10. Systemic therapies Flashcards
What criticisms of scientific modernism does it address?
- Its inability to account for human intentionality
- Neglect of contextual influences (universalism)
Systems theory specifics
- Circular causality
- Negative feedback (maintains stability by reducing deviation- equifinality)
- Positive feedback (disorganizes systemic stability by amplifying deviations- equipotentiality)
- Rules specify reference values
- Boundaries
- Open vs closed systems
- First-order vs second-order change
Gregory Bateson
Communication between schizophrenics and their family. Person labeled as symptomatic will act according to that label
Properties of a family system:
- Boundaries (may be too permeable or with unclear rules)
- Hierarchically organized
- Homeostasis (maintain steady state, process own set of mechanisms)
- Open system (energy can go freely in, within and out of the system)
Psychopathology in system therapy
- sick is the system by its dysfunctional nature. The patient is only to the extent that it is part of the system. (environment often depathologizes the person)
- When family is threatened, move toward psychotic or pathological behaviours
- When communication patterns are unclear, rules become ambiguous and psychopathology is likely to develop
Psychopathology in system therapy
Double bind theory
An individual (or group) receives two or more conflicting messages, and one message negates the other
Psychopathology in system therapy
The identified patient
- Considered an expression of the systemic family dysfunction
- The resolution of the problem is subject to the change of the family structure
- Changes in various elements of the system can favourably affect the problem
Psychopathology in system therapy
Strategic therapy suggests problems are caused by
- covert metacommunications about power
- More of the same solution creates positive feedback look and exacerbate problem
- Structural incongruities, cross-generational alliances disrupt normal lines of authorities
- Covert attempts to maintain homeostatic stability
Therapeutic process
System interventions do not intend to directly change problematic behaviours, but instead change the dysfunctional patterns of the family interaction
Objective: break the cycle seeking to apply solutions that are not “more of the same”
(1st order change= more of the same , 2nd order= affect the system parameters)
Interventions
- Redefinition
- Positive connotation
- Behavioural interventions
- Direct prescriptions
- Paradoxical prescriptions
- Ritualized prescriptions
- Rituals
- Ritualized tasks on uneven days: contradictory tasks
- Invariable prescription (separate two subsystems, no info between them)
Therapeutic relationship
Neutrality
- Not taking sides
- allied to everyone and no one
- Nonjudgemental and accepting
- Ask questions of each member, spend equal amount of time with each person
- Go around in circle, same q or same type of q
- One-way mirror: team assist in attempts of formation of special relationship with therapists
Advances available in systemic therapy
Multisystemic therapy:
- Community-based, time-limited, intensive for antisocial behaviour in youngsters
- Focus on empowering parents to solve future problems
- “Client”= all community of youth (fam, friends, school…)
- Highly structured clinical supervision
Advances available in systemic therapy
Principles
Of multisystemic therapy:
- single practitioner, 4 to 6 fams at a time
- team of 3-4 practitioners and a supervisor
- 24/7 availability: on call system
- 3 to 5 months length (4 months on average)
- work is done everywher in the community (removes barriers to service access)
Limitations of systemic therapy:
- Objectivity is impossible
- controlled research requires micro-analytical operationalization - contradicts
- Research reduces family system to a sum of conducts and verbal acts (not persons)
- Family treatment is more complicated than individual
- Difficult controlled research
Strengths of systemic therapy:
- Search for specific interaction patters that cause a specific pathology
- Include the context and social environment
- Comprehensive tool to understand family functioning
