The family is an interactive system with change in one part (individual) of the system leading to change in the entire system. The family provides the context and understanding of how this system is operating and how each individual functions within the system that creates the family’s culture. Treatment focuses on the entire family and how each individual’s functional and dysfunctional attributes contribute to the current functioning status. Change only happens when each member of the system identifies and expresses a willingness to work on their own behaviors.
Goals in family systems therapy assist individuals in becoming more effective in meeting their own needs by challenging what they are doing and relating how it contributes to either the successes or stressors within the system. Success and homeostasis is achieved when individual members each optimize their personal well-being and communication skills with the goal of functioning as a stronger unit.
The family coach functions as a teacher, model and consultant to the entire family. Through the guidance of the coach the family develops skills to detect and solve problems that are keeping the family stuck; and in many cases, passing on the dysfunction through generations. The key focus is on the family interaction and communication patterns. If you visualize a puzzle with each family member representing one piece—the puzzle is not complete without each piece (member of the family).
No single family member is the “identified” patient. Each member of the unit makes a commitment to change for the better of the family.
The Diabetic Family: A Case Study
Suzie and Bob, both are both overweight and have parents with Type 2 diabetes. Thus far, despite both having high cholesterol, neither have diabetes [yet]. Their daughter, Cassie (age 16), also overweight, an avid violinist was just diagnosed by her pediatrician as having diabetes. Her younger brother, Nolan, is 13 years old, plays soccer year round, and is slim. Both Cassie and her brother buy school lunches, making poor choices, when they bother to eat. Breakfast? What is that—maybe a Pop Tart. Both parents work long hours and then provide transportation to and from their children’s activities. They often stop for fast food, eat out, or make convenient meals (i.e. mac and cheese/frozen pizzas) for dinner. Suzie responds with anger to her daughter’s diagnosis and what she views as lazy lifestyle habits and tells her to adopt a more active lifestyle like her brother. Suzie and Cassie often engage in shouting matches that end with no resolution. There is no quality family time events, only obligations to be met. Bob and Suzie have not had anything remotely related to “date night” in over six months. While they both report being happy with the partner, both report feeling overstressed and unsatisfied in “what the marriage has become.”
Family System Approach Applied
Despite Nolan being the only healthy weight family member, his nutrition is on par with the rest of the family—and unhealthy. The entire family would benefit from following the treatment plan the physician provided to Cassie. The key focus in the coaching relationship will be to help this family individually and collectively come together, interact in a supportive, non-judgmental, dominant manner by each taking responsibility for contributions they can make to the system.
What this may look like:
1. The family meets with a coach/therapist to outline the current status/concerns in the family. All members recognize the house as stressful and desire a more positive living environment. Each member initially meets with the coach to identify and share concerns and receive guidance in identifying personal goals that will contribute to the well-being of the unit.
2. Key issues identified: Poor nutrition, need for physical activity, increased family time together characterized by positive interaction, eliminate toxic communication/fighting, collaborative efforts to help out in the daily routine.
The plan of system change is rolled out:
3. The family comes together and reviews the food/nutrition list provided by the registered dietician. Family members identify food they like/dislike. Shopping is done on Sundays when all family members are home (at some point).
4. Strategies to eat breakfast, lunch and dinner are explored. This area is clearly not a one-size fits all situation. The children, both old enough to make their breakfast and lunch, take ownership of this. They no longer eat any school lunches/visit vending machines. At work, both parents make healthier choices at the office cafeterias, or pack their own lunches as well.
5. Nolan already plays soccer—he is physically active year round. The father, Bob, goes to the company’s gym either before work or at lunch time 3-4 days per week. Suzie and her daughter Cassie walk together every night after dinner and go to a yoga class together on Saturdays.
6. Initially, Suzie and Cassie meet with the coach to work on communicating in a more effective way. They meet every other week with the coach and bring challenging situations to the session to work through using the “Speaker Listener” technique.
7. Suzie and Bob make time for “date night” and work on spending more time together during the week (i.e. cooking together, watching tv, reading in bed together, just time together).
8. The family meets together Sunday evenings with their coach to discuss and plan the week ahead. At this time, concerns/issues are addressed. As needed, family members meet with the coach individually.
9. Over time, the family meets less, going from weekly, to bi-weekly to monthly. Individual members continue that want to focus on continued personal goals. “Booster Sessions” occur quarterly or as needed.
