Diagnostic Case Study

Clinical TherapistLife CoachAdjunct Professor, Grand Canyon University

PhD StudentRegent UniversityCounselor Education and Supervision

Sonja A. Sutherland, MS, LPC, NCC

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Systemic Theories

2Developed in the 1950 1960sFoundational PremiseIndividuals can best be understood within the context of their environmentsInfluencesCybernetics General Systems Theory

Systemic TheoriesHistorical Overview

3Family systems theory speaks about the individual members of the family, and describes both the inter-relationships between and among members of the family, and the rules that exist to maintain the family in its current functioning.

Systemic TheoriesHistorical Overview

4Systems & SubsystemsStructure, Roles & RulesHierarchy - generationalPowerBoundariesFeedback loopsHomeostasis Systemic TheoriesOverview: Universal Concepts

5Virginia Satir (1916 1988)

Mother of Family TherapyCommunication / Strategic Family TherapyConjoint Family Therapy (The Satir Model)

Systemic TheoriesKey Theorists

6Systemic TheoriesCommunication/Strategic Therapy & The Satir model Key ConceptsKey Terms & techniquesCommunicationthe key to understanding human behaviorPathology is an interactional process between family membersFunction of pathology is homeostatic maintenanceTherapy focuses on change in communication patterns between individual family membersDouble Bind CommunicationPunctuationSymmetrical / complementary communicationSchism

ReframingPrescribing the symptomReduction ad absurdumTherapeutic double bindsStraight / Paradoxical directives

7Murray Bowen (1913 1990)Psychiatrist Georgetown UniversityBowenian Family Therapy

Systemic TheoriesKey Theorists

8Systemic TheoriesBowenian Family TherapyKey ConceptsKey Terms Pathology stems from inadequate differentiation of self from family of origins emotional systemSevere pathology such as schizophrenia is the result of a multigenerational transmission processGoal of therapy is to increase differentiation of selfTherapists role is to model differentiated self rather than become caught in family trianglesDifferentiation of selfFusionUndifferentiated family ego massTriangulationEmotional cut-offFamily projection processMulti-generational transmission processResponding from a responsible I position rather than we or you

9Salvador Minuchin (1921 - )

San Salvador, Entre Rios, ArgentinaRussian-Jewish HeritagePsychiatrist trained in individual psychotherapiesTheory developed within the context of the Civil Rights EraPower families have over psychopathology

Systemic TheoriesKey TheoristsStructural Family Therapy

10Treatment occurs best within the social and relational contexts of the family, rather than the individualDelinquency Anorexia Nervosa - MedicalFocus on the here and now rather than the pastPsychological distress caused and maintained by relationshipsFamily belief structure cognitive schemaSystemic Theoriesstructural Family Therapy

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IPFamilySocietySystemic Theoriesstructural Family TherapyExpanded site of pathology

12Boundary ContinuumDisengagedNormal EnmeshedFamily Structure Family Structure Family Structure

Rigid Clear Diffuse

Isolation, Disengagement, limited Frequent Communication, Encroachment on personal and access between subsystems, weak interdependent, supportive, healthy system boundaries, loss offamily connections, system closed healthy autonomy , system open to change, autonomy, system resistant to to change, inflexible organization open to change, flexible organization, adaptable change, enmeshment, poorto external change, belonging but separateness differentiation of self

Depression, psychosomaticcomplaints, antisocial symptoms Incest

Systemic Theoriesstructural Family Therapy

13Systemic Theoriesstructural Family TherapyRole of the therapist

14Active and DirectiveAware of structure and rulesFocused on the here and nowProblem reframerIndividualistic ideology vs systemic perspectiveFocus is on the individual within the systemTo interpret role of symptoms

Systemic Theoriesstructural Family TherapyRole of the therapist

15JoiningOngoing process of entering a family system to engage & influence its membersEnactmentProcess of changing patterns of interaction in the here and nowBlocking of unhealthy interactional patternsRestructuringActivities that attempt to change family rulesAccommodationProcess of adjusting to and accommodating the rules of the system.Changing family mythsChallenging family belief systemsCoaching new communication patterns

Systemic Theoriesstructural Family TherapyInterventions and Techniques

16General considerationsTherapists interest in the cultureImpacts joiningFamily observation

Systemic Theoriesstructural Family TherapyMulticultural considerations

17Specific PopulationsChinese and Hispanic familiesHighly structured boundaries and rolesEmphasis on social contextChinese American cultural disconnects

Systemic Theoriesstructural Family TherapyMulticultural considerations

18Cultural assessment tools for TherapistsCultural Auditing through Reflective PracticeWhat are my initial reactions to this family and what does it tell me about my beliefs, values and assumptions?In what ways do I assume that we are similar or different because of our cultural backgrounds?What are my initial hypotheses about the impact of culture on this familys presenting concerns? How sure am I of the accuracy of my hypotheses? How open am I to being wrong, considering new information, and modifying my assumptions?

Systemic Theoriesstructural Family TherapyMulticultural considerations

19SFT initially failed to address issues of power within same generation relationshipsAbuse of powerSome disregard the possible positive function of symptomatic behavior within the familyonly sees it as perpetuating problems in family functioningMany focus on family as a collective disregards need for individuation

Systemic Theoriescritical analysis

20General similarities emphasis on family as essential for individual growth and developmentBowenian Family Therapy most akinEmphasis on clearly defined family hierarchiesparent-child relationships (Exodus 20:12; Deuteronomy 21:18; Proverbs 22:6; Proverbs 29:17), family responsibility (1 Timothy 3:1, 4-5; 5:8), good communication (Ephesians 6:4; Colossians 3:21)marriage like union of Christ and the church (Ephesians 5:25-30).

Systemic Theoriesconceptualization of faith

21Modern

Primary use of techniques like those used in structural therapyBelief in therapists knowledge, expertise and power to influence change

Post Modern

Social constructionist view with focus on relational, narrative paradigmTherapist takes not knowing stanceUse of language and conversation to elicit clients expertise and storySystemic TheoriesModern Post Modern framework integration

22The Para-Modern Stance

A both/and approach to family therapyDual positioning allows for more effective treatmentWhat is most relevant is what works in practice rather than adherence to a theoretical position such as systemic theories or social construction theory.

An ethical stance allows family therapists to access a range of therapeutic languages and techniques at once. The priority is not what knowledge we use but how we use itputting theory to work in the service of others. (Larner, 2009, p. 54)

ConcernsDearth of evidence-based research documenting effectivenessDoes ethical utilization of theories allow for mixing and matching in the name of integrative practice?Recent documentation of effectiveness with adolescent depression and eating disordersSystemic TheoriesModern Post Modern framework integration

23Systemic TheoriesConclusion

24Systemic TheoriesTeaching ActivitiesFamily Therapy with Single Parents

Whos Afraid of Virginia Wolfe?

25American Counseling Association. (2005). American Counseling Association Code of Ethics, Alexandria, VA.Banmen, J. (1986, December 1). Virginia Satir's family therapy model. Individual Psychology: The Journal of Adlerian Theory, Research and Practice, 42(4), 480-493.Banmen, J. (2002, March). The Satir model: Yesterday and today. Contemporary Family Therapy, 24(1), 7-22.Banmen, J. (2009). Satir model developmental phases. The Satir Journal, 30(1), 14-19.Banmen, J. (2010). Forgiveness as therapy in the Satir model. The Satir Journal, 42(1), 6-23.Beels, C. (2011, March). Family process 1962 - 1969. Family Process, 50(1), 4-11. doi:10.1111/j.1545-5300.2010.01342.xCampbell, J., & Handy, J. (2011). Bound to care: Custodial grandmothers' experiences of double blind family relationships. Feminism and Psychology, 21(3), 431-439.Collins, S., Arthur, N., & Wong-Wylie, G. (2010, Summer). Enhancing reflective practice in multicultural counseling through cultural auditing. Journal of Counseling and Development, 88(3), 340 - 347.DSM-IV-TR. (2000). Arlington, VA: American Psychiatric Association.Jones, S. L., & Butman, R. E. (1991). A comprehensive Christian appraisal: Modern psychotherapies. Downers Grove, Illinois: InterVarsity Press Academic.Systemic TheoriesReferences26Jung, M. (1984). Structural family therapy: Its application to Chinese families. Family Process, 23, 365-374.Larner, G. (2009). Integrative family therapy with childhood chronic illness: An ethics of practice. The Australian and New Zealand Journal of Family Therapy, 30(1), 51-65.Minuchin, S. (1974). Families and family therapy. Cambridge, Massachusetts: Harvard University press.Minuchin, S., Montalvo, B., Guerney, B., Rossman, B., & Schumer, F. (1967). Families of the slums: An exploration of their structure and treatment. New York: Basic Books, Inc.Muir, J. A., Schwartz, S. J., & Szapocznik, J. (2004, July). A program of research with Hispanic and African American families: Three decades of intervention development and testing influenced by the changing cultural context of Miami. Journal of Marital and Family Therapy, 30(3), 285 - 303.Napoliello, A. L., & Sweet, E. S. (1992). Salvador Minuchin's structural family therapy and its application to Native Americans. Family Therapy, 19(2), 155-165.Navarre, S. E. (1998). Salvador Minuchins structural family therapy and its application to multicultural family systems. Issues in Mental Health Nursing, 19(6), 557-570. doi:10.1080/016128498248845Prochaska, J. O., & Norcross, J. C. (2010). Systems of psychotherapy: A transtheoretical analysis. Belmont, CA: Brooks/Cole, Cengage Learning.Vetere, A. (2001). Therapy matters: Structural family therapy. Child Psychology & Psychiatry Review, 6(3), 133-139.Systemic TheoriesReferences27