Beyond the Impasse? Systemic Consultation and Understanding Complex Cases Paul Rhodes, Michelle Donelly, Lesley Whatson, Kate Brearley, Jack Dikian, Anders Hansson, Tanya Franic and Lucinda Mora Statewide Behaviour Intervention Service, Ageing Disability and Home Care, Department of Family and Community Services, Sydney, Australia Accepted for publication 17 July 2013 Background Systemic consultation provides an oppor- tunity 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. Method 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. Keywords: behaviour, family therapy, mediation analysis Introduction Behaviour support clinicians frequently work with highly complex cases, involving many stakeholders across a variety of settings. Challenging behaviour can create much distress and strain relationships which, in turn, can inhibit the success of behavioural intervention. The aim of this study is to present the results of a study exploring the experience of clinicians engaged in systemic consultation, a case-based supervision model which aims to support them to negotiate complex systems. Behavioural analysis (Carr & Durand 1985; La Vigna & Donnellan 1986) has continued to dominate clinical practice in intellectual disabilities, providing a sophisticated, positive and ethical approach to behaviour change. This approach has maintained a strong emphasis on ecology, but failed initially to adequately consider a range of complex interpersonal phenomenon, including family dynamics, attachment patterns and the interpersonal effects of trauma (Rhodes 2002). Ecological change has certainly been emphasized in positive behaviour support (Carr et al. 1999), in terms of restructuring and enhancing the living environment of the identified client to increase opportunities for communication, meaningful engagement and choice. Mediation analysis is one of the many components of behavioural assessment, allowing for a systematic assessment of the capacity of carers and parents to implement behavioural strategies in each case, including an evaluation of how cognitions, emotions and distress caused by the behaviour itself might effect their capacity to implement behaviour change (Allen 1999). A closer engagement between positive behaviour support and the tradition and practice of family therapy, however, has the potential to significantly enhance the practice of clinicians working with complex cases (Rhodes 2003), providing theoretical lenses and practical tools to help them negotiate complex patterns of interactions that inhibit effective behaviour support. While the application of family therapy to intellectual disability has developed slower than mainstream mental health services, there is strong evidence that this is © 2013 John Wiley & Sons Ltd 10.1111/jar.12068 Journal of Applied Research in Intellectual Disabilities 2014, 27, 226–235 Published for the British Institute of Learning Disabilities