Family Systems Therapy

A structural Approach

Outline of Our Time Together

Clarifying some Assumptions of Understanding Family TherapyThinking SystemsChanging SystemsImpacting the SystemQuestions & Ideas Assessment with GenogramsTreatment Ideas with Sculpting

Assumptions of Understanding

Presence: Truly being present for the family is essential and in and of itself healing.

Process: Process is key to understanding. Having a methodology for meeting and knowing the family brings your lives together to create the therapeutic alliance.

More Assumptions

Therapeutic Alliance: Enables the therapist to see the hidden or unconscious structure that exists in the family

 

Family Structure: Is the key to finding the place to create change, loosen rigidity that exists and gain greater understanding and appreciation for the family.

Yet More Assumptions

Roles: Roles cannot be ignored, but can never take precedence over understanding and working with family process to enact change in family structure.

 Therapist’s role: To be the weaver of the fabric of the family. To take the strands –roles- to help the family understand, respect, nurture and weave them into the family tapestry creating a newfound fabric.

Finally . . .

The integrative process: This involves transferring knowledge to experience or Practice - Theory – Practice.

The Person of the therapist: Who we are and where we come from has a great impact on how we are informed about the work we do.

Systems thinking:

“A person cannot do right in one department of life while attempting to do wrong in another department.”

Gandhi

Family as a system

This model of a family as a system is extrapolated from the work of Ludwig Von Bertalanaffy and his General Systems Theory.

Holons: A single cell is made up of holons, just as a family is made up of individuals.

More to a system

Bounded: A cell has a “feedback loop,” enabling information to be transferred throughout the cell. All families have such a loop or process for communicating.

Interdependent: All holons are interdependent on each other. Change one and you change the system. The same holds true of individuals in the family system.

And Deceptively Simple

Homeostasis: All cells expend energy to maintain a steady state or homeostasis. This explains the difficulty of change within family systems.

This thinking moves from linear causality to a more multi-dimensional approach to families.From: A B C DTo B

A CD

Changing Systems:

“Significant problems we face cannot be solved at the same level of thinking we were at when we created the problem.”

Albert Einstein

Why a structural approach to systems work?

Structure is foundational to all systems.It is so fundamental that we don’t see it.Most assume the scene is constant – the only constant is change.Making the system (family) work so the problem can be addressed. Consider: How is structure affecting the system?

Core Structures of a System

Role Structure: Who has what rights and obligations?

Communication Structure: Who talks to whom?

Power Structure: Who influences whom?

Status Structure: Who has prestige?

Another way to look at structure

Boundaries: Hierarchy, roles, who’s in? Who’s out?Alignment: Who’s working together in relation to this particular function?Power: Who influences the outcome? How much influence does this person have versus that person?

Harry Aponte

Roles and Boundaries

Roles always require that one express only a certain part of them self.

A family becomes dysfunctional when roles are rigid; letting members only behave in one way and making demands on members they cannot meet.

Common Roles in Systems

Hero: Sacrifices self for the family and is often the first-born.

Rebel: Hero has all the goodies; often rebels are the “identified patient” and are usually detached from the family.

Family Pet: Often the youngest, sometimes identified patient and is never taken seriously.

Rigidity and Roles

Members feel emotionally locked into a role because if they play any other role, they will not get their needs met.

Both parents and child are active in setting up and maintaining roles.

These very skills that allow them to survive while a child, will hold them back in adulthood.

Boundaries: Rigid, Diffuse & Permeable

Organization allows members to know the boundaries and how one should act.

This allows for freedom of movement with the family system, and members always know where they stand within membership at any given moment.

Communication Pattern

A

B C

D

E F

More Effective Communication Pattern

A

B C

E F

D

What Keeps a System Cohesive?

Desire to be a part of the system

Ability to transcend differences

Desire for interdependence

Enjoy other members

Majority are full members

Impacting the system:

“Where mores are sufficient, laws are unnecessary. Where mores are insufficient, laws are unenforceable.”

Emile Durkheim

The Practice of the Therapist

Present OrientedIssue OrientedActiveDemands the therapist get involved, but not overwhelmed by the systemObserve and get involved while maintaining discipline and control of them self to maintain a professional role.

The Framework of Technique

Techniques come out of when the therapist relates with that person, they relate with that consciousness:

What is the role of that person?

Am I going to reinforce the role or undermine the role?

More Framework

What is the relationship between these two people?

Do I get between them or get them together?

Do I support this person’s power in relation to that person or not?

More Framework

Do I want to be like them and reinforce something that is going on and build on this momentum?

OR

Do I want to be very different and challenge them to become closer to me and therefore to change?

The Person of the Therapist

The therapist must be conscious that they are intervening through their relationship – that is the essence of this work.

The therapist is working in the present, looking at pathology as it manifests itself at this very moment through the interaction that is taking place in the room.

The Person of the Therapist

Structure is the basic framework, but it does not have soul. Therefore, the therapist must connect with the family’s values.

This is not changing the therapist’s approach, but rather relating on a human level.

Some Questions to Consider

In order to do family therapy does one need their family present?

What constitutes the family? Can a long-time neighbor, minister, friend, co-worker, or teacher be a candidate for family therapy?

How and when do you get a family in your office?

How do you make an assessment?

Some Ideas to Consider

Family therapy is a therapy of doing – actively participating in the work of the family.

Instead of trying to change behavior, try changing meanings.

More Ideas

Interviewer asks questions that would cast some light on how the symptom protected the relationship system.

Rely less on intervention and more on circular questioning.

The notion of “change” implies that someone is wrong. It implies things were bad before the change. Change may also be good for someone, but not another.

Some Strategies to Consider

Ask: “What is your idea of the problem?”

Ask: “What is the history of the idea to come to therapy?”

Genograms are a wonderful assessment tool. Always working with at least three generations. Multigenerational (Bowen)

More Strategies to Consider

Won’t come? Meet anyway and compose a message to those who do not attend. Content is less important than relational aspects. Called a “second order” move. “Gossip” in the presence of the family. Hearing what people think or say about them in front of other members is very powerful. Doing individual therapy with a couple.

Assessment

Using Genograms to gain an Understanding

Treatment

Sculpting a Family or System