Family Systems PART SET Dr MargiAnne Isaia, MD MPH PCC-T DrAnneenthusiasticLife 12

FAMILY SYSTEMS PERSPECTIVE A person is an autonomous individual, capable of free and independent choice. A person is born into a family and lives the entire life attached to one form of a family of another. In the family, the person discover who he/she is, develops and change, receives and gives support. In the family, the persons create, maintain, and live by rules (often, unspoken ones) and routines that they hope will keep the family (and each of its members) functional.

BASIC ASSUMPTION Every person is best understood through assessing the interaction between and among family members. The development and behavior of one family member are interconnected with others in the family. Symptoms are considered as an expression of a set of habits and patterns of the family. A person’s problem could be a symptom of how the family functions, and not only a person’s maladjustment to life. Family is an interactional unit with its own set of unique traits, thus the therapy is focused on interpersonal relationships.

FAMILY THERAPY A RELATIONSHIP THERAPY Actions by any individual person of the family will influence all of the family members. Their reactions will have a reciprocal effect on the individual. The problematic behavior could be seen as a symptom of dysfunctional familial patterns maintained across generations as well as the larger community and societal systems. The person is seen not only in the context of the family, but also in the context of society.

CASE SCENARIO Olga, age 29, accountant, suffers from deep sadness that lasted for more than three years. She is not able to maintain friendship and work successfully. She wants to feel better, but she is not optimistic about her life. She is still living home with her parents, in a small town. Her parents are in their 60s. She has a younger sister, who is a successful lawyer in the same town. All of the Olga’s friends have married and left their small town. She feels lonely and isolated.

FOCUS OF THE INDIVIDUAL THERAPY: Interest in obtaining the correct diagnosis: Depression/Adjustment disorder/ other medical problems/psychological disturbance, etc; Begin therapy immediately; Address causes, cognitive, emotional and behavioral processes involved in Olga’s case; Intervene to help Olga cope with the situation.

FOCUS OF THE FAMILY SYSTEMS THERAPY: How current family relationships contribute to the development and maintenance of symptoms; Assess the system looking for family processes and rules; Have Olga’s mother, father and sister into therapy with her; Focus on the family relationships; Have in mind trans-generational meanings, rules, cultural and gender issues within the family, and the community and larger systems that affect the family; Intervene to help change Olga’s context.

DEPRESSION IN FAMILY SYSTEMS THERAPY Depression can have organic, genetic or hormonal components; It may involve cognitive, emotional and behavioral patterns; Important to see how depression affects other family members and influences family process; Depression may signal her own pain and the unexpressed pain of the family; It disrupts intimate relationships of others; It can show how she adjusts to family rules, cultural standards; It is the expression of crisis in the family life cycle development.

FAMILY SYSTEM THERAPY APPROACHES ADLERIAN FAMILY THERAPY Time focus: Present with some references to the past Therapy goals: Enable parents as leaders; unlock mistaken goals and interactional patterns in the family; promotion of effective parenting Process of change: Formation of relationship based on mutual respect; investigation of birth order and mistaken goals, re-education.

FAMILY SYSTEM THERAPY APPROACHES MULTIGENERATIONAL FAMILY THERAPY Time focus: Present and past; family of origin; three generations Therapy goals: Differentiation of self; change the individual within the context of the system; Decrease anxiety Process of change: Questions and cognitive processes lead to differentiation and understanding of family of origin.

FAMILY SYSTEM THERAPY APPROACHES HUMAN VALIDATION PROCESS MODEL Time focus: here and now. Therapy goals: Promote growth, self-esteem, and connection, help family reach congruent communication and interaction. Process of change: Family is changed to move from status quo through chaos to new possibilities and new integrations.

FAMILY SYSTEM THERAPY APPROACHES EXPERIENTIAL/SYMBOLIC FAMILY THERAPY Time focus: Present. Therapy goals: Promote spontaneity, creativity, autonomy and ability to play. Process of change: Awareness and seeds of change are planted in therapy confrontations.

FAMILY SYSTEM THERAPY APPROACHES STRUCTURAL FAMILY THERAPY Time focus: Present and past. Therapy goals: Restructure family organization; change dysfunctional transactional patterns. Process of change: Therapist joints the family in a leadership role; changes structure; sets boundaries.

FAMILY SYSTEM THERAPY APPROACHES STRATEGIC FAMILY THERAPY Time focus: Present and future. Therapy goals: Eliminate presenting problem; change dysfunctional patterns; interrupt sequence. Process of change: Change occurs through action-oriented directives and paradoxical interventions.

FAMILY SYSTEM THERAPY APPROACHES FAMILY SYSTEMS THERAPY-FACILITATING CHANGE Being able to think is usually more useful than emotional reactivity. Being able to feel is better than not feeling. Good contact with others is more rewarding than isolation or self- absorption. Taking reasonable risks in the service of growth and development is more beneficial than stagnation or a retreat into fear. Family Systems therapy must be integrated with a personal therapy.

FAMILY THERAPY – BIBLICAL PERSPECTIVE Galatians 5: 22 “But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, and self-control. Against such things there is no law”.

REFERENCES Corey, G., Theory and Practice of Counseling and Psychotherapy, 8 th edition (2009).