Explaining Symptoms in Systemic Therapy. Does Triadic Thinking Come Into Play?

Abstract

The main aim of this study is to explore the breadth of the inference field and the type of etiopathogenetic contents of symptom explanations provided by the client and therapist in the first two psychotherapy sessions conducted using a systemic approach. Does the therapist use triadic explanations of psychopathology as suggested by her approach? And do clients resort almost exclusively to monadic and dyadic explanations as did the university students in our previous study? What kind of explanations do they propose? The coding system "1 to 3: from the monad to the triad" was applied to the transcripts of 25 individual systemic therapies conducted by the same therapist. This manual allows coding of the inference field of symptom explanations according to three categories: monadic, dyadic, and triadic. These three broad categories are also used to analyze the etiopathogenetic content of each explanation: traumatic, intrapersonal, and interpersonal. Our findings showed that clients and their therapist actually used different inference fields: clients resorted almost exclusively to monadic and dyadic explanations, whereas their therapist included the triadic explanatory level. Moreover, the therapist provided more interpersonal explanations than her clients. Hence, the dissonance between client and therapist about the inference fields -a crucial premise of one of the most accepted ideas of therapeutic change according to systemic therapiesis proven, at least among our participants. Thanks to this dissonance, clients and therapists can create a new story, potentially able to change clients' feelings, without disconfirming their emotions.

Is the mainstream construction of mood disorders resistant to systemic thinking?

“…Our hypotheses were fully confirmed across both textbooks' chapters examined, as they showed very similar explicative patterns. These findings support previous literature on similar topics but conducted with different methodologies (32,49,73).…”

“…This coding system allows distinguishing between monadic, dyadic (unidirectional or bidirectional) and triadic (triadic or systemic) explanatory models. This has been complemented by the additional categories included by Ugazio et al ( 49 ) to analyse the type of contents/causes of the explanations [amended from Schweizer et al ( 69 )].…”

“…Ugazio and colleagues ( 49 ) found that clients in private (systemic) psychotherapy with psychologists resorted mostly to interpersonal explanations rather than biomedical ones. Other research conducted with Italian lay populations ( 50 , 51 ) found that mental disorders (including depression) are mostly seen as a reaction to significant current life events and psycho-social stressors and that should be overcome with the help of health professionals (mainly psychologists) and/or support of significant others.…”

Paving the way for systemic phenomenological psychiatry - the forgotten heritage of Wolfgang Blankenburg

“…Similarly, from a systemic perspective, the key to explaining a symptom is, in the first place, to broaden the inferential field and put it into context ( 93 , 94 ). We have mentioned in the introduction how explanation through contextualization actually characterizes the very phenomenological method ( 95 ).…”

“…A dialectical approach on symptoms as meaningful reactions to difficult situations does not only emphasize their embedded and relational character, but also resonates with another core principle of systemic therapies, namely the idea of symptoms as solution attempts ( 93 , 94 ). A basic tenet of systemic therapy is that symptoms are constructed as “unconscious” creative - and adaptive - attempts to tackle difficult or even paradoxical relational situations: it thus positively reframes what is usually viewed as a deficit ( 96 , 97 ).…”