here's a hypothetical situation for you I've got only one slot available in my week and I get two phone calls from families needing treatment on the same day the first is from a family of a 15 year old child who has two parents and they call to tell me that he has OCD and they want family therapy to help support him the second call comes from the family of a 15 year old who refuses to go to school whenever mum and dad start fighting which would you choose call a or call B both confused I'm
a family systems therapist and here's how I would decide from a family system's perspective option A is a very typical call you might get in your private practice some concerned parents looking to support their child around a symptom and it's probably something I could figure out and help with and I'd be totally okay doing this to be honest but I don't know anything about the system all I've got is an IP some OCD and parent assuming that there are no surprises option b gives me so much more to go with the system is pretty much
spelled out I've just got so much more information on relationship Dynamics mum and dad fight and their child acts out and I'll posit a guess that when he acts out Mom and Dad's fighting decreases it's a loop that I can already imagine I can imagine the circularity around it I can kind of see what I'm doing already when I know the pattern in a family that supports the symptom I have a much clearer plan for treatment I can work on interventions that interrupt this cycle at any point compared to a this is much juicier at
least systemically now what if I were to tell you that they were the same family and I used circular questioning in my first session to transform the information from option A to the information to call B so it's a true story the family came in saying that they wanted to support their child with OCD but the technique of circular questioning allowed me to understand what was really going on in the family and that was that there were some serious issues between Mom and Dad that were impacting their child who was acting out as a result
circular questioning is the technique I'm going to explain in this video and it is a game changer it helps you understand all of the moving Parts in a family system so you can start to formulate what patterns are in place that supports the system and the current dysfunction I use circular questioning in the first few sessions to try to create a sequential description of events around how members of the family behave and feel before and after an episode of the problem Behavior just like this I also refer to this as a sort of pattern of
interaction it's a little less of a mouthful but this implies that we firstly need to identify the problem around which we're investigating interactions strategic family systems only target one problem at a time and if you're successful and you deal with that problem then you're welcome to move on to the next problem or you can terminate circular questioning gets the family members to describe elude to and elicit descriptions of interactions around uh events that trigger the problem Behavior it helps us to understand how the identified patient is treated while the problem behavior is exhibited it helps
us learn how members of the network try to deal with the problem and the outcome of any solutions that they've tried in the past so we know what doesn't work once this cycle of interaction has been identified usually in the first few sessions the rest of the time in treatment can be spent on developing and finding ways to interrupt the pattern so the behaviors stop problem identification now you might might be tempted to skip this section because it might feel like I'm belaboring a point but identifying the problem is so important getting very specific on
this issue is going to set you up for the rest of treatment it's going to be an anchor that you hold on to 10 sessions from the first one where you're a bit lost and confused so let's say I had a new family in my office and I were to ask what is the problem and I got an answer of my son is acting out well if I were to accept that answer and not dig around using circular questioning well maybe I would figure things out maybe I wouldn't but when you work or think systemically
you assume that all symptoms are relationally driven so when I assume that I just can't accept my son's acting out at face value I will need to ask more questions if all symptoms are relationally driven here's some of the questions that I might ask to get a little bit further if there were creepy Big Brother cameras in the house what would I see that would let me know that acting out is occurring under what circumstances does he act out what happens after when does it happen when does it not happen who is around when it
happens who is not around when it happens you get the picture right if you start asking everyone in the room questions like this you will get so much more information than my son acts out in fact it might sound more like I get worried about my son and his school performance so I tend to ask him a lot of questions and bug him about his homework this makes him irritable and we often get into conflict which can escalate to the point where I feel scared or powerless at which point I called my husband now up
until that point my husband has stayed out of the conflict but when he gets that cool he comes in guns blazing and he takes over my son feels ganged up on and resentful and withdraws from our relationship then acts more secretive and shows me less of his grades and doesn't come to me with problems so his grades dropped I could start the session like that saying so what is the problem it's a cycle that's a little bit more helpful than my son acts out so what do you ask well I could start the session like
that saying so what is the problem you'd like my help with the issue with that is one parent's probably got a semi-scripted answer for this question and is anticipating you asking it it will be IP focused and probably have a lot of historical data so when he was seven he fell out of a tree and had this concussion and as though we've had brain scans I think that this is another option is that the family will not have a clue how to answer that question and they will take turns giving different opinions on how or
why the IP is the problem also not very helpful or they will play nice and say communication issues or look blankly because the family doesn't actually have a problem into the IP so let's refine that question a little more how about something like I'd like each of your opinions on what you think the problem going on right now is this line of questioning gets family members thinking systemically right from the start they are being told that they are expected to and have something valuable to contribute and that the spokesperson for the family which is usually
the person that called is treated like an equal and isn't the be-all and end-all of knowledge of the family on that note I would follow up and deepen with each individual when they give you an answer so things like do you agree with what mum said or would you change anything is that usually right with things like this it's going to be really helpful and get you more information and build up that sort of report so how about we change the question to what is the problem in the family right now that you would like
my help with some version of this sort of falls out of my mouth um I like it because the right now part indicates that I don't want to hear about that story about the time he was seven and fell out of the tree yet don't really want to start with the in-depth historical intake now you probably do need one but not in the first session I want to know what the problem is by talking about the problem head-on in the first session I'm not colluding with any family secrets or rules that we don't talk about
the fact that our kid hits us or we don't talk about the fact that that drinks too much I had one family who came in um dealing with sort of this very horrific situation with their teenager and uh I could tell that they didn't want to talk about it so I kept on asking about the details of this event that had happened to them and I could see that they were getting uncomfortable but I knew I had to do it because if I didn't talk about it I'd be joining the family's rules and secrets of
not talking about this event so I'm also saying what is the problem you'd like it might help with and that means that I'm setting the tone around this being therapeutic we're here as a family to work on the problem it insinuates that I can't really help your son get better grades but I can definitely help your family understand what's going on in the relationships that doesn't allow him to study now if all else fails try asking something like what changes do you want to see in your family or if I could make any changes in
your family realistic or magical what would it be if the family is sort of giving you the run around on telling you directly what the problem is then this line of questioning is less threatening and sometimes helps get them to be more forthcoming and you can Circle back then to identify the problem once they're talking about the changes they want to see so I would like to change our communication I'd jump in and say well what tends to happen with the way communication is happening right now or if you can't if I can't change the
way you communicate what will happen to the family in a year from now in five years from now whatever the answer you get I think it's important to remember that all behavior is communication and more information can be gained from understanding Behavior circular questioning really helps with this often we just infer another person's internal state with a comment like she's depressed family systems would get some elaboration on that like what does she show when depression is present oh she slams doors and isolates and won't eat well that's a very different version of what depression looks
like compared to what I think it looks like so asking about specific descriptions around behaviors is really helpful when you do get answers about the problem don't stop there go deeper by asking what you would see or what you would notice I would try and encourage you to get a consensus or an agreement on what the problem is that's so that the family feels confident about what they're doing in future sessions and you don't get sideswiped with a change of mind later on in treatment so who do you ask well you've got some options here
the IP I usually don't start with the IP because that would reinforce their position as being the problem stay away from that the spokesperson well this is probably the person that called you often in a family session you've got one person who wants to start the conversation or do more of the talking and I don't think you can assume you know who they are just because they're doing the talking um they often they'll have a script that they recite to you often they think that they know what is going on so I'd avoid them I'd
try and go for somebody who isn't the IP and isn't the spokesperson the youngest in the room well the person at the lowest end of the hierarchy often the younger sibling has a very different and sometimes more honest view of what is going on this could be a good place to start but if there's too young I probably wouldn't go that wait for them to feel more comfortable and then my final thought is thinking about the hierarchy if parent a has done all of the talking with you parent a was the one that called you
I'd perhaps start with parent B the most powerful person in the family is the most important to identify as we want their buy-in for treatment just because Dad is being quiet doesn't mean that he's distant engage him as much as possible um and even perhaps even more than other people so often there's one parent that's more involved and one parent that's less involved and I think a solid option is always to go for the less involved parent first bring them out insist that they're going to be involved in treatment circular questioning is really more powerful
when you use it to explore a speculation or idea you have of what's going on in the family linking your questions to the hypothesis creates a purposeful and coherent interviewing pattern where information is revealed to the therapist and the family at the same time you should be able to get a sense of the problem from the intake call um so arm yourself with the right questions as soon as you have to call that parent back and these are kind of similar to what we've talked about already what is the problem you need my help with
you're going to ask that same question again when everyone's in the room but you can always ask it on the phone just to get uh you know one person's take on what it is on that note you want to insist that everyone in the household comes to the family session don't let it be just the IP and a parent let it be both parents the siblings you want everyone in the in the house and actually everyone in the system in the family session so that might be grandma has to come in if Grandma spends a
lot of time at home
