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Systemic family therapy, the most prevalent model of family treatment today, views the individual as an integral component of a unit of organization the family. Systems theory postulates that a person cannot be viewed, nor treated, out of the context in which that person is embedded.
This context, the family, may be the nuclear family (one generation) or the extended family (three or more generations). Regardless of whether the focus is the nuclear or extended family, the pathology experienced by an individual is viewed as a manifestation of some level of dysfunction in the family system.
The identified patient (IP), the individual that the family is presenting for treatment, is expressing the family’s conflict through the metaphor of a symptom. The IP may be viewed as the weak link in the system, the family member who is most vulnerable to stress and, therefore, most likely to develop the symptom.
Or one might see the IP as the individual who is most attuned and sensitive to the dysfunction in the system and capable of expressing it in order to facilitate resolution. In either case, the individual’s symptoms reflect a family dysfunction rather than an intrapsychic phenomenon.
Anxiety, traditionally viewed as an internal psychological process signaling danger, can be examined in the context of the family system.
Nathan Ackerman (1954) was the first clinician to report the treatment of whole families on an ongoing basis. In his effort to clarify the nature of family dynamics and their influence on an individual’s psychological functioning, he described the family as a, “conveyor belt for anxiety and conflict.
He observed the “contagion of mental illness” that affects all family members with such intensity that no one family member can be immune to its destructive effects.
Ackerman observed a process in families in which anxiety shifted erratically from one person to another or from one family pair to another. Although unaware of the impact of his observations on the final direction taken by family theory, his interactive formulations anticipated the current systemic conceptualization of family dynamics.
Like most of the pioneers in family therapy, Ackerman was trained psychoanalytically. This is apparent in theoretical formulations that continuously weave together psychoanalytic concepts and family relational
observations in an effort to formulate a separate theory of family treatment.
A radical shift took place when Don D. Jackson (1957), also psychoanalytically trained, abandoned the prevailing view of individual psychopathology in favor of the revolutionary belief that pathology did not exist in the individual, but only within relationships.
To Jackson, emotional dysfunction and symptomology could be traced to family interaction and pathogenic relationship patterns. The patient was seen as the individual who manifested the covert pathology of the family. Jackson referred to this member of the family as the identified patient, since the actual patient was the family as a whole.
Treatment entailed the use of strategic interventions aimed at altering patterns of interaction within the family. Jackson’s total rejection of psychoanalytic constructs in favor of observable family interaction was to have a profound effect on the evolving field of family therapy.
As a result of Jackson’s view that family theory and psychoanalytic theory were antithetical, a polarization occurred in the family therapy movement.
As noted by Samuel Slipp, Watzlawick, Beavin, and Jackson (1967) saw psychoanalysis as discontinuous with systems theory because of its reliance on energy concepts rather than information and transactional patterns to explain motivation and behavior.
Jackson and his colleagues erroneously believed that all schools of psychoanalysis subscribed to drive theory when, in fact, much of psychoanalysis had moved beyond this conceptualization to include relationships and issues of adaptation. “The intrapsychic level is not a closed system, … but interacts with and determines the interactional level.
But the polarization had already taken place. Two models of family systems theory were evolving. One adhered to Jackson’s original premise that all psychopathology can be understood within the context of information exchange or transactional patterns.
The other incorporated the concept of the family as a system with the traditional view of the individuals as separate entities possessing an inner life affecting both themselves and the family as a whole.
