SYSTEMIC MODEL
Question- Describe your understanding of a specific systemic model demonstrating both the theory and practical application through a family or couple of case you have applied it to.
INTRODUCTION
While various analysts show an inclination for adopting different models as part of their therapy, the most prominent is the psychoanalytical model and the systemic model. The former is a more clinical approach while the latter looks at developing strong bonds within groups to help the patient deal with the trauma and face the various issues on hand. The systemic model is thus seen as a more proactive approach as it addresses issues within the group. The group may be a small one like a family unit or a larger one like a local community. The size of the group would depend on the issue being handled using this method. Systemic models are increasingly used to handle matters like illness, particularly in children that have been caused by factors beyond the control of individuals, illnesses due to acute reactions, illnesses caused by environmentally hazardous industries and exposure to hazardous substances, and so on.
Palliative care groups are classic examples of systemic models being used to handle life-threatening illnesses. These systemic groups are known to help deal with emotional and physical changes that may be either long-term or short-term. The idea behind such groups is not to sympathize but rather to empathize not just with the patient but also with his or her family unit including extended family, friends, and colleagues. Unlike psychoanalysis, the systemic approach does not focus on past causes or attempt to diagnose. Instead, the focus remains on the identification of stagnant behavioral patterns within the group. Once identified these patterns are addressed directly regardless of the root cause analysis. Thus, the systematic approach may be seen as a means of dealing with change either physically or emotionally or even both. The changes would impact the thought process, growth, and outlook of the individual patent as well as his dear ones.
STRUCTURAL APPROACH IN SYSTEMIC MODEL
Designed by Salvador Minuchin, the structural approach takes a close look at both family relationships and the behavior of members. It is one of the more frequently used and preferred forms of family therapy (Dorfman, 2014.) The behavioral patterns are identified during the therapy session and are used to evaluate the family structure. Siblings, as well as Parental subsystems, are also evaluated as part of the process (Goodtherapy.org, 2017). This method focuses on a structured group like a family unit to implement the systemic approach. The case being discussed also focuses on this approach, with the patient’s mother and grandmother being the focus of the structural approach. The ease with which the patient identifies them and looks forward to the interaction with them is seen as a positive influence and hence is encouraged. Since the same rapport is not evidenced in any other relationship within the family unit (brother, sister, or their families), the structural approach is limited to two members, viz. the patient’s grandmother and mother.
KEY CONCEPTS OF STRUCTURAL THEORY
Some of the key concepts of structural theory that form the basis of this case study include the concept of individuals, family unit, and their boundaries. Individuals are only fragments of their family unit and cannot be considered in isolation (Dorfman, 2014). They impact each other both emotionally and behaviorally. The patterns that are created as a result of their interaction form the basis of the structural approach to family therapy. The rules within the family may be implicit or explicit and need to be adhered to so as to ensure that the family structure is maintained. This helps to ensure strong family traits like nurturance, growth, stability, and change within the family unit (Dorfman, 2014). This system adapts on its own and ensures continuity for the family as a whole. While individual boundaries may have been defined, as the family unit attempts to cope with the changes in its external or internal environment these boundaries may collapse and create stronger bonds between the family members (Dorfman, 2014).
ANALYSIS OF CASE STUDY
· Patient description: A young male with a low IQ.
· Patient history: The patient has been abused by both their grandfather and older brother. The mother’s and grandmother’s knowledge about the abuse or their role in the same is currently unclear. He has constantly lacked stability during childhood and has lived in several care homes.
· Family Background: While the sister has come to terms with her trauma and is now leading a normal life, his brother continues to be unable to handle a family of his own. He has, therefore, had to give up on his children who are being brought up by other family members.
· Childhood: A traumatic childhood, the patient has been abused by figures of authority, viz., grandfather and older brother, since a young age. He has also been subjected to the knowledge of his grandfather’s abuse of his siblings. His inability to make any changes in the status quo is a considerable burden that the patient has been bearing from a very young age and may be considered to have been a contributing factor to his present behavior.
· Childhood Influences: The patient has seen the close relationship between his mother and grandmother. He wishes to replicate the same and this could be the actual cause for his need to be in a close relationship with his grandmother and mother.
· Observations about the patient: Admitted to the Forensic ward of a low-secure learning disability hospital, the patient has no contact with the family but wishes for a stronger relationship with their grandmother and mother. His behavior may stem from the fact that he may have felt that a strong relationship with his mother or grandmother would have helped him to talk to them about the abuse he faced in childhood. He is prone to getting sexually excited when watching children’s T V. This behavior forces authorities to restrain him from watching it. He has been categorized as a High-Risk Patient, particularly around children, and is always escorted by a staff member though he is allowed one home visit per month.
· Behavior of mother: She is struggling to build a therapeutic relationship with the patient as well as the authorities. She is seen as highly volatile and tends to tolerate the fact that her child is not making any progress merely because he is hindered by various restrictions being placed on him. She is unable to reconcile herself to her child’s risky behavior among children. She has not attended any meetings focusing on the care or the treatment of her sick son for more than a year now.
POSSIBLE IMPACT OF MOTHER’S OR GRANDMOTHER’S BEHAVIOR ON THE PATIENT
The patient has been exposed to the closeness exhibited between his mother and grandmother. He feels the same closeness lacking in his relationship with both maternal figures, his mother and grandmother. Having been abused since childhood by both his grandfather and elder brother, he feels inadequate in social situations. He is traumatized mind attributes the abuse he faced as a child to the lack of closeness with his mother and grandmother. He now wished to remedy this and looks forward to interacting with them. The mother’s lack of understanding with regard to the severity of sexual arousal seen in the patient under various circumstances is a catalyst that further supports the need for spending more time with her (Goodtherapy.org, 2017). The lack of awareness of the continuous assault on all three children is a highly negative finding against both the mother and the grandmother who should have shown a much higher awareness of the surroundings to which young children in their care were being subjected to. This unexplainable behavior has resulted in warped behavior for both the patient and his brother (Mikulincer et al., 2002). Interestingly, the structural approach of family therapy would help the family to renew and strengthen their bonding with each other (Dorfman, 2014).
POSSIBLE IMPACT OF GRANDFATHER’S OR BROTHER’S BEHAVIOR ON THE PATIENT
The behavior of the elder brother and the grandfather has both resulted in the creation of a complex feelings in the patient. On one hand, the sexual abuse has cleared a clear apathy towards them. The child’s tender mind sees the culprits as evil and insists on distancing the child from both the grandfather and the brother. Being the object of abuse, he now views all children with the same mindset and thus gets sexually aroused when in a similar situation.
POSSIBLE IMPACT OF SISTER’S BEHAVIOR ON THE PATIENT
The sister has coped with the abuse better than both the boys. She has married and now raises two children of her own. A huge positive for herself, she is an excellent example of overcoming childhood trauma associated with sexual abuse and moving on with life. Unfortunately, the patient is not able to come to terms with this ideology and hence chooses to distance himself from the situation. This manifests as a tendency to avoid his sister and her family. Thus, the patient shows no attachment to any other member of the family other than his mother and grandmother.
POSSIBLE IMPACT OF PROXIMITY TO OTHER CHILDREN ON THE PATIENT
The proximity of other children triggers sexual arousal in the patient. This also leads to aggressive behavior that either results in the patient getting hurt or hurting other children despite being under treatment. In many instances, he is not subjected to prosecution merely because he has been identified as mentally unfit and is being under treatment for the same.
POSSIBLE SOLUTIONS THAT WOULD HELP THE PATIENT
The systemic approach using the structural theory would be highly advantageous as can be evidenced by various similar cases. Members of the group work together so as to improve not only their inter-relational experience but also their individual well-being, thus ensuring a win-win situation for concerned parties (Goodtherapy.org, 2017). The emotional bonding within the family unit is seen as a touchstone for the patient, who would respond to the emotional stimuli. True and lasting healing comes about with intervention from the family unit. It is believed that this approach is more practical and would be a considerable help for the patient to overcome his trauma, thus navigating to the mainstream of society with ease. However, for the success of this model, each and every member of the family must wholeheartedly commit themselves to the various changes in their lifestyles (Sexton, 2012).
MODE OF TREATMENT
Family therapy through a systematic approach works on the notion that the emotional health of individual members forms an integral part of family relationships. Thus, coping with various types of traumas and stress, including psychosexual issues become easier through family therapy (Counselling-directory.org.uk, 2017). The structural approach to family therapy has been observed to be highly effective in handling cases of abuse in children. Since individual members are considered along with the issue on hand, this mode of therapy is seen to be beneficial for persons from different socio-economic backgrounds. This approach is recommended for use for persons from diverse families as well as all age groups (Counselling-directory.org.uk, 2017).
The creation of a Genogram is the first step in the treatment process when using the structural approach in family therapy. This is followed by group counseling sessions involving the entire family unit. The Genogram uses graphs to draw a detailed map of a family tree and includes hereditary traits and patterns as well as the various psychological factors that form the basis of any relationship within the family unit. Understanding the operation of the emotional system is essential for the effective use of the structural approach in family therapy (Olson, Russell and Sprenkle, 2014). The Genogram helps understand the underlying characteristics of individual members as well as their relationship with each other and the group dynamics that influence various behavioral patterns in the family (Counselling-directory.org.uk, 2017). Understanding the balance between the various behavioral patterns is easier using the Genogram
THE ADVANTAGES OF THE STRUCTURAL APPROACH IN FAMILY THERAPY
The systemic approach focuses on the manner in which close groups, including families, communities, couples, and organizations are instrumental in helping identify various patterns of behavior in individuals as well as identify the root cause of many issues being considered (Counselling-directory.org.uk, 2017). This initiative helps the individual participant not only understand but also adapt themselves to prevent such issues from arising in the future (Stanton and Welsh, 2012). The structural model lays emphasis on the manner in which family units help victims overcome their relationship dilemmas and handle the various issues that they are facing (Sexton, 2012). The focus is on the family as a whole finding a solution with the help of a family counselor.
The effectiveness of using the structural approach has been subjected to various clinical trials, particularly among populations of substance abuse and psychosomatics (Lindblad-Goldberg and Northey, 2013). This approach has been found to not only be relevant but also a comfortable option for the patient as well as his family (Dorfman, 2014). In this situation, the patient is expected to respond positively to his family members over a period of time as he overcomes his antipathy to all others except his mother and grandmother. The relative impact that each member of the family has on the overall situation, including the ability to help the patient or victim is significant. This forms the basis of the structural approach seen in family therapy (Dorfman, 2014).
Therapists are of the opinion that just as the family unit helps the patient deal with the trauma of abuse, similarly, the family unit is affected by the events (Dorfman, 2014). This may in some cases be reflected as a tightening of the familial bond between the members of the family unit (Vetere, 2017). In the case under discussion, the structural approach would be helpful for the family to relate to one another. The entire case rests on the manner in which the three children handled the abuse they were subjected to, without any intervention from another adult. All three children exhibited three different behaviors to help them to overcome the trauma. Unfortunately, only one child, the sister of the patient was able to come out of the abuse-inflicted trauma and go o to live a normal life. While the patient ended up in the forensic ward, the elder brother who is a paradox, was on the receiving as well as the giving end of abuse and tried to lead a normal life which went on to become a catastrophic failure with even his own children being taken care of by family members.
CONCLUSION
The ability to see the entire system is considered essential for the success of the systematic model (Stanton and Welsh, 2012). The family is viewed as an emotional unit and hence this approach focuses not on individual healing, but rather on the involvement of the entire family in the healing process. Thus, the victim does not feel ostracized. The family handles the conflicts that arise from this situation as a unit and this helps ensure that the trauma being faced by the victim is not kept under wraps by other members of the family (Goodtherapy.org, 2017).
REFERENCES
Counselling-directory.org.uk. (2017). Family/Systemic Therapy - Counselling Directory. [online]
Dorfman, R. (2014). Paradigms of Clinical Social Work. 1st ed. London: Routledge.
Goodtherapy.org. (2017). Family Systems Therapy. [online]
Goodtherapy.org. (2017). Systems Theory / Therapy. [online]
Lindblad-Goldberg, M. and Northey, W. (2013). Ecosystemic Structural Family Therapy: Theoretical and Clinical Foundations. Contemporary Family Therapy, 35(1), pp.147-160.
Mikulincer, M., Florian, V., Cowan, P. and Cowan, C. (2002). Attachment Security in Couple Relationships: A Systemic Model and Its Implications for Family Dynamics. Family Process, 41(3), pp.405-434.
Olson, D., Russell, C. and Sprenkle, D. (2014). Circumplex Model. 1st ed. Hoboken: Taylor and Francis.
Sexton, T. (2012). The challenges, focus, and future potential of systemic thinking in couple and family psychology. Couple and Family Psychology: Research and Practice, 1(1), pp.61-65.
Stanton, M. and Welsh, R. (2012). Systemic thinking in couple and family psychology research and practice. Couple and Family Psychology: Research and Practice, 1(1), pp.14-30.
Vetere, A. (2017). Structural Family Therapy. Child and Adolescent Mental Health, 6(3), pp.133-139.
