Systemic Perspective of Family Life

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The conception and early development of family therapy began in the 1950s (Burnham 1999). Therapists began to examine families in terms of the interactions between family members. The individual's symptoms were seen for the first time as being rooted in family patterns of interaction. The family is seen as a system and therefore what happens to one family member has a direct effect on the family as a whole.

Any organisation including families, schools, hospitals, or the local doctor's surgery can be defined as a system (Altschuler 2005). A system is made up of parts which interact with each other and the sum of the parts is different from that of the whole. The importance of balance so that the system is stable, therefore, makes systems susceptible to change. This is sometimes referred to as homeostasis, and indeed there are structures in place to counteract change. Systems always aim to maintain existing patterns of interactions and ways of living.

The value of using a systemic approach is that it focuses our thinking on interactions between family members. Interventions using this approach are designed to strengthen the family's own capacity to resolve issues.

It is generally accepted that a family needs flexibility in managing the demands of a family member having a life-threatening illness. Palliative care practitioners offer a range of supportive care to underpin the family's own coping patterns, but some families may have limited flexibility because of their structure, they may be isolated, living miles from their families of origin (e.g. asylum seekers or refugees) or they may have lost flexibility because they have been caring for a long time. These are families where a family therapy approach may be helpful. Family interventions aimed at helping families are usually brief, focused and, importantly, leave families feeling competent. One example of such an intervention has been recently pioneered in Australia and in the USA: Family-focused grief therapy.

Family-focused grief therapy is a new model of intervention that has been used successfully with families using palliative care facilities (Kissane and Bloch 2002). This therapy relies on screening a family's functioning and identifying those who are at risk of morbid outcome. The importance of the interventions which have been rigorously researched are that they value strengths and identify coping that exist within the family.

I will now address some specific elements from systemic theory which are useful in understanding how families function. These are: open and closed systems, boundaries, belief systems and family scripts.

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