Why in systemic psychotherapy there are no “ill individuals,” but ill relationships
There is one school in psychotherapy that I have not written about in my blog so far, yet one to which I owe an enormous amount – systemic psychotherapy. When I first encountered it, I was deeply impressed by its paradigm for understanding the causes of psychological problems and their treatment. Much can be said about this relatively new approach in psychotherapy, but perhaps its most important insight is this:
there are no ill individuals – there are ill relationships.
This is why the aim of systemic psychotherapy is to heal relationships by exploring how the system of connections in which the client is embedded actually functions.
Very often we assume that the problem lies within us, and therefore explain our reactions through personal factors such as character, individual traits, family history, and so on. Systemic psychotherapists, however, point out that the question “Why?” is not the most important one. Even if we understand what in the past led to the emergence of a problem, this does not necessarily lead to its resolution. According to systemic therapists, the question “How?” is far more important. Or, more precisely:
“How has the present interpersonal context been created in such a way that the observed behaviour becomes an appropriate, meaningful, or even the only possible response?”
Systemic-oriented psychotherapists direct their full attention toward exploring how exactly their clients interact with their environment. The individual is not viewed in isolation, but within the context in which they have lived, are currently living, and communicating. What is sought are pathological patterns of interaction with the surrounding environment that lead to the emergence of a “symptom bearer” within the system.
Usually, this person is designated as the black sheep of the family, without the family realizing that this individual has taken on that role precisely because the system itself is dysfunctional. As a more sensitive member of the system, this person becomes the carrier of the symptom that expresses the system’s underlying distress.
Research in systemic psychotherapy goes even further, proposing systemic hypotheses for the origins of different mental disorders – that is, assumptions that illness arises as a result of unhealthy relational patterns within the system. Below, very briefly (and at the risk that, without sufficient theoretical context, what I share may be misunderstood), I outline some of these hypotheses. I find them extremely valuable because they offer a different perspective on our life difficulties, allowing us to look at ourselves differently and to seek new kinds of solutions to what troubles us.
According to the remarkable book The Baron Munchausen Complex, or Psychotherapy and Reality by Paul Watzlawick (one of the founders of this approach), the systemic causes of schizophrenia can be found in so-called double-bind communication. The most characteristic feature of these binds is their paradoxical nature – what is said is denied, and what is denied is said. Examples include messages such as “Be spontaneous!” or the paradox of a liar saying, “I am lying.” Watzlawick writes:
“Anyone whose perception of reality or of themselves is repeatedly criticised by a significant other (most often a child by their parents) will tend not to trust their own senses. Because of this insecurity, they will be compelled by others to strive to see things ‘correctly’… It becomes increasingly difficult for them to orient themselves, both in impersonal and interpersonal contexts, and they will tend to seek patterns in perceptions that appear perfectly clear to others but not to them.”
Imagine a child whose father is shouting, and the child asks, “Dad, why are you angry?” – and the father replies, shouting, that he is not angry. The child must choose either to trust themselves and distrust what the father says, or to trust the father and distrust their own perception. If this situation is repeated, if the child is dependent on the parent and feels physically threatened should they disagree, from a systemic perspective there is a risk of developing the clinical picture of schizophrenia.
Now imagine a similar situation, not concerning perception of reality, but feelings:
“Anyone who is reproached by significant others for having feelings they should not have (or for not having feelings they should have) will eventually begin to feel guilty about their inability to experience the ‘right’ feelings in order to be accepted by others… Such dilemmas most often arise when parents interpret a child’s normal, occasional sadness (or lack of courage, or tiredness) as a silent criticism of their parental worth… Sadness is then replaced by ingratitude and badness – and in the futile effort to feel what one is supposed to feel, the affected person may display behaviour corresponding to the clinical picture of depression. Similarly, depressions arise where someone is held responsible for things beyond their control (e.g., their parents’ marital conflicts, illness or failure of family members, or parental expectations exceeding the child’s capacities).”
— P. Watzlawick
The above are hypotheses for systemic causes that may lead to the development of these mental disorders. Although these causes are not the only ones, they represent recurrently observed relational patterns in the families of patients. Awareness of them helps us learn to think systemically and to explore systemic causes behind our own or others’ difficulties and feelings of inadequacy in the environments in which we live or work. It helps us to critically examine self-blaming thoughts and instead to look for those elements of the environment that contribute to how we feel.
I enjoy popularizing knowledge from psychotherapy because it helps us move toward higher levels of psychological health. Although truly healthy patterns of communication within healthy systems are rare, we can begin to create them – starting with ourselves. Since we are parts of a system, whatever changes in us will, in one way or another, affect the other members of that same system.
Kameliya Hadzhiyska
Note: The quotations are translated from Bulgarian and are not presented as verbatim citations.
