title: Beyond the impasse? Systemic consultation and understanding complex cases.
abstract: BACKGROUND
  Systemic consultation provides an opportunity for clinicians working with complex cases and behaviours of concern to reflect on interpersonal dynamics that may be inhibiting change. This approach to case review is drawn from systemic family therapy, a model that is gaining some acceptance within the field of intellectual disability.
  
  
  METHODS
  Thematic analysis was used to explore the experience of eleven clinicians attending systemic consultation. Clinicians were experienced in behaviour support, had no prior experience in family therapy and presented with complex cases described as 'stuck'.
  
  
  RESULTS
  Consultations were seen to have many benefits, including a heightened awareness of the interpersonal needs of both clients and carers and the development of a facilitative position and skills to apply to cases. Less experienced clinicians were more likely to feel overwhelmed by this less structured, more relationally oriented focus.
  
  
  CONCLUSIONS
  Systemic consultation has the potential to augment behaviour support, enabling clinicians to understand and negotiate problematic interpersonal dynamics when responding to behavioural difficulties. Less experienced clinicians may require additional training and support in the systemic approach.
authors.affiliation: Statewide Behaviour Intervention Service, Ageing Disability and Home Care, Department of Family and Community Services, Sydney, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Rhodes
authors.forename: Michelle
authors.initials: M
authors.lastname: Donelly
authors.forename: Lesley
authors.initials: L
authors.lastname: Whatson
authors.forename: Kate
authors.initials: K
authors.lastname: Brearley
authors.forename: Jack
authors.initials: J
authors.lastname: Dikian
authors.forename: Anders
authors.initials: A
authors.lastname: Hansson
authors.forename: Tanya
authors.initials: T
authors.lastname: Franic
authors.forename: Lucinda
authors.initials: L
authors.lastname: Mora
mesh_terms: D000328:Adult; D019090:Case Management / Q000592:standards*; D005196:Family Therapy / Q000592:standards*; D005500:Follow-Up Studies; D006801:Humans; D008607:Intellectual Disability / Q000628:therapy; D007398:Interpersonal Relations; D036301:Qualitative Research; D012017:Referral and Consultation / Q000592:standards*; D012920:Social Behavior Disorders / Q000628:therapy
keywords: behaviour; family therapy; mediation analysis