6. Join the System - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Kelissa and Breland have a nine-year-old Soni.  Soni has been throwing temper tantrums that have gotten progressively worse.  She will scream at the top of her lungs and hit Kelissa and/or throw things around.  She has always been difficult.  Kelissa and Breland separated six months ago but are trying to reconcile.  It was an angry separation.  Breland blames Kelissa for the separation… and for Soni's behavior.  Kelissa believes that if Breland would cooperate, it would really help Soni.  Breland does not see a problem with how he deals with Soni.  The initial assessment of the family and couple checked for any potential child abuse issues, domestic violence, and Soni being a danger to hurting herself.  The therapist ruled out organic or medical or physical issues in the initial interview along with medical examinations reported by the parents.  Various DSM diagnoses were considered for Soni:

Attention Deficit Hyperactive Disorder

Oppositional Defiant Disorder

Dysthymic Disorder

Adjustment Disorder

Intermittent Explosive Disorder

While the various diagnoses had arguable application to the behavior, they are essentially description without direct implication for treatment.  DSM diagnoses also are focused on individual pathology or disorders, specifically making A systemic assessment in this case was more compelling to focus the therapy on the family and in particular, on the couple:

Ineffective parental coalition

Poor executive subsystem

The three family members have formed an unhealthy triangle

Soni fused with her father Breland forming an opposing union coalition

Breland asserts he is on the weaker of an inequitable relationship with Kelissa, while actually maintaining greater power and control

Soni disengaged with mother Kelissa

Rigid boundaries

Power inappropriately lying with Soni

In structural family therapy, a valuable goal often is to disrupt the negative functional cycle of the family.  Kelissa and Breland have been in ongoing conflict for years and Soni has become an intricate part of the dysfunction.  Therapy tries to bring out healthy parts of the family members that are not currently being used.  "The therapist connects with and amplifies the competent aspects of each family member, and leads the family in having positive interactions in the therapy session (Diamond & Siqueland, 1995)" (Pruitt, 2007, page 74).  Therapy has three general goals:

1. Restructure the Family's System of Transactional Rules:  
For example, by creating a family map and observing and evaluating (or through an interview process) the family/system in action, the therapist can work to break-up the triangles and coalitions and shift the power, as needed.

2. Establish Appropriate Boundaries:
Depending on the structure of the family/system, the therapist will strengthen the parental executive system (parents or in organizations, the administration), mark boundaries between the sibling (staff) subsystems, or resolve conflicts and reestablish appropriate boundaries.

3. Create an Effective Hierarchical Structure:
Reestablish strength in the executive (parental) subsystem.  The therapist joins with this subsystem by functioning with it and staying in charge of the family system.

The therapist needs to join with the system.  He or she needs to be accepted by the relationship, couple, or family system in a position of authority in order to reorganize the system in a more functional manner.  "Structural therapy posits that for therapy to be effective, the therapist needs to form a new system with the family group (family plus the therapist system).  In order to do this, the therapist relies on techniques of accommodation and joining.  Accommodation is said to be the process of adjustment of the therapist to the family members, which includes:

a) planned support for the family structure i.e., offering support for what is going well, and helping to create changes in structures that will work;

b) carefully tracking the content and process of family interaction; and

c) accommodating to the family members' style and range of affect through mirroring.  

Joining refers to those actions of the therapist aimed directly at relating to family members.  The therapist must therefore be aware of taking sides, and must offer support at times when being confrontational.  This emphasis on the importance of the therapeutic relationship recognizes its potential as a vehicle for therapeutic change" (Vetere, 2001, page 135).

The therapist can use maintenance to join the system by supporting Kelissa as parent in her stated desire to control her daughter.  The therapist validates that they cannot go on.  The therapist can do this even if he or she feels that Kelissa has a control issue of her own that affects the dynamic.  The therapist will see Kelissa alone to reinforce that she can do something.  The therapist also sees Breland alone to reinforce his sense of being right.  For the time being, the therapist accepts the designation of Soni as the identified patient.  Tracking also helps the therapist join the system.  The therapist listens actively to Kelissa describing the behaviors of Soni and Breland, responding with reflective remarks, supporting her values, her assessment, her frustration, and that her goals are appropriate.  The therapist comments supportively on her attempts to discipline Soni and engage Breland.  The therapist encouraged Kelissa and Breland's attempts to set limits with Soni's tantrums.  He or she also reflects compassion to Breland when he describes his frustrations being separated and living away from home.  Mimesis also facilitates therapist acceptance by the system. The therapist copies or mimics Kelissa and Breland's communication styles, language, and body language.  If Kelissa speaks in a frustrated tone, the therapist replicates the frustration.  If Breland sags with hurt, the therapist mirrors that back to him verbal and non-verbally.

ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
(510) 614-5641 or (510) 582-5788
fax: (510) 889-6553
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