The Concept of Team in Systemic Family Therapy - Essay Example

The Concept of "Team" in Systemic Family Therapy Introduction Systemic family therapy is a school of psychology, which instead of addressing and dealing with an individual's problems, studies the individual's family members as a whole in terms of their relationships, interactions and dynamics. The earlier forms of systemic therapy were based on cybernetics. Systemic therapy, being based on the relationships and behaviors of the family as a whole, addresses issues more practically than analytically. The systemic view "looks for connections and reciprocal influences among systems of ideas, people and events" (Watson n.d., p.379). Within the systems approach, there are three different ways problems are approached, namely, the strategic approach, the structural approach and the systemic approach. The strategic family therapist addresses problems in light of uncertain and inconsistent hierarchies within the family system (Watson n.d., p.381). He/she elicits "power and control issues, and directs change by means of family assignments or paradoxical injunctions" (Haley 1976, Madanes 1981, cited in Watson n.d., p.381). A structural family therapist looks into family structure, subsystems, and boundaries with an ideal family structure in mind and tries to reorganize the boundaries of families. The systemic approach has its origin in the work of the Milan therapy team inspired by Mara Selvini Palazzoli along with L.Boscolo, G. Cecchin and G. Prata (Wright & Watson 1991, p.407). Systemic therapy involves conceptualization of family problems from a systemic perspective, which plays an important role in the treatment process. Systemic family therapy Systemic therapists offer information and advice that liberate the family and enable them to solve their own problems. 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, cited in Wright & Watson 1991, p.427). This is called reframing. The therapists redefine the context of the therapy in case the family resists therapy sessions; for example, a therapist may redefine a therapy session as a developmental session. The therapists identify and commend the strengths of the families. They offer different and contradicting views of reality, referred to as split opinions, which enable the family to be more open to change (Wright & Watson 1991, p.428). Therapists require the family to follow a pattern of behavior that is different from what it is used to. This is referred to as a ritual. Rituals help families to make new connections which in turn help them find new realities, leading to change and resolution of issues. The reflecting team In systemic family therapy, a reflecting team consisting of consultants or co-therapists from different fields helps the family in finding its own solution. The family is invited to sit behind a one-way mirror and observe the team's discussion on a previously held conversation between the family and the therapist. The team's voicing out aloud about the family's problems and possible solutions directs the family to consider alternate views of the family situation, problems and possible solutions. Andersen has suggested several assumptions and working guidelines for the reflecting team (cited in Jenkins 1996, p.1). A reflecting team follows the assumption that information needs to shared and not withheld, and based on this, the team can share its thoughts with the family during discussions. When there are multiple ideas discussed, there are different perceptions of reality, and the family's perception of its situation is also enriched on hearing these differences. Consequently, the family gets an opportunity to view its problems and possible solutions from alternate perspectives. These enriched pictures of the family and its dilemma form "an ecology of ideas" (Bogdan, cited in Jenkins 1996, p.1). Listening to the multitude of ideas and opinions of the reflecting team members helps the clients understand that doubt, ambiguity and differences in opinion can exist between members on the team on a single issue and that there is no single correct solution to a particular issue. This, however, helps the clients look at their own situation from different perspectives. If the new ideas are neither too familiar nor too strange to the clients, the new ideas can make a difference to them, resulting in a change (Lax; Mittelmeier & Friedman; cited in Jenkins 1996, p.1). According to Gottlieb and Gottlieb, reflection is an open dialogue of the therapists' reactions to the client system (cited in Jenkins 1996, p.2). The Milan school of thought The Milan school of thought, inspired by Mara Selvini Palazzoli along with L.Boscolo, G. Cecchin and G. Prata, involves the three guidelines - hypothesizing, circularity and neutrality - which allow a therapeutic conversation which helps the family find their solutions themselves to their own problems. The therapist involves a reflecting team, consisting of co-therapists from different fields, to participate in the therapeutic session and help direct the family in finding its own solution. The family is invited to sit behind a one-way mirror and watch and listen to the team's discussion on a previously held conversation between the family and the therapist. After the discussion of the reflecting team, the therapist invites the family's responses to the team's ideas while the team resumes its position behind the mirror. The team's open discussions about the family's problems and possible solutions direct the family to consider alternate views of the family situation, problems and possible solutions. A family has its own hypothesis regarding its problem. However, a therapist generates his/her own hypotheses regarding the possible connections between the system and the problem. The six basic questions - who, what, why, where, when and how - can help a therapist generate hypotheses about the relations between the system and the problem (Watson n.d., p.382). The question "who" can include questions like "who is in the system," "who is concerned about the problem," "who is affected by the problem," etc. The question "what" can include questions like "what is the problem," "what solutions have been attempted," etc. The question "why" can deal with the possible causes of the problem. The question "where" deals with the origin and prognosis of the problem. "When" refers to the time of occurrence of the problem and the time it does not occur, both in relation and otherwise to other phenomena of the system. "How" refers to how the problem affects other parts of the system and how the therapy can influence the finding of solution, etc. Circularity refers to a cycle of questions between the family and the therapist. The therapist asks questions based on the information provided by the system in response to questions asked earlier. Often, these questions themselves lead the system to finding their own solutions. "Circular questions invite family members to explore differences and make new connections between ideas, events, and behaviors" (Watson n.d., p.381). The questions may be investigative, corrective, exploratory or facilitative. Michael White and Lorraine Wright are two other therapists who have also influenced the style of using therapeutic conversations. White's approach included asking questions that distinguished problem from the person, like "What percent of time are you able to influence your anger" and "What percentage of time does your anger influence you" (Watson n.d., p.383). This helps the therapist objectify the problem rather than the person. Wright's approach involves inviting the family members to ask questions of the therapist. For example, the therapist would ask the family, what would their question be if they are allowed to ask just one question. Such questions help in focusing the therapeutic process, in revealing hidden fears and prompting the family to think. Neutrality is maintained when the family feels that the therapist is equally interested in what each member has to say and when it feels that he/she is unbiased and unprejudiced. Curiosity is the key to neutrality, as the curiosity of a therapist leads to more hypotheses which again generate more curiosity. Neutrality involves "a therapeutic posture of being nonjudgmental, nonblaming, and noninvested in any particular outcome or solution that the family may choose" (Watson n.d., p.384). The role of the therapist being vital in this form of therapy, the views and opinions influence a great deal the direction of the questions and responses between the therapist and the family. During the therapeutic discussions, if the therapist's resonance with the family suggests that the family is "at risk of illness, suicide, violence or abuse, the therapist's role may change to one of advocate, social controller, or doctor" (Harari 1996, p.66). To enable this, the therapist has to be watchful of his/her changing relationship with family in the professional, social or political setting that the therapy takes place. The observing team helps in monitoring this which may lead to new hypotheses. The advantage of the above system is that it helps the family view its own context of problems objectively and find its own solutions. However, conversations do not evolve naturally as there are techniques used by the therapists in directing the conversations. The extended model of Cecchin and Boscolo Cecchin and Boscolo of the Milan school later on introduced a variation for their team supervision model (Roberts 2003, p.336). They divided the team behind the mirror into the treatment team (T team) and the observing team (O team). The T team worked with the family and the O team watched the T team do their pre-sessions, phone-ins, intersession discussions, final interventions and post-session. After the therapy session, the O team made its comments on what it had observed. The observations focused on the therapeutic work of the group rather than its dynamics. White and Epston's narrative therapy Narrative approach in family therapy focuses on the importance of clients narrating their own story in their own way in their own time. Michael White, David Epston, Jeffrey Zimmerman, Victoria Dickerson, Michael Durrant and Kate Kawalski are some of the people associated with this model. White's therapy involves deconstructing types of questions whereby "clients are able to externalize problems from their self-identity narratives, deobjectify themselves, and reauthor new ways of being" (Gale & Long 1996, p.11). Narrative therapy helps individuals rewrite descriptions of their lives. For keeping the families empowered, White and Epston have jointly written case notes with them, used them as consultants, and had them "comment on the therapist's process on other cases by using a reflecting team" (Wetchler 1996, p.134). The psychoanalyst Theodore Reik's reference to "listening with the third ear" suggests that listening, instead of being just polite attention, is an active process. The family therapist uses this process in the narrative therapy where the family is encouraged to narrate their experiences, the empathic understanding of which "is part of the essence of therapy" (Andersen & Goolishian, cited in Harari 1996, p.66). Through such understanding, the therapist encourages the family to narrate other stories, consequent to which the family is persuaded to consider alternative outcomes and consequences if such outcomes were to occur in the past or the future. The reflecting team, after closely observing and listening to the family, discusses the family's situation, problems and solutions along with their risks and advantages, keeping in mind, with respect and empathy, the limitations, concerns and competencies of the family. The narrative approach encourages subjective and open disclosures which in turn can help the therapist positively and effectively run the conversations and facilitate the team in making relevant and helpful reflections. The linguistic system of Galveston The Galveston system is an approach developed by Harlene Anderson and Harold Goolishian of the Galveston Family Institute that has its main focus on language and meaning. According to the Galveston system, a problem becomes a problem only when people define it to be so, which means, just as a problem is defined into existence, it can be defined out of existence (Minuchin, Lee & Simon 2006, p.56). The goal of the therapy is to keep the family who has defined the problem in a well-run conversation where meaning constantly evolve and change, which will lead the family to eventually defining the problem out of existence. Resolution of the problem becomes impossible only when the people participating in the conversation become committed to and invested in justifying their own meanings. Hence the goal of the therapy is to make sure that the conversation is well run, for which the therapist acts as a participant manager. The therapist gives equal importance to all points expressed in the conversation and takes time to understand, asking questions and encouraging participants to elaborate on their points of view. This leads to exchange of more questions and answers. More than techniques, the therapeutic conversations under the Galveston system make use of attitudes, mainly the attitude of "not knowing," which helps the therapist to consider all ideas with equal importance and to prompt further elaboration by the participants. The attitude of not knowing renders the therapist "a respectful listener who does not understand too quickly (if ever)" (Anderson & Goolishian, cited in Minuchin, Lee & Simon 2006, p.57). The reflective team gives a free-form expression about what its members have comprehended from the conversation between the therapist and the family. The use of conversation and the team is devoid of a formal structure or technique. The therapeutic conversation, according to this group, is just an ordinary conversation. This school of thought emphasizes the role of empathy in the healing process. The "not knowing" attitude of the Galveston system helps the smooth flow of conversation. However, the absence of structure and techniques could cause the conversations to move haphazardly. The team concept of the Tromso group A post-Milan concept of the 'reflecting team' has been experimented and developed by the Tromso group - Tom Andersen, Magnus Hald, Anna Margareta Flam and others - in Norway (Hoffman n.d., p.48). According to this concept, the team comments spontaneously while the family watches from behind the mirror. The family then expresses its comments on the comments of the team. Unlike strategic and Milan teams, this concept did not pathologize families and the team members discussed their hypotheses in front of the family, which made the therapy more transparent and less hierarchical (Wetchler 1996, p.135). The therapeutic process involves the interviewing therapist engaging in a conversation with the family while the rest of the team observed from behind the mirror. At a certain point, the therapist and the family watch the team members discussing among themselves their observations on the conversation just observed between the therapist and the family. This again was followed by the family's interpretations on the team's thoughts on their conversation. According to Andersen, there are two types of conversations - external and internal (cited in Wetchler 1996, p.136). The external conversation is that which an individual has with others where they share their ideas as they talk. The internal conversation is that which the individual has with himself/herself while listening to others. Both the external and the internal conversations are encouraged when the family interacts with the therapist and listens to the reflecting team. According to Andersen, questions that are moderately unusual from the family's perspective prompt internal and external conversation. Questions that are too close to their perspectives provoke little conversation while those that are too different inhibit conversation. This system of the Tromso group is very effective in activating the family's thought process to look at their own problems from different perspectives and finding its own solutions to problems and issues. Constructivism According to Hoffman, a general style of systemic therapy has evolved that is influenced by a constructivist approach, according to which, there is no belief in reality, and problems exist only in the realm of meanings (n.d., p.50). Focus is not just in personal ideas but also in collective ideas. The approach does not look at the family system as the unit of treatment, but "sees a group of people who are having a conversation about a problem" (Hoffman n.d., p.51). Every individual's private reality is taken into consideration and understood. Neutrality is maintained throughout the process. There is a lack of hierarchy, and the family not only observes the deliberations of the experts, but also is given the last word in problem solution. There is less focus on power and control, and the family is considered to be always right, while the therapist has to find the logic behind the family's actions. There is a difference in the perspective of every participant in the therapeutic process. The team behind the screen sees differently from the interviewing therapist, both see differently from the family, and each family member and each team member sees differently from the other. This approach does not expect to bring about intentional change, but hopes to join with the family in creating a context in which change may happen unawares. The marital co-therapist team Charles Gottlieb and Diane Gottlieb, as wife and husband, and as marital co-therapists, adhering to systemic, constructivist framework, have studied marital co-therapy teamwork, and demonstrated how a marital co-therapist team is able to view family issues and interactions from a different perspective (Gottlieb & Gottlieb p.68). Marital and family dynamics are co-created human dramas where the realities are inventions of the minds of the participants. Gottlieb and Gottlieb have focused on their own evolving system in interaction with the client couple system. This system facilitates an objective observation of the dynamics of the couple and the therapeutic process by following neutrality in the conversations. Gottlieb & Gottlieb (1996, p.119), in the initial days of developing this system, did not view themselves as part of the situation and focused on trying to change the couple's perspectives by reframing problematic circumstances. Since initially developing it, Gottlieb and Gottlieb have evolved, expanded and altered the model of their system. They realized that co-therapists co-created with couples realities that redefined situations through conversations (Gottlieb & Gottlieb 1996, p.119). They emphasized the importance of maintaining the attitude of "not knowing" in order to elicit more information from the couple. They viewed themselves as collaborators with the couple, who observed the dynamics of the couple, studied their stories and discovered the inherent strength of the couple. Gottlieb & Gottlieb used a conversational model which they referred to as the consultative conversation (1996, p.121). The collaborative positioning of the couple and co-therapists made the model less hierarchical and more conversational. Gottlieb and Gottlieb's model also tries to incorporate White's externalization. This system of consultative conversation where the co-therapists, who are themselves couples, explore, observe and study the issues of a couple renders the conversation to be more lateral than hierarchical, and facilitates natural empathy for the issues and context of the couple. The three-act play A research by Duvall, King, Mishna & Chambon (n.d., p.4) presents the therapeutic process as a three-act play. The process takes on a storied approach which helps "interpretation of experiences that represent a person's preferred ways of being and relating in the world." The therapy has a beginning, middle and end with time segments that contain stories within stories. The process involves retelling and reconsidering the impacts of particular events in peoples' lives, how they have played a role in forming their beliefs about the world and their sense of identity and purpose (Duvall, King, Mishna & Chambon n.d., p.4). The process encourages imagination and gives due consideration to subjectivity. Act 1 constitutes the introduction of the story where the therapists begin to understand what the story is about. At this point, the client is taken more seriously than literally. The client's context, experiences, relationships, the history of relationships and the hopes, concerns and preferences for these relationships, the client's cultural heritage, gender preferences, age, race and language, all form a rich backstory. Act 2 involves exploring the events and experiences in the client's life and inviting and encouraging the client to reconsider the effects of his/her life circumstances. Curiosity plays an important role in the successful management of this phase of the therapy (Duvall, King, Mishna & Chambon n.d., p.6). The chronological lining up of events and the exploration and evaluation of these events and their effects, which had been turning points in the client's lives, lead the client to new realizations. The reflecting team plays a significant role in this phase of therapy. Witnessing by the therapist and the family of the re-tellings of the narration of their story leads to the emergence of new language, meanings and possibilities (Duvall, King, Mishna & Chambon n.d., p.8). The role of the team members is to remain tentative, conversational and generative, offering views that are neither too similar to the family's views, which may not generate any interest, nor too aberrant from them, which may have little meaning for the observers. Act 3 brings the session to a close by summarizing the work of the session thus far and considering the future direction that the family would choose to take. The storied approach of the above system encourages subjectivity. Maintaining curiosity avoids suggestions from the side of the therapist and encourages reconsideration of events and their effects by the family members themselves. The reflections of the team that are just appropriately unusual also help the family reach new realizations. References Duvall, J., King, E., Mishna, F. & Chambon, A., n.d., Research as retelling: Capturing pivotal moments in therapy and training, viewed 4 December 2008, http://www.brieftherapynetwork.com/documents/Duvallarticle.pdf Gale, J. E. & Long, J. K. 1996, 'Theoretical foundations of family therapy', in F. P. Piercy, D. H. Sprenkle & J. L. Wetchler (eds.), Family therapy sourcebook, Guilford Press, pp.1-24, viewed 2 December 2008, http://books.google.co.in/booksid=iljN3Fg4nNEC&pg=PA135&lpg=PA135&dq=tom+andersen+reflecting+team&source=web&ots=iAvQF3DXTn&sig=PgBlbpGpaBLfQj1IauVDeC3jMus&hl=en&sa=X&oi=book_result&resnum=3&ct=result#PPA11,M1 Gottlieb, C. D. & Gottlieb, D. T. 1990, 'The marital cotherapist team as a reflecting team in couples' therapy', in B. J. 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L. n.d., Family therapy, viewed 28 November 2008, http://dspace.ucalgary.ca/bitstream/1880/45117/3/Family.pdf Wetchler, J. L. 1996, 'Social constructionist family therapies', in F. P. Piercy, D. H. Sprenkle & J. L. Wetchler (eds), Family therapy sourcebook, Guilford Press, pp.129-152, viewed 1 December 2008, http://books.google.co.in/bookshl=en&id=iljN3Fg4nNEC&dq=wetchler+family+therapy+sourcebook&printsec=frontcover&source=web&ots=iAvQG2A1Np&sig=G1zR23gTIMRjn4rf_RnsnbcR96k&sa=X&oi=book_result&resnum=1&ct=result#PPA133,M1 Wright, L. M. & Watson, W. L. PP. 1991, 'Systemic family therapy and family development', in C. J. Falicov (ed.), Family transitions: Continuity and change over the life cycle, Guilford Press, 407-430, viewed 3 December 2008, http://books.google.co.in/booksid=f60Kb2G8AckC&pg=PA407&lpg=PA407&dq=systemic+family+therapy+team&source=web&ots=C_WE4mtbFV&sig=jjrBDQccBn1OMq2T7PgzV-DDDlU&hl=en&sa=X&oi=book_result&resnum=10&ct=result#PPA407,M1 Read More