Mental health articles

Four key family systems therapeutic principles are applied to the cases presented
in this chapter. Th ese consist of therapists’ eff orts to (1) maintain neutrality,
(2) help clients manage triangles and, more generally, understand parallels
between their family patterns and current diffi culties, (3) encourage clients
to establish eff ective contact with the family, and (4) help clients achieve
diff erentiation of self.
Neutrality may not be a position accepted by all clinicians who work in
college mental health. Some college clinicians may believe in assuming a position
of advocacy, or side taking, on the grounds that students are in a relatively
powerless position in relation to multiple authorities both on campus and in
their families. While students who are in crisis due to violence, suicide, or
psychosis must be protected, generally we hold that advocacy or protection is
not advisable for psychotherapists. Rather, therapists should pursue a neutral
stance, or what Boszormenyi-Nagy (1972) calls multi-partial alliances, which
involves not taking sides but instead developing positive connections to all
relevant parties. Th erapeutic neutrality then enables students to take responsibility
in their relationships.
Triangles are a common feature in family problems, since they create the
possibility of two persons who are in confl ict drawing a third into the battle,or two persons allying themselves to exclude the third. Many students have
had the anxiety-provoking experiences of feeling caught in the middle when
parents are at war, feeling like outsiders when parents or other family dyads
reject them, or fi nding themselves allied with one parent against the other.
Clinicians can assist students by explaining the concepts of triangles and
triangulation and helping students understand their own positions and other
family members’ positions within family triangles. Th erapists can further
assist by helping students analyze the positions they wish to take within the
family structure and practice taking those positions. Explaining the role
of family triangles is part of a larger therapeutic goal: helping students see
the parallels between their families of origin and their current diffi culties.
Understanding the parallels helps students make thoughtful choices in their
current relationships rather than blindly repeating dysfunctional patterns
from the past.
Because many psychological problems have their roots in students’ nuclear
and extended families, family therapists also generally encourage students
to establish contact with their families. (Exceptions may be necessary in
cases of physically or sexually abusive parents or siblings.) Establishing oneto-
one personal relationships with each member of the family system is a
part of achieving diff erentiation of self. Th e goal is for students to establish
healthy contact, as opposed to the extremes of enmeshment or cutoff . Doing
so changes not only the real relationships with these important people but
also changes students’ “introjects,” the aspects of these people that they have
incorporated into their psyches.
Embedded within the three principles mentioned above is the fourth,
diff erentiation of self. For older adolescents and young adults, this principle
is the relational parallel to developing an identity. Coming to college is oft en
a prime opportunity to work on this fundamental developmental goal. Diff erentiation
requires that students defi ne themselves and fi nd a proper balance
between remaining connected with their families and affi rming their individuality.
Work on diff erentiation of self requires students to remain in contact
with their parents while learning to evaluate and plan their own courses of
actions in response to situations at college. It is a move toward independence
from parents while remaining in healthy contact with them. Either extreme
cutoff or enmeshment is inimical to successful diff erentiation.
In employing these principles, an eff ective clinical technique is to draw a
family diagram, or genogram (McGoldrick, Gerson, & Shellenberger, 1999),
early in psychotherapy. Th is diagram is a graphic representation of the nuclear
family, the family of origin (if diff erent from the nuclear family, as with married
students), and the extended family. It allows both clinician and student to
observe relationships, repeating patterns, signifi cant losses, symptomatology,
ways of managing anxiety, and over- and underfunctioning. Th is information
may then illuminate similar relationship patterns at college. It also allows students to take note of what they do not know about their parents and other
family members. Gathering this information oft en helps students view their
parents as humans with strengths and weaknesses, a process that facilitates
their emotional development.