Family Therapy: Key Aspects
- Family members bring beliefs into their relationship from their families of origin and wider systems, e.g. society, culture, etc. (and so do the therapists!).
- Systemic approaches view a person and the ‘problem’ in contexts of relationships.
- Solution becomes part of the problem. Problems are part of sequences of interaction, which maintain and are maintained by the problem.
- Symptoms are viewed as communication about the relationship system. (.symptoms can have an impact on and are impacted by the systemic system , and can sometimes plan an important role in change within this system)
- Circular causality
- Therapy aims to change the relationships and interactional patterns
The description of the problem being different depending on who you ask. As a therapist, have to explore everyone’s perspective without taking sides. Helping the family members to see the problem in more relational contexts and interactional patterns
Once people have a more relational understanding of the problem, they can then start thinking about the role they play in the interaction, and what small steps they can both take to change their own behaviour and to change the interactional pattern
Focus of therapy
- The meaning and function of the problem in the particular family, at this particular time, of this particular symptom.
- How well the family manage conflict and negotiate the transition between stages.
- The model is also criticised for being pathology orientated, rather than acknowledging that we all change in time.
Key ideas in systemic practice
Milan Systemic approach
- Joining (.Therapist trying to join the family system, the idea being that the system that need ideas for change, would not accept these if they are too differnet, because they may be perceived as too threatening, and the therapist might be rejected)
- Reframing: Changes the original meaning of an event or situation.
- Hypothesising: Systemic or relational statement; formulation of problems in context of relationships; starting point of interviewing
- Circularity: The therapist uses questions to understand the relationships and use the feedback to form the next question; Circular questions are designed to elicit differences.
- Neutrality: in relation to family members; neutral and non-judgmental stance on the beliefs and values of the family; neutrality about the problem or the symptom (e.g. Who enjoys fighting most?; the problem might serve some kind of function within the system); neutrality about change and outcome
Circular questions: Milan Systemic approach
(Palazzoli Selvini et al., 1980; Cecchin, 1987)
- Connections between people, ideas and feelings
- Differences and similarities (comparison) between people
- Patterns of relationships
- Patterns of relationships over time
- Ask about behaviour rather than descriptions of individual characteristics: What does she do that makes you say she is xxx?
- Exploring interactive behaviour: When John loses control and pushes you, what do you do? What does your partner do? Then what happens?
- Ranking questions: Who is most worried about the problem? Who would notice when he is feeling low? Who next?
- Changes in relationships at different points in time, before and after a specific events: Did they get close to each other before or after your father died?
- Mind reading (gossiping) questions: If I were to ask your wife xyz…, what do you think she would say? Hypothetical questions: If your daughter left home who do you think would be able to take her place for your husband?
Future questions: If this situation continues for another year, what do you think will happen?
Other useful techniques
- Enactment (Structural Family Therapy)
- Externalising the Problem (Narrative Therapy)
- Internalised Interviewing Other
Definition of Family
As a therapist we have to be mindful of different deffinitions of family, and our own accounts of it
- The definition of a ‘family’ varies depending on the social and cultural contexts. Some people may have personal definitions.
- Many people today are in families that are not traditionally structured, e.g. single parents with children, remarried or 'reconstituted' families, childless couples, gay and lesbian couples with or without children, single people, etc.
- '…persisting with the idea of 'family' rather than 'families' makes it likely that all these ('deviant') configurations will regard themselves, or be regarded by others, as not forming 'proper' families' (Jones, 1993, p.xxvii).
The ‘functional/healthy’ family
Structural Family Therapy approach
- . focus on how the family is structured, and how this impacts on the problem. About relationships between family members and the roles they play
- The functional family that allows individuals to develop is assumed to have following characteristics.
- Boundaries: Clear boundaries between parental and children subsystems
- Hierarchy: Clear hierarchy between subsystems, parents in charge of the children
- Flexibility/Adaptability: Capacity to adapt to changed circumstances
- Alignment: The absence of cross-generational alliances and stable coalitions
The ‘Dysfunctional’ Family
- Diffuse (enmeshment)
- Rigid (disengagement)
- Collapsed (parents and children equal)
- Inverted (child is parentified)
- Alliance and coalition:
- Triangulation (conflict between two people is diverted through the third)
- Cross generational alliance and coalition, indicative of poor parental alliance
Key ideas about a Family System
- An evolving system
- Mutual influence (Wiener, 1961): family members influence, and are influenced by, others
- An open system. It influences and is influenced by wider systems, e.g. extended family, community, society, culture, etc.
- ‘You cannot not communicate’. Content and process levels of communication (.whatever you do or don’t do, or whatever you say or don’t say is a form of communication)
- Content: The issue under discussion
- Process: patterns of interaction
- Have to acknowledge and be mindful of both – the content and the process of communication
- Family members relate to each other as if there were certain rules governing the various aspects of their relationship.