Systemic Family Therapy and Family Development

Systemic Family Therapy and Family Development LORRAINE M. WRTGI-IT WENDY L. WATSON Systemic family therapy owes its origins to the brilliantly creat...
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Systemic Family Therapy and Family Development LORRAINE M. WRTGI-IT WENDY L. WATSON

Systemic family therapy owes its origins to the brilliantly creative and innovative clinics! team of M. Selvini-Palazzoli, L. Boscolo. G. Cecchin. and G . Prata (1X2). Wright P I a/. 11982) indicate that one common response is For parents and children to be so loyal to the nuclear family r ha! they disregard their own individual development. In families characterized by a high degree of loyalty, it is often difficult for the young adult to individuate because individuation may be seen by the family as a form of rejection. Some young adults respond to this dilemma by remaining highly dependent on their parents for emotional and. sometimes. economic support. and they often provide companionship and nurturing ior one or both parents. One could hypothesize that the adult daughter and the elderly mother in the case example responded to the threat of transition posed by the launching stage by being overly close for many years. The second extreme response of families negotiating the launching stage is for parents and children to distance themselves emotionally from each other to such an extent that they nppear to he totally disinterested in each other and totally consumed by self-interest. For example, young adults may declare [heir independence and cut ties completely with their family in an efion to individuate. When the women in the case example presented clinically at the FNU. they appeared to he exhibiting this type of extreme response. For example. thev had not spoken to each otl~erin 2 years. Their inability to acconlplish the task of parent-child separation consequently thwarted reinvestment in each nf their marriages. However. determining what direction their relationship would take was not the primary goal of the clinicians. Rather, the aim of the systemic therapy team was to create a context for change and to offer an alternate epistemology of the problem so that the family could discover their own solutions. Therapists must trust the soZutions that families find and must recognize that the pace the family takes roward problem solving is often differenr from that which the therapist might establish (e.g., sometimes much slower. sometimes much Faster). To induce the elderly mother-adult daughter system to find the direction and pace of its solutions, the therapists accepted each family member's perception of the problem (as hi~hlightedin the split-opinion intervention) and also offered an alternate view, or "reality," of the problem, The aim of this systemic perturhation is to enhance the autonomy of the system. The challenge for the therapist is not to become "married" to the alternate reality that is presented to the family or lo think it more correct than the view a fslmiIy holds. I t is, at best. a more useful view, in the sense that the new reality frees up the problem-solving ability of the svstem. There are more realities than there are families. and these realities only need to be modified when they inhihit individua! or family development. An important difference between this model and other family therapy nlodels is that the systemic approach utilizes a nonnormative model of h~mily functioning while recognizing that there clearly exist various developmental

transitions and stages. ( I t is intriguing to us that an unders~nndingui a normative model enhances the learning of a nonnormafive rnodcll. However, systemic therapists work ayalnst the impulse to direc~Families as tn how they shaulrl function or develop. The use of the splir-opinion intervention in the case exampte is an cxceilenr iIluaration oi how to intervene not only with the family hut also with the therapeutic team, to prevenl the lazter from pushing the family to chanpe in a particular direction and/or at a particular pace. 1 C FamiIics are influenced in a particular direction, that will, in t urn, clirect Family development and/or fami!? Functioning. THE PROCESS OF CHANGE

Ti? facilitate chanee in a fnmilv system is he most challenging and exciting aspect of family therapy. The process of change is a fascinating phennmenon, and v;tric>us ideas exisr ahout how and what constiiutes c h a n ~ ein Family systems. Liddle (1C)H2\ has suggerted that one of the basic issues ol all of 11s who engage in family therapy i s the interviewer's theory of chnn$e, "thal is what mechanisms permit or force change to occur'! Even more basic. what is the nature of chanye itself accorcling to one's own model." ip. 2481. We concur with Bateson's ( 1979) nvtion that systcms of rela~ionships appear to possess a tendency toward progressive change. However. these is n French proverb thnt states, "The more something chanyes. the more i t remains rhe same." T h i s highlights the cyuandary rreguently Paced in working with families. Systemic therapists must !earn to ilccep! the challenge posed hy the relationship hetween persistence (srahility) and change. Watzlawick. Weakland. and Fisch (1974) supyest that persistence ancl chanye need to he considered to,qeiher- despite thcir opposing natures. They have offered a notion of chinnee rhat is accepted by most systemic therapists, which i s that there are two different types. or levels of change. One type they refer to is first-orrler change, or change that occurs ~viilrirra given system. that is, in the elements or parts of the system. without changing the system itself. I t is n change in quantity, not quality, First-order change involves using the same problem-solvins strategies over and over again. ll it soltttic3n to a problem is difficult to find, more old strategies are used. and they are zlsually ;tpplied more zealously. Second-order change is change that alters rhc systcrn itself. This type of change is thus a "change of change." (Jr appears thnt the French proverb is applicable only to first-order chanee.) In seconrl-order change. there arc actual changes in the rules governing the system. ant1 therefnre the system is transformed structurally and/or communicationally. Scconcl-order chnnyc always involves a cliscontinuity and tends to he sudden and radical: it represents a quantum leap in the system to a different level of functioning. Systemic therapy focuses on facilitating seconit-order change. Our case

example beautifully exempliiied changes r hat were dramatic and rapid. A change occurred in the sysrern itself. in adclition to u change in the presenting problem. I n summary, we concur with Bateson (1979) that change is constantly evoIving in f:~rniliesand that frequently we are unaware or change. This is the type of con(inuous or spontaneous change that occurs with everyday living and with progression through indivic-lual and family stages of development. These changes mav or may not occur with prtofessional input. We also believe that major transformations of an entire family system can he precipitated by niajor life events and Jor interventions ly family therapists. We view change as ;I systems/cyhernetic phenomenon; that is, change within a family may occur within the cognitive. affective. or hehnvioral domains, hut changc in any one domain will have an impact on [he other domains. However, we believe that the most profound and sustain in^ change will he that which occurs within the f~trnily'sbelief system (cognition I.

There are certain concepts regarding chanye we have found particularlv useful in our systemic clinical work with Families. We will discuss the two most salient concepts here, First. (lie abiliry to alter one's perception (>Ia probIem enhances the ahilirv for change (Wright 8 Leahey. 1984). It is essential that both family members artd family rherapists alter their perceptions of a problem. If a therapist agrees with the way a family views a problem. then nothing new wilt he offered. How we. as therapists, perceive and conceptualize a particular problem determines how we will intervene. When a thempist conceptualizes developmenla1 problems from a sysrems/ cybernetic perspective. his or her perceptions will be based on a completely different conception of "reality" as a result of these theoretical assumptions. Our clinical practice with familie5 who present at the FNU with developmental problem7 is based on a svsternic-cy tlernetio-communicational theoretical foundation. Interventions are hased primaritv on the systemic model ISelviniPaIa~.zoIiei d., 1980; Tomm. IC)X4a. 1484b: ). These are some of our efforts lo think systemically. R u t what of hmilies? Individual family members construct [heir own realities of a situation haqed on personal beliefs and assump~ions. Families and familv members need assistance in moving from a linear perspective of the prohleni to a circular one. This is possible only if the therapist doesn't become cau3ht in linear thinking when attempting to understand family Jvnamics. We have found that one way to twoid becoming linear in conceptualizing developmental problems is to t~voidrhinking that the view? of a partict~lar Family mem her or OF all family mcmhers are "right" or correct.'' The challenging position of the therapist is to offer an allernate perception. reality, 01.

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epistemology that will free the family to develop its own solutions to problems. This alternate reality i s usually redefined as an interpersonal or relationship problem. The second salient concept is that change does not occur as a result of therapeutic elaboration of a family's understanding of developmental problems. In our clinical experience. we have rarely found that changes or improvements regarding developmental issues occur by embellishing a family's view of the problem. Rather, we have observed that the solutions to problems change as the family's beliefs and interactional patterns change. whether or not this is accompanied by further insight. Systemic therapy avoids the search for lineal causes and seeks, instead, te provide systemic explanations of problems and impasses.

ROADBLOCKS TO FAMILY DEVELOPMENTAL C H M G E

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Family therapists. regard jess of theoretical orientation, have noticed that many Families have not progressed smoothly or automatically from one life cycle stage to another. Their clinical Interventions focus on the stressful transition points between stages. Certainly. in our own clinical work, we have sometimes succumbed to the temptation to focus on particular transition points that have become problematic. The potential trap is far systemic therapists to become too purposive, that is. to hecome too invested in a particular outcome and to then direct the family to function or he restructured in a particular way. Systemic therapists try not to "get in the way" of family development by not being direct!^^ directive. Thus the notion that families must progress smoothly through the Eamity life cycle stages must he confronted. Smooth progression. in our estimation, is not characteristic of a developing family. However. there are occasions when families have "derailments from the family life cycle" (Caster & McCsldrick. 11380*p. 9). This notion of derailments is useful, because it conjures up a much more optimistic view of family life cycle difficulties. One of the most common derailments that we encounter in our practice is the derailment by illness. The impact on the family of a chronic or Fife-threatening illness does not automaticaIly result in a derailment, but it almost always interferes with roles, rules. and rituals. From a systemic perspective, a derailment also frequently occurs when family members are attempting to obtain meaning and clarification in a relationship. The greater the ambiguity regarding relationships, particularly at various developmental junctures throughout the family life cycle. the greater the chance for family and individual symptoms. In the earlier case example, both illness and an attempt to obtain clarification and meaning in the elderly mother-adult daughter relationship had manifested in a family life cycle derailment. A former family life cycle derailment. or nonnegotiation. and an attempt to obtain clarification and new meaning in the elderly mother-adult daughter relationship was associated with the presentation of angina in the mother.

S)rrem!c Fnrni!~!Thempj, arzd Fatnilv

De~alopmenr

427

With any derailment, it should not necessarily be the therapist's goal to have the family return to the original "track." Rather. it behooves the lherapist to create a context for change for the family. t o allow them to decide which track will provide the greatest opportunity for reduced stress and increased growth.

INTERVENTIONS THAT CREATE A CONTEXT FOR DEVELOPMENTAL CHRhrGE There are numerous interventions that can be utilized to facilitate or create a context for change. However, we will discuss only sirstemic interventions that create a context for dervlopmental change. O(ferin,y Alternnte Realities

Systemic family therapists frequently offer beliefs, opinions. or conceptions about problems without regarding them as interventions. However, when strategically thought out and planned, these various types of opinions serve as potent and useful interventions. offeringan alternate reality to those experiencing particular p~.oblems. 1. In,for.mntion and advice. Families find advice and information about developmental problems valuable and beneficial. Frequently. information about developmental issues le.g., elderly parents' needs for "spatial but not social isolation" and for "autonomy with contact"; Banziger, 1979) can liberate a family so that the members are then able to resolve their own problems. 2. S~~sremic opinion (refrarnin~)~ Presenting symptoms may serve a positive function for a family. A systemic opinion is offered by conceptualizing the presenting symptom as a solution to some other hypothetical or implied problem that would or could occur should the symptom not be present (Tomm, 1984b). In the case example, the intense intel-generational conflict was positively connoted as a distance regulator in an overly close parent-child relationship. The symptomatic behavior is systemically reframed by connecting it to other behaviors in the system. The connections are based on the information derived in the assessment through the process of circular questioning. It is essential. when offering a systemic opinion to a famiEy, that the recursiveness of the symptom be delineated: The symptom serves a positive function for the system while at the same time the system serves a function by contributing and maintaining the symptom (Wright & Leahey. 1987). 3. Redefinition of fire conre-rr of therap? A powerful opinion can be given by redefining the context in which family therapy is provided. If a family objects to attending sessions for what they have defined as Family therapy, then, based on the assessment, the familv coubd be told that family therapy sessions will be discontinued and that developmental sessions will hegin (Wright & Watson, 19821. It is not that the nature of t h e work between the

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Farnil~?Life Qck~ in Fornily Tltlrerapy ntid Clinical Troininx

therapist and family changes hut rather that the context, or "name," of the work is made more palatable. With the family described in the case example. the nature OF our work was named research rather than therapy. 4. Comrnendation,forfami!v and individual .rtren~ths.Following a recent analysis, by three observers, of 28 sessions we conducted with Tour families in a hypertension prqiect, one of the common themes identified was our routine praclice of commending families on particular strengths at the end of interviews. Feedback from both research observers and families has made us cognizant that chis practice involves more than just being courteous-it represents a significant intervention that can alter family members' realities of themselves. 5. Split ofittion. We have found the split-opinion to be a most powerful systemic intervention. Normally, a split opinion offers the family two or more different and opposing views. Each point of view is equally valued and the family is left ro struggle with the various views or reality. The splitspinion intervention in the case example was the single most powerful intervention delivered to the family. It enabled each woman to have her view of reality strongly supported while at the same time providing each with the opportunity to entertain a totally new epistemology with regard to the presenting problem. This intervention created a context for change that had previously been impossible hecause of the extreme rigidity of each family member's beliefs.

In designing and prescribing a ritual, a therapist requires that a family engage in behaviors that have not been part of their usual patterns of interaction. The existence of contusion is normally an indicator for the use of the ritual intervention. The confusion is due to the simultaneous presentation of incompatible injunctions within the family. Rituals introduce more clarity into the family system. In systemic work. the actual execution of the ritual is not as important as the feedback about what new connections the lamil? has made and. consequently. what new beliefs or realities the family now entertains. In the case example, two rituals were prescribed. The "meeting of the hearts" involved ritualizing a talking-listening session for the mother and daughter. who. for 2 years, had not spoken to each other. The "burial of the hurts so the hearts could heal" provided a forum for further purging. The mother and daughter did not execute this second ritual. The mother had stated to her daughter that there were no more bad feeIings for her. In fact, she could not imagine any more 'bad feetings! Selvini-Palazzoli (1986) indicated that some families respond just to the idea of doing something unusual. Thus the enactment of the prescribed ritual may not be essential to induce a change in the family system. Useful information to the family and the therapist may he provided through just the descriprion/prescriprion of a rituaI.

CONCLUSION Traditional life cycle theorists and therapists imply with their clearly demarcated stages, tasks, and attachments, "WE know how your family should function.'' Systemic therapists use life cycle information to generate ( I ) working hypotheses about the connection between the symptom and the system and (2) questions to perturl~the family system, so that the family can answer i t s own question. "What is the most useful way for our family to function at this time'?"

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