Systemic insight in family therapy

Systemic epistemology calls for a concept of Systemic Insight, a restructuring insight that has to do with truly grasping systemic reality. Systemic Insight is action and change-oriented, grounded in the direct systemic experience of the client, and based on the how instead of the why of the relationship problem. Its results affect the whole system. The author elucidates the definition and therapeutic application of this concept, expanding on five major ingredients and illustrating in a verbatim case and commentary specific guidelines for designing interventions which procure Systemic Insight.The concept of Systemic Insight was first presented by the author as a workshop at the European Family Therapy Association International Congress: Feelings and Systems, Sorrento, Italy, November, 1992. I would like to thank Ms. Sara Iwanir, Dr. Haviva Ayal, my co-directors, and especially my husband Ron for his unending support and the helpful out of the profession fresh views.     

Systemic change in limited family therapy

Some families present with so many problems and disordered family processes that where and how to begin is an extremely important question. When premature termination of therapy also appears likely, a family therapist may simply attempt to initiate a structural change within the family system so that the family can continue on its own. This article describes the responses of a highly chaotic family to such a single therapeutic intent.     

Psychological attachment,no-self and Chan Buddhist mind therapy

The role of Chan Buddhism for mind therapy is distinguished from psychotherapy by the objectives in diminishing or removing the deluded perceived self and the psychological self of attachments and cravings, which are considered as the more basic origins for psychological suffering and problems. The Buddhist concepts of impermanence, no-self and emptiness are discussed to explain the Buddhist explanation for human suffering. A four-stage theory is described to explain the common Buddhist meditation experience toward the realization of no-self. Removing psychological attachment is found to be of explanatory value for many enlightenment episodes of Chan masters. Meditation concentration and reduction of self-attachment will mutually reinforce each other toward a complete therapy of the mind. An innovative approach for psychotherapy in going further to tackle a person's basic life attachments is suggested.     

Liberating narratives and the play of unforbidden pleasures: In brief dynamic therapy

Drawing upon the work of Adam Phillips and Ronald Britton the author highlights the intimidating and fear-inducing nature of the super-ego and the role of the therapist in supporting the judgements of the ego and liberating it from the domination of the super-ego. He goes on to explore the proposition that moral principles do not need to be oppressive in nature and that they can emanate from objects that are more akin to sexual or aesthetic objects. These themes are linked to Woodmansey’s conceptualistion of the punitive and humiliating super-ego, and the origin of the super-ego as an internalisation of an external conflict is outlined. The role of identifying a Cyclical Maladaptive Pattern as a focus and its contribution in identifying the super-ego and how it manifests in the client’s narrative are explored, as well as the crucial contribution of a playful stance on the part of therapist in subverting and undermining the intimidating strictures of the super-ego.     

Cross-cultural perspectives: implications for attachment theory and family therapy

Cross-cultural perspectives have always been useful for understanding behavior. They clarify the distinction between aspects that are essentially part of the human condition and those that are the most responsive to variation. The interesting article by Rothbaum and his colleagues is in that tradition, contrasting the cultural values and family patterns in Japanese society with those of Western cultures, including our own, and suggesting that these differences shape the nature and course of attachment. It stimulates questions about what we have taken for granted in our theories and in our evaluations of dysfunctional behavior.     

The crucial roles of attachment in family therapy

This paper's aim is to enable family therapists from whatever approach to address family attachments during their work. It explores the role of attachment in the family, and how to enable therapists to increase security in the family so that family members can solve their own problems during and after therapy. The article gives a brief overview of the nature of family attachment relationships and the influence of secure and insecure attachments within the family and their narrative styles. This is described in language that a therapist might readily hold in mind and share the ideas in dialogue with families. The paper discusses the interplay between insecure attachments and other family problems, such as parental conflict and disagreements over authority. It also discusses ways of establishing a secure therapeutic base and the influence of the therapist's own attachment style. The implications for family therapy practice are described and illustrated by work with a specific family.     

Children's narratives and well-being

Research with adults indicates that writing causal-explanatory and emotionally disclosing narratives of stressful experiences is related to psychological well-being. Limited research with children has shown mixed results, but developmental theory suggests that simple extrapolation from adult findings might be problematic. In this study, 9- to 13-year-old children engaged in three days of writing under emotional and non-emotional instructions, and completed measures of depression, anxiety, strengths and difficulties, and somatic symptoms both at baseline and 2 months following intervention. Narratives were coded using a developmentally appropriate, exhaustive coding system. Children in the emotional writing group wrote more about negative evaluations, problems, emotions, explanations and coping than children in the non-emotional writing group. However, those children who wrote more about negative evaluations, problems and explanations subsequently showed higher levels of anxiety, depression and difficulties. Due to limited narrative and emotional regulation skills, expressive writing may not benefit, and may even be detrimental for, some children.     

Attachment and family therapy: clinical utility of adolescent-family attachment research

The divide separating research and clinical work is narrowing. New therapies have been informed by research from specialties such as developmental psychology and developmental psychopathology. In this article, we attempt to illustrate the usefulness of research on attachment relations for family-based therapy with adolescents. We examine the clinical utility of adolescent attachment research within the context of multidimensional family therapy, an empirically supported treatment model that has incorporated developmental research, including basic research on attachment, in its assessment and intervention framework.     

Representations and narratives during pregnancy

In this paper, we explore how maternal representations, and in particular their contents, are structured during pregnancy. Twenty-three primiparous women were recruited for participation in a longitudinal study about mothers' thoughts and feelings about their infants. A semistructured interview was conducted with each of the subjects in the third trimester of pregnancy. During the interview, subjects were also given five adjective lists based on the semantic differential model. Results from this sample indicate similarities in the content-free aspects of representations of self and baby, but differences in the content of these presentations. Implications of these results are discussed with regard to the construction of an internal representation of the child in the third trimester of pregnancy.     

Trauma narratives and emotional processing

The present study examined the relations between indicators of emotional processing (e.g. trauma narratives), posttraumatic stress symptoms, and psychological distress in two military samples (N = 120) exposed to significant training accidents. Trauma narratives were collected at 2-3 weeks, while outcome measures (e.g. IES-15, PTSS-10, and GHQ-30) were collected at 2-3 weeks, and 4 months after the accidents. Emotional processing was indexed by the content of positive and negative emotional expressions in the trauma narratives. The results showed that positive emotional expressions were associated with lower levels of psychological distress, whereas negative emotional expressions were linked to trauma specific symptoms and psychological distress at 2-3 weeks. Negative emotional expressions explained between 6-8% of the variance in trauma specific symptoms at 2-3 weeks, and 11% of the variance in psychological distress symptoms at 4 months after the traumatic event.     

Systemic family therapy can be manualized: research process and findings

Determining the efficacy of therapeutic interventions is becoming an increasing political and ethical necessity. Comparative therapeutic outcome trials are most powerful when there is a precise specification, or manualization, of the forms that therapies took. Manuals have begun to be developed for structural/behavioural family therapy and couple therapy. The development of these manuals is often reliant on experts' self-report, rather than a systematic analysis of the therapeutic process as it happens. This can limit their validity and applicability to standard clinical practice. In addition, no manuals exist which reflect less structured forms of family therapy aimed at incorporating systemic, postmodern and narrative frameworks. The feasibility of producing a workable manual that reflects the fluidity of such practices has been questioned.
A research project to systematically create and test such a manual is reported. Multiple data sources and research methods, primarily qualitative, were applied to generate a rich specification of the therapy. In reporting these results the contents of various aspects of the final manual are indicated. Procedures to ensure that the prescribed practice is consistent with a widely used approach to systemic family therapy are also described.
The manual will be an important tool for outcome research and therapeutic practice. The account of the research process should be helpful to researchers engaged in constructing a manual for other models of family therapy based on a rigorous analysis of actual practice. The manual itself is available for use by outcome researchers who wish to evaluate this widely used form of systemic family therapy.     

Addiction as an attachment disorder: implications for group therapy

This article presents a perspective on addiction that not only substantiates why group therapy is the treatment of choice for addiction, but also integrates diverse perspectives from 12-step abstinence-based models, self psychology, and attachment theory into a complementary integrative formula. Attachment theory, self psychology, and affect regulation theory characterize addiction as an attachment disorder induced by a person's misguided attempt at self-repair because of deficits in psychic structure. Vulnerability of the self is the consequence of developmental failures and early environmental deprivation leading to ineffective attachment styles. Substance abuse, as a reparative attempt, only exacerbates that condition because of physical dependence and further deterioration of existing physiological and psychological structures. Prolonged stress on existing structures leads to exaggerated difficulty in the regulation of affect, which leads to inadequate modulation of appropriate behavior and self-care and increased character pathology.     

个体依恋特征的二重性：特质性依恋与状态性依恋

传统依恋理论认为个体依恋心理和行为模式具有相对稳定性, 但无论在信息加工还是个体发展过程中, 个体依恋模式均表现出二重性, 即既具有相对稳定性, 又具有情境敏感性。个体在情境中所表现出的依恋模式是个体相对稳定的特质性依恋和情境特征相互作用的结果。依恋启动研究中特质性依恋特征与依恋启动效应之间的交互作用模式为理解依恋二重特征及其关系提供了窗口。依恋系统激活的两阶段模型为整合和解释这些相互作用模式提供了框架。未来研究应优化依恋二重特征关系研究中启动效应的操作检验, 考虑依恋焦虑和回避维度的交互作用, 关注高焦虑群体内的依恋差异, 以理析依恋二重特征之间的相互作用方式, 同时关注依恋策略影响依恋启动效应的时间进程, 探究依恋二重特征相互作用的机制。     

A comparison of attachment outcomes in enactment-based versus therapist-centered therapy process modalities in couple therapy

Attachment issues are viewed by many therapists as lying at the heart of couple distress. It is critical to empirically validate therapy processes that facilitate couples in responding to each other's attachment needs. This study examined enactments as a therapy process and change mechanism to promote secure attachment in couple therapy. Sixteen couples were randomly assigned to 1 of 2 experimental groups--1 group received 3 therapist-centered sessions followed by 3 enactment-based sessions, and a second group received 3 enactment-based sessions followed by 3 therapist-centered sessions. To measure between-session and within-session change, each spouse completed presession and postsession measures of attachment security each week. Results showed that couples who received enactment-based sessions first reported greater increases in attachment security than those receiving therapist-centered sessions first. These same couples continued to show improvement after switching to the therapist-centered sessions. Conversely, couples who received therapist-centered sessions first did not increase attachment after switching to enactment-based sessions. For wives, enactment-based sessions produced the greatest improvement in attachment, yet both therapy process modalities led to some improvement. Conversely, for husbands, attachment improved only when they received enactment-based sessions first. Enactment-based sessions may therefore be more important for husbands than wives. Overall, with some qualification it appears that enactment-based therapy process may improve attachment more than a therapist-centered process. These observed trends and findings are generally consistent with previous research supporting use of enactments in couple therapy.     

Becoming a teller of tales: associations between children's fictional narratives and parent-child reminiscence narratives

Previous research has revealed a connection between the contributions parents make while reminiscing and their children’s narratives for personally experienced events. The current research expands the literature by focusing on the connection between parental reminiscing and children’s production of fictional narratives. After 4- to 9-year-olds and their parents reminisced about past shared events, the children (with an experimenter) produced narratives based on wordless picture books. The results revealed that the overall quality of the fictional narratives was correlated with parents’ provision statements that emphasized orientation and evaluation in the reminiscence narrative. For younger children, correlations held for reminiscence narratives about recent events. For older children, correlations held for reminiscence narratives about events from the distant past. The results are consistent with the suggestion that children learn general storytelling skills from adult models.     

Attachment narrative therapy: integrating ideas from narrative and attachment theory in systemic family therapy with eating disorders

This paper proposes that recent developments in attachment theory, especially the move to the study of representations, offers some helpful new directions for systemic family therapy. Some of the findings of a close association between early attachment experiences and the coherence of the narratives are reviewed. It is suggested that this offers a useful link for systemic approaches in showing how early interactions in families promote not only particular emotional attachment patterns, but also shape the content and style of the narratives that are formed. These implications are then explored in the context of work with anorexia nervosa. It is suggested that commonly observed patterns, such as avoidance of conflict and apparent difficulties in discussing relationships and feelings, is consistent with transgenerational experiences of insecure/avoidant attachments. Some implications for systemic therapy with families are outlined and an illustrative case study is offered.