This is an introductory set of slides on systems model of family therapy. This slide presentation is not a substitute for further reading.

1. Dr. S. Krishnan
Associate Professor of Psychiatry
Government Medical College, Thiruvananthapuram

2.  You are an outsider
 You don’t have a right to intrude and peep
 You are not a savior or judge
 Don’t promise to solve all the family issues
 Beware of transference issues
 Family is different from HOME

3. An intervention which focuses
on altering the interactions
among family members and
improve the functioning of the
family as a unit of individual
members of the family

4.  Numerous phenomena gave rise to family
therapy and the systems perspective in the
1940s & 1950s
 Small group dynamics
 Marriage Counseling
 Research on schizophrenia
 The Child Guidance Movement

6. Precipitating
Maintaining Perpetuating

7.  Identify family’s
unspoken rules
 Disagreements about
who makes these rules
 Distorted ways of
communications in the
family
 Rigid intergenerational
patterns which cause
distress within or
between individuals

8.  Child psychiatric problems
 Adolescent crises
 Schizophrenia
 Bipolar disorders
 Dissociative disorders
 Somatoform disorders
 Dysthymia
 Recurrent depressive disorders
 And many more…

9. Understand
the rules
Modify the
rules
Improve
communication

10.  5-10 sessions (Milan Approach) at intervals of
1 month or more
 2-3 sessions when the patient is in the
hospital (preferably no more than one session
per week)
 Each session of 1-3 hours duration
 Duration of therapy depends on the model
used:
 Problem solving models (short duration)
 Growth oriented models ) (long durations - years)

12. 1
2
5 3
10

13. Improved communication
Improved autonomy for each
member
Improved agreement about
roles
Reduced conflict
Reduced distress in the index
client

15.  All families face two
types of stressors
Developmental
stressors
Environmental
stressors
Families in distress
are not sick, but have
been unable to adjust
to the stressors

16.  Marriage
 1st child in family
 1st teenager in
family
 Gender role
changes
 Death of a parent
 Children leave
home

17.  Fire
 Injury
 War
 New job or job loss
 Financial stressor
 Rape

18.  Is often unwilling to take responsibility
 Interprets problems from a linear causality
perspective, rather than a circular perspective.
 Suffers a confusion of levels (children and
parents)
 Forms coalitions (a parent and a child against
another parent)
 Appoints children to quasi-adult roles (a child
taking on the role of one parent’s confidant)

19.  Stressors -- environmental and developmental --
arise in the normal course of a family’s life.
 The failure of its members to cope with and
accommodate to stressors leads members to
disengage from some members, and become
enmeshed with others
 Indirectness of communication and anxiety ensues,
with triangular relationships substituting for direct
encounter and the pursuit of intimacy.
 Identified client is usually reason for entering
therapy, but often only the symptom of family
distress..

20.  Concept by Murray Bowen
 Two-person relationship is the basic unit of any
emotional system.
 Under stress the two-person system tends to
draw in a third person to stabilize ( three-person
system of two-against-one).
 When anxiety builds up in any one triangle, it
spills over into other triangles, filling the whole
family system.
  Problematic behavior patterns
Monica McGoldrick, Genograms. W.W.Norton, 2007

21.  Families repeat themselves.
 What happens in one generation will often
repeat itself in the next, though the actual
behavior may take a variety of forms.
Monica McGoldrick, Genograms. W.W.Norton, 2007

22.  Families have rules
that determine how
balance is reinstated.
If something violates
the rules, then one of
two things happen:
 Members reassert the
rules.
 The family changes the
rules.

23.  Families have values
that assign meaning
to various events. It
is important to
understand those
values in working
with families.
 Values are a function
of family and
cultural origins.

24.  Families have ways of describing people and
situations that reflect their values and rules.
 It is important to understand the way the
family uses language, in order to effectively
reframe people and situations whenever a
more positive viewpoint is possible.
 Reframing is using language to describe a
person or a situation in a more positive way.

25.  Psychodynamic-experiential models
 Bowen model – family systems model
 Structural model
 General systems model

26.  Murray Bowen
 The family is an emotional system
composed of many generations, whether
living or dead.
 The goal of therapy is the differentiation of
self from one’s family-of-origin.
 Individuals who are not differentiated form
unstable relationships and are prone to
triangulation.

27.  The goal of therapy is differentiation.
 Focus on family and relationship patterns
rather than specific issues.
 Look for signs of emotional cut-off and
triangles. The stance of the therapist is that
of observer.
 Therapists must be highly differentiated to
avoid the emotionality of the family system.
 Genograms help clients map
multigenerational processes.

28.  Salvador Minuchin
 General systems approach to family therapy
 Focused on the balance between stability &
change, openness & closedness.
 Its efficacy has been demonstrated with a
wide variety of family configurations.

29.  Observations made of
the communication
styles in schizophrenic
families.
 Double bind
 Marital schism
 Marital skew
 Pseudomutual and
pseudohostile
communication

30.  A view that when an individual receives an
important message with two different
meanings and is unable to respond to it, the
individual is in an impossible situation.
 If such messages are repeated over time,
individuals may begin to show signs of
schizophrenia.

31.  A situation in which one parent tries to
undermine the worth of another (parent) by
competing for sympathy or support from the
children.

32.  A situation in which the psychological
disturbance of one parent dominates the
family’s interactions.
 An unreal situation for family members is
created so that the family can deal with one
member’s disturbance.

33.  Presenting an appearance of open
relationships in a family so as to conceal
distant or troubled relationships within the
family.
 Members develop roles that they play rather
than relating honestly.

34.  A system represents a set of units that stand
in some consistent relationship to one
another.
 A system is organized around relationships.
 Elements (units) interact with each other in a
predictable, “organized” fashion.
 Units, once combined form an entity - a
whole, greater than the sum of its parts.
 Therefore, no element can be understood in
isolation.

35.  The organization of relationships may include
groups, alliances, coalitions, and tensions.
 The organization gives clues to the system’s
consistent or repetitive interactive
patterns…know as rules.

36.  Family rules:
 Family interactions follow certain persistent
patterns – rules (Jackson, 1965)
 Redundancy principle – a family interacts in
repetitive behavioral sequences.
 Rules may be
▪ Descriptive - metaphors describing patterns of
interaction.
▪ Prescriptive – directing what can or cannot occur
between members.

37.  How changes in one
family member can
bring about changes
in another, by looking
at the entire family
as a unit.

38.  Feedback: the reinsertion into a system of the
results of its past performance, as a method of
controlling the system.
 Negative feedback: Information that flows
back to a system to reduce behavior that
causes disequilibrium.
 Positive feedback: Information that leads to
deviation from the system’s norm, bringing
about change and a loss of stability.

39.  Equifinality: the ability of a system to arrive at
the same destination from different paths.
 Homeostasis: A dynamic state of balance or
equilibrium in a system, or a tendency toward
achieving and maintaining such a state in an
effort to ensure a stable environment.

41.  Assessment of the family structure
 Summarizing family structure – GENOGRAM
(Murray Bowen)
 Current and past state of family life
 Roles of the members
 Therapist tries to answer two questions:
 How the family functions
 Whether family factors are involved in client’s
problems

42.  1) Inviting entire family to session
 2) Joining and building a collaborative
relationship
 3) Assessing problem from multiple
perspectives
 4) Assessing family rules, values, language
patterns, and goals (teleological lens)
 5) Assessing cultural issues (multicultural lens),
and family of origin for patterns across the
generations (developmental lens)  genogram

43.  6) Observing, or tracking interactional patterns --
asking process questions (Bowen)
 educates the family about circular causality
 I-position encourages taking responsibility and
ending of blame
 7) Observing and encouraging typical dynamics --
enactments (Minuchin). Therapist may use
 Reframing, poking, “stroke and a kick”
 Assigning tasks
▪ boundary adjustments
▪ eliciting and supporting competencies

44. One person is asked to
comment on the
relationships of
others.
Others are asked to
comment on her
response
Purpose is to discover
and clarify confusing
and conflicting views

45.  Designed to provoke the family into making
changes which they cannot make in other
ways
 Paradoxical injunctions are impossible or
counter intuitive suggestions which force
the family to confront their hidden or
unacceptable motives

46.  Structure (genogram) (single parent, step
parent, size and age of spread of he sibship)
 Relationships (close, distant, uncooperative,
conflictual)
 Patterns of interactions (child siding with one
parent against the other)
 Changes and events (births, deaths,
departures, financial problems

52.  Contribute to patient’s problems (son does
not want to leave widowed mother after
marriage)
 Supporting the client (codependence)
 Reacting to the client’s problems (unrelated
other problems may be there)

53.  Denial
 Distortions
 Arbitrary inferences
 Selective abstraction
 Overgeneralization
 Minimization
 Maximization
 Dichotomous thinking
 Personalization…

54.  Supporting parents (hierarchies)
 Insulating parents from their own families of
origins
 Insulating parents from children
 Establishing direct communication or “De-triangulating”
 Nurturing competencies through reframing
symptoms as strengths and assigning tasks
 Redefining relationships one-to-one with
family of origin

55. Critical/Enmeshed Parent / In-Law
Acting out Teenager
Affairs

56.  Unwillingness of adult child to assert boundaries
 Unwillingness of son/daughter in-law to confront
parent directly
 Can lead to carryover of anger of adult child to
spouse
Establish better boundaries and privacy between
couple and parent
Confront in-law by adult child
Establish direct relationship between son/daughter
in-law and parent in-law (de-triangulation)

57.  Usually one parent is disengaged from the
family
 The other parent is usually over-involved in the
“problem” child’s life.
 There is a lack of intimacy between couple due
to preoccupation with child.
 There is often a neglect of other children’s
needs

58.  Get couple to work together to resolve
differences, clarify rules, and express
expectations
 Reframe teenager’s behavior if possible
 Encourage direct communication between
teenager and disengaged parent(s) without
interference

59.  Usually occurs during major developmental or
environmental stressors, which disrupt
communication and intimacy between spouses
 Can be due to lifelong suppression of one’s needs in
the context of a marital relationship
 Can be due to lack of intimacy due to family
pressures

60.  Establish that it takes two for an affair to happen.
 Need to communicate unspoken needs
 perhaps too much difference or
“complementarity”
 perhaps not enough “similarity,” and quality time
 explore unexpressed dreams

61.  Focus on process (how) rather than content
(what)
 Focus on interpersonal dynamics, rather than
personal feelings and thoughts
 Focus on here and now, vs. there and then

62.  Teach Circular Causality/Reciprocity
 Ask “process questions” that encourage
linking one’s own behavior to the effects on
others, example: “What effect does it have on
her when you withdraw and watch TV?” or
“Have you tried to talk with him about it rather
than giving him the silent treatment?”
 Encouraging I-position, not talking about
others
 Explore cross-generational patterns

63.  De-triangulating
▪ Getting people to talk directly without
interruptions
▪ Role playing direct communication
▪ Having everyone present for meeting
 Acknowledging competencies and putting them
to work
 Reframing -- “Stroke and Kick” -- Reframe and
redirect
 Genograms for cross-generational patterns

65.  When FMs can complete transactions
 When FMs can interpret hostility
 When FMs can see how others see them
 When FMs can see how they see themselves
 When one member can tell others what is
hoped, feared and expected from them or how
they manifest themselves
 When FMs can disagree
 When FMs can make choices
 When FMs can learn through practice
 When FMs can free themselves from harmful
effects of past models
 When FMs can give clear message

66. Family group therapy
Social network therapy
Paradoxical therapy