Social graces
and power.
The therapist kept asking my husband how I manage.
How systemic therapy reflects on difference and power, including ability, the therapist’s own position, and the professional systems many disabled people live inside.
What this is: an introduction to the social graces, with ability in view.
Why it matters: impairment shapes who is addressed, believed and consulted.
The sharpest reframe: a visible difference can hide an invisible one.
One thing to take away: the therapist and the services are part of the system.
The short version
Systemic practice pays attention to power and difference, including the therapist’s own. John Burnham and colleagues’ Social GGRRAAACCEEESSS mnemonic names aspects of difference such as gender, race, age, ability, class and culture, and asks which are visible or invisible, voiced or unvoiced, in a particular conversation. Ability is on the list. For disability, this means noticing how impairment shapes who is addressed, who is believed and who decides, including in the therapy room, and seeing services and professionals as part of the system rather than outside it.
You might recognise this
Illustrative statementsDrawn together from common experiences. They are not quotes from individual people.
Social GGRRAAACCEEESSS
Established theoryDeveloped by John Burnham with colleagues including Alison Roper-Hall, and spelled in several slightly different ways, the mnemonic stands for: Gender, Geography, Race, Religion, Age, Ability, Appearance, Class, Culture, Ethnicity, Education, Employment, Sexuality, Sexual orientation and Spirituality.
It is used to help therapists reflect on how these differences shape relationships, including between therapist and client. Burnham later described two further dimensions: whether an aspect is visible or invisible in a conversation, and whether it is voiced or unvoiced.
Rachel, 41, is a wheelchair user; her husband Fergal is not physically disabled. They come for couple therapy because they argue about money and housework. In the first session, the therapist asks Fergal how the couple manages the house and asks Rachel how she feels about it. Rachel goes quiet. Later it emerges that Fergal has depression, which he has never mentioned in front of professionals.
Rachel and Fergal are illustrative composites, not real people.
Visible, invisible, voiced, unvoiced
Our frameworkVisible and voiced
Rachel’s wheelchair is visible, and everyone talks about it, sometimes too much.
Visible and unvoiced
The therapist’s assumption that Fergal runs the house was never said aloud, but it shaped every question.
Invisible and unvoiced
Fergal’s depression, and how it affects housework, hasn’t been mentioned.
The therapist’s position
The therapist isn’t disabled. That is part of the room, whether or not it is named.
Asking about these dimensions can open conversations that the obvious difference had closed down. Here, focusing on Rachel’s visible impairment hid Fergal’s invisible one.
The professional system
Our frameworkDisabled people often live inside large professional systems: GPs, consultants, social workers, occupational therapists, personal assistants, benefits assessors. Systemic thinking treats these as part of the system. A family’s pattern may be partly a response to a service’s pattern, such as constant reassessment, missed visits or professionals who don’t talk to each other.
The therapist is part of it too. Therapy adds another professional relationship, with its own demands: travel, time, energy and the work of explaining yourself again. See Power, Access and the Therapy Frame and Mine, Yours, Ours, System.
What it might sound like
I want to check something. I’ve been asking Fergal about the house and Rachel about feelings. I think I made an assumption about who does what, maybe because of the wheelchair. Is that how it felt?
Yes. I do the finances and most of the cooking.
And I’ve been… not great. Since last winter. I haven’t said that here.
Thank you both. So there may be more than one kind of difficulty affecting the housework, and one has been easier to see than the other.
The repair, and what it changes: the therapist names their own assumption out loud. That makes room for Fergal’s depression to be voiced. The couple’s argument shifts from “Rachel can’t do enough” to how two people with different needs share a household.
What needs attention here?
A visible impairment dominates the conversation
Possible focus: what is invisible or unvoiced
Watch for: assuming the visible difference explains everything
Questions go to the non-disabled person about practical matters
Possible focus: who actually does what
Watch for: gendered or ableist assumptions about roles
Many professionals are involved
Possible focus: the service system’s patterns
Watch for: treating the family as the only system
The therapist’s own position is unspoken
Possible focus: naming it when it helps the work
Watch for: assuming it has no effect
Possible starting points, agreed with the person, not rules.
How you’d know it helped
- Differences that were shaping the work, including the therapist’s, can be spoken about.
- Invisible needs are recognised alongside visible ones.
- Services are seen as part of the pattern, not as background.
Words you can use
For clientsQuestions worth carrying, as a therapist
Therapist Reflection- Which differences in this room are visible, and which are invisible?
- Which have I voiced, and which am I leaving unspoken?
- Whose practical competence did I assume?
- Is the service system part of my formulation?
Evidence & sources
Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it.
Social GGRRAAACCEEESSS, and the visible–invisible and voiced–unvoiced dimensions: Burnham, J. (2018), “Developments in Social GRRRAAACCEEESSS: Visible–invisible and voiced–unvoiced”, in I.-B. Krause (ed.), Culture and Reflexivity in Systemic Psychotherapy (Routledge), 139–160.
The application to disability, the professional system and the reading of the case are this site’s synthesis.
Rachel, Fergal and the dialogue are constructed for learning. They are not real people.
We have not located research on how systemic therapists use the social graces with disabled clients.