Psychological approaches II: beyond the individual couple, family, and group work Flashcards
What engaged the development of systemic approaches?
What are the origins of structural (systemic) family therapy?
> Satisfaction with individual therapies
> Systemic family therapy was developed in mid-1950s from system theory and cybernetic theories on communication in complex systems
=> Argument: problems and “pathology” fundamentally interpersonal as opposed to individual
What was the argument of cybernetics?
Causation is best understood as a circular continuous process that relies on feedback mechanisms
E.g.
Person becomes anxious and depressed -> partner becomes worried -> children notice adult’s distress -> children become disruptive or upset -> friction between adults -> anxiety and depression…
Who are the pioneers of systemic therapy?
What is their school called and what did they start?
The Palo Alto Mental Research Institute (California)
- Bateson
- Jackson
- Weakland
- Haley
- > shared interest in the nature of the communication process
> Collaborated at the Palo Alto Mental Research Institute (MRI)
- applied anthropological observation + social system theory to families of individuals with schizophrenia
What are the three systemic approaches?
- The Palo Alto Group
- Double-bind theory (1965)
- Theodore Lidz
What did the Palo Alto Group propose?
> Symptoms of schizophrenia function to maintain homeostatic balance in families
- they are the result of interactions amongst family members
> All behaviour is communication
> Communication happens at surface (content) level AND the meta-communication (intent) level (extra-meaning)
=> Contradictions between communication levels lead to confusion (“double-bind” communication)
- e.g. exasperated parent saying “do what you want” with a frowned look and crossed arms
What does the Double-bind theory (1965) propose?
> Double-bind communication = paradoxical communication in which contradictory and logically-inconsistent messages are communicated
> Double-bind communication is used to describe how schizophrenia can be explained in context of families
> Once the receiver perceived the world in contradictory messages, he is confused
Trying to make sense of contradictory messages leads to schizophrenic symptoms
What did Theodore Lidz (1910-2001) propose?
> Investigation of family dynamics in schizophrenia
-> large number of individuals with schizophrenia reported unhealthy relationships with their families, particularly with their fathers
> Fathers have a profound influence on the development of schizophrenic symptoms in their children
=> Attention shifting to the role of the familial nucleus in the development and maintenance of psychological distress
What are the tenets (principles) of systemic therapy?
> Microsystem (home, immediate family, school) ; Mesosystem, Exosystem and Macrosystem (widely shared cultural values, beliefs, customs, and laws) all interact with the individual
-> individuals exist in relation to significant others and social networks
> Systemic therapists argue that:
- difficulties need to be explored in context of individual’s social environment
- psychotherapy should be seen as a way to help people strengthen their relationships - making disturbing symptoms less necessary or problematic
(not seen as a cure to mental illness)
What is the cultural background to systemic therapy?
> Social constructionist and postmodernist beliefs:
- reality is socially constructed by individuals in dialectical interactions
- meanings and connotations attached to objects/concepts are the result of socially-agreed conventions
> The same behaviour can have different meaning across societies and time
> Subjectivity can be investigated by studying language and communication
Regulations and interactions are negotiated and change through verbal and non-verbal communication
In systemic social theory, what characterised the family?
Family = “maker of meaning”
- communication/storytelling within families organise experiences and shape lives
- families can be dependent on these collective recollections as they are passed down from generations, limiting perceived options
- these stories are not objective accounts of reality, nut beliefs and ideas created through language and interactions
What is the argument of structural (systemic) family therapy (SFT)?
> It doesn’t matter where/what started the problem, what matters is all units of the system are interconnected
-> change in one sphere precipitates change in another sphere
> Systemic family therapists reject linear cause-and-effect as potentially carrying blame
Efforts to identify reciprocal influences / interconnectedness
> Researchers concentrate on larger family units
Family is viewed as a system or an interacting unit, with its own characteristics and rules
> Addressing symptoms and the interpersonal helped to liberate individuals from oppressive and pathologising cultures
=> This approach was revolutionary, in direct contrast to psychotherapeutic approaches which focus on the individual and assume an intrapsychic model of mental distress
What is the goal of structural (systemic) family therapy (SFT)?
Developed as a psychotherapeutic endeavour explicitly focused on:
- Altering interactions between family members
- Improve the functioning of the family as a unit
=> the locus of the problem is between people rather than within the individual
What is the evolution of systemic family therapy (SFT) as characterised by Dallos and Draper in ‘An introduction to family therapy’ (2010)?
- First order SFT:
- mid 1950s to mid 1970s
- modernist: attempted to take empirical approach to psychology (as scientific)
- structural and strategic family therapies
- attempt to classify families according to number of variables - Second order SFT:
- it became evident that such “objective” descriptions were inaccurate as different observers viewed the families’ problems in different ways
- shift in SFT, and more broadly in psychology and the social sciences -> postmodern view
- e.g. the Milan School - Third order SFT:
- emerged from social constructivist theory
- emphasised the role of language in shaping meaning - Fourth order SFT
- proposed by Dallos an Draper
- concerned with the integration of SFT and of the intrapsychic and the interpersonal
What did the Structural Family Therapy (SFT) consist of in the first order?
> Hierarchical structure of families
> Emphasised boundaries and structure (who’s in charge, how are decisions made)
> Decision-making processes and boundaries are crucial to healthy functioning of the family
> The family is a system that operates through transactional patterns, which regulate behaviours
> Individuals within a family are part of subsystems
- each belongs to multiple subsystems simultaneously
- > determines individuals’ power
In Structural (systemic) Family Therapy (SFT), what are boundaries?
> Used to protect the differentiation of the systems
Should be clear yet permeable to allow balance between autonomy and interdependencies
> Patterns of enmeshment or detachment were deemed incapacitating of family structure
> Problems result from developmental and environmental challenges that may lead to conflict avoidance through either disengagement or enmeshment
- > Boundaries become too porous, too enmeshed, too rigid, too disengaged
- > System’s failure to realign
- > Power imbalances
=> Systemic family therapists try to determine how close are family members, how flexible are the rules
- subsystem negotiation,
- dynamics between family clusters - who aligns who, who gets left out?
What is the process involved in Structural (systemic) Family Therapy (SFT)?
(therapist’s view)
Process of assessment, mapping and altering the family structure through
- escalating stress,
- creating crisis,
- enacting and balancing
What does Strategic family therapy (first order) consist of?
Who was one of the main proponents of this therapy and what did he/she propose?
What is the functionalist view point, core of this approach?
> Similar to SFT but emphasises interactional dynamics and power struggles
- resulting from a family’s need to change and reorganise at transitional stages
> Haley (1923-2007) (first order cybernetic):
- difficulties in families arise when there are incongruent and confused hierarchies
- symptomatic members get triangulated in cross-generational interactions that reinforce and contribute to the confusing hierarchies
- Functionalist view point: dysfunctional families need symptomatic behaviour as a stabilising device in order to relieve stress
<=> symptoms preserve stability
In Strategic Family Therapy, what are conflict detouring and incongruous hierarchy?
> Conflict detouring:
- identified patient becomes essential to maintaining family stability and for other members of the system to avoid confronting their own problems
> Incongruous hierarchy:
- strategic family therapists recognise the possibility that the patient uses the symptom as a strategy to control other family members
- can be used for love, protection, or domination
e.g. Parents might lose their superior position in response to the helplessness of a symptomatic child, who gains power and control
What is the position and the focus of strategic family therapists?
> Therapists view the problems as attempted solutions
> Focus on development strategies that can change need for the symptom and help balance power
> Therapists become experts and focus on the hierarchy and power struggles through directive and paradoxical tasks
- while emphasising family structure
How was the Milan School (second order SFT) developed?
> 1970s: some criticised previous approaches as too mechanical and emphasised importance of exploration of meanings, beliefs and family stories
> Milan followers (second order cybernetics) argued it’s crucial to study communication
=> It’s through communication that family relationships are defined
What does the Milan School model consist of?
> Prejudices and beliefs are located within the communicating systems
> Importance of values, background, attitudes and culture in the creation and negotiation of meaning
> Family is the maker of meaning
- tell stories which organise their experiences
> Milan School = second order cybernetics
- challenged first order cybernetics which have a functionalist view (symptoms preserve stability)
- > functional view only exists in the eye of the observer
What characterised the Milan Group?
> they did not regard clients as phenomena in reality, but as a therapeutic system consisting of the family and therapists
> used therapeutic encounters to create new meanings
-> new patterns of thought and behaviour
> focused on overcoming the “tyranny of linguistics”, which according to them keeps therapists and clients thinking in a intrapsychic linear manner
> sought to create a different language allowing them to understand families in different ways
- and allowing families to find new language open to difference and alternative meanings
- > reframe difficulties and move them from individual to relational level
> Rationale: free the family and therapeutic system from entrenched meanings that lead to systems becoming stuck
> Mental phenomena = social phenomena
- ‘mental health problem’ = problem in social interaction
> Therapies should be directed at patterns and interactions (not at individual intrapsychic dynamics)
> Problems needed to be reframed in social terms (rather than rooted in individuals)
Why can the Milan School be regarded as the most systemic family therapy?
What is the Greek Chorus?
> To maximise the systemic approach, associates work interactively in teams behind a one-way mirror
= the Greek Chorus
- offers inputs whose aims are to support, confuse, challenge and confront the family
- while remaining at a distance -> retaining an objective stance
Why can it be argued that all family therapies are systemic?
> They consider the person in a larger context of which she is simultaneously a part, yet distinct
They view the symptom of an individual member as rooted int eh family as a whole
