Systemic Psychotherapy
Individuals can only be understood _________________________________.
System –
Wholeness –
Boundaries –
Systems require methods for controlling and maintaining organization.
Homeostasis –
Controlled adaptation –
Feedback loops – most important control mechanism
positive feedback loop – increase in one behavior leads to increase in another;
negative feedback loop – increase in one behavior leads to decrease in another;
The patient is no longer an individual – the patient is the system (the family).
Communication/Strategic Therapy
Communication is the key to understanding human behavior. All behavior is communication. We cannot NOT communicate. Even silence is communication.
Theory of Psychopathology
Psychopathology
- is an

- often results from a
- is most likely w
5 Axioms of communication:
1. It is impossible to not communicate.
2. Communication implies a commitment and defines the nature of the relationship.
- report –
- command –
3. The nature of a relationship is dependent on how communication is punctuated.
4. Humans communicate verbally and nonverbally.
5. All exchanges are symmetrical or complementary.
-symmetrical – equality between partners
-schism –
-complementary –
Therapeutic Process
Goal: help family communicate more effectively.
Consciousness Raising
Focus on here and now
Become aware of dysfunction
Relabeling or reframing
Prescribing the symptom
Reductio ad absurdum

Choosing
Therapist gives paradoxical instruction and family can choose to cooperate or rebel. o If they act out symptom o If they rebel
Catharsis
Learning to express emotions more appropriately.
Types of people based on feelings they omit: o Blamers – o Placaters – o Super-reasonable – o Irrelevant communicators –
Many people express one emotion to cover another
Therapeutic Relationship
Must start with accurate empathy, positive regard, genuineness
Then therapist is active and direct
Therapist is in control of the new system
Practicalities
sessions last 1.5-2 hours
lots of videotaping, observation, supervision
fees per session not per person
sometimes must identify an IP for insurance
Structural Therapy
Theory of Psychopathology
Most concerned with what maintains psychopathology, not what caused it.
Focus on structure of system and subsystems

o o o
Focus on boundaries around system and subsystems
Two major pathological structures o Disengaged – o Enmeshed –
Therapeutic Process
Consciousness Raising
The therapist does most of the work
Therapist reframes individual problem as family problem
Enactments –
Choosing
Family members choose to attend sessions and be attentive
Therapist joins the family o
Accommodation – maintaining structure by supporting subsystems
Mimesis – matching communication patterns
Marking boundaries – drawing structure and then correcting problems
Blocking technique – change patterns of communication by blocking one member
Therapeutic Relationship
Joining creates empathy and rapport so that family can tolerate challenges.
Practicalities
Room should be large and seating should be flexible
Full family should be present
Just parents seen occasionally
Metachange – teaching family to change current and future behavior