Crisis Theory in Behavioral Health:

1
Crisis Theory in Behavioral Health

• Moving from stasis to developmental adaptation

Michael Bütz, Ph.D. Aspen Practice, P.C. Corey
Schwinn, LCSW Washington County Psychotherapy
Associates Linda Chamberlain, Psy.D. Pasco-Hernand
o Community College
2
Our Background
Michael Bütz, Ph.D. Aspen Practice, P.C. Corey
Schwinn, LCSW Washington County Psychotherapy
Associates Linda Chamberlain, Psy.D. Pasco-Hernand
o Community College
This presentation has been adapted from an
earlier version given at the Society for Chaos
Theory in Psychology Life Sciences, 14th Annual
International Conference, Milwaukee, WI on July
16, 2004 written with Karen Kesselring and David
Whalen we gratefully acknowledge their earlier
contributions.
3
Presentation Background

• Crisis Planning in-services across 4 county
  Region over the past 2 years,
• Working with a very busy regional crisis services
  system,
• Used the kinder gentler approach to
  introducing crisis theory and nonlinear dynamics
  as these concepts are somewhat unfamiliar,
• And, snappy titles

Crisis Planning in a
Chaotic World
4
Warning Avoid if at all possible!

• In our culture, that is, here in the United
  States,
• Stresses or emergencies are often seen as leading
  causally to interpersonal crises (James and
  Gilliland, 2001, pp. 9-10)
• And, these experiences tend to be regarded as
  something to avoided!!!

5
Warning Avoid if at all possible!
So, how about a little existential crisis?

• Thats like being a little pregnant,
• Or, being mostly dead

For those of you, gripping for this odd
reference, see the movie The Princess Bride
(circa 1987), and reference character Miracle Max
and the notion of mostly dead.
6
Consider, if you will
Consider if you will
Consider if you will

• Given these warnings, one may be left to ponder
  the question.
• WHY TAKE UP CRISIS THEORY AS AN AREA OF STUDY
  AND, PRACTICE?

Consider if you will
Consider if you will
7
So, Why Crisis?

• In essence, it is the seed from which all
  developmental processes unfold,
• And, crises are markers in time, a representative
  embodiment of all significant change processes

8
So, Why Crisis?

• The significance of a crisis is in its temporal
  telescoping of development. Major alterations in
  pattern may occur in a relatively short period
  and may subsequently remain stable for a long
  time.
• Gerald Caplan 1964

9
So, Why Crisis?

• And, common crisis descriptors, that
• Inappropriately continue to focus on
• Homeostasis,
• Equilibrium,
• And, static developmental notions of crises

10
So, Why Crisis?

• Besides, its the Big Picture
• Crisis Theory truly belongs to no one discipline,
  theoretical perspective, modality of treatment or
  model of care.
• Moreover, Crisis Theory applies regardless of the
  point of service that is to say the individual,
  couple, family, community or even nation.

11
The Problem Wrangling Linearity

• Colleagues in Crisis Theory
• Still see stresses or emergencies leading
  causally to interpersonal crises
• Remember the whole avoid the crisis experience
  deal?

12
The Problem Wrangling Linearity

• Yet, the field also acknowledges that crises are
• Multi-determined
• Present unique opportunities for individuals,
  families, communities and larger social systems
• Shorthand acknowledgement
• Danger Opportunity

13
The Problem Wrangling Linearity

• In fact, most mainstream crisis theorists
  acknowledge this, and use this symbol as a
  central theme
• Aguilera, 1998
• Gilliland and James, 2001
• Hoff, 2001.
• And, make use of this Chinese symbol to represent
  the phenomenon of crisis, that while there is
  danger, there is opportunity for adaptation
  and growth.

14
Theory The ordinary language

• Discussing matters scientifically, they naturally
  lend themselves to certain descriptions, words,
  mathematical expressions and the like.
• Here we will make use of words to represent
  states of existence, though undoubtedly in the
  future more refined descriptions would be
  preferable.

15
Theory The ordinary language
Warning! Prepare for an epistemological,
epistobabble deconstructionist moment, as we
confront how we explain ourselves
16
Theory The ordinary language

• Mathematics essentially means the existence of
  an algorithm which is much more precise than that
  of ordinary language. History of science attests
  that expression in ordinary language often
  preceded mathematical formulation, i.e. invention
  of an algorithm.
• von Bertalanffy, 1968

17
Crisis Theory Proper

• What is a crisis?
• According to leading authors on the topic (Hoff,
  2001 James and Gilliland, 2001), in a clinical
  context a crisis is
• an acute emotional upset arising from
  situational, developmental, or sociocultural
  sources and resulting in a temporary inability to
  cope by means of ones usual problem-solving
  devices
• crisis is a perception or experiencing of an
  event or situation as an intolerable difficulty
  that exceeds the persons current resources and
  coping mechanisms.

18
Crisis Theory Proper

• will one day make a systematic study of the
  unfolding of the significant ideas in this
  transitional period, assuming that events confirm
  our prediction that we are witnessing the
  beginning of a metamorphosis
• Caplan, 1964

19
Crisis Theory Proper

• Lindemann (1944)
• Studied responses to Coconut Grove Fire
• Identified emotional responses of people
  exhibiting signs/symptoms that resembled mental
  illness initiated discussion on crisis

20
Crisis Theory Proper

• Janosiks description of Lindemanns work (1994)
  emphasized equilibrium as a central concept as
  well
• Disturbed equilibrium,
• Grief therapy or grief work,
• Clients working through the problem or grief,
• Restoration of equilibrium.

21
Crisis Theory Proper

• Despite Lindemanns limited treatment of crises
  per se (1944, p. 141), Caplan afforded him
  important status stating that he developed the
  fundamentals of crisis theory as a conceptual
  framework for preventative psychiatry (1964, p.
  10).
• Yet, it was Caplan who subsequently identified
  that the response to a crisis situation involved
  the assessment of what was termed an individuals
  equilibrium or disequilibrium (1964, p.
  38-41).

22
Crisis Theory Proper

• The normal consistency of pattern, or
  equilibrium, is maintained by homeostatic
  re-equilibrating mechanisms, so that temporary
  deviations from the pattern call into operation
  opposing forces which automatically bring the
  pattern back to its previous state.
• Caplan,1964

23
Considering Caplan

• Non-linear focus?
• If the scale is quite small, e.g., if the
  pattern is inspected from minute to minute, it
  appears to be in constant change and movement.
  But a longer interval will show that the pattern
  continually reverts to a certain mean. If on the
  other hand, a much longer interval is taken, the
  pattern will be seen to change to a greater or a
  lesser degree.
• Caplan, 1964

24
Caplans Legacy

• Current researchers and theorists have pointed
  out that using equilibrium and homeostasis for
  describing the condition of any living being
  and/or system is, at best, problematic

25
Caplans Legacy

• Natural systems collect information over time
  that is stored and exerts an effect on both their
  current and future activity. Therefore, it is
  impossible in a natural system to start over
  again or return to a baseline. Time cannot be
  reversed, nor can the inevitable changes that
  occur over time be undone.
• Chamberlain (1995)
• Its essentially meaningless to talk about a
  complex adaptive system being in equilibrium the
  system can never get there. It is always
  unfolding, always in transition. In fact, if the
  system ever does reach equilibrium, it isnt
  stable. Its dead.
• Waldrop (1992)

26
Caplans Legacy

• Adaptation and the irreversibility of time are
  critical elements -Time is the medium in which we
  adapt, that is, we adapt across time, and time
  changes both individuals and systems
  irreversibly.
• You can never go home. That is to what home
  once was in the past home changes without the
  individual, and the individual changes as well.
• As concepts, equilibrium and homeostasis provide
  a false set, an illusion that an individual or
  system returns to a certain level of functioning,
  perhaps even a so called baseline.

27
Caplans Legacy

• From a systems perspective, von Bertalanffy
  squarely addressed both equilibrium and
  homeostasis
• We may also say that homeostasis is
  inappropriate as an explanatory principle for
  those human activities which are nonutilitatrian
  i.e., not serving the primary needs of
  self-preservation.symbolic rather than
  biological.

28
Caplans Legacy

• Every living organism is essentially an open
  system. It maintains itself in a continuous
  inflow and outflow, a building up and breaking
  down of components, never being, so long as it is
  alive, in a state of chemical and thermodynamic
  equilibrium but maintained in a so-called steady
  state which is distinct from the latter.

29
Caplans Legacy
30
Crisis Theory Proper Is it Proper?

• We are left to consider the possibility that
  behavioral scientists have mostly got it wrong
  theoretically in Crisis Theory missing the
  difference between first and second order change
  (Hoffman, 1981, pp. 50-66)
• That clients can never return to baseline,
  equilibrium or homeostasis, and a pill will not
  smooth out the personality (Kramer, 1993)
• Moreover, It is unlikely that a clinician,
  talented though they may be, is able to re-set
  an individual or a system back to a certain
  point or room temperature via negative
  feedback.

31
Getting back on track

• So, what may be useful in considering how
  individuals and/or living organic systems adapt
  to the world around them, good, bad or
  otherwise, as well as how systems grow and
  change over time?
• Historically two schools of thought have in
  combination, and separately, fit the bill, for
  building such a model - Cybernetic Theory
  (Wiener, 1961) and General Systems Theory (von
  Bertalanffy, 1968).

32
Getting back on track

• Basic to both is that these theories describe how
  systems are able to grow and adapt through
  elegantly simple explanations.
• While Cybernetic Theory uses negative and
  positive feedback to indicate how systems are
  encouraged to do less of one thing, and more of
  another
• General Systems Theory (hereafter GST) describes
  how systems move through progressively more
  developed and differentiated steady states.

33
Getting back on track

• Simply put, Cybernetic Theory describes negative
  feedback as a mechanism that focuses on slowing,
  halting or dampening the behavior of a system
  for instance, a thermostat when the room
  reaches a certain set point and shuts off.
• Positive feedback, on the other hand, encourages
  or promotes more behavior from, and/or
  information, to come into the system for example
  a third-base coach in baseball waving the base
  runner on toward home plate.

34
Getting back on track
Negative Feedback Positive Feedback
35
Getting back on track

• Systems thought, Cybernetics, GST, and other
  conceptions, describe individuals and systems as
  decreasing or increasing feedback accordingly via
  the description of being a closed or an open
  system, i.e. closed or open to more information.
  
• Closed, in that he/she is not listening to what
  I am saying, open in that he/she hears me, and
  understands. Take for example our base runner.

36
Getting back on track

• Should the runner stop on second base and ignore
  the base coaches exuberant encouragement to run
  home, the runner may be said to be closed to the
  information the coach is conveying while if the
  runner accelerates toward home base in response
  to the coach the runner is described as open.
• Whether or not a system is open or closed and
  exchanges, energy, information or matter with the
  external environment is critical (von
  Bertalanffy, 1968, pp. 158, 161-163) as the
  ability to do so defines the individual or system
  as living open.

37
Getting back on track

• Both theories complement each other in
  emphasizing the limitations equilibrium and
  homeostasis face as explanatory metaphors.
• These theories highlight the fact that biological
  systems really never return to any set point,
  per se that time moves on and systems adapt or
  do not adapt.
• That living systems never truly return to what
  they once were - as it is very difficult to
  unscramble an egg

38
Integrations, and the Edge

• There have been models, largely in family
  therapy, that do discuss both Cybernetics and
  GST, exemplars are
• Halpern, Canale, Gant and Bellamy, 1979
• Selvini-Palazzoli, Boscolo, Cecchin, and Prata,
  1978
• And though, von Bertalanffy was familiar with
  Prigogines work (1968), his novel concept of
  far-from-equilibrium, modified the way
  scientists approached this topic (Prigogine and
  Stengers, 1984).

39
Integrations, and the Edge

• Still, others in behavioral health entered the
  fray, and began to describe the benefits of using
  the language of nonlinear dynamics for crisis
  practitioners.
• Chamberlain, 1995
• Ramsay, 1997
• Chamberlain was one of the first, and offered the
  following
• Suicidal behavior may serve as a means of
  preventing change (chaos) and maintaining
  stability (order).a suicide threat may also
  serve to destabilize a family that is not
  adequately responding to change and is somehow
  stuck in more of the same when a difference is
  needed.

40
Integrations, and the Edge

• Chamberlain went on to describe the basic
  iterative cycle described in various forms
  earlier from different vantage points, that is
  the process of individual or systemic
  transformation, in stating that (p. 122),
• reorganization can occur that establishes a new
  order using its own energy. The system, however,
  must first interact in some new way either within
  itself (between different elements) or with the
  environment.

41
Integrations, and the Edge

• She also supplied a host of novel readers with
  some of the fundamental concepts and language
  through basic laws of the nonlinear paradigm
  generated by our perception of phenomena, not by
  the phenomena itself (1995, p. 121).
• In a similar vein, Ramsay (1997), provided
  language and process descriptions, but he added a
  critical element defining what may be healthy
  or unhealthy development

42
Integrations, and the Edge

• The loss of equilibrium orderliness in complex
  systems does not mean they are governed by
  randomness they do have upper thresholds of
  stability that, if transgressed, produce critical
  instabilities (Laszlo, 1985, p. 35). These
  instabilities occur when sudden or anticipated
  events of a minor or major nature trigger a
  system to branch or transition toward a new or
  different state of equilibrium. The vital instant
  when a branch or fork in the evolution of a
  system occurs is called a bifurcation and though
  causality operates at every instant, the
  branching takes place unpredictably (Briggs
  Peat, 1989, p. 145). Over time, thousands of
  bifurcation points, some planned, others out of
  the blue, become critical milestones in the
  healthy progression or pathological
  regression of a system.

43
Integrations, and the Edge

• Ramsay makes a critical point, that one of the
  greatest advantages to a nonlinear systems
  description is how the arrow of time is revealed,
  
• Or, how directionally a system may de-evolve,
  or in more familiar behavioral therapeutic
  language regress
• The greatest advantage of the far-from-equilibriu
  m model is its capacity to accommodate the
  directional duality of devolution (entropy) and
  evolution (anti entropy) of system processes. The
  two directional nature of the model fits much
  better than the original equilibrium model with
  the commonly described danger and opportunity
  characteristics of a crisis. (Ramsay, 1997, p.
  32).

44
Developmental Stage AdaptationLife Cycle of
Corn
Hence, the Basics
                                                
                       
45
Hence, the Basics

• Each stage
• Resembles the previous
• Carries the struggles successes of the previous
• Carries with it new behavior level of
  adaptability

46
Hence, the Basics

• Crisis represents developmental movement of some
  sort

Steady State
Progression
?
?
?
Steady State
Developmental Movement
?
?
?
Regression
Adaptation
47
Our approach, nonlinear

• Cybernetics feedback (-/)
• GST progressive steady states
• Nonlinear Dynamics
• Chaos
• Complexity

48
Our approach, definitions

• Nonlinear Dynamics
• An umbrella term for a whole variety of nonlinear
  phenomenon such as chaos, complexity, emergence
  and fractals to name a few
• Chaos
• Originally used by the Greeks to describe the
  limitless void, it is now used to describe
  unpredictable and apparently random structures.
  (Davies, 1989)
• Complexity
• A kind of an abstract phase transition called
  the edge of chaos, you also find complexity a
  class of behaviors in which the components of the
  system never quite lock into place, yet never
  quite dissolve into turbulence, either.
  (Waldrop, 1992)

49
Our approach

• Transformative Crisis Intervention (TCI)
• Always working toward transformation fully
  considering the coherence and energy of the
  individual or system,
• Honoring the behavioral health and nonlinear
  dynamics literature that has been laid down
  before, incorporating a lessons learned stance
  given current vernacular,

50
Our approach

• Transformative Crisis Intervention (TCI)
• And focusing on a growth model, acknowledging
  that development may be represented by a variety
  of psychiatric-appearing states, such as an
  anxiety, depression, disorientation, and periodic
  regressions.

51
Transformative Crisis Intervention

• Filling Gaps
• There are a number of gaps, and terms that may be
  miss-ques in the theory that exists on the
  overall flow of the growth process.
• Terminology
• Though von Bertalanffy has made use of steady
  states, and describe an adaptive process by using
  such terms, in the face of nonlinear dynamics, a
  more descriptive term is required.

52
Transformative Crisis Intervention

• Terminology
• Dynamic Steady States both honors von
  Bertalanffys contribution to the field, as well
  as describes the dynamic nature of a stable
  state informed by nonlinear dynamics in a
  developmental framework.
• Transformative States is also a required
  introduction, not explicitly described in earlier
  GST, and more fully describes unstable states
  with cybernetic properties, bifurcation cascades,
  complexity and chaos as transformative processes.

53
Transformative Crisis Intervention

• These terms represent developmental movement
  through successive states

Dynamic Steady State
Progression
?
?
Transformative State
?
Dynamic Steady State
Developmental Movement
?
?
?
Regression
Adaptation
54
Transformative Crisis Intervention

• A Constant Striving No Matter What
• Another premise here is that whether or not it is
  evident, that individuals or systems are
  constantly striving to adapt - regardless of
  whether or not they are successfully adapting.
• When systems lack either coherence or energy, or
  both, they may exist in a phase of development in
  which they toil at the edge of complexity without
  adequate transformative resources to make use of
  complexity, no less, chaos, as a transformative
  process.

55
Transformative Crisis Intervention

• A Constant Striving No Matter What
• Resource Structural Maladaptations describes this
  process, wherein the system lacks the metabolic
  and structural properties that would enable it to
  continue on its developmental path .
• Resource Structural Maladaptations may also be
  may also be viewed as somewhat dangerous if left
  to cycle too long, akin to a kayaker being caught
  in what is termed colloquially as a
  keeper-hole, as the system may begin to run out
  of energy and call upon its own structure,
  physical or psychological, to maintain it...

56
Transformative Crisis Intervention

• Striving, via a Resource Structural
  Maladaptations (RSM) may prove to be a risk to a
  system akin to a fever left uncontrolled by the
  act of attempting to heal itself, it harms
  itself.

Dynamic Steady State
Progression
Dynamic Steady State
?
?
Transformative State
?
?
?
?
Developmental Movement
Developmental Movement
?
?
RSM
Regression
Adaptation
57
Add In Nonlinear Dynamics
INSERT ATTRACTORS THAT CORRESPOND
58
Add In Nonlinear Dynamics
Progression
Dynamic Steady State
?
?
?
?
?
Transformative State
?
?
Developmental Movement
?
?
?
RSM
Regression
Adaptation
59
Nonlinear Dynamics Informed Approach...

• Two forms of transformation
• Chaos
• Complexity
• Inherent problems, coherence and energy
• Systems may use chaos as a developmental/transform
  ative process, but the energy and structural
  costs are great, another process that may be used
  is complexity when either are not sufficient for
  this more costly form of transformation Bütz,
  1997 (pp. 64, 132-142).

60
Applied Theory

• Case Examples
• Applying TCI
• What are the Crisis Domains?
• What would be important to assess?
• What are the markers of adaptation?

61
Nonlinear Dynamics Informed Approach...

• Two general outlines for those experiencing
  crisis
• Person struggling w/no supports and/or actively
  suffering from a mental illness who need
  stabilization support
• Person has good support system, interpersonally
  woven together, who is experiencing an
  existential crisis

62
Nonlinear Dynamics Informed Approach...

• Does the client have the internal structure
  external resources to push through the crisis?

63
Coherence

• tension due to frustration of need rises, and
  this in itself involves problems in maintaining
  the integrity of the organism or group and may be
  associated with feelings of subjective discomfort
  or strain
• Caplan, 1964

64
Coherence

• Goldstein, (1994, p. 49) addressing
  organizational structure and drawing an analogy
  between a Bernard system, also focuses on the
  coherence of the system
• With regard to self-organization in human
  systems, the two aspects of an organizations or
  work groups boundaries are also necessary the
  boundaries must be firm enough to contain the
  process of self-organization yet permeable enough
  to allow vital exchange with the environment.

65
Coherence

• Coherence is a fundamental concept in considering
  the development or maintenance of the personality
  (Bütz, 1997, pp. 199-202 Proskauer and Bütz,
  1998, pp. 197-199).
• Call it ego-strength, as in psychodynamic theory,
  or coherence (Antonovsky, 1993) it is an
  elemental concept akin to energetic fabric that
  holds cosmos together (Greene, 2004).

66
Markers of Available Energy

• Considering energy, how is it we are able to
  measure this within the individual or system?
• Dont reinvent the wheel,
• And, what are well known psychiatric markers?
• Answer Anxiety and Depression Of Course

67
Markers of Available Energy

• Anxiety and depression are not only markers of
  available energy
• They are also developmental markers,
• And, tell us where the system has been, and where
  the system is at, at this point in time
• Consider Eeyore
• Or, Rabbit

68
Crisis Domains

• As cited by some authors in the crisis field
  (James and Gilliland, 2001, pp. 5-6), Brammer
  (1985, pp. 94-95) introduced three crises
  domains
• There are normal developmental crises, such as
  birth or a child going off to school.
  Situational crises are associated with severe
  loss of status, possessions, or loved ones.
  Existential crises refer to the conflicts and
  anxious feelings experienced when facing the
  significant human issues of identity, purpose,
  responsibility, freedom and commitment.
  (Brammer and MacDonald, 1999, p. 103)

69
Crisis Domains
Developmental
Existential
Beliefs Values
Situational
Environmental
70
An Early Matrix to Consider

• Caplan outlined escalation of crisis
• Phase 1 Initial rise in tension as well as
  that persons usual methods of coping to maintain
  homeostasis
• Phase 2 Lack of success leads to rise in
  tension as well as a sense of ineffectiveness

71
An Early Matrix to Consider

• Caplan outlined escalation of crisis
• Phase 3 Further rise in tension and the
  mobilization of internal and external resources
  using experimenting with new methods. Active
  resignation on unattainable goals new levels
  of awareness.

72
An Early Matrix to Consider

• Caplan outlined escalation of crisis
• Phase 4 Problem continues and does not subside
  with usual coping skills Breaking point where
  major disorganization with drastic results
  occurs.

73
An Early Matrix to Consider

• Halpern, et. al., included person-in-environment
• Human eco-system
• Internally (intra-psychic)
• Individually
• Primary Group (small clusters in society)
• Secondary Group (social/institutional)

74
Considering the above Matrix

• Internal structure
• (Caplan Matrix level of organization)
• External resources
• (Halpern, et. al., Matrix human eco-system)

Encourage Support
?
Provide Safety Slow Process
?
?
Dynamic Steady State
Progression
Developmental Movement
?
?
?
Regression
Chaos
Adaptation
Complexity
75
Crisis Domains Updating the Matrix
Open
External Structure/Resources
Internal Structure/Resources
High Risk
Moderate Risk
Low Risk
Closed
76
Principles in Action

• Case Studies
• Open vs. Closed
• Internal Structure?
• External Resources?

77
References

• Aguilera, D.C. (1998). Crisis intervention,
  theory and methodology (8th Ed.). St. Louis, MO
  Mosby.
• Antonovsky, A. (1993). Complexity, conflict,
  chaos, coherence, coercion and civility. Social
  Science and Medicine, 37, 969-974.
• Bonanno, G.A. (2004). Loss, trauma and human
  resilience Have we underestimated the human
  capacity to thrive after extremely aversive
  events? American Psychologist, 59(1), 20-28.
• Brammer, L. M. (1985). The helping relationship
  Process and skills. (3rd Ed.). Prentice Hall
  Upper Saddle River, NJ.
• Brammer, L. M. and MacDonald, G. (1999). The
  helping relationship Process and skills. (7th
  Ed.). Allyn and Bacon Boston, MA.
• Bütz, M.R., Bowling, J.B. and Bliss, C.A. (2000).
  Psychotherapy with the mentally retarded.
  Professional Psychology Research and Practice,
  31(1), 42-47.
• Bütz, M.R. (May, 2002). Crisis as opportunity.
  Presentation for Washington County Psychotherapy
  Associates Crisis Programs, Milbridge, Maine.

78
References

• Bütz, M.R., Fitzpatrick, S. Kesselring, K.,
  Krietzer, A., Lynn, T. Schwinn, C. K., and
  Whalen, D. (February, 2003). Crisis planning in
  a chaotic world. Presented at four locations in
  Northern Maine, Bangor, Dover-Foxcroft, Ellsworth
  and Machias.
• Bütz, M.R., Fitzpatrick, S. Kesselring, K.,
  Krietzer, A., Lynn, T. Schwinn, C. K., and
  Whalen, D. (April, 2004). Crisis planning
  forum Exploring the connection between crisis
  and case management system through crisis
  planning. Presented at four locations in
  Northern Maine, Bangor, Ellsworth, Lincoln and
  Machias.
• Bütz, M.R. (1997). Chaos and complexity
  Implications for psychological theory and
  practice. Taylor Francis Washington, D.C.
• Chamberlain, L.L. and Bütz, M.R. (1998).
  Clinical chaos A therapists guide to nonlinear
  dynamics and therapeutic change. Brunner/Mazel
  Philadelphia, PA.
• Bütz, M.R., Chamberlain, L.L., and McCown, W. G.
  (1997). Strange attractors, chaos, complexity
  and the art of family therapy. John Wiley
  Sons New York.

79
References

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