Criticism of systems approaches

Many criticisms of systems approaches to family therapy have been levelled in recent years. These include:

• disregard of the subjective and intersubjective experiences of family members

• neglect of the family's history

• denial of unconscious motives, which affect individuals in a relationship

• the problem of unequal power in a family system, particularly the problem of violence against women and in various types of child abuse

• inequality and other forms of injustice based on societal attitudes towards differences in gender, ethnicity, class, and the like, and uncritically accepted as 'givens'

• minimizing the role of a therapeutic relationship.

This critique has led to growing interest in integrating systems-oriented and psychoanalytical ideas, particularly those derived from object-relations theory. Attempts at a general level are those of Flaskas and Perlesz, (!7) Braverman,(!8) Cooklin,(19> and the feminist perspective/20 Specific disorders such as schizophrenia(21) and anorexia nervosa(22) have also been targeted. Another variant of integration is Byng-Hall's (23) synthesis of attachment theory, systems-thinking, and a narrative approach.

A further criticism of systems-oriented approaches is that they minimize the impact of material reality, such as physical handicap or biological factors, in the aetiology of mental illness and sociopolitical phenomena like unemployment, racism, and poverty. These are obviously not merely the result of social constructions or linguistic games. The pain and distress they inflict on people are very real.

The 'psychoeducational' approach, 'family crisis intervention', and 'family-sensitive practice' have evolved in the context of the burden that schizophrenia places on the family and the potential for the family to influence dramatically the course of the illness. This has led to a series of family interventions:

• educating the family with regard to the nature, causes, course, and treatment of schizophrenia

• providing the family with opportunities to discuss their difficulties in caring for the patient at home, and to devise appropriate strategies

• clarifying conflict in the family not only about the illness but also about other developmental issues

• regularly evaluating the impact of the illness on the family, as individual members and collectively

• helping to resolve other family conflicts not specifically related to the illness, possibly aggravated by the demands of caring for a chronically ill person.

This type of work may be carried out with several families meeting together. Whatever the case, promising results have been achieved in reducing the relapse rate and frequency of hospital admission.(2i>

Family crisis intervention, initially devised for families with a schizophrenic relative, but since applied to other clinical states, operates on the premise that deterioration in mental state or a request by the family to hospitalize a relative may well reflect a change in a previously stable pattern of marital or family interaction. Convening an urgent meeting with the patient, spouse, and other key family members, even in a hospital emergency centre, is associated with a reduced rate of admission.(25)

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