Systemic Family Therapy Flashcards

Basic Concepts: The Systemic Approach

• Differs from individual approaches.
• Seeks to understand conflict and psychological problems through interaction patterns within larger systems, primarily the family system, rather than individual issues.
• Focuses on the family system as a whole, not just the individual.

Systemic Approach Focus:

1. Maintaining Current Behavior:
   • Focuses on what maintains current behavior patterns.
   • Underlying assumption: behavior is adaptive and maintained by environmental processes (behaviorism/homeostasis).
2. Family Relationships:
   • Focus on family relationships; observe, interact, and modify the dynamics and context between individuals.
   • Rooted in attachment theories.
3. Underlying Assumptions:
   • Concerned with cultural and transgenerational norms, gender roles, etc.
   • Based in Social Constructivism.

Intrapsychic to Interpersonal

• Rooted in Social Constructivism – reality is constructed.
• Individuals' selves are adaptable, malleable, and shaped by their contexts.
• Individuals' pasts inform their present, but they are not bound by them.
• Changes in family dynamics can alter behaviors and selves.
• Behavior is adaptable and maintained if it serves a 'gain' for the family/individual.

Core Concepts

• Complementarity: Interdependent and mutually reinforcing family behavior and roles.

• Circular Causality: Relationship difficulties are circular, without a starting point or linear cause, influenced by communication (Bateson).

• Circularities: Repetitive interaction patterns within a family system.

  • action → response → action → response etc.
  • Affects the entire dynamic if one person's behavior changes.
  • Can remove blame, but criticized in abuse cases for implying victim responsibility (Goldner et. al, 1990).
  • Each individual is seen in relation to others, influencing and being influenced.

• Linear Explanation:

  • Example: John is cold to Mary due to his childhood fears of rejection. Mary reacts strongly to John’s rejection because she has an insecure attachment style.

• Circular Explanation:

  • Example: John’s expressing difficulties fuels Mary’s insecurities. She reacts strongly, causing John to withdraw more, perpetuating the cycle.

• Homeostasis: System maintenance process once patterns are established.

• Triads: Structural unit involving three individuals (e.g., parents and a child).

• Triangulations (Bowen): Drawing in a third person to reduce anxiety or stabilize relationships.

• Conflict Detouring: Intensifying a third party's symptom (e.g., bad behavior) to maintain homeostasis.

• Stable Coalition: One parent joins the child against the other parent, leading to loss of authority.

*Problems are often triangular in nature.

*Triads reveal patterns of triangulation, alliances, exclusion, etc.

Patterns of Behavior (Bateson)

• Sequences of behavior between and within people – containing cognitive, emotional and behavioural aspects

• + patterns in relationships between people, beliefs, events and behaviours

• Process: How people communicate within a relationship.

• Content: What is being said within communications.

  • Family therapy focuses on the process instead of the content.

Family Structure

• Subsystems shaped by interactions and individual qualities.
• Boundaries mediate family structure and dynamics.

Boundaries

1) Rigid

* high independence but little affection and nurturance

2) Diffuse

* enmeshment – high feelings of support and nurturance, low independence

Family Life Cycle

• Model of change and development with common hurdles within specific stages.
• Stages (Gladding):
  1. Reorganization to accommodate growth/change.
  2. Development impacts across generations.
  3. Family impacts individual development.

Demands upon the family unit:

1. Internal

   • Biological – growth, change (eg. puberty, menopause, illness)
   • Psychosocial – needs, expectations, roles

2. External

   • Culture
   • Extended Family
   • Work
   • School
   • Friends
   • Leisure

• Problems arise when challenges cannot be accommodated.
• Beliefs: Guiding principles dictating family behavior (e.g., gender, authority).
• Punctuation: Beliefs influence predictable behavior, surprising families when disrupted.

Influences and Contexts on Therapy

1. Gender
   • External beliefs surrounding identity – how men or women should act and their roles.
   • Conflicts around gendered expectations.
   • Feminist critiques of circular causality and neutrality.
2. Culture
   • Common behavior patterns from living environments.
   • Important for the therapist to allow the clients to teach them about their culture and traditions

The Genogram

• Basic map of the client and their relationships within their family units.
• Illustrates information about the family over three generations.
• Includes information around important events (loss, illness, life cycle transitions, etc.), networks of friends etc., and provides a holistic manner in looking at complex family patterns.

Genogram Functions:

1. AS AN ASSESSMENT TOOL:

   • Gathering and organising information
   • Generating hypotheses
   • Tracking change and relationship dynamics
   • Understanding family dynamics
   • Labelling and highlighting member strengths throughout the generations
   • Helps keep in mind the whole system; which minimizes the chance of thinking linearly

2. AS A JOINING TOOL:

   • Joins with the family, discusses, reframes, highlights, normalises and de-intensifies issues presented
   • Broadens the system; allows problems to be viewed horizontally (across family context) and vertically (through the generations)

3. AS AN EVALUATING TOOL:

   • Aids in evaluating the resources, strengths, and vulnerabilities of a family
   • Patterns evolve over time – suggests certain links between members and their development

4. AS AN INTERVENTION:

   • Useful in instilling change within the thinking process of the family – they can now observe from the outside as well as from within

History and Background - Current Day

• Boundaries between the schools are very blurred
• Collaborative practice is the norm (Anderson & Goolishian, Hoffman)

Constructivism (Kelly)

• Individuals actively construct their realities through experience and interaction.
• They are interpreters and builders of their own meaning influenced by prior knowledge.

Social Constructivism (Gergen)

• Meaning is shaped and constructed through personal, social, and cultural contexts.

Family Narratives

• Constructed narratives to explain experiences, impacting interactions.
• Selection biases influence recorded behavior – shapes expectations

THE FIRST PHASE SCHOOLS

• Observed interactional patterns maintained the problems within the dynamics
• Early therapists thought that the function of a symptom has a homeostatic influence on the family system
• Symptomatic families are seen as being stuck in homeostatic patterns of communication where any change to the rigid structure is threatening
• Influenced by Modernism

Strategic Family Therapy

• Split into:
  1) MRI’s Brief Therapy
  2) Haley & Madanes Strategic Therapy
  3) Milan Systemic Model

Elements:

1. The clinician is the main driver of the therapy
2. The therapist needs to trick the families into changing their behaviour

• Interventions are all problem-centred; the therapist designs interventions around changing the communication patterns between families

The Double Bind Theory:

• Founded by the MRI School - which focused heavily on how people communicated
• Double Bind is when individuals receive criticism no matter what option they pick; it is impossible to ‘win’

The Stages of Strategic Approaches (Haley):

1. Social Stage

2. Problem Stage

3. Interactional Stage

4. Final Task

   • Intends to get the client to comply to their directives

• Paradoxical Interventions (Haley): Asking the clients to do something which goes against common sense to interrupt problem maintaining behaviours

  • Restraining Technique
  • Declaring Impotence
  • Prescribing Interminable Therapy
  • Staging a Debate

Structural Family Therapy (Minuchin, 1960s)

• Interventions are based on changing structure: the positions, roles, etc. that family members occupy
• Repeated transactions establish patterns of relating based on functional demands between individuals

Subsystems:

• the smaller groups within the larger family system which may have different rules and relationships with each other
  i) Partner Subsystem
  ii) Parental Subsystem
  iii) Sibling Subsystem

• Boundaries: defines participants and their actions

  i) Enmeshed/Diffused

  ii) Disengaged/Rigid

• Joining: The therapist joins the system; showing understanding and acceptance - to make sure the family accepts them and the interventions before they unbalance the system

• Formulation/Conceptualisation: The working model the therapist creates based on their experience with the family

Restructuring:

i) Symptom Focusing

    a) Exaggeration

    b) De-emphasis

    c) Relabelling

    d) Altering the effect

    e) Moving to a new symptom

ii) System Recomposition
    a) Adding systems
    b) Subtracting systems

iii) Structural Modification
    a) Emphasising differences
    b) Developing explicit conflict in order to bring to the surface implicit conflict (detouring)
    c) Developing new or underdeveloped structures
    d) Reinforcing current adaptive structures
    e) Reorganising

• Enactments: a therapeutic technique whereby the therapist encourages the family to act out real interactions during the session in order to assess and alter maladaptive behaviours

THE MILAN SCHOOL (Pallazoli)

• Came up with the idea that uncovering the beliefs which underlie family dynamics is an important element in changing
• Based in constructivism and social constructivism

Systemic Family Therapy - Structure of a Session:

1. Pre-Session
2. Session
3. Inter-Session Break
4. Inter-Session Intervention
5. Post-Session Discussion

*Positive Connotation:

• Emerged from Reframing
  * Symptoms are given a positive explanation for whatever is being exhibited; this is told to the family during the intervention with the injunction that it should remain the same (similar to the paradoxical interventions of the strategic school)

• Rituals:

  • Exaggerated, deliberate, time-bound actions which either:

    i) Contradicted/ran contrary to family rituals

    ii) Exaggerated rigid familial rules

    iii) To dramaticise positive connotations

    iv) To break down rigid stances

Milan School Post-Bateson Influence

• Introduced the element of Communication Theory

• Greater focus on beliefs and belief systems: dysfunctional families have beliefs which do not fit reality – therefore the role of the therapist is to introduce new meanings
  *Responsibility is more shared with the family as it is their job to create new patterns

• Circular Questioning: questions which activate a feedback loop

  1) Triadic Questioning

  • Another person is asked about the other two individuals to explore different perspectives
    2) Spatial Difference Questions

    i) Differences in closeness
    ii) Differences in ideas/beliefs
    iii) Differences in relationship over time
    3) Temporal Difference Questions

    i) Past-Past (eg. before or after a past event)

    ii) Past-Present (past vs. now)

    iii) Past-Future (if ___ in the past, would it be more likely to ___ in the future?)

    iv) Present-Future (if ___ happened now, what would happen?)

    v) Future-Future (If ___ happened in the future, would you be more likely to ____)
    4) Clarification Questions

  • Questions about differences/similarities between members in order to generate a hierarchy (get different members to answer)
    5) Behaviour Effect Questions

  • Clarifies behavioural sequences – when, where, how, what etc.

• Invariant Prescription (Palazzoli & Prata):

  * Stopped using paradoxical interventions
  * To strengthen family ties and hierarchies, parental system is asked to go out and not tell anyone where/what they did; which strengthens the ties between partners
  

• Post-Milan Techniques (Checchin and Boscolo)

  * Structure became more collaborative
  * Therapist takes on a more curious, active role – the interviewing process itself was the main treatment modality
  * Curiosity was the most essential aspect; non-judgemental, leads to exploration and the creation of alternative views
  * Less emphasis on the final message and work outside the therapeutic setting
  

• Second-Order Cybernetics: Acknowledges the role of the observer (the therapist) in the description of the system (influenced by Social Constructionism; especially Foucault)

BRIEF SOLUTION FOCUSED THERAPY (De Shazer et. al, 1970s-)

*   inspired by the MRI School.
*   therapeutic interventions are focused on finding exceptions to the rule (the problem) 

Theoretical Assumptions:
1) Clients have the resources to solve their problems and ultimately want to change

2) Change is constant – ergo rapid change is possible

3) It is not necessary to know the cause/function of the problem to find a solution

4) A small change can be enough to disrupt the entire system
5) Focus should be on what can be changed; which the therapist should attempt to identify and amplify these aspects
6) Client should define the goals and there is no inherently right/wrong way to view the situation

Stages of therapy:

1) Problem-free Talk

2) Statement of the Problem

3) Exploration of Solution Patterns through Discussion of Exceptions to the Complaint

4) Establishing therapeutic goals

Forming Goals: (essentially these are SMART goals)

* Important
* Small
* Concrete
* Specific
* Positive
* Realistic & Achievable

• The Miracle Question ‘If a miracle had to happen….’
• Scaling Questions
• First Session Formula Task

THE NARRATIVE SCHOOL (White & Epston)

• Aim of therapy is to deconstruct the dominant narrative through interpretation of the beliefs, ideas and experiences of the person, to produce alternative stories which indicate new possibilities of living

Theoretical Assumptions:

1. The problem is the problem; not the client
2. Problems do not exist 100% of the time; are grounded in sociocultural context and change over time based on understanding of them
3. There are multiple truths; not one objective truth
4. People are experts in their own lives and have the abilities/skills etc. to help themselves + therapist takes a non-expert role

• Dominant Story
• Alternative Story
• Problem Saturated Story
• Deconstruction
• Searching for Unique Outcomes
• Externalisation