The application of a domains-based analysis to family processes: implications for assessment and...

The application of a domains-based analysis tofamily processes: implications for assessmentand therapy

Jonathan Hill,a Bernadette Wren,b Jane Alderton,b

Charlotte Burck,b Eilis Kennedy,b Rob Senior,b

Neelo Aslamc and Nichaela Broydend

Social domains are classes of interpersonal processes each with distinctprocedural rules underpinning mutual understanding, emotion regula-tion and action. We describe the features of three domains of family life –safety, attachment and discipline/expectation – and contrast them withexploratory processes in terms of the emotions expressed, the role ofcertainty versus uncertainty, and the degree of hierarchy in an interac-tion. We argue that everything that people say and do in family life carriesinformation about the type of interaction they are engaged in – that is, thedomain. However, sometimes what they say or how they behave does notmake the domain clear, or participants in the social interactions are not inthe same domain (there is a domain mismatch). This may result in mis-understandings, irresolvable arguments or distress. We describe how it ispossible to identify domains and judge whether they are clear andunclear, and matched and mismatched, in observed family interactionsand in accounts of family processes. This then provides a focus for treat-ment and helps to define criteria for evaluating outcomes.

Keywords: family therapy; domains; attachment; parenting; family interactions.

Introduction

The aim of this article is to describe a way of understanding moment-by-moment family processes in order to provide a platform for treat-ment with families or with family members. We start with a sequencefrom a family therapy interview, which is followed by a description of

a Professor, University of Manchester, Manchester, M13 9PL, UK, and the Tavistockand Portman NHS Foundation Trust, London, UK. E-mail: [email protected]

b Tavistock and Portman NHS Foundation Trust, London.c Central Manchester Foundation Trust.d University of Manchester.

Journal of Family Therapy (2011) ••: ••–••doi: 10.1111/j.1467-6427.2011.00568.x

© 2011 The AuthorsJournal of Family Therapy © 2011 The Association for Family Therapy and Systemic Practice. Published byBlackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA02148, USA.

the framework, and then an illustration of the way in which theframework can be applied to family processes. For reasons of confi-dentiality the sequence is based on interactions observed in familytherapy sessions by the authors, rather than a verbatim extract fromone particular session.

In the following extract, the therapist (TH) is meeting with theyoung person (YP) who is a 15-year-old girl referred with problemsof unstable mood and self-harm, her mother (MO) and her father(F):

YP: If my mum and I talk about something that’s been on TV,if she doesn’t agree she gets mad at me.

TH: So what do you do when your mum gets mad at you?YP: Go and watch TV, or go on my computer.TH: How are you feeling when you do this?YP: Bad, really bad. But calmer watching TV.TH: ... Right, so there we are, we have this little snapshot of all

these different feelings. Does someone have a role in regu-lating all of these feelings?

YP: [points to mother]TH: Mum, Mum is the one who kind of checks out how every-

body else is.YP: Yeah, if something is not right then she will just tell you.TH: Ok, if something is not right then she will tell you.YP: Yeah if she is not happy then everybody knows about it.

Stop laughing – it’s not funny. When my mum gets sad, andsometimes she does and she cries and shuts herself away,then I go ‘Oh, not again’ and then she goes mad at me fordays.

TH: And if your mum shuts herself away do you try and checkout how she is?

YP: No I give up.TH: You give up.YP: I give up. I do feel sorry for her, but sometimes she might

cry because teachers have complained about me, then I willcomfort her. If it’s very serious then she will say somethinglike I’m a disappointment and I don’t like that, it’s verynegative.

TH: Right, I think that is right, I remember last time your Dadsaid, ‘I just want you to be an average student’ and you said,‘What am I now, below average?’

2 Jonathan Hill et al.

© 2011 The AuthorsJournal of Family Therapy © 2011 The Association for Family Therapy and Systemic Practice

YP: I’m not below average.F: I was trying to say that I only want you to do your best at

school, for your sake, for your future.YP: Yeh, but whatever I do at school mum isn’t happy with it.

I’m always a disappointment to her.TH: I have the impression that YP has a tendency to see other

people putting her down and then she goes down with it. Iwonder if that is something you have picked up: that thingsthat you say can bring her down and leave her upset orangry?

M0: Maybe, but not enough for her to do anything about it. If Ithink of school then I have been called in since nursery onendless occasions because YP has got herself into troubleabout all things and um ... she’s even been suspended fromschool ... you would think that with YP saying about mebeing upset and disappointed that if it mattered that muchthen she might try and do something about it.

YP: But I do try.

The therapist seeks to explore roles, behaviour and emotion regula-tion within the framework of systems thinking, and family membersprovide a vivid account of problematic interactions. They convey theirhelplessness, in the face of repeated failures, probably over manyyears, about their experiences in the family. As the young person saysin response to the therapist’s question about what she does when hermother cries, ‘I give up’, and for the mother, after being called in sincenursery, ‘you would think that with YP saying about me being upsetand disappointed, that if it mattered that much then she might try anddo something about it’.

In this article we describe a conceptual framework and a prac-tical method that show how the mother and daughter in thisextract are attempting the impossible – to find a solution to twomarkedly different kinds of interpersonal processes that crisscrossthrough the sequences, causing confusion and underminingemotion regulation. This domains-based approach to family lifeproposes that all interactions between family members are eitherdomain clear and matched, domain clear and mismatched ordomain unclear. Domain mismatches and low domain clarity arethought to impede interpersonal understanding and hence effectivesocial action, and to undermine emotion regulation. We alsodescribe how this understanding can be used in treatment to track

Domains-based analysis 3


and clarify family processes and hence provide a platform for alter-native family transactions.

The domains-based approach to understandingchild-parent interactions

The framework we use for understanding child-parent interactionsdraws on the theory that social life is organized into domains – differ-entiated and identifiable classes of interactions each underpinned bydistinctive rules (Bugental, 2000). Social domain theorists argue thatthe complexity of our social world presents a seemingly impossiblelearning problem with infinite room for misunderstanding and mis-interpretation. We overcome this problem by placing constraints onthe extent of this dynamic social interplay, by organizing our socialinteractions into discrete emotional and behavioural arenas –domains. The rules operating in each domain specify the scope of theinteractions, how participants’ behaviour is to be interpreted, theemotions that may be expressed and the emotional resources that maybe sought in the interactions (Bolton and Hill, 2004). This proposeddomain partitioning of social life allows different kinds of interper-sonal tasks to be achieved quickly and efficiently. Domain clarity, andthe tacit knowledge that we are occupying the same domain, haveimplications both for the quality of relationships and the welfare ofindividuals (Grusec and Davidov, 2010). The developing child has toacquire an ability to perform the procedures of domains-based func-tioning first within the family and, subsequently, in social interactionsin the wider world (Hill et al., 2010).

The transitions between the domains can be fast, but one cannot bein two domains at the same time; the activation of one domain leads tothe inhibition of the others. Certain kinds of behaviour are effective inonly one domain. For example, as Bugental (2000) suggests, powerassertive tactics are effective only in hierarchical domains: a parentcannot regulate the child’s empathy through power assertive tactics.

The domains-based model proposes that, regardless of culture,there are certain aspects of parent-child relationships that must beeffectively transacted: to keep a child safe, to give comfort and affec-tion, to help manage strong emotions, to teach about the world, andso on. How these transactions are carried out cannot be specified indetail without knowing the particular cultural world the family inhab-its. Domains themselves are not sufficient to determine how someonemight think, act or feel without setting cultural parameters that



specify how, when, where and with respect to whom the domain rulescan be implemented (Fiske, 1992).

Two distinct types of domain can be identified in family life (Hillet al., 2003). In affect-action domains sequences are commonly ini-tiated by a child’s expression of negative emotions, such as fear,distress or anger, leading parents or other caregivers to take actionto help resolve those emotions and deal with their causes. Parentsmay also take action in response to circumstances or behaviour thathave the potential to lead to negative emotions. By contrast, in theexploratory domain, sequences are initiated by playful bids, storiesof what happened during the day, expressions of opinions and ques-tions. The role of the parents is playful, companionable or inter-ested. In this domain there is no pull for the parent to take action,nor is there anything to solve. In affect-action domains parentscreate certainty through hierarchical processes in which they takethe lead or act with authority but in exploratory processes parentsembrace uncertainty through processes that are not hierarchicallyorganized.

Thus far, we have identified three affect-action domains: safety,attachment and discipline/expectation. Sequences in the safetydomain are initiated by circumstances that put the child at risk andrequire the parent to take action to lower the risk. The action may bein response to, or anticipate, fear or distress caused by the risk. Inyoung children the risks include busy roads and household hazards;in adolescents, drugs, violence or pregnancy. Cues for the attachmentdomain include expressions of fear, worry, distress, illness, injury,sadness and separation. The parent’s action takes account of thechild’s state of mind and expressed needs and involves conveying anunderstanding of the child’s experience and providing comfort. Itmay also, especially in adolescents, include working with the youngperson to manage the cause of the distress or worry. The discipline/expectation domain is initiated by child behaviour that parents regardas unacceptable, inappropriate or dangerous, or by parents’ anticipa-tion of such behaviour. It is therefore also concerned with rules andstandards. Relevant parental behaviour includes rewards and punish-ments, praise for behaviour in the home or performance in school andangry telling-off for transgressions.

We can see that domain functioning is underpinned by processesthat are in many respects similar to ‘procedural knowledge’ which theperson is not aware of, and which influence actions without consciousawareness (Baldwin, 1992). Although family members are generally



not aware of the domain organization of family life they commonlysuffer the consequences where they are unable to proceed accordingto the same rules. For example if parents interpret a child’s distress asoppositional they may respond with anger, increasing the child’s dis-tress, which in turn increases the parents’ anger. The likely conse-quences of a domain mismatch of this kind are that the participants donot feel they are understood and they have difficulty regulating emo-tions interpersonally. Difficulties also arise where some elements of adomain, but not others, are present. For example parental anger witha child usually implies the discipline domain; however this will not beclear if the parent does not also define interactions hierarchically, withthe parent taking authority.

As family therapists we link these ideas explicitly to our Batesonianheritage. Bateson argued that ‘the stream of events is commonlypunctuated into contexts of learning by a tacit agreement between thepersons regarding the nature of the relationship’ (Bateson et al., 1972,p. 299). He makes the case that the content of what is experienced infamilies (whether it is conflict, distress, play, affection or discipline/expectation) has to be anchored in confidence that the familymembers can establish a shared interpretative frame (Bateson, 1972).To interact within such a shared frame involves each member beingaware of the emotional state the other is in and understanding itspossible causes. People need to know that, for example, someone isfrightened and not angry, or that someone is angry and not joking.What Bateson called meta-communication implies a need for familiesto be clear with each other about the kind of situation or context theyare in. This kind of clarity, this maintaining of clear boundariesbetween domains, is essential if family members are to express theirideas and feelings in ways that will not be misunderstood orresponded to incoherently.

Bateson and the Palo Alto group also pioneered the concept of a‘double bind’ (Bateson et al., 1972), while Wynne pursued these earlyideas on communication with an exploration of how well children’semotional adjustment can be predicted from measures of the ‘com-munication deviance’ of their parents (Wichstrøm et al., 1993; Doaneet al., 1982, p. 221). There are similarities and important differencesbetween these ideas and the domains framework that we hope to takeup in later publications. Unlike the Bateson and Wynne perspectives,we envisage that low domain clarity and mismatches can arise inmultiple ways, for example, as the result of challenges posed by a childwith emotional or behavioural problems. Whether or not mismatches



and a lack of clarity are problematic may depend on the specific needsor vulnerabilities of family members.

The application of the domains framework with families

The principles of the domains model can be applied by trackingsequences in family conversations, and we illustrate this with an anno-tated version (annotations in italics) of the sequence from the familytherapy session shown earlier:

YP: If my mum and I talk about something that’s been on TV,if she doesn’t agree she gets mad at me. The young personreports that when she and her mum talk about something on TV inthe exploratory domain her mother often responds with an emotionalstate that belongs in the discipline/expectation domain, hence low-ering domain clarity.

TH: So what do you do when your mum gets mad at you?YP: Go and watch TV, or go on my computer.TH: How are you feeling when you do this?YP: Bad, really bad. Watching TV calms me down. The young

person describes doing something that removes her from the highemotional intensity with her mother. From a domains perspective shealso leaves an interpersonal encounter in which it is unclear howshe should respond.

TH: Or go on your computer. Right, so there we, are we have thislittle snapshot of all these different feelings. Does someonehave a role in regulating all of these feelings? The therapist asksa question that could refer to safety, attachment or discipline.

YP: [Points to mother]TH: Mum, Mum is the one who kind of checks out how everybody

else is? The therapist appears to enquire about exploratory orattachment related behaviours by the mother.

YP: Yeah if something is not right then she will just tell you. Thedaughter specifies that she is talking about discipline.

YP: Yeah if she is not happy then everybody knows about it.Reference to ‘not happy’ suggests role reversed attachment (mother’sattachment needs) or discipline. Stop laughing – it’s not funny.When my mum gets sad and sometimes she does and shecries She now defines this as a role reversed attachment need of themother, lowering domain clarity and shuts herself away, then I go‘Oh, not again’ and then she goes mad at me for days.



‘Mad at me’ often means angry, implying discipline; however in heraccount the domain is not clear.

TH: And if mum is crying regularly do you try and check out howshe is? Therapist asks if the young person accepts the role-reversedattachment bid.

YP: No I give up. From a domains perspective the young person can beseen as giving up not only on trying to understand or help her mother,but also on the possibility of clarifying what she is attempting to solvein interaction with her mother.

TH: You give up.YP: I give up. I do feel sorry for her She accepts the role reversed

attachment interaction but sometimes she might cry becauseteachers have complained about me YP says that her motherexpresses an attachment need in response to a discipline/expectation issue, and if that is confirmed by her mother and so isnot simply her perception, it is a domain mismatch then I willcomfort her. If it’s very serious then she will say somethinglike I’m a disappointment and I don’t like that it’s verynegative. From a domain perspective the daughter responds to theattachment bid (‘then I will comfort her’) and identifies the dis-cipline comment (‘she will say something like I’m a disappoint-ment’). She appears to sum up the impossibility of action andemotion processing under these conditions with, ‘I don’t like that,it’s very negative’.

Th; Right, I think that is right, I remember last time your Dadsaid, ‘I just want you to be an average student’ and yousaid, ‘What am I now, below average?’ The therapist recallsthat the father made a statement that clearly belonged in thediscipline/expectation domain.

YP: I’m not below average. And the young person responds robustlyin that domain.

F: I was trying to say that I only want you to do your best atschool, for your sake, for your future. Father responds clearlyin the discipline/expectation domain.

YP: Yeh, but whatever I do at school mum isn’t happy with it.I’m always a disappointment to her. The YP brings the con-versation back to her mother. This could be a complaint about adomain clear process, that is, that she is difficult to please, or a lessclear mix of expectation and role reversed attachment.

TH: I have the impression that YP has a tendency to see otherpeople putting her down and then she goes down with it.



I wonder if that is something you have picked up: thatthings that you say can bring her down and leave herupset or angry. The therapist raises the question of whether theYP can feel so bad in relation to discipline/expectation that sheneeds to be taken care of – attachment.

M0: Maybe Mother considers this very briefly but not enough forher to do anything about it. The mother seems to say thatif her daughter felt sufficiently upset she would stop behavingbadly, implying that her heightened attachment need shouldserve as a disciplinary measure. If I think of school then Ihave been called in since nursery on endless occasionsbecause YP has got herself into trouble about all thingsand um ... This is clearly discipline/expectation you wouldthink that with YP saying about me being upset and dis-appointed that if it mattered that much then she might tryand do something about it. Mother states that her attachmentneed should serve as an effective discipline/expectation sanction –domain mismatch.

YP: But I do try.

Using the domains-based framework to inform treatment

We have identified five main issues in planning therapeutic work: (i)whether to base the intervention on a standardized assessment; (ii)whether to explain the domains framework to the family; (iii) decidingwith whom to work in therapy; (iv) how to identify sequences forreview in sessions; and (v) the implications of the domains-basedframework for the therapist stance. These are described below.

1. A standardized assessment has been devised to provide a researchmeasure of domain functioning in families; the family domainsinterview. The assessment interview is an adaptation of the adultattachment interview (George et al., 1985) addressed in thepresent and to the whole family or subsets. The initial phase ofthe interview, asking for adjectives to describe family relation-ships and supporting examples, provides a context for explora-tory conversations. Subsequent questions are about what happensin the family when someone is sad, worried or ill (attachment),when safety is threatened (safety) and when someone is angryor a child does not do what a parent expects (discipline/expectation). The interview has the advantage of providing sys-tematic coverage of the domains that may help the therapist’s



thinking, and indicating to the family the areas that will be con-sidered in treatment. However, as evident in the example in thisarticle, conducting the standardized assessment is not essential, asour clinical experience has been that domains can be tracked infamily therapy sessions and in clinical accounts provided byparents and children.

2. Explaining the framework to the family opens up therapeuticoptions that are not otherwise available. It enables the principles ofdomain functioning to be explored in detail, leaving familymembers with the choice as to whether or not to apply them intheir family. This can be invaluable in creating an exploratoryplatform, particularly where there is a risk that parents will expe-rience a review of family relationships as threatening.

A key aim of the explanation is to create an understanding ofthe ways that domain clarity and domain matching supportproblem-solving and emotion regulation, and how much harderthis is in the presence of low clarity or mismatching. At the sametime emphasis is laid on the importance both of intensely emotionalprocesses and of cooler reflection in family life. This functionalunderstanding is designed to promote exploration in the family. Italso tends to reduce the likelihood of the therapy becoming preoc-cupied with notions such as correct versus incorrect, or good versusbad ways of relating, with the disciplinary overtones each carries.Furthermore, by making links with daily experiences in families,the framework may provide a tool that family members can applythemselves.

Inevitably, some families find the general principles easier tounderstand than do others, and there is scope for them to be misun-derstood or misapplied. Clinicians will sometimes choose not todescribe the framework.

3. The domains analysis can lead to work with whole families, subsetsof families, parents, or children. In general, where there is scopefor the family to reflect on their experiences and relate them to thedomains, whole family work can be very helpful. On the otherhand, where parents are reducing domain clarity, for example, bycomplaining about a child’s behaviour without asserting their viewhierarchically, joint sessions may risk undermining that hierarchyfurther and work with the parents alone may be more effective.Similarly where young people appear to confuse their parents bydisplaying angry reactions that obscure an underlying attachment



need, individual sessions may be the most effective way of discuss-ing what they intend to communicate and what they actually docommunicate.

4. Family interactional sequences may be identified for review eitherfrom accounts given by family members or from interactionsobserved by the clinician in the therapy room. Parents or youngpeople may press the clinician to listen and respond to particularlytraumatic or dramatic events. This can be very helpful in highlight-ing the domain processes and in reassuring the family that thetherapist is aware of how bad things can be. But these highlyemotional sequences may also create pressure on the clinician toadopt a disciplinary or caring role that may inhibit their scope forexploration and analysis. The exploratory ground can often berecovered by working together with the family on a moment-by-moment domain analysis of the sequences, or by making use of thetherapist’s analysis to anticipate ways of building domain clarityinto similar events in the future.

Equally, it may be necessary to start domain analyses with unre-markable sequences, or ones that do not involve highly emotionalaffect-action domains. The analysis of exploratory interactions can bevery illuminating, and, consistent with the domain, pleasurable. Amajor advantage of using the standard interview is that it covers awide range of family experiences, thus providing a range of interac-tions for analysis.

5. The domains framework emphasizes the difference between hier-archically structured emotion-based domains and exploration inparent-child relationships. The therapist also needs to be domain-clear and to consider whether it will be more effective at anymoment to work hierarchically or reflectively. Commonly, a com-bination is helpful. For example, initial interviews may reveal somedomain mismatching, with a parent introducing an attachmentneed during a disciplinary exchange. The parent may recognizethe significance of this mismatching only if the therapist temporar-ily leaves the reflective, uncertain stance and indicates to theparent, from a more knowing or expert position, that within thedomain model this is confusing the young person and may beleading to emotional outbursts. The therapist adopts a more hier-archical position and asserts the need to work on changing this.Additional information and understanding will continue to emergein more exploratory phases of therapy.



Using the domains framework – a clinical example

Background

AT was a 14-year-old girl referred to child and adolescent mentalhealth services by the paediatric team following an overdose. She wasseen for a psychiatric and risk assessment, accompanied by herparents. According to her parents over the preceding 2 months therehad been a change in AT’s behaviour, mood and relationship with herparents. She had mood swings and was at times irritable and aggres-sive, leading to arguments with her parents. There had been twooccasions when AT had self-harmed by taking an overdose requiringmedical attention. Her parents were also aware that she was self-harming by cutting. AT’s parents saw her behaviour as irrational,found it frightening and persecutory and responded with anger andhurt. They felt constrained and scared when trying to manage thedifficult behaviour for fear that AT may have gone on to self-harm.

AT reported that her mood had begun to fluctuate over the previ-ous few months and this appeared to be in response to her unrecip-rocated interest in a boy. She had found it very difficult to cope withfeeling low and had tried cutting (which she had witnessed in a peer)and to her surprise it helped her to cope better with her feelings. AT,eldest of two girls, attended a mainstream school and was academi-cally bright. The family were financially comfortable.

Assessment

Following the immediate management of the overdose AT was seenon three occasions, accompanied by her mother. AT and her motherwere seen separately and together on these occasions. When report-ing the same event it quickly became clear that AT’s account and hermother’s account varied significantly. Each labelled the other’s moti-vations and behaviour differently.

An illustrative incident

ATs parents arranged a special lunch for her birthday to be attendedby her grandmother. During the lunch AT’s father felt she was sullenand insufficiently grateful for all the effort they had made. He becameangry and told AT how he felt and she was sent to her room. Later hermother found AT had cut herself across her abdomen and her fatherbecame very upset and angry. He accused AT of ruining his life andbecame distressed in her presence.



AT recounted that she felt embarrassed by recent events, found itdifficult to face her grandmother and had not wanted a fuss on herbirthday. She had also been feeling low, following an encounter withthe boy at school. AT had found it difficult to join in with the conver-sation at lunch and had been thinking about cutting. She also feltguilty for not enjoying the lunch after her family had gone to so mucheffort but at the same time felt angry because they had not respectedher wishes. The cutting had helped her to feel better; she did not doit to upset her parents. She was shocked by her father’s response, asshe had not seen him so upset before. AT felt that being sent to herroom was entirely unjustified and that she was being punished forbeing upset.

The domain analysis

The arrangement of the lunch can be understood in domain terms.Generally such occasions are established in the exploratory domain.They are planned in consultation with the young person in relation toher wishes and ideas are shared. There is an anticipation of positiveemotions such as pleasure and excitement. However, in this contextthe domain appeared to have been unclear. The parents did notdiscuss the plans with their daughter and there may have been unspo-ken expectations along the lines of ‘You should do this for yourgrandmother’ or role-reversed attachment, with the parents expect-ing to receive their daughter’s affection or gratitude for taking care ofher. If this were the case, when the girl was sullen, she and her parentsdid not have a shared domain in which to work out emotions. If theevent had been planned in the exploratory domain, then parentscould, with clarity, have responded to the daughter’s sullenness withan attempt to restore the exploratory domain. Alternatively, theycould have been angry with her in the discipline/expectation domainon the grounds that they planned it together and she had responsi-bilities to help make it work.

The father was reported to have become angry with her, whichimplies the discipline domain. From the daughter’s perspective thelunch was not planned in the exploratory mode and she reacted bothwith attachment needs arising from the failed relationship and inthe oppositional mode, feeling that her views were not respected.Although the father’s response implied discipline/expectation, theway the lunch event was set up and the emotions brought to it bythe parents and their daughter meant that the domain was unclear.



Hence, both parents and daughter lacked a framework in which tounderstand each other and regulate their emotions.

The daughter attempted to deal with this by cutting. Cutting isparticularly challenging from a domain perspective because it con-tains cues for safety, attachment and discipline domains. The fatherresponds in a highly complex fashion, getting angry (implying dis-cipline) sending to her room (thus clarifying discipline), showingdistress (clarifying role-reversed attachment) and telling her shehad ruined his life (role-reversed punishment). Thus, a sequencethat started domain unclear (with the arrangements for the lunch),concludes with a domain mismatch (between the girl being disci-plined and being exposed to her father’s attachment needs). Fromthe girl’s perspective she also probably experienced the domain mis-match of being punished for having attachment needs, although wecannot be sure of this because she did not provide clear cues forattachment.

The clinical approach

The initial appointments were offered to AT and her parents;however, the father did not attend the first few because he could notget enough time off work. The decision was made to start without him,but on the understanding that it was essential that he attend later. Thetherapist explained that she was going to outline a way of understand-ing family relationships that they might find helpful in identifyingwhy some events went well and others led to misunderstandings andhurt or angry feelings. These might also be the times when AT mostfelt the need to cut. The therapist based an explanation of thedomains framework on the example of the party, highlighting thedifficulties for the parents and AT in resolving emotionally intenseexchanges when the participants were attempting to find solutions todifferent problems. AT and her mother were able to grasp the conceptand her mother said it helped her in her struggle to see and under-stand events from AT’s viewpoint. AT felt she needed to make herneeds clearer to her parents; for example, if she was upset then sheneeded to communicate this more directly.

At subsequent sessions AT and her mother were seen together toreview recent events. One key event would be chosen for detaileddiscussion using the domains framework. AT and her mother wouldthen be seen separately to give their account of this event, becauseinitially each found it difficult to express themselves fully in the



presence of the other, for fear of causing upset. Later on they wereable to have these discussions together with the therapist. Often thetherapist would bring the mother’s and daughter’s versions of anevent that had been reviewed in the individual sessions, placing themin a domains framework for further discussion. This allowed the lackof domain clarity and domain mismatches to be identified, and facili-tated the mother and daughter talking together about ways in whichthey could prevent this happening. After three sessions AT and hermother seemed to have become adept at identifying the potential fordomain mismatches during their interactions and at preventing themby communicating their intentions and wishes more clearly. Themother said that she discussed the sessions with her husband and theyhad become able jointly to review events from a domains perspective.Subsequently, arrangements were made for him to attend sessionsboth with and without AT. This enabled the parents to discuss with thetherapist their understanding of the framework and its application toevents in the family.

The family felt they were able to communicate more effectivelyand understand each other’s needs better by using this approach.The parents felt empowered enough to manage episodes of cuttingbecause they no longer felt persecuted and upset. In turn, AT’scutting reduced in frequency and after 2 months stopped altogether.The fluctuations in her mood decreased and then also stopped after 3months.

Discussion

In this article we have set out to specify a set of principles for applyingthe domains-based framework in therapeutic work with young peopleand their parents or carers. The account of the therapy shows how keyprocesses in family interactions can be identified. There are a host ofways in which therapists could enable these processes – and the waysthey are enacted in each family – to be examined, discussed, under-stood and changed. The framework is genuinely pan-therapeutic andcould support individual or family work from a range of modalities.Our experience so far suggests that for some families a description ofthe framework is sufficient for them to identify key events and makechanges. For other families, as in the case described in this article,more detailed work is needed. Either way, the work gathers momen-tum from a combination of the plausibility of the theory, and theevident gains from making changes.



While this is encouraging, we believe that this approach will be noless prone to becoming stuck than other treatments. In the face ofany therapeutic ‘stuckness’, the aim of the domains analysis will be,firstly, to pinpoint the exact nature of the hold-up. For example, doparents respond with irritability to a young person’s distress, thuslowering domain clarity, because they find it annoying or because theydo not believe the distress is real? This analysis in domains termswill then provide the platform for the next therapeutic step. In sub-sequent publications we will provide more details on interactionalfamily dynamics identified through a domains-based analysis andon the range of possible interventions that might be pursued. At thesame time, there will always be a need for the therapist’s judgement,based on training, experience, personal qualities and the therapeuticrelationship.

In the light of recent trends in family therapy, a proposed frame-work that includes concepts of hierarchy and discipline may seem todisrespect the integrity of each family and its distinctive narrative (forexample, Anderson 1997; Anderson and Gehart 2007). The idea thatthe therapist may at times take an expert or authoritative positioncould, similarly, be seen as failing to take sufficient account of theunique encounter between the therapist and the family. In our viewthese concerns have made valuable contributions to the developmentof contemporary family therapy, but at the same time have discon-nected it from several mainstream bodies of developmental theoryand research, and hence treatment. Attachment theory and researchare explicitly concerned with a parent’s ability to sooth a distressedchild in a hierarchically organized encounter (Bretherton, 1985;Byng-Hall, 2008; Sroufe et al., 1990). Parenting programmes aim toimprove parents’ abilities to structure rewards and punishments inhierarchical encounters with their children and have been shown tohelp children’s behaviour problems (Gardner et al., 2007; Hutchingset al., 2007). Furthermore, in clinical and child protection practice aparent’s ability to ensure their child’s safety is a paramount consid-eration. This can be achieved only by a parent adopting a hierarchicalposition and taking responsibility for the child’s welfare.

We also argue that concepts such as hierarchy, authority and cer-tainty are critical in understanding how families negotiate key tasks.Such terms have fallen out of use in systemic family therapy partlybecause of being inadequately theorized. A good theory of familyfunctioning needs to specify under what conditions hierarchicallyorganized interactions can be effective and what they can achieve.



Similarly, we believe that the idea of the knowing or expert therapisthas been unnecessarily and unhelpfully discredited in favour of thenotion that the only way for a therapist to be collaborative is totransact all therapy in the exploratory mode. According to our model,hierarchical parent-child (and therapist-client) processes remainimportant in any family work where matters of safety, attachment anddiscipline are at issue and where emotions are running high. We takethe view that systemic therapists routinely recognize and work withthese processes but often feel uncomfortable in naming them as such.Therapists engage with families using their experience and knowl-edge to support and encourage new learning and new ways of relat-ing, but this expert stance is often disavowed and operates covertly(Guilfoyle, 2003).

The domains analysis is essentially a way of classifying types ofinteractions in families. This distinguishes it from much of the currentprocess literature that focuses on family-therapist interactions. It hasthe potential for both broad and specific applications. We believe itcould be of particular value to practitioners working with parents andchildren by providing a framework for assessment. Currently, theconcepts and categories used by mental health professionals indescribing and assessing family problems are either well-defined butlimited, as in the case of psychiatric diagnoses, or extensive andsophisticated but poorly operationalized, as in the case of manytherapy models. The domains-based framework makes use of fewconcepts but our aim is for these concepts both to be carefully opera-tionalized (and therefore communicable with accuracy), and to beuseful pointers to treatment.

A domains-based assessment might point to the value of treatmentfocused on domain issues or it might suggest the possible usefulnessof another treatment approach. For example, domain-mismatchedparental responses to oppositional behaviour are likely to requirea domains-based approach, but poorly timed or overly punitiveresponses that are domain-matched may be best helped throughparent training. Parent training, if ineffective, might indicate the needfor couple or individual therapy to help the parents find ways to relateto their child in a more playful, less hierarchical, way. Such work couldinvolve a systemic exploration of meanings and beliefs held by thecouple. The domains analysis may also have a particular role wheretherapeutic work has become stuck or bogged down. Low domainclarity or domain mismatches may have been evident at the outsetbut not identified or they may become more evident as therapy



progresses, with family members intensifying their mismatched effortsto make things better. In such situations, a domains analysis can bebased either on interactions already identified in family sessions or oninteractions elicited through the standardized interview, and futuredirections in the treatment can be developed from the outcome of theanalysis. The domains model as outlined here is limited in its appli-cation to parent-child interactional processes only. Further work willextend the approach to understanding couple or sibling processes indomain terms.

In concluding, we wish to re-emphasize that the domains approachwas developed within both a clinical and a research context, and thatwe regard adequate definition, identification and hence measurementof the key processes to be crucial to making progress. Ultimately thevalidity of the framework described here will depend on demonstrat-ing that it makes a difference to the outcomes for families who seekour help.

References

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Gardner, F., Shaw, D. S., Dishion, T. J., Burton, J. and Supplee, L. (2007)Randomised prevention trial for early conduct problems: effects on proactiveparenting and links to toddler disruptive behaviour. Journal of Family Psychol-ogy, 21: 398–406.

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