Family Therapy

100 Key Points and Techniques

Mark Rivett, Eddy Street

• Publisher: Routledge
• Year: 2009
• ISBN:
  9781134129393
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Family therapy is increasingly recognised as one of the evidence based psychotherapies. In contemporary therapeutic practice, family therapy is helpful across the age span and for distress caused by family conflict, trauma and mental health difficulties. Because of this, many psychotherapists integrate elements of family therapy within their approaches.

Family Therapy: 100 Key Points and Techniques provides a concise and jargon-free guide to 100 of the fundamental ideas and techniques of this approach.

Divided into helpful sections, it covers:

• Family therapy theory
• Essential family therapy practice
• Using family therapy techniques
• Common challenges in family therapy
• Contemporary debates and issues
• Self issues for family therapists.

Family Therapy: 100 Key Points and Techniques is an invaluable resource for psychotherapists and counsellors in training and in practice. As well as appealing to established family therapists, this latest addition to the 100 Key Points series will also find an audience with other mental health professionals working with families and interested in learning more about family therapy techniques.

Part 1
SYSTEMS THEORY

1
What is a system?

The fundamental theory that underlies the interactional ‘mind set’ of family therapists is that of systems theory (Bateson 1972, 1979; Nichols and Schwartz 1998; Becvar and Becvar 1999; Glick et al. 2000; Goldenberg and Goldenberg 2000; Dallos and Draper 2005). For instance, Walrond-Skinner (1976) called family therapy ‘the treatment of natural systems’. This is the radical root of all the ideas and techniques that grow within the ‘tradition’ of family therapy. Indeed, many family therapists prefer to be called ‘systemic therapist’ rather than ‘family therapist’. So naturally, this is where Family Therapy: 100 Key Points and Techniques must start.

It is not possible to conceive of the functioning of the natural world without thinking in terms of the operation of systems. Let us take a simple natural process in a particular location: In any field the plants and animals are linked to each other in terms of their habitats and the climate they inhabit. They form an ecological ‘system’. Their interdependence is demonstrated when an unusually hot summer occurs. For instance, the heightened temperature causes an increase in the number of insects living in the field and this results in more birds visiting the field looking for food. However, let us say that the increased number of birds destroys some of the plants on which the insects live. So now the field becomes a less favourable habitat for the insects and their number decreases. Before long the birds too decrease as they go elsewhere looking for insects to eat. The natural world is full of such ecological systems.

We can consider the field and its inhabitants as a system but it would not be helpful to think that this system is separate from the rest of the world. The hedge around the field does not seal this ecological system ‘in’, but is an arbitrary way in which we define the system we are studying. For example we might focus down on one corner of the field that retains moisture more easily than others. Hence in this small ‘subsystem’ of the field different plants may grow, which in turn support different insects. These may attract different birds. Thus we have defined a new smaller system within the larger ecosystem of the field. Similarly we can expand our view of the field to include other fields in the locality. This will give us a wider picture of flora and wildlife activity in the context of many fields. Our field then becomes a ‘subsystem’ of the locality. One way of describing this is to say that everything is potentially a subsystem of something else. The process by which we determine which system we will arbitrarily look at is called, by family therapists, punctuating the system.

There are other dimensions to consider when thinking about natural systems. All systems move through time. Thus, we might think about how human cultivation affected the ecology of the field, and we might also think about the effects of global warming on our field. The boundary and punctuation that we adopt when we look at a system therefore might be defined by geography, time or what determines our intention/focus (in other words the context of the ‘observer’). Systems theory implies that all systems are permeable (their boundaries are loose), that what is inside and outside any system is an arbitrary act of definition and that any system can be viewed from a multitude of ‘lenses’. Bateson (Bateson and Bateson 1988) and some family therapists (Keeney 1983) have argued that no one can ever fully describe any system: Descriptions are partial and biased by the intention/ prejudices of the describer (Keeney 1983; Cecchin and Lane 1991). The recognition that the observer influences what is observed has been called second order systems theory or second order cybernetics (Becvar and Becvar 1999). Thus a human being observing the field may scare off a substantial number of birds, so the bird population cannot be accurately measured: The observer system is a skewed version of the non-observed system.

To return to the field: It is possible to identify characteristics of naturally occurring systems by highlighting the way in which the ‘parts’ are interrelated and interact each with the other. These multiple interrelations influence the system’s total functioning. We can therefore consider the functioning of the system in terms of the patterns of connection between the parts. This is why many systems theorists claim that ‘the whole is greater than the sum of its parts’. These connections involve the exchange of information. In our field, this information exchange is about plants growing with the increase in temperature, insects eating plants, birds eating insects, etc. Each part connects to, and interrelates in some way with, the other parts and what occurs in this information exchange will depend on the nature of the system. This process of information exchange is called feedback. In the field more plants might lead to more insects, which will lead to more birds. This is called escalating/reinforcing feedback (O’Connor and McDermott 1997). Alternatively, the feedback might ‘halt’ the pattern and cause a decrease in the original process. In the field this will occur when the plant population declines. This kind of feedback is called balancing feedback (O’Connor and McDermott 1997). Within human systems information exchange can occur via words, feelings and behavioural interaction.

Systems typically use the information that passes between the constituent parts to attempt to maintain itself in a balance. A change in one element will produce new information that will be communicated, resulting in a change elsewhere in the system so that functioning is not effected. An example is the way the human body maintains its temperature by causing us to sweat or take off clothes when we are hot. In systems theory, this process is called homeostasis. However, because all systems are to some extent open to outside influence, which is uncontrollable by them, and because systems evolve (move through time), they also constantly change. This process is called morphogenesis in systems theory.

2
The family as a system

Family therapists are interested in applying systems theory to families whatever their structure may be, e.g. ‘nuclear’ families, gay and lesbian families, lone parent families, step-families and extended families (Walrond-Skinner 1976; Nock 2000; McGoldrick and Hardy 2008). Accordingly, the focus of family therapists is on the pattern of connections between one individual and another, each component of a family system being seen as contributing to its operation as a whole.

In the same way that in a natural system a change in one part has an effect on another part, this also occurs in families, with every behaviour having a relationship dynamic. A simple family example would be noting how the way a mother and father interact has an impact on how one of them deals with their child’s behaviour. This in turn will produce feedback, which may or may not change the way the parents interact. Of course the process of feedback makes for complex processes. For instance the child may then provide differential feedback to each parent, which may lead to an escalating pattern. Therefore the family functions by means of patterns of connections between its members. These connections are established by the process of information exchange (emotional, cognitive or behavioural), which constitutes communication.

Within families the usual way of exchanging information may initially appear to be by verbal communication but we also have to consider non-verbal communication and all the other ways in which people behave. In a family it is impossible not to communicate: Everything that any one person does provides an opportunity for information exchange within and between family members. As an open human system the family can therefore be considered to be defined by its communicational patterns. These often provide the ‘definition’ of the family in phrases such as ‘we are a close family’, ‘Dad is closer to his daughter than his son’, etc. These definitions (note they are always ‘partial’ in any systemic interpretation) provide the ‘meaning’ of the ‘family’ to its members. It is also important to recognise that some communication is contradictory. This concept was termed the double bind by Bateson (1972). Thus, the child in the above example may say he is angry with his mother but may behave lovingly by, for instance, asking for a cuddle from her. Bateson believed that such contradictory patterns of communication were unhelpful. He also described relationship patterns in which behaviours centred around escalating feedback (he called these symmetrical relationships) and complementary feedback (complementary relationships). If the father for instance became aggressive with his child, in our example, the relationship would be symmetrical if the child responded with aggression too. If however the child became compliant, the relationship would be complementary.

The capacity to see families not as a collection of individual ‘selves’ but as a gestalt, a whole, leads to a crucial aspect of systems theory and family therapy practice. Individual characteristics in family members are seen as behavioural forms of communication rather than as personal attributes located within an individual. From this perspective it is more accurate to describe individuals as communicating certain behaviours rather than describing them as being a particular type of person. Therefore, to say that someone is a controlling person does not capture the sense of all the interactions around that person at any particular time. Nor does it include (as a systemic description) the perspective of the describer, who may only be offering a partial definition of that person because of their own position in the system. It is more accurate to report that when certain interactions occur within the family’s communicational system then that person is displaying ‘controlling type’ behaviour. Human action and activity are therefore embedded within the connections, the interactions, between people.

Information exchange, what we have termed ‘communication’, is the fuel of the interaction in human systems. To be human is to communicate and to communicate is to be in relation to someone else. Indeed, from this perspective, it is not so much that an individual ‘communicates’ as it is that the individual is constituted by his or her communication. The process of communication in terms of its frequency and impact is what determines the boundaries of the family system. Individuals who live together and share intimate moments and tasks such as childcare, caring for the elderly, financial budgets, etc. have a continual stream of communication that contributes to the definition of who they are. With our example above a grandparent might be involved in caring for the child when the child is ill. This person has less communication overall than the other members but at particular times he/she will have a significant impact on what happens and therefore the boundaries of the family have some fluidity and at any particular moment will depend on who is considered to be involved and with whom. Families therefore also have subsystems in the same way that other natural systems have. In this sense the boundary of any family or human system is dependent on how the individuals themselves wish to define it or how external observers wish to define who is in and who is out of that system. Individuals are therefore part of the communication system we call the family and to be involved in a communication system continually is at the core of human identity.

3
Individuals and systems

Even though humans are social creatures embedded as we have implied in families, groups and cultures, all of which are systems, there is a twist in the systemic nature of the individual person. We all become blinded to the systemic nature of being a human being. Even though we are always part of something else, we somehow forget it.

This is because every behaviour is at one and the same time both an expression of that person and a communication to others. To emphasise one to the neglect of the other is to lose our essential systemic nature. Yet for us as individuals there is a strong tendency to experience our communications solely as expressions of the self. We emphasise the ‘what I do’ to the neglect of ‘this is my contribution to what we do’.

Another reason why human beings lose an overall conception of their systemic nature is that they need to formulate action ahead of events; they need to create strategies and tactics prior to being involved in situations of informational complexity. In constructing our own stories or narratives of what has happened in the past (or what will happen in the future) we make a reflexive withdrawal from ongoing events; we stand outside of what is happening at that moment and give ourselves space to ‘think’. The individual then focuses on a self-conscious view rather than on the consciousness of the moment where the ongoing activities of others will have important influences on the interactive process. Doing this allows us to work out what we are going to do but the ‘timeout’ period results in a loss of awareness of how the system is operating. The degree to which any individual indulges in an overly focused view of his or her own particular conception of events in the system will determine the extent to which that person is distant from appreciating his or her operation within the functioning system. Within families this happens continually as family members focus on ‘this is what I need’, or ‘this is what others do to me’, rather than considering the process of interaction for the family as a whole. Individuals and families therefore have the ability to understand the social interactive nature of themselves but unfortunately this understanding requires the individual to subsume his or her view within that of the system and it does not occur readily, particularly at times when problems arise.

The idea that human beings find systemic thinking unnatural suggests that family therapy is constantly in tension with many other ‘individually’ orientated therapies. Most helping services are designed to ‘blame’ one family member and seek to organise, change or ameliorate that person’s behaviour, beliefs or feelings. For this reason early family therapists (Haley 1981) warned against family therapy becoming part of mental health services. Contrary to many such approaches to therapy, family therapy always places individuals’ beliefs, behaviours and emotions in context. In doing so, it either dilutes blame or seeks to escape blaming interventions.

4
Circularity and interconnection

Within systems, the process through which patterns of stability and change occur is a circular one rather than a linear one, therefore any action is a response to the other interactions within the system. By this process we can see that how one family member behaves is a direct response to the interactions of other family members, whether those interactions are directed towards that individual or merely observed by that individual. The behaviour of that one individual initiates further interactions in other family members. Any cause leads to an effect, which automatically becomes another cause. This is called circularity.

Let us take another example. A child is on his own in the kitchen and he stands on a chair to reach the ice cream in a fridge. He falls off the chair and breaks his leg. The mother who is at home has to take the child to the hospital and so she calls the father at work to come home to look after the other children. The father does this but is concerned about how this will affect his work schedule for the day. So after a few hours he rings up his mother to ask her if she will come over to look after the children and he returns to work. The grandmother, in looking after the other children, prepares them a meal but when the mother returns home she is concerned and upset as the wrong food has been used.

In the example above if we just think about what happened in terms of a limited straightforward linear cause and effect we might say that the events began with poor supervision by the mother. Then the father ‘caused’ his own mother to interfere with normal family routines (e.g. what got cooked). However, such a linear approach to cause and effect, which considers beginnings and endings, does not encapsulate the complexity of interactions in this simple example. A circular understanding on the other hand fails to find a beginning (a place to lay blame) but rather understands the embedded nature of family life. On the contrary, by emphasising the contexts that affect family members, it encourages not blame but responsibility since all family members have a part to play in how things turn out.

Systems such as families are continually communicating and provide cycles of unbroken interaction between all parts and all levels of the system. As we have seen each and every family system communicates, receives communication and can be viewed as being its communication. This continuous endless looping of information exchange has no beginning and no end but is like a spiralling circle moving through time.

In such a conception of the family how does change occur? Such a question used to dominate family therapy thinking (Keeney 1983; Rivett and Street 2003). We have already noted that systems ‘naturally’ tend to reach a stable place but we have also noted that change is a constant ...

Table of contents

• 100 Key Points
• Contents
• Preface
• Part 1 SYSTEMS THEORY
• Part 2 COMPLEXITIES AND MISUNDERSTANDINGS
• Part 3 BEGINNING THERAPY
• Part 4 THE THERAPIST’S TECHNIQUES
• Part 5 DEVELOPING INTERVENTIONS
• Part 6 TECHNIQUES FROM SCHOOLS OF FAMILY THERAPY
• Part 7 ENDING THERAPY
• Part 8 THE SELF OF THE THERAPIST
• Part 9 DEALING WITH COMMON CHALLENGES IN FAMILY THERAPY
• Part 10 FAMILY THERAPY IN CONTEXTS
• Part 11 DEBATES AND ISSUES
• References