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pathology within the person, often as a constitutional or pathogenic
characteristic; the cause was frequently seen as beyond the patient’s
conscious control. Therapy was likely to be targeted on the individual to
alter the pathological process, whether by changing their mental processes
through psychotherapy or their chemical processes through drugs.
From the mid-1960s to the mid-1980s, systems thinking and other
developments led to a way of thinking that emphasised that people’s be-
haviour was strongly influenced by their interaction and communication
with those around them. Behavioural psychology had already described
how the pattern of stimuli and responses could determine an individual’s
behaviour, but family systems thinkers focused on a more complex set of
environmental determinants. The client was seen as a basically healthy
person who was not functioning well because they were responding
to unreasonable demands put on them by the outside system; anyone
might reasonably respond that way in those circumstances. The therapist
attempted to alter the family influences on the client, with the result
that the whole system shifted, including the personal characteristics and
problems of the client. Therapy was carried out in the ‘here and now’
working on current problems. It did not concern itself with past origins
of difficulties, or with behaviour that the therapist, but not the client,
perceived as a problem. The focus was on changing external contingencies
rather than on the individual as a conscious agent.
The past two decades have seen further conceptual developments. The
wider cultural context of people’s lives has been more explicitly recog-
nised, and there has been more focus on what people can do rather
than what they cannot. The active, conscious processes through which
a person shapes their sense of identity are more fully acknowledged,
rather than their being seen as only reacting to events. People construct
a story about themselves that has to be respected and worked with, using
the person’s own language rather than imposing professional jargon. The
person is seen as having many strengths that may need mobilising to fight
the difficulties outside themselves. The therapist focuses on helping the
individual to deploy more of the effective strategies that are already part of
their repertoire. This may be achieved by helping the person become aware
of the narrative ‘script’ they are living, and enabling them to ‘rewrite’ a
more positive story by which to live their life.
There are also other approaches to working with families which
recognise the complexities of wider interrelationships, but which did not
primarily evolve from cybernetic systems theory. These include psychody-
namic family therapy and behavioural family therapy. The latter has had
well-documented success in adult disorders improving the outcome for
people with schizophrenia by reducing the number of critical comments
by nearest relatives. In children and adolescents, behaviourally-based
parent training is effective in improving disruptive behaviour. It is also
totally systemic – in some versions of group parent training the child or
adolescent is not even seen – yet perhaps ironically behaviourally-based
parent training tends to not be seen by systemic therapists as part of their
family of interventions.