Lesson Proper for Week 15

I. Family Systems Perspective

 In this sense, a family systems perspective holds that individuals are best understood
through assessing the interactions between and among family members. The
development and behavior of one family member is inextricably interconnected with
others in the family.

 Symptoms are often viewed as an expression of a set of habits and patterns within a
family. It is revolutionary to conclude that the identified client’s problem might be a
symptom of how the system functions, not just a symptom of the individual’s
maladjustment, history, and psychosocial development.

 This perspective is grounded on the assumptions that a client’s problematic behavior

may (1) serve a function or purpose for the family, (2) be unintentionally maintained
by family processes, (3) be a function of the family’s inability to operate
productively, especially during developmental transitions, or (4) be a symptom of
dysfunctional patterns handed down across generations. All these assumptions
challenge the more traditional intrapsychic frameworks for conceptualizing human
problems and their formation.

II. Differences between Systemic and Individual Approaches

 There are significant differences between individual therapeutic approaches and

systemic approaches.

 A case may help to illustrate these differences. Ann, age 22, sees a counselor because
she is suffering from a depression that has total behavior lasted for more than 2 years
and has impaired her ability to maintain friendships and work productively. She
wants to feel better, but she is pessimistic about her chances. How will a therapist
choose to help her? Both the individual therapist and the systemic therapist are
interested in Ann’s current living situation and life experiences.

 Both discover that she is still living at home with her parents, who are in their 60s.
They note that she has a very successful older sister, who is a prominent lawyer in the
small town in which the two live.

 The therapists are impressed by Ann’s loss of friends who have married and left town
over the years while she stayed behind, often lonely and isolated. Finally, both
therapists note that Ann’s depression affects others as well as herself. It is here,
however, that the similarities tend to end:
  The individual therapist may:
o Focus on obtaining an accurate diagnosis, perhaps using the DSM-V
(American Psychiatric Association, 2013).
o Begin therapy with Ann immediately.
o Focus on the causes, purposes, and cognitive, emotional, and behavioral
processes involved in Ann’s depression and coping.
o Be concerned with Ann’s individual experiences and perspectives.
o Intervene in ways designed to help Ann cope.

 The systemic therapist may:

o Explore the system for family process and rules, perhaps using a
genogram.
o Invite Ann’s mother, father, and sister into therapy with her.
o Focus on the family relationships within which the continuation of Ann’s
depression “makes sense”.
o Be concerned with transgenerational meanings, rules, cultural, and gender
perspectives within the system, and even the community and larger
systems affecting the family.
o Intervene in ways designed to help change Ann’s context.

III. The Development of Family Systems Therapy

a. Adlerian Family Therapy

 Adler (1927) was the first to notice that the development of children within the family
constellation (his phrase for family system) was heavily influenced by birth order.

 Adler was a phenomenologist, and even though birth order appeared to have some
constancy to each position, he believed it was the interpretations children assigned to
their birth positions that counted.

 Adler also noted that all behavior was purposeful—and that children often acted in
patterns motivated by a desire to belong, even when these patterns were useless or
mistaken.

b. Multigenerational Family Therapy

 One of Bowen’s key concepts is triangulation, a process in which triads result in a

two-against- one experience. Bowen assumed that triangulation could easily happen
between family members and the therapist, which is why Bowen placed so much
emphasis on his trainees becoming aware of their own family-of-origin issues.
  A major contribution of Bowen’s theory is the notion of differentiation of the self.

 Differentiation of the self involves both the psychological separation of intellect and
emotion and independence of the self from others.

 In the process of individuation, individuals acquire a sense of self-identity. This

differentiation from the family of origin enables them to accept personal
responsibility for their thoughts, feelings, perceptions, and actions.

c. Keep the Therapy in the Present

 The reality therapist does not totally reject the past. If the client wants to talk about
past successes or good relationships in the past, the therapist will listen because these
may be repeated in the present.

 Reality therapists will devote only enough time to past failures to assure clients that
they are not rejecting them. As soon as possible, therapists tell clients: “What has
happened is over; it can’t be changed.

 The more time we spend looking back, the more we avoid looking forward.”
Although the past has propelled us to the present, it does not have to determine our
future.

d. Human Validation Process Model

 Over her lifetime as a family therapist, Satir gained international fame and developed
many innovative interventions. She was highly intuitive and believed spontaneity,
creativity, humor, self-disclosure, risk-taking, and personal touch were central to
family therapy.

 In her view, techniques were secondary to the relationship the therapist develops with
the family.

Her experiential and humanistic approach came to be called the human validation process model,
but her early work with families was best known as conjoint family therapy.

e. Experiential Family Therapy

 Whitaker’s freewheeling, intuitive approach sought to unmask pretense and create

new meaning while liberating family members to be themselves. Whitaker did not
 propose a set of methods; rather, it is the personal involvement of the therapist with a
family that makes a difference.

 When techniques are employed, they arise from the therapist’s intuitive and
spontaneous reactions to the present situation and are designed to increase clients’
awareness of their inner potential and to open channels of family interaction.

d. Structural-Strategic Family Therapy

 In the late 1960s Jay Haley joined Minuchin at the Philadelphia Child Guidance
Clinic. The work of Haley and Minuchin shared so many similarities in goals and
process that many clinicians in the 1980s and 1990s would question whether the two
models were distinct schools of thought.

Indeed, by the late 1970s, structural-strategic approaches were the most used models in family
systems therapy.

 Both models seek to reorganize dysfunctional or problematic structures in the

families; boundary setting, unbalancing, reframing, ordeals, and enactments all
became part of the family therapeutic process.

 Neither approach deals much with exploration or interpretation of the past. Rather, it
is the job of structural-strategic therapists to join with the family, to block stereotyped
interactional patterns, to reorganize family hierarchies or subsystems, and to facilitate
the development of more flexible or useful transactions.

IV. Eight Lenses in Family Systems Therapy

a. The Individual’s Internal Family System

 Every theorist-practitioner who works with the concepts of internal parts posits a
super-entity that integrates, governs, organizes, and selects essential parts.

 That entity, known as the self or the person, is the “whole” of the individual system—
that which operates the rest of the parts. Stan is currently struggling with such a
reorganization of his internal parts.

b. The Teleological Lens

 Teleology refers to the study of final causes, goals, endpoints, and purposes.
  The teleological lens enables the family therapist to develop an understanding of what
motivates individual behavior, the systemic purposes of symptoms, the goals of
triangulation, and the uses of patterned interactions and routines.

 Purposeful actions promote growth and development when they are characterized by
reasonable risk, courage, confidence, self-esteem, energy, optimism, hope, and
sequences of experience that open even wider possibilities for experience.

 Alternatively, actions and interactions characterized by retreat, fear, and protection

tend to constrain growth and development. Both individuals and families-as-a-whole
act purposively.

c. The Organization Lens

 Individuals and families have some organizing process that holds everything together
and provides a sense of unity. In family systems, organization is manifest in family
rules, routines, rituals, and expected roles (that is, the living structure of the family).

 In the early years of family therapy, emphasis was given to the concept of the
hierarchical structure of the family system, and strategic interventions were designed
to establish a more functional hierarchy and to redistribute the power in the system
toward more productive ends.

d. The Developmental Lens

 Unlike individual development models that map the stages of life from birth onward,
the family life cycle focuses on six significant transitions (Carter & McGoldrick,
2005):

1. A single, young adult leaves home to live a more or less independent life.
2. Individuals marry or become a couple to build a life together.
3. The couple has children and starts a family.
4. The children become adolescents.
5. The parents launch their children into the world and prepare to live a life without children.
6. The family reaches its later years where children may have to care for parents as well as their
own children, and the parents prepare for the end of their lives.

e. The Multicultural Lens

  A multicultural lens challenges the privilege of the dominant culture and introduces
diversity and complexity into our understanding of the human condition. By
reframing the dominant culture as simply one of many, an appreciation and valuing of
diversity is fostered.

 McGoldrick, Giordano, and Garcia-Preto (2005) describe the multiple cultures that
comprise

Europe and that have “blended” into the dominant culture we call “American.”

 This multiplicity challenges the notion that there is a single Western norm to which
all people should aspire. As therapists, we do well to consider that our perspective
might be biased and only one of many useful perspectives in understanding reality.

f. The Gender Lens

 The oldest and most pervasive discrimination and oppression in the world is against
women in all cultures, and with few exceptions, across the human life span. Feminists
have challenged not only the fundamental precepts of family therapy (Luepnitz,
1988) but also the idea that the family, itself, is good for women (Hare-Mustin,
1978).

 Women still bear the largest responsibility for and most of the work related to child
rearing, kin-keeping, homemaking, and community involvement.

 Financially, women tend to earn less than men in comparable positions. Even when
women earn significant wages, they may not have much say in how the family
finances are spent. Between a man and a woman, the woman is more likely to be
expected to sacrifice herself for the good of the whole.

g. The Process Lens

 To function effectively, couples and families create routines that enable them to meet
the needs and demands of everyday life (Satir & Bitter, 2000). As long as these
routines generally help and enable people within their living systems, they are
maintained as the status quo.

 When essential routines are interfered with, the result is a disruption that throws a
system out of balance. In the face of disruption, families may initially seek to retreat,
but they generally fall into a state of chaos.
 Because chaos is experienced as crisis, family members often want to make huge
decisions even though everything seems out of balance. Therapists immediately
become one of the family’s external resources with a primary responsibility to help
individuals reconnect with their internal resources and strengths, which are often not
recognized.