Systemic Theory
Includes the Systemic Theories:
- Strategic Therapy
- Mental Research Institute (MRI) therapy
- Milan Systemic Therapy
Process of Therapy
- Assess interactional sequence
- Interrupt interactional sequence
- Evaluate outcome to interventions
- Interrupt new pattern
Repeat until presenting issue is resolved.
Interaction Patterns
(Strategic/ MRI)
Involves identifying the earliest triggers or signs of the problem and tracing the increase in tension until the problem or symptom occurs.
Family Games
(Strategic)
Hidden power struggles within a family system.
“More of the Same” Solutions
Solutions that perpetuate the problem. In MRI Systemic Therapy, this term refers to the problem in families being a failure to appropriately respond to normal life circumstances, making the attempted solution to the problem the problem. Families falling into this pattern end up doing “more of the same” behavior, meaning that they do more of the failed solution as opposed to trying a different solution.
Strategic Conceptualizations
Five ways to think about a problem in strategic therapy; these dimensions can be used to conceptualize the role of a symptom in the family system or in an individual’s broader social world:
- Involuntary versus Voluntary
- Helplessness versus power
- Metaphorical versus literal
- Hierarchy versus equality
- Hostility versus love
Problems as Attempted Solution (MRI)
MRI systemic approach targets the attempted solution rather than the presenting problem.
Example: Rather than target a child’s tantrums by teaching parents how to employ positive and negative reinforcement, systemic therapists identify the class of solutions used by the parents and develop an intervention that represents a 180-degree shift. If the parents respond by becoming embarrassed and giving in, the therapist designs an intervention in which the parents are emotionally unaffected and consistent in carrying out consequences. On the other hand, if the parents typically respond with strict, harsh punishment, the therapist suggests an emotionally engaged and gentle approach.
Strategic Goals
Strategic therapy does not have a predefined set of long-term goals for individual or family functioning, other than to promote a change that alters people’s subjective experiences (mood, thoughts, and behaviors). The ultimate strategic goal is to help clients find ways to love without dominating, intruding upon, or harming the other.
Hypothesizing
(Milan Therapy)
This act is best described using the concepts of cybernetic feedback loops, for as the family’s response to the question modifies or alters one hypothesis, another is formed based on the specifics of that new feedback. This continuous process of hypothesis construction requires the therapist to reconceptualize constantly, both as an interviewer and team member.
Positive Connotation
(Milan Therapy)
Use to respect both the family’s fear of change and their request for change.
Paradoxical intervention
(Milan Therapy)
Involves instructing clients to engage in the problem behavior in some fashion, such as by assigning a couple to argue from 7:00 to 7:15 on Tuesday and Thursday.
Double Bind (MRI/Strategic) or Counterparadox (Milan)
The MRI therapeutic double bind is used to undo a double-bind message in a family or relationship; similarly, the Milan counterparadox is used to therapeutically respond to the paradoxes, or double binds, that families and couples create for themselves.
Systemic Reframing
Involves piecing together each member’s description of the problem and reframing it to reveal the broader systemic dynamic.
One-Down Stance
(Strategic/MRI)
Used to increase clients’ motivation, often paradoxically by the therapist claiming that they are not sure if they can help the client with their problem. This move is often helpful with clients who act as if their situation is hopeless; when the therapist takes the hopeless stance, the client is motivated to find hope.
Invariant prescription
(Milan Systemic Model)
An intervention that is not varied across families.
Example: Parents are instructed to arrange to go on a date (or other outing) and to not tell the children where they are going or why. The desired effect is to create a secret between the parents, ending inappropriate coalitions by creating a clear boundary between the parents as a unified team and the symptomatic child.
Directives
Used in both strategic and MRI approaches, directives are behavioral tasks that the therapist gives to clients to alter their interaction patterns.
Straightforward directives
Are used when the therapist has the power and influence to get people to do what is asked. Most straightforward directives aim to change the way the family interacts by introducing new action.
Indirect directives
Are used when the therapist has less authority in the eyes of the client. Indirect directives generally take the form of paradoxical or metaphorical tasks.
Circular Questions
(Milan Therapy)
Are perhaps one of the most useful techniques when working with more than one person in the room. Such questions help assess and make overt the overall dynamics and interactive patterns in the system, thereby reframing the problem for all participants without the therapist having to verbally provide a reframe.
Ordeals
(Strategic Therapy)
Used in strategic therapy when the client feels helpless in controlling a symptom such as overeating, smoking, nail biting, and drinking. The ordeal need not be directly related to the undesired activity, but it often has a metaphoric relation to it.
Larger Relational Systems
Systemic counselors always view a person as inherently part of:
- Family of origin (mother, father, siblings, extended family)
- Family of procreation (spouse, partner, children, stepchildren, etc.)
- Social communities (e.g., church, neighborhoods, online communities)
- Broader societal groups (e.g., gay/lesbian communities, ethnic communities, state, nation, etc.)
Nonpathologizing Position
Not blaming persons within the system or the system itself for the symptoms. Instead, symptoms are viewed more neutrally and with curious enthusiasm.
Respecting and Trusting the System
Systemic counselors respect the system of which the client is a part and view it as an entity that has its unique epistemology or way of knowing and understanding the world. Fully and humbly aware that they do not have direct control over a system, systemic counselors have an abiding trust that the system will reorganize itself in new and better ways without the counselor forcing the change.
Circular Questioning (Milan)
Used to ascertain family members’ differences in perspective about the family’s situation, particular events and the relationship within the family. Helps family members understand that not everyone shares the same beliefs about the family.
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DSM-5-TR Diagnosis104
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Mental Status and Clinical Assessment52
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Law, Ethics, and Crisis47
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General Treatment, Tx Planning, and Termination32
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Systemic and Cybernetic Foundations38
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Strategic and Systemic Theories35
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Structural Family Therapy35
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Intergenerational/Bowen Therapy31
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Experiential-Satir Family Therapy22
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Emotionally Focused Couple and Family Therapy22
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CBT/CBFT41
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Rational Emotive Behavioral Therapy25
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Dialetic Behavior Therapy (DBT)19
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Psychodynamic Family Therapy22
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Attachment-Based Psychotherapy (Psychodynamic)28
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Object Relations Therapy26
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Self Psychology20
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Postmodern: Narrative & Solution-Focused41
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Person-Centered Therapy (Carl Rogers)21
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Gestalt Therapy (Fritz Perls)19
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Family Development Theories35
