MFT Systemic Formulation 7 page APA format

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The Signature Assignment for this course will be an application of concepts explored throughout the course, and Module 6 in particular. To the best of your ability, briefly explain how an MFT would conceptualize Three Phases of Systemic Formulation in the context of your own family or a family you know well. Details can be fabricated if necessary. Use initials to identify members. This is a clinical, objective, observational analysis of the family system, explained in a third-person narrative. The genogram can be created in Word or drawn by hand and scanned in, but it must be included in the paper. Be sure to define and explore the following:

Explain the following examples of Systemic Formulation and how they are used: Genograms (construct one for your own family—a genogram is three generations deep)

The referral Deconstructing the problems

Contextual factors

Beliefs and explanations Problem-maintaining patterns and feedback loops Emotions and attachments

Synthesis

Attached is a chapter of systemic formulation. PLEASE USE IT TO UNDERSTAND THE ASSIGNMENT

Writing Guidelines Must be double-spaced with 1-inch margins and typed in 12-point Times New Roman. Proofread for spelling and grammar. You must cite all sources used, including page numbers to avoid plagiarism.

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Page 141 5 Systemic formulation Copyright © 2010. McGraw-Hill Education. All rights reserved. Cultural landscape As we have seen, systemic therapy offered a way of looking at problems and distress that differed from other approaches. Instead of starting with the person and his or her internal states as the initial focus, systemic family therapy saw distress and problems experienced as intimately bound up with relationships. As it has evolved there have been changes and shifts with systemic therapy as to how we explain problems, from problems in structures and patterns in the first phase to meanings and culturally shared language processes in the second and third phases. But how does such understanding or theory lead to our clinical practice? Increasingly in the psychotherapies there has been an emphasis on ‘formulation’ (Eels 1997). This is broadly definable as the process of putting together an understanding of the difficulties, combining information about the problems, observation, conversations with the family together with theory, clinical experience and the therapist’s own personal experiences. This formulation essentially puts together a local theory about the causes of the problems, what is maintaining them and what might assist in facilitating change. Formulation therefore helps to offer explanations, but also ideas or guides for action. This emphasis has also been spurred by the various guidelines that have evolved on good clinical practice, for example the National Institute for Clinical Excellence (NICE 2001) guidelines which stress the need for clear assessment and choice of treatment informed by clinical evidence. At a simple level this can become an attempt to match the treatment to the type of problem based on the research evidence. In practice it is much more complex than this and formulation embodies the idea of fitting the treatment closely to a detailed exploration with families of their problems. Formulation also helps to clarify communication and understanding between various professionals and between them and the family. Importantly, formulation offers an alternative to psychiatric diagnosis. It offers an understanding based on psychological processes including thoughts and feelings and the impact of environmental events. In part, the roots of formulation can be traced to ideas regarding the ‘function’ of symptoms, for example in the behavioural therapies and in the process of ‘functional analysis’ (Slade 1982) and also in psychoanalytic Dallos, R., & Draper, R. (2010). Introduction to family therapy. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2018-10-20 09:20:35. 09:28:10:03:10 Page 141 Page 142 Copyright © 2010. McGraw-Hill Education. All rights reserved. 142 A N I N T R O D U C T I O N T O FA M I LY T H E R A P Y theory, for ideas such as the defensive function that a symptom was seen to be serving (Freud 1958). This attempt to look for active psychological factors in the causation and maintenance of problems offers a contrast to diagnosis and diagnostic systems such as DSM (American Psychiatric Association 1980) and ICD. Though subjected to extensive critiques (Boyle 1990; Johnstone 1993) these still continue to be extensively employed in most mental health settings. This offers the challenge to those of us not wishing to acquiesce to notions of illness or disease as the basis of problems to be clear and convincing in the alternative explanations that we are able to offer. It is increasingly becoming recognized that formulation needs to be a collaborative process whereby the therapist and family work together to co-construct a shared understanding of the difficulties. In effect, both the therapist and the family have their formulations. For example, many families come to us with forceful ideas influenced by medical theories, for example, that their child ‘has’ ADHD and this is what is causing the problems. Moreover, as we will also see in the next chapter, formulation typically takes place in a context where colleagues work together who may hold quite different theories and ideas about problems. For example, psychologists, psychiatrists and social workers frequently work alongside each other in clinical work with children. In order to facilitate communication it is important to be clear and explicit about what their different understandings and explanations may be. Often in family therapy teams our experience has been that though we share a systemic perspective there are layers of differences shaped by our particular professional base. Formulation allows each team member to hold their own variation of a formulation regarding a family or system but also to move towards an understanding of points of agreement and, importantly, disagreement. The latter can then be employed as useful and creative tensions rather than covert feelings and later obstacles to cooperative work. In this and the following chapter we want to outline a model of systemic formulation that offers a map to guide and encourage systemic thinking. As we will discuss in the following chapter, systemic thinking is not predominantly the application of specific techniques but a way of thinking about problems and difficulties. One of the major developments of systemic therapy has been the extension of such thinking not only to different family problems and configurations but also to the relationships within and between organizations and agencies. Systemic theory: assessment and formulation The initial model guiding systemic family therapy came from general systems theory, especially the notion of self-governing systems. The key concepts in the model were of problems as resulting from processes over time, of circular as opposed to linear causation, escalation and interconnected systems and subsystems. The emphasis in the first and second phases was on making ‘objective’ and ‘scientific’ assessments and formulations. The family was seen as an entity ‘out there’, which could be accurately described and assessed. The purpose of formulations was to be able to map the nature of the dysfunction and subsequently develop corrective interventions. A range of standardized tests measuring family function were developed, among them the McMaster, Family Adaptability and Cohesiveness Evaluation Scales (FACES) and circumplex models (Olson et al. 1979). The aim was to assess Dallos, R., & Draper, R. (2010). Introduction to family therapy. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2018-10-20 09:20:35. 09:28:10:03:10 Page 142 Page 143 Copyright © 2010. McGraw-Hill Education. All rights reserved. S Y S T E M I C F O R M U L AT I O N ‘dysfunctions’ of family structure and process. For example, a family might be seen as lacking a clear hierarchy and decision-making capacity in the parental subsystem. Alternatively, they might be seen as caught up in a process whereby attempts by either parent to take control would be met by the other parent siding with the child. These formulations of dysfunctional structure and process would then guide the interventions specifically targeted to correct these. Systemic theory has evolved since its inception in the 1950s from a theory centred on a biological metaphor of families as homeostatic systems to one of families as ‘problem-saturated’ linguistic systems. Symptoms are seen as problems in interaction and communication between people rather than as existing within persons. Importantly systemic approaches have increasingly come to regard all aspects of therapy as interactional and collaborative processes. Formulation, therefore, is not seen as something that the therapist does to the family but as something that he or she does with the family. The process of formulation is seen not as an objective process but as a set of perturbations which starts to change the family system. The questions that are asked, when and how they are asked and ensuing conversations can potentially prompt significant changes in families. Systemic therapists thus make less of a distinction between assessment, formulation and intervention. It is tempting to aspire to promote schemes of assessment and formulation which set out clear and detailed guidelines that clinicians can follow, especially when the dictionary definition of formulate is ‘to express clearly and exactly’. While it may be helpful to contemplate developing such maps, efforts to produce clear maps reveal the complexity of the task involved. However, we suggest that formulation contains within it core conceptual, psychological and philosophical issues relating to therapy. Most fundamentally, we are compelled to consider the meaning of what we consider to be a problem or symptom. Historically, family therapy has been critical of medical models and instead offered an interpersonal model of the causes and maintenance of problems. Significantly, it has also become increasingly critical of medical and pathologizing processes (White and Epston 1990; Hoffman 1993; Dallos and Draper 2000). Within this framework family therapy offers a critical position in that it endeavours to question the potentially oppressive assumptions that may be made about family members and which family members may have been ‘conscripted’ into holding about themselves. The first phase Function of a symptom A cornerstone of early systemic thinking was that symptoms in families served a function of stabilizing a family system. In many ways this appeared a counter-intuitive idea since the established view was that the symptoms were the very thing that was causing the distress and unhappiness in the family. Don Jackson (1957) was the first to state clearly that a family with serious problems could be seen as if it was a rigid or homeostatic system. Examples of this could be seen in accounts of how the removal of a patient from a family into a psychiatric unit could be followed by another member of the family developing some difficulties as if to maintain the status quo of the family Dallos, R., & Draper, R. (2010). Introduction to family therapy. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2018-10-20 09:20:35. 09:28:10:03:10 143 Page 143 Page 144 144 A N I N T R O D U C T I O N T O FA M I LY T H E R A P Y dynamics. The classic example came from work with children where it was suggested that, for example, a symptom shown by a child could serve a function of distracting attention from the parents’ conflicts with each other and thereby stabilizing the marriage. As the child’s symptom grew more intense the definition of the situation as the child having or being the problem would become increasingly dominant. In a sense family members were seen to be acting as if they had an investment in keeping the symptomatic member in that role despite overtly stating that they wanted them to change. It is possible to see connections here with psychoanalytic ideas, with the family as acting on the basis of the collective unconscious needs of its members (Ferreira 1963). Attempted solutions One of the most enduring and helpful ideas from the first phase is the model of formulation proposed by the MRI team. This consists of the elegantly simple idea that many problems arise from the failing solutions that are applied to ordinary difficulties: Copyright © 2010. McGraw-Hill Education. All rights reserved. In this approach to formulation the focus is on an identification of what is seen as the problem and how this is linked to difficulties which the family has attempted to overcome. The formulation consists of the following steps: • Deconstruction of the problem – when did it start, who first noticed, what was first noticed? • • • • • Linking the problem to ordinary difficulties. Exploration of what was attempted to solve the difficulties. Beliefs about the difficulties and what to do about them. Discussion/evaluation of what worked and what did not work. What decisions were made about whether to persist with the attempted solutions and which solutions to pursue. As we can see, this model bears a resemblance to a behavioural functional analysis (ABC) and cognitive behavioural analysis in that attempted solutions in effect represent behaviours, consequences are the effects of the attempted solutions and antecedents are in effect the difficulties or triggers that set off the attempted solutions. Like functional analysis, this model assumes that there is a recursive cycle in play so that the attempted solutions can serve to construct a vicious cycle whereby there is an escalation of the difficulties. Dallos, R., & Draper, R. (2010). Introduction to family therapy. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2018-10-20 09:20:35. 09:28:10:03:10 Page 144 Page 145 S Y S T E M I C F O R M U L AT I O N 145 The second phase – progressive hypothesizing The Milan team (Palazzoli et al. 1980: 4) influentially articulated the idea of family therapy as inevitably progressing through a process of hypothesizing: By hypothesising we refer to the formulation by the therapist of a hypothesis based upon the information he possesses regarding the family that he is interviewing. The hypothesis establishes a starting point for his investigation as well as verification of the validity of that hypothesis based upon scientific methods and skill. If the hypothesis proves false, the therapist must form a second hypothesis based upon the information gathered during the testing of the first. Copyright © 2010. McGraw-Hill Education. All rights reserved. The process of developing hypotheses, they argued, was fundamental not only to the process of formulation but also to the practice of clinical work. A hypothesis could help to cut through the potential chaos of overwhelming amounts of information and help to organize the information into a manageable structure. A hypothesis can help the therapist to actively engage the family by pursuing issues and asking questions to explore and test the hypothesis and can offer a direction to the work, reducing therapist and family anxiety. A hypothesis was not to be seen as necessarily being true but as being more or less useful as a tool for eliciting new information. The Milan team went on to note a number of other important aspects of this process: • Explicitly forming and stating our hypotheses can help to reflect on our implicit assumptions, which if left implicit may get in the way of therapeutic progress. • Articulation of hypotheses can help to reveal differences and agreements within the therapy team, which again might impede therapy if left unstated. • There is less pressure on the therapist to ‘get it right’, which can reduce anxiety especially in the early stages of therapy. • As the engagement with the family is less of an ‘expert’ position it may make it easier for the therapist and the team to remain curious and interested as opposed to trying to develop a correct formulation. In the second phase it could seem as if the Milan team made statements about their hypothesis being ‘correct’ in providing an explanation for family dynamics. The team created hypotheses, and not the team and the family collaboratively. The third phase Systemic family therapy began to move towards constructivism – mutiple lenses, narratives and language. Families were no longer seen as objectively ‘out there’ and the task of the therapy team as being to accurately assess their dysfunctional patterns. It was recognized that we could only see a family through our own constructions – our personal lenses. Consequently, descriptions and formulations were seen as having an ‘as if ’ quality – they were propositions rather than truth. As such these propositions Dallos, R., & Draper, R. (2010). Introduction to family therapy. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2018-10-20 09:20:35. 09:28:10:03:10 Page 145 Page 146 146 A N I N T R O D U C T I O N T O FA M I LY T H E R A P Y Copyright © 2010. McGraw-Hill Education. All rights reserved. could be more or less useful in guiding our work with families. The value of the propositions was essentially in terms of the extent to which they facilitated positive change. Instead of assessment and formulation being seen as a one off scientific activity, they came to be seen as a continual process of developing, testing and revising formulations. This has much in common with George Kelly’s (1955) notion of ‘man the scientist’ – that science and human experience are similar in essence in that both are engaged in a process of inquiry in which ideas about the world are formed, tested and revised where necessary (Hoffman 1993; Procter 1996; Dallos 1997). Exploration of meaning and explanation The work of the Milan team showed a significant shift in that the focus of the hypotheses and formulations was the belief systems of family members. Increasingly the emphasis was on the meanings that family members ascribed to each other’s actions. For example, they describe a case of an adolescent boy who was displaying delinquent problems. The boy was living alone with his ‘attractive’ divorced mother. Their first hypothesis was that his behaviour was intended to draw his father back into the family. However, this was rapidly disproved and a more accurate hypothesis suggested itself: ‘The mother was an attractive and charming woman, and, perhaps after these years of maternal dedication, she had met another man, and perhaps her son was jealous and angry, and was showing this through his behaviour’ (Palazzoli et al. 1980: 2). Two members of the Milan team (Luigi Boscolo and Gianfranco Cecchin) developed a more social constructionist view of formulation, which emphasized ‘curiosity’ as the cornerstone of systemic formulation rather than the analogies with the scientific process of hypothesizing and hypothesis testing (Cecchin 1987) Systemic practice since the mid-1980s has shown a significant move towards social constructionism encapsulated in narrative approaches to therapy, which emphasize the idea of socially constructed realities and the centrality of language. Interestingly, this emphasis reconnects with its roots in communications theory, which emphasized that families were communicational systems, so that each and every action is seen as a potential communication. Likewise, symptoms were seen as attempts to communicate what was too difficult or too dangerous to say in any other way (Jackson 1957, 1965a, 1965b; Haley 1987). Social constructionism shares these roots in communications theory in emphasizing that language is not fundamentally used to convey inner beliefs of the family members but that talk is in itself an action. How talk happens shapes the experiences, feelings and beliefs of family members. The idea is that when families increasingly or predominantly talk to each other in terms of problems and pathology, this creates problem-saturated systems (Anderson et al. 1986). Another important feature of social constructionist approaches in current practice is the consideration of the role of dominant ideas or discourses that are shared in different cultures. For example, ideas such as that of mental health, satisfactory family life and normal transitions are seen to be embedded in language and shape the expectations and actions of family members. Therapy in part consists of raising these discourses to consciousness in order to assist families to be less trapped. Formulation Dallos, R., & Draper, R. (2010). Introduction to family therapy. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2018-10-20 09:20:35. 09:28:10:03:10 Page 146 Page 147 S Y S T E ...
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Dr_Bestwriter
School: Duke University

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Running head: MFT SYSTEMATIC FORMULATION

MFT Systematic Formulation

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MFT SYSTEMATIC FORMULATION

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Introduction
Family development theory analyses the patterned and systematic changes of family
members encountered throughout the course of their lives. In this context, a family is a social
group made up of at least one parent and one child. It is governed and organized by the norms
of society. Genograms are some of the tools used in conceptualizing the phases of the
systematic formulation of families. It is a graphic representation that provides details about
relationships within a family. Compared to a family tree, a genogram is more advanced for
the reason that it can analyze the psychological dynamics and hereditary arrangements that
punctuate family relationships (Dallos & Draper, 2015, p. 144). In psychology, therapists use
genograms to identify a patient’s family history that could possibly be an influence on the
patient’s current mood and frame of mind.
Genograms contain detailed information of the families they represent. They contain
the same data as contained in a family tree. This includes the names, gender, dates of birth
and death for each family member represented. Other information that may be included is
occupation, social behaviors, emotional relationships, and education (Peseschkian, 2012, p.
16). Other genograms may detail information on disorders such as diseases, alcoholism,
alliances, and depression. For this reason, genograms vary on basis that the type of data is
unlimited. For this paper, I will review a family’s history after a married couple’s discovery
of their family’s shared features of nature and nurture.
The referral
Marriage is a unique institution where two individuals vow to love one another and
remain together for the rest of their lives. Therefore, individuals need to first learn of their
partners’ unique personalities before committing into marriage. Learning to be accepting of
each other’s uniqueness is an ingredient of a successful marriage. Otherwise, a marriage may

MFT SYSTEMATIC FORMULATION

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experience communication breakdowns and other related problems that may fracture its
arrangement. For couples experiences such marital problems, it is recommended to seek
marital counseling where the couple’s relationship and communication skills are improved.
Billy and Mary have bee...

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