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Theory and Design in Counseling and Psychotherapy
Susan X Day , Iowa State University and University of Houston
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CHAPTER 10: Systemic Approaches: Family Therapy
Chapter Review
Family therapies are characterized by viewing the client as a group, rather than treating the individuals within the system separately. Even when individual clients are seen alone, a major focus of counseling is the influence of the family. Systemic thinking explores the impact of group as an organism functioning as a whole with interrelated parts. The most basic grouping is the family of origin, the group in which a person is born, a nuclear family consisting of parents and children. The basic family group has an extended family consisting of relatives and very close friends. Each family is unique, characterized by its history across generations and by establishing its own way of doing things, or its own rules that can be explicitly stated or implicitly enforced. The family, like individuals, has different experiences across the life cycle, starting with a couple's early-marriage period; changing to parenting of first young children, then older ones, until the children become adults and leave home. Children are an important factor in the system, and they behave in ways that meet their own goals, though systemic mechanisms regulate their behavior and development.
An important systemic concept is the balancing of the needs of individual members and the needs of the group, stabilizing group functioning, in an effort to maintain homeostasis. Each family has interaction patterns that govern the communication between members and alignments between individuals and between subgroups within the system. Boundaries separate the family group from outside influences and can be either permeable, allowing a flow of information, or impermeable, permitting only minor input.
When families present themselves for counseling, often there is an identified patient-the person said to have a problem. From a systemic perspective, the "problem," though attached to one person, is actually a group issue; and the individual member's difficulties may serve a function for the group as a whole (symptom functionality). A family may be a problem-determined system, meaning that the focus on difficulties allows the family to deal with the group's anxiety regarding less obvious issues. A common example would be parents bringing to counseling a rebellious teenager whose behavior may actually hide marital difficulties in the parents. A problem-determined system includes everyone who considers themselves affected by the problem, so sometimes a family member may not be included, and sometimes a nonfamily member is included.
A number of family therapy approaches have different explanations for how families work and what goes wrong when groups become dysfunctional. The systemic approach emphasizes group anxiety and what functions a symptom serves. Bowen describes how families come together to worry about one member's difficulties in a process called family projection. Cross-generational transmission can carry problems from one generation to the next. Families may establish
interaction patterns where emotions and thinking are so undifferentiated that the feelings and thoughts are said to be fused. Where fusion dominates, family members operate on the basis of pseudoselves, where thoughtful consideration is denied in favor of doing whatever it takes to maintain emotional connections. To tease out the pervasive themes that may induce families to act out historically reinforced emotions, genograms may be used by counselors. A genogram is a diagram showing the family in an historical sequence. Exploring stories about the family depicted on the genogram helps therapists and clients determine multigenerational influences. Another systemic concept is triangulation: two people in conflict involve a third member and avoid direct confrontation. The triangle interaction is meant to reduce anxiety for the triad and for the system as a whole. However, it doesn't always work and often produces more problems.
The structural therapy approach emphasizes the construction of the family organization. What are the openly spoken rules and the unspoken ones? What subgroups exist where two or more family members align themselves and interact with other subsystems? Often parents are one subsystem with its own purposes and relationship, and siblings, or some combination of the children, form other coalitions. How tight knit is the family? How close are family members? The family structure maintains boundaries around the group and dictates how much outside influence is allowed in. When the flow of communication and emotional connections are disrupted, some members may disengage or cut off direct exchanges. Or, the degree of closeness may be too intertwined, with family members enmeshed, suggesting that they have difficulty separating their individual needs from each other.
The strategic therapy approach pays attention to the circular causality within families: what happens to any part of the system affects the rest of the system. Therapists use a technique called circular questioning, asking each and every member the same question to reveal the interrelationships and expose differing points of view. Strategic therapists use calculated interventions to create systemic changes, and they may choose not to reveal the purpose of the therapeutic techniques. One such method is paradoxical intention where clients are told to do more of a symptom. Other techniques help clients gain new interpretations of family events or problems. The counselor may use a new word to reframe a single client perception, or new interpretations may fully restructure broad cognitive patterns used by family members.
Experiential family therapists share techniques and counseling goals with Gestaltists. The purpose of many counseling activities is to induce full emotional experiences so everyone in the group will be more congruent in communicating and will gain empathy for what others are going through. Techniques include the parts party, where family members act out one person's personality parts; and sculpting, where one person directs others in a pantomime of a family scene. Experiential counselors attempt to create change for primary, underlying emotions, rather than fixing surface feelings, or secondary emotions. Some dysfunctional families may exhibit emotional deadness: awareness of feelings and spontaneity is lacking. Experiential counselors themselves may join the empathic sharing among family members as everyone shares in the experiencing of the moment.
The narrative approach stresses the impact of family stories that depict how families characterize themselves and relay values through shared lore. The social constructions each person carries from the family narrative may include unexamined meanings. By telling the stories, old interpretations can be examined and changed or held with respect. Family social constructionists also assign letter writing so clients can express what they might want to say to another family member, even though the client may choose not to send the letter. Reflecting teams observe
family sessions and then share their thoughts with the family so differing viewpoints can be noted.
Although different family therapy approaches may vary in their emphasis, all share the broad ideas of systemwide influences. Some approaches prefer the counselor to take a neutral stance and objectively observe families interacting. Other approaches may prefer participating in the family experience. Some family counselors may accommodate family language and emotional tone to join the system. Common techniques include the miracle question, asking clients how their lives would be different if problems magically disappeared. Or, clients may be asked to recall a time when they did not experience the problem, a technique called unique outcome, or asked to rate the problem's severity on a scale to gain perspective. Family drawings are commonly used as a visual depiction of family members or family activities, as with kinetic drawings. Yet another technique is family mapping, where clients label characteristics of each family member and identify interaction patterns between dyads. Sometimes counseling can offer the means for families to reduce surface level anxieties and create what is termed first-order change. At other times, second order changes are achieved where the basic structure of the family is transformed.
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