The Family Systems heal

The family systemic model locates psychopathology in the relationships between family members and sees problem behaviour as serving a function in the family system (Rothbaum, Rosen, Ujie, & Uchida, 2002). For instance, the family systems model proposes that the overcontrolling or overprotective parent and the influence of the associated parenting style on the child’s sense of control is central to the development of psychopathology. This is demonstrated in anorexia where the parent-child relationship is characterised by a coercive parental overprotection response and a deficient understanding of the child’s age-appropriate need for individuation and independence (Stern, 1986). Self-starvation serves the function in the family of both maintaining the dependence of the child on the parent and also acts as a form of rebellion (Wenar et al., 2000).

Through an emphasis on the function of behaviour associated with psychopathology in relation to the maintenance of familial relations the systemic model moves closer towards explaining the relationship between psychopathology and caregiving. However, this explanation of anorexia whilst coherent with clinical manifestation does not explain causative mechanisms or developmental processes which lead to either disturbed familial relations or psychopathology.

The family systems model attempts to explain the developmental process of attachment as resulting from the social interaction of the caregiver and child (Byng-Hall, 1995). Abnormal attachment patterns are proposed to arise when caregiver-child relationships are characterised by overinvolvement, or when marital conflict produces an inconsistent pattern of preoccupied then distant care giving (Rothbaum et al., 2002). The family systems model also relates relationship characteristics associated with deviance in the developmental process of attachment formation to disorder. For instance, parent-child overinvolvement and marital conflict are also central features in the families of children with major depression, a disorder associated with abnormal patterns of attachment (Lopez, 1986). Parental conflict and overinvolvement are also found in anorexia nervosa, as are patterns of insecure attachment (Dallos, 2004).

The family systems model proposes that a transgenerational transmission of insecure attachment occurs in anorexia (Rothbaum et al., 2002). The insecure attachment of the mother has also been proposed to result in a reluctance on her part to express feelings or emotion (Armstrong & Roth, 1989). This contributes to the maintenance of insecure attachment in her child and also the emergence and continuance of the disorder (Dallos, 2004). The family systems model is useful in that it explains the source and maintenance of insecure attachment. The model does not, however, explain how exposure to abnormal patterns of caregiving results in either abnormal attachment or disorder.

The link between family relationships, developmental processes and psychopathology is largely associative in family systems theory. Cluster analytic findings indicate that a range of parent-child relationships can be associated with a specific disorder. It is important that the family systems model further investigate family processes such as conflict resolution, emotional expression and value expression and the functional relevance of these processes (Carr, 1999). This would help to identify commonalities between families as different family relationships lead to the same disorder, and to explain the differentiation in developmental paths of children with similar familial relationships who progress to a specific disorder from those who do not (Wenar et al., 2000).

The family systems model currently offers a significant contribution to the understanding of the emergence of psychopathology in that it specifies interpersonal relationships and a number of relationship characteristics (e.g. function and effect on child) related to abnormal developmental processes and psychopathology. Whilst limited in their explanatory power in isolation these relational processes are useful when added to unspecified components of other models. For instance, in the case of the negative stimuli referred to in the cognitive model of learned helplessness discussed below the family systems model can be invoked to explain these stimuli as characteristics of relationships within the family system such as interparental conflict, controlling parenting, child maltreatment, or parental loss (Messer & Gross, 1995).

The Cognitive Model

In the cognitive model, psychopathology is evident in maladaptive thoughts and interpretations of experiences (Craighead, Craighead, Kazdin, & Mahoney, 1994). The cognitive model typically explains psychopathology through reference to models, schemas and cognitive processes. For instance, the cognitive model of attachment elucidates the intrapersonal processes of attachment as involving the development of an internal working model (IWM) of the caregiver’s behaviour within the child (Miller, 1993). The cognitive model also explains processes which occur within this model. The IWM is proposed to focus on the synchrony between mother and child in terms of cues and expectations, and the child is proposed to develop an internal model of expectation of caregiver responsiveness. The concept of the IWM thus extends to include the perception of self and others.

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