Negotiation of Responsibility in a Family Therapy Intervention for Adolescents who Self-harm: a Discourse Analysis

Systemic interventions, including family therapy (FT), have been found to have positive outcomes for individuals who engage in self-harm behaviour (SHB) (Brent et al., 2013; Carr, 2016; Cottrell et al., 2018b). A number of factors related to family functioning have been associated with SHB (Fortune, Cottrell, & Fife, 2016).
Research has shown that narratives of responsibility are an important part of the FT process, however, none investigate how responsibility for self-harm is negotiated in a FT setting. This study uses the discursive action model (DAM, Edwards & Potter, 1993) to explore how responsibility is negotiated within FT for adolescents who have self-harmed. Video data of FT sessions were made available under the access provisions of the Self-Harm Intervention- Family Therapy (SHIFT) Trial (Wright-Hughes et al., 2015; Cottrell et al., 2018b).
The findings show that negotiations of responsibility are central to the talk in the initial FT sessions and that family members and therapists managed their interests (stakes) through a variety of actions within the talk. The analysis revealed that family members, in particular the parents, tend to enter therapy with interests which compete with the therapist’s goal of achieving a narrative of shared responsibility. For example, parents entered therapy with actions that managed the risk that they are seen as ‘bad parents’ and responsible for their child’s SHB.
It is, therefore, important for therapists to consider how they might negotiate powerful discourses of responsibility, whilst considering the interests of family members and maintaining a therapeutic relationship. I have evidenced the applicability of the DAM in deconstructing the discourse in a FT setting. I suggest its use as a clinical tool in FT practice. Principles from the DAM could be used in identifying the actions and stakes of family members in order to be mindful of these within the FT process.