Family systems theory views the family as an emotional unit where members are interconnected and interdependent. Key concepts from systems theory applied to families include: seeing the family as a system greater than the sum of its parts; understanding that a change in one family member impacts the entire family system; and recognizing that families have relationship patterns and a structure that can evolve over time. This theoretical approach informs family social work practice by conceptualizing client issues within the context of the entire family system.

1. S W K 4 6 0 8 S O C I A L W O R K P R A C T I C E W I T H F A M I L I E S
THE WHOLE IS LARGER THAN
THE SUM OF ITS PARTS:
Family Systems/Family Therapy Foundations
Contemporary Family Therapy
Welcome!
Prof Susan Stern
Factor-Inwentash Faculty of Social Work

2. AGENDA – DAY 1
Ø Welcome and introductions
Ø Course overview
ØNature of course, mutual expectations, learning environment,
assignments
ØContemporary Family Therapy
ØFamily systems theory introduction to key concepts and
constructs
ØDiversity and family systems
ØApplying family systems thinking: Nine Lives
ØCase conceptualization in an ecological context
ØFrameworks and developing hypothesis
ØFamily Groups-family development
ØEngagement with families 2

3. • Introduce self – placement, other family courses you
have taken, experience working with families?
• Name one hope/one challenge for this course
• One random fact about you
• Something that might surprise us?
• Fun fact?
• Something new you learned during the pandemic?
• Chat box
• Anyone doing online counselling with children, caregivers
or families … now or previous experience?
• Anyone joining us from another field of practice than
C&F?
HI, I AM

4. Course Overview
ØNature of course, mutual expectations
ØLearning environment/Class contribution
ØFamily Groups
ØRole Plays, Debriefs, Group Reflection
ØAssignments
ØLearning Reflections 20%
ØMuses 10%
ØFamily Group/Self as Social Worker 10%
ØFamily Case Application Individual
Reflection 40%
ØFamily Engagement, Assessment &
Treatment Plan 40%
Critical thinking
Self-reflection
Clinically relevant
applied exercises
& assignments

5. ROLE PLAYS: FAMILY SESSION/SELF AS SOCIAL WORKER
LEARNING REFLECTION
• Reflect on what skills/competencies you intentionally and purposively used with this
family.
• What did you find most challenging in this situation
• and if you could revisit any part of the role play, what would you do differently and
why?
• How did you feel during the simulated family session and what self-regulation skills did
you or could you use?
• What did you and your group learn and better understand about therapeutic processes
and change mechanisms in working with families?
• What did you learn about yourself and how can you use this self-awareness for working
with families in the future?

6. REVIEW SYLLABUS

7. CREATING OUR LEARNING
ENVIRONMENT
• How should we be with
each other here?
• How do we create an
environment that feels safe
and facilitates a positive
learning experience?
• Expectations
• Presence
• Preparation
• Engagement
• Flexibility
• Feedback, problem-
solving
• Respectful, collaborative,
supportive
• Video on
• What said here, stays here
• Recording slides
presentations only

8. COURSE COMPETENCIES
• Effectively engage a family and develop a systemic
therapeutic alliance.
• Ability to conduct an eco-systemic assessment and
develop systemic hypotheses.
• Ability to develop evidence-informed family
intervention plans based on systemic assessments.
• Ability to facilitate change in parenting and family
interactions patterns to achieve desired outcomes.

9. “There is no finding as
well-replicated in
psychological research
as the importance of
family in the lives of
the individuals within
the family”.
(Lebow, 2018).
9

10. EVIDENCE BASED CHILD-FOCUSED
FAMILY CENTERED PRACTICE
THEMES IN THE RESEARCH LITERATURE
• Parenting and family centered interventions are at the heart of
effective practice for children and youth (e.g., Campbell Systematic
Review, 2008; CDC, 2008; Stern, 2009)
• Evidence-based interventions focus on:
• Strengthening parenting skills and the caregiver(s)-child relationship
• Modifying coercive family interactions
• Evidence-based interventions are ecological and multi-
component
• Multi-component research-based parenting and family
prevention programs are stronger and more durable than
those focused solely on children
S.B. Stern, 2010

11. EXPANDING THE LENS:
INDIVIDUAL TO THE FAMILY
Ø Practice with families as a paradigm shift
Ø Ever-evolving and changing approaches
Ø Practice models and approaches have undergone refinements as a
result of theoretical and research developments
Ø Movement towards multisystemic clinical models that integrate research,
theory and clinical wisdom
Ø Continuing evolution and adaptations for different populations,
concerns, contexts, cultures, countries and to address social justice issues
Ø Many different venues for family therapy and numerous professions –
family centered social work practice
Ø Family intervention science – growing body of outcome and process
research 11

12. 12
1st Generation Family Process Models
Intergenerational, family of origin
Structural
Strategic
Experiential
Behavioural
Psychoeducation
-The Dawning of Systems
Theory
Practice with families as a
paradigm shift
2nd Generation Post Modern Models: From Problem to
Possibilities
Milan systemic
Narrative
Solution focused
-Attention to meaning and story
-Development of collaborative
dialogues
-Importance of language and
communication
-Therapist as collaborator, multiple
views of the problem*
-Emphasis on changing not just
behavior but beliefs and values that
influence family interactions
3rd Generation: Evidence Based
Models
Multisystemic Therapy (MST)
Functional Family Therapy (FFT)
Brief Strategic Family Therapy (BSFT)
Multidimensional Family Therapy
(MDFT)
Attachment Based Family Therapy
(ABFT)
Parent Management Training (PMT)
Multidimensional Foster Care
(MDFC)
Cognitive Behavioural Therapy (CBT)
Emotionally Focused Couples
Therapy (EFT)
The Evolution of Family Therapy
Ø Common factors across the generations: Conceptualizing difficulties in relational terms; disrupting
dysfunctional patterns; expanding the therapeutic alliance and direct treatment system
Ø Relational engagement, assessment and intervention
Ecological
approaches
Integrative
Tailoring
treatment

13. COMMON FACTORS ACROSS THE GENERATIONS
AND UNIQUE TO FAMILY & MARITAL THERAPY
• Common factors-in techniques and therapeutic change
mechanisms-transcend certain models and related to
successful outcome
• Conceptualizing difficulties in relational terms – systemic lens
• Disrupting dysfunctional relational patterns, replacement
with healthy relational interactions
• Expanding the therapeutic alliance
• Expanding the direct treatment system
Source: Karam, Blow, Sprenkle & Davis (2015)
Practice with Families as a Paradigm Shift
Relational engagement, assessment
And intervention

14. HOW FAMILY SYSTEM APPROACHES HAVE
CHANGED; ARE CHANGING, NEED TO CHANGE
• Target focal problems/disorders
• The problem is the problem
• Anchored in empirical knowledge on the identified problem, child development,
family processes and life context
• Ecological context
• Informed by evidence on the ecological nexus of the identified problem, e.g., risk
& protective factors
• Biobehavioral, neuroscience, as well as psychosocial underpinnings
• More nuanced understanding/investigation of cultural influences
• Systemic focus
• More sophisticated nuanced one
• Incorporates evidence on causal processes
• An understanding of reciprocal influence & power/privilege distribution in families
• Shift to address social justice & the complex interaction within and between
societal systems (economic, political, social), power dynamics and family systems
• Increasingly trauma-informed*
• A set of core values and core competencies aimed at improving service
delivery-attention to larger systems

15. Alphabet Soup?
MDFT?
SFT?

16. DEVELOPMENTAL/ECOLOGICAL/EVIDENCE-INFORMED
Therapy Process
•Engagement, joining,
therapeutic alliances
•Reduce within session
negativity and blaming
•Develop a relational focus
•Manage within session
process, resolve impasses
•Treatment fidelity
•Feedback informed
Within Family
Mechanisms of Change
•Shifting parenting
•Modifying coercive and
maladaptive interactions
•Improve interactional and
behavioral competencies
•Repair attachment,
reconnect family members
•Joining
•Diagnosis
•Restructuring
ØEnactment
ØReframing
•Psychoeducation
•Functional analysis
(ABCs)
•Coaching parenting skills
•Communication and
problem-solving
•Modeling and role play
•Reframe and support
MST
MDFC
ABFT
PMT
MDFT
FFT
BSFT
CBT
•Unique planned
strategy
•Problem-focused
•Targets structure
and hierarchy
•Directives
•Reframing
EVIDENCE-BASED FAMILY THERAPY MODELS & PROCESS
S.B. Stern, 2012
STRUCTURAL
STRATEGIC
BEHAVIORAL
Common Practice Elements

17. MATURE CLINICAL MODELS
• Decades of clinical research – dialectic between
practice and research
• Increased links between family process research and
treatment outcome research
• Interventions target behavioral, cognitive and affective
and contextual change
• Focus on engagement
• Build on family strengths
• Increased attention to cultural diversity
• Focus on prevention
• Informed by research on change mechanisms and
therapy process within and across models
• Model maps (logic models)with fidelity measures but
also shared evidence informed strategies
• Coherent, conceptual framework that underlies model
specific clinical interventions -Intentionality

18. NATURE OF EVIDENCE INFORMED
SOCIAL WORK PRACTICE WITH FAMILIES
• Common factors, therapy processes, common
(evidence-informed) practice elements, core
mechanisms of change
• Clinically relevant evidence
• Evidence-based family models
• Practice-based research
• Clinical decision-making
• Case conceptualization and tailoring treatment
• Collaborative partnerships with families
• Treatment monitoring and evaluation
• Diverse families, diverse contexts and settings

19. Stern, 2003
Evidence, Critical Thinking &
Clinical Decision-Making
Family Systems, Ecological, & Developmental
Theory & Research
Evidence-based Practice
Assessment
Hypotheses
Goals
Critical
Thinking
Cultural
Competence
Contextually
Responsive
Self
Clients
Agency
Accountability
Child & Family
Outcomes
Practitioner
Interventions
Evaluate Practice

20. WHAT IS A FAMILY?

21. DIVERSE FAMILIES

22. FAMILIES
Blackish Family Ties
Fresh
Prince

23. FAMILIES OF CHOICE

24. FAMILIES OF CHOICE

25. Diversity and
family systems
Family Developmental Framework
Families – complex web of kin ties within and across
households and generations
ØMay be defined by blood, legal and/or historical
ties; formal and informal kin bonds, residential
patterns, future commitments
ØIndividual and family development co-evolve over
the life course and across generations
ØGrowing diversity and complexity of family systems
over lengthening life courses
ØMultiple, evolving family cultures and structures
ØRelationships with siblings, spouses, children other
family members grow and change, boundaries may
shift, roles redefined, new members and losses require
adaptation
The Developmental
Context
26

26. Diversity and
family systems
ØStrengths under stress – crises or prolonged adversity
ØCrises and transition – disequilibrium
ØStress intensified during periods of transitions from
one developmental phase to another
ØMajor stressors – complex changing conditions (e.g.,
divorce, step-family integration, illness, chronic
disability, economic loss, migration), pandemics,
racial and social injustices and violence
ØFamily functioning over the life course – depends on
relational connections, flexibility in structures, roles
and responses to new developmental priorities and
challenges
The Developmental
Context
27

27. Diversity and
Family Systems:
Multicontextual
Life Cycle
Framework for
Clinical Assessment
Source: McGoldrick, Carter, &
Garcia-Preto (2015).

28. CULTURAL DIVERSITY AND FAMILY
SYSTEMS THEORETICAL CONCEPTS
• Family life cycle: diversity in how developmental stages and
transitions in the family life cycle are culturally patterned
• Family organization: diversity in the preferred forms of
cultural family organization and the values connected to
these arrangements
• Ecological context: diversity in the interactions between
family and their ecological context and stresses and
supports across key systems in which family life embedded
(e.g., community)
• Migration and acculturation: diversity in where family
members came from, when, how and why; how they live;
and their future aspirations; disruptions of ecological “fit”

29. POVERTY AS A SOCIAL DETERMINANT
THE PATHWAY FROM POVERTY FAMILY PROCESSES
CHILD & YOUTH BEHAVIORAL HEALTH PROBLEMS
• Parenting and parent-child interactions
• Partner relationships
• Parent mental health
And in turn
• Child and adolescent behavioral health

30. FAMILY STRESS MODEL
• Economic hardship
• Low income, income loss
• Daily pressures of income inadequacy
• Lacking basic necessities, unable to pay bills
• Perceived strain
• Parent emotional distress
• Sadness, pessimism for the future, anger, despair, family
interaction withdrawal
• Family processes -more irritable, less supportive
• Increase conflict and instability in martial relationship
• Disrupts protective parenting

31. THE DAWNING OF SYSTEMS THEORY
ØParadigm shift – to relational
interventions
ØEarly principles of systems theory
and application to family therapy –
alternate and comprehensive belief
system based on communication,
cybernetics and relational processes

32. WHY DO WE NEED THEORY?

33. Family Systems Theoretical Foundations
• General systems theory Ludwig von Bertalnaffy, 1901-1972
• Arrangement and relationships between parts
• Interaction with environment – acquire new properties,
continual evolution
• Open systems potential to change
• A system can be composed of smaller systems and can also be
part of a larger system
• Cybernetics Gregory Bateson 1904-1980
• Structure of complex systems include comm. processes, control
mechanisms, feedback principles (positive & negative loops)
• Systems have self-regulatory mechanisms and a tendency to
resist change in order to maintain a steady state (homeostasis)

34. KEY THEORETICAL
CONCEPTS
• Whole is greater than the sum of its parts
• Parts interconnected
• Change in one part affects others
• Relatively stable patterns of interaction
• A family is part of a larger system and is composed of many
subsystems
• Shift from linear to circular causality
• Change & stability (negative & positive feedback
loops, homeostasis, adaptability, morphogenesis)
• Boundary around system – open & closed
• Equifinality – many different paths to change
• Person in environment

35. COMPLEMENTARITY
RECIPROCITY OF RELATIONSHIPS

36. INTERCONNECTEDNESS
The essence of systems thinking is seeing patterns of
connection where others see only isolated events.
This is the idea that change in one part of the
system will affect all the other parts of the system.
Family therapists constantly make connections
between actions that create problems for family
members.

37. SEQUENCES OF FAMILY
INTERACTION
• Recurrent patterns of interpersonal interaction that surround
and help explain various problems and behaviours.
• Observing these recurring patterns gives family social
workers data to help explain the family’s problems and
develop interventions.
• 2nd order change alters the rules around the recurrent
pattern (e.g. that govern interaction).
• Family strengths are also identified and reflected to family
members through tracking of sequences of interaction.
• Intervention strategies target modifying and strengthening
interactions and relationships.

38. CIRCULAR CAUSALITY
• The idea that actions are related through a series of
recursive loops or repeating cycles. These repeating
sequences in interactions can become entrenched in
problematic actions that prevent effective problem solving.
This concept is a move away from linear causality.
•What you need to know
• Rather than seeking underlying causes the family therapist
facilitates healthier interactions within the session and in the
family’s natural ecology.
• Attempted solutions can be part of what maintains the problem.
• Don’t do more of the same. Do something different.
• Recursive patterns can apply to both positive and solution-
oriented interactions as well as negative and problem-maintaining
ones.
• Patterns are rule governed relationships
• From circular causality to escalating spirals of interaction

39. FAMILY STRUCTURE
• Family structure defines the organization within which
family patterns of interaction take place.
• Systems and sub-systems (open or closed)
• Boundaries (rigid, diffuse, clear)
• Hierarchy Minuchin 1921-
•Tracking sequences of family interaction reveal
manifestations of the family’s structure. The functional
organization of families influence how family members
interact and how they interact reinforces the structure of
the family.

40. WHAT DOES THIS HAVE TO DO WITH FAMILIES?
• Families are systems too - of interconnected and interdependent
individuals, roles, rules, relationships and behaviors, none of which can be
understood in isolation from the emotional unit of the family
• Individual behaviors are understood in light of how they affect, and are
affected by, family interaction.
• Families have structure; they can be open or closed
• Boundaries around a system, in a system and boundaries of each
member determine the health of the family system
• Families are systems that can evolve . . . and therefore can change
• Families are subject to cybernetics and feedback loops that cause them
to become “stuck.”
• *Returning to steady state –behaving in ways to protect familiar patterns
• Forces outside the system can become a part of the family system and
facilitate change.
• Therapist can interrupt these patterns and have the family discover
more productive patterns of relating
• Paradigm shift - Relational interventions

41. SAMANTHA
FROM NINE LIVES
• From your experience, knowledge
• Apply family system’s concepts/lenses to understanding
the family
• Begin to develop a family system’s hypothesis
• What presenting problem(s) might this family be
seeking therapy for?
• How might you invite this family into treatment?
• Who would you want to see?

42. NINE LIVES
• https://www.youtube.com/watch?v=eTRrHrxYZZw
• Samantha
• Counter # 41-51

43. UNDERSTANDING FAMILY SYSTEMS:
PRACTICE IMPLICATIONS
• Triads and triangles
• Family structure
• Subsystems (open,
closed) and boundaries
(rigid, diffuse, clear)
• Hierarchy and cross-
generational coalitions
• Family roles
• Communication (meta), rule
governed systems
• Repeating family interaction
cycles
• Family development life
cycle, transitions
• Multigenerational
• Family reality and belief
system, story or narrative,
theme
• Family ecology
• Family culture