WEEK 4
Section 4: Theoretical Orientations Towards Change: The Systemic Schools
1 Section overview
This section continues to investigate varying theoretical orientations towards change and the change process. However, the focus will turn now towards systemic schools. These were alluded to in the previous section in the discussion on Susan Johnson’s application of Emotionally Focused Therapy where it was shown that EFT marries intrapsychic and humanistic experiential concepts (emotion and attachment theory) with systemic principles of interaction (recurring habitual patterns of behaviour).
This section proposes to expand upon the systemic ideas mentioned previously. The goal is to encourage the consideration of change and the change process from the perspective of another world view. Rather than adopting linear/cause-and-effect thinking where any problem is solvable if the answer to the question, “why”, is found, this section presents the notion of circular and reciprocal causality and the question “what”. Rather than believing that there are subjects and objects, and absolute truths about reality, black or white, right or wrong explanations which are measurable and objective, the schools in this section propose a worldview where reality is not external to us but constructed by us; where subjectivity is inevitable and a value-free science is impossible. Rather than focusing on reductionist notions of the individual and the internal events of the human mind, the approaches in this section emphasize context and the relational, i.e. interactions and patterns of behaviour (Becvar & Becvar, 2013, pp. 1-11).
For example, Gehart (2010, p. 149) reports that Bateson concluded that most of the propositions humans assume to be true are erroneous; that they “appear true because they capture one dimension of an interactional sequence, but they rarely include the broader awareness of how observer and observed reciprocally reinforce and impact each other”. For example, when a wife complains her husband is cold and indifferent, her statement does not take into account how their behaviour, responses and interpretations have been shaped by an ongoing series of interactions. When a family reports that a daughter has always been a certain way, whether it is angry, helpful or forgetful, it does not indicate a truth about the daughter but describes a statement about ongoing patterns of behaviour and expectations within this family. It is possibly even a statement about the rules (possible rigidity) of this family system (Gehart, 2010, p. 149).
Systemic therapy was basically developed through, and for, working with families but it has come to be adapted to working with couples (Bouris, 2007) and is arguably fundamentally important in conceptualising and working clinically with individual clients as well (McGoldrick, 2012).
Winek (2010, p. 536) makes an interesting comment. He says:
A person’s experience and behaviour are influenced by her or his nervous system, organ systems, tissues, cell, organelles, and so forth, down to subatomic particles. Likewise, each person is a member of two-person (dyad) relationships; a member of a family, community, and culture or subculture; and ultimately part of the biosphere.
Ultimately, says Gehart (2010, p. 144) systemic family therapy is not simply a modality but “a unique philosophical view of human behaviour”.
In order to pursue systemic thinking and practice further, this section will investigate three of the earlier systemic models which have been so influential and relevant to current practice. These are:
1. The Strategic Approach which developed from the projects of eminent anthropologist Gregory Bateson and his research team John Weakland, Jay Haley, Don Jackson and William Fry. Don Jackson established the Mental Research Institute in Palo Alto, California, in 1959 where he was later joined by Virginia Satir, Jules Riskin and Paul Watzlawick. MRI became one of the most important research and clinical institutes in the field of family therapy (“Bateson research projects”, nd)
2. Salvador Minuchin’s structural approach and
3. The natural family systems approach of Murray Bowen, which is a transgenerational model.
Learning outcomes
On completion of this section, students will be able to:
• describe how systemic approaches differ from psychodynamic and humanistic models
• describe how Bowenian, structural and strategic schools theorize and facilitate change, explaining how these schools are both similar and different from each other
• describe the difference between first and second order epistemologies and the relevance of this for the change process and for considering power and influence
• identify the different ways that these schools work with patterns of behaviour
• explain the rationale for short term or brief models of therapy
• define more clearly their own beliefs around the change process and what they think facilitates change
2 Section requirements
Activities
There are five self-directed activities in this section.
Textbook
The textbook for this unit is:
Duncan, B. L., Miller, S. D., Wampold, B. E. & Hubble, M. A. (2010). The heart and soul of change: Delivering what works in therapy (2nd ed.). Washington, DC: American Psychological Association.
There is no textbook reading.
Reading
There is one reading for this section plus a genogram for Stan’s case study.
1. Becvar, D. S., & Becvar, R. J. (2013). Two different worldviews. In Family therapy: A systemic integration (8th ed., pp. 3-12). Boston, MA: Pearson.
2. Corey, G (2009). Fig 14.1: Three generation genogram of Stan’s family. In Theories and practice of counseling and psychotherapy(9th ed., p. 453). Belmont, CA: Thomson Higher Education.
Self-assessment
Please complete the self-assessment questions at the end of this section to test your understanding and knowledge against the objectives stated in this section.
3 Introduction
Reading
Please read Becvar, D. S., & Becvar, R. J. (2013). Two different worldviews. In Family therapy: A systemic integration (8th ed., pp. 3-12). Boston, MA: Pearson.
This chapter explains in greater detail the concepts described in the section overview.
Systemic therapy is a broad term that covers a number of varying philosophical schools. As Nichols (2014, p. 18) explains, “For many years, therapists resisted the idea of seeing members of a patient’s family in order to safeguard the privacy of the therapeutic relationship”. Freud excluded the real family so that the unconscious and introjected family could be explored and Rogerians saw the individual alone so that they could enable unconditional positive regard. A number of events in the 1940’s and 1950’s are however, pointed to the idea that the family was a living system, an organic whole (Nichols, 2014, pp. 18-19).
One development was that psychiatrists noticed that when patients got better, someone else in the family got worse. When there was change in one person, the whole system changed. For example, Don Jackson (cited in Nichols, 2014, p. 1) reported a case of a woman he was treating for depression. When she began to improve, her husband complained that she was getting worse. When she continued to get better, her husband lost his job. Finally, the woman was reported as having become totally well, but the husband killed himself. Nichols (2014, p. 2) states that “apparently this man’s stability was predicated on having a sick wife”. Another example cited in Nichols (2014, p. 2) is that of a young client who was being seen by Salvador Minuchin. This young man had a very close relationship with his mother which strengthened when his father, a compulsive gambler, went missing for 7 years. On the father’s return, the young man began self-mutilating and he was hospitalised for trying to scratch his own eyes out. In the hospital, he functioned normally but when he went home, he returned to self-mutilation. What this case illustrates is that the problem did not rest totally with the symptomatic “patient” and simply treating him did not have any long term effect. Minuchin had to challenge the father to protect the son by not treating his wife in a demeaning fashion. The wife would then not seek her son’s “protection”. He was being used as a buffer to protect his parents from intimacy. Accordingly, as symptoms began to be seen as products of the family system rather than as features of the individual person, therapists began to consider the importance of treating the whole family as a means of most effectively helping the individual (p. 19).
Another occurrence was that as a result of World War II, many efforts and interdisciplinary studies were undertaken in both the physical and social sciences (Becvar & Becvar, 2013, pp. 17-19). Josiah Macy (of the Macy department store chain) instigated a series of conferences which began in New York in 1946 (the final one was held in 1953) which were attended by cutting edge experts and scholars in fields as diverse as rocket science, anthropology and ecology. What these researchers discovered was that whether they studied mechanical parts, social groups or animals, all systems operated using the same basic principles (Gehart, 2010, p. 145).
As a result, systems theory emerged (Goldenberg & Goldenberg, 2008, p. 78) which was further developed by different schools of thought. For example, Ludwig von Bertalanffy, a biologist, developed general systems therapy, which offers
a set of assumptions regarding the maintenance of any organism or entity, as a result of the complex interaction of its elements or parts. Early family therapists, seeking a scientific model, were particularly attracted to the notion that attention be directed more to the transactions taking place between family members than to separate qualities or characteristics of each family member. For them, systems concepts became a useful language for conceptualising a family’s interactive process” (Goldenberg & Goldenberg, 2008, p. 77).
Another closely related theory was that developed by Gregory Bateson who received grants from both the Rockefeller Foundation in 1952 and the Macy Foundation in 1954 to conduct research on levels of communication and schizophrenic communication respectively (Becvar & Becvar, 2013, pp. 19-20). As a result, cybernetics systems theory evolved which has had the most influence on the field of family therapy (Gehart, 2010, p. 145). At this point (as cybernetics systems theory will be expanded upon below), suffice to say that cybernetic systems theory particularly emphasises a system’s ability to self-correct and to maintain homeostasis (Gehart, 2010, p. 137), which in the family is “the desire to maintain stability or the status quo (Hecker, Bims & Bougher, 2003, p. 53)”. It is important however to recognise that homeostasis ought not to be static but dynamic. Systems ought to be in constant flux in order to be stable (Gehart, 2010, p. 145).
Gehart (2010, p. 137) has a summary of systemic assumptions that are pertinent in concluding this introduction:
• One cannot not communicate; all behaviour is a form of communication.
• An individual’s behaviour and symptoms always make sense in the person’s broader relational contexts.
• All behaviours, including unwanted symptoms, serve a purpose within the system, allowing the system to maintain or regain its homeostasis or feeling of “normalcy”.
• No one individual unilaterally controls behaviour in a system; thus no one person can be blamed for problems in a couple or family relationship; instead, problematic behaviour is viewed as emerging from the interactions between members of the system.
• Therapeutic change involves alternating the interaction patterns within the system.
4 Cybernetic Systems Theory
Cybernetics, although the brainchild of a mathematician, Norbert Wiener, was a term introduced to family therapy by Gregory Bateson (Nichols, 2014). It is basically the study of communication in self-regulating systems (or even mechanical systems) in which feedback or information “from one part of a system generates an action in another part of the system automatically” (Rhodes & Wallis, 2011, p. 17). Therefore, the idea is that in the family system, family members engage in both overt and covert processes of mutually influencing each other.
The way in which a system is thought to survive is through feedback loops which help moderate against excessive fluctuations. Feedback loops “introduce information about a system’s output back to its input, in order to alter, correct, and ultimately govern the system’s functioning and ensure its viability” (Goldenberg & Goldenberg, 2008, p. 85). There are two forms of feedback, positive and negative – neither is better than the other and a family requires both in order to endure. Positive feedback leads to change so that a family can adapt to changing conditions (such as family developmental stages) whereas negative feedback keeps the family “running on a steady course (until further change becomes necessary)” (p. 85). It can be likened to an air-conditioning unit that switches on when the temperature in a room gets too hot, but switches off when it reaches a comfortable temperature and so that it doesn’t get too cold (Hecker, Bims & Bougher, 2003). The problem is that some families have a repertoire limited to negative feedback, remaining inflexible and unable to deal with changing circumstances whereas others allow positive feedback to “reach runaway proportions” without the stability provided by negative feedback, resulting in the family being forced beyond its coping limits (Goldenberg & Goldenberg, 2008, p. 86).
Change is, therefore, a complex concept because a family is thought to have a tendency to resist change in order to maintain stability, balance or equilibrium (homeostasis) and to remain in the same pattern of functioning (Adams, 2003: Rhodes & Wallis, 2011). The key issue is the flexibility of the family system to make change (Rhodes & Wallis, 2011; Goldenberg & Goldenberg, 2008).
To the degree that a family is functional, it is able to preserve a sense of order and sameness. At the same time, it must subtly promote change and growth within its members and the family as a whole … Well functioning families are resilient and able to achieve change without forfeiting long-term stability (Goldenberg & Goldenberg, 2008, p. 85).
Don Jackson believed that a redundancy principle operates in family life. This means that families interact in repetitive behavioural patterns i.e. “instead of using the full range of possible behaviour open to them, members typically settle on a narrow option range or limited redundant patterns when dealing with one another” (p. 82). Rather than meeting individual needs and drives, Jackson believed it was these rules that determined behavioural sequences and that all members learned these rules, which could be overt or covert (pp. 82-83). Therefore, simplistically stated, the idea for cybernetic practitioners is that a therapist identifies these recurring patterns of behaviour which are problematic and gets them to try something different.
Families often make misguided attempts to solve their difficulties and, on finding that the problem persists, apply more of the same attempted solution. This only produces an escalation of the problem, which provokes more of the same and so on – in a vicious cycle (Nichols, 2014, p. 110).
However, how cybernetic practitioners did this varies depending on whether they focused on the process (how family members interact) or the structure (how the family is organised) of the family system (Nichols, 2014, p. 73). There were three strategic schools of cybernetic practitioners – the Mental Research Institute (MRI), Jay Haley and Chloe Madanes and the Milan School, a team of 4 therapists, Mara Selvini Palazzoli, Guiliana Prata, Luigi Boscolo and Gianfranco Cecchin based in Milan. The title strategic is best described by Chloe Madanes (cited in Rosen, 2003, p. 95). She said:
A strategic therapist must have a strategy. The issue is choosing the strategy that is best suited to each different kind of problem.
Strategic therapists had a focus on problem solving and would try to outwit resistance and provoke change through directives or tasks tailored to the needs of the particular family (Nichols, 2014, p. 107). Jay Haley would say that it is not enough to explain problems to clients. “What counts is getting them to do something about it” (Haley cited in Nichols, 2014, p. 12). These models of therapy are brief in that they focus on the present and on solving the presenting problem as quickly as possible (Rosen, 2003, p. 116). They aim to achieve a specific goal (Goldenberg & Goldenberg, 2008, p. 439) and are focused upon behaviour. As Winek (2010, pp. 64-65) states, “behavioural therapy was probably the first widely accepted approach to be successful at challenging the idea that psychotherapy has to address deep-seated unconscious issues to be effective. The advent of the behavioural approach greatly shortened the time required to treat clients”. Furthermore, Nichols (2014, p. 107) adds that the fact that the tasks or directives were so tailor made for the needs of the particular family, meant that change was often sudden and decisive. The Milan school approach has been known as “long brief therapy” (Tomm, 1984, as cited in Adams, 2003, p. 131). The reason for this is that though they would conduct relatively few sessions (about 10). These were often even a month apart. Initially this was because clients had to travel long distances to see the team, but later the team realised that their interventions for changing how the family system functioned took time “to incubate and finally to take effect” (p. 131).
In facilitating change, the three schools, as stated previously, differed in terms of their focus on process or structure. The case of 16 year old Tommy can be used to illustrate these differences (Niolon, 1999).
Tommy was brought to counselling because he had recently started refusing to go out of the house. MRI practitioners would adopt a cybernetic model. From this perspective, counsellors would see Tommy’s parent’s attempts to force him to go out as increasing positive feedback loops to the point where they had reached runaway proportions. The therapist’s goal would be to find the feedback loop or recurring pattern of behaviour and the rules governing it, and then change them and send the family home. They would not be looking to intervene in any other problems in the family unless the family specifically asks. Their goal is not long term change or insight or consideration of the function of the problem. It is simply to achieve immediate behavioural change with the belief that a family needs to act differently and then see that their rules for problem solving need to be, and can be, more flexible (Niolan, 1999, pp. 2-7).
On the other hand, Jay Haley and Chloe Madanes would adopt a more structural approach where consideration would be given to the family hierarchy and boundaries. They would concentrate on the triadic relationship between Tommy and his parents, strengthening generational boundaries and reorganising the dysfunctional hierarchy/structure where a child (Tommy) has become symptomatic in order to change the unresolved conflicts and marital struggles of his parents. Haley and Madanes would, therefore, adopt a combination of a structural and functional approach. It would also be behavioural and focused upon the problem, but more than MRI, they were interested in sequences of behaviour that had lasted over months and years and which would be reflecting chronic structural problems. Like MRI, they were unconcerned about insight (Niolan, 1999, pp. 2-7).
On the other hand, Jay Haley and Chloe Madanes would adopt a more structural approach where consideration would be given to the family hierarchy and boundaries. They would concentrate on the triadic relationship between Tommy and his parents, strengthening generational boundaries and reorganising the dysfunctional hierarchy/structure where a child (Tommy) has become symptomatic in order to change the unresolved conflicts and marital struggles of his parents. Haley and Madanes would, therefore, adopt a combination of a structural and functional approach. It would also be behavioural and focused upon the problem, but more than MRI, they were interested in sequences of behaviour that had lasted over months and years and which would be reflecting chronic structural problems. Like MRI, they were unconcerned about insight (Niolan, 1999, pp. 2-7).
The Milan team’s approach was functional. A family member was understood to develop symptoms for a purpose. Initially, this was seen as intending to control others and the team would consider hidden power struggles and family games. Tommy’s behaviour would originally have been seen as helping one of the other family members, his mother or father, “win” (Niolon, 1999, p. 3). Milan therapists, initially, saw their role as outwitting the family and their games. They would try and “discover, interrupt, and thus change the rules of the game” so that change could occur (Adams, 2003, p. 140).
As will be seen in the following section, the notions of social constructivism and second order cybernetics would cause these views to be reviewed. But even by 1980, the Milan School concepts of hypothesising, circularity and neutrality became fundamental. Neutrality is not about being non-involved. Rather it is about maintaining curiosity so that combined with circular, rather than lineal questions the therapist brings feedback to the family arousing their own curiosity and opportunity for change. Circular questions ‘highlight differences in perception about events and relationships among family members” (p. 142). They are used to gather information but in an exploratory way as against the investigative style of lineal questions. They are based on the assumption that everything is connected to everything else and so the questions reveal patterns rather than discrete causes (Ryan & Carr, 2001, p. 67).
The following questions would be lineal:
“What problems brought you in to see me today? (It’s mainly depression); “Who gets depressed?” (My husband); “What gets you so depressed?” (I don’t know); “Are you having difficulty sleeping?” (No); “Have you lost or gained any weight?” (No); “Do you have any symptoms?” (No); “Any illnesses lately?” (No); “Are you down on yourself about something?” (No); “There must be something troubling you. What could it be?” (Tomm, 1988, cited in Ryan & Carr, 2001, p. 67).
However, the following sequence of questions in the same scenario would be circular:
“How is it that we find ourselves together today?” (I called because I am worried about my husband’s depression); “Who else worries?” (The kids); “Who do you think worries the most?” (She does); “Who do you imagine worries the least?”(I guess I do); ‘What does she do when she worries?” (She complains a lot, mainly about money and bills); What do you do when she shows you that she is worrying?” (I don’t bother her, just keep to myself) (Tomm, 1988, cited in Ryan & Carr, 2001, p. 67).
This form of questioning according to Tomm (1988, as cited in Ryan & Carr, 2001, p. 68), encourages the family to become more aware of the circular nature of their interactions which are then easier to interrupt.
Milan therapists do not believe they can “fix” or “correct” a family’s interactions. Instead, they can only perturb or shake up the system so that it self-corrects. Invariably, when families have their normal interaction patterns interrupted, they quite easily choose a better course of action. It seems that most of us consciously know what would be a more ideal response to a given situation but the pull of the systemic dynamics makes it hard to do (Gehart, 2013, p. 94).
Hypothesising encourages the therapist to continue to speculate and make assumptions about the family situation which not only increases curiosity and keeps the therapist neutral but provides a guide for the questions to be asked in the sessions and encourages new information to be fed into the family system (pp. 123-128). Hypotheses are never considered to be the truth or set in concrete. Their goal is not truth but change (p. 126). But in regard to change, Milan “therapists remain neutral as to how, or if, the family changes (MacKinnon & James, 1987, p. 91). They are concerned with “the meta goal of facilitating change in existing patterns of change, thus transforming the relational patterns within the system”. The Milan team structured their therapy session in such a way as to encourage the development of hypotheses and questions related to these. The session comprised five parts: a pre-session discussion where therapists would meet to hypothesise; the interview; an inter-session discussion where the team hypothesised once again and developed feedback for the family; the intervention when the feedback was given by the therapist to the client; and a post-session where the session was reviewed and new hypotheses suggested for the next sessions (Barker & Chang, 2013, p. 7).
4.1 First and Second Order Cybernetics
Already, the difference in the stance taken by the therapist might be becoming evident. This is where it is necessary to differentiate between first and second order cybernetics. When a therapist sees reality as “out there” and the problem as something they can “discover” and “treat” (Becvar and Becvar, 2013, p. 81), they are working from a first order cybernetic approach. The therapist is seen to be objective, a knowledgeable expert who leans more towards the modernist tendency of finding a more objective form of truth (Gehart, 2010, p. 138). The early strategic and structural schools were largely based upon first order cybernetics.
On the other hand, second order cybernetic theory posits that the therapist cannot be an outside observer but instead creates a new system of which the therapist is part. This system will function with the same dynamics as any other system including the tendency towards homeostasis and recursive patterns of behaviour (Gehart, 2010, p. 138). The system and meaning is co-created. Second order cybernetic theory maintains that
Whatever the therapist observes in the family reveals more about the therapist’s values and priorities than about the families because any description exposes what the therapist pays attention to and what the therapist ignores or misses (Gehart, 2010, p. 138).
As Goldenberg and Goldenberg (2008, p. 288) state, “truth” therefore is taken away from the therapist. Goal setting becomes a participatory process in which both the family and the family members participate. “The therapist as a non-hierarchical collaborator (although hopefully a knowledgeable and inventive one who is both curious and impartial) allows the family to investigate and decide about its future in its own way and at its own pace” (p. 288). The Milan School gravitated towards second order cybernetics and Goldenberg and Goldenberg (2008, pp. 288-289) comment that
the theoretical and therapeutic implications of this very contemporary viewpoint helped catapult the contributions of the original Milan group, especially Luigi Boscolo and Gianfranco Cecchin, to the forefront of 1990’s family therapy thinking and practice.
The collaborative stance and second order perspective of Boscolo and Cecchin was a precursor to the post-modernist schools that will be investigated in the following section.
Another development partly as a result of second order cybernetics was the use of the one-way screen. An entire family and one or two therapists would sit together in a room whilst the rest of the team sat behind a one way mirror to gain a different perspective (Rosen, 2003, p. 131). As Gehart, (2010, p. 168) explains:
The team could see the systemic dance more rapidly and completely because the person in the room very quickly falls in sync with the family system and has a more difficult time seeing the entire dance. Anyone who has spent time behind a mirror and in front of it knows that you are always smarter behind it. The distance created by not being part of the interactional dance of the family increases one’s ability to see the dance more clearly and quickly.
From time to time during the session, the observing team would either phone in questions or call the therapist out of the room in order to make suggestions or give directions for the therapy (Rosen, 2003, p. 131).
4.2 First and Second Order Change
Becvar and Becvar (2013, p. 298) use the two diagrams above, usually known as the nine dot problem, to explain first and second order change. If given the simple instruction of connecting all 9 dots with four straight lines and without lifting the pencil from the paper, the usual first attempts bog down in the assumption that the nine dots form a square. This is the “implicit” rule. Yet, any attempt to do this will meet with failure. This can be likened to first order change. On the other hand, if one changes the “rule” and goes beyond the square, solution is possible and second order change is achieved.
Becvar and Becvar (298, p. 299) give another example. If Susie and Harry are having an argument and both start yelling louder and louder at each other, the problem will not be solved. If, on the other hand, they switch tactics and ignore each other, still nothing is accomplished. Both of these are first order solutions. However, if either of them comes up with a totally different tactic, say for example, Harry stands on his head, Susie probably will not be able to yell or ignore him for much longer. She might laugh instead. The rules have been changed and the pattern within which yelling or ignoring are maintained is broken. It is interesting that it does not matter what Susie and Harry are arguing about (the content). Rather what matters is how they are fighting (the process).
Therefore, first order change is change that “occurs within the system, consistent with the rules of that system” (Becvar & Becvar, 2013, p. 298). They are temporary or superficial changes that do not change the organisation of the system (Nichols, 2014, p. 298). Second order change “involves a change in the rules of the system and thus change in the system itself” (Becvar & Becvar, 2013, p. 298). It is change in the structure and functioning of the system (Nichols, 2014, p. 298).
Activity 4.1: Self-directed
Please watch Haley, J., & Richeport-Haley, M. (2001). The boy who can’t stop fighting. La Jolla, CA: Triangle Productions. 43:44 mins. Retrieved from http://search.alexanderstreet.com.elibrary.acap.edu.au/counseling-therapy/view/work/1779266.
This video shows Haley in consultation with a therapist who is seeing an African American boy. The boy has been sent from school to school, therapist to therapist and group to group because of an issue with fighting. Whilst the video might appear somewhat chaotic it is important because it demonstrates some of the concepts mentioned in this section.
In the first instance, the approach is a very different approach to one focusing on pathology or attributing blame to the identified client. Not only the boy but the whole family is seen and implicated. Haley’s hypothesis is that the boy is helping his mother by giving her something other than her misery with her husband to think about. The boy has instigated the mother being brought to therapy. Haley believes that the mother has not quite accepted the stepfather and the boy represents that. He also believes that the boy must be influenced by the fact that all the men in his family have been murdered.
The approach in the video demonstrates Haley’s strategic approach. It is very much problem focused and uses a combination of strategic and structural techniques. Haley wants to improve the hierarchy in the family. He believes that the mother should be in charge of the children and that the stepfather should be integrated into the family. He encourages the therapist to see the father alone for a short time to explain to him what she is doing with the family. Haley sees the father as being at the bottom of the family and that ignoring him would put him even lower. Seeing the stepfather would show that he is respected enough to be told what is happening and would give him interest and authority in the family.
Strategically, the “good” boy is invited to fight instead of the “bad” boy. This is a paradoxical intervention which aims to break the usual pattern of behaviour where the “bad” boy takes responsibility for the family’s situation. In the video, Haley (2001) explains:
The good boy is asked by the therapist to do something bad, because the bad boy is being overloaded with being bad. The good boy goes and fools with the microphone being bad, and so he has been good as he should. When the bad boy sees the good boy being bad, he also goes and fools with the microphone to be bad, not wanting the good boy to be bad alone, since he, the bad boy, is accustomed to being bad. So the bad boy is not obeying.
Haley (2001) stated that:
1. The therapist only needed to see the family one more time.
2. The brothers did not trade places but laughed about the intervention and recognised the difference between play and combat. They also accepted that they had encouraged one another to increase the violence.
3. Mom said that things were better.
4. The stepfather was encouraged to take the boys to a wrestling match; unlike other the family had seen who had opposed wrestling.
5. The boys’ relationship with the dad improved and they treated him with more respect.
6. The mother focused on her career and was promoted.
4.3 Structural Therapy
Like the three strategic models discussed above, the structural family therapy approach of Salvador Minuchin concerns itself with transactional patterns (Goldenberg & Goldenberg, 2008, p. 152). However, structural practitioners focus upon the family structure, a structure which is revealed when the family is in action (Nichols, 2014, p. 152). This is the reason why enactments are such an important technique used by structural family therapists. Enactment is a “technique in which a therapist has family members engage in their problematic behaviours in the therapy room to assess their family structure” (Wetchler, 2003, p.92). Nichols (2014, p. 152) states that for structural therapists, any therapist who fails to consider the whole structure and intervenes in only one subsystem, is unlikely to affect lasting change.
If a mother’s overinvolvement with her son is part of a structure that includes distance from her husband, no amount of therapy for the mother and son is likely to bring about basic change in the family (Nichols, 2013, p. 152).
Becvar and Becvar (2013, p. 175) say that structural theory defines three subsystems: the spousal subsystem, the parental subsystem and the sibling subsystem. Goldenberg and Goldenberg (2008, p. 472) define a subsystem as “an organised, coexisting component within an overall system, having its own autonomous functions as well as a specified role in the operation of the larger system”. Subsystems are regulated by boundaries. These need to be clear enough to maintain independence but permeable enough to allow connection (Nichols, 2014, p. 153). Enmeshed families have diffuse boundaries whilst distanced families have rigid boundaries (Becvar & Becvar, 2013, p. 179). A structural therapist aims to join the family system and accommodate to its style (Goldenberg & Goldenberg, 2008, p. 249). They then would assess the family interactions through enactments and unbalancing which is a technique that supports one family member to interfere with the family homeostasis. Other techniques are boundary making, which is the realignment of inappropriate or outdated boundaries, and reframing, which is the relabelling or redefining of the problem as a function of the family’s structure (Goldenberg & Goldenberg, 2008, p. 261). Ultimately, the goal is to “restructure the family’s transactional rules by developing more appropriate boundaries between subsystems and strengthening the family’s hierarchical order” (p. 261).
Parents must take charge and support and accommodate each other to provide a united front for the children and to allow a sibling subsystem to become a system of peers. If the family is disengaged the aim is to increase interaction. If the family is enmeshed, the goal is to foster the differentiation of individuals (Becvar & Becvar, 2013, p. 186).
Activity 4.2: Self-directed
Please watch Minuchin, S., & Lappin, J. (2011). Salvador Minuchin on family therapy. Mill Valley, California: Psychotherapy.net. Retrieved from https://ezproxy.navitas.com/login?url=http://search.alexanderstreet.com.ezproxy.navitas.com/counseling-therapy/view/work/1779266
In this video, Salvador Minuchin is interviewed by Jay Lappin and explains his thoughts on change, enactments, joining and challenging. One of the interesting elements is his criticism of practitioners, like Susan Johnson, who use attachment theory as “a prototype of our ways of relating to people in the future”.
Activity 4.3: Self-directed
Please watch Salvador Minuchin in Unfolding the Laundry, which was recorded live at the American Association for Marriage and Family Therapy Conference in San Francisco in 1984. It was published in Washington, DC by the American Association for Marriage and Family Therapy. There are three parts to Unfolding the Laundry. The first is the pre-session Case Discussion; the second is the Family Consultation in which Minuchin works with a blended family consisting of the husband and wife and five children; and the final part is the Concluding Review in which the audience asks Minuchin to explain his work. These parts are available on YouTube, Retrieved from
https://www.youtube.com/watch?v=leIVxF-kpos&feature=youtu.be
https://www.youtube.com/watch?v=9DXghgwr_DI&feature=youtu.be
https://www.youtube.com/watch?v=cJ5H-ZWIx2M&feature=youtu.be
This video clearly demonstrates Minuchin’s structural approach. The identified client is a 13 year old boy, who has been described as having poor grades, poor hygiene; as having been defiant to his mother, not doing his chores, bullying and taking things like the dad’s tools. Towards the end of the family consultation, Minuchin asks how Jeff got saddled with the role of being his mother’s teddy bear. The mother and father are challenged to function more appropriately in the parental and spousal subsystems.
5 Bowen’s Natural Family Systems Theory
Murray Bowen’s ideas provide a bridge between the systemic and psychodynamic schools of thought. He began his formal training as a psychiatrist at the Menninger Clinic in Kansas, which was known for its Freudian psychoanalytic approach (Goldenberg & Goldenberg, 2008, p. 176). In 1954, he moved to the National Institute of Mental Health in Maryland because he had a growing interest in moving beyond a theory focused on individual pathology.
Here he conducted research with families who had a member diagnosed with schizophrenia. During this five year research project, entire families lived in the research ward for durations of one to three years and Bowen concluded that the relationship patterns he observed in the live-in families were also present to some degree in less disturbed and normal families (“Vermont Center for Family Studies”, nd).
Bowen was struck by the emotional sensitivity that he observed between his patients and their mothers (Nichols, 2014, p 81). Whilst some people call this interaction, symbiosis, Bowen saw it as a more intense version of a natural process that exists in all relationships – the tendency to react emotionally to one another (p. 81). He increasingly believed that human emotional functioning was part of a natural system that followed the same laws as other systems in nature, just like the laws of gravity (Goldenberg & Goldenberg, 2008, p. 177). So whilst Bowen was originally “imbued with the individual focus of psychoanalysis” (p. 176), he came to conceptualise “the family as an emotional unit, a network of interlocking relationships, best understood when analysed within a multigenerational or historical framework” (p. 175).
From a psychoanalytical perspective, Bowen theorised about the nature of being human. He emphasised self-development, unconscious drives and the significance of the past (Goldenberg & Goldenberg, 2008). Above all, for Bowen the core issue for all humans is attempting to balance two life forces, the need for family togetherness and the need for individual autonomy
Bowen’s natural family systems theory is a systemic theory in that it uses the following practices:
• It examines a client’s early relationships to understand present functioning
• It traces transgenerational and extended family dynamics to understand a client’s complaints
• It promotes insight into extended family dynamics to facilitate change
• It identifies and alters destructive beliefs and patterns of behaviour (Gehart, 2010, p. 283).
Bowen developed eight interlocking theoretical concepts: differentiation of self, triangles, nuclear family emotional system, family projection process, emotional cutoff, multigenerational transmission process, sibling position and societal regression and believed that
Current family patterns are embedded in unresolved issues in the families of origin. That is not to say that these problems are caused by earlier generations, but rather that they tend to remain unsettled and thus persist and repeat themselves in ongoing patterns that span generations. How today’s family members form attachments, manage intimacy, deal with power, resolve conflict, and so on, may mirror to a greater or lesser extent early family patterns (Goldenberg & Goldenberg, 2008, p. 175).
The aim of therapy, very briefly, is to increase the client’s level of differentiation and to decrease emotional reactivity to chronic anxiety in the system. As differentiation increases, so anxiety will decrease (Gehart, 2010, p. 290). Basically differentiation may be defined as the ability to separate intrapersonal from interpersonal distress. From an intrapersonal perspective, one should be able to separate feelings from thoughts in order to be able to respond rather than react. From an interpersonal angle, it is necessary to be able to know where oneself ends and another begins without a loss of self (Gehart (2010, p. 284).
In the video you are required to watch Monica McGoldrick, a renowned therapist, who has based her work upon the ideas of Murray Bowen, and she demonstrates these concepts clearly. She also employs the genogram in order to demonstrate repeating intergenerational family relationship patterns and unresolved emotional issues that are being replayed from one generation to another (Goldenberg & Goldenberg, 2008, p. 193). As Roberto-Forman (2008, p. 199) states,
Bowen used the genogram, an old medical tool for charting family history – but with a twist. He and his trainees mapped symptom-bearers in relation to their extended families, then looked for intense relationships and triangles that might be helping to maintain clients’ distress.
McGoldrick also uses process questions which help the client see the systemic process and dynamics they are enacting e.g. “How do the struggles you are experiencing with your spouse now compare with those of your parents?” “Similar or different?” “Is it similar to the type of conflict you had with your parents when you were younger?” (Gehart, 2010, p. 291).
Activity 4.4: Self-directed
Please watch McGoldrick, M. (2012). Harnessing the power of genograms in psychotherapy. Mill Valley, California: Psychotherapy.net. Retrieved from https://ezproxy.navitas.com/login?url=http://www.psychotherapy.net.ezproxy.navitas.com/stream/acap/video?vid=219
In her interview with Yalom, McGoldrick makes a number of statements pertinent to this section. She validates short term therapy, for example, when she says:
I think there is an issue of clients becoming too dependent on us and that they have to tell us every story and every fight they had and every time something went wrong… we do better when we give them some things to work on, and think about, and the time to process it and trust that they might really be able to do that, and then let us know when they get stuck. And hopefully, we can then help them go to the next level. So I am a big believer in trusting people to do their business … I don’t think people always need to be in therapy to sort through their issues. (McGoldrick, 2012, np.)
She also argues for systemic practice and seeing clients within their contexts:
I think it's something about the meaning of home, of who we are as human beings. That none of us ever goes anywhere alone. We take with us people who live in our hearts. We take with us the wounds of people who we have lost or not been able to work things out with. And I think that all matters, in terms of how we then think about ourselves and our lives when we get stuck.
And a whole lot of psychotherapy is done from an extremely individual perspective, as if people were alone in the universe, able to just work out their relationships with each other and with themselves and deal with their anxieties and depression. And I just think that's a false idea.
It’s important for us as clinicians to remind people who they belong to and who matters to them in order to help them make the best decisions they can for their lives, which is what I think our job is to the end of the day - to help people make the best decisions about what do they want to do next.
If you think you're completely alone, then you have sort of no field of vision about what's the context in which you would be making a particular decision or another. If I get it that I am here because my grandmother loved me, and struggled for me, and wanted me to do something important in life, then I might be much better able to take the struggle I’m having now with my child or my siblings, and say, “what would my grandmother want me to do now?” And then bring that into who I’m trying to be. (McGoldrick, 2012, np.)
Section 12 concentrates on change and the therapist. However, as a conclusion to this activity, it seems fitting to mention Monica McGoldrick’s view. Yalom asked her how she learnt to incorporate genograms into her therapy sessions. She answered:
that's the deeper part. Because that's the part that's really about thinking systemically, thinking about how people are connected, and looking for patterns. For that, I think, and this is what Murray Bowen said long ago, your study of your own family is your best way of learning to think systems. (McGoldrick, 2012, n.p.)
6 Stan – A Case Study
Reading
Please refer to the three generation genogram of Stan’s family.
Corey, G. (2009). Fig 14.1: Three generation genogram of Stan’s family. In Theories and practice of counseling and psychotherapy (9th ed., p. 453). Belmont, CA: Thomson Higher Education.
Corey (2009, p. 435) discusses family therapy as applied to the case of Stan. It should now be evident, however, that there is not only one way of conducting family therapy with Stan. In this section, only the strategic therapies of the MRI team, Jay Haley and the early Milan School, the structural ideas of Salvador Minuchin and Bowen’s natural family system’s approach have been discussed. Whilst they share some similar ideas such as their emphasis on interactional patterns, their focus and techniques differ somewhat and in addition, they do not represent the full gamut of possible family therapies.
Whilst it is optimum to work with an entire family, the theories and practice techniques of systemic practice can, if not ought, to be used with individuals and couples as well. It is also important to consider that particularly as Stan is an adult, it is not entirely necessary to have the whole family attend counselling. In fact, one of the tasks for a family therapist is always to consider who to invite to therapy (and when) because a therapist may be buying into laying blame on the identified client. For example, would it be useful to work individually with Stan to increase his level of differentiation so that he is better able to respond, rather than react, in a family therapy environment with high levels of anxiety? Absent members of a family can always be brought into the room hypothetically by the use of a form of circular questioning called other-oriented questioning. An example of such a question would be, “Stan, if I asked your mother her view on your drinking, what do you think she would say?” “What would Dad say?” “What would the supervisor at the children’s camp say?” Furthermore, extra chairs can be placed strategically and used in different ways.
As in the video you watched with Monica McGoldrick and her client, 39 year old, African American, graphic designer, John, a genogram would be a useful technique to highlight multigenerational patterns of behaviour and unresolved family issues for Stan. Stan would become immediately aware of the repeating pattern of alcohol abuse in his extended family. This is indicated on the genogram (Corey, 2009, p. 436) by the lower half of circles representing his grandmother, Martha, and his aunt, Margie, and the squares indicating his father, Frank Senior, his brother-in-law, Matt, and himself, being shaded. But rather than being seen as solely Stan’s “issue”, alcohol in this approach takes on systemic meaning and useful questions might be, “How does this problem affect the family?” and “Is the family using this problem to serve some other purpose? (Corey, 2009, p. 435)”. Stan might walk away saying “It never occurred to me how all these events fit together” (Nichols, 2014, p. 99).
A therapist using a Bowenian approach would also consider triangles. As Goldenberg and Goldenberg (2008, p. 472) explain, a dyad, i.e. a two person emotional system, under stress recruits a third person into the system in order that the anxiety and intensity is lowered. Unfortunately, if levels of tension remain high, or increase as one person feels increasingly left out of the triangle, one person might involve another outsider and so on so that there are a series of interlocking triangles which in some cases heighten the problem that the initial triangle attempted to resolve (Goldenberg & Goldenberg, 2008). The genogram of Stan (Corey, 2009, p. 436) indicate a number of possible triangles. For example:
1. Frank Senior’s relationship with Angie has been shown to be conflictual (indicated by the jagged lines between their names). It appears that Frank Senior could possibly have triangled in Frank Junior to reduce the tension he feels with his wife (three straight lines indicate a very close or even fused relationship). As a result Stan has been distanced from both his father and his brother, Frank Junior (indicated by the broken lines).
2. Similarly, Angie might have triangled in Karl, as a means of coping with the anxiety in her relationship with her husband, as there are three lines between their two names.
3. Whilst Stan appears to have a close relationship to his younger brother Karl, he appears to be marginalised in a relationship with his mother in the triangle Angie, Karl and Stan. How does this affect him in terms of needing a parental relationship and possibly his need to self-medicate by drinking?
Bowenian therapists work to neutralise triangles (Nichols, 2014, p. 99) and to improve dyads but this cannot be accomplished without also working with Stan to improve differentiation or the ability to choose responses rather than knee-jerk behaviours to handle stress (Nelson, 2003, p. 265). Stan might be asked to conduct a relationship experiment. For example, he might be asked to connect with his brother, Frank, and in some small way to communicate his personal thoughts and feelings to him rather than avoiding him or capitulating to his demands (Nelson, 2003, p. 100). He might be coached on taking an “I” position and generally helped to understand more fully how he functions as an individual, how he gets along with his family, and how patterns of behaviour have been transmitted and repeated through the generations (Nichols, 2014, p. 100).
By the same token, a Milan approach could be used and emphasis placed upon the function of Stan’s behaviour. One could be curious about the reason for Stan having an issue with alcohol whilst his siblings do not. How much is this Stan’s attempt to take the focus away from Frank Senior’s troubled relationship with his wife, Angie? Do Stan’s problems allow Frank Senior and Angie to find some common ground? And has Stan become a scapegoat in order that Judy, Frank Junior and Karl are freed up to pursue their own goals? Behaviour would be reframed for Stan so that positive motives are ascribed to symptomatic behaviour (Barker & Chang, 2013, p. 156).
A Milan session is a circular process (Barker & Chang, p. 2013, p. 80) and therefore, the therapist would respond to the information Stan provides about relationships, by formulating more hypotheses and formulating more questions, which would be framed as circular questions. The aim of these questions with Stan (and members of his family if they do attend) would be to:
• Open up the system to new information
• Allows members to learn about themselves from others
• Allows members to take a reflective rather than a reactive stance to other members. This may lead to increased understanding and empathy between family members (Barker & Chang, 2013, p. 80).
In working with Stan, the therapist’s aim as mentioned earlier in this section would not be to “fix” Stan, but rather to introduce news of difference so that the system is perturbed, redundant patterns of pursuit and withdrawal are broken and a better course of action may be chosen (Gehart, 2013, p. 94).
Activity 4.5: Self-directed
Now consider the case of Stan from the point of view of some of the other concepts mentioned in this section. For example, conceptualise the case of Stan from a structural approach, considering subsystems such as the parental subsystem, the spousal subsystem and the sibling subsystem. In regard to the family structure, hierarchy and boundaries, what would you seek to work with? Do you believe this system is fraught with diffuse or rigid boundaries? Enmeshment or distance?
What other hypotheses can you think of for the behaviour of other members of the family, such as Frank Senior and Angie? What other situations and events do you think have some bearing on Stan’s current situation? For example, it is interesting that Corey (2009, p. 436) does not include Stan’s ex-wife or marriage on the genogram. One cannot help being curious about whether Stan is able (hypothetically) to leave home if his function is to take the tension from his parent’s relationship. Remember that it is important not to demonise any member of the family. Rather it is important to consider interactional patterns and wider systemic influences. Jot down your thoughts in your journal.
7 Conclusion and Self-assessment
Conclusion
In this section, it has become clear that a therapist is no longer necessarily an “objective, neutral, and technical expert who is knowledgeable about pathology and normalcy and who can read the inner mind of a person like a text” (Anderson, 1997, as cited in Barker & Chang, 2013, p. 12). Rather, family therapy and a systemic approach argue for the consideration of relationships and patterns of interaction when working towards change. As stated by Barker and Chang (2013) the family approach is based upon a belief that problems and symptomatic behaviour are related to:
1. The current interactions taking place between the individuals in the family
2. Interactions between these individuals and other social systems, and
3. Multigenerational and extended family factors. (Barker and Chang, 2013, p. 13)
In addition, in regard to the change process, a more collaborative relationship between client and therapist has become apparent. This will become even more pronounced in the next section on the Post Modern approaches where “client and therapist become conversational partners in the telling, inquiring, interpreting, and shaping of the narratives” (p. 12). Solutions are no longer to be achieved by the therapist but rather they will be seen to emerge from the collaboration between client and therapist (p. 12).
Self-assessment
Did you achieve the objectives for this section? To test your knowledge, write brief answers to the following questions:
1. How do systemic approaches differ from psychodynamic and humanistic approaches in regard to the change process?
2. How do Bowenian, structural and strategic schools theorise and facilitate change?
3. How do these approaches differ from each other particularly in regard to their approach to patterns of behaviour?
4. What is the difference between first order and second order cybernetics? In which approach does the therapist theoretically hold more power?
5. What is first order change? How is second order change different to first order?
6. How do the systemic schools rationalise short term therapy? How do you understand the term long brief therapy?
7. In terms of your own practice, what have you personally gained from this section on systemic approaches, and specifically the exploration of strategic (including the Milan school), structural and natural family systems theories?
8 Reference
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Barker, P., & Chang J. (2013). Basic family therapy. London, England: Wiley-Blackwell.
Bateson research projects (n.d.).Retrieved from http://www.mri.org/dondjackson/brp.htm.
Becvar, D. S., & Becvar, R.J. (2013). Family therapy: A systemic integration (8th ed.). Boston, M.A.:Pearson.
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Gehart, D. (2010). Mastering competencies in family therapy: A practical approach to theories and clinical case documentation. CA: Brooks/Cole.
Gehart, D. (2013). Mastering competencies in family therapy: A practical approach to theories and clinical case documentation (2th ed.). CA: Brooks/Cole.
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Minuchin, S. & Lappin, J. (2011). Salvador Minuchin on family therapy. Mill Valley, California: Psychotherapy.net. Retrieved from http://www.psychotherapy.net.elibrary.acap.edu.au/stream/acap/video?vid=185.
Minuchin, S. (1984). Unfolding the laundry. Washington, D.C.: The American Association for Marriage and Family Therapy. Retrieved from:
https://www.youtube.com/watch?v=leIVxF-kpos&feature=youtu.be
https://www.youtube.com/watch?v=9DXghgwr_DI&feature=youtu.be
https://www.youtube.com/watch?v=cJ5H-ZWIx2M&feature=youtu.be
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“Vermont Centre for Family Studies”. Retrieved from: http://www.vermontcenterforfamilystudies.org/about_vcfs/dr_murray_bowen/.
Wetchler, J. L. (2003). Structural family therapy. In L. L. Hecker & J. L. Wetchler (Eds.), An introduction to marriage and family therapy. New York, NY: The Haworth Clinical Practice Press.
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