Group Counseling: Peggy Papp Initial

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 4: Setting the Terms for Therapy

In this chapter, the central theme seems to revolve around the importance of establishing a 'therapeutic contract' with the family by setting "terms" for therapy, based on the hypothesis the therapist has developed regarding the specific problem or situation that needs addressing (p. 27).

The main point in this chapter is that the therapist must set the terms not the family, in order to avoid a lack of control and further problems resulting from abnormal family behaviors. Of interest to me in this chapters was the point that a therapist need be aware of the potential for family members to have hidden agendas when presenting requests and this may influence their ability to honestly describe problems.

Papp also discusses interventions in this chapter, suggesting that 'symptoms' are created to serve different purposes in different situations, and some are more critical than others, suggesting that the therapist should be on the lookout for symptoms that are merely transitory in nature or deeply rooted (p. 29).

She also discusses how paradox can be used to approach symptoms, and the idea that a systemic paradox may exist in familial relationships (p. 35). Various interventions are discussed for resolving contradictory behaviors that are helpful and meaningful, including methods for resolving things individually and within the context of a family therapy session.

Chapter 5: Negotiating Change

This chapter focuses on therapeutic techniques specifically related to group change and problems.

The central message or theme in this chapter is the notion that the use of a consultation group can be beneficial in assisting negotiations regarding the dilemma of change. Papp proposes that the most potent manner in which a group can be used is via creation of a 'therapeutic triangle" where the group stakes the position off the antagonist of change, while the therapist takes on the role of the family, defining their ability to adjust their situation, and the family is subsequently put in the position of "determining who is right through their subsequent behavior" (p. 47). Though this seems like it may be a useful form of therapy, my first impressions are that it would not work in many situations.

One technique I felt beneficial suggested by Papp is referred to as 'staging a failure' where the therapist and group work to anticipate how the family can deliberately stage a failure to dramatize issues relevant to change and teach adaptive techniques (p. 49). This seems like it would be very effective.

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