Contents
System model D.N. Oudtshoorn suggests that problems in the family can be at various levels, requiring a different approach each time. This approach provides a stereoscopic vision of the situation, helps to formulate the necessary therapeutic program and delimits the areas of competence of different specialists.
The first level considers the problems of family members in the context of social ties. It covers, among other things, school or family work, relationships with more distant relatives, friends, acquaintances, neighbors, housing and family income. Hypotheses of this level explain the emergence of psychological problems by unfavorable environmental factors. For example, the bullying of a child by classmates, the lack of work in their specialty for parents, the low material security of the family, violence on the street, and other variants of a traumatic or impoverished external environment. This is the traditional area of social psychiatry, social workers, employment services, class teachers, commissions for minors, etc. In developed social assistance structures, it requires specialists to contact and mediate with the employer if the teenager is working, and with the school if he is still studying. Sometimes mediation is required in solving housing problems and finding a job.
Level 2: Problems in the family system
At this level, the problems of the family as a natural group are considered. The symptomatic behavior of the identified patient is analyzed as a consequence of dysfunctions of the entire family or its individual subsystems. The emphasis is not on the individual characteristics of family members, but on their interaction and structural features of the family organization. Family or marital psychotherapy deals with problems of this level, involving the whole family or relevant subsystems in the work. See →
The next four levels describe individual difficulties.
Level 3: Cognitive and behavioral problems
They cover disturbances or difficulties in the area of emotions, cognition or behavior of the patient, explained from the perspective of learning theory. Examples of problems at this level are low self-esteem, underdevelopment of social skills, learning lag. The main types of help here are cognitive and behavioral therapy.
Level 4: Emotional conflicts with aspects of the unconscious
For this level, the most common diagnosis is neurosis or neurotic conflict. Emotional disorders have a conscious side and an unconscious, or «double bottom». In these cases, an outside observer is struck by contradictions and inadequate reactions. In children or adolescents, we often observe what is called “reaction formation” or “overcompensation”, which can eventually lead to characterological disorders. The hypothesis of this level requires psychodynamic psychotherapy. The therapist deals with unconscious processes and resistances.
Level 5: Developmental and personality disorders
Here long-term and deep properties and deviations are formed. This applies to various aspects, such as temperament, character traits, personality disorders, autism and early developmental disorders like autism, as well as specific developmental anomalies. It is difficult to cure, but counseling or psychotherapy can help adjust.
Level 6: Biological disorders
At this level, if there are grounds, a hypothesis is formulated indicating the presence of somatopsychic connections, when somatic (biochemical, neurophysiological or pathological) factors are primary, and mental disorders become their consequences; or psychosomatic connections when we are dealing with a reverse situation. In the latter case, it refers to «functional» complaints (eg headache) or «psychosomatic disorders» in which a physical illness, such as an ulcer, is always present. Help at this level is mainly medical.
General considerations
All these levels are interconnected and, in accordance with the general systems theory, improvement in any area and at any level of the system will affect all others, unless the strength of these levels neutralizes the success of therapy [Spiegel, 1969].
The higher the level, the more optimistic the hypothesis looks to the therapist. When developing a psychotherapy strategy, Oudtshoorn believes, it is necessary to choose no more than three levels, where the violations are most pronounced, and focus on them.
How to work: you need to start with a simpler level:
- Do not feed pills to someone who can do without them.
- No need to adapt to what can be solved.
- No need to dig into the unconscious where you can solve the issue at the level of behavior.