Family and Systemic Therapies 357Individuals are asked to state the problem in behavioural terms, not in
terms of mood states.
The effect of the symptom on relationships is discussed: ‘Who does what
in response? Who is most affected? Who noticed first? Who is most
worried?’
Differences between people are considered: ‘Who cares most that Lucy
won’t eat?’
Hypothetical scenarios are considered, to define the effect of the symp-
tom on relationships: ‘If Jim didn’t have the problem, who would be
closest to him?’
Timing is explored: ‘What were relationships like before and after the
“problem”?’ Thinking about the future, ‘What would happen if it never
got better?’
Questioning may be triadic, that is, asking a third person about the
relations of the other two: ‘How do your brother’s tantrums affect your
mother?’
New alternatives are canvassed: ‘What would have to happen to stop
Jim misbehaving?’ Meanings and actions are separated.
Circular questioning of silent or ‘mad’ family members is used: ‘If he
were to speak, what would he say?’
Emotions are treated descriptively, not sympathised with: ‘Which of
your children understands your depression best?’ ‘What would have to
change to reduce your depression?’
Information is shown to have different meanings for different family
members, thus revealing family relationships.Positive connotation
This is more than a form of reframing or relabelling, because it tries to
address the rules of the whole family ‘game’, rather than one individ-
ual’s behaviour.
Symptomatic behaviour is reframed as good because it helps maintain
the system’s balance, so facilitating family cohesion and well-being.
Thus, volition is ascribed, and the symptom is seen as helping the family,
not as a negative entity.
The presumed intent is what is positively connoted, not the behaviour:
‘Thank you for preventing the outbreak of family strife over your
brother’s bad behaviour by refusing to eat.’ It was believed by early
systemic therapists that because positive connotations express approval,
families do not resist them. More recently therapists have taken the
view that it is not change that is necessarily resisted, but approaches
to treatment which do not match the families’ beliefs.
After perhaps 30–40 minutes of a session, the systemic therapist often
withdraws to confer with their team behind the one-way mirror for ten
minutes or so. After this, they re-enter the room and give ‘the message’
which may be accompanied by a task for family members to carry out. An
example of each follows.