Family Systems Therapy: The Adlerian Approach - Essay Example

Family Systems Therapy: The Adlerian Approach When an individual suffers from a mental or behavior disorder it takes place within the family environment. The problems suffered by a family member can resonate throughout the family and lead to psychological disorders, domestic violence, substance abuse, and divorce. Treating the individual that is the focus of the problem can help, but the relationships that are torn apart by family strife also need professional attention. Many times the family may be the source of the family members anxiety or disorder. Other times they act as enablers that perpetuate and nurture the individuals problem. A mental health crisis, mental disorders, relationship problems, or parent-child relationship problems all bring the family into the involvement with the individuals treatment. The family may be counseled on how best to cope with a family member in crisis, or they may be a part of the treatment. No matter what the emotional disturbance is, the family is an integral part of the interaction and must be a part of the therapy. Systemic family therapies have been developed to treat the family as a cohesive unit. Behaviors and relationships are all interdependent within a family and as such need treated within the family environment. It will do no good to treat a single family member for substance abuse if the source of the users anxiety is the family relationship. Likewise, family members need to be aware of the impact that each relationship has on all the other family members. To study and manage the impact that the family has on mental illness, Alfred Adler pioneered the Adlerian technique of family therapy. More recent models such as brief therapy, and cognitive behavior techniques have all drawn from the research and writings of Adler. Because Adlers methods are at the roots of many other therapies, it is important to understand the Adlerian Family Therapy. It shapes and defines the family, its relationships, the influence of the individual members, and the actions necessary to correct family problems. Historical Components Alfred Adler was born in Vienna in 1870 and after receiving a medical degree turned to psychiatry in the early 1900s. He was an associate of Freud and worked with him on several projects and occasions. During this period, he developed theories which would later evolve into the more recent ideas on self-actualization (Boeree, 2006). Followers of Adler include Rogers, Horney, Fromm, and Sullivan (Boeree, 2006). Adler stressed the importance of the individual within the family and postulated several theories on why family members act within the family structure as they do. According to Adler, one of the core drives that motivate the individual is the drive for perfection. Adler believed that this drive was established early in childhood and set the stage for behavior later in life as an adult. Out of this realization came the associated theories on masculine behavior, birth order, and aggression. His close associate, Freud, also believed that the experiences of early childhood greatly influenced the person as an adult. yet, there is a major difference between Freud and Adler. While Freud believed that childhood experience pushed the individual into the future, Adler believed the child was drawn into the future based on the past. In other words, Adler believed we are drawn to our goals and not driven to them. Hans Vaihinger was a major influence on Adlers thinking. Together they developed theories on what is known as fictionalism. Because we can not know the future, we have only partial truths to relate it. These partial truths are known as fictions. As an example, a family member may not know how their spouse will react to a given behavior, yet they will act as if they do. As Boeree (2006) states it, "The fiction lies in the future, and yet influences our behavior today". Adler spent his life refining and redefining these principles. Adlerian therapy believes that the family is the central unit and it is central to the individuals behavior. This individual behavior is interactive and has purpose (Carlton, Sperry, & Lewis, 2005, p.19). The individual is driven by childhood experience and the family structure towards an imagined, and fictional, future. This sets the stage for family interaction by establishing power, rules, domination, and coalitions within the family unit. Freeman (2004) states, "The life problem of the neurotic, according to Adler (1964), is not how to fit in with the demands of self-living, but how to satisfy his desires for superiority" (p.150). This has led to the more recent models of Adlerian therapy that focus on the family constellation, birth order, and family atmosphere as the key components of individual behavior. It is within this context that Adlerian therapy operates. At the core of Adlerian therapy is the family constellation. Adler defines the family as the immediate family consisting of parent and siblings. In addition, anyone that spends considerable time with, or exerts significant influence over, a family is also considered a part of the family constellation. The family constellation defines how people fit into their role as a family member and how that forms a basis for the family relationships. These inter-family relationships create the family dynamics that are addressed by Adlerian therapy. The inter-family relationships that form the family constellation take place within what is called the family atmosphere. The family atmosphere forms the emotional role model for the children and creates the climate that the marriage and parental roles act in. The atmosphere builds value systems and is the role model that the children will emulate as they grow into adulthood. It also builds patterns of communication, both verbal and non-verbal. This communication takes place with a set of implied rules. If there is a dysfunction in the family communication or a misunderstanding of the rules, it will lead to miscommunication and dysfunctional behavior. Another key component of Adlers thinking was his concept of the influence that birth order has on the development of the individual. In general terms he believed that children develop a personality based on their hierarchy in the family and the associated expectations of the parents. The oldest child is an authoritarian figure and is favored by the parents. First born children are often high achievers that may be prone to a neurosis based on unrealistic expectations and goals. The second born child will often compete with the first born and as such will develop a sense of rivalry within the family. This rivalry can become the source of the individual or family problems. The last born child is pampered and is often granted additional permissiveness in their behavior. They may be creative, rebellious, or exhibit behavior that is considered revolutionary within the context of the family atmosphere (Boeree, 2006). Implementing Alderian therapy requires the involvement of the entire family constellation. Adlerian therapy organizes the therapy into four distinct phases. (Carlton, Sperry, & Lewis, 2005, p.21). During the first and second phase the therapist gains access to the family and completes an assessment during which time a hypothesis if formed based on the dynamics of the family. During the third stage of treatment, the family is made aware of the problems and devotes themselves to accepting changes in the family dynamics. During the fourth phase the therapist highlights the success, solidifies the progress, and begins to disengage from the family unit. According to Freeman (2004), "The main thrust of Adlerian therapy is to explain to the patient those subjective convictions that hamper his effective functioning in life and to encourage the patient to use his insights to meet the challenges of life with courage and cooperation" (p.154). By addressing family issues the patient is more able to confront their other social interests. A recent model of Alderian therapy put forth by Grunwald and McAbee (1985) suggests that there are key techniques closely associated with the therapy (as cited in Carlton, Sperry, & Lewis, 2005, p.21). These techniques include obtaining information through individual interviews with family members. The therapist will outline a typical day and assist the family in creating realistic goals. The therapist acts as a collaborator with the family and engages the family in creating better channels of communication. This creates a family dynamic of social equality and honesty from which corrections in the family dysfunction or the individual disorder can be corrected. Literature Review One of the key components of Adlerian therapy is the reliance on the influence of birth order as a determining factor that underpins all family relationships as well as the individuals behavior. Significant research has been done on the impact of birth order on personality and it generally confirms Adlers findings. According to Miller, Anderson, and Keala (2004), "…research generally supports the idea that birth order affects personality development" (p.461). However, much of this research has been criticized for not accounting for age spacing, gender, and socio-economic status (Miller, Anderson, & Keala, 2004, p.461). In addition, the research largely is only able to confirm the theoretical pattern as it relates to the first born, as subsequent children adhere to the theory less clearly (Miller, Anderson, & Keala, 2004, p.461). Miller, Anderson, and Keala (2004) concluded that there is significant empirical support for Adlers theories regarding birth order (p.461). A study by Khan, Ahmad, and Arshad (2006) further confirms Adlers birth order theory when they state, "It has also been reported that the incidence of major psychiatric illness was increased in individuals, who belonged to beyond the third birth order. In the same way, among Kuwaiti adolescents, family size and birth order had positive correlation with anxiety" (p.39). Though this does not completely reflect Adlers thinking, it does show the impact that birth order has on personality and its associated disorders as well as indicating the universality of the theory across cultures. The dynamics of the family constellation are another factor that Adlers theory focuses on. Koch (1955) addressed the problem of sibling spacing while confirming the importance of family interaction when she writes, "It is also relevant to the problem of the effect of spacing that the amount of contact sibs have with each other and the degree of disparity in their circle of friends affects not only the interactions they have with each other but also the relations they have with their parents" (p.33). Further research on Adlers contention that the family constellation is integral to the individuals mental health has been reported in relationship to single parent families. Bernstein and Borchardt (1996) reporting on past research stated that, "…children from single-parent and from stepparent families were rated by their mothers as significantly more neurotic and antisocial than children from two-biological-parent homes" (p.2). This is evidence that the dynamics of the family affect, if not create, mental disorders within its members. Bernstein and Borchardt (1996) further found that children of stepparent families are more prone to psychological disorders and indicated that the dynamic of the family constellation was far more complicated than previously recognized (p.16). While Adler recognized the impact that family constellation has on the functioning of the children, his theories fail to elaborate on the complex nature of alternative and extended families. Adler contended that family communication is a key aspect of family interaction. Miscommunication can lie at the heart of an individuals psychological disorders. This is supported by Denton and Kampfe (1994) who reported "…that that there is a communication gap between family members of adolescents who are chemically dependent. This is supported by findings that teenagers who abuse drugs typically describe their communication with parents as closed and unclear". However, it could be possible that the miscommunication is the result of the substance abuse rather than the abuse being a symptom of poor communication. However, Denton and Kampfe (1994) also reported that parents who have teenagers that suffer from substance abuse also have poor communication skills. Denton and Kampfe (1994) state that, "Parents have also reported communication problems. A significant number of these parents indicate that they are inadequate in communicating trust, acceptance, and understanding". Clearly, Adlers focus on communication and truth is instrumental in promoting the correction of family problems. It is the task of the therapist to open up the channels of communication and encourage the family members to participate in open and honest discussion. Personal Critique Though Adlers theories were put forth over a century ago, they are still relevant in todays world and in light of recent research. Adlerian therapy has been updated to deal with many of the complex issues that Adler failed to address. Adlers theory on birth order provides a firm foundation for future research to be built upon. Past research has indicated a strong correlation between birth order and personal anxieties and psychological disorders. However, moderating variables such as gender and family structure were not accounted for in Adlers writings. These can have a significant impact on family dynamics and the hierarchy of the sibling structure. Boeree (2006) contends that Adlers theories suffer from a lack of foundation in empirical evidence. This is especially true of birth order and its associated influences. Adlers contention that family constellation has a fundamental impact on mental health is intuitive as well as pragmatic. The relationships between family members will necessarily be impacted by the social forces that drive the relationships. Stepparents, birth spacing, and the realities of socio-economic status all form the family constellation. An older child may need to assume the parental role in a single parent family that needs to financially depend on the child for supervision. Stepparents may not have the authority required to elicit truthful communication and can spawn rebellion and acting out of the child. Adler was correct in focusing on this aspect of family therapy as a route to healing. While it may seem obvious that good communication is imperative for good family mental health, Adlers contribution was in his techniques to encourage honesty. The technique of a deliberate assessment through family observation and individual interviews is important, not only to Adlerian therapy, but also many therapies that have evolved out of his concepts. The phases of assessment, communication, and disengagement are as relevant today as they were a century ago. The key to successful Adlerian therapy is to collaborate with the family while remaining objective and somewhat distant. This balancing act is necessary to prevent the therapist from falling victim to the same psychological disorders that impact the family. In conclusion, Adlers theories on systemic family therapy, though general in nature, are useful in understanding and correcting family problems. Adlerian therapy can result in behavior modification by the realization that people are goal driven. This search for self-actualization is at the heart of personal drive and is formulated by the childhood experience. Adlers viewpoint accepts that the personality formed by the past can not be significantly altered, but there is hope that the future direction can be changed. References Bernstein, G. A., & Borchardt, C. M. (1996). School refusal: Family constellation and family functioning. Journal of Anxiety Disorders, 10(1), 1-19. Boeree, C. G. (2006). Alfred Adler. Retrieved February 14, 2008, from http://webspace.ship.edu/cgboer/adler.html Carlson, J., Sperry, L., & Lewis, J. A. (2005). Family therapy techniques: Integrating and tailoring treatment. New York: Psychology Press. Denton, R. E., & Kampfe, C. M. (1994). The relationship between family variables and adolescent substance abuse: A literature review [Electronic version]. Adolescence, 29(114). from EBSCO. Freeman, A. (2004). Cognition and psychotherapy. New York: Springer Publishing. Khan, M. S., Ahmad, S., & Arshad, N. (2006). Birth order, family size, and its association with conversion disorders. Pakistani Journal of Medical Science, 22(1), 38-42. Koch, H. A. (1955). The relation of certain family constellation characteristics and the attitudes of children toward adults. Child Development, 26(1), 13-40. Miller, R. B., Anderson, S., & Keala, D. K. (2004). Is Bowen theory valid?: A review of basic research. Journal of Marital and Family Therapy, 30(4), 453-466. Read More