Contents
Introduction 2
Family life cycle: 2
Setting the scene 4
Jackson postulates 4
Chapter 1 4
Communication levels 6
Structural family therapy 7
Techniques: 7
Strategic family therapy 8
Beliefs and premises 8
Commentary 8
Skills guides 9
Family sculpting 9
Family tree and timelines 9
Chapter 2 The second phase: mid 70s-mid 80s 9
Cultural landscape 9
Skills guide 12
Chapter 3 The third phase mid 80s-2000 12
Practice 14
Goal setting 14
Skills guide 15
Consultation 15
Externalising the problem 15
Collaborative enquiry 15
Reflecting teams 16
Chapter 4 Emotions and attachments as the driving force in family systems 16
Triangulation 17
Attachment theory 17
Attachment based family therapy 19
Attachment narrative therapy 19
Chapter 5 Systemic formulation and formulating 20
First phase 20
Second phase 20
Third phase 20
Systemic formulation 21
Chapter 6 21st century practice development 21
Working with addictions 21
Working in forensic settings 22
Problem: 22
Beliefs 22
Problem maintaining loops 22
Anorexia 22
The problem 22
Beliefs 22
Problem maintaining loops 23
Emotions and attachments: 23
Psychosis 23
Cognitive behavioural family therapy for conduct disorders 23
Chapter 7 Couple therapy 23
Integrative therapy: 23
Emotionally focused couples work 23
The Gottman method 23
Families understood culturally from society, and from my
family of what a family should be, then what this family is, and what I want
the family to be, then what my partner thinks in similar fashion.
Key stages:
Marriage
Children: babies, teenagers, left home
Bereavement
As families needs change it need to negotiate through three
interconnected areas
1.
Social, cultural, spirituals: laws, frameworks,
customs
2.
The familial: how this family works and how it
responds to change
3.
The personal: each family member has a unique
set of beliefs.
The family has an identity to the external world. There are
external relationships from the family to the world. Families have beliefs, ways of behaving, and
the amalgamation of this constitutes their identity. Their identity is
presumably both their desired identity and how they find themselves. Families have differing views on boundaries,
what is said outside the family, who is invited in.
As much as a family might be defined by external
relationships it is also defined by internal relationships.
1.
Power, intimacy and boundaries. Whilst families
are complex these issues regularly surface
a.
Power: duties, obligations, responsibilities
b.
Boundaries: personal space and privacy
c.
Intimacy: support, sex, affection
2.
Rules and tasks
a.
Ground rules that enable basic physical needs to
be met
3.
Gender
a.
Roles and expectation
4.
Society
a.
Media influences about good family\bad family,
families in moral crisis affect in turn families
Social constructivism: through social interaction reality is
created and exists in me
Social construction: through social interaction reality is
created
1970s: Modernist family approaches, led by rationality and
evidence
But people disagreed
1980s: post modern, constructivist approach
First order cybernetics: = systems that are rationally definable
Second order cybernetics= systems that are postmodernly
describable
Positivism
That a person can look, and using their rationality to
understand the evidence, decide what reality is
Post modernity
That a person is in a network of relations and involved in a
certain relationship, describes what reality is that in turn affects the
relationship that leads to this description.
Reality is constructed within relationship and is based on
feedback, this can be different to some degree for different people.
Third phase social constructionism, language is a major
determinant in family life and dynamics. Language is political, holds racial,
gender ideas. It also has a structure, with words as things, causal and linear.
Fourth phase: the weave of inter personal and intra personal
therapist
1950s Don Jackson: a system purist, controversial.
Behavioural sciences as bedrock of systemic thinking??!!
Harry Stack Sullivan: a personality cannot be isolated from
the complex network of interpersonal relations that it is a part of.
1.
We are always in relationship and always trying
to define these relationships possibly a driving force
2.
A person is always interacting there is no
resting state.
3.
At times the definition of the relationship is
in sharper focus
4. Relationships are either symmetrical or complementary
5.
Character traits or symptoms are attempts by a
person to define the relation
6.
There is a tendency to maintain a status-quo,
driving force?
7.
There is always a centre point in relationship
between people
8.
There is also a tendency by the above 1-6 for
the relationship to change, it is never completely static.
9.
The system can be modified by the introduction
of new rules, or parameters
10.
A system is defined by regular patterns
11. Messages between parts of the system, are
affirmed, disqualified, or clarified
12.
A pattern in a system has a particular
equilibrium, there can be many patterns in a system
A phenomena remains unexplainable
as long as you don’t have a wide enough context to understand it, if you don’t
it can either remain unexplainable or you explain it by giving the object
certain properties it may not contain
Cybernetic model=change in one
part of the system will change all other parts
Cybernetics=Greek word for steersman
Feedback in a system, enables control in the system to
happen, as one part informs other parts, and they in turn respond, like a
thermostat in a heating system. Thus a
system can be self-regulating. This
leads to cybernetics being circularly causal not lineally.
Whilst the heating system is a mechanical system, in terms
of metaphors for the family it is limited. The body can regulate its
temperature even though there are large changes in external temperature, and
the body has evolved to produce this system, so the system evolves on the basis
of feedback within it.
Biological systems also evolve and change in the short and
long term. We can survive in different temperature climates and we evolve. In a
mechanical system we designed the system, in a biological system we observe it,
the biological system seems more closely linked to the family system. You can also observe at different levels
within the biological system, in terms of organs, or chemistry, or the overall
body. Bertalannffy a biologist: to understand a living organism you have to
understand the transactions between all of its components, this is general
systems theory.
Bateson: assume a family as a social system that runs
according to rules then you can understand the behaviour within it.
Early 1970s=3 distinct family therapy schools:
1.
Structural: Minuchin
2.
Strategic: Hayley
3.
Communication and validation=Satir
4.
Existential: Whitaker
5.
Family of origin: frame
Mechanical systems are determined and predictable,
biological systems we can only develop inferences and hypothesis, human systems
are infinitely complex.
System thinking shows that systems dynamics constructs
individual pathology. It also shows how the dynamics can change the identity of
the individual. This weakens individual autonomy and responsibility
Functionalism=behaviours only maintain if they offer some
form of gain. The change from behaviourism to systems thinking is the pay off
moves from the individual to the system.
Emergent properties, when two or more people interact then
this is creative, and you can’t predict
what the outcome will be. There
is interdependence in action, one both influences and is influenced by the
other. Every action is a reaction to a
previous action=circularity
Circular causality
John withdraws as Mary demands
Mary demands as john with withdraws
A family evolves via trial and error within the context of
the systems it exists in, networks the family members are part of networks the
family is part of, culture, society , local community.
Key step in systems theory is the move from studying monads
to triads.
Open systems allow information to flow in and out from
outside of the system.
Closed systems : feedback runs to enable homeostasis but
little interaction outside to and from system boundaries.
Runaway systems, an escalation: e.g. who is most ill, or
escalating conflict, then these symptoms might get to a point where a third
person gets involved to stabilise the system.
So a row between a couple may de-escalate if their child
gets sick so they focus on them, the child’s sickness then may be used to help
with rows in the future. The third
persons involvement in de-escalating only serves as a distraction and doesn’t
help to resolve the problem
Families have explicit and implicit rules
Feedback in human systems encompasses reflexivity, i.e. the
ability to reflect on what happened.
Feedback is the results of the last action being fed back
into the system.
Homeostasis is enabled through communication of the
components of the system
Schizophrenic behaviour most makes sense in a double bind,
when there is powerful contradictory communications. There are levels of
communications and logical types.
Relationships proceed by an attempt to make sense of what is
happening in a relationship. You may ask what do you mean by x, which is a meta
question. Double binds make meta questions harder.
How I act
How I speak
Meta communication
Bateson=two types of system where feedback provides
escalation in an open system, and feedback provides homeostatic mechanisms in a
closed system. Systems need both the
open and the escalating enables change but without homeostasis the system would
disintegrate.
Mutual escalation can happen in terms of competition, or
conflict, or flattery or sexual desire.
Family systems and homeostasis. A family member with a
symptom then operates to provide homeostasis within the system, so If you seek
to change it directly you will encounter resistances.
Family life cycle: responds to changes in
1.
Family composition
2.
Cultural, or community changes
3.
Changes to the role\identity of individual
members
4.
Life stages of individual members
So there are internal and external influences.
External=culture expectations, work, school, leisure
Internal=rules, alliances, intimacy, life stages
Family life cycle seems to then affect both, i.e. new
member, changes to individual members.
Family influences, what we are given vertically from our
parents, what we horizontally from our society and culture and then what we do
with it.
Families are a changing system but can have rules determined
for them.
One rule is the hierarchical organization of a family who takes
decisions, who is in charge. Minuchin:
children thrive when parents collaborate in looking after them. This
being the case the effects of triangulation weaken, so a child hasn’t got to
take sides in a conflict, or have to adopt an adult level of responsibility to
support one parent.
There are many subsystems within a family, siblings, the
couple, parent child. From a structural point of view clear boundaries between
these is important, so the grandparent\grandchild subsystem, shouldn’t
undermine the parent child subsystem
Clarity about decision making is important as is clarity
about boundaries. Family members in a subsystem can be over involved or under
involved . Over involved means that parts of the subsystem speak for the other
as they see them as identical e.g. parent and child subsystem, the parent talks
for the child. At the other end there is no interest between parts of the
subsystem
Families generate alternative beliefs as
1.
They are challenged
2.
They are offered new ones
3.
They try different ways of interacting that
generate new ones.
As the structure of the family changes so does, symptoms,
rules, beliefs experiences and identities
of participants.
The structural approach assumes the family has an objective
structure. It also assumes that there
are dysfunctional structures e.g. triangular, which need intervention.
Escalating stress, creating a crisis
How this has been done is children watch their parents
argument, for a child who wants to look
after both parents and is drawn into their disagreement this will mean their
stress lasts longer. So within a triangulated relationship, a child can be
brought into an argument and their symptoms can defuse the argument. To work with triangulation like this then get
the parents to resolve the conflict without the child being present. Again the
parents might want to change the subject to the children, again the therapist
should bring their attention back to the argument.
Enactment
So instead of talking about anorexia with a child, have the
therapy session during lunchtime
Unbalancing
As a couple seek to get the therapist on one side, the
therapist might side with one of the partners to effect change
Based on the work of Erikson.
Frequently parents have a hidden interest in having the
children remain at home.
Everyone predicts the
behaviour, and beliefs of others as we are in a power struggle with people
and we seek to be the ones making the decisions, defining the relationship.
Some people have problems as they see things that aren’t a
problem for others as a problem, over identifying, and the reverse is true they
have a problem that others would see as a problem that they deny, under
identifying.
The former is utopia syndrome that the everyday stresses of
life can be avoided.
Over or under emphasis is also a cultural phenomenon, as
every life stage is birth, marriage, getting a home, retirement is seen as a
good thing but the change is significant and comes with problems.
Strategic tasks: can be directive or paradoxical, the latter
being doing the opposite of what the therapist’s wants them to do. Tasks are
most effective when the whole family ware involved. A directive task focusses on disrupting
previous patterns.
Paradoxical tasks maybe used when the family have
difficulties in following directive tasks. Paradoxical tasks encourage the symptom, and
that at least then he will have a sense of control over the symptom.
Systems therapy criticized for seeing all problems as
interpersonal, as opposed to cultural, generational. Likewise family life cycle
trades on a normative view of the family, this ignores the different family
models with the complex overlapping of life cycle stages.
Balance of power in a relationship: resources: economic,
physical, educational, but social status, resilience. The valuation of these
resources is a social not interpersonal thing. There are also expectations
socially again which see the couple playing out certain roles that are not
theirs.
Gender value: women’s values as beauty as carer are
transient. Her caring role is contingent on being in a relationship.
Satisfaction in relationship as equal distribution of power
so each can affect the other, influence the other.
Normative life cycle models assumes a nuclear family and
effectively condemns the non-nuclear, with how things should be.
A physical arrangement of the family is made by the sculpt
director, either how they see the family or how they would like it to be.
People are asked to remain silent as they are moved in the sculpt but to notice
their feelings. Then members are asked
to comment on their feelings on being allocated where they are. Then the director asks members to move to a
position where they would feel more comfortable. Then members are asked to comment on what
would need to happen to allow them to remain in this more comfortable
place. You can also use symbolic objects
rather than actual family members.
Stones can be a good thing to use.
Helps organize the large amount of information that comes
from a family. Time lines connect the
genograms to stop them being cluttered, so in some ways you could move from one
genogram via a timeline to another
genogram.
Family invited to draw the genogram at a significant point, e.g.
life stage. Look for themes in the genogram, the types of relation
Timelines can also be done in terms of events that led up to
symptom formation.
Movement from phase 1, which was more behaviours to a more
Kantian constructionist approach . There was also a growth of individualism and
alternative ways of life. There was the constructivist approach of George Kelly
and person-centred approach of carl rogers. So empathy towards the individuals
constructed world! So the move is from positivism and behaviourism to
understand how the client creates the world they have. Advent of the Milan
team: creating shared meaning, through common epistemology and multi layered
communications.
This is the shift to second order cybernetics, that the
therapist is not an objective outsider but is part of the family system. The second phase embraces post modernism
rather than constructivism of the first phase.
The first phase are modernist and the second phase post modernists.
First order cybernetics: therapist as expert diviner of how
meaning is created
Second order cybernetics: therapist as collaborative
explorer
Bateson argues that what we hear is in part determined by
what we want to hear, what we expect to hear and is determined by the context
of the relationship.
First order cybernetics: functionalism and homeostatic, but
second order questions this as being in the mind of the observer.
Second order: family life faces life stage challenges,
external challenges that may or may not create distress dependent on how they
are handled.
Watzlawick: communication confusions can occur as meaning is
hierarchical.
There can be contradictions between what is said and how the
body acts.
When there is ambiguity between verbal and non verbal
components meta communication may be used.
Communication is simultaneously an act and a message
Communication then can contain multiple pieces of
information and an act
“Don’t hassle me, you’re always doing that” contains a
classification of behaviour, a generalization and is an act of criticism. “
What act can be determined by relationship history, context
of where it is said, tone of voice etc.
The process of communication requires meta perspectives of
how each understand the other, their general and current intentions and how
they see the relationship.
In relationship a shared set of beliefs can be formed, that
then creates a shared set of patterns of emotional response, behaviour and
thought.
However of course in relationship there can be different
understandings about what is going on, what the context means, what the
intentions are etc.
First order cybernetic is a message as a behaviour, an
action
Second order cybernetics a message is meaning
creation\adoption + an action.
Watzlawick=punctuation is the chunks that breaks up
communication into meaningful chunks (meta c) that then enables a fixed way of
seeing the relationship that can provoke repeated patterns of behaviour. So punctuation can be in terms of expectation
of thought\emotions and behaviour.
So if you are expecting one thing, and get another, this
surprises you which in turn weakens (attenuates) the significance of the behaviour.
IN this way your expectation can
maintain behaviour.
So the context that defines meaning, is understanding the
other, expectations of what’s going to happen, physical\temporal context,
beliefs about the relationship.
Shared action=I expect you to act in a certain way, so I
make my choice. Thus my choice is a shared action, a pattern between us.
Most information doesn’t reach us as we filter it out
according to our expectations.
Communication=intention + unintended effect (unconscious
effect) + relational interpretation effect (what we didn’t intent effect)
Second order cybernetics=no such this as the family dynamics
as observing has an effect, and the therapist creates a new system.
Punctuation enables hypothesis that can be more or less
helpful to what’s going on
Communication=intention + consequences
Understanding disagreements via deconstruction=>disagreements
can be more about different understandings of concepts.
History of relationship as the context to understand current
action. Higher levels of context are
family relationship values and cultural relationship values. If there is ambiguity in the relationship it
can be resolved by a higher order context, if there is ambiguity in those
context this can lead to the world not being trustworthy. This could explain insecure “personalities”
where the higher order contexts are understood as ambiguous.
As much as we might have expectation of our partner, our
families, societies are given expectations on us, from others, by ourselves,
these are the should in the world.
Second order cybernetics embraces constructivism (no
objective truth only have subjective lens, but we are all individuals!!)
Second order cybernetics ignores social systems, and is optimistic
about human potential.
First order cybernetics: problems are the actions taken to
achieve homeostasis
Second order cybernetics: problems are differences of
meaning about difficulties
Structural determinism, you can only act on the basis of
your internal map of the world: Maturana.
Bateson and Maturana: we have personal epistemology and we filter
out much information because of our expectations.
Communication=intervention, misunderstanding and unconscious
communication.
Second order cybernetics there is no objective reality just
our subjective perception of it.
Extreme relativism of second order cybernetics leads to some
difficulties with issues of violence and abuse, and social factors of poverty ,
prejudice etc. This would lead to
condoning the behaviour and ignoring the influence.
Constructivist and systems theorist imply that everyone in
the system has equal power to construct relationships but this isn’t the case
The concept of normal is very powerful, this is what should
happen, that is natural, and doesn’t brook debate.
Intentions may be positive even if the outcomes are not.
Milan group
People have their own epistemology based on certain
premises. The therapists job is helping the client learn to learn.
Positive connotation=reflecting back all the positive things
about a action.
Paradoxical directive: do something to increase the symptom.
Using positive connotation to everyone in a family stops the
understanding of victims and victimisers.
Teamwork: requires ability to give up your favourite hypothesis
Teams skills: have a discussion, everyone participates,
first person adds and idea, second person, comments on the previous idea and a
new one is added. Each comment should be
brief and the iteration should be 4 or 5 times around the group.
Hypothesising
Scientific hypothesis=something to be proved
Systems hypothesis=way of organizing information that can
lead to how interviews are structured. Systems
hypothesis are helpful or unhelpful.
Exercise:
Complete the following sentences
I have a hunch that…
I therefore am curious about …..
Positive connotation
Originally developed to find out the logic behind a symptom.
Recognition and appreciation of the function, the value of a
symptom is the first step in dissolving it.
If you don’t like something, don’t value it, it is unlikely
that you will want to engage, you don’t want to be near it, want to deny it
Positive connotations in a family are how do someone’s
actions attempt to take care of the family .
Circular questioning.
Circular questions ask about difference, so you have a low opinion
of yourself, who in your life disagrees and what do they say.
Circular questions ask about differences in meaning, of
events relationships and so on.
Transformational change
This is change=changing the rules of behaviour that the
family operate on.
Exercise: bring a pear in, and then share the selection
process with others
99% of suffering is due to the derogatory opinions people
hold about themselves or about the labels that have been applied to them.
The third phase brings in context, social and cultural
effects into the systems.
Phase 1: System is knowable by therapist objectively and
operates to homeostatic principles: more behavioural
Phase 2: therapist is part of the system and the system
transacts meaning: slightly more constructivist
Phase 3 The system sits within larger systems: more post
modern
The problems the system of the family is shaped by the heritage
of power relations that is encapsulated in language.
The third phase is the death of systemic theory, where the
system can only be understood through the broader social effects and
relationships that create it.
Social construction relates to systems theory= focus on
context and interaction to give meaning.
The importance of the function of words rhetorically to
persuade, flatter, accuse, generate sympathy
First order cybernetics had the transaction in relationship
about information, second phase and social constructionism its more about
meaning. Information being fixed,
meaning being dynamic.
Constructivism, your internal personal map describes the
world
Constructionism you ,your world and the map are all created
by social relations where language is an important aspect of that relation
Language habits tends to accentuate our personal explanation,
rather than interpersonal explanations, he is angry rather than shows anger
Page 95
Dearth of language to describe the interpersonal ends up in personal
explanations, I am x
Page 95
systems theory problems happen interpersonally, constructivism,: it is a
persons private way of seeing the world that leads to problems, phase 2 systems
theory: meaning is developed interpersonally, social constructionism
shows that meaning is generated interpersonally as are problems, and it is held
as a being in language
Page 95:
disagreements in families can be : relationship struggles, failed attempts to
solve problems, a struggle to maintain a positive view of self in face of a different
one
Page 96:
dominant narratives being those with social power, we then try to fit our
experience into the dominant narratives
People present for therapy when there is a gap between the narrative
of their lived experience and their lived experience , so the narrative doesn’t
represent well.
Narratives map what is possible and desirable, we experience
distress when our experience doesn’t live our to our narratives expectations.
The more strongly the ideal of the narrative is held, then
the more distress if things are different.
How we understand this gap is by labelling our self incompetent etc.
Madness is a social constructed label that exists within a
culture at a certain time.
The discourses that enable the created narratives and
conceptions that we use are derivative of the flows of power that constitute
them and are manifest in them.
Constructivists see people as free to understand their
worlds in their worn way
Constructionists see people are constrained by current
discourses. Power both enables and
restricts, medical professions both get to label and define and have to act in
certain ways.
We have identity out of role\narrative there can be
conflicts between role e.g. mother and career woman.
Social constructionism sees there are social realities i.e.,
shared ways of looking at things which therefore seem fixed if not substantive.
A social constructionist may well bring dominant cultural beliefs
and narratives into the room to discuss its influence.
Social constructionism as top down: explicit dominant
discourse effects s. Bottom up, discourses produce meanings in our everyday
interactions and are transformed, so are less easily identifiable.
The third phase is a lot less led by technique, but do
include the following
·
Reflecting teams and processes
·
Externalising the problem and narrative therapy
·
Interviewing the internalised other
·
Therapist as non expert
Brief solution focussed therapy
This challenge the notion of problem, dysfunction and
pathologizing and looks instead for the competencies of the client, This is an
inversion so instead of looking at problems we look at solutions which seem
just the inverse, its also possible the client might think in terms of problem
speak.
Focus on solutions, focus on exceptions to problems, and get
family to connect with their strengths and to build on them. What’s been helping prior to coming to
therapy? If no exceptions are there, the family can imagine what might be
helpful, or remember what has been helpful.
Two types of exception, deliberate and incidental caused by external
factors.
Use the miracle question to get specific, behavioural goals,
and to also see how much is being done already as well as what next.
3 Rules
1.
If it ain’t broke don’t fix it
2.
Once you know what works, do more of it .
3.
If it doesn’t work, don’t do it again, do
something different.
When you stop something, there is implicit blame that it was
wrong to do in the first place, replacing behaviour in this way avoids this.
Negative patterns are held in place by constrictive thinking
such as always, never, which stop thought and narrow thinking.
Page 103 in narrative therapy a
problem is externalised, so instead of being a problem, then either blaming or
denying you can be in relationship
Page 104 Personifying the problem
externalises it
Apply systemic skills to organisations
1
What is the problem?
2
What does the problem enable people in the
organization to do/not to do?
3
Which roles and relationships in the
organization are affected by 1 and 2?
4
How does 3 represent a dilemma for the
organization?
5
How does this pattern of relationships enable
the organization to manage change?
6
What are the gains and losses of 5 to A
and for the organization?
7
What does
6 enable A and the organization to do and not to do?
8
A, B, and C share their experiences and
learning.
Exploring a problem as if it were external to the client can
produce new agency in the client. Doing this enables clients to re-author their
narratives.
Collaborative enquiry triangle: presenter, observer or
explorer.
Exercise Participants are asked to take one of three
positions: explorer, presenter or observer (Figure 3.1). The explorer is given
the following guidelines for a conversation:
1 Keep the inquiry within the parameters of
the problem described. 2 Allow yourself to hear multiple and contradictory
ideas simultaneously. 3 Choose
cooperative rather than uncooperative language. 4 Use the same
words and language as your conversation partner. 5 Ask new
questions that are based on the answers to previous questions.
6 Be a respectful listener, and do not try to understand too
quickly. 7 Create a conversational context that allows for
mutual collaboration in the problem-defining and dissolving process.
8 Keep a conversation going with yourself in your head about
what you are hearing from your conversation partner. Similarly, the observer is
offered guidelines for listening and watching the three stages of the
conversation: 1 Ask the presenter to describe a problem,
complaint or worry (this can be work-related or personal).
2 Find out how describing the problem in this way creates a
problem for the presenter. For example, how does it lead the presenter to
organize his or her relationships or behaviour? Map how his or her important
relationships are affected by the way he or she (the presenter) is describing
their problem. Clarify who are the key players and what they are doing in
relation to the problem. 3 Find out what different
explanations the presenter and others who are affected by the problem hold.
Clarify what effect the different explanations have on the relationships
described by the presenter. After 10 minutes of exploration, the explorer and
observer discuss what has interested them in the conversation and speculate
about ways forward in the presenter’s situation, while the presenter listens
without participating. The presenter is then invited to comment on what they
have heard and suggest a direction in which the conversation could usefully
develop. Following another 10 minutes of conversation between the explorer and
the presenter, the observer joins in a three-way conversation about the
learning and the experience. Each member of the trio takes a turn in each of
the positions.
Coming from team behind the glass idea.
Exercise: reflecting team discussion 1 Participants
are asked to form groups of three, four or five. One person is asked to present
a case or situation he or she is feeling stuck with and to say something about
the therapy, why he or she feels stuck, and what he or she has done to get
‘unstuck’. This should proceed for no longer than 10 minutes.
2 The others in the group then discuss the case or situation
together, and the presenter becomes an observer, forbidden to speak or even
correct any misunderstanding. The group aim to arrive at some systemic
understanding of why this person is stuck with this case. This should take
about 10 minutes. We often ask the group to use the sequential format described
earlier for their discussion. 3 The presenter is then invited
to comment on the discussion. He or she usually has views about what seemed
accurate or inaccurate, helpful or unhelpful but is asked to refrain from
trying to explain his or her views, and invited to comment on the discussion he
or she has just heard in step 2.
4 Again the group turn to each other to
discuss the comments made by the presenter. These comments should be used as
information to enable the group to develop further their systemic formulation
about the case. They can ask themselves, ‘What does it tell us about this system/situation
that the presenter has chosen to comment on these particular aspects of our
discussion?’ This takes about 5 minutes. 5 The presenter can
then be invited to comment on this second discussion.
Dallos, Rudi. An Introduction To Family Therapy: Systemic
Theory And Practice (p. 117). Open University Press. Kindle Edition.
02/01/19: Summarised
Family therapy evolving from behavioural systems to meaning
making systems.
Emotions both define relationships and influence partners
behaviour. .
Systemic therapists argue that emotions are produce
relationally so you should attend to the interpersonal rather than the
intrapersonal
West tends to reify emotions, john is angry, as opposed to
transient states that change within relational dynamics.
Two members in tension draw in a third who regulates the
relationship. The third as outsider then is either favoured or recited by a
member. The idea then s to block the
triangle so that couples can deal with their difficulties directly
Schizophrenia
In what situation does schizophrenia make perfect sense.
Double binds make sense of schizophrenia where there is contradictory
information and there is no escape from it.
Ambivalence and contradictory behaviour can arise out of a
deep fear of rejection.
Weaves together systems theory, object relations,
evolutionary theory.
Bowlby goes to Darwin to say that we have a natural instinct
to attachment
So even though children can now survive without one primary
care giver and added to the argument that animals show this behaviour,
therefore it is a natural and current aspect of modern man.
Attachment=keep safe by being in close proximity
AS the infant is left
1.
Tears and searching
2.
Passive and sad
3.
Angry and detached, wont calm down even for mum
Securely attached children can tolerate absence for longer
Attachment strategies
Ainsworth: strange situation . Attachment styles are
relational dynamics.
Two types of insecure
Anxious avoidant: disinterested in mum goes, detached from
her. Mum has rejected needs.
Anxious ambivalent extreme
protests extreme anger when
she returns . Mum responds
ambivalent, ambiguously to needs
Disorganised=mum is the comfort and the threat.
Internal working attachment model, of how you get your needs
met, and what can be expected of of others. Core beliefs also get
generated as to why I don’t get my needs met, if there are attachment
difficulties.
Dispositional representation of attachment experiences, sees
an expectation that the past attachment experiences will be repeated, so
Procedural knowledge=infants learn the how to get their
needs met, may learn how rejection or distress may happen so in some way
becomes an automatic behaviour like riding a bike. There may be
associations between the sensations of mummy smiling and pleasure and mummy
anger and pain. Our attachment knowledge also spans distinct narratives
within episodes, from start to end.
Procedural and sensory knowledge derived pre verbal stay
with us all the way through our lives.
Parents who didn’t have secure attachment might try to do
the conscious right thing with their children when an automatic procedural
response could have been handier.
Attachment theory suggests that events are only traumatic if
they cant be processed within our relationships.
Procedural memories can be recalled outside awareness and
produce physiological effects.
Attachment theory is trans generational, the parents
attachments styles affecting their attachment with their children.
Childs angry behaviour affects father in two ways, empathy,
mirror neurons lead to feeling the anger, and procedural memories of his
fathers anger can replay, leading him to feeling scared.
Heightened emotions make it harder to think of ones own or
the others thoughts.
Likewise research shows that children with insecure
attachment find it harder to think about their thoughts or others (??)
During the family life cycle one major change is attachment
issues, close or distant. Attachment coping styles may also be challenge in
life cycle events, so self reliant previously, then have a baby and you’re not.
Secure base=somewhere to explore from
Safe have=somewhere for comfort
Parent message: ‘I will support and encourage you to explore
the world and I will welcome you back and sooth and comfort you if necessary
when you return’.
Powel proposes that when a parent has experienced repeated
rejection and withdrawal when they have wanted comfort from their parent, then
they will have this procedural memory activated which will cause distress when
their child wants soothing. A child can
detect this and miscue and ask for an activity instead, which will start
shaping their behaviour, so in which case the child may become independent in
masking their need for comfort. Likewise if
desire for exploration and independence was rejected then the child may
become clingy to mask their desires.
Adolescents need attachment figures, for a secure base to
explore for a safe haven to soothe. Parents may have feelings of distress in
the face of their children’s attachment needs as it reminds them of their own
distress when they were children.
There are primary and secondary emotions involved in
attachment theory treatment, one is the emotion tied up with need (sadness,
anxiety) the other one is the complaint when attachment needs aren’t met, e.g.
anger, withdrawal. So vulnerability the primary emotions and secondary emotions
the protest, the maintenance happens as focus for both sides is on the
secondary emotion
4 stages of AFBT: aim to build a secure base!!
Stage 1: The relational reframe
See the problem as the family dynamic not the individual
person
Focus on the soft emotions how a sense of distance, sadness
and separation has become part of the relationship. Why don’t you turn to your
parents when you feel depressed? Aim to elucidate the primary emotions.
Stage 2: building alliances with the adolescent
Highlight adolescent strengths and interests. Develop an
understanding of the teenagers problems and then why they don’t take these
problems to the parents. Depressed adolescents are hyper sensitive to feelings
of rejection or being unappreciated by their parents. They are encouraged to
risk this to enable re-connection.
Stage 3 Building an alliance with the parents
Focus on parents strengths ,interests and resources. Assess
their childhoods. Take the risk of criticism to enable re-connection. Avoid
trying to defend yourself or to fix things prematurely
Stage 4 Reattachment
Discuss core relational failures, adolescent tells parents
their problems, parents just listen. The
aim here is to get through the secondary emotions to the primary, a
softening. Then the parents tell the
adolescent what its like for them and the teenager needs to just listen.
Stage 1 Creating a secure base
Check in the unpleasant feelings about coming to therapy:
Make therapy a secure base, see how unpleasant feelings are communicated
Stage 2 Exploration
Using genograms, trans generational attachment patterns.
What are the corrective and replicative scrips?
Stage 3 Considering alternatives
Focus on corrective and replicate scripts, often there can
be a sense of failure of what they are trying to do
Stage 4 Maintain the therapeutic base
How does therapy get maintained in the family?
You need to be able to recognise attachment requests and
responses without feeling blame if you didn’t respond to them, if you feel
blamed then you will deny, or get angry, or re-blame.
How did the parents get their needs met from their parents,
what cross generational script did this set up. There may be a double whammy of
the child complaining of things that the parent wanted for themselves.
At the heart of attachment theory is how is comfort given
and received. How is it currently given and how was it given when you were
growing up, How might children wish to give comfort when they are parents.
Enables MDT to formulate differently and share from each. A corner stone of early systemic
thinking is that a symptom functions as a system stabiliser.
Formulating questions
Who first noticed the problem?
How does the problem relate to ordinary difficulties
What were the attempts to solve it
What were the decisions made to stop attempted solutions
So you get a problem attempted solutions, the difficulties
caused by the attempted solution which feeds into the problem.
Here a hypothesis is used to understand the problem, and
then the hypothesis when disproved is superseded by another hypothesis. The
hypothesis is never right, merely the best we have.
Using second phase hypothesis making and constructivism
change in sense of hypothesis as a helpful lens as opposed to truth.
Systemic practices move towards social constructionism with
a narrative approach to therapy.
A systemic formulation involves
1.
The problem
2.
The context
3.
The beliefs
4.
The problem maintaining patterns, attempted
solution and effects
5.
Emotions and attachment
Two tasks of formulation
1.
Analysis
a.
Getting more information
2.
Synthesis
a.
Producing hypothesis
Deconstructing the problem
1.
Who first noticed the problem
2.
Who is most affected by the problem
3.
Genogram
The context
1.
General : Social, economic, cultural
2.
Specific: what’s currently going on
Beliefs
1.
What is clients view of the problem, what
started it, what keeps it going.
The problem
This usually involves all aspects of the drinkers systems as
everyone is affected by their drinking
Contextual factors
Heavy drinking associations: male potency and sexuality,
fun. Narrative of 12 steps admit defeat at rock bottom and be abstinent
Beliefs and explanations
Drinking as involuntary, but drinker should be able to do
something about it, if they really wanted to.
Tension between drinking as an illness or irresponsible.
Also drinking as a reaction to distress and caused by others.
Pre contemplation: there isn’t a problem
Contemplation: there is a problem but I cant do anything
about it
Preparation: there is something that can be done and preparing
for it
Action Acting on the change plan
Maintenance: keeping the plan on track
Problem maintaining patterns: main relationship is with
alcohol. People trying to help the drinker, by hiding alcohol, or taking the
moral high ground by telling them off, can shame the client and then they
become angry and then drink.
Emotions and attachment: alcohol is the secure base, safe
haven, its hard for others to show much affection to the drinker which re-enforces
the sense of failure and abandonment, which leads to drinking.
The escape from an intolerable situation into the
“certainty” of a simple situation, that ignores the complexity.
The children who show greatest problem with relational break
up and new partners, show greatest loyalty to the original relationship.
Emotions and attachments: Adult attachments may seem
increasingly transient and the only thing that can be clung onto is the
attachment with the child. So the
child meets the parents needs against aloneness, and provides them some
stability.
What is the problem and for whom?
The worse the crime the easier it is to reach for simplistic
causality that they are either bad or mad. Probably because it is much harder
to tolerate uncertainty and the unknown with such a horrible thing.
Seeing someone as ill, or suffering from something means
they can give up any desire or feel any responsibility for change.
Therapist as expert means they now shoulder the
responsibility for a clients distress, so if things go well or badly its down
to the therapist.
1 in 5 will die within 20 years of having this
Closely linked with the need for emotional comfort, security
and reassurance as well as emotional processes in the family. Families see a
stubborn refusal to eat, clients see an inability to eat, an illness outside of
their control. Clients can get anxiety
if they give into their hunger and that they are weak and have failed . There
can be an escalating tension between parents and clients, as one sides tries to
encourage, force, demand eating and there is an air or anger, tension, and a
feeling of helplessness in the face of anorexia
Parents can have alternate views as child as bad or ill and either
needing discipline or understanding. Hard to think that the Childs problems may
come from the internal family dynamics of conflict and distress.
Conflict between client and parent, anxiety as the
connection from client to parent that gives the only connection and blocks any
other connection to find out what’s wrong, cycles of nagging, deception and
withdrawal, blame to child for ding thing, blame to the parents for causing
this.
Food as a comforter, family meal times as the time to come
together to talk, parents as not having the experiences of being comforted
themselves
Parents can develop narratives that exclude how things were
for them growing up.
When there is a either a big problem or a big explanation in
the room, e.g. psychosis, everything else can either be minimized or attributed
to being caused by it, almost the opposite of the elephant in the room. Multi family group therapy allows the
therapist to not be the expert, well and successful in distinction to their
clients.
Most parents with a child with conduct disorder have their
network of relationships affected and they feel like they are under siege.
Co-ordinated management of meaning=hierarchy of
meaning=message, episode, couple relationship, family and culture.
So a specific message might make sense in terms of an episode,
likewise these episodes might be made sense of by what’s currently happening in
the relationship, or by family beliefs, or cultural values.
Gender of therapist=> fear of sexes ganging up on one
partner of couple.
Marriage counselling started via the church and religiously
minded people helping to keep up the vows of marriage.
All relationships are dominated by power, standardly man to
woman. Man as wounded prince from his childhood, that then puts the woman into
rescuer mode. Leading to desperation on her part and a desire to leave with coercion
and emotional abuse on his side, leading to
a volatile attachment.
Attachment and emotions as key. Managing attachment
injuries, managing attachment protests dances.
Four horses: stonewalling, contempt, criticism and defensiveness.
Contempt being the strongest aspect of these. Gottman aims to prevent the
horses and replace with a safer house, of mutual admiration and knowledge
Nothing to add here..
