The structure function theoretical framework emphasizes the role of marriage and family in providing

Family Systems Theory

Family systems theory is an approach to understand human functioning that focuses on interactions between people in a family and between the family and the context(s) in which that family is embedded. Family systems theory has been applied to a wide variety of areas including psychotherapy in general and family therapy in particular (working from a systems framework with emotional, behavioral, or relational symptoms in individual, couples, and families); school systems; community problems (e.g., working with polarized disputes and facilitating ‘difficult conversations’ as in the Public Conversations Project, peace studies, nonviolence training); organizations (consulting, leadership training, coaching); and health care (medical family therapy – tracking the emotional dynamics of illness and facilitating collaboration among patients, families, providers, and health care systems).

According to a family systems perspective, an individual's functioning is determined not so much by intrapsychic factors as by a person's place in the system(s) in which he or she finds himself or herself, subject to the pushes and pulls of the system, including competing emotional demands, role definitions and expectations, boundary and hierarchy issues, coalitions and collusions, loyalty conflicts, family and institutional culture and belief systems, double binds, projective identifications, and systemic anxiety. In addition, self-correcting and self-reinforcing feedback loops in a system can either facilitate or hinder pathology or health, breakdown or resilience.

A thorough understanding of family systems theory requires an elucidation of the foundational contributions of systems theory itself.

Systems theory is a field that informed and inspired the founders of the family therapy field and upon which family systems theory is based in many important respects. Unfortunately, as the field of family therapy has developed, the important contributions of systems theory to the theoretical foundations of the field have too often been neglected, undervalued, or only dimly understood. The following discussion will review the key concepts of systems theory that are most relevant to family systems theory and family therapy, followed by a description of the primary schools of family therapy and enduring family systems concepts and family therapy techniques. The concepts throughout will be illustrated with both actual and hypothetical clinical case examples.

Family Systems Theory

Family systems theory also arose in the late 1950s (a time ripe for theoretical innovations in psychology) and staked its unique claim by proposing that psychopathology does not reside in the individual, but rather in a disturbed system of family relations. As with psychoanalysis, family systems theory actually refers to a collection of rather disparate formulations, but all systemic schools of thought share this fundamental underlying assumption that where there is a patient, there is a troubled family system. Salvador Minuchin exemplifies this approach with his innovative argument that he did not treat youth with anorexia, but rather anorexic families. In Minuchin's conceptualization, called structural family theory, psychopathology arises as a function of poor boundaries among family members. In the families of those who came to him for treatment, he observed children who were parenting their parents (termed role reversal), parents who were coping with unacknowledged marital problems by focusing their attention on the child (termed detouring), and families in which certain family members had joined forces to scapegoat others (termed triangulation). Minuchin also believed that families, like any dynamic system, sought stability and so the system would resist change. This homeostasis, as he termed it, existed in part because the system worked: the fact that one family member was symptomatic served a function for the family. For example, one function might be to distract attention from problems that family members felt to be more threatening – such as a crumbling marriage – and therefore more difficult to face. Only by reinforcing appropriate boundaries and clearing the communication channels could psychopathology in the family be alleviated.

Family Systems Theory

Family systems theory is derived from the fields of biology and cybernetics going back to the 1940s and 1950s. Bertalanffy (1950), an Austrian biologist, attempted to integrate systems thinking and biology into a universal theory of living systems. Early family therapists (Speer, 1970) applied von Bertalanffy’s ideas to family systems focusing on the interactional patterns among family members using concepts such as equifinality (i.e.,the ability of a family) to reach a given final goal in many different ways), morphostasis (i.e., forces that stabilized the family’s structure), morphogenesis (i.e., forces that support the family’s ability to grow and change). These concepts are in line with von Bertalanffy’s idea that families are open systems that interact with their environment. Furthermore, they derive from the idea that a system is larger than the sum of its parts. Applied to FT this means that family therapist not only work with the ‘parts’ of the family or its individual members, but also with the interactions or relationships among family members (the addition to the ‘sum of its parts’). The second major influence of family systems theory was Cybernetics, the study feedback mechanisms in self-regulating systems (Wiener, 1948). The idea of positive and negative feedback loops was applied to families to explain how they use information and communication to maintain a sense of stability over time and develop mechanisms to adapt to changes in their environment. The ‘traditional approaches’ to FT as discussed below are based on the notions of family systems theory as derived from Wiener’s and von Bertalanffy’s ideas.

The 1970s and 1980s introduced new theoretical ideas to the field of FT. In addition to internal adaptive mechanisms and interactions families face, the discourse expanded to include how family members’ beliefs affect their interactions and how cultural forces shape these beliefs. Constructivist theorists (e.g., von Foerster, 1981; Maturana and Varela, 1980) suggested that nothing is perceived directly, but filtered through the mind of the observer. The meaning that is derived from what family members observe in mutual interactions influences their interactions in significant ways. Thus, the use of language became a crucial part when working with families. Social constructionist theorists (Gergen, 1985) went a step further by suggesting that families’ experiences are shaped by the social context in which they live and the meaning they develop from interacting within their social context. Some of these ‘postmodern approaches’ to FT are discussed below.

1.10.4.1 Bowen's Family Systems Theory

Family systems theory (Kerr and Bowen, 1988) is a theory of human behavior that defines the family unit as a complex social system, in which members interact to influence each other's behavior. Family members interconnect, allowing to view the system as a whole rather than as individual elements. Any change in one individual within a family is likely to influence the entire system and may even lead to changes in other members. Many interventions designed to promote behavior change in children are directed at the parent-child unit, although according to Kerr and Bowen (1988) it may be more beneficial to focus on the family as a whole. Family systems theory recognizes that the family plays a key role in both emotional and physical well-being across the life course since most individuals have contact with their family of origin through their entire lives. Families often influence day-to-day lives; families come together to both celebrate and help each other through crizes. Family systems theory emphasizes the idea that families are continuous entities, with rules, beliefs, and values that shape members over time. A family system framework influences professionals to not only support the individual with mental health problems, but also to focus on the family as a whole, while acknowledging the many subsystems within a family that emphasize family interactions. Family dynamics (e.g., structures, roles, communication patterns, boundaries, and power relations) impact human relationships, such as what draws people together, drives them apart, and considers any conflict and intergenerational transmission. Family functions change over time but could include daily care of a family member with disabilities, community involvement and advocacy, economic support or guidance for any members, and spiritual and social encouragement, to illustrate a few of the endless possibilities that depend on individual and family preferences, interests, and resources. Family systems theory places primary focus on exchanges of behavior that take place in a given moment of interaction between members of the family. The theory states that patterns of interaction between family members create, maintain, and perpetuate both problem and nonproblematic behaviors. Nonpathology-oriented, family system theory seeks to identify and generate reconstitutive behavioral exchanges between family members. Emphasis is placed on identifying and interrupting repeating sequences of behavioral exchanges of which the problem behavior is a part. According to this theory, the problem behavior dissipates and the treatment is complete, when these problem-perpetuating patterns are successfully interrupted.

The Bowen's family systems theory is composed of eight interlocking concepts: Triangles, Differentiation of Self, Nuclear Family Emotional Process, Family Projection Process, Multigenerational Transmission Process, Emotional Cut-Off, and Sibling Positions. A triangle in the family systems theory is a three-person relationship and is considered a “building block” for larger family systems. These relationships are seen as the most stable because a two-person relationship is too small and tension easily builds. With an additional person in the mix, the tension can be shifted around between three people, so none of the relationships become too volatile. If tension builds between the insiders, one of them will choose to grow closer to the outsider. The relationship dynamics of a triangle tend to frequently shift based on conflict or tension that arises between any two people in the triangle. When tension is high, it becomes more desirable to be the outsider. Though the triangle dynamic is seen as stable, it can be a catalyst for many familial problems. Within a triangle or family system, every person is unique (Differentiation of Self). The less developed one's sense of self, the more likely they are to be influenced by others. One the one hand, whether consciously or unconsciously, they will also try to exert their influence over other people. On the other hand, someone with a stronger sense of self is less influenced by others and does not try to push their personality on other people. Yet, everyone is born with an inherent “self,” the degree to which someone develops their sense of self is dependent on familial relationships during childhood and adolescence. In all families, as well as in society at large, there will always be a mix of people with poor and strong differentiation of self. Families vary in their levels of emotional interdependence based on the levels of differentiation of self of the family members. The more emotionally interdependent a family is, the weaker differentiation of self are the members. This also means that it will be more challenging for a family unit to adapt to stressful situations, as an individual's problem affect the entire family unit emotionally. Higher self-differentiation in young adults is associated with less parental conflicts and a better quality of social relationships compared to those with less self-differentiation (Gharehbaghy, 2011). There has also been empirical support for the relationship between differentiation and chronic anxiety, marital satisfaction, and psychological distress. The nuclear family emotional process is composed of four relationship patterns that govern familial problems: Marital Conflict, Dysfunction in one spouse, Impairment of one or more Children, and Emotional Distance: All of the nuclear family emotional processes can overlap. For example, a marital conflict may lead to emotional distance, and cause a mother to focus too much on a child, which inhibits the child's differentiation of self. The Family Projection Process describes how parents may transmit their emotional problems on their children. Children can inherit many types of problems, as well as strengths, from their parents, but the probably most impactful are relationship sensitivities such as a strong need for approval from others or feeling responsible for the happiness of other people. The project process follows three steps: (1) The parent focuses extra attention on a child out of fear that there is something wrong with the child, (2) The parent finds something in the child's actions or behavior that they perceive as confirming their fear, and (3) The parent then treats the child as if there is something truly wrong with it. By focusing so much attention on these perceived faults with the child, they usually end up causing the child to embody the things that they fear a self-fulfilling prophecy. Typically, children develop similar levels of differentiation of self as their parents, through learning and observing their parents (Multigenerational Transmission Process). People tend to seek out mates with similar levels of differentiation of self as themselves. Then their children will, for the most part, take after them. This means that small differences in the level of differentiation between parents and children will grow larger over time. For example, the child who is more differentiated from their parents will go on to have children who are likely to be slightly more differentiated than themselves. As the pattern continues, the differences in differentiation between generations can become drastic. Level of differentiation affects many components of one's life and relationship, including health, marital stability, occupational success, and more. Thus, different generations of the same family may have extremely different lifestyles from one another due to their differences in differentiation. In general, people with higher levels of differentiation of self, have more stable nuclear family relationships. Emotional cutoff occurs when people attempt to manage their unresolved problems with family members by totally cutting off emotional contact. Cutting off emotional contact is not necessarily the same as cutting off communication. But it involves distancing oneself from family members to become more emotionally independent. Another aspect in Bowen's family system are the sibling positions and the associated personality traits, which can impact family relationships, especially when it comes to marital couples. The concepts of family systems theory not only apply to families but non-family groups such as workers in an office. Societal emotional processes, along with cultural forces, impact how well society can adapt to change or overcome challenges. A progressive period is when things are changing for the better, while a regressive period will see spikes in violent crime, increasing divorce rate, and more corrupt behavior from government officials. There is evidence for a reduction in martial conflicts associated with Bowen's Family System Theory and Practice (Yektatalab et al., 2016) in comparison with to a control group, however further research to validate the model and to evaluate treatment efficacy is warranted.

8 Family Systems Theory

Family systems theory emphasizes the interdependent nature of subsystems within families (Cox & Paley, 1997; Minuchin, 1985), conceptualizing families as organized wholes (Cox & Paley, 2003). These notions gave rise to our views of families as hierarchically organized, consisting of multiple family members and relationships. Families are capable of both self-regulation and self-reorganization (Cox & Paley, 1997). Self-regulation involves stabilizing interaction patterns; for example, there may be rapid changes in family conflict followed by self-regulation back to the family's typical low levels of conflict. Self-reorganization refers to adaptation to the environment. For example, a downturn in the economy may cause a father to lose his job, which may prompt the family to reorganize itself around new roles, such as the mother becoming the primary source of income.

Similarly, Bretherton (1985) discussed links between children's internal representations of multiple family relationships, and McHale and Fivaz-Depeursinge (1999) called for an examination of families as wholes, rather than as a group of individuals or dyads. Moreover, they described the notion of a family's personality as the family's tendency toward certain emotions and behaviors. For example, one family may have a warm and expressive personality, whereas another family may tend toward a cold, detached personality. Thus, these notions of families as hierarchically organized wholes with their own personalities, and of multiple pathways of influence play an integral part in our conceptualization of transactional family dynamics.

5.07.2.1.5 Reciprocal vs. linear causality

Family systems theory assumes reciprocal as opposed to linear causal explanations. Linear causality is based on the traditional stimulus–response behavioral view that one event “A” causes some response “B.” This type of reductionistic thinking fails to capture the interdependence of individuals in any system. While it may be appropriate to highlight microanalytic sequences within the family (e.g., parents allow their adolescent daughter to stay out after curfew to avoid a confrontation with her), limiting our focus on these sequences fails to capture the true complexity of family interactions.

Circular causality assumes that any behavior in an interaction is simultaneously influenced by and influential on other behaviors in the interaction. In other words, causality is bidirectional. Thus, in the example of parents allowing their daughter to stay out after curfew to avoid a confrontation, a circular view of this sequence would begin with a recognition that the parent's behavior (e.g., avoiding confrontation) not only influenced the daughter's immediate likelihood of not being angry, but it also influenced the probability of her staying out beyond curfew in the future. Such a parental response may be the result of previous interactions in which the daughter responded with intense anger to the parent's confrontation. As a result, the parents' avoidance of confrontation in the current interaction may also influence the likelihood that the daughter will respond with intense anger to future parental confrontations of the daughter's behavior.

As is evident from this description, circular causality is informed by combinations of sequences of behavior. In this example only one particular sequence was highlighted. From a systemic perspective, however, it is not possible to understand a sequence outside of the context in which it occurs. Thus, to fully understand the mutual influence of parents and the adolescent in this example, the family systems therapist must also address other factors within the family (i.e., the parent's may not agree on basic rules within the house; consequently, they are unable to present a unified front to their daughter) or outside the family (i.e., the daughter may be associating with friends that foster an attitude of parental disrespect).

1 A review of the literature on siblings of individuals with severe intellectual and developmental disabilities

Family systems theory posits that the family is a single emotional, interdependent unit (Bowen, 1966). The needs and abilities of one family member will affect all family members. The interactions of subsystems between parents, between parents and children, and between children affect each individual and influence the whole (Turnbull, Turnbull, Erwin, & Soodak, 2006). A robust body of research exists on the specific importance of the sibling subsystem (Lamb & Sutton-Smith, 1982; Sutton-Smith & Rosenberg, 1970). The sibling relationship is often the longest relationship of an individual's life, and in cultures around the world, siblings play central roles in each other's lives across the lifespan (Cicarelli, 1995; Whiteman, McHale, & Soli, 2011).

The experiences of the typically developing siblings of individuals with intellectual and developmental disabilities (IDD) require special consideration in light of the diverse impact that a child with disabilities can have on the family system. As described by one mother: “Our family as a whole is so important to the quality of life of my son, but my son's disability also has a strong influence on the quality of life of the rest of us in the family” (Brown & Brown, 2003, p. 173). Diagnoses of IDD are increasing in the United States, and this is accompanied by an increasing number of individuals growing up with a sibling with IDD (Tudor & Lerner, 2015). Additionally, the lifespan of people with disabilities is increasing; as a result, typically developing siblings sometimes care for their siblings with disabilities into old age (Heller & Arnold, 2010). Besides potentially playing the crucial role of guardian later in life, siblings report that they play many other roles beyond sibling throughout the lifespan, such as friend, caregiver, advocate, service coordinator, legal representative and leisure planner (Hall & Rossetti, 2018). Considering these diverse roles, supporting positive outcomes for siblings will benefit more than just the siblings themselves, but could enhance person-centered care for the individual with disabilities as well as family quality of life (Brown & Brown, 2003).

There is an established literature on typically developing siblings, with earlier literature focusing on negative impact and more recent literature acknowledging positive outcomes such as character strengths (Heller & Arnold, 2010). Within this literature, siblings of individuals with IDD are identified as an at-risk population; they receive less parental support, have more responsibilities, and have a variety of psychological vulnerabilities such as increased risk for depression, anxiety, or other psychopathological symptoms (Barr & McLeod, 2010; Goudie, Havercamp, Jamieson, & Sahr, 2013; Hannah & Midlarsky, 2005). In more recent research, positive or neutral effects have been identified; siblings are more likely to have character strengths like resilience, empathy, compassion, and independence, to choose a helping profession such as medicine, education, or allied health fields, and to have positive self-concepts and higher internal loci of control (Burton & Parks, 1994; Cox, Marshall, Mandleco, & Olsen, 2003; Dyke, Mulroy, & Leonard, 2009; Macks & Reeve, 2007). Research-identified factors that differentially affect outcomes include characteristics of the family, culture, reference sibling's disability, and the siblings themselves (Macks & Reeve, 2007).

This literature is, however, incomplete. The majority of the existing research describes siblings of individuals with mild to moderate disabilities of high incidence (Rossetti & Hall, 2015). There is reason to hypothesize that some of the experiences and needs of the subpopulation of siblings of individuals with severe or profound disabilities are unique. Functional abilities are significantly correlated with increased caregiving provided by the sibling, and individuals with more severe disability are more likely to need support throughout the lifespan (Heller & Arnold, 2010; Lee, Burke, & Arnold, 2019). Increased caregiving responsibility is negatively related to sibling wellbeing as a result of maladaptive internalizing, externalizing, and asocial behaviors (Lee, Burke, Arnold, & Owen, 2019). At any age, the nature of the sibling relationship will be different when one sibling has communication differences or adaptations are required for siblings to participate in shared activities (Moyson & Roeyers, 2012).

This review surveys the literature that exists on the subpopulation of siblings of individuals with severe or profound IDD with the purposes of (1) characterizing the state of the literature on this subpopulation, (2) identifying evidence for differential impacts and needs in this subpopulation as compared to the umbrella population of siblings of individuals with IDD, and (3) identifying future directions researchers should take to determine the implications of these differential impact(s), should they exist.

Theses purposes are primarily framed by a special education lens (in accordance with the researcher's background). In special education, disabilities are categorized as severe disabilities, high incidence disabilities, and early childhood disabilities. This structure is not adopted by most sibling researchers, which will be addressed in both the method section and the limitations section. Further, this review surveys literature pertaining to the full sibling lifespan, but the distinction between being the sibling of a child or an adult with severe disabilities is an important one, and will be referenced throughout.

5.07.3.1.3 Transactional Nature

Within the FST framework, special attention is given to the phenomenon of circular causality: the way in which dyadic interactions between the youth client and caregiver(s) result in dysfunctional patterns within the family system over time (Nichols and Davis, 2016). Although the dyadic interactions between elements of the family system are common treatment targets, clinicians implementing family-based treatment interventions must be mindful of how transactions between the therapeutic and family systems are locked in a circle of mutual influence. Each time the clinician engages in a dyadic interaction, whether intended to establish or maintain therapeutic alliance or to intentionally facilitate a shift in an otherwise established dyadic transaction between family members, the clinician functions as a catalyst for a feedback mechanism between and within the therapeutic and family systems. As a result, the system either minimizes deviations and works to maintain stasis (negative feedback) or promotes variation and facilitates change (positive feedback) (Granic and Patterson, 2006). For example, when a clinician provides in-vivo coaching to the caregiver on how to actively ignore a child's yelling behavior while waiting for the first opportunity to provide the child with positive attention for a more desired behavior, the clinician induces positive feedback within the family system and facilitates the emergence of a new transactional pattern between caregiver and child. Similarly, when faced with poor caregiver engagement in treatment, the clinician's enthusiasm for increments of increased homework compliance can lead to positive feedback between the clinician and the caregiver. Given that each member of the family system can shape clinician behavior, clinicians implementing family-based treatments are encouraged to seek supervision and consultation, as needed, to best manage the complex transactional dynamics between and within therapeutic and family systems.

1.16.1 Introduction

The place of family systems theories and couples and family therapies within psychology has vastly expanded in recent years. Once seen as a radical departure from the more traditional focus on the individual that has typified the mental health disciplines, family systems viewpoints have now been with us for over 40 years and gained wide acceptance. Many systemic theories and therapies have been developed, and couple and family therapies are now among the most widely practiced. Several prominent guild organizations supporting the practice of family therapy have blossomed, including The American Association for Marriage and Family Therapy, the American Family Therapy Academy, and the Division of Family Psychology of the American Psychological Association, as have a number of prominent journals including Family Process, Journal of Marital and Family Therapy, and Family Therapy Networker. The Division of Family Psychology within the American Psychological Association now has over 6000 members, while the American Association for Marriage and Family Therapy has over 25 000 members.

The essence of what has driven all this attention lies in the emergence of a broad recognition of the importance of the family in the life of the individuals within it and the society made up of families. Whether we consider the impact of a depressed parent on a child, the role of poor parenting practices as a risk factor for conduct disorder in children, or the impact spouses have on one another, both clinical experience and much research point to the enormous influence of the family. Gurin, Veroff, and Feld (1960) found that 42% of all people who had sought professional help for psychological problems viewed their problems as related to a marital problem, and another 17% viewed their problems as pertaining to family relationships.

However, family therapy is truly unified only in the shared belief that relationships are of at least as much importance in the behavior and experience of people as are internal processes within individuals or broader social forces. As Gurman, Kniskern, and Pinsof (1986) have suggested, family therapy includes therapists from many professions, has no unified theory, and few techniques that are specific to it. There are many distinct systemic therapies, which differ enormously from one another. Some are directed to the treatment of families, some to subsystems within the family (e.g., couples), and others abandon the specific focus on the family entirely, aiming at the broader social nexus. In this chapter, we overview basic systems concepts and the field of family therapy, highlighting both the common threads underlying these methods and the differences that have emerged across the schools of practice.

5.08.1.5 Contributions from Family Systems Theory

Current PT programs have also been influenced by family systems theory. In this theoretical perspective, family factors are recognized as the larger context for parentndash;child interactions. From a family systems perspective, this means the focus of concern in PT is enlarged to include such factors as family roles, rules, and communication patterns, and those factors are conceptualized as family structures (Minuchin, 1974) and processes (Haley, 1976). A family systems perspective emphasizes the impact of these structures and processes on the parent-child relationship and behaviors. Inherent in the treatment of families from the systems perspective is an understanding of how family dysfunction (e.g., marital conflict) impacts both parent and child functioning, and PT targets not just parenting behaviors but family interaction patterns (including parentndash;child, marital, and sibling relationships), family perceptions of individual members, as well as parents' memories of their family of origin and what they learned from that experience.