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Showing posts with label family systems. Show all posts
Showing posts with label family systems. Show all posts

Monday, April 16, 2018

11 Laws of Systems Thinking





Systems thinking is one of the main themes of Peter M. Senge's best-selling book, The Fifth Discipline, which I reviewed back on November 22, 2016. Family systems therapy - which is at the heart of my form of psychotherapy for personality disorders - is based on systems thinking, and looks at the role of the interactions of all family members over at least three generations in the genesis, triggering, and reinforcement of self-destructive behavior in individual members. 

Senge's book discusses eleven “laws” that apply to the behavior of individuals within groups who are engaged in trying to solve a variety of difficulties that affect the achievments of the group’s goals. The laws look at how a wide variety of different variables interact over the long term, and discuss the folly of efforts to try to reduce problems down to just simple relationships between only two or three variables over the short term.

In this post, I list the eleven laws from the book, with a few minor changes or additions I made to make them more relevant to problem solving specifically in dysfunctional families—as opposed to just any organization.

11 Laws of Systems Thinking.

#1: Today's problems come from yesterday's "solutions." In our desire to avoid conflict, we solve problems by avoiding them. Inevitably, the problem comes right back more intensely and in an even more frightening aspect. Solution: Learning to negotiate and solve problems cooperatively in a win/win manner.

#2. The law of reversed effort: the harder you push, the harder the system pushes back. Attacking the people in the system creates resistance. For example, the more you lecture children about something, the more likely they will be to keep doing whatever you are complaining about.

#3. Dysfunctional family and other problematic interpersonal group behavior gets better before it grows worse, and conversely, it grows worse before it gets better.

When we sacrifice our own needs in order to give the family or group what it seems to need, this stabilizes it over the short run, but since structural problems and ongoing shared intrapsychic conflicts are never dealt with or even addressed, this soon starts causing more problems over and over again.

Conversely, when problems are finally addressed, people often escalate their previous dysfunctional behavior in order to test whether everyone else really wants change - but if everyone sticks to their guns, the problematic behavior eventually subsides and then starts to go away altogether (except for occasional relapses which must then also be openly addressed).

#4. The easy way out usually leads back in. Quick and easy solutions often lead to weak and poorly thought out approaches that backfire. Solutions that come from a desire to avoid conflict or difficulty overlook the deep listening required to reveal the emotional core of family issues.

#5. The cure can be worse than the disease. Without thinking about ALL of the interacting variables, we often fix the wrong problem or approach the right problem inappropriately. Reactions and counter-reactions often leave us in a worse place than we where we started.

#6. Go slow to go fast. Rushing to completion leads to a lack of thoughtfulness and reversals of direction to go back and pick up missing pieces.

#7. Cause and effect are not necessarily closely related in time and space. We often assume the solution to be close to the problem, but most often, today's problems were caused by decisions made long ago but forgotten.

#8. Small changes can produce big results -- but the areas of highest leverage are often the least obvious. Taking the widest possible systemic view allows us to see the small changes that will have long term and beneficial outcomes.

#9. You can have your cake and eat it too -- but not at the same time. Patience is its own reward. Rushing produces compromise such as "I'll cut off my leg if you cut off yours." Taking the long view allows you to accomplish more and reap the benefits of the work.

#10. Dividing an elephant in half does not produce two small elephants. One must look at groups as a whole. Simply dividing people in a family or organization into separate, smaller groups will not produce the same dynamics, nor double the value. The right hand has to know what the left hand is doing.

#11. There is no blame. Perhaps the most critical of the laws of systems thinking, stopping blame eliminates the fear that turns employees or family members against you. Don't try to change people, change systems. Discover the systems problems and you can change the entire direction of a work group or family.



Tuesday, November 3, 2015

Where Psychotherapy Goes Wrong




In my post of November 4, 2014, I discussed something called the fundamental attribution error. As described by Richard Nisbett and Lee Ross, this is defined as “the assumption that behavior is caused primarily by the enduring and consistent disposition of the actor, as opposed to the particular characteristics of the situation to which the actor responds.” That post discussed how this error results frequently in mistaken conclusions that are drawn based on studies of people with personality disorders.

It is also the main reason why psychotherapy has not really progressed much as a science in the last 25 years or so.  The 1980's and early 1990's were a period of amazing creativity in the field, during which new ways of looking at human behavior and new interventions to help change that behavior seemed to be coming out every day. In particular, family systems thinkers began to realize that the causes of behavioral problems like self-destructiveness, as well as the causes of symptoms like chronic dysphoria and anxiety, do not reside entirely within the heads of the people coming for help.  

Some of it can be a normal and adaptive response to a very abnormal interpersonal environment. The "attachment" literature, which is fairly strong, shows that kin behavior has a huge effect on the psychological stability and the relationships of all human beings.  Much more so, I always say, than the food pellets and electric shocks favored by behaviorists.

Due to the wide variety of independent factors listed in the masthead of this block, family systems ideas have, unfortunately, been left behind to a significant degree, and therapists are back to looking at people as if their problems were "all in their heads."

Critics blasted systems ideas by focusing disingenuously on areas about which family systems theorists were completely wrong - like the genesis of such real brain diseases as schizophrenia (and yes, the evidence that schizophrenia is truly a brain disease is overwhelming, so spare me the "myth of mental illness" bullcrap). They pulled the usual slick ploy of making arguments based on black and white thinking: if family systems theorists were wrong about some things, then they must have been wrong about everything.

Because the effectiveness of psychotherapy interventions meant to change interpersonal behavior are hard to prove in a treatment outcome study, the systems people were also accused of being unscientific. As if observation were not the first step in the scientific method! (So much for much of what we know about astronomy). "Outcome studies" were touted as definitive proof of various treatment methods, despite the fact that they are extremely limited in their overall validity because there are almost an infinite number of variables that cannot be controlled. And they cannot be double blinded. And the therapists who are participating are not all doing exactly the same thing.

And the studies that are touted show only exceedingly modest effects in those subjects who do improve, as well as showing that a significant percentage of subjects did not get better at all.

Then there is another important fallacy that psychologists discuss: confusing an inference about an observation with the observation itself. Or, in other words, jumping to conclusions, and then acting like the those conclusions are facts. Andrew C. Papanicolaou, Ph.D, a neurobiologist at the University of Tennessee Health Science Center where I used to work, observes,  "Scientific discourse is unique in that it aims to maintain clear distinctions among assumptions, hypotheses and facts and treat each of them appropriately. Although this aim is often attained, it is rarely attained fully and occasionally is not attained at all."

Especially in psychiatry and psychology.

There's this rather big issue of what is really going on with patients, as opposed to what looks like is going on.  If you do not think people have hidden ulterior motives for their behavior, secrets about themselves that they don't want to share, and lack a complete understanding of the behavior of all of those around them who affect their lives, then I am afraid you are living in an alternate universe.

But still, therapists observe their client's performance, and confuse it with ability, as described in a previous post. Even when therapists look at what is basically interpersonal behavior, they make this error. Good examples of this are two of the current "evidenced-based" therapies for borderline personality disorder (BPD), Schema Therapy and Mentalization-Based Therapy. Both posit that people have mental models of how to behave in the interpersonal world, as well as of the motives and intentions of other people in their world. 

In schema therapy, the theory correctly asserts that these mental models or schemas are built up in childhood through interactions with primary attachment figures. It then goes about trying to change those schemas that it identifies as "maladaptive."  Surely, they are maladaptive in some ways, but that they serve no adaptive purpose at all is just assumed.

Although these therapists have started to look at how the primary attachment figures of their patients are behaving in the present , I have not seen much about the fact that schemas are continually updated (through the Piagetan process of assimilation and accomodation) during a person's ongoing interactions with those attachment figures. To understand what is really happening, you also have to look at the schemas of those other people.  The schemas of the various players in the family drama interact with one another!

Mentalization therapy also deals with a person's mental models of the motivations and intentions of other people, but just assumes that the mental models of their patients with BPD are distorted. This is based entirely on the way the patients respond to others, while completely ignoring the motivations and intentions on which that behavior is based. Maybe the patient wants other people to think they have distorted mental models. Why? Because they are playing the role of spoiler. The incorrect assessment of the accuracy of the patient's mental models is confused with the feigned actions of that patient.

Sorry, but we cannot read minds. You have to look at both the behavior and the history of everyone involved, and even then you can get a highly distorted picture yourself. So therapists should quit accusing their patients of what they themselves are doing - distortion.

People who have a history together base their behavior on that entire history, not just what is going on at any particular moment.  And when they talk, they can leave a lot out (ellipsis) and still understand each other, because they both already know what both of them already know. An outside observer does not know these things, and therefore their conclusions based entirely on what is said in front of them can be way off.

Of course, it is true that a therapist can never be absolutely certain of anything. For that, you would not only need a movie camera with sound on all participants 24 hours a day like in the Truman Show, but this equipment would have to be in place throughout the entire lifetime of the patient since birth!  

Still, the more information therapists can gather on the whole picture, the more likely it will be that they will better understand what might be going on and figure out what can be done to change it.

But first, they have to stop their myopic focus on that which is going on entirely in the patient's head.