Critically Consider the Application of Systemic Family Therapy to Working with Children

Family Therapy-defining concepts

At first, family therapy was an experiment. In the post-World War II, many psychologists and psychiatrists strove to comprehend the multiple influences on human behaviour and adjustment. This is the common background of the biopsychosocial approach, the systemic approach, or family systems theory.

Gurman, Kniskern, and Pinsof (1986) state that the 'Family therapy may be defined as any psychotherapeutic endeavor that explicitly focuses on altering the interactions between or among family members and seeks to improve the functioning of the family as the unit, or its subsystems, and/or functioning of the individual members of the family' (p.565).

In other words, rather than focusing solely on the individual, family therapy is concerned with the person in his or her own right. The problem of an individual, therefore, is viewed by family therapists as stemming from the source larger than the person. The main advantage of this is the possibility of influencing the problem via a number of people (i.e. family members), instead of just one. Symptoms are changed through alterations of relationships in which people are involved.

The varieties of family therapy practice and family systems theory range from those derived from psychoanalysis (psychodynamic family therapy of Ackerman, Bowen systems therapy, and object relations therapy); to those primarily centred around expressiveness and communications (Satir's conjoint therapy); to those focused on organisation (structural family therapy of Minuchin); and to those derived from hypnotic practises of Milton Erickson. The unifying theme of the techniques employed is the identification of the family process as the targets for intervention and alteration.

Beginning with Ackerman, one line of family therapists who work with young children concentrates on psychodynamics. Zilbach (1986) emphasises the important contributions of young children to the content and timing of emotional events. Scharff and Scharff (1987) show how, by providing a therapeutic environment and through the use of transference, countertransference and interpretation, they help families to identify the problem of the past. This allows the family to confront emotional difficulties and to master stress.

Another line of work with children from Minuchin's structural approach (Minuchin, 1974); in which family organisation is viewed as crucial to the experience of individuals in the family. In families, boundaries are the conceptual markers of differentiation between individuals and subsystems representing the family's managements of both roles and proximity. Most problems in relational functioning can be described under one of three categories: disorders of membership (lack of clarity about who is in and who is out of the family), status (lack of clarity about roles), and proximity (over- or under-involvement of family members). Some forms of childhood difficulties are associated with diffuse boundaries characterised by a lack of role clarity and over involvement, and others are associated with disengagement, where boundaries separate individuals in the family too rigidly. In healthy families, the parent-child boundary marks the differentiation of parent and child functions, preserving functional family hierarchy, and separating the parental subsystem from the child system. Structural family therapists assist families to achieve a more functional organisation.

A third application to children has evolved out of the strategic school and is described by Madanes (1984). A child's symptoms are understood as metaphors about the family's situation. Through playing out themes in which family members pretend to be in the relationships metaphorically represented by the symptoms, the family's repertoire of interactions is expanded, increasing the flexibility and adaptation.

Family therapy using Cognitive-Behavioural Therapy (CBT) techniques attempts to change the ways people think or behave in order to reduce or get rid of the problem. While cognitive behaviour therapy with children and adolescents is an effective and widely used therapeutic modality, practitioners are provided with little guidance regarding working with parents and other family members. Children's problems occur in a familial context and accordingly, family members play a role in the initiation, maintenance, as well as exacerbation of children's problems.

The systemic approach to family therapy is the one in which we take a much broader and more general approach. The focus is on addressing current relationship patterns rather than analyzing causes such as subconscious impulses or childhood trauma. Systemic Family Therapy attempts to identify the problems and relationships, ideas and attitudes of all the family to get an idea about what is going on for the whole family. Once these areas are clear the therapist will sometimes attempt to shift the problem to a position that is more beneficial, less damaging, or more realistic. This might be done in a number of ways, which may include education, homework tasks, experimentation, or attempting to provide some insight to the family members about what is really going on. Systemic therapy also differs from family systems therapy in that it addresses other living systems (i.e. groups of people) in addition to the family, for example businesses, such fields as education, politics, and family medicine.

Systemic therapy traces its roots to the Milan school of Mara Selvini Palazzoli. The original Milan therapy was based on the idea that the family system 'needed' the problem to maintain its balance. The Milan team's theory of change suggested that pathology was a result of hidden family games. If these were declared as understandable, then the family would be free to develop in a healthier way. A circular hypothesis was developed that linked family members' positions to the presented problems and then the instruction was given to 'stay the same'.

What unites these different approaches is the importance placed on understanding psychological difficulties in the context of social relationships. Another unifying feature of systemic therapy is the significance of drawing distinctions and marking 'difference' as an aspect of creating change. All of these approaches involve work primarily with whole families. Children's difficulties are conceptualised as functional within the family system, and problem resolution is directed through changing the family emotional atmosphere (as in object relations therapy), family organisation and structure (as in structural family therapy), or increasing the avenues for managing relationships (as in strategic family therapy). Family therapists who work with young children firmly believe that children's difficulties