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Journal of Family Therapy (1992) 14: 1-14

0163-4445 $3.00

Family therapy without the family: a framework


for systemic practice,

Hugh Jenkins” a n d Karl Asen?

This paper contrasts the basic tenets of systemic thinking withsome


guiding principles of the psychodynamic approach, and outlines specific
techniques which family therapists can use when seeing individuals. It is
arguedthat a usefulsystemicframework can be maintained if the
therapist aims to keep the therapy system ‘open’ for relevant others to
join at any time.

Introduction: from individuals, to families, to individuals


T h e shiftfrom anintrapsychicindividualperspectivetoaninter-
actionalonewasanimportantdevelopment in
psychotherapy.
However, while emphasizing differences in how to think about people,
the pioneers of family therapy did not propose that therapists should
ignore the individual. For example, Ackerman (1966) stated: ‘Family
therapy can help substantially with some types of adolescent disorder,
as long as it is not viewed as total therapy’ (p. 21 1 ) . Minuchin’s work,
describing direct work with individuals as an integral component of
the therapy of severely disturbed patients and theirfamilies, supports
this thesis (Minuchin et al., 1978), while Haley (1971) introduces a
different perspective on work with an individual froma family therapy
perspective:‘Fromthefamilyview,whatwasonceconsidered
individual therapy is seen as one way of intervening in a family or
other natural group’ (p. 273). Systemic therapy is thus not a question
of how many people are seen, butrefers to the theoretical framework
which informs what the therapist does.
I t seems that from themid-1970s onwards, in the UK at least, work
withindividuals by family therapistsassumeda low profile. If
practitioners worked with an individual, they did not regard this as

* Institute of Family Therapy, 43New Cavendish Street, London WIM 7RG,


UK; and Department of Children and Adolescents, Maudsley Hospital, London SE5
8AZ, UK.
t Marlborough Family Service, 38 Marlborough Place, London NW8 OPJ, UK.
2 Hugh Jenkins and Karl h e n
‘family therapy’. To many family therapists it seemed wrong not to
see the whole family, even though the theory they were taught said
that change in any one partof a system would lead to a related change
in others. Such rigidity of thinking may have had something to do
with the process of establishing a new way both of thinking about
problemformationand of practisingtherapywhenfacedwith
opposition from proponents of traditional methods of working.
AtthesametimetheMentalResearchInstitute ( M R I ) brief
therapy group in Palo Alto, USA (Watzlawick et al., 1974; Fisch et al.,
1982) had developed an approach to working with individuals. This
group made the distinction between working with the ‘customer’, that
is the person(s) defining awish for change, and the ‘client’, being the
person(s) for whom change is wanted by others. The customer and
clientcouldbe,butoften arenot,thesameperson.Providingthe
therapistcan see thecustomer, for examplethe parent(s) witha
concern about a child, then from the MRI model it is still possible to
work systemically. Similarly,if the therapist has aclient under duress,
such as an adolescent‘sent’ by his parents, the therapist can maintain
asystemic focus providedshe is explicit aboutwho is asking for
change,andwhat will be a minimum sufficient change for the
individual no longer to have to see the therapist. Such a model does
not demand the presenceof the whole family, and supports systemic a
approach, providing the therapist always holds in mind who is the
customer.
However,somecriticshavearguedthatmanyfamilytherapists,
including for example Palazzoli (Palazzoli et al., 1978), have not only
lost the individual, but behave as though individuals were parts of a
mechanistic process, the powerbeinglocated inthe rules of the
system. Nichols (1987) argues strongly against this tendency. In the
preface to his book, The Selfin the System, he says: ‘My primary purpose
for writing this book is toremind family therapiststhat we are
working with persons not abstractions . . . it is important to analyse
the system and often to work directly with it. But change ultimately
works through individuals within thc system’ (p. xii). While Nichols
arguestheimportance of notforgettingtheindividual,thispaper
focuses more on practical ways of working with individuals from a
family, or more correctly, a systems perspective.

A framework for systemic practice with individuals


Theprimary concerns of systemictherapistsare with patterns of
Family therapy without the family 3
relationshipsin human systems,andunderstandingproblems in
context. Clients frequently feel that they have no choices in how to
deal with their problems, often perceiving themselves as the victims of
circumstance. C‘sually clients believe that if only others would ‘stop
behaving like this’, the situation would improve. Clients are rarely in
a position to appreciate their role in the perpetuation of difficulties, or
if they do, will profess themselves powerless to be different. Systemic
therapists focus oncreating newconnections
between different
patterns of relationships for the client as a first stage in developing a
therapeutic climate for change.
Figure 1 represents the developing focus of therapists who work
systemically with an individual. Not only will the therapist focus on
the present but also on the past in relation to the present, the present
in relation to difrerent points in the future, the past in relation to the
future, or the future in the context of the past. At different stages in
the therapeutic process, the focus may be on one time period more
than another. The therapist will try to help the client establish new
connections,thereby
introducingthe
possibility of alternative
solutions.
Figure 1 shows how therapists begin from the perspective of the
individual. The picture is broadened through a series of interlocking
questions about relationships. T h e client is asked how another person
views the‘problem’; how athirdperson views therelationship
between the client and the first person; how the client sees himself or
another significant person
in
relation
to the
problem,to
the
development of the problem, to the possibility of change, and to the
disappearance of theproblem.Systemictherapists,unliketheir
individually oriented psychodynamic colleagues, are interventive or
‘leading’ inquirers, attempting to introduce new ideas and ways of
looking at familiar concerns, rather than waiting for the client to ‘say
anything that comes to mind’ and then responding to this emerging
‘material’.
T h e major features of systemic therapy with a n individual can be
characterized asfollows. Therapists conduct the first, and subsequent,
sessions as an open therapy system, open in the sense that significant
others could join at any time. As long as this remains a possibility, a
very specific context for all further therapeutic venturesis established.
Sessions are conducted asif other people were present, or could be so.
Rather than fostering an exclusive therapeutic setting within which
intimacy, projection and transference are promoted and made use of,
systemic therapists and clients co-create therapeutic contexts which
4 Hugh Jenkins and
AsenKarl

THERAPIST-* INDIVIDUAL
1
DYAD
I
7 TRIAD -
I
I
GROUP
l
7’
I
I
MULTIPLE
CONTEXTS 7
I
I
1
I

I
-1 -
-

l l

~ TIME PRESENT TIME


PAST

Figure 1. This emphasizes the shift by the therapist from the individual to
his wider contexts. What it can only partly show is the interplay between:
one dyadic relationship and another; the individual and the family; different
dyads and triads; widersocialcontexts.Each of these permutations may
occur in relation to the past, present, or future.

also include the potential participationof the client’s real-life ‘objects’


or persons. It is mainly through the process of interactionally framed
questions that therapists define their position in relation to the client.
Other people are brought into the room as ‘ghosts’,encouraging the
clienttoconsideranother’s views about his dilemmas,as well as
connecting his symptomatic behaviour and the family’s responses to
it. If theproblem is locatedin a non-familycontext suchasthe
workplace, the therapist will relate her questions to that. However,
her approach might include asking for the client’s beliefs about the
possibleresponsestohisbehaviour ifkey family members were
Family without
therapy the farnib 5
available, or alive. In this way the client is encouraged to view his
problems in an (evenimaginary)interactionalcontext. The thera-
pist’s inquiringcuriosityhelpsorganizefamiliarways of viewing
difficulties within a new framework (Cecchin, 1987).

Asking questions
A major tool of systemic therapistsis the askingof questions which are
intended to lead the client to question the beliefs, expectations and
roles, for himself and for those around him (Penn,1985; Tomm, 1987a
and b, 1988). Systemic therapists might start by asking how the client
decided it should be just him who should attend for the interview.
Whom did he discuss it with? If he had brought his spouselpartnerl
parent, what might that person saynow? Would the client agree with
that response? If the client disagreed, what might the other person say
at this point? How would they settle this disagreement? Carpenter
and Treacher (1983) have addressed these questions as part of the
process of engaging the family in treatment.The particular emphasis
in this current paper is that it is just as importantto elicit the client’s
beliefs about others and his beliefs about their position in relation to
him, as it is to use this as an active focus for convening either the
family andlor the wider social or agency systems.

Case example l
T h e case of Amy P illustrates how a therapist, working systemically
withonepersonfromthestart,bringsthewidercontextintothe
interview.
Twelve-year-old Amy was referred toa child guidance clinic by her
G P because of a n ‘eating disorder’. T h e G Pmentioned in his referral
letter that Amy’s mother had come to see him on her own to voice her
concernabout Amy’s deliberate dietingand weight loss. She
apparently told her doctor that she was the ‘main worrier’ in the
family as her husband was often abroad on business trips. Amy is one
of three children. The therapist (male) sent an appointment letter,
addressed to the parents, inviting thewhole family to attend, ‘so that
we can get everyone’s views and ideas of the problem, and how to
help’. In the event only Mrs P came.
MRSP: I’m sorry it’sjust me, but my husband is very busy, andhe has a very
important meeting today.
TH.:I see . . . does he know you have come here today?
6 Hugh Jenkins and Knrl Asen
I

hlRs P: Well, I don‘t think I toldhim. He doesn’t believe in doctors and


psychologists and all that . . .
I ‘ H . : Supposing he knewyou had come here . . . what would his vicwsbe
about that?
M R S P: I really don’t know. He’d probably be cross and say that 1 worry too
much. Or maybe he’d say that it’s my ,job to make Amy eat.
T H . : If he said that, would you agree?
MRS P: I would not agree that I wc‘rry too much. She has lost a stone i n the
past month, and I think that she is worrying, don’t you think so?
T H . : I can see that you are worried and I know many parents who would be
worriedjust like you. So why is it, in your opinion, that your husband does
not share your concern?
MRS P: He thinks it’s my job to sort the kids o u t - the other two areall right.
James is fifteen and so competent, and Jane is terribly sweet. She just
turned six.
Th.: Who else in the family knows that you have comc here today?
MRSP: Nobody . . . I thought I’d just have a talk with you before dragging
the rest of the family here.
T H . : If other family members had come herc today-, what might they say the
problem was, and what help would they want? Why don’t you start with
Amy?
MRS 1’: Amy would say 1 fuss too much, that I just worry about nothing . . .
that there is nothing t o worry about . . .
TH.:And if your husband were here how would he respond to that?
MRSP: They would both gang up on me . . . H r would back her and I would
look silly. James would probably take my side . . . he is so responsible . . .
T H . : M’hen your husband backs Amy and \\hen your son sides with you . . .
what efkct dors that have on you?
MRS P: It’snotright. 1 feel crosswithmyhusband,buthewon’tlisten,
anything for a n easy time. It’s not right for my son to act more responsibly
than his father!
T H . : So is that something you want t o change?
MRS P: Yes, it’s wrong, it can’t go on like that . . .
TH.:How can you change that without your husband and the rest of the
family coming here?
> l R S P: I don’t know . . . I’m not surpriscd Am), won’t eat - I f k l likc going
on strike . . .
Within a few minutes the whole family drama has come alive in the
interview room. The other family members are almost present, a n d
alliances and conflicts are outin the open. T h e rest of the meeting was
spent getting Mrs P to consider (and rehearse) how to convince the
other family members to come to the next onc.
T h e following time the whole family attended and the thcrapist was
‘in business’. However, he would havc gone ahead with the meeting
Family therapy without the f a m i b 7
irrespective of howmanypeoplehadattended.Inthiscaseboth
process andcontentwouldhavevarieddependingonwhowas
present. Had Mrs P comeonherownagain,onemajorquestion
raised would have been:
‘How can I help your daughterif she does not come here?Do you want her to
get help? So what would you have to do or say to her for her to come?’

If mother and daughter had come together, the therapist would see
what the daughter could do to get her father involved:
‘What would you have to do to get your father to come to these meetings?
How much more weight would you have to lose before he would agree to
come?’

The therapist ‘accepts’ the system in the room. No matter whether


this is an individual, dyad, triad, or thewhole family, this acceptance
doesnotpreventhimfromquestioning,andgettingthefamilyto
question, the wisdom of not including other important parts of the
family system.

Discussion
This approach is significantlydifferentfromaone-to-onepsycho-
dynamic relationship where therapists relate the patient’s responses
to themselves. Instead, systemic therapists ask the client to consider
his dilemmas in relation to the people who are naturally involved in
his lifc. This could include asking:
‘Why might you not be able to say certain things if X or Y were present?’
‘What would happen if your wifelmotherletc. heard you say this?’
‘What might be the implication of feeling this way but of X not knowing
about it?’
‘How would the client behave if X knew?’
‘How could he tell X?’ and, ‘What might be Y’s response?’
‘How would that alter their relationships with each other?’

The therapist’s questioning is intended to help the clientview himself


ashavingoptions for change,examine his beliefs aboutothers’
imagined beliefs about him, and see himself and others as parts of a
wider interactional system than he may have at first imagined. The
familiar frameworks within which the client has operated until then
will beviewed in a different light, and new patterns of linkage be
established. It is hoped the effect of this will spill over into his home,
8 Hugh Jenkins
Karl and Asen
social, or worksettings,bothinterms of the specific dilemmas
addressed in the session, but also more generally to other areasof life.
Therapists will work with the effects of the client behaving differently
in his social context, using that level of feedback to construct new
questions and new interventions. T o underline these points, systemic
therapists will repeatedly question the client’s decision to bring issues
tosessions, ratherthantacklingand resolving themoutsidethe
session with the people with whom he is currently involved.

Case example 2
M r D’s wife participated only in the final three meetings, although
had she not, it is likely that therapeutic work would still have been
effective. The important point is thatthedoorwas left ‘open’ for
others to join at any point during therapy.
M r D, aged 53, was referred to a psychiatric out-patient depart-
ment by his GP, who stated in her letter: ‘Mr D has suffered from
depression for many years and this has created considerable tensions
in the marriage. I have discussed the possibility of marital or family
therapy with him and also separately, with his wife. She is adamant
that she does not w.ant to be involved in his treatment.’ T h e therapist
(male) decided to offer an appointment to M r D and the following is
an excerpt from the first meeting, some ten minutes into the session.

TH.: . . . and when you get really low, who is the first to notice?
M R D: Probably my daughter, . . . she is very sensitive.
TH.:What is it that she observes, you think, that makes her realize you are
low?
M R D: I don’t know . . .
TH.:I would really like you to imagine very hard, what it might be that she
observes that leads her to conclude that you are feeling low?
M R D: I suppose she notices the expressions on my face.
TH.:W h a t d o you think is it actually that she observes?
M R D: I probably look dejected, as if I am going to burst into tears. . . pace
up and down . . . I probably sigh a lot . . .
TH.:And then what happens? What does she do? What does anyone else do?
M R D: She tries to cheer me up. Sometimes she puts her arm around me . . .
TH.: And what happens then?
M R D: I feel awful.
TH.:More or less awful than before?
M R D: I don’t know . . .
TH.:When you feel awful in this sort of way, what is it that you do next?
Family theraFy without the f a m i b 9
MR D: I try to leave the room. I go to my bedroom.
TH.:And what happens then?
MR D: I think someone elsein the family comes and checks whether I’m
OK.
TH.: When all this happens, what is your wife doing?
MR D: I think she has given up on me. . . I guess that’s why the children are
so involved.
TH.:What is it that she does or says that makes you think that she has given
up on you?
MR D: She makes an angry face, or makes some cutting remarks, or she just
walks out.
TH.:Letmeaskyousomethingthatmaysound a bitstrange.Ifyou
deliberately wanted to upset her, what would you have to do?
MR D: . . . j u s t be bloody depressed and morose . . .
TH.:C a n you tell me about situations when you think she is more likely to
give up on you?
MR D: The more depressed I get, the more she withdraws. O r if I want her
to ring my employer to say that I am not feeling well . . .
TII.:And what about times when youfeel she is not withdrawing, when you
feel she might try and get closer to you?
MR D: When I take an interest in her work or her family or her silly friends
. . , but I’m too depressed to do that!

In this example the therapist accepts that, at least for the time being,
the patient is not the family but M r D, who is asked to look at himself
fromdifferentperspectives, andtoscrutinize family interactions
which involve him. A diary homework task requested him to observe
fluctuations in his mood over a week and note the circumstances and
peoplepresent. I n addition, by askinghimtosee his depression
through other people’s eyes he was gradually able to appreciate the
effect his depressive behaviour was having on those around him, as
well as seeing the effects that various family members’ responses were
having on his depressive symptoms. Identifying specific patterns of
interaction helped him to experiment withnew ways of behaving. For
example (Session 4):

TH.:Supposing you wanted to surprise your wife and do something quite


unpredictable . . . what would her reaction be?
MR D: I don’t quite see what you mean . . .
TH.:When was the last time you really surprised your wife?
MR D: You mean like dressing up?
TH.:Well, for example . . .
MR D: I haven’t done that for ages . . . I don’tthinkshewouldexpect
something like that . . . she’d think I’m off my rocker!
10 Hugh Jenkins and Karl Aserz
Supposing that was her response -what would you make of it - would it
‘I‘II.:
be a good thing or a bad thing if she thought that?
MR D: [Intrigued] I t would certainly be something different.

M r D then considers how else he could surprise his wife and begins to
predict her responses. After seven sessions M r D said that his wife had
expressed an interest in attending the meetings. Discussing the pros
and cons of acceding to this request resulted in M r D deciding to
involve her. Three further joint meetings took place, with both M r
and Mrs D stating that hc had ‘recovered from the depression’.
Therapists can continue to think and practise systemically as long
as they keep open the possibility of a ‘relevant other’ from the client’s
life comingtothe nextsession, as in theexample of M r D. The
moment this option is abandoned in the therapist’s mind, there is a
greater risk of therapist and client becoming trapped in a twosome
that will push the therapist to consider using herself as an agent of
change, and of assuming a pre-eminent role for the client.
Clients will, whether they wish toornot,attributeor‘transfer’
certaincharacteristicsontosystemictherapists. But whilst our
psychodynamicallyorientedcolleagueswould use thedeveloping
client-therapist relationship as the metaphor for addressing ‘outside’
relationships,systemictherapistsdeliberately refrainfrommaking
overt references to this, or from interpreting the transference. Even
whenworkingwithcouplesorfamiliespresent in theroom,there
always exists the danger of over-identification by one member with
the therapist (Carpenter and Treacher,1989; pp. 215-2 16), and while
i t is important to be aware of theseprocesses, it is notthedirect
material of therapy. It is the specific way of asking questions that
defines the stance of systemic therapists, and i t is the specific stance
systemic therapists assumein relation to their clients that allows them
to generate these questions.

Types of questions
T h e ways in which questions are constructed can be flexible, both in
terms of content, and in terms of time frame, ranging from the past
through the present to the future (see Figure 1): for example, ‘when
the problem began’, ‘the problem now’, or ‘when i t changes in the
future’. These three time frames can be placed within a hypothetical
perspective, as in: ‘If such and such had beendifferent in the past’, or
‘now’, or ‘in the future’, ‘how then might that affect . . .?’ In this way
Family therapy without the famil_y 11
relatedness is experienced anew and the client frequently states that
he had already thought about these issues, ‘but not like that’.
r 7

I he process of asking questions has been emphasized, along with


some possible pitfalls, The mere asking of different types of questions
in itself is not a suflicient technique. Questions must be related to the
client’s preoccupations, although differentenoughfrom the client’s
frameworktobegintoperturbandchallenge his beliefs about the
possibility of change. ‘The questions are therefore suggested by the
client’s responses; in this sense the questions are circular, being based
on feedback from the client.The thcrapist then expands the impactof
the client’s response in the way the next question is framed,
introducing other people, other time frames, other contexts, or other
consequences, and thereby creating other hypothetical contexts. ‘The
therapist will build on a word, phrase or concept suggested by the
client, and in this sense therapy cannot be planned in advance. It is
linked intimately to the internal processes of the session. The client
should feel that he is being very closely attended to, since so much is
constructed around what he says or does.
Finally, although we have concentrated on the process of asking
questions as a means of introducing new information into the system
and of promoting change, i t should also be mentioned that many of
thetechniqueswithwhichfamilytherapists will befamiliar are
helpful in systemic work with individuals.In particular, we frequently
use geneograms in ourpractice.Lieherman(1979)describes work
with individuals from a transgenerational perspective. We also use
family drawings with individuals (Jenkins and Donnelly, 1983); and
with younger patients, many of the approaches described by O’Brien
andLoudon (1985) are particularly helpful. Burns (1990)has
described his work using
family-centredcircle
drawings. This
technique lends itself well to the systemic therapist who is working
with individuals. We have used letter writing, although the lettcrs are
notsent,andthe client maywrite‘toand from himself,thereby
experiencing both perspectives (Jenkins, 1989). What these and other
techniques seem to do is help the individual gain some measure of
control over his dilemmas or problems, both by externalizing them
and by developinginteractionalcopingstrategies.Inthisrespect
there are clearly similarities in thinking and practice withGestalt work
andpsychodrama(Compernolle,1981),and with Tomm’s modifi-
cation of the Japanese Kan-No-Mushi (Tomm et al., 1990).
12 Hughand
,Jenkins Karl Asen

Indications and contra-indications for individual


systemic work
The indications are relatively easy. First, individual systemic work is
for
those
who haveno
immediate or
‘relevant’ social system.
However, it is often surprising how significant peoplc seem to emerge
fromnowhere if therapists keeplooking for them,challengingthe
apparent void. A second reason for seeing a client on his own, at least
initially, may bc his resistance to bringing the whole family. Insteadof
‘firing’ the client, and by implication his family, this resistance can be
seen asinformation, his way of ‘co-operating’ (deShazer, 1982),
requiringtherapists to engagetheclient so that his stancecan bc
challenged. This can allow for the possibility of con.joint family work
later if that seems useful.
Thereare specific contra-indications for systemic work with
individuals. In particular these include: when there is more than one
person designated as having problems in the family, whether by a
referrer or by one or more family members; when the family and/or
the referrer are asking for family therapy; and particularly when a
child is the referredclient. In thislatterinstance, we believe that
failuretoengagethefamily risks involving thetherapist in covert
alliances with the child. I t also makes it more likely that the more
powerful (adult) forccs within the family can undermine any changes
in the child. Montalvo and Haley(1973) have discussed some of these
dangers. In cases of physical or sexual abuse, individual work with the
child as part of the service offered will be indicated, and in some
instances may be the primary focus of treatment (Jenkins, 1989). How
one deals with theseissues, in relation to both families and referrers, is
beyond the scope of this paper.

Conclusion
Systemic work with individuals is fundamentally different from other
individualpsychotherapies,aboveall in that it emphasizesthe
openness of the therapeutic system. Within such a framework there is
little room for working with the transference which emphasizes the
crucial importance of a reference person inside the session and outside
the client’s natural social system. h‘hilst there are constant moves to
‘bridge’thevarioustherapies, often in thc name of somekind of
pragmatic eclecticism, there is a danger that in doing so the systemic
perspective is abandoned.
Family therapy without the family 13
The therapist who chooses to work systemically with individuals
must first be at ease in work with family groups, both at a conceptual
level, and in terms of interviewingskills.Systemicworkwith
individuals should not be viewed as the easier option. I t challenges
the therapist to hold a systemic framework, while working with the
intensity of only one other person in the room. The therapist must
constantly hold thctension between theindividualand his wider
social context if comfort and cosiness are to be avoided.

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