1
Signature Assignment
Department of MFT, Touro University Worldwide
MFT610: Contemporary Issues in MFT
Professor Ida Guttman
June 26, 2022
2
Signature Assignment
The purpose of this paper is to research, analyze and apply various concepts in marriage
and family therapy that we have been studying in module six, MFT 610. These include important
concepts and tools utilized in the Three Phases of Systemic Formulation. Each concept will be
defined, followed by a clinical, objective, third person descriptive narrative of a real-world
example from an actual family, Desi, Lucy, and their son Ricky. The names of family members
have been changed to protect their identity.
Systemic Formulation
Systemic formulation is the idea that problems don’t come from within an individual—
people are not the problem—but rather from the interpersonal interactions and communication
between people (Watzlawick and Weakland, 1977). According to Dallos and Draper, “The key
feature of a systemic formulation is a view of problems as resulting from interactional
processes.” (2015, p. 148) Systemic Formulation is a co-constructional process, the therapist
doesn’t do to the family, but rather with the family in an active and fluid process. Perturbation is
encouraged, as a way to encourage change within the family system. There are three stages of
Systemic Formulation, each developing based on the ideas learned in the previous stage.
In phase one, Symptoms were a function used to stabilize the family system—keeping the
family in a state of homeostasis. The MRI team proposed that problems can arise when the
solutions tried by the family to fix things, fail. They developed a formulation, which was similar
to cognitive behavioral therapy, to figure out what the problem was that the family was trying to
fix. Dallos and Draper (2015) describe the steps of formulation this way:
3
The formulation consists of the following steps:

Deconstructing the problem – when did it start, who first noticed,
what was first noticed?

Linking the problem to ordinary difficulties.

Identifying what was attempted to solve the difficulties.

Exploring beliefs about the difficulties and what to do about them.

Discussing/evaluating what worked and what did not work.

Identifying the decisions made about whether to persist with the
attempted solutions and which solutions to pursue.
Phase two was about hypothesizing the problem. Hypothesizing was fundamental to
formulations and clinical work. The therapist keeps a curious and open mind, creating
hypotheses and then testing them with the clients. Hypothesizing was helpful in gathering and
organizing information. It also helped the therapist to construct questions for the family and to
use those questions to test a theory. “By hypothesising we refer to the formulation by the
therapist of a hypothesis based upon the information he possesses regarding the family that he is
interviewing. The hypothesis establishes a starting point for his investigation as well as
verification of the validity of that hypothesis based upon scientific methods and skill. If the
hypothesis proves false, the therapist must form a second hypothesis based upon the information
gathered during the testing of the first.” (Palazzoli et al., 1980)
Phase three saw a progression to a process that was more collaborative and
propositional—a search for the truth. Dallos and Draper say, “Instead of assessment and
formulation being seen as a one-off scientific activity, they came to be seen as a continuous
process of developing, testing, and revising formulations” (2015, p. 152). It became important
4
for a therapist to have curiosity, rather than hypothesizing, and was based more on social
constructionism—especially since the mid 1980’s, with a move towards narrative approaches to
therapy. Cultural considerations became important, as was socially constructed realities and
centrality of language.
Within systemic formulation, several key tools and concepts are utilized, and will be
defined and their use explained with a real-world example. These concepts include Genograms,
The referral, Deconstructing the problems, Contextual factors, Beliefs and explanations,
Problem-maintaining patterns and feedback loops, Emotions and attachments, and Synthesis.
Genograms – A Genogram is like a family tree, a visualizing tool with additional
information, such as relationships and medical history information. In therapy it can be used to
help the therapist understand transgenerational patterns and connections, and various interactions
between relatives. It can give a more complete picture of the family as a whole. According to
verywell mind, “The genogram uses different symbols to represent gender, diagnoses, and
connections between various family members. A therapist might use a genogram to help their
client see transgenerational patterns or make connections about interactions between their
5
relatives.” (What to Know About Genograms, 2022) Above is a sample genogram, as might be
used by a therapist to better understand the client(s).
The referral – When a family is having issues that are not being resolved internally,
sometimes a family member will request therapy for the family—called a referral. When This
happens, it can be helpful for the therapist in figuring out which member(s) of the family are
considered the ‘problem’ or who is ‘causing’ the problems. It can also help to show who makes
decisions or has power within the relationships. Additionally, in clinical referrals people outside
of the family, such as social workers, medical providers, or others involved with the family can
refer the family to a therapist for services when they see issues that they believe therapy could
help. In this case, according to Dallos and Draper, “The details of the case are outlined in the
form given by the professional (social worker, nurse) ‘keyworking’ the case, thus reflecting the
‘hard’ data/information a family therapist/team has available at the point of referral.” (2015, p.
153)
When Lucy and Desi were having problems in their relationship, Lucy suggested that
they attend family therapy. She made the referral for the family and called to set up the
appointment with the therapist.
Deconstructing the problems – Initially, when the family starts therapy, it is important
to determine where the referral came from—which family member, and what the problem is
according to the family member(s). Dallos and Draper state, “A related question in systemic
formulation is what impact or influence the problem is having on others and who is most
distressed or inconvenienced by the symptoms.” (2015, p. 154) Within Systemic family therapy,
6
which is based on communication, it is very important to understand the communication
patterns—who said what to whom and how it was said.
During the first therapy session, the therapist started to deconstruct the problems. She
noted that it was Lucy who initiated family therapy based on the problems she perceived
between herself and Desi. The therapist listened to the problems being described by the family
with curiosity, paying attention what was said by whom, and to whom as the issues were
discussed, and who seemed to have the most distress. Desi complained about Lucy not spending
enough time with him, and Lucy complained she had too much on her plate and needed a
break—so she thought Desi should help more around the house and with Ricky. Also, Ricky was
acting out, being rude and not listening when they asked him to do chores or homework. Lucy
appeared to be the most upset and frazzled.
Contextual factors — Contextual factors can include relationships between family
members, their individual histories, their environment, socio-economic conditions, social and
cultural contexts, gender roles, decision-making processes, religious beliefs, and other
influences. According to Dallos and Draper, these include “Family structure and genograms,
family lifeline, history of the problem, environmental factors, family resources, cultural factors,
role and history of other agencies.” (2015, p. 166)
The therapist noted several contextual factors as she met with Desi, Lucy, and Ricky.
She noticed that traditional gender roles were at play, for instance Lucy was expected to do most
of the cooking and cleaning. She also noted that Ricky seemed to side with his father during
sessions, while Lucy seemed to lead the decision-making processes for the family.
Beliefs and explanations — Each person brings their own ideas, or beliefs and
explanations for what the problems are, what the causes are, their agreements and disagreements
7
about these, and how they interact with their cultural, religious, and societal beliefs and attitudes.
These beliefs and explanations are shaped by individual experiences and communication.
According to Dallos and Vetere, “This part of the model invites exploration of the meanings that
different family members hold regarding the problems and what should be done about it” (2003).
In therapy, Desi shared that he believes that the problems between he and Lucy are
because she does not like him—he thinks this because she doesn't spend as much time with him
as he would like, and it makes him feel unimportant and abandoned. He hates to be alone, so he
focuses on Ricky instead, and sides with Ricky in arguments, to gain favor and have the status of
favorite parent. Lucy shares that she believes the problem is that Desi and Ricky don’t help
around the house enough, and this leaves her having to do most of the cooking and cleaning on
top of her full-time job. This makes her feel resentful, and she states she is too exhausted to
spend more time with Desi—it isn’t that she doesn’t like him, she is overwhelmed.
Problem-maintaining patterns and feedback loops — Within the family system, often
feedback loops are used internally to keep the family within homeostasis—even if that is not a
comfortable or healthy place to stay—it is easy for families to keep things as the status quo. In
therapy, it is important to look at the family systems and understand the hierarchy of power, the
processes and feedback loops that keep the family in repetitive behaviors, and to look for the
patterns used by the family. Understanding the family systems and subsystems can help the
therapist disrupt those processes that are not helping the family, so that change can occur. Dallos
and Vetere, suggest looking at Structures to explore and map the organization of the family
boundaries, power, and interconnected systems, as well as looking at the process and feedback
loops that will show the repetitive patterns of behavior happening in different areas of the system
(2003).
8
Lucy and Desi often fight about their relationship, and when Desi complains that Lucy is
not spending time with him, she retreats to her office. Lucy states she feels overwhelmed and
pressured when he complains, and this leads to fights. This, in turn, leads to Desi taking Ricky to
do a fun activity like go get ice cream—leaving Lucy out of the fun and as the parent who nags
about chores and homework instead. Desi ends up focusing a lot of time on Ricky and this
appears to also lead to both Desi and Ricky ganging up on Lucy in disagreements about things
like Ricky needing to help more with chores or complete his homework. This is a problemmaintaining pattern, based on a negative feedback loop to maintain homeostasis.
Emotions and attachments — The therapist should look at the emotional dependencies
and attachments between family members, and even across generations. Attachment styles are
built from our earliest experiences and can affect relationships over the lifetime. Past history
effects the emotions and attachments between family members, and when formulating, it is
important for the therapist to keep these things in mind as they ask questions in the therapeutic
process.
As the therapy sessions progressed, the therapist asked Lucy about her attachment with
her parents, and she reported that her dad was away for work much of the time, but she was very
close to her mother. She reports she feels sad that Desi and Ricky have a much stronger bond and
seem close, while she feels like Ricky doesn’t like her now that he is a teenager. She feels like
Ricky relies on his father for help with things, and fights with her. This brings about emotions of
sadness and guilt, as well as feeling like there is a lack of attachment with her son. Desi states
that he was a latchkey kid and was alone a lot when not at school. When he got married, he
thought that he would not have to be alone anymore, but now he feels lonely and abandoned.
9
Synthesis — Dallos and Draper state “This information needs to be translated into a
manageable formulation, which require engaging in a process of selection of what is seen to be
key as opposed to peripheral to our understanding of the problem (2015). Synthesis is attempting
to bring all the information together (synthesize the information) and choose what is relevant and
most important. There is a lot of information, and it is not possible to be ‘correct’ but rather to
maintain a sense of curiosity and keep actively listening and learning, being open to change the
thinking and formulations based on the information being learned.
As therapy progressed, the therapist synthesized all the information she was learning
about the family dynamics and problems that were being reported by the family. She used this
information to formulate the patterns of interactions and communications that were leading to
these problems and began to perturb the situation to effect change.
Using the formulations developed, the therapist and the family together came to realize
that there was an issue of triangulation between Desi, Lucy, and Ricky. This triangulation was
unhealthy, in that it kept Desi and Lucy from working together to solve their marital problems.
They were focusing on Ricky instead of each other. They needed to learn to communicate
effectively with each other about their needs, and about the balance of power and expectations
for each person in the relationship. Also, this triangulation was unhealthy for Ricky. He was
being put in the middle of their fights and felt that he needed to take sides, causing him to act
out. He was also being asked to be his father’s best friend, taking on too much emotional
responsibility for his father, that did not allow him to be a regular teenager with his own friends.
The therapist and family continue to meet, using systemic and narrative therapy theories and
techniques to effect change.
10
References
APA Dictionary of Psychology. (n.d.). American Psychological Association. Retrieved June 12,
2022, from https://dictionary.apa.org/referral
Dallos, R., & Draper, R. (2015). An introduction to family therapy: Systemic theory and practice
(4th ed.). McGraw Hill
Dallos, R., & Vetere, A. (2003). Working systemically with families: Formulation, intervention
and evaluation. Taylor & Francis Group.
Palazzoli M. S., Boscolo, L., Cecchin, G., & Prata, G. (1980). Hypothesizing - Circularity Neutrality: Three Guidelines for the Conductor of the Session. Family Process, 19(1).
https://doi.org/10.1111/j.1545-5300.1980.00003.x
Watzlawick, P., & Weakland, J. H. (1977). The Interactional View: Studies at the Mental
Research Institute, Palo Alto, 1965–1974 (1st ed.) [E-book]. W W Norton & Co Inc.
What to Know About Genograms. (2022, February 14). Verywell Mind. Retrieved June 11, 2022,
from https://www.verywellmind.com/what-is-a-genogram5217739#:%7E:text=The%20genogram%20uses%20different%20symbols,about%20inte
ractions%20between%20their%20relatives.