Systemic Approaches

The fourth set of approaches includes variants of systemic family therapy, which generally reflect a social constructionist concern with "languaging" and its role in shaping the family's definition of the problem. From this perspective, ''psychological disorders'' are not viewed as syndromes or symptoms that attach themselves to persons, but instead are defined in language through the interaction of those persons —including the identified "client"—engaged in the problem. For example, whether a woman's depressive withdrawal after the death of her stillborn child is considered ''normal'' or "pathological" is very much a matter for social negotiation, especially within the family context. Problems arise and are sustained in language when they are conferred a ''reality'' by individuals, family members, and the broader society, and particularly when they are attributed to deficiencies, deficits, or diseases in one individual. Therapy, in this perspective, consists of creatively helping participants in a problem system ''language away'' the difficulty by re-framing it in a way that it is either viewed as no longer problematic (e.g., the mother's continuing sadness is reconstrued as an attempt to maintain her connection to her deceased child) or becomes amenable to solution (e.g., her sense of loss might be validated by a shared family ritual acknowledging the place of the child in their collective lives).

In this approach to therapy, the therapist assumes the role of conversation manager, artfully eliciting divergent views of the problem within the family system and exploring their implications for each member. Because family members are often engaged in interlocking patterns of recursive validation (e.g., when the be reaved father's confused withdrawal from his wife is viewed by her as emotional abandonment, and her resulting tearfulness is construed by him as further evidence for her ''falling apart''), the therapist must often find ways of exposing the hidden premises of each family member's view, and prompting them to view their interaction, at least temporarily, in novel terms. Among the many techniques for accomplishing this are the use of circular questions, which inquire about perceptions among family members (e.g., ''Who is most convinced that mom is suffering from major depression? Who is least convinced that this is what is going on?'') and their relationships to one another (e.g., ''Who in the family is next most depressed? Next? Least?'').

Systemic therapists who operate from a construc-tivist standpoint also make use of novel therapy formats, such as the reflecting team, in which a group of clinicians observes a family therapy session, and then joins the therapist and family to share divergent, but provocative interpretations of the family's difficulty. The aim of such interventions is not to determine the single ''correct'' interpretation of the complaint, but to dislodge both therapist and clients from habitual ways of thinking about the problem in a way that contributes to its maintenance. As the systemic therapies have continued to evolve, they have become increasingly open to ''importing'' concepts from more individual constructivist approaches (e.g., personal construct and narrative models) that help reveal the ''selves'' within the system, and that provide a means of tacking back and forth between individual and family level work across the course of a given therapy.

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