1. Systems of Psychotherapy: A Transtheoretical Analysis
Chapter 11 – Systemic Therapies

2. 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

3. 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

4. Multiple Meanings of Systemic Therapies
Therapy modality or format
Treatment content or goal
Paradigm shift

5. Three Systemic Therapies
Communication/strategic therapy
Structural therapy
Bowenian therapy

6. 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

7. 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

8. 5 Axioms of Communication
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)

9. Theory of Therapeutic Processes
Help individuals and systems to communicate clearly & constructively
Changing communication changes relationships and power dynamics

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. Therapeutic Relationship
Therapist joins each member or sub-system of family
Initial relationship involves empathy, warmth, and caring
Once relationship established, therapist becomes authoritative leader
Therapist challenges, blocks, & disrupts homeostasis

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Practicalities Often work with spouses or with one motivated patient
Central couple is most important
Strong proponent of family of origin therapy for psychotherapists

25. 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”