Day 2 of FGC training in Tokyo

Today, Saturday 18 July 2015, the second day of the training on Family Group Conferencing took place in Tokyo. At 9 AM all participants (over 50 persons) gathered in the big room on the 6th floor, and we started with a reflection from the participants on yesterday’s session.

Rob and Hedda inventoried the questions that had arisen, which were diverse, such as that Japanese traditional families are used to excluding persons who are considered “destructive” to the family life, which brings a lot of challenges for Family Group Conferencing. Additionally the Japanese concept of family also brings complications, because traditionally the parents are dominant and the rest is subordinate, so the family has to listen to the parents and the others are not considered as relevant experts themselves. Also the situation in rural areas is different from big cities where people don’t know each other so well, which makes it harder to widen the circle. So how to deal with that? These questions were also added to the “parking lot”, to be answered at a later stage, after some more presentations of Rob and Hedda on the model of Family Group Conferencing.
On the question of what had struck the most in yesterday’s session, also a lot of responses came, such as the principle of widening the circle and asking more people to think along, which is the opposite of current practice in the case of persons with mental/psychosocial disabilities, where usually the circle is narrowed down based on confidentiality and privacy.
Some more questions were raised, such as: who/what is at the centre of the circle? Who is the main persons? And when persons with psychosocial disabilities show not much affinity with the people around them, it may be not enough to just expand the circle. How can the opinion of the main person be encouraged, especially when the person has a disability and faces a weak position while the family is in the lead? How to change the situation where the family is the biggest discriminator? Can Family Group Conferencing also be used to help persons who are committing criminal acts, like sex crimes, and who are considered to be socially dangerous, and who think they are independent enough while there are serious concerns of repetition? What if some persons of the family want to widen the circle, but others do not want that? Again these questions were put on the Parking lot.

Then Rob and Hedda started to explain the model of Family Group Conferencing, which is a decision making model where the group makes a plan. There are many parties involved, such as the main person, the family circle and professional service providers. The professionals are often the referrers to FGC. When there is a need for a plan, FGC can be a way to make a plan. After referral comes the preparation, which is the most important phase, and which is done by an independent FGC-coordinator (NOT a service provider, but an independent citizen who has no interest in the outcome of the plan). The coordinator is not involved in the substance of the plan, but his goal is to widen the circle.
One of the participants had given an example of a personal case of 2 children who were not going to school, and had asked how this situation could be addressed and solved by FGC. This situation was taken as an illustrative example for explaining the FGC model. In this case it appeared not only the children had a need, but also the mother had a need because she now could not leave the house because of the 24/7 care for the children (6 and 8 years old). So then the next step was to identify what the main question was for the FGC: what needs a plan? This needs to be phrased as an open question without a solution in it (so not: how can the children go to school, because that is already having a clear direction of a solution). The main question turned out to be: “How can we expand the world of my children and my wife?”. The main persons are the children and the mother in this case. Then the coordinator, in agreement with the main person, invites other people, who are connected or have an interest in the family, such as parts of the wider family, friends, neighbours, colleagues, acquaintances. The coordinator explains to these persons that there will be a conference about “how to expand the world of the children and the mother?” and asks if these people want to come and think along with the group to make a plan to realize a solution. Mostly these persons accept the invitation, because they care and want to help to bring change in the situation. This is widening the circle.
Often the group needs some specific information before they can make a plan, such as on the current situation or available services. In the example case of the children this could be the school counsellor and the persons from the private school who now also help to the children. These professional service providers will share the information in the first part of the conference, to all of the group, so everyone knows, and can take this into account when making suggestions for the plan.
Also, for children of 6 and 8 a Family Group Conference is not easy to participate in, facing many adults, so the children need preparation, such as explaining what the conference is and why, and what their role is. Also, for children there always needs to be a support person to ensure that their voice is heard. This is preferably someone from the inner circle, so that this doesn’t conflict with the principle of private family time in the second part of the Family Group Conference, where the family group talks without any outsiders present, so that they can talk more freely within their inner circle. Also adults can get a support person to empower them and help them being heard if the situation requests that. It is the job of the FGC-coordinator to ask every person what they need to be able to speak out. Besides the substantial preparation of the Family Group Conference, the coordinator also arranges the practical part, such as the venue and beverages.
The Family Group Conference then starts with the information sharing part, where professional service providers give information. Then the professionals and all outsiders leave, and the private family time starts, where the group makes a plan. This can take several hours. The agreements are written down, and when the family group is ready, they call the coordinator back into the room, and sometimes the professionals as well. Then the family group presents the plan, and the coordinator will then formalize the plan and send all participants a copy. The group also decides when to evaluate the plan together, to see if the plan works or needs to be changed. The role of the coordinator stops here. The plan is owned by the family, and family and professionals have to work with the plan in collaboration.
In the Netherlands, research has shown that on average a family group plan contains 18 agreements, of which 80% is done by family, and 20% by professional service providers.

After this explanation, another series of questions was inventoried. Such as: What to do when there is are different types of information which are conflicting, such as on school-absence which can be explained as a social issue, but professionals can also explain it as a medical issue (“school-phobia”) and suggest a medical treatment. How to deal with this? And what about decision-making for minors, can their opinion be substituted by guardians and parents?

Then I was given 5 minutes to briefly explain something about using Family Group Conferencing in the mental health care context. I briefly mentioned that psychosocial problems are mainly social problems, and the concept of recovery and empowerment as developed by the user movement (such as Deegan) shows that the social circumstances are crucial for either making the situation worse, or enabling recovery. And the social circumstances are adjustable, rather than the psychological functioning of the person. Real helpful alternatives to the standardized psychiatric approach need to be found on the individual level, because every situation is unique. And these were some of the reasons why I wrote a counter-proposal in the consultation of the Dutch law reform process on forced treatments. (unfortunately the law proposal is still proposing to expand the options for forced treatments, and the Netherlands has not ratifies the UN Convention on the Rights of Persons with Disabilities yet). Now we have started a pilot project in the Netherlands with using Family Group Conferencing to avoid forced psychiatric interventions.

Then a short 7-minute film on this topic was shown. The film is called “Not alone” (Dutch version: https://www.youtube.com/watch?v=tg2fp0p69pE ). But the translators could not keep up with the speed of the screens, so it became somehow chaotic, and missing the point. After that it was break time.

After the break, the big group was divided into 2 smaller groups of about 30 person each, one hosted by Rob and one by Hedda. I went with Hedda, and in the first part of the afternoon session, the questions from the parking lot were answered.

If the network is worn out and burned out, and the family is tired and finished with the person, and this often is the case, it is still worth to try to invite people to think together in a wider circle to find a solution, which can also bring relief for the family. Many times people are willing to talk about what they would like to see changed, however, this doesn’t always succeed. But you don’t know for sure of you don’t try.
By now it was clear that the question is in the middle of the circle.
About the tradition of exclusion that can happen in Japanese families, we as Dutch foreigners in Japan cannot judge on that, and the participants are the experts. If they think it is impossible to start FGC in Japan, than that is a reality, sad but true. And similarly, it’s the Japanese participants who can judge whether FGC would fit in rural areas or cities in Japanese culture.
A remark was made about the commonalities of human beings all over the world, we all want human dignity, and we all face parents’ expectations. Also in Japan, there are certain universalities that apply to all human beings, so why would a model like FGC that clearly has a basis in these universalities not be fitting in Japan?
Someone asked if there were examples of Asian families doing a Family Group Conference in the Netherlands, and there are. It appeared that often shame is a big issue, and some persons do not want to share their problems, or family fears that they are doing wrong for a person. It appeared that in this case it was necessary to take small steps, and first ask if there is 1 person that the main person has talked to about the problems. Then the next preparation meeting was with the 2 of them and again it was asked if anyone could be invited. Eventually a group could be formed to have a Family Group Conference. This isn’t always easy.
About the concept of family where parent have a dominant role and should be respected, it is the challenge to widen the circle, and bring in the right people to create balance. In Moroccan families in the Netherlands who have done an FGC, similar dynamics apply, and it can help to invite for example the grandparents. It shows that FGC in itself is a process that brings change. All situations are unique, but the principles are the same.
About children’s decision-making: this is mainly a theoretical question, and in practice this appears not to be any problem, because generally the aim of FGC is to bring people together again, and also the children are included and encouraged to share their views, and their age doesn’t matter so much.

Then some more questions were raised: such as: Is it better to have a wide scope or to focus? – in reality it is the professional service providers who select and create a hierarchy in various problems, while the group generally wants to improve the total situation and wellbeing of the family, and they will take up anything they can, since they see the mix of problems as a barrier to the wellbeing. Families don’t take a sectional approach and make a plan for everything.
Another question was: What if there are conflicting wishes, for example the children want to live in the community, but the parents do not agree to that? – This depends on the main question, which could be openly phrased: “where can the children live best”? And it is also a matter of widening the circle. If there are only 2 polarized opinions, there will not be a good plan coming out, but by inviting others, there can be different opinions and new perspectives on solutions. Again the importance of a good preparation is evident.

Then in the last slot of the afternoon session, there was a role play of a situation of a husband Hiro who had psychosocial problems, including alcohol abuse, fights and debts, his wife Reiko who was desperate, and his children Yuka and Masumi were unhappy and often went to the neighbours to escape from the stress and tension at home. There were 15 other family members and friends/neighbours involved and 3 professional care providers. The roles were divided amongst the participants, and they simulated the start of the Family Group Conference together.

In the reflection it became clear that this was really helpful for the understanding of the FGC model. Before the conference the husband Hiro and the wife Reiko first felt very stuck, vulnerable and without perspective. But when they experienced that the group was listening and thinking along with them, they got a new perspective, new hope and sense of value. Hiro stated that he now felt motivated and able to change, because of the support of the group, who came up with the idea of finding a new job, which gave him new hope. The participants said that they now had seen the light. This was a very good ending of the day.

At 17.00 PM we cleared the rooms, and we all went for a dinner together. It was a Japanese buffet, and it was very nice to talk to so many diverse participants. After the dinner I went along to party 2; having a drink together with 10 participants in a Spanish bar. That was very very nice. All had a special interest in the mental health field and the rights of persons with psychosocial and intellectual disabilities, and we have been talking about that all evening. I answered many question, and explained some typical vulnerabilities of using FGC in the mental health care context, such as the risk of the single sided information on the medical model of psychiatry, which often suggests medication and institutionalization as THE solution, and can dominate and obstruct any meaningful discussion on family plans. Also the willingness to really listen to persons with psychosocial or intellectual disabilities is not common yet. And also trust is a big issue, which can prevent any meaningful conversation. Many found it very helpful that I explained that Family Group Conferencing is in fact rather “Citizen Group Conferencing”, because it doesn’t necessarily include family, but FGC can also be done without the family, with only friends and colleagues and others. This really was an eye opener, because in the mental health care context, it is often the family who are also having a role in the exclusion-practice (such as requesting hospitalization or forced interventions), which undermines trust and equal dialogues. Additionally, it can be very hard to speak out about psychosocial problems, such as feeling suicidal or hearing voices, because the threat of interventions can increase by such expressions.

The participants of the conference are mainly persons interested in the mental health care field and the rights of persons with psychosocial and intellectual disabilities, but the FGC-training by Rob and Hedda is quite generalistic (mainly taking child care as an example), which does raise a lot of questions, because the participants try to relate the information to the mental health care field, but this is not centralized in the discussions. I found that quite unpractical, and I understand why there are so many questions. Also somehow felt like the 5th wheel on the car today. Rob and Hedda were doing the general training-programme that they always do to show the broad potential of FGC application, and I was just in the background. This evening it became clear that the participants really want to hear my view, because they want to learn more about FGC in the mental health care context in specific. So I think the programme will be adjusted a bit again, so I can have time to explore that dimension with the group.

Now it’s 3 AM. Tomorrow I will probably regret staying up so long, but it was a very interesting day, and I wanted to offload the information here, to share and archive this information. So that is done now, and I can go to rest. Good night!