Family Systems Therapy

Question 1

give a brief overview of family systems therapy

Answer 1

Helps individuals resolve their problems in the context of their family units,
where many problems are likely to begin. Each family member works together with
the others to better understand their group dynamic and
how their individual actions affect each other and the family unit as a whole.

One of the most important premises of family systems therapy is that what happens to one member of a family happens to everyone in the family.

Question 2

WHo is associated with family systems therapy?

Answer 2

Murray Bowen

Alfred Adler

Question 3

What are the key concepts of family systems therapy?

Answer 3

Families are multilayered systems that both affect and are affected by the larger systems in which they are embedded.

Families can be described in terms of their individual members and the various roles they play, the relationships between the members, and the sequential patterns of the interactions and the purposes these sequences serve.

Question 4

What is family systems therapy’s view of human nature?

Answer 4

FIND

Question 5

What is the focus of family system’s therapy?

Answer 5

FIND

Question 6

What are the goals of family systems therapy?

Answer 6

1. To facilitate change

Question 7

What is the role of the therapist in family systems therapy?

Answer 7

The therapist is socially active and aids clients in taking a preferred stand in relation to
the dominant culture that may be oppressing them.

Question 8

What is the clients’ experience in family systems therapy?

Answer 8

FIND

Question 9

What is the client therapist relationship in family systems therapy?

Answer 9

A multilayered approach to family therapy is best supported by a
collaborative therapist–client relationship in which mutual respect, caring, empathy, and
a genuine interest in others is primary. In addition, we believe directed actions and enactments
are most useful when they are a joint venture of both the therapist and the family.

Question 10

What are the methods, techniques and procedures associated with family systems therapy?

Answer 10

Genograms: enable the family structure and stories to be presented
in a clearer, more orderly manner (a map of the family)
- The parents are listed with their name, age, and date of birth in either a rectangle (for males) or a circle (for females).
- A double square or a double circle to indicate the index person, or person on whom the genogram is focused.
- An upside-down triangle in a square or circle is used to indicate a gay man or a lesbian woman. We shade the bottom half of a square or circle to indicate substance abuse.
- We use double parallel lines to indicate a strong relationship between two people and three parallel lines to indicate a fused or enmeshed relationship
- A dotted line indicates a distant relationship, and conflict is indicated with lines that look like an up and down zigzag

Question 11

What is a strength of family systems therapy from a diversity perspectivr?

Answer 11

One of the strengths of the systemic perspective in working from a
multicultural framework is that many ethnic and cultural groups place great
value on the extended family. If therapists are working with an individual
from a cultural background that gives special value to including grandparents,
aunts, and uncles in the treatment, it is easy to see that family approaches have
a distinct advantage over individual therapy

Question 12

What are the limitations of family systems therapy from a diversity perspective?

Answer 12

This model advocates for the
individual and not the collective

Question 13

Describe family systems therapy

Answer 13

Family systems therapy is a rapidly developing field. The purpose of this lesson is to introduce you to the family systems perspective and make you aware of the major types of therapy that are in use today. The viability of any system is based on order and structure. From a general theoretical perspective individual family members cannot be understood without knowing how a family functions as a whole unit. Change in any part of a system will impact the whole system. The individual orientation places the source of dysfunction with the client, whereas the systems orientation focuses on the interpersonal context in which the client lives. The primary purpose of any family system is the maintenance of an acceptable behavioural balance within the family (Goldenberg & Goldenberg, 2000).

Question 14

Upon completion of the lesson you should be able to:

describe the key concepts involved in family systems therapy in general;
describe specific aspects and techniques characteristic of each type of family therapy;
outline the therapeutic process with respect to the role of the therapist, the client, and the relationship between the two;
evaluate the degree to which the various approaches to family therapy are consistent with your theoretical notions of a counsellor.
Readings

The text reading for this lesson is Chapter 14 of Corey’s Theory and Practice of Counseling and Psychotherapy and the supplementary articles by Charles (2001) and Suddeath et al. (2017). Read the chapter before you begin to work on the lesson in order to get an overview of the theories.

Question 15

What are the general principles of family systems therapy?

Answer 15

In its 40-year history, the family therapy movement has not yet developed a single integrated theory that would be shared by all family systems theorists (Guerin & Chabot, 1997). However, some general underlying principles have emerged and they highlight the most salient differences between the systems perspective and the more traditional views encountered in individual counselling.

Family systems therapy focuses on the whole family as a unit, rather than on an individual client. As a system, the family is a group of members interacting with one another.

As any system, a family unit has a self-regulating mechanism that aims at maintaining a state of equilibrium, or homeostasis. Given this tendency towards maintaining the status quo, changes may be perceived by family members as undesirable, even traumatic, and a lot of energy may be spent in trying to prevent or delay change.

On the other hand, a paradoxical tendency ensures that family units continually change and advance toward different levels of functioning and organization. “The balance between change and stability enables the family to function adaptively throughout the family’s and individual’s life cycle” (Kaslow & Celano, 1995, p. 346).

Family therapists adopt a holistic perspective according to which the family system is qualitatively more than just the sum of its members.

Based on the holistic view mentioned above, family therapists acknowledge the synergistic effect of change, which means that one change occurring in one family member can impact on other levels of functioning within that family system.

Family therapists adopt the view of circular causality (as opposed to linear causality), according to which singular events are seen as both cause and effect and are reciprocally related. As such, family systems continuously exchange information through feedback loops. Kaslow and Celano (1995) defined the feedback loops as “circular patterns of responses, in which there is a return flow of information within the system” (p. 346). The feedback can be positive (enabling families to evolve to a new state), or negative (counteracting deviations in the system to restore homeostasis).

Most family therapists accept the role played by the transmission of patterns of family functioning from one generation to the next, be it through genetically inherited predispositions or through the mechanisms of social learning.

Question 16

What are the approaches to family therapy?

Answer 16

In its relatively short history, the family therapy movement generated a number of distinct approaches or models and the exchange of ideas among various family systems theorists has created a very fertile landscape of theoretical assumptions and practical techniques. In Chapter 14 of your textbook, Corey (2017) presents some differences and commonalities among various approaches to family therapy. Building on the material presented in previous chapters, particularly the ones related to psychoanalysis, Adlerian counselling, and Gestalt therapy, Corey’s comments help you appreciate the various influences that other schools of psychotherapy have had on the development of family therapy. As such, reading this chapter can also serve as a review, from a different (systems) angle, of some of the material you studied in previous lessons.

Of course, the ideas and theories developed by the family systems school did not appear out of thin air; a number of precursors have been acknowledged for their considerable influences on the contemporary systemic views. Among them: Sigmund Freud, Alfred Adler, Harry Stack Sullivan, the Object Relations school (in particular Melanie Klein and W. R. D. Fairbairn), and the Gestalt school.

In this lesson, I would like to introduce you to the classification of family therapy approaches proposed by Guerin and Chabot (1997), and briefly review the main representatives of each approach and the major concepts they contributed to the development of family systems therapy. In addition to the family therapy models presented here, there are a number of more recent approaches have been developed under the influence of contemporary trends in psychotherapy, such as: solution-focused, constructive-narrative, psychoeducational, etc.

Question 17

What is strategic communication in family systems therapy?

Answer 17

Representatives: Gregory Bateson, Jay Haley, Cloe Madanes, John Weakland, Don Jackson
There are three conceptual directions included under this school: (1) the communication school (lead by G. Bateson), (2) the problem solving therapy (Haley and Madanes), and the brief therapy approach (which later included Paul Watzlawick).

The Bateson Project began in California in the early 1950’s with the purpose of exploring the way in which communication patterns in families with a schizophrenic member could be understood in the relationship context or culture in which the symptoms were produced. One of the earliest and most important concepts developed by the Bateson group was that of the double bind. The concept is related to the notions of family homeostasis and multiple, often contradictory levels of communication in relationships. As Guerin and Chabot (1997) explain, “in certain relationship situations an overt and explicit meaning of a communication is contradicted by the implicit metamessage” (p. 184). The frequently cited example of such a bind is when a person in a relationship expresses to the other the command “dominate me”. When the person addressed obeys the command he or she is only doing the opposite of domination. Families that enact such patterns of communication create a potentially malignant context in which symptomatic behaviour is fostered.

Don Jackson is credited with extending the concept of the double bind to what is known as the therapeutic double bind. The therapeutic double bind is a type of paradoxical injunction used by family therapists to help clients change symptomatic behaviours. This therapeutic concept is based on the recognition of the general tendency to resist change (and thus oppose the therapist’s recommendations) intrinsic in most family clients. “This technique prescribes the symptom and is based on an attempt to turn the neutral oppositional forces within the family system onto the pathological process under investigation, thereby neutralizing the pathological forces and eliminating the symptoms” (Guerin & Chabot, 1997, p. 185).

Jackson is also credited with the introduction of the concept of homeostasis, according to which, families, like other organic systems, resist change and strive to maintain the status quo in relationships, often at considerable emotional cost to one of their members. He was also among the first to observe how a child’s behavioural symptoms provided a camouflage for covert parental conflict.

One of the characteristics of Jay Haley’s method was his string belief in the uselessness of direct educational techniques. Unlike other family therapists who would deal with the phenomenon of triangulation by educating the families about this process, Haley preferred to operate covertly upon the process of power within a relationship.

Bateson’s focus on communication processes, as well as the strategic therapy of Milton Erickson has significantly influenced the problem-solving strategy developed by Haley and Madanes (Madanes, 1981). This approach is relatively short-term and pragmatic, focusing on symptoms as unacknowledged ways of communicating within the family. Also, together with his wife, Cloe Madanes, Haley developed a strategic therapeutic approach for working with severe marital dysfunction, called ordeal therapy (Haley, 1984).

Paul Watzlawick is credited with having introduced the distinction between first-order change and second-order change. Watzlawick, Weakland, and Fish (1974) also addressed such issues as problem formation, problem resolution, reframing, and the use of paradox.

Question 18

Who are the representatives of multigenerational family therapy?

Answer 18

Representatives: John Bell, Murray Bowen
The goal in psychoanalytical multigenerational family therapy is to increase the clients’ insight into relationship dynamics. Psychoanalytically oriented family therapists focus on patterns of ego defenses, particularly the use of splitting and projective identification.

John Bell is credited with the application of group therapy principles in his approach to family counselling. He proposed that, during the therapeutic process of change, family members experience a sequence of stages similar to those of group development: initiation, testing, struggle for power, settling on a common task, working on the common task, achieving completion, and finally separation. By separation, Bell (1974) meant the readiness of the family group to separate from the therapist and resume its natural developmental life. Bell strongly believed in the importance of maintaining effective boundaries between the counsellor and the family group.

As a family theorist, Bowen advocated for conceptual parsimony and adopted a strong anti-eclectic attitude. Based on psychoanalytic principles, his approach “is the most comprehensive model of family systems theory insofar as it consists of a defined number of concepts with a corresponding clinical methodology closely linked with the theory” (Guerin & Chabot, 1997, p. 196). One of his most important constructs is that of differentiation of self, which Bowen contrasts to that of emotional fusion within the dyad. He believed that, in a dysfunctional family, each individual is entrapped in a reactive emotional process, a kind of chain reaction that increases the level of anxiety throughout the relationship system.

Among other important concepts explored by Bowen are: triangulation, emotional cut-off, multigenerational transmission, sibling rivalry, and societal regression. When there is a great deal of friction or conflict within a marriage, there is a tendency to triangulate or focus on the third party. The third party can be the marriage itself, a child, or even a somatic complaint. Therapy is necessary when individuals are enmeshed in their families of origin and thus unable to assert their feelings and thoughts. (Kerr & Bowen, 1988).

Among the techniques representative of multigenerational family therapy

the genogram is used to identify transmission process and the dynamic structure of at least three generations in a given family.

Question 19

Who are the representatives of experientalists in family therapy?

Answer 19

Representatives: Carl Whitaker, Virginia Satir
Experiential/Symbolic Family Therapy advocates non-rational, creative experiences and lets the form of these methods develop as therapy unfolds (Gladding, 1996). The goal of therapy is to change family patterns of behaving and help family members become more honest, open, and spontaneous with each other as a result. The therapy aims to uncover and use the unconscious life of the family based on the idea that disrupting rigidity in the system brings about change. The therapist is unconventional and sometimes uses absurdity in working with families. He or she often acts as a family coach, is active, and personally involved.

While generally adopting an atheoretical stance, Carl Whitaker focuses on intuition, feelings and unconscious processes. The goal of his approach to family therapy is for family members to achieve a sense of autonomy and a sense of belonging. Whitaker is also known for his use of the technique of exaggeration (similar to paradoxical intention; also see Gestalt therapy).

As pointed out by Guerin and Chabot (1997), “Virginia Satir, like Whitaker, represents a clinical method that is highly personalized, experiential, and immensely popular” (p. 204). Virginia Satir is more important as a skilled clinician and teacher than as an original theorist. Her approach to family therapy is direct, sometimes didactic, yet always characterized by a warm and empathic style. Far that reason, her approach to family therapy has been also known as the Human Validation Model. Satir’s focus is on self-esteem, communication, rules of interaction, and the family linkage to society. Satir believes that families do not function as closed systems separate from society, but rather connected to larger systems in society. The Human Validation model uses sculpting, role playing, and empathy.

According to Satir, when family members are under stress, they may handle their communication in one of four unproductive roles (Gladding, 1999):

placator: agrees and tries to please.
blamer: dominates and finds fault
responsible analyzer: remains emotionally detached and intellectual.
distractor: interrupts and constantly chatters about irrelevant topics.

Question 20

Who are the representatives of the structuralists in family systems therapy?

Answer 20

Representatives: Nathan Ackerman, Salvador Minuchin
The contributions made by the structural school of family therapy are rooted in the work of Alfred Adler (particularly his concept of the influence of families on troubled children) and the clinical experience gained from working with dysfunctional children and adolescents.

As a psychoanalytically oriented family therapist, Ackerman focused on the family members’ use of ego defenses and on the impact of the social context on family functioning. Ackerman’s most important contribution to the field of family therapy was his insistence on the need for a typology of families. In The Psychodynamics of Family Life, Ackerman (1958) propose a clinical, symptom-based typology of families along the following categories:

disturbance of marital pairs;
disturbance of parental pairs;
disturbance of childhood;
disturbance of adolescence; and
psychosomatic families.
Ackerman was Minuchin’s supervisor during the latter’s psychiatric training. Salvador Minuchin’s conceptual model relies on the notion that families are determined by structure, function, boundaries between subsystems, and degrees of functional attachment among individual members. Families with dysfunctional structures are grouped into two categories: enmeshed families (characterized by overly permeable or absent boundaries) and disengaged families (rigid boundaries between individuals, without flexibility of response or sufficient relationship attachment). Among the techniques used by Minuchin in his structural approach to family therapy are: reframing (to help clients change their perception of the problem) and enactment (family members are instructed to act out a conflict, which helps clients work with the presenting concern as it appears in the here-and-now).

According to Guerin and Chabot (1997), “one of the most admirable aspects of Minuchin’s work has been the ability to make his conceptual ideas and clinical methodologies effective with an underprivileged population” (p. 210).

Question 21

What is the assessment in family therapy?

Answer 21

Despite the growing consensus around the value of family assessment, there is a lot of divergence among theorists and clinicians regarding the range of constructs to be examined, their interrelationship, and the interpretation of the underlying processes (Kaslow & Celano, 1995). From a counselling perspective, assessment of family functioning must be integrated into the therapeutic process, “as it is cost-effective and yields a relatively rapid overview of marital/family dynamics, useful in problem identification, treatment selection, evaluation of ongoing therapy, and termination of treatment efficacy” (p. 352).

There are innumerable self-report instruments designed to assess family adjustment. Thee are also numerous self-report measures of marital communication and intimacy, family life events, and the quality of family life. The following are the most frequently used self-report measures of family dynamics.

The Dyadic Adjustment Scale (DAS) (Spanier, 1976) and Abbreviated Dyadic Adjustment Scale (ADAS) (Sharpley, 1984)
Family Environment Scale (FES) (Moos & Moos, 1981)
Family Adaptability and Cohesion Evaluation Scales (FACES) (Olson, et al., 1983)
The McMaster Family Assessment Device (FAD) (Epstein, Baldwin, & Bishop, 1983)
Family Assessment Measure (FAM) (Skinner, Steinhauer, & Santa-Barbara, 1983)
For those of you interested in finding out more about specific psychological assessment instruments, I have included links to two important websites for conducting test research.

Question 22

Of the many approaches to family counselling addressed in this lesson, which one do you prefer? What are the reasons for your choice?
Articulate the main points of a feminist critique of family systems therapy.
What, in your opinion, may be some cross-cultural limitations of some of the family therapy approaches discussed in this lesson?
How would a Gestalt therapist work with families to bring about change?
How would an Adlerian therapist work with families to bring about change?