Peggy Papp's systems approach to family therapy practice

Group Counseling: Peggy Papp

Initial Impressions/Introduction

Peggy Papp's purpose in writing this book is to provide a practical guide exploring couple and family therapy within a systems framework. The book is useful in providing central ideas related to family therapy techniques and interventions. Her intention was to show a step-by-step process that therapists could use to combine theory and practice, her point being that when theory is separated from practice it is not useful.

To demonstrate her ideas completely, she uses several case analysis. There are several themes presented in the work, notably ones that suggest that (1) a non-judgmental approach to therapy is most effective, that (2) analysis of a family system must take place for effective therapy to be realized, and (3) and that each situation is unique and should be considered individually, though it is also essential to look at parts as a whole. My reactions to her work are exhibited below on a chapter by chapter basis.

Chapter 2: The Dilemma of Change

In this chapter Peggy begins by discussing the definition of system, suggesting that the term has become "cliche" and lost its meaning in family therapy settings (p. 6). I am impressed with her emphasis on the idea that systems thinking should entail examining events within the context that they occur in, with attention being focused on "connections and relationships" instead of individual characteristics (p. 7). Far too easy is it in a therapeutic setting to focus on individual events rather than the person, picture, family or situation as a whole. This approach is necessary to determine patterns and get at the core of problems.

Another theme present in this chapter is the notion that systems constantly shift over time, and that to maintain balance an individual has to constantly shift and adapt to a new equilibrium. She refers to this idea as patterning and circular organization, and suggests that it is the foundation upon which "family therapy rests" (p. 7). Thus, one can conclude that no one event is more important than another, but rather all are interrelated. Therapeutic intervention is sought out when symptoms arise from imbalances in individual and family systems.

Papp also suggests the notion that a symptom is a mechanism of regulation, and that change defined is a dilemma that needs to be resolved, with the help of a therapist. Thus a therapist should look at systems, the symptoms that result when balance is disrupted within the system, and the individual dilemmas that result from symptoms happening within the system. This can definitely be attributed to a pattern approach or systems thinking with regard to therapy.

Chapter 3: Forming a Hypothesis

The main crux of this chapter is that a hypothesis is necessary as the first approach to therapy in any situation, and that a therapist will first speculate about a situation in order to gain more information from the client about the actual dilemmas or symptoms that need to be resolved (p. 17). One theme apparent in this chapter is the need for therapists to be non-judgmental to behaviors in order to elicit accurate and honest feedback from their clients. This point seemed rather obvious, after all the point of therapy is to provide a safe and non-judgmental environment for patients to begin with.

Papp also theorizes that detailed information about a person or group's behavior will often reveal "distortions or contradictions" key to understanding the purpose or function of the behavior in question (p. 20). Generally Papp wants to point out that a therapist needs focus on the events and behaviors leading up to and after a problem that needs resolving. The theme emphasized here is that detail is essential to getting at the route cause of behavioral problems.

Chapter 6: Case Presentation: the Daughter Who Said No

This chapter focuses on a case study presentation of the treatment of a family where the parents are described as symmetrical in their positions, and divert conflict through their daughter who is anorectic. The case is broken down into stages, where ultimately Papp connects the symptom (anorexia in the patient) with the family system, where the parents subvert issues and direct conflict through their daughter (p. 73). Papp then goes through the process of setting terms and defining the problems as a family dilemma. The theme here is connecting the symptom with the family system in order to resolve the issue being dealt with.

If each chapter were structured in exactly this manner with a case study to describe the primary theme, Papp would do very well. The author successfully makes her point via demonstration. By far the best chapter in the work.

Chapter 7: Variations on the Style and Form of Interventions

Here Papp points out that each family dilemma is different, thus therapists have an obligation of matching the method of intervention with the individual family system, symptoms and dilemma being addressed (p. 104). To demonstrate various interventions Papp uses multiple case studies. One case involves providing a therapeutic intervention through the form of a fairy tail in order to replicate the 'melodramatic' style of the family with regard to change (p. 105).

The primary theme or concept discussed here is the notion that any intervention can be modified to more specifically suit the needs of the individual or group it is aimed at. This is an exceptional point. I feel this ties in to the central idea that therapeutic interventions should be examined as a whole, rather than as simply a subset or part of systems. Other interventions discussed include the use of ceremony and 'alteration of the invisible triangle' in a family system.

Chapter 8: The Use of Paradox in a Medical Setting

Here Papp specifically addresses the issue of a non-compliant patient in a medical care setting who refuses to follow advice. The central notion is that paradoxical interventions can be successful when combined with structured interventions in a pediatric setting (p. 121). The structured approach is discussed, the primary theme is that strengthening the boundaries between family subsystems such as child and parent is important for therapeutic success (p. 121).

Papp suggests that for this approach to work a family hierarchy must be accomplished with active intervention from the therapists, suggesting that change will take place within rather than outside of a session (as is the case in a paradoxical approach) (p. 121).

This chapter was useful in the context of viewing therapeutic interventions from a more clinical perspective, and helping to suggest techniques that might be useful in a non-compliant or forced situation.

Chapter 9: Treating Couples

Here Papp acknowledges that the criteria to be used when deciding to treat a couple rather than the entire family vary from therapist to therapist (p. 138). Papp focuses on martial therapy specifically, and suggests that the major criteria to be used in this case are the "definition of the presenting problem as a martial problem and a commitment and ability on the part of the couple to worn on their marriage" for at minimum 12 sessions (p. 139).

Further the central theme Papp focuses on is the notion that no matter what the problem in couples therapy the therapist must look for reciprocity in the relationship and the central notion around which this reciprocity is organized (p. 140). The ideas is that couples tend to choose partners where they are more likely to fall into patterns of over-adequacies and inadequacies that can normally be balanced, but often external events cause a shift in this balance which results in a problem. The idea is that for therapy to be effective in this case it must focus on a central emotional theme within the couple and analysis of how the couple negotiates to maintain their individual reciprocity (p. 141).

This makes sense, in essence Papp is suggesting that couples maintain a system of checks and balances by bargaining and engage in transactions meant to maintain balance.

Papp also introduces the notion of couples 'choreography' or a dance that married couples play to define their marital relationship in metaphors. She states that when these 'metaphors' or fantasies are acted out, and then the balance in a relationship can be disrupted (p. 163). Here systemic intervention may be helpful in addressing dilemmas.

Chapter 10: Case of Presentation, Anatomy of Violence

Here Papp attempts to discuss how a single approach can be applied to family members who habitually deal with violent behavior. Here Papp focuses on the conflict that occurs between therapist and the family over control, suggesting that the therapist can deliberately create a series of crises within the family in a manner that forces stress back into the family, which in turn compels the family to seek out ways (other than violent ones) to address the issue (p. 173).

This chapter makes approaching violence seem like very common sense business. She discusses how families tend to use 'ploys' to block change including violent threats and actions, and that the role of the therapist is to 'force' or compel the family to learn new methods for dealing with change.

Ultimately this makes sense, though the initial portions of therapy must be very volatile, particularly because Papp is suggesting that the therapist introduce more stress into an already volatile situation.

Chapter 11: Failures and Pitfalls

Papp concludes with this chapter that it is impossible to assess "all the elements that go into effecting change" because of their complex nature (p. 215). She emphasizes the central theme however that the role of the therapist is to set the stage for change. She also however points out how important it is for the therapist to never attempt to predict how change will take place or even if it will take place because of random elements that can't be accounted for (p. 215).

Papp also suggests that the therapist must work to correct false impressions which will usually lead to effective change. She acknowledges that failures in therapy are possible, but also that the key to overcoming them is acknowledging ones limitations and working toward a positive outcome. It seems that her primary point is that failures can occur in a judgmental environment, which ties back to her early theme that for therapy to be successful it must be non-judgmental.

Conclusions

Overall the work was very beneficial, providing accurate insight into proven methods for effective therapy. Papp presents may themes including the use of non-judgmental and individualized interventions for family therapy, while at the same time promoting a systems approach to healing. She also acknowledges room for error on the part of the therapist in her final chapter.

Papp suggests many common sense approaches, including analyzing the system in which a family operates, and discusses symptoms as the impetus for change. Papp also emphasizes throughout the work the central theme or notion that every situation must be accounted for individually and taken into consideration individually for therapy to be effective. Overall the work was useful, enlightening and informative.