From the earliest conception of westernised family therapy in the mid to late 20th century, where directive, structured models dominated practice and literature, to the shift to neutrality and curiosity, where systemic theory started to become more mainstream, through the safe and sometimes unsafe uncertain times of constructionism, to the present day, where appreciation of past and present are coming together, exciting and ultimately useful concepts abound.
Paramodernism, and Pocock’s advocacy of Critical Realism (the recognition that both real and constructed contributions to family functioning multiply interact), opens renewed access to an already open door. Taking psychodynamic theory as an example, which pre-dates systemic family therapy in evolution yet lives on today; this can be spotted weaving its influence over the decades, sometimes in disguise and sometimes for only its stark absence.
Contemporary archaeology offers systemic therapy a compelling example of paramodernism. Instead of an early 20th century team just looking at a recently unearthed clay pot and wondering what its visual appearance and proximity to others reminded them of, many different disciplines are now brought together. Geophysics and soil science, carbon dating, knowledge of cultural artefacts, stories and other evidence provided from ancient documents and carvings, pollen analysis, human DNA from local populations, etc. – each had evolved in independently of one-another, but would now be combined to deepen any 21st century archaeology’s approach to understanding the pot.
Far less boldly, in 1985 the 1st edition of Integrated Family Therapy had brought together three theoretical models then in current vogue which for the ten years before had been largely practiced separately. Minuchin’s Structural model, with its account of family boundaries, subsystems and explorations of emotional closeness and distance, was incorporated into other family domains (roles, behavioural management and family affect-regulation) that had been deconstructed by the McMaster group in Canada. As we describe elsewhere, a further layer of the model had taken key defensive and relational themes from the psychodynamic model.
For example, psychodynamic theory had not been taught to structural family therapy trainees in Philadelphia, nor to those learning the McMaster model in Hamilton, Ontario (although many of their trainees were quite familiar with psychodynamic concepts). Those training in London had been taught primarily from a psychodynamic perspective; structural concepts became of interest until these were trumped by strategic ideas. This type of development ultimately often led to ‘either/or’ positions, where working from only one perspective or from another did not sufficiently reflect the complexity of family difficulties.
So the 1st edition’s integration of models had brought some synergy and a genuine celebration of multiple perspectives, capturing more of the complexity of emotional and behavioural functioning within families. Integrating the models had mattered because, however valuable each were, the sum of each does not equal the whole.
This edition of Integrated Family Therapy holds on to this fundamental framework of ‘both/and’ positions, and assimilates additional perspectives taken from the many developments over the thirty years since the 1st edition was published. This includes:
- McGoldrick’s emphasis on the family life cycle
- Byng-Hall’s focus on Inter-generational attachment patterns and family scripts
- attention to Burnham’s Social GGRRAAACCEEESSS, which considers power and privilege in therapeutic relationships
- consideration of therapeutic safety and Mason’s position of Safe Uncertainty as optimal for therapeutic change.
And as well, concepts from the postmodern years broaden the scope of the model into an even greater appreciation of the complexity of family functioning:
- Narrative Therapy recognizes the power of language on the construction of meaning within families and how dominant family and social stories can negate under-developed strengths and possibilities for change.
- Constructivism, which emerged within Solution-Focused Therapy, reminds us that individual and shared emotional states and therefore hope, creativity and optimism can be constructed and developed within families with carefully formulated, sequential questions.
Finally, we also take account of recent dramatic developments in understanding from epigenetics and neuroscience. For example, Seigel’s work of interweaving brain-based development and reactions to external and perceived (relational) stimuli. Integration of models would not be complete without taking account these important contributions to our knowledge-base. So these too can be brought into family psychotherapy thinking and practice in considering how to create space within families for planes of new possibility.
This edition of Integrated Family Therapy therefore explores family functioning at multiple levels:
- the broad structure of families and its impact on health and social functioning
- the detail of behavioural and emotional regulation patterns within families
- the way in which defensive and relational intra-psychic mechanisms are enacted within ‘here and now’ family dynamics, sometimes linked by neurologically-based chains of association to adverse historical experience
- the understanding of how intergenerational patterns and lifecycle transitions impact on family wellbeing
- how power, language and socially constructed meaning can create or block opportunities in families for change
- and how systemic family therapy practice can influence the development of positive emotional states that enhance motivation for change; and how all of this for better and for worse impacts on mind and brain, and vice versa.
Inevitably, every therapist will privilege different aspects of the Integrated model, at different times and with different families. Without an awareness of which domains they are most and least comfortable and what is required to stretch their therapeutic ideology, the unique combination of need that each family brings to therapy is unlikely to be fully, or even adequately, met.
Multiple positions are particularly useful, even vital, to work with complex family relationships. The heuristic value of the kaleidoscope of ever-changing harmonies and nuances an integrated approach offers, compared to the spurious precision provided by any one perspective, lies in the multiple contributions brought to sense-making. That is, the formulation that arises after first contact facilitates clarity of thinking and purpose rather than confused problem-solving.