Page 1 An Introduction to Family Therapy SYSTEMIC THEORY AND PRACTICE Third edition 09:28:10:03:10 Page 1 Page 2 09:28:10:03:10 Page 2 Page 3 An Introduction to Family Therapy SYSTEMIC THEORY AND PRACTICE Third edition Rudi Dallos and Ros Draper 09:28:10:03:10 Page 3 Page 4 Open University Press McGraw-Hill Education McGraw-Hill House Shoppenhangers Road Maidenhead Berkshire England SL6 2QL email: [email protected] world wide web: www.openup.co.uk and Two Penn Plaza, New York, NY 10121-2289, USA First published 2000 Second edition 2005 Reprinted 2007, 2008 First published in this third edition 2010 Copyright © Rudi Dallos and Ros Draper 2010 All rights reserved. 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A catalogue record of this book is available from the British Library ISBN-13: 978-0-33-523801-9 ISBN-10: 0-33-523801-7 Library of Congress Cataloging-in-Publication Data CIP data applied for Typeset by RefineCatch Limited, Bungay, Suffolk Printed in the UK by Bell and Bain Ltd., Glasgow Fictitious names of companies, products, people, characters and/or data that may be used herein (in case studies or in examples) are not intended to represent any real individual, company, product or event. 09:28:10:03:10 Page 4 Page 5 Contents List of figures xi List of tables xii Notes on the authors xiii Preface xiv Foreword xvii Acknowledgements xviii Introduction 1 Experiences of systemic and family therapy 1 A family’s view 1 Two therapists’ views 3 What is the ‘family’? 5 The family life cycle 7 Allowing the family a voice 9 The organizing framework of this book 10 Key texts offering a historical overview of systemic and family therapy 13 Setting the scene – 1950s 15 1 The first phase – 1950s to mid-1970s 26 Cultural landscape 26 Influential people and ideas 27 Seeds of systemic and family therapy 27 Systemic thinking – from intrapsychic to interpersonal 31 Systems theory – biological analogy 32 Emergent properties of a system 32 Circularities 33 Triads, triangulation and conflict detouring 36 Rules, pattern and process 38 Feedback 38 09:28:10:03:10 Page 5 Page 6 vi CONTENTS Family coordination through communication 39 Double-bind concept 39 Meta-communication 40 Open and closed systems 41 Family homeostasis 41 Family life cycle 42 Practice 44 Structural family therapy 44 Beliefs and structures 45 Therapeutic orientations 46 Directive stance 46 Strategic family therapy 49 Beliefs and premises 51 Strategic tasks 53 Commentary 55 Gender and shifting inequalities of power 56 Normative assumptions of life-cycle models 57 Key texts 58 Skill guides 58 Family sculpting 59 Family tree and time line 60 Reframing 63 2 The second phase – mid-1970s to mid-1980s 64 Cultural landscape 64 Influential people and ideas 66 Second-order cybernetics 66 Meta-communication 67 Communication 68 The person as private ‘biosphere’ 70 Intention 71 Beliefs and actions in triads 71 Ecological perspective – multiple systems 72 Observing systems 73 Practice 73 Hypothesizing 73 Reframing 74 Co-construction of shared histories 75 Commentary 76 Moral and political implications 77 Power 78 Milan approaches 78 Positive connotation 79 Key texts 80 Skill guides 81 Teamwork 81 09:28:10:03:10 Page 6 Page 7 CONTENTS vii Hypothesizing 82 Positive connotation 83 Circular questioning 84 Transformational change 85 3 The third phase – mid-1980s to 2000 87 Cultural landscape 87 Theoretical perspectives 88 Connections and links to the second and first phases of systemic family therapy 90 Influential people and ideas 91 View of the person – construction of experience 94 Practice 97 Brief solution-focused therapy 97 Reflecting teams 100 Narrative therapies 100 Externalizing problems 101 Writing 102 Feminist therapies 103 Power and the construction of reality 104 Culturally available stories 104 Commentary – feminist orientations 106 Key texts 107 Skill guides 109 Consultation 109 Externalizing the problem 110 Collaborative inquiry 112 Reflecting processes 113 4 Ideas that keep knocking on the door: emotions, attachments and systems 116 The role of emotions in systemic theory and practice 116 Emotions and early family therapy concepts 119 Triangulation 119 The double-bind 120 Emotions, escalation and couples’ interactions 121 Emotions, narratives and the language of emotions 123 Attachment theory 126 Family life cycle and attachments 128 Attachment styles and couples’ dynamics 129 Attachments: from dyads to triads 130 Trauma and loss 131 Attachment and meaning-making processes: beliefs and narratives 132 Integrations with psychoanalytic thinking 134 The therapeutic relationship 134 Defence processes and unconscious communication 135 09:28:10:03:10 Page 7 Page 8 viii CONTENTS Transference 136 Key texts 137 5 Systemic formulation 141 Cultural landscape 141 Systemic theory: assessment and formulation 142 The first phase 143 The second phase – progressive hypothesizing 145 The third phase 145 Example of systemic formulation 147 Genograms 148 The referral 149 Deconstructing the problems 150 Contextual factors 150 Beliefs and explanations 151 Problem-maintaining patterns and feedback loops 152 Emotions and attachments 152 Synthesis 153 Formulations: Mary and Janet 153 Commentary 154 Key texts 155 Skill guide 156 Systemic formulation 156 6 Twenty-first century practice development: conversations across the boundaries of models 159 Cultural landscape 159 Practice 161 Working with addictions 162 Working with post-divorce processes and contact disputes 167 Work in forensic contexts 173 Working systemically with attachment narratives – ANT: eating disorders 177 Psychosis and multiple family group therapy (MFGT) – Eia Asen and Heiner Schuff 183 Commentary 187 Formulation 187 Contexts 187 Patterns and processes 188 Multiple models 189 Key texts 190 7 Couple therapy 193 Cultural landscape 194 Marital or couple therapy 194 Recent legislation relevant to the cultural context 195 Other forms of partnership and legislation 196 09:28:10:03:10 Page 8 Page 9 CONTENTS ix Divorce and mediation 197 Influential people and ideas 197 Couple therapy approaches using a relational paradigm 203 Integrative therapy – the politics of passion 203 Emotionally focused couple therapy 203 The Gottman method 204 Imago Relationship Therapy 205 Relationship education for couples 206 Commentary 207 Key texts 210 8 Research and evaluation 212 Introduction 212 Why conduct research? 213 Evidence-based practice and practice-based evidence 214 Cost-effectiveness 215 Practice-based evidence 216 Science, research and systemic therapy 219 Varieties of research 220 Evaluation research: does family therapy work? 223 Meta-analysis 224 Group comparison evaluative studies 226 Evaluative case studies 228 Observational studies 229 Questionnaire and self-report studies 229 Therapy process research 230 A therapeutic process study 231 In-depth single case process study 231 Exploring the experience of family therapy 232 Family theory research 234 A participant observational study 235 Interview studies 235 A conjoint interview study 236 Case study series 237 Discussion and reflections 237 Key texts 238 Varieties of research 238 Family therapy outcome studies 239 9Reflections 2009 243 Current state of the art 245 Crystal-ball gazing 247 Developmental perspectives 247 Review and summary 248 Integrations 249 09:28:10:03:10 Page 9 Page 10 x CONTENTS Postscripts 251 Topic reading lists 264 Formats for exploration 317 Glossary of terms 333 British texts 337 References 342 Index 357 09:28:10:03:10 Page 10 Page 11 Figures 1.1 Circularity encapsulating a ‘peripheral father role’ 34 1.2 Linear vs circular causality I 34 1.3 Linear vs circular causality II 35 1.4 Conflict detouring in a work setting 36 1.5 A simple cybernetic system 37 1.6 The family life cycle: external and internal demands for change 43 1.7 Developmental influences on the family 44 1.8 Change in free fatty acid levels, the Collins family 47 1.9 Time line 61 2.1 Punctuation 70 2.2 Triangulation: parental conflict detouring through a child 71 3.1 Collaborative inquiry triangle 112 4.1 Relational and autonomous emotional discourses 123 4.2 Attachment as triadic process 131 4.3 A systemic summary of transference and counter-transference 136 4.4 A systemic summary of projective identification 137 5.1 Janet’s family genogram 148 6.1 Safety/certainty matrix 177 6.2 Escalating cycles in families with anorexia 180 8.1 Varieties of research methods 222 09:28:10:03:10 Page 11 Page 12 Tables 2.1 Varieties of contradictory levels of communications 67 8.1 Outcome studies of adult problems 224 8.2 Outcome studies of child and adolescent problems 225 09:28:10:03:10 Page 12 Page 13 Notes on the authors Rudi Dallos is a psychologist who has been involved in systemic family therapy for over 20 years. He was previously with the Open University where he had written various texts on family life and relationships. He is currently Programme Director and Professor in Clinical Psychology on the Plymouth University doctoral training course in clinical psychology. He is also an honorary family therapist with the Plymouth Child and Adolescent Mental Health Service. He teaches on several family therapy training courses and is extensively involved in research and supervision. He has writ- ten several previous books utilizing both his research and clinical experiences, includ- ing: Working Systemically with Families: Formulation, Intervention and Evaluation; Researching Psychotherapy and Counselling; Family Belief Systems, Therapy and Change; Couples, Sex and Power: The Politics of Desire; Interacting Stories, Narratives, Family Beliefs and Therapy; and Working Systemically with Attachment Narratives.