Family Therapy & Systemic Practice

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Archive for August, 2008

Walking the line

Posted by Psych@Bower on 11th August 2008

In the western world, the ‘individual’ holds a privileged position. This is reflected in the mental health diagnostic model that provides society with an understanding of mental health issues, and which locates them within the individual. Whether it is Attention Deficit Disorder, Oppositional Defiant Disorder or Anxiety – the diagnosis is attached to one member of the family system. This  provides the  cloak under which lies concealed the broader relationship patterns from which the symptoms of the individual has emerged. This cultural view of mental illness can serve as an invisible layer of support to the defensive system created in families that keeps problems safely contained within an individual family member. This is an issue that commonly presents in therapy when there is a request of the therapist to ‘fix the child’ but the parents do not want to explore the inner workings of their own psychological world.
Jenny Brown (2008) addresses this in a recently published article titled “We Don’t Need Your Help, But Will You Please Help Our Children”.  In her paper, Brown provides an interesting exploration of two cases, both of which present with a request to focus on the adolescent exhibiting difficulties. In one case the therapeutic process was successful in helping the parents to explore their couple relationship and families of origin but in the other case therapy was discontinued when family of origin dynamics began to be explored. In her examination of the two studies, Brown provides client feedback about the therapeutic process to provide insight into how a therapist can walk the fine line of maintaining respectful engagement while at the same time not increasing the burden of responsibility on the child by entering broader system exploration. Brown describes how a family system’s approach allows therapists to achieve this balance because it encompasses the “view that parents are not the cause of their children’s symptoms, but rather, have the ability to provide some leadership and can therefore initiate some change in their own behaviour that has a ripple effect through the family”. She argues for the importance of the therapist patiently exploring with the family what they are seeing and learning by their interactions, so that the system can decide when it is ready to expand its view of the problem rather than the therapist acting on the family’s anxiety and imposing these ideas prematurely. In order to achieve this, she promotes the Bowen Family Systems approach. The first task of therapy is to calm down the anxiety in the system through engaging and thoughtful investigation in order to achieve a reasonable degree of symptom relief.
While the widely promoted individual focus can provide parents with a compelling framework for understanding the issue of their child or adolescent when they are anxious about being blamed, a systemic approach can empower them by providing them with the tools to help their child’s behaviour to “be less of an automatic reaction” to their own behaviour and “more an expression of their individuality”.
Brown, Jenny. (2008). We don’t need your help, but will you please fix our children. Australian and New Zealand Journal of Family Therapy, 29 (2), pg 61-69.

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Family of Origin Work

Posted by Psych@Bower on 11th August 2008

Article: Cattapan, O., & Grimwade, J. (2008). Parental illicit drug use and family life: Reports from those who sought help. Australian and New Zealand Journal of Family Therapy, 29(2), p. 77- 87.
 

Enquiry beyond the individual client into the system - the world in which a client lives - takes us unequivocally into the realm of family of origin.  Family of origin shapes us, leaving benign or malignant marks on our identity and our ability to be or to see ourselves as more alike or more different from them.  As therapists we know that reflection on our past can allow meaning and understanding, and yet we also know this does not necessarily produce change.   A recent study by Cattapan and Grimwade (2008) explored the impact of early life experiences on substance users as parents and on their children. Fifteen parents participated in a qualitative, longitudinal study about their family life, treatment and drug of choice.  Eight of these participants had just begun alcohol and other drug counselling (AOD) and comprised the in-treatment (IT) group, while the remaining seven had completed alcohol and other drug counselling and were labeled the post-treatment (PT) group.   Four themes of parental perception of family life were examined: (i) the perceived impact of the family of origin on the parent drug user, (ii) self-perception, (iii) the impact of parental illicit drug use on the family environment, and (iv) the impact of parental illicit drug use on children. 

The study revealed that enquiry across these domains yielded predictable responses from participants confirming that when parents prioritize drug use ahead of parenting, they expose their children to danger, pseudo-maturity, drug use, and at the very least, living in a destabilized household with irregular routines.  Subsequently, comparisons between “in-therapy” and “post-therapy” groups indicated that parents who relinquish substance use are then able to restore family routines and domestic organization, and also notice positive changes in their children 

Enquiry into the substance users’ family of origin elicited two themes which appeared to contribute to participant’s adult use of substances.  The first was labeled ‘family of origin symptomatic behaviour’, which included the participants’ parents own use and addiction, and the participants’ parents indulgent behaviour. This was defined as either indulging themselves by using their children (e.g. one participant spoke of how from the age of 12 years her mother gave her the responsibility of transporting her amphetamines) or indulging their children (e.g. reports by participants of parents turning a ‘blind eye’ to their substance use as a teenager, or parents or relatives supplying them with cigarettes, alcohol, cannabis etc. at a young age).  The second theme was ‘inappropriate boundary regulation’.  This included participants’ reports of difficulties with appropriate limit setting (seeing parents as either too restrictive or not restrictive enough), violence and abuse, sudden loss and a nostalgic and often idealized yearning for the family of origin which suggested difficulty differentiating.  Some participants were able to connect family of origin experiences with their subsequent addiction and current parental behaviour, and  for others family of origin experiences seemed to ‘set the scene’ for their future (present) addiction.  Most participants identified a desire for a corrective script in the raising of their own children. 

The authors concluded that for parents struggling with a substance addiction recovery included a process of differentiation from family of origin, “when they succeed in differentiating from their parents, they achieve greater agency on their parenting.”  When given permission and ability to see themselves as different and separate from their own parent(s) they were better equipped to live the corrective script they dreamed of for their children.  The authors suggest that the themes explored in this study may encourage counselors and therapists to direct client attention to relevant aspects of the experience of families where parents use or have used drugs.

This article reinforces the importance of exploring the system and in particular family of origin with our clients.   It suggests that for substance users who had parents who also had addictions, a central part of their recovery was exploration of their backgrounds and the subsequent meanings and self-perceptions. We know as therapists that if differentiation from our family of origin has been stalled, delayed, warped, hindered or perhaps accelerated, an individual may experience difficulties in terms of personal development and their relationships. Central to the  recovery of this study’s population was the ability to differentiate from their family of origin and while we may be able to provide understanding for our clients, change may not occur without permission or ability to see themselves as different from their family of origin.  This also raises the question of what exactly is successful differentiation from family of origin? Do any of us ever achieve this? While differentiation may have the power to liberate it may also bring to the fore themes of hurt, abuse, disloyalty, fear of the unknown, loneliness, inadequacy, abandonment and rejection from their family of origin.  Either way differentiated or not our families leave a mark.

News Piece: Substance Abuse, Differentiation and Family of Origin
 

Cattapan, O., & Grimwade, J. (2008). paper “Parental illicit drug use and Family Life: Reports from those who Sought Help.” in the Australian and New Zealand Journal of Family Therapy, 29(2), p. 77- 87, reinforces the importance of exploring the system and in particular family of origin with our clients.   It suggests that for substance users whose parents also had addictions a central part of recovery was exploration of their backgrounds and subsequent meanings and self-perceptions. We know as therapists that if differentiation from our family of origin has been stalled, delayed, warped, hindered or perhaps accelerated, an individual may experience difficulties with their personal development and their relationships.  Central to the recovery of  this study’s population recovery was the ability to differentiate from their family of origin and while we may be able to provide understanding, change may not occur without permission or ability to see themselves as different from their family of origin.  This however also raises the question of what exactly is successful differentiation from family of origin? And do any of us ever achieve this? While differentiation may have the power to liberate it may also bring to the fore themes of hurt, abuse, disloyalty, fear of the unknown, loneliness, inadequacy, abandonment and rejection from their family of origin.  Either way differentiated or not our families leave a mark.

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