By:
Marcia J. Wood
The family systems approach emerged to overcome the limitations of other perspectives
seeking to work only with the identified individual patient. The family systems
approach emerged from research and treatments geared to address problems
associated with interpersonal communication among schizophrenic patients and between family members. The family systems approach began with the Bateson group in Palo
Alto, California, during the 1950s.
The goals of the family systems approach commonly include improved communication among family members and a de-emphasis on the problems of any one member in favor of attention to the family system as a whole.
Family systems professionals meet with all family members rather
than with just the person who has the identified problem(s). Family systems
professionals might also involve extended members of the family or other
significant figures in the life of the family such as neighbors, friends, and
teachers in their therapeutic work. Family systems perspectives maintain a systemic view of
problems and relationships. That is, they suggest that any change in the
behavior or functioning of any one member of the family system is likely to
influence other members of the system.
Therefore, even if improved psychological functioning and
behavior is achieved in individual members, others must adjust to and contribute
to these new changes in family functioning. Paradoxically, improvements among some
family members may lead to problems among other family members.
For example, if Mary becomes less fearful and more independent,
she may no longer need her husband to drive her around town for errands. Her
husband would then lose an important and powerful role in his relationship with
his wife, perhaps feeling somewhat uncomfortable and even threatened by her new
found independence. This change might result in marital discord that may
encourage Mary to relapse into her panic behaviors.
Examples of Family Systems Concepts and Techniques
Reframing Altering the way one understands and interprets a given behavior. For example, Mary’s panic might be reframed as an attempt to engage her husband in her life and assist him in feeling more manly.Paradoxical intention Prescribing the problematic symptom in order to combat resistance to treatment. For example, ask Mary to schedule a number of panic attacks each day.
Joining Therapist attempts to connect with the family and become part of the family unit rather than act in an detached observer manner in the sessions.
Enmeshment Over and maladaptive involvement in the lives of family members. For example, Mary’s over-involvement in her son’s life results in her being highly critical of all work and relationship decisions that he makes that are not consistent with her interests.
Disengagement Over detachment of one family member from others. For example, Mary’s daughter has little interest in activities and functioning of the family and prefers to stay out of any emotional involvement with the family.
Like the previously reviewed approaches, there are many
variations of the family systems approach identified with individual professionals.These
include, for example, the communication approach of Virginia Satir, the structural approach of Salvador Minuchin, the strategic
perspectives of Jay Haley and Milton Erickson, and the narrative approach of
Michael White. While there are many other perspectives within family systems,
five main orientations are briefly presented.
The Communication Approach:
The communication approach was developed by Virginia Satir
(1967) and colleagues at the Mental Research Institute (MRI) in Palo Alto,
California. The approach suggests that problems in effective communication
contribute to family problems and
dysfunction. Unspoken and unreasonable expectations, rules, and assumptions
about how family members should relate to one another and live their lives
result in conflict and problems in family functioning.
Satir outlined several communication styles in families, which include placating, blaming, super-reasonable, irrelevant, and congruent. In problem families the father may be super-reasonable, maintaining a rational style and keeping his feelings to himself. The mother may placate the father by agreeing with him and not expressing her feelings.
One of the
children may use a blaming style attributing all of his or her problems in school and at
home on someone else. Irrelevant
communication might involve annoying habits on the part of a sibling. Satir
encourages family members to embrace congruent communication, which focuses on expressing genuine feelings.
A communications approach may encourage Mary to express her true
feelings more directly about needing to be taken care of by her husband. Her
panic behavior might be viewed as a way to communicate a need for attention and
care by her husband and others. Her husband may be encouraged to express his
feelings about his need to feel important and useful in the relationship.
Taking care of Mary during panic episodes may be a way to feel powerful and
important in the relationship.
The Structural Approach:
The structural approach was developed by Salvador Minuchin
(1974) and focuses on altering and restructuring the pattern of relationships between family members. The
structural perspective focuses on appropriate and adaptive levels of differentiation, enmeshment, and
disengagement among
family members (Minuchin, 1974; Minuchin & Fishman, 1981).
For example, a mother and daughter may be overly enmeshed
with each other resulting in distance and disengagement in the father.
Furthermore, the daughter’s over-involvement in her mother’s life and troubles may
make it difficult for her to develop satisfying peer relationships and levels
of independence. The mother’s over-involvement with her daughter may result in
less interest and energy for her relationship with her husband.
Due to dysfunctional family patterns, conflicts and problems
emerge within the family unit as a whole. The structural
perspective emphasizes more functional, balanced, and
hierarchical family relationships. The therapist may actually rearrange seating
in the therapy session in order to join the family and to alter the structure
of family dyads and interactions.
For example, Mary may be overly involved with her son, resulting
in resentment from her daughter and husband. Furthermore, her son may feel that
her over-involvement makes it difficult for him to develop more independence
and greater connection with his father. The therapist might try to assist Mary
in disengaging from her son (starting by having her sit away from her son
during the session) and engaging more with her daughter and husband.
The Milan Approach:
In the Milan approach, the professional is viewed as an integral part of the family
system or unit (Boscolo, Cecchin, Hoffman, & Penn, 1987). The Milan approach
highly values neutrality as well as acceptance and respect for the family system. The Milan approach uses
hypothesizing as well as positive, logical connotation (Selvini Palazzoli, Boscolo,
Cecchin, & Prata, 1980) to assist in better understanding family dynamics. Hypothesizing
helps to better understand the function and dynamics of the family, whereas
positive, logical connotation reframes the behavior of the family in more
positive and accepting terms.
The Milan school also encourages the use of a team approach. For
example, family systems professionals using the Milan approach might request
that Mary bring her entire family to the treatment sessions. While a therapist
meets with Mary’s family, several colleagues observe the session using a
one-way mirror. Efforts at hypothesizing and positive, logical connotation
would be aimed at a better understanding of family interactions and a more acceptable, positive
reframing of family issues.
The treatment team discusses the session as it occurs and offers
suggestions to the therapist working with the family via a telephone in the
treatment room. Following the session, the family might be invited to observe
the treatment team as they discuss the session with the treating therapist. The Milan school also uses “rituals,” asking the family to behave in certain
prescribed ways between sessions.
The Strategic Approach:
The strategic approach was developed by Jay Haley (1973, 1987) and others such as
Milton Erikson
(1980) to help professionals deal more effectively with resistance in their work.
(1980) to help professionals deal more effectively with resistance in their work.
The approach utilizes very active and direct involvement by the
clinician. The strategic perspective maintains that any attempt to change a
member or set of members within a family system will be met with resistance and
sabotage (conscious or unconscious). Therefore, the professional must find ways
to combat this resistance by directing and altering the behavior of the family.
One of the most common and well-known examples of a strategic
intervention involves the use of paradoxical
techniques. Paradoxical approaches are often referred to by the
general public as “reverse psychology.” Paradoxical
techniques involve prescribing the
symptom of concern in an exaggerated form and so it appears to contradict the goals of intervention.
For example, a child who terrorizes the family with frequent and
intense temper tantrums might be encouraged by the professional to yell and
scream louder: “Yell louder—I don’t think you are trying hard enough and I’m
sure people in the next room cannot hear you.”
Strategic theorists believe that since people resist direct
interventions to change the family system, the clinician can assist others in
reaching intervention goals by asking the client to do the opposite of those goals.
For example, a strategic therapist might encourage Mary to
schedule her panic attacks throughout the day and to never leave her house.
Since resistance can be expected, Mary would likely have difficulty scheduling
frequent panic attacks and have trouble staying in her home. Therefore, the
ultimate goals of therapy (decreased panic and increased independence) are likely
to be met.
Using these paradoxical techniques is both controversial and
risky (e.g., asking an anorexia nervosa patient to further decrease food
consumption could be ill-advised and tantamount to malpractice).
Strategic techniques assume that people will be resistant to the
suggestions. They also assist the client in being more aware of the undesirability
of the problematic behaviors as well as provide the client with a greater sense
of control.
For example, Mary may find it dull to stay home all day beyond
her usual at-home schedule and she may wish to do something other than have a
panic attack at the therapist’s prescribed time of day.
Another technique utilized by strategic clinicians is reframing.
Reframing involves reinterpretation
of a behavior or issue in a new and different light. Therefore, behaviors
considered negative by the family may be reinterpreted as being positive.
For example, a child who steals might be viewed as trying to
alert the family to their emotional deprivation and neediness. Mary’s panic
behavior might be reframed as being an attempt to stay close to her husband and
to help him feel more powerful and masculine. An adolescent who has run away
from home and made poor choices could be viewed as “doing the wrong things for
the right reasons” (i.e., increased independence).
The Narrative Approach:
The narrative approach (M. White, 1986; M. White & Epston, 1990) holds that family
members
conceptualize their problems and concerns through a series of stories about their lives and various members of the family system.
conceptualize their problems and concerns through a series of stories about their lives and various members of the family system.
Using techniques such as externalizing and relative
influence questioning, professionals assist family members in relating
their stories in a more objective manner, allowing them to take a less negative
and blaming approach to family problems.
The narrative approach highlights the restraining influence that
certain ideas and stories place on people. For example, an abusive male may
feel that women are property and that they
should have less power and influence than men. He may feel that he protects his weak, unstable,
and inferior wife and that she would be in a great deal of trouble trying to
survive without him. He may describe their relationship as one where he constantly
protects her while she resists his efforts.
These myths and worldviews influence his behavior toward women. Mary
and her family might be asked, for example, to relate their story of Mary’s mother’s
panic attacks and the role Mary’s mother had on the development of family
relationships and activities. They may be asked to discuss family stories about
Mary’s mother and examine what beliefs and myths play a role in current family functioning.
References
Contemporary clinical psychology / Thomas
G. Plante — 2nd ed. Copyright © 2005 by John Wiley & Sons, Inc.
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