Article prepared by Learn Seeing Therapy, a Spanish center specializing in online education and therapy.
The system is a group that acquires its own entity category and is maintained by mutual interaction among its members. It is more than the sum of its members.
From this point of view, the individual is part of a larger system that surrounds him and inscribes him in a context, without which his behavior makes no sense. The focus of attention is on the relationships established between the members of the system, because this will help to understand and make sense of individual behavior.
The systems can be closed or open, and have a number of properties:
Totality: Every system works as a unit, so changes in one of the elements will cause changes and adjustments in the rest of the system. Making changes individually is less effective since it can cause the family to oppose those changes.
Equifinity and fairness: Equifinity means that a system can reach the same result from different initial conditions, and equicusality is that the same initial condition can lead to different results.
Feedback / Feedback: The feedback or feedback mechanism allows you to continually readjust and adapt the system as it reinsertes in it what has resulted from your previous actions, which allows you to adapt. In family systems, there are two types of feedback:
- Negative feedback or Homeostasis: This type of feedback does not promote change but tries to find the stability of the system by correcting the deviations within it. The function of the symptom that one of the elements undergoes at the individual level is to maintain the stability of the system and counteract the change.
- Positive Feedback or Morphogenesis: This type of feedback promotes change and deviation within the system with the intention of keeping the system viable. It aims at the growth of the system and its adaptation to the environment. Crisis situations are a way to introduce moments of change and overcome Homeostasis.
Families oscillate between these two types of feedback, always trying to adjust while maintaining internal consistency and stability.
Interaction patterns
Each family has thousands of possibilities to interact, but over time certain interaction patterns and relationship rules are established. These guidelines establish when, in what way and with whom you can relate and give order and consistency to the system. Each family generates their own interaction patterns and is maintained by the expectations of family members.
Following these guidelines tells us a lot about the system and its structure. For example, the first to start talking usually has the power in the family and the ability to define problems, etc.
Circularity
In a system that is self-regulating continuously, it makes no sense to look for cause-effect relationships, since there is nothing "that happens first." In other words, linear causality does not exist, there is no part that regulates the rest.
What is sought is to identify the self-regulation cycle that is taking place. That is, search and interrupt or modify the circular patterns of interaction that occur in the family. All family members are related in this way.
Exchange rates
Having these concepts, two types of changes are defined within a system:
First-order changes: The change occurs at the individual level, that is, one of the elements of the system, but it does not translate into a change in the structure of the system nor does it have any more impact. These changes are understood as unreliable, since the system in which the symptom was generated continues to maintain the same structure, and the symptom may return, or another symptom may appear in another family member.
Second order changes: There are changes in the set of interactions and rules that govern the internal structure of the system. There is a qualitative change in the system that affects all its elements. This entails lasting and stable changes.
Axioms of communication
According to Paul Watzlawick, there are five axioms that are always met in human communication, since they are inherent in it. When communication is not clear or misunderstood, conflict arises.
It is impossible not to communicate. All behavior communicates something. Silence or not acting is also a way of communicating, so it is not possible not to communicate.
All communication has a relational level and another level of content. In addition to the level of content, or what a person is saying, it is transmitting more information and defining how the relationship between the sender and the receiver is. The relational level is the most important of the message and classifies the content of the message, determining how the recipient receives that message. Accepting the message is to accept the level of relationship established by the issuer, which can lead to conflict.
All communication is analog and digital. All communication has a digital part, or what is said in words, and another analog: non-verbal language or as it is said. A conflict may arise or be confusing when they do not match.
Linear causality does not exist, there is no part that regulates the rest
The nature of the relationship depends on how the participants rate the sequence of events. Both the receiver and the sender punctuate the communication sequence in a certain way and this determines how they react to it. For example, before the same discussion, if we ask each one, he will explain his reactions in relation to what the other has done. The entire sequence will be reduced to cause-effect chains when in fact the interaction is cyclic.
Communication can be symmetric or complementary. The relationship between sender and receiver can be equal to equal, which leads to symmetric communications, or it can be a complementary relationship in which a role is adopted and both are coupled. Many times they are relationships related to some form of authority (eg, teacher - student, mother - child).
Metacommunication
As can be seen from the axioms of communication, in the act of communicating we also communicate, that is, we communicate something about communication. While studying schizophrenia, they realized that the patients admitted worsened with family visits. In a classic example, they tell how a mother visits her daughter and she embraces her with joy. The mother becomes rigid, which leads her daughter to withdraw the hug. When her daughter walks away, the mother asks "Do you not love me anymore?"
From examples like this hypothesize that the cause of schizophrenia could be the contradictory messages between what is said and what is communicated about the relationship. This theory was called the Double Link theory.
Family life cycle
The family develops, adapts and changes over time, in a series of normative phases that can be classified by stages. Each of these stages has different challenges to face and to which the family must adapt. They are a series of expected evolutionary crises and there are a series of “evolutionary tasks” that, if not achieved, hinders or hinders the proper development of family members. When a family gets stuck in certain tasks, they influence and hinder the later stages. Following Carter and McGoldrick, six phases can be established:
Young adult independence
In this phase, the main task is autonomy, both practical and emotional, and reconciliation with the family of origin. Doing it properly implies the independence of the young adult without breaking with the family, without seeking a precipitous substitute or will not become independent.
It involves formulating one's own vital objectives, finding work, and being autonomous enough to relate to an equal-to-equal couple and to raise a family. Usually the fundamental problem is to accept the change of the relationship with the parents and move from a type of complementary parent-child relationship to one of equal to equal.
Couple training
The formation of the stable couple implies the union of two people who come from different family systems, which will involve joining and negotiating beliefs, expectations, values and behaviors, forming a new organization different from those of the previous systems.
The basic task is the commitment to the new system, establishing adequate borders with the outside and a common functioning in the couple. The limits are negotiated with explicit and implicit agreements. For example, relationships with the family, etc. are renegotiated. The goal is to develop an intimate space without disconnecting from its surroundings.
The couple develops their own mode of organization and renegotiates their expectations and relationship patterns, from how the affection is expressed to who cooks, cleanses, roles, hierarchy, etc. They establish common values, accept their disagreements and guide how they negotiate, who makes the decisions, etc.
Usually the main difficulty is usually establishing limits with the family of origin. There are usually poor borders that encourage intrusion or too strong that lead to isolation and loss of support.
Family with small children
With the birth of the first child, a third party appears in the system that needs to be accommodated and influences all relationships. New subsystems appear (parents, couple, children). A basic task that arises is to maintain a minimal space while facing the functions of childcare. There are new domestic tasks to be distributed and of course, also distribute the functions of care, parenting, protection and control of children. Each family finds its own way of expressing affection and managing control, and they must be modified and adjusted to the age of the children as they grow up.
One of the first problems is gender roles. Although there is an agreement on what a man and a woman do from the previous stage, it is in this when these agreements become more visible and it is easier for the couple to fall into the traditional roles of g January, in which the man acts as a provider and the woman renounces her professional career to take care of the house. Many times these problems manifest themselves in sexuality or in the form of depression.
When the children finally become independent, the parents lose their parental function and become only a couple again.
The other big problem is usually the affective bond with the children, either because they fall into overprotection or excessive distance. A common situation is a very close son and mother, who stand against the father who seems to be a more distant figure in the family.
This is the stage that generates more divorces, and therefore, the most complicated. New children will involve new reorganizations and the appearance of the subsystem of the brothers and the management of rivalry and cooperation. In addition, at this stage the school appears as an external institution with which the family has to relate and of great importance. The school adds new tasks such as taking care of picking up the children, taking care of the school tasks, interacting with classmates, etc.
Family with teenage children
The transition from childhood to adolescence means a great change in family relationships and their roles. The family goes from having a function of protection to a function of preparation for the responsibilities of the adult world.
At this stage, the peer group acquires much greater importance for adolescence, has a new capacity for judgment and places demands on parents. Changes in sexuality appear, while seeking to define their identity and increase their autonomy. Autonomy and control usually become the main conflict and the fundamental task is to make the limits more flexible to allow the adolescent to explore and experiment, being able to return for support when he cannot face something alone.
In turn, parents often enter the "midlife crisis" in which they assess their level of satisfaction in their life in general, including work and the relationship itself. It usually involves a lot of renegotiation and extra tension on parents. It can also be that at this stage parents begin to be caregivers of their own parents, already in physical and psychological decline.
The most common problem at this stage is that the adolescent becomes dependent and fails to follow his own path of autonomy. It can be difficult for parents to accept their autonomy and eventual progress and make this process difficult, generating symptoms to retain it, such as depression.
Child independence
When the children finally become independent, the parents lose their parental function and become only a couple again. On the one hand they combine caring for their own parents while making room in the family for the grandchildren. This stage of reunion with the couple, is also a stage of being able to resume abandoned projects for not having time during the upbringing of the children.
The most common problems have to do with conflicting relationships that try to retain the last child so as not to meet again as a couple, or the “empty nest” that refers to the depression that manifests especially in women when they have turned all their energy into raise their children and lose that function and meaning.
Family in the elderly
This phase begins after retirement and involves numerous duels: Family, friends, work, health, etc. In this stage the energy is turned into maintaining personal and couple functioning and assessing what has been achieved throughout life. As the quality of life improves, it can also be a stage to explore and experience.
In relation to the rest of the family, it is a time to readjust to provide support without overloading.
Family therapy schools
Structural
Structural therapy, initiated by Minuchin, starts from the fact that the family as an organism needs some form of internal structure that indicates how, when and with whom to interact. That is, they are relatively stable relationship patterns that organize their family components and tell us how things work for that family, who has that function, etc. The hierarchy is necessary for the family and problems arise when problems occur in this or in the boundaries between subcomponents. Depending on the evolutionary cycle or what happens in the family, both hierarchy and limits may change.
In the family system there are subsystems, the most common are the relationship of the couple (marital subsystem), the parents (parental subsystem), that of the children (filial subsystem) and that of the brothers themselves (fraternal subsystem). Each subsystem has a position and a function within the family. For example, parents exercise control and care, but in the face of the father's illness, the older brother may begin to exercise functions that belonged to his father and thus be included in the parental subsystem temporarily.
When forming a family, as we saw in the family life cycle, it is essential that the couple set their own space for privacy and protect it. This forms the conjugal subsystem, which will be a model for your children of how intimate relationships are and how to communicate.
As parents they will form the parental subsystem and transmit to their children how to exercise authority, etc. Over time it should be flexible to give more autonomy to the children as they grow up. The children in turn will form their own subsystem and also that of siblings, where they will learn to support, cooperate or compete. Each subsystem communicates in a way. Members of a subsystem will speak equally, while parents to children will tend to complementary communication.
The limits regulate the contact between the subsystems, and therefore are very important. There are three types:
- Rigid: There is very little exchange / communication between the subsystems and the family seems fragmented, each making their own life. There is great autonomy, but very little contact. It promotes independence and the search for one's own resources but limits warmth and affection.
- Of course: There is contact and exchange, but certain areas remain for the subsystem itself. It allows autonomy and contact.
- Diffuse: There is too much communication and exchange, which causes the subsystems to get confused. There is a lot of emotional support but there is no autonomy. Children become dependent on parents and have trouble relating outside the family.
The limits regulate the contact between the subsystems, and therefore are very important
Structural therapy focuses on modifying the position of relative power or the boundaries between the subsystems to facilitate the internal functioning of the family.
Interactional / MRI of Palo Alto
This school is very based on authors like Watzlawick, and drinks a lot from the axioms of communication explained above.
For this way of understanding systemic therapy, the problem to be addressed is the solution that the family has tried to solve a problem and it has not worked "The solution is the problem". There are several forms of these "tried solutions":
The attempt to force an event that can only be spontaneous.
The attempt to dominate a feared event by avoiding it.
The attempt to reach agreement through an opposition.
The attempt to achieve submission through free acceptance.
Confirm the accusers' suspicions through self-defense.
The attempt to remain only attracting attention.
The attempt to teach responsibility by removing it.
The general attitude is to go slowly introducing small changes in the sequence of interaction of the family problem to modify it, and taking into account what would happen if the situation improved for the family. What consequences would there be if X ceases to be depressed?
This school is the one that introduces the notion of first and second order change explained above. In addition, they develop a series of interventions:
- Redefinition: Change the "label" or conception of the problem associated with it.
- Direct tasks: Manipulate the sequence of interaction of the family problem? Among the different changes that can be introduced in the interaction sequence are:
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- Paradoxical task: The family is prescribed to continue with the problem, doing more of the same, with the intention that this generates a change. It is usually a risky intervention and it is called paradoxical because if they fulfill it they are fulfilling the therapist's task, and if not, they are changing and therefore the change is achieved.
Milan
This model of systemic therapy is based on the work of Boscolo, Selvini- Palazzoli, Bateson). The therapy focuses on formulating systemic hypotheses that explain in a circular way what happens to the family, and try to contrast them throughout the sessions. If the hypothesis does not work, it is discarded to redo it and continue contrasting it.
The work context was very structured, in which there is a team behind a unidirectional mirror to support the therapists, and they leave the session to discuss the case with them twice, the last one before make the return. The return is made at the end of the session, in which the team and the therapists give a message to the family and propose the tasks they see fit. During the time of return the family cannot respond.
In the miracle question, the family is asked what the day would be like if a miracle occurred and their problem was solved suddenly
This form of work focuses the attention of therapists, who seek to form a family map as a network of interconnected elements, looking at the way in which they were related, for example, looking for who would ally With who, etc. The main technique used is derived from this way of working, the circular question in which a family member is asked about the behavior of another member, instead of his own. In this way, more information is obtained, the family is encouraged to share their points of view, and it promotes a circular and interactional explanation for the problem. An example of a circular question could be: How does your father react when your brother starts yelling at him?
Strategic
This therapy is based on authors like Jay Haley. This school is much more interested in techniques than in technique, and seeks to make tactics for problems. The most important thing is to know how to define the problem and how to solve it. It does not try to modify the family structure.
It poses a succession of stages:
- Social stage: First contact between family and therapist. Greetings are exchanged and an attempt is made to make the situation comfortable for the family and the therapist.
- Problem statement: The family poses the problem that brings them to therapy.
- Interaction stage: Family dialogue about the problem is encouraged to discover how they communicate, what hierarchical organization there is, etc. In summary, we seek to collect information about family structure.
- Goal setting stage: It is necessary to define the goal specifically, and observably.
Then they go to the interventions themselves. Interventions can be direct, such as ordering someone to do something different, or ordering someone to do something. There are also indirect interventions, such as the paradoxical task in which the family is asked not to change or the ordeal, in which it is sought to make it more difficult for a person to have a symptom than to abandon it. This must be done in such a way that it can be executed, there is no objection, and it does not cause harm.
Transgenerational
The transgenerational school, with a very psychoanalytic influence, starts from the base that there are patterns that are repeated from one generation to the next. They work a lot with the genogram, a family map shaped like a family tree in which relations between members are represented, looking for alliances, conflicts, etc.
Among other authors, one could mention John Byng-Hall, who spoke of “family scripts” that define problem situations in which the family is making the same pattern of relationships and that are transmitted from generation to generation. The next generation can take over that familiar script and repeat it, choose to do the opposite, or find a new and innovative solution.
Some common techniques in family therapy
In systemic family therapy, there are a number of interventions that are among the most common. Some are taken from other forms of therapy, and of course it is a way of working that admits the use of any technique deemed appropriate. We will only mention some habitual ones, but there are books that collect techniques and forms of interventions, such as “24 ideas for a brief therapy” (Mark Beyebach).
Positive reformulation
Positive reformulation is perhaps the simplest of all. It consists in formulating and returning to the family a circular hypothesis about the problem, which reformulates the usual complaint tone in the family by a positive message. It tries to counteract the linear hypotheses that the family poses at the outset and that designate a family member as “the problem”, with the negative emotional charge that this label associates.
An example that could be typical is that of a mother imagine depressed with a small child who is very rebellious and does not stop worrying. The mother will probably arrive criticizing her son's behavior or feeling guilty of not knowing how to control him. One hypothesis that could be given is that the son, noting that his mother is going through a difficult time (let's put a duel) has reacted by becoming rebellious to get his mother out of apathy.
If the therapist and his team observe that this is a real possibility, it can be returned to the family, turning the child's behavior into an attempt to care for his mother and redefining the relationship.
Exceptions and miracle questions
Exceptions and miracle questions are brief therapy techniques. In the miracle question, the family is asked what the day would be like if a miracle occurred and their problem is solved suddenly. For example, it is sought that it would be the first thing they would notice, etc. This gives us clues about elements to introduce to make the miracle begin to occur in the family.
In the exceptions, we ask about those situations in which things were done differently and those that went well. In this way, we help them turn their attention to the positive, and give us the opportunity to introduce variations to encourage it. If, for example, the mother and the son do not argue because the father supports the mother on some occasions, we can encourage the father to support the mother more times.
Questions scale
One type of question that is sometimes useful is to ask the family to assess, from 1 to 10, at what point their problem is.
From here you can say that it would be necessary to raise a point on the scale, or if the score is low, what they have done to keep it from going down. If for example it tells you a 5, what would it take to get to 6? How did you make it not a four or even less?
Circular questions
Although we have mentioned them before, we remember them here because it is the fundamental technique. With circular questions, we ask another family member about what he does, feels, etc. the member we want to know something about.
This avoids an escalation of discussions, encourages a cyclical and interrelated vision of the problem that affects everyone, and often allows unknown information or new points of view to flow.
For example, if a father and a mother argue often, asking them will give you a linear vision "is that he provoked me by telling me that" will always be described in the form of reactions. If we ask the children, they will often be able to have a broader vision. They may listen to how their discussions impact their children, or how they see their partner feel when they do such a thing, without having to defend themselves from an attack. Ideally, a circular situation is formulated “When dad does such, mom worries a lot. Dad is overwhelmed and distanced, which makes Mom worry even more and persecute him. ”
Direct and paradoxical tasks
In systemic therapy, many home tasks are used. Once a hypothesis is formulated about what is happening in the family, changes are made in the interactional sequence that has been detected to try to produce changes. Hence, the therapy is usually done every fifteen days, so that there is time for them to notice certain changes.
Paradoxical tasks are usually reserved for when everything has been tried and nothing has worked.
For example, if a family lives too disconnected from each other, they can be proposed to do a task together, even if it is to have dinner together. It is often suggested that other family members intervene, etc. These tasks can be as creative as the therapist wants. For example, if a member of the couple is usually the one who makes the decisions or the one who exercises a certain role, they can exchange the roles and play the other one for alternate days, or throw a coin to see who n plays a certain role at a certain time, for example, who helps children with homework or cleans the house.
Paradoxical tasks are usually reserved for when everything has been tried and nothing has worked. The idea is to convey to the family that they do not change and that the best thing for them is not to change. In this way, the forces of homeostasis that are preventing the family from changing are increased, so that if they do not change they are fulfilling the therapist, and if they do not meet and change, the objective is achieved. The risk of these interventions is considerable, and it is not advisable to do them if the therapist is not convinced that it is the best option and can be firm in it.
Therapeutic equipment
On many occasions the therapeutic team itself is being used, which is seeing and supporting the therapist as a way to intervene. For example, sometimes in the return the team is used to express ambiguous feelings or internal debates that are considered to contribute something to the family. The clearest use of the therapeutic equipment as a tool is when the therapist asks the team to go to the room, and the therapist and clients go to the room from where they see the team as they discuss what has happened in session and the ideas and approaches that are made about how each one reacts and what may be happening.
Sculpture
Although sculpture is a technique of psychodrama, it is sometimes used to work as the family feels the family situation. Normally they are asked to represent their family. It is usually useful to start asking children, who enjoy playing with their family, capture the family's emotional climate very well, and make it easier for the family to enter the exercise. Once they represent it, you can ask how they feel in that situation, what they would like to change, you can make comments about the distances between each one or the feeling that the family gives, etc.
Una variante interesante, es en vez de usar a la propia familia para que se represente as misma, usar unos playmobilpara representar a la familia. De este modo muchas veces es menos amenazante para la familia.
Genograma
El genograma es una manera de representar a la familia y las relaciones entre sus miembros. A modo de ejemplo ponemos la familia de Indira Gandhi, primera ministra de India.
La estructura es la de un árbol familiar con cada miembro representado por un símbolo (cuadrados hombres, círculos mujeres, si hay una X ha fallecido, etc). En el ejemplo de Indira, solo se marca la relación entre ella (marcada con doble borde como paciente identificado, que sería aquel con el síntoma) y su padre. La doble línea indica una buena relación entre ambos, una alianza. También es posible, a medida que se va teniendo más información, ir representando alianzas, relaciones conflictivas, etc. Este genograma se puede hacer con la propia familia en las primeras sesiones, y habitualmente es una manera curiosa para los niños de hablar de su familia.
El valor del genograma es que sirve para dar una representación visual de toda la información de la que disponemos de la familia, permitiendo generar hipótesis de una manera mucho más sencilla. Habitualmente, se buscan también los llamados “triángulos”. Por ejemplo, si ambos padres tienen relaciones conflictivas con el mismo hijo, muy probablemente estarán aliados entre ellos.
El genograma también permite identificar patrones de relaciones que se repiten de generación en generación. Por ejemplo, quizás se repite el mismo número de hermanos, o siempre las mujeres son las que tienen buena relación con los hijos y los varones tienen relaciones distantes. También ayuda a darse cuenta de situaciones poco fáciles de ver, como por ejemplo, si el padre tiene relaciones conflictivas con todos los miembros de la familia, es fácil que se vuelva distante, se deprima, etc.
Descarga este artículo completo en formato PDF: Todo lo que necesitas para enteder la Terapia Sistémica
Origen: http://www.psyciencia.com/2015/05/20/todo-lo-que-necesitas-saber-para-entender-la-terapia-sistemica/
