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sector, and statutory services will also reach out as much as they can. So, I’ll abbreviate it here as family therapy in the community. I have crystallised a longer argument into this condensed form: When surgeons found they were seeing a lot of death and damage caused by car accidents, it got back to politicians and lawmakers to make roads and drivers safer in the community. Surgeons, car dealers, brewers and drivers themselves – key players though they are in the road traffi c accident system – may not have liked these restrictions to job and freedom, but they valued saving life and preventing accidents. Surgeons are ethical. T ey are good scientists and basic systemic thinkers. Dealers and healers also like to arrive safely themselves. So bet er care in the community is best. Prevention is bet er than cure. Dealers now fi t seatbelts and safety features in cars, and label their products with tokens of moral standards – ‘drive safely’, ‘drink wisely’. Healers have a higher moral vocation – they give wholehearted support for prevention. T e alternative is unthinkable: their support for a system that promotes suff ering and damage so that only they get the work. When doctors found they were seeing a lot of death and illness caused by smoking, it got back to people, politicians and lawmakers to reduce smoking in the community. Doctors, cigaret e manufacturers and smokers themselves – key players though they were in the system – may not have liked these restrictions to job and freedom, but they valued saving life and preventing illness. Doctors are ethical. T ey are good scientists and basic systemic thinkers. Dealers and healers also like bet er health themselves. So bet er care in the community is best. Prevention is bet er than cure. Dealers now limit the marketing of cigaret es, and label their products with tokens of moral standards – ‘smoking kills’. Healers have a higher moral vocation – they give wholehearted support for prevention. T e alternative is unthinkable: their support for a system that promotes suff ering, illness and disorder so that only they get the work. T ere are many more examples of


the importance of the wider system and community around illness and health services: tuberculosis and living conditions, infections and vaccination, and AIDS and safe sex. Let’s apply the logic to ourselves:


Context February 2012


NHS family therapy: ticket-holders only When NHS family therapists found they


were involved in seeing and helping a lot of suff ering and disorders through at ending to the patients’ family relationships, it began to get back to people, AFT, politicians and others to improve and help people’s relationships in the community in all kinds of ways. Family therapists themselves – notable key players though they are in the NHS treatment system – may not like these distractions to their diffi cult job, but they value preventing suff ering and disorders. Family therapists are ethical. T ey are good scientists and basic systemic thinkers. Healers prefer early help if they need it too. So, bet er care in the community is best. Prevention is bet er than cure. T ere are no specifi c dealers in bad relationships, but healers have a high moral vocation – they give wholehearted support for prevention. T e alternative is unthinkable: their support for a system that promotes suff ering, disorder and deterioration so that only they get the work. I’ll restate the last bit. If we don’t work


equally hard to build family therapy services outside the NHS, we are unwit ingly and systematically promoting suff ering, disorder, delay and deterioration as the way to get relationship help from family therapists in the NHS. T is just must not be true since we would then be guilty of poor systemic-thinking and immoral ethics, by any defi nition. By “relationship help” I mean a wide range of systemic help and therapy for a wide range


of clients. Couple counselling counts even if it may not yet be very systemic. Lots of research shows that good


relationships at home, work and play make for happiness and health. So, anyway, long before problematic relationships get bad enough to contribute to more serious disorders, diagnoses, suff ering, deterioration, risk and abuse, it makes sense to provide easily accessible services and help, and to promote a culture of families get ing and valuing relationship help sooner when they need it. People should be able to get relationship help without a ticket of having a symptom or disorder. T e NHS recognises this in the provision


of counselling and therapy in front line primary care in health centres. But still the NHS context encourages a medical and illness framework as you get your ticket (oſt en from your doctor) for psychological or relationship help. Relationship help should, of course, be available in NHS and health centres, but it should also be at least equally available in the wider community. Apart from this rationale around illness- labeled disorders and family therapy, the community is family therapy’s natural home, as it is for all psychotherapies. Life, relationship and its discontents – though they weave together with sickness (Taylor, 1982) – are in a diff erent realm than illness and medicine; they’re not comfortable hospital bedfellows. We are now discovering there are unsung family therapists providing some of these


29


Systemic means much more – in the community and for other professions


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