Family Systems Therapy

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Family Systems Therapy

• A structural Approach

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Outline of Our Time Together

• Clarifying some Assumptions of Understanding
  Family Therapy
• Thinking Systems
• Changing Systems
• Impacting the System
• Questions Ideas
• Assessment with Genograms
• Treatment Ideas with Sculpting

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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.

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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.

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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.
•  Therapists 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.

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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.

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Systems thinking

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

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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.

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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.

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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 D
• To B
• A C
• D

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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

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Why a structural approach to systems work?

• Structure is foundational to all systems.
• It is so fundamental that we dont 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?

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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?

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Another way to look at structure

• Boundaries Hierarchy, roles, whos in? Whos
  out?
• Alignment Whos 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

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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.

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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.

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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.

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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.

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Communication Pattern

• A
• B C
• D
• E F

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More Effective Communication Pattern

• A
• B C
• E F
• D

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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

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Impacting the system

• Where mores are sufficient, laws are
  unnecessary. Where mores are insufficient, laws
  are unenforceable.
• Emile Durkheim

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The Practice of the Therapist

• Present Oriented
• Issue Oriented
• Active
• Demands the therapist get involved, but not
  overwhelmed by the system
• Observe and get involved while maintaining
  discipline and control of them self to maintain a
  professional role.

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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?

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More Framework

• What is the relationship between these two
  people?
• Do I get between them or get them together?
• Do I support this persons power in relation to
  that person or not?

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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?

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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.

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The Person of the Therapist

• Structure is the basic framework, but it does not
  have soul. Therefore, the therapist must connect
  with the familys values.
• This is not changing the therapists approach,
  but rather relating on a human level.

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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?

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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.

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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.

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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)

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More Strategies to Consider

• Wont 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.

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Assessment

• Using Genograms to gain an Understanding

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Treatment

• Sculpting a Family or System