Conclusion: Therapy Temp Exec System - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Roles, Rigidity, Repair, and Renovation in Relationships and Therapy
CONCLUSION: THERAPIST AS TEMPORARY EXECUTIVE SUBSYSTEM
by Ronald Mah





While effective therapeutic style may come from the therapist's individual preferences, they may also be from cultural or family training.  Although the therapist will often have favored therapeutic strategies and theories and a comfort zone for his or her personal style, he or she should remember he or she is doing the client's therapy- not his or her own therapy.  The therapist should be sensitive to the habitual or preferred styles of the clients.  That however is not to say that the clients' habitual or preferred styles are inherently healthy or functional.  Some clients are very comfortable and respond well to a client-centered or evocative approach that may have little therapist structure or feedback.  The therapist may initially accept the client's style in order to join with the system.  Client-centered or non-directive therapies, however may be too vague or permissive for clients, couples, or families where there has not been appropriate operational boundaries, roles, and relationship structure.  Many clients arrive in therapy having experienced problematic relationship, couple, or family compositions, abuse, and substance or behavioral abuse or addictions and have fundamental difficulties maintaining healthy boundaries on their own.  They have already failed at establishing healthy boundaries and may find a passive therapist suggesting they set their own boundaries to be disappointing.  Such therapy may exacerbate the sense of uncertainty and anxiety from not having safe and secure containment from disruptive, invalidating, insecure, and unsafe relationship, couple, or family dynamics.

The therapist is the enlisted expressed patriarch or matriarch of the relationship, couple, or family in need.  If he or she does not step in as the functional leader as expected, the relationship, couple, or family may remain in chaos.  The therapist risks being recruited to become enmeshed in the system as other members are already are.  Allowing the relationship, couple, or family to behave as normal (beyond for initial observation and assessment) without intervening allows the relationship, couple, or family to continue to function in pain.  The relationship, couple, or family system may already be dysfunctionally permissive.  After being accepted into the system, the therapist may need to unbalance the system equilibrium through assertive entry and interaction.  Individuals used to functioning in a permissive system often have difficulty finding and holding structure and coherence.  As a result, they would probably be receptive to more direction from the therapist as long as the direction is sensitive to their needs and allows for expression. Some clients may prefer and benefit from a more structured and therapist directed process.  They may immediately defer to the authority of the therapist and overtly ask him or her to tell them what to do.  The authoritarian oriented client may in fact be more than receptive to a directive approach.  A Thai or other individual, couple, or family as discussed earlier from authoritarian traditions or personal experiences for example will often expect and respect an authoritarian therapist role.

When relationship, couple, or family characteristics or presenting issues indicate using a structural approach, the strong directive therapist voice can offer stability, predictability, and consistency to systems that have been functioning as anarchies.  The therapist should direct attention and change where problematic roles, porous boundaries, and unhealthy coalitions harm partners or members individually and the relationship, couple, or family as a whole.  Asserting boundaries, empowering the executive subsystem, breaking triangulation, and facilitating appropriate alignments may help challenge enmeshed or disengaged system structures.  However, the therapist runs the risk of being too dictatorial if not attentive to the specific qualities and challenges of the client, couple, or family.  The therapist should take care not to apply structural therapy and principles (or any other theory/therapy) prescriptively as some clinical panacea, or he or she runs the risk of duplicating a dysfunctional rigid family system.  Since a relationship, couple, or family may already be disengaged, the therapist's disconnection to individual and system uniqueness and needs could further systemic dysfunction.  With sensitivity to clients, the therapist becomes authoritative rather than becoming an authoritarian voice that may get caught up in conflict and battle for control battle with an authoritarian client.

The sensitive and authoritative role of the therapist is often appropriate from a structural perspective.  The individual's psychic system or system of the couple or the family has become dysfunctional in part from a lack of effective leadership.  The superego or rational part of the individual has not kept the emotional, perhaps the impulsive part under wraps.  The executive subsystem or the parental dyad or the parent has become ineffective in the family.  In the couple, the balance of roles and power is not working for each partner.  The individual, couple, or family is essentially out of control, and needs someone to provide control before it spins irrevocably into a death spiral.  The authoritative therapist becomes the temporary executive subsystem to provide transitional leadership for the system.  A therapeutic parent to the individual, couple, or family, the therapist facilitates healthy development, problem-solves, teaches, and prepares for and allows for independence away from therapy.  Essentially taking the leadership role in therapy is comparable to parenting children to functional healthy independent adulthood living.  The therapist takes control with client permission to use structural principles to change organizational patterns.  Problematic communication patterns and styles of communication that cause neglect or harm behaviors are targeted for alteration.  Structural changes in relationships shift each person in the system and his or her experience.  With changes in roles and boundaries, the relationship and members reduce or eliminate emotionally and psychologically harmful symptoms.  The therapist entry as a leader into the individual's intrapsychic system or the relationship, couple, or family system changes the structure immediately.  He or she uses this position to make individual, couple, or family members aware of behavior, situations, individual roles, and how choices are made to facilitate change.

Not all individuals, couples, or families need a therapist to step so assertively, influentially, and even manipulatively into the relationship.  Clients who respond well to an authoritative voice because of family-of-origin models and/or cultural models may be receptive.  On the other hand, some couples or families benefit from a more facilitative or reflective therapist or a therapist as a psycho-educator or as a consultant.  However, the ones that are out of control may most benefit from a therapist with strong structural and understanding and directive skills.  This would include individuals, couples, or families where there is emotional, physical, or sexual aggression (including but not limited to behaviors warranting breaching confidentiality to report to legal authorities), affairs, substance and behavioral abuse or dependence, or other out-of-control or chaotic behaviors.  The therapist's ability to be flexible and sensitively adapt his or her role to set appropriate boundaries for changing circumstances in client, couple, and family presentation is highly comparable to structural conceptualization of the needs of the functional or clear family system.  In addition, the therapist when considering structural principles with a relationship, couple, or family should be reminded again that the principles from other theories for relationship satisfaction and health, such as from Gottman: sharing of power, accepting influence, communication, respecting each other, deep friendship, and knowing each other and the details of each other's lives, are compatible with structural theory guidance.  The therapist may work with individuals, couples, and families from and apply therapeutic strategies and interventions from other theories. The therapist would find the principles of structural theory inherently expressed in other theories/therapies' successful outcomes for individuals, couples, and families: clear effective hierarchy of authority; well-defined roles, prescribed and actuated channels of communication, appropriate and respected boundaries; appropriate alignments; growth, well-being, and satisfaction of all family members; mutual advancement of community and family; and achievement of developmentally appropriate needs and goals of the relationship, couple, or family unit.  As such, structural principles working with clients may be indicated as primary or as contributing strategies as circumstances demand.  It will be up to the in-session assessment and clinical intuition of the therapist.

The dog Chipper being out of control or somehow a big… that is, bigger than expected part of the family may be the first of many clues that there something wrong with the structure of those clients.  Canine and human roles somewhat confused hint at authority, nurturing, caretaking, and discipline roles possibly also out of whack.  Inability to flex boundaries about feeding people food from the kitchen table and Clipper sleeping in the bed indicate rigidity while blurring of boundaries distinguishing canine versus human intimacy.  Closeness gets complicated indicating enmeshment.  Rigid and enmeshed extremes in any area can indicate dysfunctional coalitions among human members: between two intimate partners or among family members.  The therapist becomes the facilitator of reparative processes for addressing problematic or broken dynamics.  Sometimes, the relationship or intimacy structure is weakened or harmed and can be restored to better health or functioning.  Therapy accentuates the good and effective, further facilitate healthy recovery and growth.  Ineffective and harmful structure and boundaries are minimized and if possible, eliminated.  However, repair may not be possible.  Sometimes, the relationship structure or boundaries may be inherently corrupt.  Repair to restore prior functioning may not be indicated if earlier models were never that healthy.  Old boundaries were never effective or appropriate.  Relationship habits learned in the family-of-origin and replicated in new intimacies never led to mutually healthy reciprocal nurturance and support in the past or the present.  Coalitions formed perpetuated unhealthy dynamics and lead to a family member painfully excluded.  Inordinate and exhausting energy is spent maintaining the relationship, couple, or family, but never achieves any real stability.  The frailty of the relationship or system keeps everyone on edge and periodically explodes in sometimes destructive force on intimates.  Rather than repair the relationship structure, the therapist becomes the therapeutic contractor that helps the individual, couple, or family renovate or remodel the relationship fundamentally.  Feeding Chipper human food or not… letting Chipper sleep in the bed or not… whatever!  Feeding one another emotionally and spiritually or not, or letting everyone express authentically and be in a secure mutually beneficial relationship- that is, out of the dog house and home or not- these are the goals of relationship and of therapy that can be served with structural conceptualizations and strategies.  

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