approach has been utilised with families where at least one
family member has an intellectual disability, particularly where the family’s needs are
complex and the person with a disability engages in behaviours of concern (Baum,
2006; Baum & Walden, 2006; Baum, 2007; Leenstra & Rhodes, 2014; Rhodes,
2002, 2003; Rhodes, Donelly, et al., 2014). The aim of this article is to describe a
model of intervention that applies the systemic approach to families where case man-
agers or allied health professionals are working with the family and are finding it diffi-
cult to make lasting changes. After discussing the theoretical underpinnings and
elaborating on our principles for practice, we will outline the model and present a
case study. The model described here is a Network Therapy Clinic which aimed to

Address for correspondence: Lorren.krilich@hotmail.com

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 Network Therapy Clinic for Intellectual Disability

support the family to recognise their achievements and find a way forward. A single
session format was used to maximise efficiency (Young & Rycroft, 2012).

Systemic Therapy and the Disability Field

The Network Therapy Clinic is underpinned by a combination of systemic therapy,
network therapy, and single session therapy, applying these to the field of intellectual dis-
ability. Systemic family therapy focuses on exploring the meaning of a family’s patterns
of interaction (Flaskas, 2011). This approach views the individual and family in terms of
competence and strengths, rather than focusing on the family’s limitations (Baum,
2007). The behaviour of each person in the system is assumed to have meaning, and pre-
senting problems are considered in the context of their relationships and interactions
(Baum, 2007; Leenstra & Rhodes, 2014). For this reason, the therapist adopts a neutral
stance, believing that no one is singularly to blame for the difficulties faced by the family;
each family member’s behaviour makes sense when viewed in context (Wallis & Rhodes,
2011). In systemic therapy, the therapist does not provide advice or recommendations;
their role is to facilitate the process as the family explores the issues together and considers
their meaning (Baum, 2007). The therapist is curious, asking questions rather than
offering suggestions (Flaskas, 2004, 2011; Rhodes et al., 2011). Change must come from
within the family, and the family are able to come up with their own solutions to prob-
lems; this is not the role of the therapist (Tomm, 1987; Israelstam, 1988).
A systemic approach has been used with people with intellectual disability since the
1980s, but the disability field as a whole has been slow to embrace this way of working
(Baum, 2006; Leenstra & Rhodes, 2014; Rhodes, 2002, 2003). A systemic approach
lends itself particularly well to this population for a number of reasons. Firstly, disability
services have traditionally taken a behavioural approach to therapy, and moving to a
more systemic model could be seen as a natural progression in cases where this approach
is proving ineffective (Rhodes, 2003). A behavioural approach focuses on the function
of the client’s behaviour, for example, acknowledging that the behaviour may be an
attempt to communicate or to gain attention. When the same behaviour is considered
from a systemic viewpoint, the behaviour is viewed as an unconscious attempt by the
family to maintain homeostasis; the function of the behaviour is to maintain the current
patterns of interaction, as this serves some purpose for the family (Rhodes, 2003).
A second reason that systemic therapy may be useful with this client group is the
involvement of various formal and informal supports. A person with a disability may have
a particularly wide variety of people in their immediate environment. They may be sup-
ported by staff in a formal care arrangement, either in a group home or drop-in support
model. They may have significant relationships with doctors, therapists, case managers or
other professionals. In order to effect change in behaviour, the context of that behaviour
must be considered (Baum, 2007; Leenstra & Rhodes, 2014; Rhodes, 2003). When there
is such a wide network of support, it is especially important to consider how these sup-
ports may impact on the client’s behaviour and presentation (Baum, 2006).
Thirdly, families where one or more members have a disability may experience
increased levels of stress (Baum, 2006; Fidell, 2000). For example, the client’s support
needs may limit parents’ ability to work outside the home, or the client may have
extensive medical or therapy bills, leading to financial stress. This client population
can also be vulnerable to social isolation, if it is difficult for them to access the com-
munity. These experiences can lead to an increased baseline level of stress, so when

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the family are faced with an additional stressor they may find their resources quickly
depleting. This can cause the family to become overwhelmed or feel ‘stuck’ (Ander-
sen, 1987; Baum, 2007; Leenstra & Rhodes, 2014; Rhodes, Donelly, et al., 2014).
If a family is dealing with additional stressors such as illness or unemployment, it
may be difficult for them to commit to working on therapy goals. These competing
priorities may not be identified by the family as a factor preventing the implementa-
tion of strategies, which can make it difficult for clients and clinicians to move for-
ward and can contribute to the sense of ‘stuckness.’ For any family, additional stress
can arise during times of transition in the life cycle such as when children start high
school or move out of home. This stress can be particularly heightened in families
with intellectual disability (Baum, 2007). At these times, families with a child with
intellectual disability may experience a sense of grief and loss when they are reminded
of the milestones their child has not reached or the ways in which their child is differ-
ent from his/her peers (Baum, 2006; Rhodes, 2003; Vetere, 1993). Baum (2006) sug-
gests that a systemic approach is particularly suited to this population because it
focuses on the changes to interaction patterns required to move through these times
of transition. A systemic approach also looks beyond the immediate family, and since
social support networks are an important predictor of a family’s ability to cope
(Baum, 2006), it is important for professionals to strengthen these networks if they
have the opportunity.
The Network Therapy Clinic applied a systemic approach in a single session format.
There is evidence that a single therapy session can be helpful for a family even when no
follow-up sessions are offered (Campbell, 1999; Fry, 2012; Tomm, 1987; Young &
Rycroft, 2012). In a single session, the assessment is the intervention; the therapist’s
questions are used to stimulate change within the system (Tomm, 1987). This encour-
ages collaboration, and allows the family to make the decision to pursue further therapy
if required (Young & Rycroft, 2012). This can also be an efficient way to support fami-
lies, particularly when services have long waiting lists (Young & Rycroft, 2012).
Working as part of a team is integral to the systemic approach, as it maximises
the development of hypotheses (Andersen, 1991; Brownlee, Vis, & McKenna, 2009;
Israelstam, 1988). An important aspect of systemic or family therapy is acknowledging
that there are many ways to view an issue; the therapy team is helping the family to
see one or more versions of the problem, to help them gain a greater understanding
(Andersen, 1991). For this reason, the Network Therapy Clinic uses a consultation
team to work with the family. Extending the impact of a therapeutic team, Andersen
(1987) developed the practice of using a ‘reflective team’ to watch and listen to the
discussion. The reflective team then discuss the information provided by the family,
highlighting the positive connotations and brainstorming hypotheses about the mean-
ing behind the family’s patterns of interaction (Andersen, 1987; Brownlee et al.,
2009). The Network Therapy Clinic team have used this technique of reflection as a
central part of the intervention model, and this was experienced as a powerful aspect
of the clinic.
The aim of network therapy is to assist the family and wider network to develop
new meanings for current issues (Cutler & Madore, 1980; Rhodes, Fennessey, et al.,
2014; Seikkula et al., 2006). The role of the lead therapist is to ensure that every
point made by a participant is acknowledged and responded to (Seikkula, 2008,
2011). This is achieved while using a language familiar to the family and wider sys-
tem (Seikkula, 2008). Arnkil and Seikkula (2015) highlight the importance of being

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present in the moment with participants, allowing the narrative to be formed by the
network rather than the direction being predetermined by professionals.

Including the Extended Network

Family therapy works with immediate family members rather than focusing only on the
client themselves; network therapy involves other significant people in the client’s life,
beyond the immediate family. This can include extended family, informal supports, and
professionals. Network therapy is based on the idea that change must occur in the wider
system if sustainable change is to occur within the family (Halevy-Martini, Hemley-Van
der Velden, Ruhf, & Schoenfeld, 1984). The professionals working with these families
are recognised as parts of the system, who influence and are influenced by members of
the family (Rhodes, 2003; Wallis & Rhodes, 2011). In families where one member has
an intellectual disability, the professionals may have a particularly significant role. There
may be several services involved and the line between the parents’ and the professionals’
roles may be unclear (Vetere, 1993). Due to this role confusion, professionals may also
find themselves stuck in unhelpful patterns of interaction, as they can become enmeshed
with members of the family. Professionals are also affected by their own personal values
and history, which can affect their interaction with family members (Wallis & Rhodes,
2011). For example, if a professional identifies strongly with one particular member of
the family, they may find it difficult to view the situation objectively without assigning
blame. This can impede their ability to provide an effective intervention, which can
compound the family’s experience, preventing them from moving forward and making
lasting changes (Rhodes et al., 2011).
Unlike a traditional case review, network therapy emphasises the importance of
making clinical decisions with involvement from the family, rather than making these
decisions when the family members are absent (Arnkil & Seikkula, 2015; Leenstra &
Rhodes, 2014; Seikkula & Olson, 2003; Seikkula, 2011). Including the professional
network in these therapy sessions can improve the alliance between these professionals
and the family, as it places everyone on the same ‘team’ and prevents the professionals
from working at cross-purposes or blaming the family for their predicament (Cutler
& Madore, 1980).

Principles for Practice

The Network Therapy Team considered the following to be their principles for
practice:

Dialogue
Families and professionals met together as equals, sitting in a relaxed setting, for one
to two hours, while a lead therapist supported them in a dialogue aimed at mutual
listening. The focus of the Network Therapy Session was the sharing of viewpoints
and an exploration of meaning, until a way forward could be found in challenging
circumstances.

Exploration of patterns in relationships

In both the Systemic Consultation and the Network Therapy Session, the emphasis was
on exploring complex patterns of interaction that might currently be restraining change.

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 Lorren Krilich et al.

Systemic empathy
A successful meeting was one where the lead therapist had supported the participants to
gradually recognise the lived experience and intentions of other participants. This was
considered to be an essential prerequisite to effective conversations about solutions.

Curiosity
The role of the therapists was not to fix things, develop reports, or provide advice,
but rather to speak as listeners, asking questions that allowed for distressing interac-
tions to be better understood, relationships to be enhanced, and working alliances to
be supported.

Transparency
Families and clients were welcomed further into decision-making processes, participat-
ing as equals in an open, transparent setting rather than feeling that decisions were
made without them. The Network Therapy Team may have provided feedback at the
end of the session, but only by tentatively conversing with one another about their
impressions while the rest of the participants listened in.

Network Therapy Clinic

The Network Therapy Clinic provided a single session of network therapy to clients
with an intellectual disability, their families and the wider system. The Network Ther-
apy Team were psychologists and managers from the NSW Department of Family and
Community Services (FACS) and Ageing, Disability and Home Care (ADHC). The cli-
ents of this service were children and adults aged 0–65 with mild, moderate, or severe
intellectual disability. While the team were not formally trained family therapists, they
had extensive experience in providing behavioural therapies and/or case management to
individuals with intellectual disability and their families. The team received training and
supervision from a trained family therapist throughout the development and initial
implementation of the clinic. The team had identified that in many of the more complex
cases, behavioural therapies and other services had been provided over a long time frame,
with the same clients repeatedly returning to the service with the same behaviour pat-
terns recurring despite intervention. In many of these cases, the Network Therapy Team
identified that systemic issues within the family or professional network were preventing
the implementation of effective behaviour management techniques. The family and pro-
fessionals may have had conflicting ideas on how best to move forward, or the family
may have found that making changes felt like an overwhelming or unrealistic task. The
client or family may have had a poor alliance with the therapist or case manager which
could have prevented the intervention from progressing. The Network Therapy Team
hypothesised that it would be helpful to use a systemic approach with cases like these,
particularly where there were many family members or professionals involved in sup-
porting the client. The family ‘network’ was defined as the immediate family, as well as
any extended family members or professionals with a significant role in the client’s life.
The Network Therapy Clinic was a two-part process. The ADHC staff working
with the family attended a Systemic Consultation, and then the family and profes-
sionals (both internal and external to ADHC) attended a single Network Therapy
Session.

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Referrals
Referrals came from case managers and therapists within the local FACS district. The
cases being referred had received some prior intervention or support from various
ADHC case managers and therapists. Despite intervention, there had been very little
change noted in the client’s presentation.

Systemic consultation
State-wide Behaviour Intervention Service, ADHC, previously developed a Systemic
Consultation model where the professionals involved with the family met with a team
of family therapists and discussed complex cases where one or more family members
had a disability (Rhodes et al., 2011). This provided an opportunity to explore how
the patterns of interaction within the family were contributing to or maintaining the
current situation. Rhodes et al. (2011) found that the consultation helped clinicians
to develop new perspectives, to develop more empathy for families, and to consider
their own role in the system. This helped the professionals to view the situation more
objectively and appreciate the ‘relational landscape’ (Rhodes et al., 2011, p. 80) where
the challenging situation was occurring.
When applying a systemic approach to clients with intellectual disability, Baum
(2007) describes a ‘pre-session meeting’ (p. 10) as a useful way of generating hypothe-
ses to inform the session with the family. The Network Therapy Clinic used a Sys-
temic Consultation (Rhodes et al., 2011) as a pre-session meeting. The Systemic
Consultation process outlined by Rhodes et al. (2011) was used as a guide. The
ADHC therapist or case manager and other members of the professional system pre-
sented the case to the Network Therapy Team during a two-hour period where the
client, family, and professionals from other organisations were not present. This dis-
cussion informed the team of demographic information, diagnoses, relationships, and
key events before the family came in for the Network Therapy Session; this allowed
the therapy session to be more focused and to not become ‘bogged down’ in recap-
ping details of family history. A sociogram was used to visually depict the family and
system, as described by Rhodes, Donelly, et al. (2014). The Network Therapy Team
interviewed the referrer and others present about interactions and relationships
between family members. During this discussion, they began to form hypotheses
about what was maintaining the current patterns of interaction.

Network therapy session

Wallis and Rhodes (2011) set out structured guidelines for a first session with a fam-
ily using a post-Milan systemic therapeutic approach. The Network Therapy Clinic
used an adapted version of this as a single session of therapy. The aim of this session
was to facilitate an exchange of perspectives to allow members of the network to
explore a variety of interpretations of the family’s situation. The lead therapist began
the session by outlining the format to the participants, so that everyone in the room
knew what to expect. The lead therapist then engaged each of the network members
one by one, by asking about each person’s hobbies and interests. This was followed
by asking each person to outline their concerns and comment on the onset of the
problem. Members of the network were asked to describe a recent example of a typi-
cal incident, and the lead therapist asked questions to explore the interactions
involved in this. After this, questions focused on exploring the relationships amongst

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members of the network. The role of the lead therapist during the session was to
remain neutral and curious, assisting the participants to explore their interactions and
develop their own strategies to improve the situation. The therapist did not offer any
suggestions at this time. During the Network Therapy Session, it was important for
the therapists to be truly present and not give in to the temptation to focus on
hypotheses generated during the Systemic Consultation if these were not supported
by the information presented by the family. It was crucial that these ‘hypotheses’
remained tentative, and were treated as ideas to explore rather than conclusions or
recommendations.
The Network Therapy Session was attended by all members of the immediate
family, other family members with a significant role in the family (as determined at
time of referral by the family themselves and the ADHC staff involved), and the per-
son with disability where possible. Any other professionals working with the family
were also invited to attend – for example, paid care staff (such as respite), school
teachers, or staff from non-government organisations. During the Network Therapy
Session, the lead therapist sat in the room with the family and other members of the
network, while the remaining members of the Network Therapy Team comprised the
‘reflective team’ and sat behind a one-way mirror for the majority of the session.
At the beginning of the session, the family were introduced to the therapists
behind the mirror, and the format of the Network Therapy Session was explained.
The lead therapist first engaged each person in the room individually, asking them to
share something about themselves. They then explored the presenting concern, gain-
ing input from every member of the network. The relationships between the client,
the family, and the professional network were explored using dyadic and triadic ques-
tions. At the end of the session, the family network changed places with the reflective
team behind the mirror, and the family network listened as the reflective team dis-
cussed the presenting issue. This was an opportunity for everyone involved to reflect
on what had been discussed.
The reflective team affirmed what the family and network had already achieved,
and presented hypotheses regarding the meaning of the family’s behaviour. Hypothe-
ses were presented as questions (‘I wonder what would happen if . . .’) or tentative
statements (‘It’s almost as if . . .’), to make it easier for the family to hear and enter-
tain alternative meanings for their own behaviour (Wallis & Rhodes, 2011). Various
hypotheses were presented, to allow the family to reflect on a range of ideas that may
stimulate change if they resonate with the family (Wallis & Rhodes, 2011). At times,
the reflective team tentatively suggested ideas about what might help the family move
forward in the future. However, as there was no follow-up session, the onus was on
the family or network to decide if these tasks were valuable and achievable. After the
reflective team had completed their short discussion, the groups swapped rooms again
and members of the network were encouraged to briefly reflect on what they had
heard before the session was completed.

Letter to the family

Following the Network Therapy Session, a therapeutic letter was written to the family
to reiterate the reflective discussion. The letter was not printed on organisational let-
terhead and the tone of the writing was informal. This was to continue the ‘mood’ of
the session by presenting hypotheses tentatively and acknowledging that the members
of the network have to own the responsibility for change. In some cases, an additional

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 Network Therapy Clinic for Intellectual Disability

letter was written to the children or adolescents (both clients and siblings) who
attended the session, to highlight their part of the process and praise them for their
attendance and involvement.

Network Therapy Clinic: Case Study

A 10-year-old male was referred to the Network Therapy Clinic by an ADHC psy-
chologist. The family had presented due to the client’s behaviour; the family reported
that he would hit, spit, break objects, and bang his head against hard surfaces. The
client had been diagnosed with an intellectual disability in the severe range and Aut-
ism Spectrum Disorder. The referring psychologist reported that the client’s behaviour
served a communicative function, as the client was non-verbal and his behaviour was
an effective way for him to have his needs and wants met. The psychologist had tried
focusing on the behaviour’s communication function, and provided strategies to help
the client communicate in different ways. However, she found that the family contin-
ued to revert to familiar patterns of interaction, particularly in times of stress. As a
result, it was hard for the family to make lasting changes and the mother was report-
ing a risk of family breakdown.

Systemic consultation
The referring psychologist attended the Systemic Consultation with the Network
Therapy Team and discussed the family’s history and current situation. The psycholo-
gist had been working with the client, his mother and his 13-year-old sister for a per-
iod of 11 months. The father had left the family after repeated incidents of domestic
violence primarily directed towards the mother. The psychologist reported that the
sister often provided support to the mother in caring for the client and would com-
fort the mother when she was feeling down. The sister also had an intellectual disabil-
ity in the mild range.
The Systemic Consultation highlighted a confusion of roles in the family. It was
hypothesised that the client’s behaviour was allowing him to be ‘in charge’ at home,
but he did not necessarily want to remain in this role. However, it was easier for his
mother to continue to acquiesce to any demands made by the client, in order to
avoid behaviour that was difficult to manage. It also appeared that the sister was being
parentified, often stepping in to support the mother when she was upset.

Network therapy session

The Network Therapy Session was attended by the client’s mother and sister, the
referring psychologist, a behaviour support implementer from a non-government
organisation, and the respite manager. The client did not participate in the session, as
the team believed that listening to the discussion would increase his anxiety and may
trigger behaviours of concern.
Family members were asked what they were most concerned about. The mother
identified that she felt that every day was ‘Groundhog Day’ with her son, and that
his behaviour was becoming increasingly difficult to manage. This was the mother’s
acknowledgement that the family were stuck in repetitive patterns of interaction. The
mother reported that she had recently been admitted to hospital, and after this the
client’s behaviours of concern had increased, particularly before, during, and after
times of transport. The sister also reported that the client’s behaviour would increase

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 Lorren Krilich et al.

before access visits with their father. This led the mother to question if the client’s
behaviour could have been learnt through observations of his father’s past domestic
violence. Perhaps this behaviour was so similar to the behaviour displayed by the
father in the past that it impacted the family’s ability to move beyond these previous
experiences. At this point in the session the sister shared how the domestic violence
had affected her, and the referring psychologist later reported to the Network Therapy
Team that to her knowledge this had not been discussed in the family before.
After changing places with the family in the room, the reflective team highlighted
that despite all the challenges, the family were still very close and the mother was very
committed to her children. The team also suggested that the client may be taking
charge within the home, and wondered aloud at the potential for change if these roles
could be reversed. Perhaps the client was resisting any change to his relationship with
his mother and was anxious about being separated from her again like he was during
her hospital visit. Would it relieve some of the client’s anxiety if the responsibility for
managing the relationships at home no longer belonged to him? Could the mother
take back the authority at home and therefore improve communication among the
family members? The therapists queried how the network could support the mother
to make these changes. They also acknowledged the family’s past experiences of
domestic violence and the continuing impact this was having on their relationships.
The reflective team wondered if it would be beneficial for the family to attend
family counselling to support them to deal with the impact of these experiences. After
hearing these reflections, the mother said she would be interested in following up on
family counselling for herself and her daughter. This was an important step as it
demonstrated the mother taking responsibility for making change within the family.
The mother also recognised the parentified role played by her daughter in the family,
and identified that she would like to treat her more like a daughter by doing fun
activities together and helping her daughter get ready for her upcoming formal. The
others in the room identified that the content of the session was a good reflection of
the mother’s resilience and the resources already present within the network to assist
with change. These reflections were reinforced in the letters sent to the mother and
sister after the session.

Discussion
The Network Therapy Clinic utilised the principles of systemic therapy to support
families through difficult points in their lives, by offering a Systemic Consultation fol-
lowed by a single Network Therapy Session. This model served to provide new per-
spectives for family and professionals, assisting those involved to reflect on their
current situation and how to move towards their goals. The Systemic Consultation
was a valuable opportunity for the team to gain information, which helped them
develop hypotheses to be explored during the Network Therapy Session. The team
also observed that the Systemic Consultation helped the professionals involved to view
the family’s behaviour more positively and understand the meaning behind the family’s
patterns of interaction. The professionals involved in these sessions reported that the
discussion helped them to understand what was happening in the family more clearly.
The Network Therapy Session was an opportunity for the family to consider how
their relationships impacted on their behaviour, and how they could use their
strengths to work together more effectively. Having this discussion together as a

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family helped family members to identify their capacity to make changes, which
encouraged them to ‘own’ the intervention and have more input into its direction. In
the case study, the family appeared to receive the information more readily when they
heard it presented tentatively by a group of professionals appearing to talk amongst
themselves. A variety of suggestions were tentatively put forward, and the client’s
mother picked up on the suggestions which resonated with her and became motivated
to seek further therapy for her family in the future. The session also provided an
opportunity for the professionals in the network to be more closely aligned with the
family. Informal feedback from the referring psychologist in the case study stated that
the Network Therapy Session had strengthened her relationship with the family,
which increased the effectiveness of the psychologist’s intervention.
Some limitations were observed in the development of the model. The Network
Therapy Team were not formally trained in family therapy which meant that they
had to learn how to apply these principles before beginning to use the model, particu-
larly the questioning style. This learning was supported by supervision with a trained
family therapist. However, the team’s limited experience could be considered a limita-
tion. In the case study, the family and the professional members of the network had
different expectations in regards to what would take place in the Network Therapy
Session. Although the professionals involved had been advised that they were attend-
ing a family therapy session, some members of the network were expecting a work
meeting or case conference. It is unusual for professionals to be included with a fam-
ily in a therapeutic session and this seemed to create some confusion. The profession-
als’ expectations had to be addressed at the beginning of the session and this led to
questions about the research behind the model. The team felt that this interrupted
the natural flow of the session and made the session more formal than it needed to
be; the priority at this point in the session was to establish rapport with the family
and network, and discussing the theoretical aspects of the model detracted from this.
However, addressing this ahead of time with the professional members of the network
may introduce further challenges as it may affect the informal nature of the session
and encourage the professionals involved to prepare information beforehand rather
than respond to the team’s questions and comments spontaneously.
The Network Therapy Clinic included a Systemic Consultation, which meant that
ADHC staff met without the family present before the Network Therapy Session.
Although this was useful for the Network Therapy Team, it could be viewed as a lim-
itation as it does not reflect the transparent nature of network therapy (Arnkil &
Seikkula, 2015; Leenstra & Rhodes, 2014; Seikkula & Olson, 2003; Seikkula, 2011).
However, the Network Therapy Team felt that the advantages of incorporating this
pre-session meeting outweighed the limitations. The Systemic Consultation assisted
the professionals involved with the family to explore the issues from their perspective
and to contribute to the development of hypotheses, which in turn helped the Net-
work Therapy Team prepare for the Network Therapy Session. In order to adhere to
the principles of network therapy, it was important to ensure that hypotheses were
tentative, as they must not hinder the ability of the Network Therapy Team to listen
to what is going on during the session with the family.
As this model of service continues to develop, the team will include the client with
a disability in the Network Therapy Session where possible. The team will also con-
tinue to explore appropriate ways of including a wider network in the family session,
including teachers and support staff from respite services, post-school programs, etc.

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 Lorren Krilich et al.

This provides an opportunity for change to occur in the entire network, beyond the
immediate family, recognising the fact that all the professionals involved with the
family are part of the system. In future sessions, more consideration will be given to
how to prepare the members of the network for the session, to avoid questions about
the model during the Network Therapy Session itself. Additionally Fry (2012) sug-
gested following up with professionals more formally. Providing them with a thera-
peutic letter could be an effective way of collating information as to the outcome of
the session for these members of the network.
Future direction would include assessing the efficacy of the model, which is
beyond the scope of this paper. In order to evaluate the usefulness of the intervention,
a pre- and post-measure should be used with each member of the network. Fry
(2012) has developed a pre-session questionnaire and a single session rating scale
which could be used for this purpose.
The initial applications of this model of intervention have shown promising results
for people with intellectual disability and their families. The Systemic Consultation
has provided a valuable opportunity to explore the issues and affect the way profes-
sionals relate to families. The Network Therapy Session allows the family to explore
the meaning behind their patterns of interaction, and the reflective team can re-pre-
sent this information while tentatively commenting on its meaning, in the hopes of
stimulating change in the way members of the network relate to each other. Helping
the family and others in the system to understand their relationships and interactions
means that they are better able to work together to find solutions and make lasting
changes.

Disclaimer
The authors disclaim that information and views contained in this research are not
intended as a statement of NSW Family & Community Services (FACS) and do not
necessarily, or at all, reflect the views held within NSW FACS.

Acknowledgements
We would like to acknowledge NSW Family and Community Services, Ageing Dis-
ability and Home Care (ADHC) for supporting us to develop the Network Therapy
Clinic and permitting us to report on its outcomes. Thank you also to The Benevo-
lent Society for allowing us to continue this work.

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