Systemic Theroy & Practice

Question 1

What is dominant discourse?

Answer 1

Prevailing ideas, beliefs & narratives that are widely accepted & perpetuated in society, shaping the way we make sense of our experiences

Question 2

What is the medical model?

Answer 2

How emotional experiences and behavioural expressions are related to biological causes & problems
Treats mental disorders as a biological disease - focus on persons distress, neurotransmitters, neurophysiology

Question 3

What are the uncritical uses of diagnosis?

Answer 3

Implies experience, relationships, discrimination & socio-marital factors aren’t significant
Undermines individual & cultural meaning
Results in seeing self as abnormal
Stigma/ discrimination

Question 4

What are challenges related to diagnosis?

Answer 4

Health services have been established and it organised around a medical model
Value people place on diagnosis and this could be experienced as dismissive

Question 5

What are benefits relating to diagnosis?

Answer 5

Comfort
Removal of blame
Access to services & benefits
Hope

Question 6

What are challenges of the medical model?

Answer 6

Reductionism
Over-reliance on medication
Stigmatisation
Neglect of individuals experience
Diagnostic limitations

Question 7

What is systemic therapy?

Answer 7

Psychotherapeutic evidence based approach developing in 1950s
Attends to & understands ‘symptoms’ in context

Question 8

What is the systemic perspective on mental health?

Answer 8

Diagnostic criteria based on socially constructed notions of what is normal
Idea of mental disorder changes with context

Question 9

What are systemic ways of thinking?

Answer 9

Live lives through relationships
Sense of who you are is intimately associated with relationships
Appreciation of context & understanding symptoms and distress within context that it occurs

Question 10

What does it mean to be systemic?

Answer 10

Zoom out and look at wider context - relationships, environment, social context etc
Individual distress can no longer be seen as product of individual but as complex iterative process
Give meaning to experiences we see in our lives

Question 11

What is the history for systemic thinking?

Answer 11

Based on cybernetics (study of complex systems)
Guided by principle numerous different systems can be studies
Developed in 50s/60s

Question 12

What are 1st order approaches?

Answer 12

Challenge to oppressive psychiatric practices
Make sense of problem in terms of circular aetiology, patterns of behaviours, healthy & unhealthy relationships
Positivist view - objective view

Question 13

How does homeostasis relate to this theory?

Answer 13

Families strive for sense of homeostasis
Not found = dynamic adjusted
Work to keep stable via emotional, cognitive & behavioural responses
Emerged in 50s

Question 14

What are double binds and where might you see them?

Answer 14

Conflicting relational signals cause significant distress
Parental communication, emotional expressiveness, affection & distance

Question 15

What is the family life cycle?

Answer 15

Family can experience stress, anxiety & distress at points where significant & fundamental changes need to be made
Onset of problems connected to emotionally destabilising aspects of family transitions

Question 16

What is circularity?

Answer 16

Avoids oversimplification (1 causality)
How each member in a family affects one another
Patterns may mutually influence one another
Every behaviour is a communication - individuals impacted by everyone around them

Question 17

What is the systemic concept for problems?

Answer 17

Problems in one individual can be instead be seen as product of interactional dynamics in family
Symptoms seen as problems in interactions between people, rather than residing with individuals
Circularity central to concept

Question 18

What are second order tactics?

Answer 18

Developed through late 80s/90s
Influenced by feminist critique & challenges first order approaches
Problems are patterns of meaning making in relation to problems & relationships - attention to wider context
Looks at social constructionist, post modernism, reflexivity

Question 19

What are core assumptions of second order systemic?

Answer 19

Appreciation power
Language creates meaning
Acknowledging multiple truths
Living with curiosity
Persons as separate to problems
Social GGRRAACCESS
Self

Question 20

What is formulation?

Answer 20

Therapy is interactional & collaborative
Therapist does it with family, not to them

Question 21

How is formulation used in an alternative way?

Answer 21

Alternative to diagnosis as it focuses on unique interactions, personal history, context & relational dynamics influencing a persons experiences

Question 22

What are features of formulations?

Answer 22

Collaborative
Informed by evidence
Offer ideas about how problems developed, maintained & what would help
Non-blaming
Open to re-working
Consider strengths
Valid for person

Question 23

What are characteristics of systemic formulation?

Answer 23

Problems regarded as residing in relational processes
Centrally concerned with exploring meanings, understanding & explanations that family members hold about problems
Dynamic process
Promote change
Collaborative

Question 24

What is systemic intervention?

Answer 24

Focus on relationship & creating safety
Collaborative
Understanding & valuing people
Making meaning of distress in context
Attending to relationships
Double listening - distress stories & smaller stories of resilience
Attend to difficulties in context

Question 25

What are critiques of systemic approaches?

Answer 25

Early first order therapy didn’t attention to power within relationships, based on mechanical systems
Contrast with medical model, which is dominant for distress