Psychopathology: Theory and Practice

23 April 2020 – Arnon Bentovim

The language of family psychopathology was established by the pioneering group of professionals working with Gregory Bateson in the 1950s who used the perspective of General Systems Theory as the basis of their observations to establish the ‘Double Bind Theory’ of schizophrenia. Concepts such as boundaries, homeostasis, reciprocal transactions, symmetrical and complementary communication, feedback loops, alliances, triangulation have entered shared language. The Family Therapy Movement differentiated from the pervasive psychodynamic orientation in the US, but as practitioners trained in psychodynamic approaches we attempted to link psychodynamic and systemic thinking.

Based on our research on family functioning we introduced the Family Assessment model which provides the tools for practitioners to work with families. It describes the Family System as being made up of parts or sub-systems such as the parental partnership, and the parent-child subsystem which all contribute to the working or functioning of the system as a whole. Properties include how family members communicate, the nature of family alliances including attachments, and the management of boundaries and feeling states affect how the family system operates. The family system is more than the sum of its parts and there are characteristic patterns and core ways of relating and being – not so much cause and effect, but patterns of interaction. Families are located within the wider social system of extended family, local community and cultural norms and expectations.

Conflict is inherent in family life as a result of significant differences in gender, age, and developmental stage of family members. The basic structure of the family needs to work optionally to manage differences. The experiences of the parents as children – inter-generational effects – have a profound impact on the way the family functions. Parents with a history of trauma, abuse and dysfunction may have distorted, complex relationships with partners – and children, with mutual dependence and high levels of conflict. Traumatic events ‘organise’ relationships justifying harsh, abusive or neglectful responses. Children may be organised into caring roles for parents with mental health and substance abuse, children with special needs can organise the lives of the family around their needs.

A variety of therapeutic approaches have been developed to work with families including the SAAF Assessment approaches to determine whether the family is via-ble as an organisation or whether there is a potential for positive outcome, strengths which can be built on, goals which can be met. It is essential that practitioners develop skills to engage with children, young people and family members, joining, managing conflict in the here and now, using a variety of tasks to promote communication, allowing all family members to have a voice. “Structural approaches’ aim to intervene to change dysfunctional patterns, block dominating controlling voices, and promote and reinforce alternate patterns. Solution Focused approaches look for instances of appropriate responses – care rather than criticism, and helps the family to build on the positive – the solution. Attachment based approaches promote positive responsive, reflective key relationships to develop security and organisation of relationships. Mentalisation based approaches aims to help family members to begin to put themselves in each other’s shoes, and develop relationships based on understanding rather than beliefs.

The Hope for Children and Families approach takes the key practice elements therapeutic procedures across the field to provide the practitioner with a step by step approach to working with families. The seminar will use video examples to explore the concepts of family psychopathology and introduce approaches to intervention.

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Dr Arnon Bentovim

Arnon is a Child and Adolescent Psychiatrist. He also trained as a Psychoanalyst and Family Therapist. He was a Consultant at Great Ormond Children’s Hospital and the Tavistock Clinic. He subsequently established the Child and Family Practice London, and Child and Family Training UK., and is a Visiting Professor at Royal Holloway, University of London. He was part of the network of mental health practitioners who together with Robin Skynner worked with Salvador Minuchin, and Luigi Boscolo and Gianfranco Cecchin from the Milan Group.