FAMILY SYSTEMS

THERAPY
 BASIC ASSUMPTIONS
The family systems therapy models are grounded on the assumptions that a client’s
problematic behavior may
(1) serve a function or purpose for the family,
(2) be a function of the family’s inability to operate productively, especially during
developmental transitions, or
(3) 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. The multilayered process of
family therapy represents different perspectives in working with any family. The goal is
to provide the therapist with multiple perspectives for tailoring therapy to the needs
and situations of a family.
 THERAPEUTIC RELATIONSHIP
• In the strategic and structural approaches to family therapy, the
therapeutic relationship is not emphasized. However, the experiential
and human validation models are based on the quality of that
relationship. Many family therapists are primarily concerned with
teaching members how to modify dysfunctional interactional patterns
and change stereotypical patterns. Some family therapists are more
concerned with implementation of techniques designed to solve
presenting problems than with the quality of the therapeutic relationship.
Others realize that their relationship with family members is temporary,
and thus they focus more on the quality of relationships within a family.
 ROLE AND FUNCTION OF
FAMILY THERAPISTS
Here are some central roles associated with the major approaches to family therapy.
■ Adlerian family therapists assume the roles of educators, motivational investigators,
and collaborators.
■ In Bowen’s multigenerational therapy, therapists function as guides and objective
researchers. Therapists monitor their own reactions and take an active role in
facilitating change in a family. Once individuals have gathered information about
their family of origin, the therapist coaches each person in developing strategies for
dealing with signifi cant others outside of the therapy sessions.
 ROLE AND FUNCTION OF
FAMILY THERAPISTS
■ In the human validation process model of family therapy, the fundamental function of the
therapist is to guide the individual family members through the process of change. The
therapist provides the family with new experiences and teaches members how to
communicate openly. In this model the therapist is an active facilitator who models
congruence and serves as a resource person. ■ The experiential family therapist functions as
a family coach, challenger, and model for change through play. Therapists have various
functions at different points in therapy, including being a stress activator, a growth activator,
and a creativity stimulator. ■ Structural family therapists function as stage directors. They
join the system and attempt to manipulate family structure for the purpose of modifying
dysfunctional patterns. The therapist’s central task is to deal with the family as a unit, in the
present, with the goal of initiating a restructuring process.
 ROLE AND FUNCTION OF
FAMILY THERAPISTS
■ In the strategic model therapists function in active and directive ways.
Working as consultants and experts, they are manipulative and
authoritarian in dealing with resistive behaviors. The therapist is the
agent responsible for changing the organization of a family and
resolving the family’s presenting problems. ■ In the integrative approach
to family therapy, therapists look at a family from multiple perspectives
and collaboratively work out with a family specific processes and
practices that will lead to change.
 THERAPEUTIC TECHNIQUES
There is a diversity of techniques, depending on the therapist’s theoretical
orientation, and a considerable degree of fl exibility in applying them,
even among practitioners within a school. Family therapists tend to be
active, directive, oriented toward the solution of problems, and open to
using techniques borrowed from various approaches. Here are some of
the primary intervention strategies associated with the various schools of
family therapy.
 THERAPEUTIC TECHNIQUES
■ Adlerian family therapists employ techniques such as family
constellation, reporting of a typical day, goal disclosure, and logical
consequences.
■ Multigenerational family therapy focuses on asking questions, tracking
interactional sequences, assigning homework, and educating.
■ Throughout Satir’s use of the human validation process model, various
techniques are used to facilitate enhanced interpersonal communication
within the family, a few of which are drama, reframing, humor, touch,
family reconstruction, role playing, family life-fact chronology, and
family sculpture.
 THERAPEUTIC TECHNIQUES
■ Experiential family therapists utilize themselves as their best therapeutic
technique, creating interventions that grow out of the phenomenological
context in working with a family. ■ Structural family therapists engage
in tracking transactional sequences, reframing, issuing directives, joining
and accommodating a family, restructuring, and enactment. ■ Strategic
therapists utilize reframing, directives, and paradoxical interventions,
and they also track interactional sequences.
 SAMPLE CASE STUDY
Navid, a 22-year-old of Persian descent, has come to counseling because his parents have insisted he
deal with his pot use, or they will not pay for him to finish his last semester at an elite private
college. Navid admits that his grades have plummeted this last semester, but he claims that it is
because his parents want him to become a doctor, and he does not want to. He says that he smokes
pot only on the weekends with friends and when he is stressed and preparing for an exam; he
denies other substance use except for drinking “a few beers” at parties. He prefers to play music—
he is an avid guitarist—but his parents say that is not a real profession. His younger sister in high
school, who is the “perfect one,” understands his frustration but would never speak up for him in a
conversation with their parents. His parents recently caught him smoking pot during a recent visit
home. His uncle, a medical doctor, was called in to “educate” him about drugs. His father stopped
talking to him for the rest of the visit because he was so upset by Navid’s choice to “throw his life
away after all I’ve done for him.” He reports hearing his mother frequently cry over the incident.
Navid said he really doesn’t care about graduating but is coming to counseling because he doesn’t
know what else to do with his family and his life.
 INITIAL PHASE OF
1. Develop working counseling relationship.
TREATMENT
Diversity consideration: Assess for AM’s level of acculturation and adapt style of connection and
emotional expression to Persian norms. Relationship building intervention:
a. Joinwith AM using social courtesy and by respecting family’s culture and class; maintain a neutral
position when AM discusses frustration with his family, especially the father.
2. Assess individual, systemic, and broader cultural dynamics.
Diversity consideration: Consider Persian norms and assess level of acculturation and education
before assessing family dynamics.
Assessment Strategies:
b. Obtain detailed description of problem behavioral sequences, encouraging nonblaming
descriptions of each person’s actions.
b. Identify boundary, subsystems, triangles, hierarchy, and complementary patterns that contribute to
AM’s substance use and family conflict.
 INITIAL PHASE OF
TREATMENT
Initial Phase Client Goals
1. Increase AM sense of concern about his future to increase responsible decision
making and reduce use of marijuana.
Interventions:
a. Reframing crisis situation to increase AM’s sense of personal responsibility for life
direction and reduce need to rebel against father.
b. b. Directives to interrupt escalation of substance use when stressed and identify
alternative means to manage stress.
 WORKING PHASE OF TREATMENT
1. Monitor quality of the working alliance.
Diversity consideration:
Ensure positive alliance with AM and family members who are not in session; adapt
communication considering Persian norms and education level.
Assessment Intervention:
a. Use Session Rating Scale; verbally ask AM about alliance.

Working Phase Client Goals 1. Increase AM’s ability to interrupt problem interaction
cycle and do something different to reduce stress related to father and motivation to
use substances.
 WORKING PHASE OF TREATMENT
Interventions:
a. Directive to do one small thing different on his part to interrupt
problem interaction pattern, such as writing a thank-you to uncle.
b. Systemic reframing that frames his substance use as a way his father is
still controlling him because he is simply being the antithesis of what
father wants rather than own person.
c. Ordeal and paradoxical directions that require AM to engage in
unappealing ordeal before substance use in order to reduce use.
 WORKING PHASE OF TREATMENT
Increase clear boundaries with parents that allow for better communication of personal needs and wishes to
reduce self-sabotaging substance use.
Interventions:
a. Enactments adapted for individual to help AM practice alternative ways of responding to parents.
b. Circular questions to increase AM’s understanding of the covert family dynamics and his role in
perpetuating them.
3. Increase developmental and cultural appropriateness of AM’s rules for relating to reduce his use of
substances and increase responsibility for life direction. Interventions:
a. Circular questions to increase awareness of relational assumptions that underlie family conflict and AM’s
substance use.
b. Challenging worldviews and relational rules that support and maintain the problem while remaining
respectful of cultural norms.
 CLOSING PHASE OF TREATMENT
1. Develop aftercare plan and maintain gains.
Diversity consideration: Consider Persian and university community resources.
Intervention:
a. Reinforce new epistemology and relational rules and use circular questions to apply new
skills to future challenges.
b. Reassess functioning in all areas before ending counseling to ensure problem has not
shifted to another aspect of system.

Closing Phase Client Goals

1. Increase satisfying interactions with nuclear and extended to reduce feelings of
hopelessness.
 CLOSING PHASE OF TREATMENT
Interventions:
a. Shaping competency to transfer strengths from relating to father to relating to all family
members.
b. Circular questions to capitalize on strengths and expand to new areas.

2. Increase effective development transition to young adult who makes good life decisions
without parents’ intervention to reduce substance abuse and self-sabotage.
Interventions:
b. Challenge rigid definitions of self based on old role in system as child.
c. b. Circular questions to increase AM’s ability to see the responsibilities and
possibilities of his new development stage more clearly.
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