Module IV : Systemic Approaches to Counselling

The systemic approach to counselling attempts to understand the individual not in isolation but in relationship
with others. It focuses on recognising and understanding the patterns in a relationship,
rather unhealthy patterns which can be altered within existing systems. The approach does not examine the
origins of patterns. Counselling is not directive. Individuals learn how to recognise the patterns for themselves
facilitated by the counsellor.

Behavioral Family Counselling

Behavioural Family Counselling is a skills based intervention which is aimed at providing support to families
where mental health problem is being experienced by a family member. Each family member is also encouraged
to set realistic and achievable personal goals for themselves. Positive communication, problem solving skill
training and stress management within the family is promoted. Intervention consists of engagement, assessment,
formulation and identifying early warning signs so treatment goals are achieved. Approach works well for the
individual and the family with mental health difficulties. Improves quality of life of individual and families.

Structural Family Therapy

Structural family therapy, developed by Salvador Minuchin, helps families by dealing with problems as they
affect current interactions of family members. Of particular interest are boundaries between family members.
Are members too close or too distant? What is the nature of relationships within the family? Therapeutic
approaches emphasise changing the nature and intensity of relationships within the family both inside and
outside the therapy session.

FOUNDERS/DEVELOPERS. Salvador Minuchin.

VIEW OF HUMAN NATURE. Every family has a structure, according to Minuchin (1974). A structure is
the informal way in which a family organizes itself and interacts. Structure influences people in families for
better or worse. If there is a hierarchical structure, people relate well to each other. However, if there is no such
structure or little structure, developmental or situational events increase family stress, rigidity, chaos, and
dysfunctionality, throwing the family into crisis. In such circumstances, coalitions (i.e., alliances between
specific members against a third member) or cross-generational alliances (alliances between family members
of two dif- ferent generations) arise. Neither works well in the healthy growth of individuals or a family.

ROLE OF THE COUNSELOR. Structural family counseling practitioners are both observers and experts in
making interventions to modify and change the underlying structure of a family. They advocate for structural
changes in the organization of the family unit, with particular attention on changing interactional patterns in
subsystems of the family such as in the marital dyad. They also work at establishing clear boundaries among
family members. In working with families, structural family counselors join with the family in a position of
leadership. They map within their minds the structure of a family, determining how it is stuck in a dysfunctional
pattern, and how to help it change.

TECHNIQUES. Structuralists employ a number of techniques aimed at getting a family to change the way it
operates (Minuchin & Fishman, 1981). One primary technique is to work with family interaction. When family
members repeat non-productive sequences of behavior or demonstrate a disengaged or enmeshed position in the
family structure, the counselor will rearrange the physical environment so they have to act in a different way.
The technique may be as simple as having people face each other when they talk.

Structural family counselors also use reframing, a technique that involves helping the family see its problem
from a different and more positive perspective. For example, if a child is misbehaving, the behavior may be
labeled “naughty” instead of “incorrigible.” As a consequence, the child and his or her actions will be viewed as
less pathological.

Other structural techniques are:

  Punctuation—“the selective description of a transaction” (Colapinto, 2000, p. 158)—for instance,
declaring a person competent at a specific moment in time, such as when they are silent.
 Unbalancing—aprocedurewhereinthecounselorsupportsanindividualorsubsystemagainst the rest of the
family (e.g., a daughter who is lobbying for a later curfew against her parents).
 Enactment—a process that consists of a family bringing their problematic behaviors, such as making
decisions, into treatment sessions and demonstrating them. In the process, the counselor challenges
their existing patterns and rules as the family gains heightened aware- ness of the way they function.
 Boundary making—the process of creating lines that separate people or subsystems from each other
psychologically in order to maximize individual and group development and functioning.
 Intensity—the structural method of changing maladaptive transactions by using strong affect, repeated
intervention, or prolonged pressure in order to help an individual or family reach a goal by doing
something differently (Minuchin & Fishman, 1981).
 Restructuring—changing the structure of a family by altering existing hierarchies or interaction
patterns so that problems are not maintained (e.g., uniformly refusing to obey a certain request or to act
in a specific way).
 Adding cognitive constructions—the verbal component of what is a primarily action- oriented
approach that includes advice, information, pragmatic fictions (i.e., pronouncements that help people
change, such as “you are capable”), and paradox (a confusing message, such as “don’t change,” meant
tofrustrate and motivate an individual or group to seek alternative actions).
 Family mapping- Maps of family interaction allow therapists to better understand repeated
dysfunctional behaviour so that strategies for modification can be applied.
 Accommodating and Joining- To bring about change within a family, Minuchin (1974) believes that
it is important to join a family system and accommodate to its way of interacting. By using the same
type of language and telling amusing stories relevant to the family, he seeks to fit in. One example of
joining the family is mimesis, which refers to imitating the style and content of a family’s
communications. For example, if an adolescent sprawls on his chair, the family therapist may do
likewise. Similarly, structural therapists use tracking to follow and make use of symbols of family life.
For example, if an enmeshed family uses the phrase “our life is an open book,” a structural therapist
may attend to issues in which family members are too deeply involved in each others’ activities and
may later make use of the “open book” metaphor as a way of helping families clarify their boundaries.
By joining a family system, a structural therapist not only has a good understanding of the family’s
systemic operation but also is in a good position to make changes in it.

Theoretical Basis of Structural Family Therapy

Although family members differ in the power they have in making decisions, the ways family members work
together are indications of the degree of flexibility or rigidity within the family structure. Minuchin uses
concepts such as boundaries, alignments, and coalitions to explain family systems.

1) Family Structure- the structure of the family refers to the rules that have been developed over the years to
determine who interacts with whom. Structures may be temporary or long-standing. For example, two older
brothers may form a coalition against a younger sister for a short period of time or for several years. It is
Minuchin’s view that there should be a hierarchical structure within the family, with the parents having more
power than the children and older children having more responsibilities than younger children. Parents take
different roles; for example, one parent may be the disciplinarian, and the other may provide sympathy to the
children. Eventually children learn the rules of the family about which parent behaves in what way and to which
child. When new circumstances develop, such as one of the children going off to college, the family must be
able to change to accommodate this event. Being aware of family rules, and thus the structure, is important for
therapists in deter- mining the best way to help dysfunctional families change. Within the family system are
subsystems that also have their own rules.

2) Family Subsystems- For a family to function well, members must work together to carry out functions. The
most obvious subsystems are those of husband–wife, parents–children, and siblings. The purpose of the
husband–wife or marital sub- system is to meet the changing needs of the two partners. The parental sub-
system is usually a father–mother team but may also be a parent and/or another relative who is responsible for
raising children. Although the same people may be in the marital subsystem and the parental subsystem, their
roles are different, although overlapping. In sibling subsystems, children learn how to relate to their brothers or
sisters and, in doing so, learn how to build coalitions and meet their own needs, as well as deal with parents.
Other subsystems may develop, such as when the oldest child learns to make dinner for the family when the
mother or father is drunk. Thus, a child–parent subsystem develops. Such alliances may arise depending on the
roles, skills, and problems of the individual members. Who does what and with whom depends on boundaries
that are not always clearly defined.

3) Boundary Permeability- Both systems and subsystems have rules as to who can participate in interactions and
how they can participate (Minuchin, 1974). These rules of interaction, or boundaries, vary as to how flexible
they are. Permeability of boundaries describes the type of contact that members within family systems and
subsystems have with each other. A highly permeable boundary would be found in enmeshed families, whereas
non-permeable or rigid boundaries would be found in disengaged families.

4) Alignments and Coalitions- Alignments refer to the ways that family members join with each other or oppose
each other in dealing with an activity. Coalitions refer to alliances between family members against another
family member. Sometimes they are flexible and sometimes they are fixed, such as when a mother and daughter
work together to control a disruptive father. Thus, power within the family shifts, depending upon alignments
and coalitions.

In the family system, power refers to who makes the decisions and who carries out the decisions. Being able to
influence decisions increases one’s power. Thus, a child who aligns with the most powerful parent increases her
own power. Because certain decisions are made by one parent and other decisions by the other parent, power
shifts, depending on the family activity. In an enmeshed family, power is not clear, and children may ask one
parent permission to do something, even if the other parent has said “no.” When the family’s rules become
inoperative, the family becomes dysfunctional. When boundaries become either too rigid or too permeable,
families have difficulty operating as a system. If the family does not operate as a hierarchical unit, with parents
being the primary decision makers and the older children having more responsibility than younger children,
confusion and difficulty may result. Alignments within the family may be dysfunctional, such as parents who
are arguing over money both asking the oldest child to agree with them (triangulation).

Goals of Structural Family Therapy

• Structural family therapists try to alter coalitions and alliances to bring about change in the family. • They also
work to establish boundaries within the family that are neither too rigid nor too flexible.

• By supporting the parental subsystem as the decision-making system that is responsible for the family,
therapists work to help the family system use power in a way that functions well.

• The ability to cope with stress and conflict improves with restructured positions and functions of the family
members.

• The restructuring allows the new and the under-utilised resources to be put in motion By releasing family
members from their stereotyped positions leading to improvement in the family dynamics.

STRENGTHS AND CONTRIBUTIONS. Structural family therapy is unique in its contribution to

counseling in the following ways:

 The approach is quite versatile, being a process that is appropriate for low-socioeconomic- level
families as well as for other families (Minuchin, Colapinto, & Minuchin, 1999).
 The approach is effective, having been used in treating juvenile delinquents, alcoholics, and anorexics
(Fishman, 1988).
 The approach is culturally sensitive and appropriate for use in multicultural settings.
 The approach is clear in its definition of terms and procedures and is easily applicable.
 The approach emphasizes symptom removal and a reorganization of the family in a pragmatic way.

LIMITATIONS. The structural approach’s main limitations include the following:

 Critics have charged that structural work is not complex enough, may be sexist at times, and
focuses too much on the present.
  The accusation that structural therapy has been influenced by strategic family therapy and the
charge that it is difficult to distinguish it from strategic therapy at times is problematic.
 Sincethecounselorisinchargeoftheprocessofchange,familiesmaynotbecomeempowered enough,
which may limit their overall adjustment and change in the future

Strategic Family Counselling

VIEW OF HUMAN NATURE. Strategic theory is based on the belief that when dysfunctional symptoms
occur, they are an attempt to help people adapt. This approach sees problems as occurring within a
developmental framework of the family life cycle. For instance, marital difficulties are generated by the
system the couple is in. Consequently, the symptoms that emerge help maintain the marital system in which they
operate.

As a group, strategic counselors focus on several dimensions of family life that are developmentally significant,
such as

 family rules—the overt and covert rules families use to govern themselves,
 family homeostasis—the tendency of families to remain in their same pattern of functioning unless
challenged to do otherwise,
 quid pro quo—the responsiveness of family members to treat each other in the ways they are treated
(i.e., something for something), and
 circular causality—the idea that events are interconnected and that factors behind a behavior are
multiple.

Concepts of Strategic Therapy

Like Minuchin, Haley observes the interaction among family members, attending particularly to power
relationships and to the ways parents deal with power. Viewing relationships as power struggles, Haley (1976)
is interested in understanding how relationships are defined. Thus, a communication from one person to another
is an act that defines the relationship (Haley, 1963). When a mother says to her son, “Your room is messy,” she
is not only reporting on the state of the room but also commanding the son to clean it up. If the son does not
clean up the room, he is engaging in a power struggle with his mother. Important to Haley, as well as to
Minuchin, is the concept of hierarchy, in which the parents are in a superior position to the children in terms of
making decisions and adhering to family responsibilities. Like Minuchin, he is concerned with family triangles
such as those in which one parent is over involved with the child and the other is under involved. What separates
structural from strategic approaches is the attention given by strategic family therapists to symptoms. For Haley,
symptoms are an unacknowledged way of communicating within the family system, usually when there is no
other solution to a problem. For strategic therapists, the symptom is often a metaphor (Madanes, 1981) for a
way of feeling or behaving within the family.

Goals of Strategic Family Therapy

Although the therapist may ask family members why they have come and what they want to accomplish, the
therapist ultimately decides on the goal. Such goals may be intermediate as well as final and must be concrete
and not vague. The goal to reduce anxiety must be stated in such a way that the therapist knows which family
members are experiencing anxiety, in what way, and in which situations. There must be sufficient information
so that therapists can plan strategies to reach goals.

The idea behind the strategic approach is to resolve, remove, or ameliorate a problematic behavior brought to
counseling. In the process, new functional behaviors are generated that will help individuals, couples, and
families achieve a specific goal. By limiting the number of sessions available for treatment, strategic counselors
hope to increase the motivation and determination of the client to be successful. Another goal of the approach is
for the persons involved in the process to learn new skills for resolving future conflicts.
ROLE OF THE COUNSELOR. Strategic counselors take a systemic view of problem behaviors and focus on
the process rather than the content of dysfunctional interactions. The job of a strategic counselor is to get people
to try new behaviors because their old behaviors are not working. A specific behavior is targeted for change. If
this behavior can be modified, a spillover effect often occurs; that is, the results will help individuals make
other behavior changes as well.

Thus, strategic counselors strive to resolve presenting problems and pay little attention to instilling insight. To
bring about change, counselors are active, direct, and goal oriented as well as problem focused, pragmatic, and
brief (Snider, 1992; Todd, 1986). They usually limit the number of times they see families to 10 visits or less.

TECHNIQUES. As a group, strategic family counselors are quite innovative. Each intervention is tailored to
the specifics of persons and problems. This customization makes strategic counsel- ing one of the most
technique-driven approaches within systems theory. Strategic family coun- selors are nonblaming, avoid
pathological labels, accept the presenting problems of families, and view symptoms as serving the positive
purpose of communication.

Relabeling (giving a new perspective to a behavior) is frequently used. (For example, in regard to asking for a
second helping of pie several times, Johnny’s behavior might be relabeled “assertive” rather than “rude”).
Paradoxing (insisting on just the opposite of what one wants) and prescribing the symptom (having the
couple or family display voluntarily what they had previously manifested involuntarily, such as fighting) are
employed, too. In addition, the counselor may use pretend to have the client make changes or carry out
homework assignments that would not be completed otherwise (Madanes, 1984; Minuchin, 1974).

Individuals or families are sometimes asked to go through ordeals, such as traveling or suffering, during the
treatment process. The idea is that if people have to make sacrifices to get better, then the long-term
improvements of treatment are enhanced. A major aspect of strategic family counseling is the assignment of
original homework tasks (often given in the form of prescriptions or directives) that are to be completed
between sessions.

1) Straightforward Tasks- When strategic family therapists judge that the family they are trying to help is
likely to comply with their suggestions, they may assign a straightforward task. By talking with the family and
observing family boundaries and subsystems, the therapist will be able to help the family accomplish its goals
(Madanes, 1981). Sometimes suggestions can consist of relatively simple advice to families, but more often
families require suggestions to change a variety of ways members interact with each other (Papp, 1980). Just
because tasks are assigned does not mean that each member of the family will be cooperative. To gain
cooperation from family members, Haley (1976) suggests several ways to ensure they complete tasks. Before
suggesting tasks, therapists should explore what the family has done to solve the problem so they do not make
suggestions that have been tried and failed. By examining what happens if the problem is not solved, then,
family members are more likely to appreciate the importance of doing something about the problem. When tasks
are assigned, they should be relatively easy to accomplish, clearly explained, and fit the ability level of the
children as well as the adults who will complete the task. In strategic family therapy, the therapist is clearly the
expert, and she may make use of her status as the expert to get the family to comply with her instructions.
Designing tasks, particularly metaphorical tasks, takes experience and confidence.

2) Paradoxical tasks- Basically, paradoxical suggestions are those that ask the family to continue the behaviour
for which they are requesting help, but in such a way that whether they comply or not, positive change will
result. In a sense, the therapist is trying to get the family to decide not to do what they have been asked to do.
Families are often confused by why the therapist is not asking them to change. Use of paradoxical directives
takes experience and confidence on the part of the therapist, and they are used only when the family resists
straightforward suggestions. In describing the use of paradoxical tasks, Papp (1980, 1984) has suggested three
steps: redefining, prescribing, and restraining. The first step is to redefine the symptom in terms of the benefits it
provides for the family. As Goldenberg and Goldenberg (2008) suggest, anger can be called love, suffering can
be seen as self-sacrifice, and distancing can be used as a way of reinforcing closeness. In prescribing the
symptom, the family is encouraged to continue what they have been doing because if they do not there will be a
loss of benefits to the family. Thus, an angry child may be asked to continue to be angry and throw tantrums. In
prescribing the symptom, the therapist must be clear and sincere in the rationale. When the family starts to show
improvement, the therapist tries to restrain the growth or change in order to keep the paradox working. For
example, a couple who argue frequently and has been told to argue over kitchen chores may report that they are
fighting less. Rather than reinforce the change, the strategic family therapist may caution the couple to be
careful; otherwise, one or the other might lose the powerful position relative to the other. In doing this, the
therapist never takes credit for the change or acts sarcastically. Throughout the process of using paradoxical
tasks, the therapist shows concern for the family and, when change occurs, may express surprise but also hope
that change can take place.

STRENGTHS AND CONTRIBUTIONS. Like other approaches, strategic counselors have unique aspects to
what they do and how. Among the most prominent of these emphases are the following:

 Many of these therapists work in teams.

 The nature of the approach is pragmatic and flexible.
 The focus of practitioners is on innovation and creativity, which is in the lineage of Milton Erickson
who was especially good at devising novel ways to help his clients.

 The emphasis within the approach is to change the perceptions within people as a way of fostering new
behaviors.
 A deliberate attempt is made to work on one problem at a time and limit the number of therapeutic
sessions so that the focus and motivation for doing things differently is enhanced.
 The approach may be modified and carried over into settings, such as schools, where it may be
systemically applied to serve a total population, as well as individuals and families in them (Nelson,
2006).

LIMITATIONS. The limitations of the strategic approach are few in number but significant:

 First, some of its underlying foundation and techniques overlap with other systems and brief therapy
theories. Therefore, there is sometimes confusion as to whether a counselor is using the strategic
approach or another approach, such as the structural.
 Second, some of the stands taken by leading strategic practitioners are controversial, such as Jay
Haley’s view that schizophrenia is not biologically based.
 Finally, the emphasis within strategic camps on the expertise and power of the counselor may mean
that clients do not attain as much independence or ability as they might otherwise.

Experiential Family Therapy

Carl Whitaker (1912–1995) saw theory as a hindrance in clinical work and preferred an intuitive approach,
using the therapist’s own resources. Characteristic of his approach is the use of countertransference (his own
reactions to clients). Not only do clients grow and change in therapy; so do therapists. Because clients and
therapists affect each other, each takes on the role of patient and therapist at various moments in therapy.

This interaction fosters the goal of interpersonal growth among family members (and therapists). In his intuitive
approach to families, Whitaker (1976) listened for impulses and symbols of unconscious behaviour. Sometimes
he responded consciously to feelings or family members’ ways of relating; at other times he would be unaware
of why he was responding the way he was. Relating symbolically, he often suggested clients fantasise about an
experience. This may lead to understanding the absurdity of a situation. Situations are viewed in ways that
emphasise choice and experience rather than sickness or pathology. Whitaker and Keith (1981) described the
beginning, middle, and ending phases of therapy. In the beginning phase, there is a battle for taking initiative in
developing a structure, such as determining who is going to be present at the therapy sessions. In the middle
phase, Whitaker worked actively on family issues, bringing in extended family when appropriate. To bring
about change, he used confrontation, exaggeration, or absurdity. When he picked up an absurdity in the patient,
he built upon it until the patient recognised it and could change her approach. The ending phase of therapy deals
with separation anxiety on the part of the family (and therapist) and the gradual disentanglement from each
other’s lives. Throughout the therapeutic process, Whitaker’s style was marked by energy, involvement, and
creativity.

It is a therapeutic approach that encourages clients to identify and address hidden or subconscious
issues. Based on the humanistic-existential theory of human beings. The goal is to assist clients towards self
growth by realising their potential. Therapeutic experiences lead to significant transformations during the
therapeutic process. Acquisition of meaningful insight and understanding often furthers therapeutic change.
Therapeutic change is promoted upon uncovering alternative and more adaptive responses to one’s environment.
The main goal is to facilitate individual autonomy and bring all family members a sense of inter-connection or
belonging. To help the family encourage each of the other family member’s individuation. The approach relies
heavily on the therapist’s personal self-awareness. The therapist must be willing to participate in personal
therapy sessions.

Techniques of Experiential Family Therapy

 Experiential family therapy is an intuitive approach that utilises active, expressive multi-sensory
techniques.

 Role-playing or acting,

 props

 arts and crafts

 music

 animal care

 guided imagery

 various forms of recreation to re-enact and re-experience emotional situations from past and recent
relationships.