ABSTRACT
INTRODUCTION The word ‘systemic’ has entered popular discourse in a similar way to Freudian concepts, such as unconscious drives and catharsis. It derives from general systems theory, which became one of the guiding conceptual frameworks for family therapy. However, it has a wider range of application than families and is increasingly been used to consider patterns and processes within organizations such as the National Health Service (NHS) in terms of the interactions and problems within and between different services and professional groups. For the medical professions and psychiatry, there are significant issues regarding their power relationships to other professionals and referrers. Interestingly, many of the pioneers of family therapy were medically trained and specialists in psychiatry.1-5 It is perhaps worth speculating from the outset that the type of family therapy models they developed had a tendency to use more directive approaches to family therapy, which utilized their high status and power as physicians and psychiatrists. Later waves of family therapy that advocate more narrative, collaborative and non-directive approaches were developed by social workers.6,7
Family therapy has existed as a form of clinical intervention for a variety of conditions for about 50 years.8-10
Alongside the development of a variety of forms of therapeutic techniques and orientations, ‘the family’ has also continually been a source of social and political debate and intervention.11 More specifically, the concept of ‘the family’ has shifted and been the centre of great controversies over its desired nature and function. There have been dramatic changes in the structure and nature of family life, such that many children no longer grow up in the traditional nuclear family but live in reconstituted families with step-parents or homosexual parents or in adoptive or foster-care situations.11,12 There have even been dramatic attempts to remove the family and replace it with structures such as communes, collectives and kibbutzim.11 Although the debates and issues are complex and controversial, one important dimension has been the extent to which families are seen as the cause of problems – the family to blame – as opposed to the extent to which families are seen as a positive resource. These two aspects are not distinct, but social
policy and political rhetoric seem to revolve in cycles between the two extremes, for example increasing attempts to control families and their functioning. Some examples include the development of antisocial behaviour orders (ASBOs), parenting orders in the criminal justice systems, and forms of early intervention such as the Sure Start parenting and child programmes designed to help correct ineffective or destructive parenting. Sure Start and similar programmes attempt to help families to become a positive resource, but possibly they also carry an assumption that something is currently awry and needs repair. The alternative stance emphasizes potential and resources that families may hold and looks to factors that may block or impede this, for example social conditions, housing, ill-health, poverty and crime. This view fosters an orientation of working alongside families to help ameliorate these conditions and free them up to function well.
