There is much debate within the research literature about the scientific validity and coherence of the concept 'resilience'. We have some sympathy with those who perceive it to have little analytic explanatory power. However, as both mental health practitioners and researchers we argue that the concept has an important pragmatic role in helping to design and deliver effective therapeutic interventions in families.

This presentation contrasts the relative effectiveness of 'resilient' formulations and interventions with those adopting a pathological or psycho-analytic model.

In-depth case data from families in crisis will be examined. These families all presented to our child therapy agency and have been worked with extensively over a 5 year period. Therapeutic teams involved with the families are multi-disciplinary, and include child psychiatrists, family therapists, nurses and counsellors.

Each of these families have multiple vulnerabilities and are at high risk of family breakdown, statutory child protection intervention, criminality, substance misuse and mental health difficulties. They all live in the context of a high level of relative deprivation.

Based on a single-case design model we will explore factors contributing to the therapeutic outcomes for each of these families. Different therapeutic intervenitons with each family over time will be explored and classified according to the therapeutic logic which lay behind them. We will examine the role of the therapist(s) in enhancing the relative effectiveness of interventions. We will also demonstrate the importance of 'resilient' interventions in effecting long term change.

Drawing on our practice examples, we conclude that it is possible to work with families with multiple vulnerabilities using a resilient model and that a pathological model, and/or a psycho-analytic model of intervention can be very unhelpful. Identifying and enlisting resources in the wider context is effective, and should be seen as a central part of the clinician's role. This is particularly the case where the nature of contextual support is resonant with family strengths.

There are implications from this work for the design of services in areas of deprivation. Clinicians must be prepared to work with ecological frameworks in practice, rather than simply in theory. Crucially they must see themselves as resilient agents in the family system, and be prepared to act accordingly.