By Dr Kate Owen
Clinical Family Therapist and Clinical Psychologist
The myth of “family therapy” is that you need more than 1 person in the room. Often when I am running a training event on family therapy I am asked the question, “But can I do family therapy if I only see individuals?”. The answer is most definitely “yes”. This is the reason why the teaching team at The QLD Institute of Family Therapy (QIFT) often describes therapeutic practice as “Systemic Psychotherapy”, “Systemic Therapy”, and “Systems Theory” to broaden the understanding of the potential for this way of working to fit with individuals, families, groups, and workplaces. In fact….any “system”. Even a system of one.
You see, systemic family therapy is not about the number of people in the room. It is about how you as the practitioner view the presenting problem, how you think about change and how problems get resolved, what types of questions you ask, where you choose to focus your enquiry, and what is targeted in treatment.
If you are new to family therapy, or have been in the field for a while and would like to reflect on your practice, below are 6 guiding principles to help you determine if you are working systemically with individuals:
1. Consider Context
“The fundamental premise of family therapy is that people are products of their context” (Nichols, 2010: p99).
The hallmark of systemic practice is appreciating that people are shaped and influenced by the context in which they live. This includes era in time, culture, immediate family, significant relationships outside of the family, community, geographical location, religious beliefs, broader society, and many other factors.
Importantly, the systemic practitioner appreciates that this includes both the present as well as past context. That is, a multigenerational context. As McGoldrick and colleagues (2011: p1) proclaim, “All human problems are framed by the formative course of our family’s past, the present tasks it is trying to master, and the future to which it aspires.”
For example, your individual client might present with symptoms of anxiety, and through a systemic lens you discover that the anxiety developed within the context of a critical upbringing, ongoing strained family relationships, dissatisfaction in the workplace due to competitive colleagues, and worry about the future due to fertility challenges.
In practice, when working systemically with individuals, it is important to hold curiosity about the clients’ context and maintain an interest in the “bigger picture” of their life. We call this "taking the helicopter view". Practically, you might map a Genogram of at least 3 generations, and chart a Timeline that focuses on both the individual's journey through life as well as the significant events and transitions of their family.
2. Viewing “Relationships” As The Client
“Experience teaches that what shows up as one person’s behaviour may be a product of relationship” (Nichols, 2010: p91).
It is the focus on the relationships in a person’s life that is a defining feature of family therapy, as the basic systemic premise is that the behaviour of another is most likely relevant to maintaining the problem.
When working systemically with individuals it is important to hold in mind the concept that “1 + 1 = 3”. This means that your client might be having challenges with another individual and it is the relationship between them that constitutes the third element of the dynamic, which is often the focus of systemic therapy. Therefore, defining the problem in relational terms and setting relational goals is a good indicator that you are doing family therapy with one person in the room. A systemic question to assist goal setting with individual clients is “What would be different in your relationships after you have finished here? And what is the first small step to take to head in that direction?”
However, if a client feels strongly about a certain view of the problem (e.g., “I’m depressed” or “My partner’s drug use is the problem”), a systemic practitioner must “negotiate a cooperative relationship above all else, rather than one that unwittingly becomes subtly adversarial due to philosophical differences” (Hanna, 2007: p144). The art of systemic therapy is defining the presenting problem in a way that unifies diverse opinions, such as “His drug use has affected your relationship and you hope that things can be better for you both”. Therefore, in the initial stages of therapy, the practitioner explicitly accepts the family’s definition of the problem while implicitly exploring additional ways to describe it using relational terms (Hanna, 2007).
3. Holding A Triadic Focus
“The fact that triadic thinking permits a more complete understanding doesn’t mean that family therapists must always include all parties in treatment. The issue isn’t how many people are in the consulting room but whether the therapist considers problems in their full context” (Nichols, 2010: 393).
As outlined in this article already, it is the bigger picture, interconnectedness, and context that define systemic family therapy. Therefore, it is no surprise that the family therapist views the presenting problem from a triadic lens. For example, if a child escalates in behaviour when their mother is unable to meet their emotional needs, teaching the mother how to attune to her child may not help the situation if her behaviour reflects challenges in the relationship with her husband. That is, perhaps her distancing from her child’s emotional needs reflects her hyperfocus on the couple relationship as it is also under emotional strain. To extend this further, perhaps the husband’s emotional distancing from his wife might be due to worry about financial pressures and challenges in his workplace.
In practice, when working systemically with individuals, this involves recognising that problems are interactional which means thinking in twos, threes, and more. So when clients describe a challenge that they are having with another person, it is helpful to explore the interconnected and implicit relationships inherent in that dynamic. For example, the client might say “I feel so angry! I don’t get along with my partner and we are fighting all the time”. To which the family therapist would ask “So who do you turn to for support? And where are you seeking your connection?”
If problems can develop through interconnected relationships, it would also make sense that change, outcome, progress, etc can also come through any relationship. For example, with the scenario above, perhaps a therapeutic intervention with the mother would be helpful, or perhaps the child is given extra care from his grandmother which alleviates some of his distress and reduces his symptoms, or perhaps the father receives a pay rise which alleviates his stress which makes him more emotionally available to his family.
In practice, this means working with the most motivated person, empowering your client to see how they can affect change, and being humble in appreciating that the therapist is one relationship that may contribute to change but may not be the most significant relationship in the client's life as the catalyst for change.
4. Thinking in Circles
“The illusion of unilateral influence tempts therapists too, especially when they hear only one side of the story. But once they understand that reciprocity is the governing principle of relationship, therapists can help people get past thinking in terms of villains and victims” (Nichols, 2010: p7).
Linear explanations take the form of A causes B, and in most counselling degrees there is a strong focus on A leading to B which leads to C for individuals. For example, when little Johnny sees his parents arguing (A) he has negative thoughts believing that it is his fault they are in conflict (B), which leads to him becoming dysregulated (C). Although linear thinking is not seen as incorrect, it may be misleading as it only punctuates one part of a larger whole, and a circular perspective provides a more complete and coherent perspective (Becvar & Becvar, 2013).
By thinking in circles and helping your client look for patterns of mutual influence, the systemic therapist attempts to remove blame and empower people to look at the part of the pattern that they can control, influence, and change.
In practice, when working systemically with individuals, be mindful to explore all the significant others involved in maintaining the presenting problem, including the client in the room. Map out the sequence around the presenting problem: the steps in the “dance” and the “dancers” involved. Tracking these sequences is the “microscope” of the family therapist (Hanna, 2007: p148).
Some great questions to map the sequence include:
What happened next?
Who else was involved?
What were you/they thinking at that time?
What came after that?
How did it end?
5. Asking Relational Questions
Information “is a difference that makes a difference” (Bateson, 1972: p459).
Enquiry, curiosity, and thoughtful questions are the hallmark of therapeutic practice. In fact, asking the right question is often the best intervention as it provokes thought and introduces a new understanding. With a new understanding of a situation, event, person, or behaviour, a new context is created which has the potential to lead to change.
Of course, a systemic therapist will ask intrapsychic and linear questions, such as “What were you thinking when that happened?” and “How did you feel?”. However, the hallmark of systemic therapy is to ask questions that explore relationships, interactions, context, different viewpoints, meaning-making, collective strengths, and help the client move from a linear to an interactional perspective. The beauty of family therapy is that you can ask systemic questions even if you only have one person in the room by inviting the opinion of significant others not present. This is a great way to “bring the family” into the session.
Here is a small sample of systemic questions to demonstrate what this looks like in practice when working with an individual:
“If your wife was here what would she say is the problem?”
“Who else in your family would agree with your point of view?”
“After you have a fight with your partner, what happens next, and who else gets involved?”
“How have you and your family gotten through difficult times in the past?”
“How has The Anxiety gotten between you and your friends?”
6. Monitoring Your Systemic Alliance
“The alliance in couples and family treatment differs from the alliance in individual psychotherapy in that the couples and family therapist must establish and maintain multiple alliances” (Rait, 2000: p211).
If you are in the helping profession then my assumption is that you are well-versed in how to strengthen the therapeutic relationship with your clients and have strategies, explicit and implicit, in your therapeutic repertoire. What can be challenging for even the most seasoned family therapist, is maintaining a 'systemic alliance’ when working with individuals. That is, maintaining multiple alliances when you only see one person in the system.
In practice, when working systemically with individuals, this requires the systemic practitioner to monitor their alliance. For example, do you feel strongly aligned with the person in front of you, or do you engage with the client as if other family members were sitting in the room? You might consider keeping the genogram close by as a reminder of your client's significant relationships or consider using chairs to represent the missing family members in the room who are important in the conversation.
Summary
The myth of family therapy is that you need more than one person in the room. That is not the case. However, practitioners are human too and are not immune to being influenced in relationships. When therapists work with individuals, the invitation to align with the client's story, emotions, and become "blinkered" is real. Therefore, for those systemic practitioners who work predominately with individuals, the 6 guiding principles above are a helpful tool to reflect on your clinical practice and maintain the integrity of your systemic framework.
References
Bateson, G. (1972). Steps to an Ecology of Mind: Collected Essays in Anthropology, Psychiatry, Evolution, and Epistemology. Jason Aronosn Inc.
Becvar, D. S. & Becvar, R. J. (2013). Family Therapy: A Systemic Integration (8th ed.). Pearson.
Hanna, S. M. (2007). The Practice of Family Therapy: Key Elements Across Models (4th ed). Brooks/Cole.
McGoldrick, M., Carter, B., & Garcia-Preto, N. (2011). The Expanded Family Life Cycle: Individual, Family, and Social Perspectives (4th ed.). Pearson.
Nichols, M. P. (2010). Family Therapy: Concepts and Methods (9th ed.). Pearson
Rait, D. S. (2000). The therapeutic alliance in couples and family therapy. Journal of Clinical Psychology 56(2): 211-24.
Please note that this article is educational in nature and does not constitute therapeutic advice or suggestion. If you require support please seek professional assistance.