Translation of the last chapter of my book:
"Fundamental Concepts in Psychotherapy" (publ. 1985, rev. 1989)
Towards a Synthesis: Person-Centered Systems Theory
In the preface, I stated, that I wanted in this book to present the various schools of psychotherapy on the basis of their own inner logic and development, avoiding any hasty criticism. In the event, the result of following this principle has turned out to be more of a motley kaleidoscope of juxtaposed approaches, albeit with many cross-references a state of affairs which in fact reflects the current condition of therapeutic theory and practice rather well. Accordingly, it seems obvious that explanations of a person's condition and of changes of in his condition and behavior can center on particular aspects (or a network of aspects) such as basic inherited structures, biochemical and neuronal processes, muscular and general physical constitution, experi ences and ways of storing them, self-indoctrination, role expectations, styles of familial interaction, economic situation, or social values and norms, to name just a few.
For this reason, I do not believe that controversies in which the behavior therapists accuse the psychoanalysts of being unscientific, humanists abuse behavior therapy as "rat technology," and systems-oriented therapists refer to the thinking of others as "primitive and monocausal" are helpful in illuminating therapeutic processes. Certainly, nothing is to be gained by blurring over the differences between standpoints, but this does not mean that any of them must be the one "correct" one. Rather, different standpoints make possible different views on one and the same complex subject, and it is precisely having a plurality of views that enables one to reconstruct this subject adequately. We need not ignore the valuable contribution of many "old" approaches to our understanding of clinical processes just because they describe phenomena which we happen, from another theoretical standpoint, to perceive differently or not at all, for behind every one of the major approaches to therapy lie decades of striving for understanding and knowledge, innumerable experiences, and hard-earned lessons about the effectiveness of clinical action.
Consequently, in this final chapter I am going to outline a systemic theory by which many elements of the various approaches to therapy may be better seen in relation to each other. This "person-centered system theory" has been molded by a score of years of search for an integrated understanding of what therapy is, i.e., how to explain the phenomena I have been confronted with - as a human, a therapist, and a university teacher. I do not claim to be offering yet another therapetic approach; I am more concerned to suggest a framework which may help therapist in their clinical work to become more receptive to things that in the tradition in which they were trained tended to be ignored. The therapist must be aware that what he is intervening in from one particular angle is a complex network. He is not required to take all interrelations and levels into account, but sometimes, especially when the therapy is not going on satisfactorily, it can be helpful to switch perspectives.
Person-centered systems theory is rooted in both humanistic psychology (and the early organismic theories of personality) and the systemic approach (especially to clinical psychology and family therapy), and tries to include many of the common and familiar concepts, principles and assumptions of other personality theories and various kinds of psychotherapy in order to profit from these documents of insight and experience. It may be helpful to start with some of the central features of this theory in very short form:
1. Society is understood as a very complex dynamic system of "communications." The individual elements - the communications - are of very brief duration, and, therefore, most of the concepts which we talk about in our theories, explanations, etc., of social phenomena refer not to these transient elements themselves but to the more constant structure of the processes which create and organize these elements. (We might take the burning molecules and the flame of a candle as a simple model for the relationship between transient elements and the constancy of a processual structure.)
2. In this dynamic process, the individual is seen as a "transformer", continually transforming, in an unbroken stream, "impressions" (I) into "expressions" (E). The latter, E, is to a great extent what an observer would call "communicating" or "acting" in the everyday sense. However, in contrast to most systemic approaches, which focus in a rather behavioristic manner on the sequence (or, more precisely, on patterns of sequences) of communications:
---- -> ----------------> --------------->
C (P1) C ( P2) C ( P1)
Person-centered systems theory stresses that it is not a communication that produces another communication, but rather a person who perceives a communication, processes information, and reacts to it. Moreover, person P2 may "react" more to other I (e.g. a picture on the wall which he has just noticed) than to an E from P1, or may even not have noticed P2's xx E at all. The above diagram is therefore changed as follows (this can be interpreted as new interpunctuation - see Chpt. 17):
--- -> P1-------->
I -------> P2 ------>
I E I I E I I
The view has thus become person-centered. Moreover, it should be noticed that the terms "information," "perceiving," and "reacting" are also person-centered: an observer of the communicaton might "perceive" rather differently, pick up other "information", and find the "reaction" totally idiosyncratic.
3. This process of transformation in the individual is structured by beeing coupled to two processes on a "lower" level: (a) the neuronal processes of the central nervous system (CNS) usually called memory (in the broad sense), and (b) nonneuronal processes in the body which influence the neuronal processes via internal receptors (conceptualized by term like "muscular tension," "postures," "blood pressure," etc.)
4. According to many psychological theories, it makes sense to separate (analytically!) a particular subprocess out of the neuronal processes. This subprocess is able to refer to itself, i.e., it enables the organism to become aware of itself. By distancing ourselves from the immediate "here" and "now" we project ourselves into a standpoint which is as it were "there" and "then" - xx as if we were looking at our own being from the standpoint of an external observer. Both dimensions of this projection are significant. i) The perspective from "there" to "here" - i.e., looking back at oneself from the (imaginary) position of another person. This has been stressed by George Mead and the symbolic interactionists. Mead has shown how this perspective, combined with "role-taking," is the basis for (self)-consciousness, and many social phenomena. ii) The perspective from "then" to "now" - i.e., looking back at "now" from an (imaginary) position in the past and/or in the future. This gives our phenomenal world the framework of historiality which has been stressed by William James in his work about the stream of consciousness. Every act experienced in the present also contains both a relation to past experiences and a certain anticipation of what is going to occur. The processes outlined in (i) and (ii) constitute something which we call "experienced consciousness" (the self reflective, aware consciousness, in contradistinction to the "consciousness" which means "not fainted"). Obviously, this is also relevant for concepts like "will," "intention," and, therefore, "responsibility" and "guilt."
5.Impressions, expressions and conscious experiences are brief elements in a process whose structural constancy is due to multiple linkages to other processes. In addition to "memory" and "body" (see 3 above), the social system "family" represents a very important process. Because the communication is face to face, the expressions of one member are to a grater or lesser extent the impressions of the other members. Moreover, the expectations in a family regarding intimacy, confidence, and mutual confirmation of "reality" (including the self-perception and self-esteem of each member) give the family an extremely important function, especially in regard to mental health. Additionally, a remarkable proportion of the expressions are manifested in a material way - for example, furniture, pictures on the wall, things of everyday life - which can be understood as temporally "frozen" communications: a lot of them lead to impressions in the "now" although they were manifested some time ago (indeed, most "things" we perceive around us can be seen that way). Obviously, the same is true for the processes on "higher" social system levels - up to society - in which the familial communication processes are imbedded. In the totality of communication processes called "society," systems on different levels ("persons," "families," "organizations") are linked together in a complex manner, and each person contributes to the fairly stable structure of the unstable comminications in a way that makes him both actor and victim, creating social reality.
6. This linking of the processes makes it clear that they are not independent of each other. On the other hand, all processes within a system have to be understood as to be self-organized and, therefore, not determined by the other (or the "environment"). Only at a first glance does this seem to be a contradiction, for as we learn from modern systems theory - especially from its most elaborate formulation in Haken's synergetics - the emergence of self-organized patterns and the transition from one pattern to a new one is not determined by the systems's environment, although the environment gives the conditions for the framework in which this structural evolution takes place. (Of course, we cannot go into detail here, but it should be remarked that Haken's synergetic gives a profound answer to the question of how we can conceptualize these processes mathematically. Moreover, Haken himself and manys other using synergetics have shown amazing analogies between completely different systems, from physics to sociology. For an introduction see Haken 1983, Kriz 1990). The communication patterns of the system "family," for example, are formed through self-organization: no external orders or rules are given, but the persons act together by a kind of mutual understanding, each acting as if keeping the rules of a "game". These rules have to change according to different phases of family development; what is functional behavior for a family with young children may become dysfunctional when the children are grown up. Particular clinical "symptoms" in one member may result from lack of adaptation of a rigid perpetuation of communication patterns which can become more and more "pathological."
7. Consequently, the term "change" does not imply that the therapist can determine or plan the new patterns of interaction (i.e., with respect to the transformation process from impressions to expressions described above), either at the level of the family or at the individual level. He can at most, influence conditions in the communicative environment (meaning, interpretation, mutual expectations etc.) so that the processes aband on the current structural form and reorganize autonomously in other words, the system activates its self-organizing mechanisms to attain a new balance.
8. That every family regulates itself through patterns of communication which, in the "pathological" case, can even be reflected in the form the "symptom" takes, is in no way to deny that there are intrapersonal aspects. Om the contrary: if we ask why it was that a certain sequence of communications appeared, we have to focus on the outlined transformation process above. Moreover, especially in "pathological" families, an observer often can find that a present communication seems to be a rather strange reaction to a past one. The reason for this is that a particular expression in a family is a reaction to another expression not in what the latter xx means to the observer but, in wat it means to the family member. Following what was argued in 2 - 4 above, this meaning depends on many processes linked to the transformation process (impression, expectations, body feelings, thoughts, etc.). Consequently, the past expression might be only a vague trigger to start an "internal movie," and, indeed, often an expression is a reaction to that movie. We will discuss this later in more detail.
After this outline of some fundamental aspects of person-centered systems theory, some connections to other aproaches should be pointed out more clearly. Obviously, a change in the transformation process would result in a change in the experienced reality of the individual and, at the same time, a change in the patterns of familial communications (i.e., the transition from one communication to another one): psychotherapy thus represents a change in this transformation process.
In order to analyze these processes in some more detail we may use the classification of sensory memory or very short-term memory (VSTM), short-term memory (STM) and long-term memory (LTM), often used in the context of memory theory (Atkinson and Shiffrin 1968). This model can be helpful as long as one realizes that it is only a pragmatic model for the purpose of understanding and ordering phenomena. Moreover, we should understand the term "memory" as a process (not a storage container) and these "three types of memory" as particular subprocesses of what we will call the "central nervous information process" (CIP). In this regard, this notion is congruent, not contradictory, to an alternative view of memory (Craik and Lockhart 1972) proposing that how well we remember depends on how deeply we process information. Independently, there seems to be some evidence that these memories are based on different biological processes: VSTM on processes in receptors, LTM on biochemical processes in the neurons, and STM on neuronal electrical activity and its wave patterns.
Processes of the VSTM keep internal and external impulses available to the CIP as transformed patterns of the sensory systems for approximately 0.25 s. (see Fig. 20). Many experiments have demonstrated that the accessing of information, as well as processing it into a particular content, takes place actively and selectively even at this level.
Without being able to go into any explanatory detail I shall simply claim that the experienced "now" is approximately as long as the attention span - related to the process "STM": about 10-20 s - roughly the length of time we are able to keep perceived or recalled information in mind without rehearsing it or having to perceive or recall it again. "Recall" in this sense means that the CIP accesses the subprocess of the lLTM. The result of this total information process can be observed as the person's expressions (actions, words, etc.). However, not all impressions (or all recalled information) are transformed into expressions. great portion are used to regulate further processing (and accessing).
According to the above notion, the total transformation process remains unconscious, except a small portion of the information in the CIP which is processed to experienced consciousness. Experienced consciousness must be regarded as a special phenomenon of the CIP. There is substantial evidence that there are certain kinds of processing which do not reach experienced consciousness. Take the common phenomenon of a driver of an automobile who, deep in thought or in conversation, can still operate the car and go the right way "automatically," and can perceive, understand, and react to traffic lights and street signs. Only something out of the ordinary will steer his consciousness back to the driving situation. In addition, a number of experimental studies have been concerned with the process of seeing. Most of the glances (0.1 xx 0.3 s. between gross eye movements) are dependent upon stimulus and task; that is, these directed glances are constantly occurring as the result of the evaluation of complex information - a process which, except for a very few conscious glances, takes place unconsciously. Moreover, the findings with regard to what is called perceptual defense also show that unpleasant or anxiety-producing stimuli (e.g., certain pictures or words) tend to be blocked out of awareness.
The fact that CIP information does not happen to be in the experienced consciousness does not mean that this information has no influence on the content of consciousness and on the further transformation process. Unconscious stimulus information and/or memory "content" can also take part in the accessing and processing of information from the LTM and/or other stimuli.
Having accepted this as a working model, one can draw far-reaching conclusions. Whereas the significance of stimuli and "memories" is usually xx (over)emphasized, here the accessing and selecting process should be ascribed at least the same amount of importance. The main thing is not whether the information concerning an unpleasant situation is stored in the LTM or not, but whether, how often, and in what context these memories are accessed and how they are processed in the CIP. Accordingly, it is not the "incoming stimuli" which are important, but the selection and processing of them, together with information from the LTM, to an experienced consciousness (and/or their influence on the further process in the CIP). For example, anybody can recall the proposition "Death is a fact" - but if someone were really do so very often, it would become an important part of his experienced consciousness and hence might have great influence on the way he perceives, the way he acts, the way he recalls other information, etc.
I have already mentioned how perceptions, actions and thoughts - the elements of the processes of impression, expression, and experienced consciousness - last only a few seconds and how by contrast, our stream of consciousness and our experienced world phenomenologically show a considerable degree of continuity. Moreover, therapy is usually carried out with the goal of change: i.e., the system to be treated (the individual patient or the family) apparently is no longer able to change itself. Even the terms used to describe these systems point out this inability to change: "rigid coalition," "body armor," or "defense mechanisms." Consequently we now have to focus on linkages to systems with a lower frequency of change.
Three important systems were differentiated above: The first was the cognitive LTM, which processes not only linguistic information but also images, sounds, and recollections of feelings. This process is linked directly to experienced consciousness and hence to the "internal dialogue" emphasized in many schools of psychotherapy - in particular in Elli's rational emotive therapy but also in Jungian and Adlerian therapy. George Mead and the symbolic interactionists stress how reality (including its norms and values) is structured and stabilized by this constant internal conversation with oneself (not necessarily verbal). Even most esoteric schools of mysticism (e.g., Zen, Sufism, some parts of Hinduism and of medieral Christianity) emphasize the importance of this internal dialogue for the "illusion of reality."
The contribution of the second system, the nonneuronal body process, has been stressed by Wilhelm Reich, Alexaner Lowen and other body therapists. Body attitudes and muscular tension can be understood as processes of storing experience and behavior. A child who is forced to suppress feelings such as sorrow, pain, and frustration learns very soon that he is able to get these feelings under control by reducing his breathing. If such situations happen often he will develop characteristically shallow respiration and the chest muscles will become chronically tense, which in turn will restrict the breathing and obstruct the flow of feelings. In this way, a certain defense or coping strategy is physically manifested, and this manifestation (the muscular tension) ensures continuity of this element of experience and behavior: the muscular armoring restricts respiration and keeps emotions like sorrow, pain, and despair from being expressed. This would be an example of how earlier experience via body parameters also influences experience in the present "now" - again, often without this becoming conscious.
Other physical aspects are closely connected with these body attitudes. Earlier ways of life (such as alcohol and drug abuse) and ways of coping with problems (such as psychosomatic illness) manifested in the body, give rise to stimuli inside the body in the present "now," and via internal receptors have an impact on what constitutes experienced consciousness. This occurs both through the contents ("Darn, my stomach hurts again, I shouldn't let myself get so upset") and via the processing and access patterns which may remain unconscious but, nevertheless, might make the visual field especially open to a particular impression and/or influence a particular action. Another body aspect which Reich and other body therapists emphasize is the energy balance, a concept which we cannot go into further here. The third system has been referred above to by the term "society" (and subsystems such as "family"). It processes far more information than the body systems; moreover, it concerns a great deal of information that we as individuals did not even produce. The stimuli that flow into the VSTM as an impression are for the most part artificial stimuli created by humans. If we take a look around, we see a mass of objects which affect the organism in the present "now" in the form of stimuli - but they are the materially manifested results of accumulated social experience and knowledge from the past. the "then". Moreover, there is plenty of accumulated social experience which, however, is not manifested primarily in material but in social structures: work, friends, family, etc., involve social relationships, i.e., roles, the structures of which others confirm by their actions. A person behaves differently depending on whether he is acting as a friend, a parent, or a colleague, and the "appropriate" behavior is constantly being confirmed. Behavior is directed by one's being able to expect what others expect from him in a particular context.
These mutual expectations of expectations, and their confirmation, are not only what sociologists have made the foundation of social relationships, institutions, and societies in general. In addition, this network explains the outstanding function of the particular social system "family" and the mutual relationship of expression and impression in face-to-face communication. On the other hand, it has also been stressed that what the CIP makes of an impression need not be congruent to what an observer would claim was the reality of an expression. Especially in "pathological" families the variety of situations and behavior is reduced by interpretation to only a few categories of impression (this correlates with the "internal movie" mentioned above). The persons' perceptiveness xx is reduced, for everybody "knows" what the meaning of X's expression will be the moment X starts to act. The mutual coordination of impressions and expressions will therefore cause a similar reduction in the varity of expression ("Why should I change my behavior xx - they wouldn't even notice it" is a often heard statement in psychotherapy which reflects this systemic process of meaning and acting). This process reduces the family system's degrees of freedom. Even small random fluctuations of behavior cannot be used for greater change, because of the reduced categorization of the impressions. The family therapist therefore has to perturb the system by bringing in new information, with the techniques grouped together above under the label "reframing." It should be clear now that reframing works only within the complex process of mutually confirming expectations, impressions and expressions.
By the same logic, education and socialization are intended particulary to transmit the learned meaning of material, social, and symbolic products of social development to the next generation. These structures of meaning for decoding stimuli and for modes of behavior are learned, and deviations are discouraged through sanctions: a fountain pen is not something you throw, it is something you write with; you don't cheat your friends; as an employee, you do what is required of you. And in this uninterrupted process of transforming impressions into expressions, imbedded in the general structures of meaning confirmed by all members of the society, everybody is both committer (of his expressions) and victim (of other's expressions and his impressions). However, within this general framework of meaning each family (and within the family each person) has a claim to personal meaning. A person is surrounded by his house and furniture, his friends, his experiences made manifest: in material form, like that picture on the wall that reminds him of his last vacation, or symbolically and socially, like a certain catchword which a man and a woman use in their "private language" to bring into the CIP a particular experience they had together. However, compared to the possible degrees of freedom for interpretation and meaning, even the most "pathological" family and the most idiosyncratic person can be still recognized as a member of a particular society (and not coming from a foreign planet), and is, thus, relatively "normal."
Many social scientists, particularly the symbolic interactionists, who go back to Mead, even see the basis of reflexive consciousness in these processes and social roles. Newborns (and animals) act and react accordance with internal and external stimuli, and they can also learn to increase or decrease the frequency of behaviors (crying, for instance). Nevertheless, we can assume that they are not aware of the meaning of their behavior. In contrast, a 2-year-old child is already able to play mother and child, assigning his own role, that of the child, to the doll. He can now look back on himself from the position of an other person (in this case the mother) and can have some expectations that his mother has. He has a reflexive consciousness of himself, and can use gestures (like crying) intentionally. This is the developmental perspective on the process of experienced consciousness we discussed above. By progressive abstraction from the roles and attitudes of particular others to roles and attitudes in general, the so-called "generalized other" is formed, which incorporates the attitudes and values of the society.
Thus, each person's process of transformation from impression to expression is embedded from the very first moment to the last minute of life in family and other social processes. Through these systemic processes, earlier experiences and decisions still act in the present "now": the profession we have chosen, our spouse, children, friends, material possessions, what we expect of our environment - all of this we are constantly re-encountering in the "now." Often we must make an extreme effort to keep from completely freezing in this web of material obligations, social expectations, communication structures, etc., which are constantly bombarding us in form of impressions (and, conversely, which we constantly emit in form of expressions to our social partners). Here, the difficulties associated with individual therapy become evident: this entire network, which supports continuity, is always being counteracted by the efforts towards change. This also illustrates the narrow perspective of some therapeutic approaches when they (e.g., rational emotive therapy) judge cognitive statements and belief systems to be individual and "irrational," overlooking the rationality of meaning and its stability in the particular social subsystem (for example, the family).
The mutual confirmation of impressions, expressions and conscious experience gives significance to the findings of a host of experiments which demonstrated how necessary it is for a subject that the CIP constitutes "meaning structures": for example, when lights in a lamp matrix flash randomly, they are perceived as a figured pattern, and, similarly, a certain regularity is perceived in even a random sequence of certain stimuli. Accordingly, "meaning" as a factor, and the pathogenetic significance of disturbed structuring of meaning, is reflected in many therapeutic concepts; for example, in some families it is not possible to structure meaning because the messages are pragmatically contradictory and because the meaning attached to any definition of a relationship is not confirmed by the other persons. If the contradictory information causes the CIP to fail in its attempt to structure meaning - or to transform its impressions to expressions which are accepted - it is entirely understandable that schizophrenics typically retreat from communicative stimuli and/or engage in the struggle for power over the definition of the relationship, as the Palo Alto school has shown (see Chap. 19).
Victor Frankl's concept of the no”genic neurosis, the suffering from meaninglessness, also fits in here. The no”genic neurosis concerns not so much the illogical/contradictory stimulus structures themselves as the lack of prestructured patterns of meaning, from which a historically and purposefully structured world of everyday life can be developed. Concepts like Adler's "life style" and "life plan," Eric Berne's "script" or the "delegation" in family therapy are concerned with structuring meaning in the life history, which in the pathogenic case can affect processing in the CIP by an early unassimilated intake of meaning structures from outside and/or by association with dysfunctional content (this is Adler's "tendentious apperception").
In order to outline the pathogenesis, let us take a child who in a certain early phase of development in connection with toilet training experiences certain conflicts, reflecting an exaggerated emphasis on such things as power, order, and sexuality in the previous generation. Many verbal and nonverbal impressions are brought via the CIP into the LTM, and since the child is repeatedly confronted with them, they are recalled into the CIP, processed, and stored in new variations and with new associations. Through the processes discussed above, stimulus- and environment-specific meaning structures are formed, which are of decisive significance for the nature of further information processing. At the same time, certain muscle reactions, the warding off of feelings, and expressions of fear lead to certain manifest effects in the body processes. Wilhelm Reich already pointed out the connections between cognitive and physical defense attitudes and even their interrelationship with social conditions. In the "generalized other," norms and values in reference to power, order, and cleanliness are generalized and actualized in the impression -expression process with the parents even beyond toilet training. Moreover, these expectations and values will be reflected in the material and social surroundings in the home, and the child learns to apply his material structuring process ("Keep everything neat and tidy!").
Later when the conflict has been settled, the CIP continues to be confronted with information and stimuli in the three systems (long-term memory, body, surroundings), and this information will influence the total transformation process - from impressions to expressions, meanings. etc. Thus, even many years after the conflict, one may find many elements manifested in this process which can be interpreted in relation to the particular theoretical approach of the analyst: the transactional analyst will discover certain patterns of transaction, the couples therapist will find typical "anal-collusive partner selection" (see Chap. 18), and the family therapist will detect certain patterns of communication and interaction structures in the newly started family. The rational emotive therapist, in examining the belief systems and cognitive statements of his client, will find that particular "must"-statements (i.e., norms) play a major role: the internal dialogue, which is the perpetuating access of the CIP to the LTM, revolves around topics corresponding to power, order, and clealiness (as in the LTM-process, a huge amount of associations related to these topic are involved, and body and social surroundings constantly supply the stimuli). The therapist doing individual therapy will thus discover many actions of the person that express a certain "guiding fictional goal" to realize a "life plan.". The network of typical statements, syntax, voice, appearance, body attitudes, and aspects of self-experience was best described by Virginia Satir in the form of "communications patterns."
Of course, no development will follow such a straight course as the above example. There are countless situations in which a tendency can be weakened or strengthened, especially by the influence of the larger social process on the intrinsie evolution of the system: for example, the death of a family member, losing a job, or meeting a loved one. Nevertheless, in the system (person or family) which requires psychotherapy certain tendencies of structuring have apparently become so strongly manifested that the system suffers from its lebenswelt and is not able to change the structure of the processes on its own.
There are numerous approaches to therapeutic intervention. A lot of details concerning interventions in relation to the concepts of each approach have been presented in the previous chapters. The purpose of this chapter was to convey the idea that every modification of a system - regardless of level on which the therapy is carried out - ultimately has to produce changes in the entire systemic network if it is to be successful, changes on levels that are not explicitly dealt with by the particular therapeutic concept used. This is not to say that a therapist needs to be thinking of all possible aspects at once. But understanding the network of the interwoven processes can make it easier to change from one approach to another when systemic feedback on another level of process counteracts the change intended in the patient or the family. To the extent that he is unaware of this interacting network, the therapist reduces the number of parameters and degrees of freedom upon which his therapeutic creativity can be based, thus limiting the chances of a successful therapy.