Craig Chalquist, MS PhD
These notes from my therapy school days reflect the Family Systems paradigm I was given in the course of my first education into doing psychotherapy. Many of the concepts retain their clinical usefulness, although some of the more mechanistic/cybernetic language has been replaced in step with our understanding that the psyche is not so much a mechanism as a weaver of narratives. We do not tell stories only: we are stories.
Accomodating:adapting to a family's communication style.
Ackerman, Nathan: adapted psychoanalytic ideas to family therapy.
Inversely varying or mutually escalating or deescalating interactions--can be distorted by interaction patterns; usually fails in the marriage and spreads downward. Conflict at the individual or family level affects the whole family.
Competing family factions.
Therapist's job: clarify role definitions and what members expect from one another. Therapist as catalyst.
Alignments: when family members side with one another.
Analogic communication: nonverbal, connotative, process dimension of communication.
Assimilation: incorporation of knowledge into existing schema.
Bateson, Gregory: applied cybernetic principles to human communications. "Information is a difference that makes a difference." Big influence on the Milan group.
Behavioral family therapy (Gerald Patterson, Robert Liberman, Richard Stuart): procedures follow from behavioral theory. Tends to be linear. Behavioral analysis of family difficulties; functional analysis to determine a symptom's reinforcers and value. Eliminate the current environmental, situational, and social supports of symptomatic behavior while increasing positive interactions and training a couple to use contingency contracting, clear communicating, and problem-solving skills.
Stuart's operant interpersonal therapy assumes that the current pattern of interaction is the most rewarding of alternatives, that successful marriages involve a quid pro quo and frequent reciprocal positive reinforcements, which spouses record when given or received, and a written contract of what's wanted to avoid mindreading; he also uses a token economy.
Thibaut and Kelly's social exchange theory, which Stuart draws on, combines operant and social learning models.
Patterson and Reid stress in BPT the circle of parental behavior causing child's acting out, which causes parental behavior.
Functional family therapy combines systems, cognitive theory, and behaviorism to understand and change the function of a behavior (all behavior is adaptive, serves a function that has to do with merging, separating, or midpointing) to achieve its end in a different way
Bell, John: a founder of family therapy. His kind: family context therapy, an outgrowth of family group therapy. Applies small-group theories to the family. Whole family attends. Therapist stays outside the family. Stages of therapy: child-centered, parent-centered, family-centered.
Bias: a family's emotional thermostat. The therapist needs to look into who has the power to reset it.
Bowen, Murray: Bowen extended family therapy.
The eight interlocking concepts:
Differentiation (intrapsychic: between feelings and thoughts; interpersonal: between person and family) of self. Differentiation or its lack comes from evolution/intergenerational processes, family system, and mainly the mother. Differentiation is the opposite of fusion.
Triangles operating between two people and a triangulated third handle stress between fusion and differentiation. Usually the least differentiated person gets triangled.
Nuclear family emotional system (formerly called undifferentiated family ego mass).
Family projection process, which transmits undifferentiation and immaturity to the children.
Emotional cutoff (reaction to fusion), which usually leads to fusions outside the family.
Multigenerational transmission process by which pathology is carried on, usually by the least differentiated members of families.
Emotional divorce (like when a sick child holds the parents together); theory is important; no one ever really leaves the family system; mother-child symbiosis when unresolved predisposes to schizophrenia; solid self vs. pseudoself; over- underadequate reciprocity.
Two natural forces: growth of individual and emotional connection. Emphasized the first.
Fusion breeds anxiety and increases emotional reactivity. Three outcomes of fusion: physical or mental dysfunction in a spouse; in a child; chronic marital conflict.
Dysfunctional reciprocal relationships include overadequate/underadequate, decisive/indecisive, dominant/submissive, hysterical/obsessive, schizoid/conflict, or cutoff between spouses.
Main therapeutic interventions: genogram, differentiation work, and detriangulation.
Others: change interactions. One parent increasing differentiation may affect the other's--that and reducing anxiety (caused by either too much distance/closeness or too little) are main goals. Works mainly with parents, who talk through therapist. Therapist educates about and stays out of triangles to help people differentiate. Works long-term (Bowen says four years to get differentiation going). Reduce fusion, triangling, pseudoself. Separate thoughts from feelings. Teach how to face conflicts. Teach systems dynamics, intergen dynamics. Reduce reactivity, cutoff.
Boszormenyi-Nagy, Ivan: contextual therapy. Draws on psychoanalytic, object relations, and systems. Family obligations and debts. Legacy. Loyalty. Need to balance family ledgers. Three-generational view. The need to build trust in relationships. Nagy gave an ethical slant to family therapy; symptoms result from breakdown of trust and support.
Calibration: setting of a range limit (bias) in a system, like a thermostat in a room. The limit of how much change a family will tolerate.
Carter, Betty: feminist therapist who challenged traditionally masculine notions of personal and family development and with Monica McGoldrick emphasized the family's multigenerational life cycle, also pointing out how divorce and remarriage add stages to that cycle.
Centrifugal/centripetal: tendency of family members to move toward or away from a family.
Circular (mutual, reciprocal) causality: when things cause each other rather than just one causing the other (linear causality). Emphasizes present, process over past, content.
Closed systems: those unfriendly to new information; they tend to have a lot of entropy.
Coalitions: alignments of family members against other family members.
Collaborative family therapy: use of two or more therapists.
Concurrent family therapy: both spouses seen individually by one therapist.
Conjoint family therapy: all family members meet as a group.
Cybernetics: Norbert Weiner (1948) used this term to describe systems that self-regulate via feedback loops.
DeShazer, Steve: Solution-Focused Family Therapy: system is stuck; "skeleton key" solutions that work for many locks; families resist only interventions that don't seem to fit; change is inevitable.
Digital communication: verbal, denotative, content dimension of communication.
Disengagement: too much emotional distance between family members.
Double bind (Bateson, Jackson, Haley, Weakland): when the content and process of a message don't line up and you're not allowed to comment on that.
Enmeshment: inappropriate, boundary-violating closeness in which family members are emotionally overreactive to one another.
Equifinality: things with dissimilar origins can wind up in similar places (e.g., an abuse survivor and someone from a healthy family can both grow up to be good parents).
Equipotentiality: things with a common origin can go in very different directions of development (e.g., of two abuse survivors, one heals and the other becomes a criminal).
Ethnicity: filtered/interpreted by the family. Ethnicity has to do with identity and can therefore surpass race, gender, etc. in importance.
Family Choreography: an outgrowth of family sculpting developed by Peggy Papp. A moving sculpture.
Family Life Cycle: just like an individual, a family has developmental tasks and key (second-order) transitions like leaving home, joining of families through marriage, families with young children (the key milestone, and one that initiates vertical realignment), families with adolescents, launching children and moving on, families in later life. Key question: "How well did the family do on its last assignment?" Horizontal stressors are those involving these transitional assignments; vertical stressors are transmitted mainly via multigenerational triangling. Symptoms tend to occur when horizontal and vertical stressors intersect. Divorce adds extra developmental steps for all involved families.
Family Sculpting: developed by Duhl, Kantor, and Duhl. An activity in which family members place themselves in postures symbolic of the family dynamics. Satir placed people in position herself to activate right-brain experiencing.
Feedback loops: information pathways that help the system balance and correct itself. Can be negative (maintains the current bias and level of functioning) or positive (changes the bias/level of functioning).
First-order change: change that helps the system accommodate to its current level of functioning.
Framo, James: object relations family therapy; amalgam of personal and systems thought. Family problems rooted in extended family system. Parental (split) introjects are a major obstacle to change. Need to untriangle child and work on marriage. The couple is guided through conjoint, couples group, and family of origin (without the partner present) sessions.
Fromm-Reichmann: coined the term "schizophrenogenic mother."
Haley, Jay: strategic family therapist who worked at both the Palo Alto and MRI schools and whose collaboration with Salvador Minuchin helped bridge the gap between structural and strategic family therapy. Saw symptoms as springing from the gap between the manifest and covert layers of communication; they are also attempts to control a relationship. Explore those interactions maintaining the symptom and change them.
Jackson, Don: MRI cofounder; first to note that family interactions follow persistent patterns governed by descriptive (metaphors describing interchange patterns) and prescriptive rules. Homeostasis. Marital quid pro quo. Redundancy principle. Metarules--usually unstated. "Conjoint" therapy. Complementary (one up and one down) and symmetrical (between equals) styles of communication.
Kantor and Lehr's three basic family strategies: those that maintain the system; those that accentuate stress to reach a goal; and those aimed at repair.
Kempler, Walter: Gestalt family therapy. Emphasizes presence. There's no such thing as an individual. Active and directive. Forces members to talk to each other.
Lidz: came up with concepts of marital schism (split; periods of intense conflict) and skew (one partner up, one down; conflict denied, surface harmony).
Milan Systemic family therapy: led by Mara Selvini-Palazzoli. "Long brief therapy": sessions held about once a month to let things incubate; families wanting more are trying to control the therapy. Emphasis on information, paradox, circular feedback loops.
Other key concepts:
Repetitive interactions: games by which members try to control one another. Change the interactions and the behavior will too.
Dysfunctional families make an "epistemological error" that can be corrected.
Therapy: one or two therapists see the family while a team watches from behind a mirror. Sessions broken by an intersession during which the therapist talks to the team away from the family. Counterparadox. Pre-session hypothesizing. Circular and triadic questioning. Neutral, nonreactive therapist who asks family to generate its own solutions. Positive connotation of a behavior's intent. Assignment of rituals. Invariant prescription to loosen parent-child collusion.
Minuchin, Salvador: structural family therapy. Directive, change-oriented through changing the family structure (transaction-governing rules of a family). A symptom services and is rooted in dysfunctional transactions, structure (boundaries).
Enmeshment encourages somatization, and disengagement, acting out. High resonance.
Ecological context: the family's church, schools, work, extended family members.
Sick child: family conflict defuser.
Common boundary problem: parents confuse spouse functions with parent functions.
Generic and idiosyncratic rules that regulate transactions govern structure.
Boundaries: can be diffuse (enmeshed), rigid (disengaged), or clear.
Power: determined by authority and responsibility for acting on it.
Coalitions: can be stable or detouring.
Families are constantly in transition, and transitional anxieties and lack of differentiation are sometimes mislabeled pathological.
A family will either dismiss the therapist's probes, assimilate to previous transaction patterns, or respond as to a novel situation, in which case stress increases and the probe is restructuring.
Rigid triad: where parents habitually use a child to lightningrod conflict. Rigid boundary around the triad; common when the children have severe psychosomatic problems.
A dysfunctional family is one that responds to inner or outer demands for change by stereotyping its functioning.
Clients move for three reasons: they are challenged in their perception of their reality, given alternative possibilities that make sense, or self-reinforcing new relationships appear once they've tried out new alternatives. People need some support within a family to move into the unknown.
Four sources of family stress: one member with extrafamilial forces, whole family with extrafamilial forces, transition points in the family's evolution, idiosyncratic problems.
Sets: repeated family reactions to stress. Spontaneous sets: interpreted like enactments.
Goals: clear boundaries as gatekeepers, clear lines of authority, systems and subsystems (the parental one is where pathology begins), increase flexibility to alternative transactions, help negotiate family life cycle transitions. Family mapping via diagram of current structure. Interventions include joining and accomodating (same process: joining emphasizes therapist's outer adjustment to family, accomodating therapist's inner adjustment; adopting family's affective style; joining from a distant position = teaching, advice), mimesis (imitation, or joining from a close position), tracking (of family communications and behavior, or joining from a median position), enactments that simulate transactions to be changed, detriangulation of IP by forming a coalition with him against a parent, maintenance (of the family's current structure), marking boundaries (when they are strengthened, the subsystem's functioning will increase), mimic IP to show that he's like the powerful therapist rather than deviant, make the IP a cotherapist to the overfunctioner, reframing in terms of structure or interaction, unbalancing by escalating stress, general restructuring techniques (e.g., rearranging how they sit, blocking certain transactions, working as a family insider). Not very insight- or multigeneration-oriented.
Moreno, Jay: creator of psychodrama; first to do group therapy.
Mental Research Institute (Palo Alto): communications specialists. Emphasis on transactions, process more than people, metacommunication vs. content, what rather than why. All behavior communicates, and each communication has a report and command (relationship-defining) aspect. Pathology comes from redundant interactions; solutions can cause problems. Interventions: therapeutic double-bind (e.g., prescribing the symptom, relabeling); Brief Family Therapy (max 10 sessions; gets rid of problem-making solutions like action taken at the wrong level; uses paradoxes change frame of reference; therapy team behind a mirror.)
Multiple Family Therapy (MFT): four or five families in a therapy group, each a subsystem that affects the whole.
Multiple-Impact Therapy (MacGregor, Robert): crisis-focused; family seen by multidisciplinary team over a two-day period.
Non-summativity: the whole (family) is greater than the sum of its parts.
No-talk rule: an unwritten family rule against members commenting on certain uncomfortable issues.
Open systems: those that embrace new information and display negentropy (growth).
Punctuation: thinking that you cause what I say.
Retribalization: a form of network therapy in which the therapist organizes the client's entire support system for a meeting. Symptoms reframed as indicators of an inadequate network.
Rules: expectations that govern the system on many levels. Can be covert or overt. Good rules maintain stability while allowing some adaptive changes; rigid ones block even modest attempts to adapt. A therapeutic task is to make the covert rules overt.
Satir, Virginia: humanistic family therapy. One of the founders of the MRI communications school. Emphasized the importance of giving families hope and building self-esteem in family members.
Turn roles into relationships, rules into guidelines.
Our similarities unite us, and our differences make us grow.
A symptom may be distorting self-growth by trying to alleviate family pain; symptoms are a light on the dashboard or a ticket into therapy. Broken families follow broken rules. Pathology is a deficit in growth. What growth price does each part of the system pay to keep the overall balanced? "Rupture point": where coping skills fail and family needs to change.
Primary triad (mother, father, child) is source of self-identity.
Mind, soul, body triad: a current basis of self-identity.
Self, the core, has eight levels: physical, intellectual, emotional, sensual, interactional, contextual, nutritional, and spiritual. A good therapist works on all levels.
Five communication stances: placater, blamer, super-reasonable, irrelevant, and congruent (or leveling) communicator. The first four are mostly poses covering lack of self-worth.
Three parts to every communication: me, you, context. Dysfunctional communications leave one of these out of account.
Games: rescue games, coalition games, lethal games, growth games.
The five freedoms: to see and hear what is here instead of what should be, was, or will be; to say what one feels and thinks, instead of what one should; to feel what one feels, instead of what one ought; to ask for what one wants, instead of always waiting for permission; to take risks in one's own behalf, instead of choosing to be only "secure" and not rocking the boat.
Maturation: development of a clear identity and power of choice; self-relatedness; ability to communicate with others. Coping skills increase with self-esteem.
"Threat and Reward" (rule-makers/followers; rigid roles) vs. "Seed" (innate growth potential) worldviews.
Five components of self-esteem: security, belonging, competence, direction, selfhood.
In a dysfunctional family, symptomatic behavior makes sense. It is also covertly rewarded.
Interventions: reduce individual and family pain. Family life chronology (three generations). Communication work and esteem building. Growth. Identification of family roles, and turning these into relationships. Family reconstruction: an exercise in which roles in significant family historical events are directed by the Explorer, who is led by the Guide. Look at implicit premises that guide perceptions and interactions. Analysis of how family members handle differentness. Cut games, straighten transactions. Self-manifestation (congruence) analysis. Model analysis of which models have impacted early on. Expand experiencing and choice-making. Parts party: awareness and exercise of mind and body. Sculpting (group posture) technique. Labeling assets. Use of drama, metaphor, art, stories, self.
Criteria for termination: when family members can complete transactions, check, ask; can interpret hostility; can see how others see them; can see how they see themselves; can tell each other how he manifests himself; can tell other member what he hopes, fears, expects from the other; can disagree; can make choices; can learn through practice; can free selves from harmful effects of past models; can give a clear message, be congruent.
Second-order change: a change that fundamentally impacts the system, thereby taking it to a new level of functioning.
Skynner, A.C. Robin: open-systems, group-analytic approach. Kleinian object relations emphasis. Families have intergenerational developmental milestones similar to Freud's psychosexual stages. Projective systems (leftover expectations) correspond to stages of blocked development. A "semipermeable interface" between therapist and the family. Therapist uses empathy and gets involved in their projective systems, then works out the solution to them internally.
Strategic Family Therapy (Madanes and Haley): designs a strategy for each specific problem. Clear goals set, symptoms deprived of their relationship-controlling function. Therapist controls the therapy. Every interaction is a struggle for control of the relationship's definition. Symmetrical (similar, often competitive) vs. complementary (different, often counterresponding) interactions. Metacommunication and repetitive interactions examined. Prescriptive and descriptive paradoxical assignments. Madanes: "pretend techniques." Circular questioning. Positive connotation (as reframe of symptomatic behavior).
Three kinds of therapeutic double-binds or paradoxes: prescribing, restraining ("don't change"), and positioning (exaggerate neg. interps of the situation).
Von Bertalanffy, Ludwig: the biologist who invented general systems theory. Interrelations are more important than components.
Watzlawick, Paul: accesses right hemisphere with paradoxes, puns, imagery, etc. to create second-order change.
White, Michael: narrative family therapy: people's lives are organized by their life narratives. We become the stories we tell about our own experience. Replace unhelpful stories with helpful ones.
Whitaker, Carl: symbolic-experiential family therapy. Uses a cotherapist; multigenerational counseling; "psychotherapy of the absurd." Experience is what changes you. Each person is both client and therapist to each other. The focus is on process. Roles need to be flexible. Uses positive feedback to unbalance the system. Therapist must win the battle for structure; client must win the battle for initiative.
Wynne, Lyman: noticed that many families exhibit pseudomutuality (fake togetherness).
West of the West