Third-Order Thinking in Family Therapy: Addressing

Social Justice Across Family Therapy Practice

TERESA McDOWELL*
CARMEN KNUDSON-MARTIN*
J. MARIA BERMUDEZ†

To read this article in Spanish, please see the article’s Supporting Information on Wiley Online Library
(wileyonlinelibrary.com/journal/famp).

We contend that the field of family therapy is undergoing a notable shift from second- to
third-order thinking. We offer theoretical support and examples to demonstrate how third-
order thinking provides a framework for integrating heightened sociocultural attunement
into family therapy practice. We discuss the importance of third-order thinking relative to
being prepared to invite families into third-order change. Finally, we offer a case example
to show specific guidelines for third-order practice.

Keywords: Third Order; Thinking; Change; Family Therapy

Fam Proc 58:9–22, 2019

THIRD-ORDER THINKING IN FAMILY THERAPY

F amily therapy instituted a new way of thinking that framed clinical problems as part
of a larger whole and enabled practices that targeted systemic change. Although many
family therapists and scholars still consider themselves systems thinkers, a first-order,
general systems approach was limited and relatively short-lived; primarily because the
metaphor of families as being similar to mechanical or biological self-correcting systems
was reductionistic. Feminist family scholars challenged first-order thinking by pointing
out how inequities in societal systems impact family roles and power dynamics (Hair,
Fine, & Ryan, 1996; Hare-Mustin, 1978). In time, Hoffman (1981, 1985) and others (e.g.,
Anderson & Goolishan, 1992; Keeney, 1983) called for second-order systems thinking; a
shift that included acknowledging the influence of our own context and viewpoint on how
we “know” families with whom we work. Second-order thinking opened the door for recog-
nizing the impact of the therapist’s role in the therapeutic system and understanding fam-
ily therapy itself as a situated, polyvocal, and potentially contested process. Social
constructivists ushered in yet another shift, challenging the very foundations of our
advent as uniquely relying on systems theory to understand families (Dickerson, 2014)
and expanding the focus on social context.
We argue that critical and social constructivist understandings of power and social con-
text are leading to another important shift that has the potential to influence practice
across family therapy models. What we are calling third-order thinking builds on our past,
drawing on Bateson’s (1972) idea of third-order learning to make visible systems of sys-
tems. By systems of systems, we mean the complex interaction within and between

*Lewis & Clark Graduate School of Education and Counseling, Portland, OR.
†
University of Georgia, Athens, GA.
Correspondence concerning this article should be addressed to Teresa McDowell, Ed.D., Chair Depart-
ment of Counseling Psychology MSC 86, Lewis & Clark Graduate School of Education and Counseling,
0615 S.W. Palatine Hill Rd., Portland, OR, 97219. E-mail: teresamc@lclark.edu

9
Family Process, Vol. 58, No. 1, 2019 © 2018 Family Process Institute
doi: 10.1111/famp.12383
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societal systems (e.g., economic, political, social). Third-order thinking requires therapists
to expand the metaview of their participation with families to more intentionally include
the impact of societal systems and power dynamics as well as collective meaning making
and culture. This allows us to conceptualize sets of alternatives within interconnecting
systems and effectively respond, providing a framework for how to integrate heightened
sociocultural awareness more effectively across our practices (McDowell, Knudson-Mar-
tin, & Bermudez, 2018).
Many in the field, ourselves among them, have grappled with how to theoretically and
practically integrate our increasing awareness of the influence of institutional, sociocon-
textual, and societal power processes into clinical work (e.g., D’Arrigo-Patrick, Hoff, Knud-
son-Martin, & Tuttle, 2017; Falicov, 1995, 2014; Garcia & McDowell, 2010; McGoldrick &
Hardy, 2008). Some approaches intentionally consider the relationship between societal
discourses and family narratives, couple power dynamics and societal power dynamics,
and/or the effect of societal systems of power and privilege on families (e.g., the Cultural
Context Model, Almeida, Dolan-Del Vecchio, & Parker, 2008; Narrative Family Therapy,
White & Epstein, 1990; Socio-Emotional Relational Therapy, Knudson-Martin & Huener-
gardt, 2010; and Just Therapy, Waldegrave & Tamasese, 1994). Many family therapists,
however, find themselves drawing on disparate epistemological frameworks to do so, even
within the same day (Hoff & Distelberg, 2017). It can also be difficult, even when using
conceptual frameworks that consider the impact of societal systems on a theoretical level,
to apply these understandings to the relational dynamics and material realities of clients’
lives (McDowell, 2015).
In this paper, we invite family therapists to go back to what we have always known
about the importance of societal context and to do so in ways that guide us forward. We
propose a deliberate shift in the field toward third-order thinking that recognizes why
power matters (Knudson-Martin, 2013), acknowledges the material realities associated
with societal systems, and supports social and relational equity across all family therapy
models (McDowell et al., 2018). In what follows, we attempt to honor enduring systems’
concepts without allowing the metaphor of systems to limit or regulate our understanding
of social construction or the nature of truth. We move from a more narrow view of systems
as “real” to a broader meaning of systems as a metaphor that is one way to describe rela-
tional processes. Just as we employ metaphors such as narratives, family structure, sche-
mas, and attachment to organizing our understanding of families and our ability to move
within the frameworks of our understanding, so we employ metaphors such as societal
systems, culture, and power to understand and move within complex social contexts.
We contend that family therapists are able to invite third-order change by fully embrac-
ing an understanding of families and therapists as part of therapeutic processes embedded
in societal context and power dynamics. We put forth that while first- and second-order
change continue to have an important place in the practice of family therapy, as a field we
are evolving to more routinely include the potential for third-order change (McDowell,
2015; McDowell et al., 2018). Elsewhere in our work (McDowell et al., 2018), we have
illustrated how societal context and power can be conceptualized in ways that are effective
and congruent across family therapy models, including how we help families navigate soci-
etal forces and expand choices for how to be in relationships. In this article, we specifically
address the concept of third-order thinking as a prerequisite to inviting families into
third-order, transformative change.

CRITICAL POSTMODERN CONCEPTUALIZATION OF POWER

We define power as social processes that determine collective and individual interests
(McDowell et al., 2018). We believe that these processes play an integral role in

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determining individual, relational, and community well-being and should be considered
across family therapy models. This is not new. Early on, family therapists tended to see
power dynamics as contributing to the formation and maintenance of symptoms. This
included Jackson and Jackson’s (1968) categories of couples as symmetrical or complemen-
tary, Minuchin’s (1974) concepts of horizontal and vertical power dynamics in family orga-
nization or hierarchy, and Madanes’ (1981) view of symptoms emerging from power
imbalances. These early conceptualizations of power tended to be framed as existing
within families rather than being routinely understood and addressed as situated within
societal contexts.
Critical social theory affected the practice of family therapy by encouraging the
understanding of societal power, privilege, and oppression as directly connected to the
influence family members have relative to each other (McDowell, 2015). In general,
critical theorists tend to view power as bidirectional within modernist, structural
frameworks. Postmodern approaches to understanding power (Foucault, 1972) include
understanding power and knowledge as inseparable. In other words, what is widely
accepted as knowledge or “true” is determined by societal power dynamics, that is,
those with more power have greater influence on collective meaning making. Individu-
als do not own or possess power; they enact it. Power is generative and constructive
as well as constraining. Rather than being viewed as simply coercive, power is under-
stood as an organizing force in society.
Our conceptualization of power attempts to bridge these approaches to effectively apply
them to the practice of family therapy. This approach to power has been described else-
where (McDowell, 2015, p. 6–7):
Power is pervasive and unevenly distributed; systematic and idiosyncratic. Imagine power as
everywhere shaping our collective and individual decisions about how to interact with each
other across diverse contexts. We basically know what to expect within our cultural groups and
familiar settings. We maintain social practices by policing each other and ourselves. Now imag-
ine that power also pools up or thickens in some places; that some of us have more resources
and greater influence to bring to bear in shaping singular and collective interactions. Collec-
tively, those with greater resources and influence shape cultural practices and ideologies in
ways that benefit their own group and maintain greater access to resources. Now imagine all of
this in motion with those being threatened reacting to potential and actualized power by yield-
ing, withdrawing, navigating and/or pushing back.. . . In other words, imagine a complex web of
influence that is systematically designed to maintain power and access to resources of some
over others but is also filled with idiosyncratic, highly nuanced power dynamics in local specific
contexts. It is this type of complexity we deal with daily in the practice of family therapy.
The connection between power dynamics and presenting problems includes factoring in
emotional and relational effects of oppression, including the possibility of symptoms being
forms of resistance to oppression. Failure to recognize resistance can not only maintain
the status quo but also contribute to oppression by pathologizing those in less powerful
positions. Consider Mary and Esther, who both identify as European American cisgender
women. Mary clearly takes the lead in the relationship. She is driven in her career and
highly focused on tasks. Esther typically accommodates Mary, withdrawing when Mary
becomes angry with her. Mary has been physically forceful in the past. The couple pre-
sents with concerns that Esther is depressed. The therapist attempts to get Esther to tell
Mary about her feelings and stand up for what she needs, but Esther remains withdrawn
while Mary labels her as overly sensitive. A continued focus on Esther as the problem
would fail to recognize Esther’s withdrawal as resistance to Mary’s power and control in
the relationship, further pathologizing Esther. Viewing Esther’s response as a form of
resistance provides new pathways for encouraging a more equal relationship that sup-
ports the well-being of both partners.

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THIRD-ORDER THINKING
Third-order thinking encourages us to continue to recognize our own social location and
viewpoint as an essential component of therapy (Fergus & Reid, 2002) but goes beyond
this stance. Taking a third-order perspective means taking a metaview of systems of sys-
tems to map relationships between society, ourselves, and families. This requires us to
attune to sociocultural experience and adopt perspectives that include frameworks for
understanding societal context and power. For example, we might recognize and/or experi-
ence sexism in our daily lives and the lives of our clients. We know that it is unjust and
may try to help empower women. This might include encouraging female clients to speak
up for themselves with male family members or colleagues. The implicit understanding of
the power dynamic leads to a commonsense solution, that is, if you are not being heard,
speak up! This is only one aspect, however, of much bigger, more pervasive dynamics at a
societal level. A different picture emerges when we place sexism in a broader context,
using feminist theory to explain dynamics of systemic male privilege, social, political, and
economic inequality, and the impact of intersecting identities (e.g., race, class, sexual ori-
entation, looks, abilities, nation of origin). In the example above, both Mary and Esther
are females who are deeply affected not only by homophobia and heteronormativity but
also sexism in a society that privileges males and masculinity. Mary’s career success as a
woman relies in part on her ability to perform in traditionally masculine ways, including
being competitive, self-assured, and in control. Esther tends to perform gender in more
traditionally feminine ways, including accommodating and focusing on the needs to
others. Mary’s tendency to see Esther as overly sensitive further reflects a broader, sexist
discourse that blames women for reacting to unjust gendered relationships.
How we organize the vast amount of information we gather from larger contexts—what
we pay attention to and how we organize what we notice—affects how we understand fam-
ilies. Our implicit impressions and/or explicit use of social theory to make sense of societal
context and power largely determine and define what we search for, what we see, and how
we organize our observations into meaningful frameworks that guide our work. This
delimits what we envision and believe is possible, which in turn informs our ability to help
clients engage in third-order change. We are routinely charged with making sense of the
plethora of interactions within families in order to take action in a focused and intentional
manner. We do this through our own worldviews and the models or defined approaches we
use for family therapy practice. Third-order thinking requires us to find ways to expand
these models to include broad societal contexts and power and/or adopt theories from fields
that focus on this level of thinking (e.g., sociology, philosophy, education, economics, geog-
raphy, political science).
For instance, we routinely explore emotion; however, rarely do we specifically connect
emotion to relational power dynamics in sociocultural context. Sociologists have found
that negative emotion often occurs when we perceive ourselves as not getting what we
deserve (Turner, 2007). Consider the angry pushback that can accompany challenging
privilege or the feelings of a teen who routinely feels undervalued. Generally those with
more power and influence experience more positive emotions, particularly when they feel
that they are getting the rewards and respect they deserve. Those with less privilege and
influence tend to experience more negative emotions, including shame, guilt, hurt, and
anger (Turner, 2007). If we integrate the sociology of emotion into, say, experiential ther-
apy (McDowell et al., 2018), we are better able to link societal dynamics with intimate
family experiences in ways that enhance and contextualize emotional expression and the
sharing of wants and needs.
Processes that infer or directly describe third-order thinking can be noted across a num-
ber of fields including organizational development (Bartunek & Moch, 1987), critical

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geography (Soja, 2010), decolonizing theory (Laenui, 2006), and liberatory education
(Freire, 1970). While they differ in some respects, there are common threads across these
descriptions that correlate with how we are defining first-, second-, and third-order think-
ing. For example, Paulo Freire (1970) noticed those who are oppressed often feel powerless
at first and tend to conform (i.e., first-order thinking) rather than substantially change
their lives. As they become more aware of dynamics of oppression in their lives, they begin
to see how they might challenge unjust relationships (i.e., second-order thinking). Eventu-
ally they become aware of societal systems and institutionalized power dynamics in which
their lives are embedded and discover how these systems support their oppression and
others’ privilege (i.e., third-order thinking). Ideally, the aim of third-order change is to dis-
rupt the unjust systems themselves.
Soja (2010), a postmodern critical geographer, proposed the concept of the first, second,
and third space. First space refers to actual physical space including location, objects, and
physical environment. Second space includes who is in the space and activities that occur
there. Soja’s (2010) description of the first and second space is essential to understanding
families as it helps us place families in environmental context. First space includes our
understanding of the impact on mental health and relational well-being of where families
live; their access to food, medical care, and education; and the privacy, safety, personal
space, and social interactions (Fitzpatrick & MaGlory, 2000) that they are afforded in
their daily lives. Second space refers to what we typically center on in family therapy, that
is, who is in these spaces and their interactions. Third space adds another dimension to
our understanding of space on a metalevel that is congruent with third-order thinking.
Soja (2010) contended that it is within third space that resistance and action toward more
just relationships can be planned and social change can be imagined. Third-order thinking
in family therapy can occur when the process includes creating this type of space.

THIRD-ORDER CHANGE: TRANSFORMATIONAL PROCESSES

The concept of third-order change is not new to family therapy even though it has not
been widely applied or, until recently, clearly defined (McDowell, 2015; McDowell et al.,
2018). According to McDowell et al. (2018, p. 23):
Third order change occurs when there is a shift in how we understand and relate to sociocultural
systems, how we understand the system we are in as part of a system of systems. This awareness
expands our choices beyond what is possible with second order change, enabling us to envision
and engage in meaningful transformation.
The roots of first-, second-, and third-order change can be found in Bateson’s description
of levels of learning in Steps to an Ecology of Mind. We view these levels of learning as pre-
cursors to our understanding of first-, second-, and third-order change. While Bateson
used the term levels of learning, he described learning as change that occurs when we
think or understand things differently (Bateson, 1972):
Learning I is change in specificity of response by correction of errors of choice within a set of alter-
natives. Learning II is change in the process of Learning I, e.g., a corrective change in the set of
alternatives from which choice is made, or it is a change in how the sequence of experience is
punctuated. Learning III is change in the process of Learning II, e.g., a corrective change in the
system of sets of alternatives from which choice is made. (p. 298)
First-order change (Bateson’s level 1 learning) refers to changes or solutions to problems
that fit within existing relational frameworks. Watzlawick, Weakland, and Fisch (1974)
referred to these as commonsense solutions that do not make a difference in the way rela-
tionships are organized or problems are understood. This type of change does not alter the
system’s rules or structure and maintains schemas that are not only shared within

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families but also often reflect dominant cultural values and beliefs. Commonsense solu-
tions run the risk of maintaining the privilege of those who have the most influence over
how what is “true” (i.e., common sense) is defined (McDowell et al., 2018). Common sense
often reflects the relationship between knowledge and power in which dominant cultural
discourses and worldviews are considered to be natural and true (Gramsci, 1971). In other
words, common sense is often dominant sense.
Second-order change (Bateson’s second level of learning) occurs when there is change in
the process level of relationships, for example, change in repetitive patterns and schemas
(Bartunek & Moch, 1987). This type of change is what most family therapists aim for;
helping create differences that help families shift how they understand problems/solutions
and how they organize their relationships. Second-order change tends to be discontinuous,
altering the structure, rules, and/or order of a system (Watzlawick et al., 1974). Change in
interactions is accompanied by change in rules and shared meaning. To create second-
order change, we often invite families to take a metaview of how they are relating and
what they understand about each other.
Third-order change (Bateson’s Level 3 learning) requires another step in taking a meta-
perspective in which we are able to consider systems of systems, that is, sets of alterna-
tives that allow us to choose between schemas (Bartunek & Moch, 1987) and alternative
relationship patterns. Focusing on metaprocesses and metanarratives (third-order think-
ing) creates change in how we see the world (Ecker & Hulley, 1996), our relationships,
and our lives in general (Laurel & Hulley, 1996). Therapists who target third-order
change do so intentionally. They create space to take apart, inspect, and disrupt what is
often taken for granted to help families consider multiple possibilities and perspectives. In
essence, they invite families to inspect the impact of culture, societal systems, and power
on their relationships and presenting problems. We contend that first-, second-, and third-
order change are all foundational to the practice of family therapy.

BECOMING AN AGENT OF THIRD-ORDER CHANGE

Facilitating third-order change requires us to do the following; (1) take a metaview of
ourselves and the families with whom we work as acting within systems of systems, (2)
integrate our understanding of societal systems and power into treatment models, and (3)
invite clients to view their own lives from metaperspectives that assist them in solving
problems and expanding possibilities for organizing relationships.

Case of the Missing Meta

As noted earlier, working from a third-order perspective goes beyond stepping back to
view families and family therapy within a broader societal context in general, to adopting
conceptual frameworks that help us make sense of and navigate these complex contexts.
Third-order thinking requires connecting power dynamics at intimate relational levels to
those in the broader societal context. Consider the concept of isomorphism, which family
therapists have used for decades to describe parallel processes across systems levels.
Thinking of isomorphism from a sociological perspective includes viewing isomorphism as
normative, mimetic, or coercive (DiMaggio & Powell, 1983). This provides a framework for
more fully understanding the connection between societal context and family dynamics.
Families often mimic the structure, rules, and organization of larger societal systems (e.g.,
patriarchy). They also adhere to social values and norms that govern societal institutions
(e.g., valuing education and hard work). Likewise, families are pressured to conform to
cultural and societal expectations (e.g., parenting in particular ways). This conceptual
framework shifts how we might think about the relationship between families and societal

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systems, including power processes. In turn, this is likely to shift how we engage in thera-
peutic practice.
Let us consider Kay, a European American, female family therapist in training who is
working with Melissa, an African American student in a predominantly white college.
Melissa describes what it is like for her to be the only student of color in a number of her
classes and shares her experiences of instructors failing to address microaggressions in
the classroom. Kay identifies as feminist and antiracist. Kay and Melissa engage in con-
versations that focus on the impact of racism. In this case, Kay is using an unexamined,
common understanding of racism as a societal problem rooted in individual attitudes. If
Kay was adept in social theories that connect the historic construction of race with the ten-
sions between capitalism and democracy, she would be able to help Melissa place her expe-
rience in a much broader context. Kay would realize that democracy assumes equal
influence and opportunity for all citizens while capitalism requires some to work for
others’ profits. Capitalism also requires an excess of workers (i.e., unemployment) while
democracy suggests everyone can get a fair share if they participate. Racism and classism
can be understood as by-products of this inherent conflict as they attempt to justify
unequal opportunity based on group membership and/or personal attributes.
Connecting societal systems to environmental realities (e.g., economic consequences of
white privilege and predominantly white classrooms in white neighborhoods) provides a
way to ground interactional patterns in both time and space. In other words, culture, soci-
etal systems, and power impact the spaces we occupy, how we are treated, and the
resources available to us in those spaces. When Kay is able to hold Melissa’s personal
experiences within a metaperspective of systemic racism and white privilege, she is more
likely to recognize the complex territory Melissa must navigate. Kay would also need to
take a metaview of the educational context within the broader societal context to recognize
the material consequences of racism rather than limiting her attention to Melissa’s experi-
ence and emotions. For example, Melissa may be subtly marginalized among peers, which
in turn could limit group learning activities and affect grades. Her thoughts and state-
ments in class may not be heard as loudly by instructors, leading to less stellar graduate
school admissions evaluations. These dynamics may exacerbate the unequal playing field
that privileges white graduates. It is important to note that lack of purposeful observation
and analysis of context do not ease its impact.

Case of the Mapless Guide

Even when we become more socially aware and able to articulate theories that describe
and explain societal systems and power dynamics, we are still left with the task of connect-
ing the dots between these social forces and individual and relational problems. Doing so
thoughtfully in ways that are congruent with our theoretical approaches provides maps
for integrating societal context into therapeutic goals and processes. Consider Louise, a
newly licensed family therapist who describes herself as working from a structural family
therapy approach. She meets with a married couple, Lina (38) and John (39), along with
their teenage daughter Rebecca (16). Lina and John are concerned about Rebecca “re-
belling,” describing her as “always challenging her father.” In session, Louise notices that
John tends to speak over Lina and Rebecca and that Lina often yields to him. Rebecca
occasionally challenges her father by saying things like “It can’t all be your way” or “No! I
won’t do that.” When Rebecca does this, Lina falls silent as John shouts a response. From
a structural perspective, Louise is interested in helping John and Lina work as a parent-
ing team. She wants Lina to stand up with John to send a clear united message to Rebec-
ca. She asks them to talk with each other about rules and consequences for Rebecca, so
they can stand firmly together. Without a way to expand her structural map to include

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societal systems, Louise remains uncertain of how these systems influence relational pat-
terns or how to use an awareness of broader systems to intervene. This includes the perva-
sive societal pattern of male privilege and dominance and female submission and
accommodation.
When Louise is able to connect the family structure to the broader societal structure,
she can consider new possibilities. Rather than viewing Rebecca as simply trying to gain
autonomy and/or acting out because parents are not functioning as a team, Louise might
entertain the idea that Rebecca and Lina are challenging patriarchy together. Rebecca is
in a position to do so more directly in part because, unlike her mother, she will soon be on
her own. Louise could broaden the structural map she is using to include patriarchal
structures, noting how these societal one-up/one-down power dynamics are reflected in
family relationships. Doing so would allow Louise to help the couple work as a team to cre-
ate a more equitable relationship and support their daughter’s attempts to negotiate gen-
dered power dynamics as she becomes an adult.
Structural goals might include a clearer boundary around the family to disrupt norma-
tive, mimetic, and coercive isomorphism (DiMaggio & Powell, 1983). For example, Louise
might ask Rebecca, Lina, and John to reflect on how being male or female makes a differ-
ence in society (e.g., in politics, business, religious, and family life) and how these dynam-
ics may or may not be reflected in how their family is structured (mimetic isomorphism).
She might also ask Lina and John to express their values and what they want for their
daughter (e.g., equal opportunity as a woman) and then consider what they can do to sup-
port this goal in and out of the family (normative isomorphism). Louise could ask Lina and
John about social barriers to a more equitable relationship (e.g., teasing from male friends,
expectations within faith systems, habits, and routines) and Rebecca about pressure to
enact gender in specific ways in school and social groups (coercive isomorphism).

Case of the Disappearing Therapist

Therapists must be able to conceptualize and articulate an understanding of societal
context and power dynamics to be prepared to help clients make sense of the impact these
systems have on their lives (D’Arrigo-Patrick et al., 2017). Working from a third-order
perspective requires us to develop conceptual frameworks for making sense of systems
while listening carefully to unique experiences of each individual within these systems. As
we are asking about experience, emotion, and relational dynamics, we are developing an
understanding of the relationship between specific families within larger, societal con-
texts. These conversations raise awareness of how family interactions are connected to
societal systems.
We have noticed that some of the most socially aware beginning family therapists seem
to abandon their therapeutic models in favor of teaching clients about societal systems.
They seek to inform clients rather than raising and integrating social awareness into ther-
apeutic goals and processes. In the example above, it might be tempting for Louise to
explain the impact of societal structures, including patriarchy, on family structures with
the expectation that if Lina, John, and Rebecca were handed this information, they would
change their relational dynamics. Rather than listen for specific and nuanced experiences,
Louise might quickly jump to an analysis of what it must be like for each member of the
family given their social context. This abruptly shifts Louise from ally and collaborator to
expert, leaving behind therapeutic process.
Were Louise able to maintain a therapeutic stance while taking a metaview of systems
of systems, she would be able to ask and carefully listen to Rebecca as she describes expe-
riencing anger toward her father. Rather than allowing Lina to interrupt and point out
John’s good intentions, Louise might follow up with questions about gender and power in

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the broader society and the home. Louise might ask John and Lina similar questions about
their experiences and what they want for their daughter—for themselves. As Louise con-
tinued to explore things like the relational costs of power-over and how this model of mas-
culinity is threaded throughout society, she could invite Lina, John, and Rebecca into
third-order thinking about their own lives.

ANVIET: GUIDELINES FOR THIRD-ORDER PRACTICE

In our recent work (Knudson-Martin, McDowell, & Bermudez, 2017; McDowell et al.,
2018), we suggested a set of transtheoretical guidelines that reflect and encourage equity-
based practice from a third-order perspective. We use the acronym ANVIET (attune,
name, value, interrupt, envision, transform) to describe steps that help therapists and cli-
ents consider and move toward more just relationships. These guidelines help bring soci-
etal processes into stark relief, so they can be more directly and purposefully considered.
The process includes intentionally noticing, or attuning, to the emotional, experiential,
and relational impact of societal systems on individuals and relationships. Noticing these
experiences and naming what is unjust allows these dynamics to be acknowledged, often
making what is covert overt. Valuing includes listening carefully and helping clients put
into words (Fricker, 2007) what has been previously silenced, dismissed, or marginalized.
The guidelines assume that it is not enough to understand and notice what is unjust in
relationships, encouraging therapists to actively interrupt unequal power dynamics when
they witness them. As therapists and clients gain awareness of the impact of societal
forces on specific relationships, they are in a better position to envision solutions
(Berm udez, Keeling, & Carlson, 2009) and alternative ways to organize relationships,
entertaining more options for what is possible. Finally, therapists work with clients to
support them in transforming their relationships into what they have envisioned. These
guidelines reflect and guide third-order thinking in ways that enhance the potential for
third-order change.

Case of the Socioculturally Attuned Family Therapist

Third-order thinking applies across practice models and presenting issues (McDowell
et al., 2018). We use the case of Julia and Joan as an example. To protect confidentiality,
identifying information and some clinical details have been changed. Julia (37) and Joan
(30) are a biracial, cisgender, lesbian couple who have been married for 8 years. They are
mothers of 5-year-old Nathan, who is also biracial. Joan is seeking therapy following panic
attacks that have become increasingly problematic since she changed jobs 5 months ago.
She was referred to Glenda (LMFT) through her Employee Assistance Program. Glenda
(46), who identifies as a white heterosexual cisgender woman, suggests including Julia in
the sessions. She draws on multiple family therapy models, with particular focus on family
structure, narratives, and relational attachment, as she integrates the ANVIET guidelines.

Attune
Glenda expands her systemic lens from the very beginning. She seeks to attune to how
larger sociocultural systems are connected to what each partner experiences—what they
think, feel, and do. When Glenda asks what brought them to therapy, Joan explains they
each have mental health disorders (a long list of diagnoses over the years); that they each
had “abusive childhoods.” Joan says previous therapy has helped her learn how to manage
panic attacks and that she recently had a consultation to modify her medications, which
has helped. As Glenda explores this history, she begins to get a sense of how central their
diagnoses are to their identities and their relationship:

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Joan We are very patient with each other. We know our diagnoses.
Julia I understand why she’s upset, you know. That it’s part of the disorder.
With third-order thinking, Glenda is attuned to their “disorder identities” at individual,
relationship, and societal levels. She is aware that the mental health services system is
one of the systems of systems at work in their lives.
Glenda begins to sense that Julia and Joan see themselves as damaged women in rela-
tion to the broader social world. From an attachment perspective, she wants to know more
not only about the working models of relationships they have each internalized but also
how their perceptions of belonging and connection are related to social locations and soci-
etal power and how these support or interfere with attachment bonds (McDowell et al.,
2018). From a structural perspective, Glenda joins their system through developing a deep
understanding of the economic, social, symbolic, and cultural capital in their family maps.
She attunes to how societal systems of dominance and privilege may have framed their
experiences and how these are reflected in their communication patterns (McDowell et al.,
2018). She is also interested in how the words Joan and Julia use to describe themselves
and their situation align with or counter dominant social systems.
Glenda notes that Julia is much more attentive to Joan than Joan is to her and that
Joan seems to expect that Julia be there for her whenever she wants:
Glenda Joan, I notice that Julia is very attentive when you speak about your
distress. She seems very in tune with you. Are you also in tune with her?
Joan Julia is a caretaker.
Julia Yeah. I’m a caretaker. We’re working on that.
Julia and Joan have learned individualistic systems of thinking that discredit the value of
tending to others. They judge caretaking as a pathology, unaware of how this view stems
from and supports institutionalized gender and economic systems that privilege Western
values of autonomy and financial success over relational ones.

Name
Third-order thinking helps Glenda recognize and name unjust or unfair circumstances
and voice that which has been minimized or silenced (McDowell et al., 2018). If she does
not, Joan and Julia will continue to blame themselves without connecting their problems
to larger systems (McGoldrick, 2016; St. George & Wulff, 2016). Joan, whose white Euro-
pean American heritage is never discussed, was raised by working class grandparents
whom Joan describes as providing for her physical needs, but being not emotionally pre-
sent. According to Joan, her mother “abandoned” her. Glenda asks about the father’s role
and raises questions about the sociopolitical contexts in which her mother made this
choice.
Joan I think she was really alone. All I ever heard about my father is that he was
a “dirtbag.” She was really young—seventeen. (pauses) It probably wasn’t
possible for her to take care of me without help.
Glenda How do you think it happens that a young woman like your mother would
get left alone like that?
Joan had never given much thought to her mother’s gender or economic circumstances,
but as the conversation unfolds, she has a lot to say about “unfairness” faced by women in
the community in which she grew up, and how she deals with it in her own life:

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MCDOWELL, KNUDSON-MARTIN, & BERMUDEZ / 19
Joan There wouldn’t have been much of a life for her here . . . especially not stuck
with a kid.
Glenda What do you think life would be like for women in that position?
Joan On your own. Stuck in low paying jobs. Working all the time. Treated like
you’re nothing!! Like you’re not worth shit!
Glenda It sounds like you’ve seen single mothers face a lot of discrimination and
economic struggles.
Joan Women have it hard in general! You have to work twice as hard!!
Joan responded to the unfairness in her life by keeping to herself, doing well, hiding to fit
into dominant culture standards. She came to value independence and economic success,
while rejecting most traits associated with women. Until she met Julia at the age of 19,
she largely ignored her sexuality and remained socially isolated. Glenda named the injus-
tice of living in a community in which being a woman was not valued and loving another
woman was not safe.
Julia faced a different set of societal injustices. While raised in a low income mostly
white community by her white single mother, phenotypically she resembled her black
father. From an early age, Julia was aware of how hard her mother worked and the stres-
ses she faced. Julia saw that people in her community looked out for each other and
learned to do what was necessary to survive and to be there for others. Although sexually
abused by her uncle, she did not tell her mother because she did not want to add to her
burdens. At school, she struggled academically and socially. When she was bullied, she
told only one friend who was also marginalized. All her life, Julia’s experience as a biracial
person in white communities has been ignored or minimized, as was her sexual abuse and
bisexual identity. Glenda brings these injustices into the clinical conversation and helps
clients name them.

Value
Third-order thinkers “develop special radar for ferreting out and highlighting strengths
that dominant cultural and power processes mask” (McDowell et al., 2018, p. 239). Both
Joan and Julia pathologize caregiving and vulnerability. Although dedicated to each
other, neither is comfortable with vulnerability. Joan is anxious about meeting the
demands of her new job. Given her sociocultural experience as an isolated woman judging
herself and expecting to be judged by dominant culture values of independence, social
assertiveness, and financial success, she is not in the habit of focusing on her fears or shar-
ing them with anyone. She expects Julia to make it safe for her without having to actually
be vulnerable. Julia has never been in a context where anyone focused on her and is regu-
larly told by Joan (and previous counselors) that she is too giving to friends, family, and
people at work. Glenda raises consciousness about the value of both giving care and vul-
nerability, helping the couple begin to be more intentional about the systems they prefer.
She begins by validating relational ideals:
Glenda Your life must be a lot better because of the caring that Julia gives . . . in our
society it sometimes seems like that’s not valued very much.

Interrupt
When Glenda notices individualistic and pathologizing systems at work in the couple
relationship, she finds ways to respectfully interrupt them. In the example below, she
interrupts the taken-for-granted societal idea that caring too much is a problem:

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Julia Joan’s mad at me for helping my cousin with all that; I know I’m too caring,
but I just can’t help it. When someone needs my help and there’s something I
can do, I do it.
Glenda How does it happen that caring is seen as a bad thing?
Glenda also interrupts the imbalance of caring between partners by helping Joan take
more responsibility for attuning to Julia:
Glenda Joan, you talk a lot about the caring that Julia gives. She’s not used to
expecting it in return.
Joan I know, I ask her how I can help or what I can do for her and she always says
“I’m OK.”
Glenda What do you think Julia needs from you? How can you be there for her?

Envision
Identifying societal contexts and equities is not sufficient to create third-order change.
Therapists must create space to imagine alternatives. For example, Joan is upset because
their son Nathan was “acting out” at kindergarten. She thinks Julia, the birth mother, is
coddling him. Glenda helps them envision their response through lenses that openly
address the stigmas they face as lesbian mothers and the role of race in their lives:
Glenda What do you think it is like for Nathan to be biracial with two mothers?
Joan Why can’t he just behave!! People are always looking for us to mess up. I feel
it every day at work, and now this!
Glenda I know how much you love Julia and Nathan . . . it’s hard for those of us who
are white to be aware of what it is like to live in a world that privileges
whiteness.. . . What do you think would help you tune into them—to get the
ways racism affects each of them and how you parent?

Transform
Third-order thinking helps Julia and Joan make what they envision real. When domi-
nant culture standards minimize their relational goals, Glenda brings the couple back to
them. They come to see Joan’s panic attacks and their “communication problems” con-
nected to larger social systems that do not always serve them very well and work together
to more intentionally position their responses. For Julia and Joan, this includes becoming
part of larger communities of support and resilience that value their relationship and find-
ing ways to openly address the effects of dominant discourses such as homophobia, white
privilege, and what it means to be a biracial family.

CONCLUSION
New theoretical concepts and practice models tend to emerge when there are challenges
to existing ways of thinking. Systems theory and social constructivism were major para-
digm shifts in which new ideas flourished. There have been many other shifts including
second-order systems thinking (Anderson & Goolishan, 1992; Hoffman, 1981, 1985;
Keeney, 1983), the feminist critique (Hair et al., 1996; Hare-Mustin, 1978), and a focus on
diversity and social justice (McGoldrick & Hardy, 2008) to name a few. We suggest that
third-order thinking is yet another shift in how we conceptualize problems and engage

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MCDOWELL, KNUDSON-MARTIN, & BERMUDEZ / 21
families in processes of change. The construct of third-order thinking offers us a way to
conceptualize and language our growing awareness of the impact of societal context and
power. It provides a framework for adopting a metaview at the broadest possible level to
be able to invite families into third-order, transformative change.
As we look forward, we wonder about the potential impact of third-order thinking on
the field itself—our educational agendas, supervision practices, and professional organiza-
tions and workplaces. We are left with a number of questions. For instance, what would
need to change to consider third-order thinking as more central in family therapy educa-
tion? How might we better prepare all supervisors to lead conversations about the effects
of societal systems and power on families? How do we ensure third-order thinking is inte-
grated into supervisory processes as regularly as second-order thinking? Finally, how do
we consider our various professional organizations from a third-order perspective? How do
we socioculturally attune or fail to attune to members of our organizations? How is this
communicated by the knowledge and topics we privilege at conferences and in journals?
We hope the ideas presented in this paper will inspire conversations and potential
answers for these types of questions and open space for all of us to envision more equitable
practices.

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