Transcript 1 Research in the Human Services Research in the Human Services

Systems of Psychotherapy:
A Transtheoretical Analysis
Chapter 11 – Systemic
Therapies
The Context of
Systemic Therapies





Individuals can only be understood within their
social context
Contextless is meaninglessness
Patient is the entire system, not the identified
patient (IP)
General Systems Theory & cybernetics are the
intellectual inspirations for systemic therapy
Systems = parts of an organization +
relationships among those parts
Homeostasis





Homeostasis or balance explains how living
systems control steady state
Feedback loops are the important control
mechanisms
Not linear cause and effect, but rather reciprocal
effect
Positive feedback loops set up runaway
situations that drive systems beyond their limits
Negative feedback loops decrease deviations
from system rules
Multiple Meanings of
Systemic Therapies
1.
2.
3.
Therapy modality or format
Treatment content or goal
Paradigm shift
Three Systemic Therapies
 Communication/strategic
 Structural
therapy
 Bowenian therapy
therapy
Communication/Strategic
Therapy
Mental Research Institute (MRI) & Double
Bind Communications Project
 Key figures: Jay Haley, John Weakland,
Donald Jackon, Virginia Satir
 Communication is key to understanding
behavior
 Assume that all behavior is communication
 Classic example: double bind
 Interventions change communication

Theory of Psychopathology
Psychopathology is a function of unclear
or hostile communication
 Pathology is family’s homeostatic
mechanism to maintain system balance of
 Psychopathology occurs when rules of
relating become ambiguous
 Unclear communication patterns make
rules ambiguous

5 Axioms of Communication
1.
2.
3.
4.
5.
It is impossible not to communicate; silence is
ambiguous communication
Communication implies commitment and
defines relationships; both report and
command elements
Relationships are contingent on how a
communication is punctuated or ended
Communication is both verbal and nonverbal
Communications are symmetrical (either side
can lead the communication) or
complementary (one side leads)
Theory of Therapeutic
Processes


Help individuals and systems to
communicate clearly & constructively
Changing communication changes
relationships and power dynamics
Processes of Change




Consciousness raising: aware of rules for
communicating and relating
Choosing: straight directives and
paradoxical techniques
Catharsis: Satir’s emphasis on feelings
Counterconditioning: Haley’s emphasis on
power and ordeal therapy
Therapeutic Relationship




Develop an atmosphere conducive to
congruent communication
Empathy and positive regard are
important
Therapist is in charge and in control
Therapist uses direct and indirect
techniques to control relationship
Effectiveness of
Communication/Strategic
Not a lot of controlled outcome studies
 Effective in tx of substance abusers
 Uncertain effectiveness in schizophrenia,
anxiety, & psychosomatic disorders
 Paradoxicals are as effective as
straight/direct interventions

Structural Therapy
Developed by Salvador Minuchin (1922  Created to treat delinquents as systemic
issue rather then individual problem
 Initial focus on delinquency and anorexia
nervosa
 Influential and pragmatic approach

)
Structural Theory of
Psychopathology
Structural theory is more concerned with
what maintains psychopathology than with
its causes
 Historical causes cannot be empirically
determined and cannot be changed
 Dysfunctional dynamics of the family
system maintain psychopathology

Boundaries
An organized family has clearly marked
boundaries
 Disengaged families have rigid boundaries
 Enmeshed families have diffuse boundaries
 Dysfunctional families respond to demands
for change in pathological ways

Structural Theory of
Therapeutic Processes
Goal: restructure families to free members
to grow and relate
 Changing family structure involves
changing rules for relating and boundaries
 Consciousness Raising: education,
reframing
 Choosing or social liberation: Minuchin as
freedom fighter

Therapeutic Relationship
Therapist joins each member or subsystem of family
 Initial relationship involves empathy,
warmth, and caring
 Once relationship established, therapist
becomes authoritative leader
 Therapist challenges, blocks, & disrupts
homeostasis

Effectiveness of
Structural Therapy
Reliance on clinical case surveys
 Few controlled studies
 Found superior to no tx and probably
superior to individual tx for substance
abuse, psychosomatic disorder, and
conduct disorder
 Untested in tx of other disorders

Bowen Family
Systems Therapy
Developed by Murray Bowen (1913 –
1990)
 Initially applied to schizophrenic families at
NIMH
 Dramatically applied to his own family
 A cerebral and deliberate approach

Bowen’s Theory of
Psychopathology
Differentiation of self is ability to be
objective & controlled about emotional
issues
 Emotional illness arises when individuals
are unable to differentiate from their families
of origin (fusion)
 Fusion results in undifferentiated family ego
mass
 Fusion leads to triangulation

Bowen’s Theory of
Psychopathology (cont.)
The child closest to parents is most likely to
develop pathological symptoms
 Emotional cutoffs are efforts to cope with
unresolved attachments to families of origin
 Family projection process
 Multi-generational transmission process

Theory of Therapeutic Processes
Goal: increase differentiation of self from
family emotional system
 Detriangulate family members
 Change produced in one triad will cause
change in all family triangles
 Consciousness raising
 Choosing

Therapeutic Relationship
Therapists do not allow themselves to be
triangulated
 Maintain an objective “I” position
 Therapists act as models of autonomous,
responsible, and differentiated behavior
 Therapists rely on observation and reason
(not empathy) to understand family

Practicalities
Often work with spouses or with one
motivated patient
 Central couple is most important
 Strong proponent of family of origin
therapy for psychotherapists

Effectiveness of
Systemic Therapies





20+ meta-analyses indicate couples & family
therapies are effective; average ES = .65
Positive effects remain but taper over time
Martial therapy tends to show higher effects
than family therapy
No difference in effectiveness among different
systemic therapies
No consistent outcome differences between
individual and family therapy; “for now, a tie”