Lecture 1 introduction to systemic therapy


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Conceptual and Clinical Influences

Lecture 1 introduction to systemic therapy

  1. 1. SYSTEMIC COMPARATIVE Lecture 1 Introduction to Systemic therapy: THE HISTORY OF FAMILY THERAPY Conceptual and Clinical Influences Kevin Standish Newham College University Centre
  2. 2. Learning Objectives  Understand the Shift From Linear to Systemic Epistemology  Understand and define key concepts used in systemic therapy  Describe the historical and clinical developments of systemic therapy
  4. 4. What is Systemic family therapy?  Systemic family therapy is an approach to helping people with psychological difficulties which is radically different from other therapies.  It does not see its work as being to cure mental illnesses that reside within individuals, but to help people to mobilise the strengths of their relationships so as to make disturbing symptoms unnecessary or less problematic (Stratton 2010).
  5. 5. The Systemic Family Therapy Perspective on problems  We live our lives through our relationships. Research into what matters most to people consistently finds that close relationships, especially family relationships, rank higher than anything else.  Our sense of who we are is intimately associated with our relationships – both to other people and the contexts in which we live. When relationships do not give us what we need, we lose our sense of comfort and confidence about the person that we are.
  6. 6. The Systemic Family Therapy Perspective on problems  When relationships go seriously wrong, powerful psychological process come to operate.  Often not in full awareness, and often with unwanted consequences.  Much psychological distress is a result of these processes.
  7. 7. The Systemic Family Therapy Perspective on problems  Conditions that get given labels such as depression, anxiety, and conduct disorder, are very often effects of relationship problems.  Conversely, when systemic family therapists see someone in psychological distress they look first for relationships that have gone awry. (Stratton 2010)
  8. 8. Advantages of Systemic interactional based therapies  Relationship problems are usually best treated within those relationships.  Problems are being treated in the context in which they arose  The other people in the family or group with close relationships are a powerful (and nearly always willing) resource for change.
  9. 9. Advantages of Systemic interactional based therapies  Therapeutic gains that have been achieved in collaboration with the family and other relational systems are most likely to continue as the person moves forward in their context of everyday living.  therapy carried out within relational systems is so effective that it is often not necessary to understand where a problem such as depression came from.
  10. 10. How Systemic Family Therapy Works (Simple version)  Systemic family therapy has developed a varied repertoire of highly effective methods that a family therapist can call on to meet the needs of clients and families. These include: 1. An awareness of how family processes operate and ability to make these apparent to the family. 2. An ability to work with children in relation to their parents and vice-versa. 3. Working with families to understand and productively use the influence of their
  11. 11. How Systemic Family Therapy Works (Simple version) 4. Through both conversation and action, helping family members to recognise options they have not been making use of. 5. Collaborative exploration of strengths and resources of family members that they can bring to bear to support each other. 6. It always takes account of the full range of systems that can be seen as nesting inside each other. 7. It place a high priority on working with all aspects of diversity and to be concerned with issues of power , gender, race and economic contexts
  12. 12. Who gets systemic therapy?  It is most often offered to couples or families  Group specific behaviors like classroom or organisational issues.  But always with the larger and smaller systems in mind, and with an awareness that change at any level of the systems is likely to impact on the other systems.  A counterbalance is provided by an increasing willingness in systemic therapy to incorporate understandings of internal processes as they have been understood by psychodynamic and cognitive therapies. Systemic therapy with individuals
  13. 13. Who gets systemic therapy?  A typical family therapy clinic helps families deal with a great variety of physical and psychological difficulties.  The families will vary widely in terms of family structure, ethnicity and culture.  Treatment most often consists of about seven sessions, spread over six months. Long short therapy
  15. 15. THE HISTORY OF FAMILY THERAPY Conceptual and Clinical Influences  Family therapy as a distinct method of did not actually emerge until the early1960s.  Conceptual and clinical influences that informed the development of family therapy are traced to a much earlier period.  Beginning with the development of professional social work in late19th and early20th centuries, along with the early group-work, marriage counseling, and child guidance movements in the early 20th century  family therapy research on the etiology of schizophrenia in the1950s play an influential role
  16. 16. THE HISTORY OF FAMILY THERAPY Conceptual and Clinical Influences  1940s and 1950s the development of cybernetics, systems, and communication theory.  These theories, informed by concepts from sociology, anthropology, and biology,  provided powerful theoretical frameworks for a more in-depth under-standing of the complexities of family interaction.  challenged the dominant psychoanalytic understanding that emotional disorders were of intrapsychic origin  Postulated the rather innovative and then novel hypothesis that these disorders were symptomatic of troubled family relationships
  17. 17. THE HISTORY OF FAMILY THERAPY Conceptual and Clinical Influences  The history of family therapy reveals profound paradigm shifts in under-standing the causative factors that contribute to emotional disorders.  These paradigm shifts will become evident as we examine the theoretical and clinical influences on the formation of the varied family therapy models.  It is vital you understand the shift in epistemology and paradigms  Epistemology: How we explain how we know what we know. A system of beliefs on how we view and explain the world.
  18. 18. First challenge: Relational self  Initially a challenge to the notion of the autonomous self with the systems-based concepts of the relational self  Based on the paradigm of the autonomous self, emotional disorders were viewed as symptomatic of a disordered inner self. Even though the family unit has always been valued in society, the family was seen as a collection of individuals that could either support or impede the development of the autonomous self.
  19. 19. First challenge: Relational self  Symbolic interactionism and structural functional theories challenged the notion of the autonomous self with the understanding that the human self was embedded in a system of human relationships.  the emergence of systems and communication theories, and those theorists and researchers in early schizophrenia confirmed that the human self was indeed a relational and communicating being.
  20. 20. First challenge: Relational self  This self is embedded in a system of relational networks, the primary one being the family.  This concept of the Self as embedded or as the relational self was the guiding paradigm for early family therapy.  The source of human emotional suffering was seen as symptomatic of disordered family relationships and/or disordered family communication patterns.
  21. 21. Second challenge: Post Modern Narrative approaches  a more contemporary and postmodern perspective of the self, is the narrative self.  This postmodern understanding of the self provides a unique insight into understanding families by giving attention to how family members construct their intrafamilial experiences through language.  Language is the means of organizing and structuring life experiences.
  22. 22. Second challenge: Post Modern Narrative approaches  It is the narrative that individuals construct about their lives that provides them with a sense of personal identity.  Narratives reveal the significance of individuals‟ lived experience within the context of their social worlds (Gergen, 1999; Polkinghorne, 1988).  The focus shifts from examining relational interactions and communication patterns to examining the meaning embedded in narrative forms of expression.
  23. 23. Second challenge: Post Modern Narrative approaches  Human actions and relationships as expressed through narratives or stories are seen as efforts to create meaning out of personal experiences.  These efforts at meaning construction are reflected in narratives or stories that give organization and structure to a person or family (Kilpatrick & Holland, 2009).
  24. 24. Second challenge: Post Modern Narrative approaches  Thus family problems are located within narrative constructions of meaning.  The narrative emphasis on “meaning” is further supplemented by a focus on ways in which broader sociopolitical influences impact family and individual narratives
  25. 25. MODERN/POST MODERN? What do these terms mean? How do they influence the approach in therapy?
  26. 26. Postmodernism in Context: A Brief History of Thought  The three historical epochs of premodern, modern, and postmodern as paradigms or schemas that coexist within specific historical context  Western societies currently are transitioning the modern to the postmodern paradigm.  Certain approaches to epistemology prevailed in each of these developmental periods. Themes typically relate back to this central question of how we know what we know
  27. 27. Historical time periods Premodern ism Modernism Post- modernism Time Period Up to 1650‟s 1650 – 1950‟s 1950‟s onwards Epistemolog y Religion & Revelation Reason, Empiricism and Science Pluralism & constructed reality
  28. 28. Premodernism: Truth Revealed The premodern period dates from the beginning of recorded thought until the mid 1600s.  During this time, truth was revealed by God or more specifically, a special revelation from God.  Later developments in the premodern period focused on authoritative texts or books written by authoritative sources.  The ultimate source of Truth was still God, but most people could only access this Truth through religious leaders. The role of religious leaders was not to discover, control, or construct Truth, but to
  29. 29. Modernist: the truth can be known  major modernist thinkers had to first deconstruct pre-modern thought and call into question pre-modern assumptions and demonstrated their insufficiency,  Major blow in the 1500s with the Protestant Reformation challenged the authority of the church  scientists such as Copernicus and Galileo promoted scientific theories that countered long-accepted truth.
  30. 30. Modernist: the truth can be known  Proven wrong the church was unable to defend its claim as the source of Truth. In this context, two new epistemological approaches emerged: reason and empiricism(or positivism).  A key process in the establishment of the modern period was the construction or development of methodology. This replaced the role of systematic theology and the sacred texts of the premodern period.
  31. 31. Modernism to post modernism  Failures of inventions and philosophies (e.g. League of Nations) to end war and promote peace left many disgruntled with the tenets of modernism.  In this context, numerous thinkers proposed alternatives to modernism, many of which have been identified as postmodern  Postmodern approaches to epistemology emphasize the need for multiple epistemologies and question over-
  32. 32. Post-Modernism  Postmodernism is difficult to define because it is still a relatively new paradigm in the process of defining itself.  the focus has shifted toward developing a new approach to epistemology, what we call a pluralistic approach  The characteristic epistemology of this phase was constructivism, a belief
  33. 33. Post-Modernism  While epistemology focuses on how we know what we know an important underlying question pertains to the nature of truth.  Premodernism and modernism function with the assumption that people are able to attain ultimate truth (“T” truth).  In the premodern era, God revealed Truth to people; in the modern era, humans aimed to discover and control Truth through reason and science.  However postmodernism takes a different stand on the nature of truth. What is consistent among postmodern thinkers is the belief that humans are unable to attain ultimate truth.  What is not agreed upon is whether ultimate truth
  34. 34. Concepts associated with modernism and post-modernism Modernism  Belief in societal progress  Optimism  Rationality  Belief in absolute knowledge through science, technology and politics  Belief in the true self  Belief in universal structures, usually containing binary opposites Post-modernism  Multiple versions of post-modernism: no single definition  Distrust in promises made in the name of progress  Looking for what is between binary opposites and what has been excluded by the particular distinctions  Importance of variation over coherence Belief in a socially constructed
  35. 35. FAMILY THERAPY AND THE PATH TOWARDS POST- MODERNISM Boston, P. (2000) Systemic family therapy and the influence of post-modernism Advances in Psychiatric Treatment vol. 6, pp. 450-457
  36. 36. Family therapy and the path towards post-modernism Family therapy became a distinct form of practice with the adaptation of general systems theory (von Bertalanffy, 1950).  The major points of development were based on Minuchin‟s structural family therapy model (1968). Primarily concerned with the issue of the optimal organisation of the family and clarity of boundaries  Bateson‟s cybernetic model (1972)  The cybernetic model was adapted by clinicians to consider the family as a homoeostatic mechanism with communication pat-terns analogous to those in mechanical information- processing systems.
  37. 37. Family therapy and the path towards post-modernism  The Milan method (Selvini Palazzoli et al, 1978) and brief therapy (De Shazer, 1985) are based on Bateson‟s cybernetic model (1972)  These were the major paradigms until the mid 1980s.  This was first-order family therapy, characterised by the therapist‟s observation of the system from the outside.
  38. 38. Family therapy and the path towards post-modernism  Second-order family therapy was marked by the inclusion of the concept of constructivism.  Inherent in this body of thought is the notion that what is „known‟ in the external world is determined by our innate mental and sensory structures (Maturana & Varela, 1984).  This was a change from the former position that external reality was „knowable‟.  In terms of family therapy, this now meant that therapists were called upon to include their own personal or theoretical bias as part of the observation.
  39. 39. Family therapy and the path towards post-modernism  Another profoundly different way of considering reality comes from social constructionism.  This suggests that reality is created through language in an ongoing interactional and relational process.  Discourse about the world is not a reflection or map of reality, but an artefact of com-munal interchange (Gergen, 1985).  Family therapists now became interested in the active process of meaning-making and the greater variation of possibilities – the inherent assumptions in partic-ular discourses and ideas that had been excluded
  40. 40. constructivism to social constructionism  For systemic thinking, the movement from constructivism to social constructionism initially appeared to have been a small step, but it proved to be a huge leap (Gergen, 1991).  Social constructionism introduced us to post-modernism.
  41. 41. The post-modern model  Social constructionism and the philosophical culture of hermeneutics, the science of interpretation and explanation play a vital role in the development of the model.  The structure of therapy is less about beginning, middle and end points, and more about creating space for a specific kind of conversation between participants.  The process of therapy is characterised by a quiet, reflective stance on the part of the therapist. Questions would gently be aimed at the expansion and uncovering of meanings for the individuals in the system.  the therapist avoids the “expert” role.  The therapist‟s primary contribution to the process of change is in the construction of a particular style of conversation.  „Reflecting-team conversations‟ are ones in which team members speak to one another in front of the family (Andersen, 1987).
  42. 42. The principal components of post-modern therapy  The therapist is the participant–manager of the conversation, not the „expert‟  Language, rather than interactional pattern, is the system  Meaning and understanding are achievable through continued efforts  Difficulties are constructed in the language system and can be „dissolved‟ through language  Change occurs through development of new language  Reflecting teams are used to comment on and participate in the co-construction of alternative meanings
  43. 43. The narrative model  The narrative model is also based on social constructionism,  Draws directly from the French post- structuralists.  Derrida‟s (1976) concept of deconstruction  Foucault„s (1975) ideas about dominant and subjugated discourses are central notions.  Using Bruner and Luciarello‟s research (1989) on the importance of narrative structure in meaning-making for humans,  White has linked societal discourses to individual narratives (White & Epston, 1990; Epston & White, 1992).
  44. 44. The principal components of narrative therapy  An individual‟s identity is embodied in a personal narrative that includes different versions of the self  Clients come to therapy with a ‘problem- saturated narrative’ that has become internalised as their primary self- description  Problem stories/identities are created, lived and kept alive by their connection to important others.  The technique of externalisation disconnects the problem from the client‟s self-descriptions
  45. 45. The principal components of narrative therapy  The influence of the problem is „mapped‟, thus connecting the problem narrative to relevant others  Narratives are created at a societal level, so problem ideas held by family members require „deconstruction‟  The therapist looks for ‘unique outcomes‟ – positive exceptions to the problematic story – and amplifies change using letter-writing, specific audiences (others who have successfully conquered the same issue) and personal enthusiasm
  46. 46. “Religion without science becomes superstition; science without religion becomes a monster” Garrit tenZythoff
  47. 47. Readings  Dallos & Draper (2010) intro & Chap 1  Metcalff (2011) chap 1  Boston, P. (2000) Systemic family therapy and the influence of post-modernism Advances in Psychiatric Treatment vol. 6, pp. 450-457  THE HISTORY OF FAMILY THERAPY Conceptual and Clinical Influences  Hoffman et al (no date) Modern and Postmodern Ways of Knowing: Implications for Therapy and Integration  Stratton (2011) Evidence Base of Systemic Family and CouplesTherapies