CH 11 Systemic Therapies/Family & Couples Therapies
• Individuals can only be understood within their social context
• Inspired by General Systems Theory (GST) & Cybernetics,
o GST advocated studying the biological processes that lead to increasing complexity of
organization of whole organisms
o Cybernetics advocated studying the methods of communication and control common to living
organisms and machines, especially computer systems.
• In this chapter, we will first look at how systems are understood from these two perspectives and then
see how this understanding has been applied to the treatment of troubled individuals, couples, and
• A family system, comprises not only, say, four individuals but also the interrelationships among those
four individuals and the entire context and rules of the family
• The concept of wholeness A marital system, cannot be broken down simply into two separate
individuals. Not only are there two individual subsystems, but there is also a consistent relationship
between the individuals that creates a marital subsystem
• Boundaries In incestuous families, the boundaries between the parental subsystem and the child
subsystem are unclear and permeable to the point of pathological.
o Boundaries can also be too rigid, preventing adequate interactions among individuals in a
system or between systems. Families with child abuse, may be rigidly bound off from the larger
social system and be unable to accept social support that could help prevent such abuse
• Hierarchical organization A family system comprises individual subsystems, a partner/marital
subsystem, a sibling subsystem, and a parental subsystem.
o The family system → a larger neighborhood system, → the community, the region, and the
• Systems theory actually emphasizes controlled change, which allows the development of highly
complex interactional patterns that increase rather than decrease options for the system.
• Homeostasis, or balance, explains how living systems control or maintain a steady state.
o Family systems possess their own set of mechanisms whose primary purpose is maintenance of
an acceptable behavioral balance within the family. Families have been found, for example, to
maintain surprisingly stable rates of speech interaction
• The mechanisms that contribute to selfregulatory processes within a couple or family are analogous to
servomechanisms in cybernetics
1 • Servomechanisms are automatic devices used to correct the performance of a mechanism by means of
errorsensing feedback. Feedback loops are seen as the most control mechanisms. Instead of two events
being related only in a linear, causeandeffect fashion, two events can be related in a circular manner,
characterized as either a positive or negative feedback loop
o Positive feedback loop
Violent arguments in families, for example, can get out of control as anger in one
partner increases anger in the other, which in turn increases anger in a circular manner.
Runaway rage can disrupt or even destroy a family’s ability to function
o Negative loop
If one family member becomes angry, another may become sick. If the two deviations
balance each other, the family can maintain a stable level of hostility in the system.
• Living systems are characterized as open systems, which means that energy can be freely transported
into, within, and out of the system
o Communication involves the process by which information is either changed from one state to
another, or moved from one point to another in space
• 3 meanings of Systemic Therapies
o First, systemic, or systems, therapy can refer to a therapy modality or format. Like individual
therapy or group therapy, systems therapy denotes meeting with a certain number of people, in
this case, a couple or family.
o Second, systemic therapy can refer to treatment content or goal. The treatment deals with
family systems content and works toward improving the family system. An individual is not the
patient; the couple, the family, or another system is the patient
o Third, systems thinking and systemic therapy can refer to a paradigm shift. It represents a
discontinuous break with past ideas of linear and intrapsychic causality
Theory of psychopathology
• Psychopathology is fundamentally an interactional process among family members, rather than an
intrapersonal problem within one member. Psychopathology serves as a homeostatic mechanism to
help families maintain an internal balance for family functioning.
o When a family is threatened, it can move toward balance through puzzling, psychotic, or other
pathological behaviors. A family’s status quo may be one in which the parents fight infrequently.
o When they do fight, if violence threatens to run out of control, a child can communicate concern
by becoming symptomatic. → serve as a negative feedback loop → a halt in hostilities → the
2 family develops a newfound concern with the identified (or index) patient (IP). But the entire
system should be the patient, not merely the individual who has developed symptoms to save the
• If the rules become ambiguous, the system becomes disorganized, and symptoms are likely to
develop to restore order to the family. If the rules are clear, such as the rule that family members will
not relate violently, then an argument between parents need not threaten the family’s functioning, and a
child will not have to develop symptoms to control a threat of violence
• When communication patterns in families are unclear, then rules become more ambiguous and
psychopathology is likely to develop. Double bind communications are among the most troublesome
patterns of communicating because they involve two incompatible messages
• 5 axioms of communication
o It is impossible not to communicate
Even silence is ambiguous communication
o Communication implies commitment & defines relationships
if the content and the command are congruous, then the relationship is defined as
o Relationships are contingent on how a communication is punctuated or ended
If a communication response cannot end until the same person always has the last word,
then such punctuation defines the person with the last word = exerting greater power in
o Communication is both verbal & nonverbal
The more families rely on nonverbal messages, the more ambiguous their relationships
are likely to be and the more problems are likely to arise.
o Communications can be symmetrical (either side leads) or complementary (one side leads)
Psychopathology can occur in either type of relationship.
• The emphasis in communication therapy is not on the content of the communication, but rather on the
relationshipdefining aspects of communication
• Homeostatic mechanisms in families make family systems resistant to change. If therapists are to be
effective in changing the family’s ingrained rules for communicating and relating, then they will need to
intervene with a definite strategy (and thus are also known as strategic therapists) powerful enough to
disrupt the family’s rigid resistance
• Help individuals & systems to communicate clearly & constructively
3 • Changing communication changes relationships & power dynamics
• Develop atmosphere conducive to congruent communication
• Empathy & positive regard important
• Therapist is in charge & in control
• Therapist uses direct & indirect techniques to control relationship
• 1‐ to 1 ½ hour sessions
• Better if whole family present but can work with the couple subsystem
• Video: behavior of beating > she's a bad person; therapist helps family in a nonhostile way; Nonverbal
• Family therapists in general, and communication/strategic therapists in particular, are at the forefront of
videotaping, direct observation, and supervision through a oneway mirror
• Strategic and communication therapies remain highly compatible with the contemporary emphasis on
• Developed by Salvador Minuchin
• Created to treat delinquents as systemic issue rather than individual problem
• Initial focus on delinquency & anorexia nervosa
Theory of Psychopathology
• More concerned with what maintains psychopathology than with its causes → we should be
concentrating on pathological family structures rather than searching for pathological intrapsychic
• Pathological family systems can best be understood in contrast with healthy family systems
o An organized family will maintain clearly marked boundaries. The marital subsystem will have
closed boundaries to protect the privacy of the spouses. The parental subsystem will have clear
boundaries between it and the children, but not so impenetrable as to limit the access necessary
for good parenting.
o The sibling subsystem will have its own boundaries and will be organized hierarchically, so that
children are given responsibilities and privileges consistent with age as determined by the
4 family’s culture. Each family member is also an individual subsystem with a boundary that
needs to be respected.
o Finally, the boundary around the nuclear family will also be respected, although the extent to
which kin are allowed in varies greatly with cultural, social, and economic factors
o The development of skills for negotiating among siblings requires noninterference from parents.
Clear boundaries or rules help maintain freedom from outside interference
2 types of pathological family structures
Disengaged family Enmeshed family;
excessively rigid boundaries; its boundaries are diffuse.
there is little or no contact between family members. The distinguishing quality of enmeshed families is a
“tight interlocking” of its members: attempts on the
relative absence of healthy structure, order, or
part of one member to change elicit immediate
authority. Ties between family members are weak or
complementary resistance on the part of others
Enmeshment is essentially a weakening of
The overall impression of a disengaged family is
boundaries among family subsystems.
distance and disconnect.
Because the boundary between nuclear family and
families of origin is not well maintained, inlaw
The mother in this group tends to be passive and problems are likely to develop. The boundary
immobile. separating the parents from their children is crossed
frequently in improper ways, such as incest.
The roles of spouse and parent are insufficiently
She feels overwhelmed, has a derogatory selfimage,
differentiated, so that neither the spouse, subsystem
experiences herself as exploited, and almost always
develops psychosomatic and depressive nor the parental subsystem can operate.
symptomatology. Individual boundaries are not respected, so that
individual subsystems are not able to develop
adequate autonomy and identity.
The children in such families are at risk of developing
eg. An anorexic adolescent may assert autonomy only
by saying no to the family’s demands to eat.
• Dysfunctional families respond to demands for change in pathological ways, as when the mother in a
disengaged family becomes more depressed or a child acts out. Usually one family member develops
symptoms and becomes the identified patient.
5 Therapeutic Processes
• Because symptoms are manifested and maintained in family structures unable to adapt, the goal of
therapy is to restructure families to free the members to grow and relate. Because the family
structure reflects the rules for interacting, changing a family’s structure involves changing its rules
for relating. This typically entails changing the system’s boundaries from rigid or diffuse to normal,