Family pattern of mental health disorders
Systemic therapy involves the entire family, and sometimes the entire family, with typically two or more therapists.
Based on systems theory, family models of mental health disorders and their treatment have been developed. This theory views the family or other social groups as a system of interrelated individuals. The behavior of everyone in the system does not appear individually but follows the circular principle. According to this principle, no one's conduct should be considered the beginning or the result of the event. X's behavior affects Y, Y's behavior affects X's behavior, and so on. Behaviors create a cycle of cause and effect, with no beginning or end. And intervening at any point in the system can create a change in this continuing set of behaviors.
Systemic therapy involves the entire family, and sometimes the extended family, with typically two or more therapists. The family may not know the therapists well, only that they are present. In most cases, a group of therapists sit behind a one-way mirror and monitor the progress of the therapy. They can discuss issues that arise in therapy, identify the nature of interactions among family members, and develop interaction strategies. They can assist therapists who are in the room with the family because those therapists may be so focused on controlling the treatment process that they may not be able to see all the complex relationships that arise. Outside observers can play an active, flexible role. They can communicate with the therapist inside the room by phone, or the therapist can walk out of the room on their own for advice and share ideas about the nature of the problem. Observers may even ask the therapist to perform a particular movement or ask specific questions. As a result, the experience of family therapy is very different from that of individual therapies. People who attended family therapy sessions for the first time shared those positive and negative experiences: The experience of family therapy is very different from that of individual therapy. People who attended family therapy sessions for the first time shared those positive and negative experiences: The experience of family therapy is very different from that of individual therapy. People who attended family therapy sessions for the first time shared those positive and negative experiences:
I find it both uncomfortable and inconvenient. Not all of us wanted to attend therapy, and when we got there it wasn't entirely clear what was going on. I don't think it's right for people behind a glass to watch us. You can't see their reaction to what's going on…it's annoying. I don't like it at all. I don't think we'll be back.
It was very strange and not what I was expecting. The therapist paced back and forth to talk to all of us. He even asked some of us to walk! That's not what you would expect. I thought he or she should be quite quiet and make us take turns talking. No need to walk around, interrupt, and so on… Knowing that there are people watching behind the glass also makes you lose your temper. You can't see them, however, and I've slowly begun to forget their presence, especially when we're working through difficult issues in therapy.
This chapter examines two approaches to systemic therapy that emerge from two very different theoretical perspectives. Other therapeutic approaches are described in subsequent chapters as appropriate.
Family structure therapy
In 1974, Salvador Minuchin was the first to develop the structural school of family therapy. The basic premise underlying this approach is the notion that the family develops structures to fulfill roles. Structures include family rules that govern how people relate to each other in the family. For example, fathers will relate in different ways, to different people at different times: husband, father, disciplinarian, friend, etc. This relationship is very diverse. However, each of these relationships can be carried out according to open or confidential principles.
Minuchin also elucidated a series of coordinated factors that determine family organization and interaction style. Subsystems are family units within the family in which people share a common element such as generation, gender, interest, etc. An individual can be a member of several subsystems. There are boundaries between subsystems and between the family and the outside world. According to Minuchin, clear boundaries are needed to allow subsystems to perform their distinct roles and develop autonomy and a sense of ownership. When these boundaries are built wrongly in the family, problems arise. In the case of flexible boundaries, easy information exchange between sub-systems, family members are extremely close and intimate. However, they can become too attached and this leads to a state of entanglement, with each individual member having no autonomy or independence. On the contrary, too rigid boundaries will hinder information exchange between sub-systems, creating emotional separation and separation among members.
These subsystems are organized hierarchically. The parent subsystem is generally recognized as superior to others such as sibling subgroups and is considered to have executive functions. It makes important family decisions. There may also be the breakdown or establishment of temporary subsystems, in the form of alliances. In this case, members of different subsystems cooperate with each other, often only on a short-term basis. Fathers and sons can combine to form an opposing force to maternal powers etc.. These alliances, especially when they are long, are thought to be prone to disrupting the hierarchical structure of the family. family and is an indicator of dysfunction.
Minuchin argues that the main characteristics of a well-functioning family include: having clear boundaries, proper hierarchy, and alliances that are flexible enough to adjust, change, and encourage and motivate members. of. Families that are dysfunctional have opposite characteristics. According to Minuchin, when an individual presents a problem that requires treatment, those problems represent problems for the whole system. Minuchin's group has linked specific diagnoses to types of family dynamics. For example, Minuchin and his colleagues (1978) identified the main characteristics of the "anorexic family" as awkwardness, overprotection, rigidity, and conflict avoidance, accompanied by conflicts. implicitly between parents. Also according to Minuchin, The stresses associated with fostering independence in such a family increase the risk of revealing conflicts between parents. To avoid this problem, children develop anorexia behaviors to prevent disagreements, complete separation of the family. These behaviors can help families unite around the “patient-specific” and distract attention from parental conflict.
The goal of this approach is to identify the location of dysfunctions and modify them: to establish a normal family structure in which the parental subsystem has control, the boundaries between and within generational clarity, and the absence of lasting alliances. Each family member needs age-appropriate independence and still feels part of the family.
The family structure method is behavioral, direct, and dynamic. The therapist is proactive and flexible in therapy processes. They may move, reposition family members to develop or break alliances, interfere with specific rules of responsibility/duty, and decide with other family members. family. Family therapy includes three elements:
Stimulate family awareness of reality.
Give them the ability to identify problems.
Once they have tried to act in a new way to solve the problem, they need to develop new relationships and structures that can sustain themselves.
The course of therapy includes a series of stages:
Family Engagement: During this phase, the therapist enters the system, participates, or builds relationships by adjusting to the family's culture, mood, style, and language. . They can mechanically participate in the family and decide with them.
Assess family structure: at this stage, the therapist examines boundaries, hierarchies, and alliances. This can be a very dynamic process. Interactions between individuals or subsystems are observed through role play. The therapist can create the conditions that make this interaction real. For example, Minuchin et al (1978) regularly conduct therapy sessions with families with children with anorexia at lunchtime so that the family can be invited to eat together. These sessions may indicate, for example, the inability of the parents to cooperate in encouraging the child to eat or the abnormalities of the parent's alliance with the child. This can lead to family discussions about the causes of different behaviors.
Systemic imbalance: in this phase, the therapist carefully and thoughtfully de-balances existing patterns of deviant behavior in order to place the family in a disproportionate position. The process is essentially direct, and the therapist may have to align himself with different subsystems and alliances. An example of this process is the case of a depressed woman who was very pessimistic and hopeless when therapy started, but her mood improved when she released unpleasant feelings about her health. her husband and her husband's family, who were always critical and demanding of her. Instead of taking the middle ground as in most individual therapy, the therapist began siding with her husband, empathizing with his problems in order to help everyone in the family. happy.
Restructuring works: once the system is out of balance, all efforts and efforts are focused on rebuilding a normal family structure. This process can include a range of strategies:
Realization of useful behavioral patterns in the family: This process involves developing appropriate behavioral patterns through strategies such as role-playing, guided practice, and manipulation. appropriate bodies of individuals incompatible subsystems (e.g. parents sitting side by side and interacting with members of other systems).
Increased stress: this strategy includes preventing recent patterns of inappropriate behavior in the family and the development of the conflict in order to encourage new alliances between compatible subsystems.
It is assumed that any change has a reinforcing effect and that the family will continue to grow without further interventions. However, therapy can be continued once a week for several months. One advantage of this approach is that it presents a clear therapeutic pattern. The goals and objectives of therapy are clearly defined from the outset. The process of change and the strategies for achieving the goals are outlined very specifically. However, its simplicity can also be a drawback, and many new therapists attempt to restructure the family before fully grasping the family's rules. Too rigidly applying the family function chart can have consequences: the therapist imposes solutions on the family and those solutions can be completely wrong.
Family strategy therapy
Walzalawick et al (1974) were one of the originators of the strategic model for family therapy. This model also focuses on interactions between family members. Families are thought to tend to organize themselves in repetitive sequences of interactions. Problems mostly arise following a poor or unsuccessful adaptation at critical times in the family life cycle.
They suggest that when the family is faced with a problem, its members interact in repetitive ways and apply strategies that have been used to solve the problem. If that method works, the problem will be solved. But when the strategy fails, only some families will adopt some new approach to trying to solve the problem. Other families may continue to use old ineffective strategies to try to achieve change. In this case, efforts to solve the problem can become a problem in itself: perhaps more serious than the original problems. The fact that a man reacts to his wife's lack of attachment with frustration and anger is an example of this process. In a fit of rage, he tries to convince his wife to be more committed and enthusiastic in their relationship. However, in response to his anger, she became more and more withdrawn, avoiding and the situation continued. Here, the anger the husband used as an attempt to change the original problem became part of the problem, not a solution—the woman became more closed. It should be noted that the fact that both responses are repeated (husband's anger and wife's closure) rather than just his anger exacerbates the problem. It should also be added that in cases like these, traditional psychotherapy often focuses on the husband's anger. not a solution - the woman has become more closed. It should be noted that the fact that both responses are repeated (husband's anger and wife's closure) rather than just his anger exacerbates the problem. It should also be added that in cases like these, traditional psychotherapy often focuses on the husband's anger. not a solution - the woman has become more closed. It should be noted that the fact that both responses are repeated (husband's anger and wife's closure) rather than just his anger exacerbates the problem. It should also be added that in cases like these, traditional psychotherapy often focuses on the husband's anger.
The goal of therapy is to identify repetitive and destructive attempts at problem-solving. Limit the tendency to look for the cause of the problem and attribute it to an individual, because this tendency only exacerbates problems rather than solves them. The strategic school emphasizes the importance of both verbal and nonverbal communication between family members. All behaviors are said to be manifestations of some form of communication. There is nothing that is not communicative: inactivity is as informative as activity.
The purpose of the strategic approach is to break the behavioral cycles that perpetuate the problem and to provide the conditions for a more appropriate pattern of behavior. The treatment process takes place in several distinct stages:
Investigate and identify specific difficulties to be solved.
Develop a strategic plan to break the chain of interactions that perpetuate the problem.
Implement strategic interventions – often including home exercises interspersed with therapy sessions. Its main purpose is to break the chain of problems.
Feedback on the outcome of the intervention.
Reassess treatment plan, including review of exercise and other interventions used.
The therapist's style is also an emotional distance between the therapist and the family. To avoid confrontation, they need to accept a lower position than the position of an expert. They must not insist that the whole family participate in therapy: They will work with anyone who attends. Therapeutic approaches focus on two main strategies of change: positive restructuring and paradoxical intervention.
Structural reframing: includes a positive interpretation of the behavior that causes the problem. The process is not as difficult as it might seem because, according to strategic therapists, these behaviors are misguided, but they are sincere attempts at problem-solving. In the same way, a couple can be told that their argument is also an indication that they are both working to make the relationship better. The purpose of restructuring is to help families become aware of an existing problem and to encourage them to redefine and find new meaning to it. Once the problem has been redefined, the family can no longer apply the same solutions as before. And so new solutions and new models of interaction will become possible.
Paradoxical interventions: include tasks required in therapy that appear to contradict or contradict conventional wisdom. For example, a quarreling couple may be asked to continue arguing – it may be necessary to further explain, of course, that “fighting proves you are still together”. When paradoxical intervention is used, the therapist must make a therapeutic connection by explaining why it (the quarrel) does not happen as advised because one wants an outcome. opposite. The paradox is meant to give the problem a new meaning and the people involved will be forced to decide whether to change or not to change - this is itself a change in the system. Many paradoxical strategies have been identified. This example is known as a symptom prescription. A similar technique is called assumption. It is assuming that there is a particular problem in the family and that family members reproduce their usual behaviors with that 'symptom' existing. This is meant to disrupt normal family interactions and make behavioral changes more convenient. This approach has many strengths and its authors have achieved considerable success (Watzlawick et al., 1974). However, the ethical implications of this approach are highly controversial because the power in the therapist and the method is unknown to the client. Box 4.1 illustrates both the structural and strategic approaches. It is assuming that there is a particular problem in the family and that family members reproduce their usual behaviors with that 'symptom' existing. This means disrupting normal family interactions and making behavioral changes more convenient. This approach has many strengths and its authors have achieved considerable success (Watzlawick et al., 1974). However, the ethical implications of this approach are highly controversial because the power in the therapist and the method is unknown to the client. Box 4.1 illustrates both the structural and strategic approaches. It is assuming that there is a particular problem in the family and that family members reproduce their usual behaviors with that 'symptom' existing. This is meant to disrupt normal family interactions and make behavioral changes more convenient. This approach has many strengths and its authors have achieved considerable success (Watzlawick et al., 1974). However, the ethical implications of this approach are highly controversial because the power of the therapist and the method is unknown to the client.