Evolution of Systems Approaches in Counseling and Psychotherapy

Theoretical Models of Counseling and Psychotherapy, 4th Edition Chapter 13: Systems Approaches Mario De La Garza, Ph.D. Southern Methodist University

Main focus in mental health had been on the individual. Systemic approach arose due to public s need and demand for more socially holistic approaches to child guidance, marriage counseling, and the treatment of schizophrenia. Psychoanalytic community opposed this trend.

1920s: Abraham and Hannah Stone established marriage and family counseling center in New York. 1930s: Paul Papanoe and Emily Mudd begin treating couples together and conceptualizing problems as mutual rather than individual. 1945: American Association of Marriage Counselors established (precursor to AAMFT).

1950s: Researchers at the Mental Research Institute in Palo Alto, CA, found evidence of a causal relationship between parental behavior and schizophrenia. Not all pathology was rooted in the individual. Family communication and behavior could possibly cause pathology. Working with the family dynamics rather than one member s intrapsychic dynamics would produce change.

Systems theorists have drawn from: Cybernetics Anthropology Biology Systems theory is an umbrella term that includes numerous unique theories addressing mental health from a shared perspective.

Systems are organized wholes, and elements within a system are interdependent. Patterns in a system are circular, not linear. A A B B

Family of origin Family of creation Many forms Monogamous Polygamous Nuclear Extended

Family systems have purpose: to facilitate the greatest overall survival, health, and development of system members. May sacrifice one member for the good of the system (geriatricide, infanticide, scapegoating)

Family systems maintain dynamic equilibrium. Morphogenesis Morphostasis Perturbations Corrective strategies Negative feedback Positive feedback First order change Second order change

Universal Community Extended family Nuclear family Individual

Spousal subsystem Family system Gender subsystem Parental subsystem Sibling subsystem

Family is system of focus, so its influence and importance is primary. Extrafamilial environment influences individuals in family systems; this influence may contribute to or perturb family equilibrium.

Clear subsystem boundaries and clear family roles Clear family rules with consistent and fair enforcement Respect for individual autonomy coexisting with respect for family Clear and direct communication

System boundaries either too rigid or too diffuse Rules and enforcement either too rigid or very inconsistent Roles and expectations of members either too rigid or not clearly defined Individual identity not encouraged or even recognized Communication unclear, indirect, abusive, and/or coercive

Family must view problem as systemic issue; may call for redefinition of problem. Family must change how it addresses change, because dynamic equilibrium is not being restored effectively. First order change: clarifying and following system s existing rules Second order change: creating and implementing new rules

Change occurs by taking systemic relationships into account. Change occurs by addressing faulty interaction patterns. Change in system will produce change in individuals. Change is more likely with entire system in therapy. Change is dependent upon permeability of boundaries. Changing unhealthy family interactive patterns will affect dysfunctional symptoms.

View the problem as systemic rather than individual. Express resistance to give more information to the counselor.

Become part of the system. Disturb (perturb) the balance of the system. Provide new information to the system.

Initial contact Brief overview of problem Get entire family to come to therapy First interview Build rapport with system Gather information about family dynamics (genograms and family maps)

Early phase Perturbation of system for change to occur Middle phase Encouraging new interaction patterns and testing out new ways of being Therapist becomes less directive Termination Family decides further change is not necessary New sense of equilibrium has been reached

Reframing Sculpting Prescriptions Paradoxical Countersystemic Restructuring

Nature/Nurture Genetics and environment influence the individual and the system. DSM 5 Diagnosis DSM is individually based. Interactional diagnoses are supported but not well integrated into current manual Pharmacotherapy Use psychoactive medication in conjunction with therapy; medication is not a cure-all.

Managed Care and Brief Therapy Systems approaches are time-limited and focus on problem solving. Technical Eclecticism Systems perspective unifies all systems theories; techniques from different approaches can be used.

Effectiveness of psychotherapy Greater efficacy of systems therapy (when compared to no treatment or individual treatment) has been found. No definitive positive impact of one particular systems approach over the others

Culture Culture is embedded into the systemic balance Actively explore interconnected and disconnected elements of the interaction between counselor and systemic cultures Role of Culture Broker

Gender and LGBTQ Issues Conceptualization of gender has greatly evolved from the 1950s and systems theorists have been in the forefront of grappling with the complexity of role identities within couples and families and the broader issue of gender fluidity Acceptance or rejection from one s identified family has significant implications for LBGTQ individuals mental health

Gender and LGBTQ Issues (cont) The seven competencies and the Empowerment descriptions (Knudson-Martin et al., 2015, p. 220) Identify Enactments of Social Discourse Attune to Underlying Sociocultural Emotion Identify Relational Power Dynamics Facilitate Relational Safety Create a Relationship Model Based on Equality Facilitate Shared Relationship Responsibility

Spirituality Seen to play a significant role in the family system

Limitations Does mutual causality blame victims? Using the word marriage instead of relationship Contributions Acknowledging the system as the place of intervention rather than the individual

Fall, K. A., Holden, J. M., & Marquis, A. (2023). Theoretical models of counseling and psychotherapy (4th ed.). Routledge.