The Family Construct Approach and Psychosomatic Research

The Family Construct Approach and Psychosomatic Research by H. G. Procter BSc. PhD. Dip. Psych. (shortened version for publication) Paper presented at the Seventeenth European Conference on Psychosomatic Research, Marburg, West Germany. September 4th - 9th, 1988 In the thirty three years since Kelly's original opus the creative potential of construct theory continues to be realised in a steadily accumulating literature . Kelly's influence, often unacknowledged, is evident in a wide variety of writings. My own work has involved using and extending Kelly's theory for the study of and therapeutic intervention into families. Kelly's ideas appealed because they resolved many of the problems attached to psychoanalytic, behavioural and cognitive psychologies (Procter, 1978). But Kelly's theory was still primarily a psychology of the individual. Also about this time, in the late sixties, I began to come across the interactional literature on the family - Watzlawick, Haley, Bateson - and was persuaded by the arguments that for a full understanding of normal and pathological human situations it is necessary to use an interpersonal, systemic view that transcends intrapsychic theories. But in spite of the tremendous advance in our understanding that the systemic and cybernetic approach provided us with, it left a rather impersonal and even mechanistic view of family processes. Laing had pointed out how vital it was in understanding a situation to be able to enter the point of view of each of the participants of the drama. This has for me been proved valid time and time again both in my own experience and in clinical practice. Personal construct theory became for me the tool for beginning a systematic and rigourous approach to the family that, whilst remaining consistent, would simultaneously act as a descriptive system, a research paradigm (for example in the repertory grid research with families) , a tool for therapy and a way of subsuming and reconciling the incompatablities of previous models. This work has been described in a series of papers (Procter 1981, 1985a, 1985b, 1986, Dallos and Procter 1984). Flowing from Kelly's person~as-a-scientist metaphor is a vital principle, which was emphasised by Don Bannister, who contributed so much before his recent death. This is the principle of reflexivity - that any psychological theorising should be able simultaneously to account for itself as well as its subject matter. In practice this is an extremely useful principle involving a continuous cross-check between the content of the theory, the process of theorising and back again. As far as families are concerned this means a basic view that every family member is a person, like us, struggling to make sense of the family situation, applying theories and constructs to anticipate the events of family life. The members are themselves systems theorists, whether they know it or not, making constructions about the relationships in the family and acting in accordance with these constructions. This principle is one of the attributes which construct theory rather surprisingly shares with Hegel and indeed dialectical thinking lies at the heart of Kelly's psychology, a tradition he presumably picked up through Dewey, who had been a Hegelian in his early career. Kelly also has interesting correspondences at a philosophical level with Marx's materialist dialectics which may open up some interesting discussions with colleagues from Eastern Europe. The person in the system Kelly insists on putting the "person9* at the centre of his theory. Each of us makes choices. Constructs are basically alternatives, not only in construing or thought but in practice. It is essential to have this concept if one is to do proper justice to the ethical issues of personal responsibility in our model. Of course a person is not simply free to generate any reality, and is constrained to work within a construct system that is embedded in the culture, family experiences traditions and particular personal (Procter and Parry, 1978). In this view, a family system consists of what emerges when a number of people, each a person anticipating, hypothesising, choosing are put together in the same family. The family construct system consists of the sum of the individual construct systems of each member in dynamic relation with each other. The events or "evidence" that each member is processing consists of the actions and opinions of the others with whom they are interacting. There is therefore the tendency for the family reality to "drift" in idiosyncratic ways, in a manner not under the control of any particular member. The family construct system has, as it were, a life of its own. It is an entity in itself which provides choice and constraint to the individual members. It can be seen how this is rather different to Kelly's original view, where the individual construct system was seen as the most important determining entity. As Kelly says of individuals, the assumption is that each family has its own unique reality arising out of its traditions and melded (or left fragmented) by the negotiation that occurs between the partners of realities built up in each of their families of origin. The family construct system consists of a shared set of constructs. The construing of each individual family member is not received passively, however, but is built up painstakingly anew in daily experience using the constructs on hand in the family context. Each individual member is unique, but construing is only evoked or even brought into existence in a particular social context. Bach attributes family can be characterised of its construing system: according constricted, to tight, loose, polarised and so on. The "boundary" of the family system can be seen as the cleavage line discriminating (in the family's construing) who is in or out of the group or a subgroup. Indeed constructs may actually be formed from the elements or figures in the system, even though we normally think of contructs as generating our own particular version of reality. An important design feature of a theory of the family is that it is anthropologically sound. By this I mean that it allows one to enter the study of a family with the minimum of preconceived assumptions that we might impose on the situation so easily. It is an "open" theory, the particular details being "filled in" as we proceed. This is certainly not true of many earlier traditions in individual and family therapy or in previous theories of family functioning. There is no model here of "healthy functioning" or "normal" family life. Indeed, within this model, when a family has problems this is seen as intimately tied up with how an external referring agent or figure is construing the family. This might be such that a drift toward increased polarisation of the construing occurs rather than problem resolution. The crucial business occurs at the interface between the family and the external system rather than being simply internal to the family. All this may sound rather philosophical but in actual practice the theory has I simplicity and elegance, attributes would value highly in our work, proven by the ability of unsophisticated students in the health service setting to grasp and utilise the method. Students are encouraged to build up a picture of the family's construing in a step-bystep jigsaw fashion. For example, analysis may start with a particular dyad in the family at a particularly crucial point in their interaction. The picture is built up in levels. How they consrue themselves, each other, adding how a third construes the pair's relationship, how each construes the dyadic relations, how a forth construes the threesome until sufficient sense is made of the situation. This picture is then tested in practice with the family, using Kelly's famous dictum "if you don't know what is happening, ask the client, he may just tell you"! My experience suggests that the approach is of great value in family (and individual) therapy. It is also useful in, and indeed arose out of research. My own work with repertory grids examining interpersonal perception and using a pooled family grid with various measures is interesting not only for the empirical data that it can reveal but also because it reveals a kind of grammar, or a table of possible permutations and combinations of interpersonal construing in families. Guillem Feixas and his group in Barcelona are using the method to tease out these kind of processes in families with alcohol problems (Feixas et al, 1987). I think more and more people are now becoming aware of the power of this approach. In my own group I would mention the work of Rudi Dallos and David Aldridge (1986, 1987, 1988) on deliberate self harm and suicide and on the processes of handing on constructs down the generations of a family. The Neimeyer productive in their relationships brothers work have been on construing enormously in marital (eg. Neimeyer and Neimeyer, 1985) and Alexander and Follette (1986) have taken the theory into the treatment of incest. Vetere and Gale (1987) carried out a project involoving the intensive participant observation of normal families and Rosemary Hayhow (1987) is researching the families of stutterers. Cunningham and Davis have looked at families with mental handicap and how to help them. David Reiss's work (1981) has developed in a slightly different way, but shows the theory operating in the context of experimental social psychology. Kenny's (1986) work on cancer and the link with physiological process represents another exciting new direction. Implications for research into psychosomatic processes Most research on psychosomatic processes has been limited by its reliance on very general psychological concepts, such as emotional states and personality traits. Looking at construing especially as it occurs specifically in its relational context may break us out of this impasse. As long as we investigate a general process such as "anxiety" or "stress" we will only learn very general things about the associated physiology - such as general arousal levels. Kelly criticised the tyrany of the contruct emotionversus- cognition that we so readily project on to the world -and then suffer the consequences of the apparently objective split. He then went on brilliantly to define emotional states in a radical new way as aspects of construct structure and transition. But this aspect of his thinking seems still intrapsychic. Emotions are fundamentally interpersonal matters, especially when we look at the actual events in a microprocess time frame. The way forward seems to be to investigate these processes by focussing on moment-by-moment events in the life of the family. It is my belief that the crucial processes occur at quite specific points in construing and at particular points in the interaction of the family. This is observable clinically time after time. For example, a bulimic girl begins to feel sick at a strategic point in the interaction, triggered by the physiological signs of flushing with anger in her mother. Mother's anger, in turn is the result of an anticipation of her daughter, based in the way she construes her behaviour, perhaps as "manipulative". These two events have become coupled or linked, but not directly, only because they are construed in a particular way by the two of them. Physiologists will have to develop biochemical, neuroelectric and other physiological techniques to "trap" these ephemeral processes. With an understanding that they are anchored in a more predicatable way in family interaction, we should be able to proceed. Conclusion The construct approach to families and other relationships throws much light on processes in a highly specific and precise way and yet with a flexibility that allows many older alternatives to be synthesised in a new and consistent theoretical language. It also begs new questions; or rather poses old questions in a new way allowing new avenues research to proceed. Most importantly and excitingly I think it poses a challenge to traditional models of psychiatric and other medical research which should allow an enormous step forward to be made. This is achieved by providing a methodology which focusses on illness processes in the context, specifically, of the interpersonal construing surrounding the illness events, rather than arbitrarilly isolating an individual and divorcing the study from these. Psychiatry and Psychosomatic medicine have been stuck conceptually for decades, stuck with general categories which can only provide general truths. References Aldridge,D. and Dallos, R. (1986) Distinguishing families where suicidal behaviour is present from families where suicidal behaviour is absent. J. Fam. Ther. 8, 243-252. Alexander, P.C. and Follette, V.M. (1986) Personal Constructs in the Group Treatment of Incest. In Neimeyer,R and Neimeyer, 6.(eds) A Casebook in Personal Construct Therapy Springer Publications, New York. Cunningham, C. and Davis, H. (1985) Working with parents: Frameworks for Collaboration. Open University Press, Milton Keynes. Dallos, R and Aldridge,D (1986) Change: How do we recognize it? J. Fam. Ther. 8, 45-49 Dallos, R. and Aldridge, D. (1987) Handing it on: Family Constructs, Symptoms and Choice. J. Fam. Ther. 9, 39-55. Dallos, R. and Aldridge, D. (1988) Choice of Pathology and Systems of Construing. J. Strat. Syst. Ther. 7, 1, 27-41. Dallos,R. and Procter,H.6. (1984) Family Processes: An Interactional View. D307 Social Psychology Course, Open University, Milton Keynes. Feixas, G. , Cunillera, C. and Villegas, M. (1987) PCT and the Systems Approach: A theoretical and methodological proposal for integration. Paper presented at 7th Internat. Congress on PCT. Memphis, TN. Hayhow, R. (1987) Personal Construct Therapy with Children who stutter and their Families. In: Ledy, C. Stuttering Therapies: Practical Aproaches. Crooro Helm, Beckenham. Kelly, G . A . (1955) The Psychology of Vols 1 & 2. Norton, New York. Personal Constructs, Kenny, V. (1986) Family Somatics: A personal construct approach to cancer. In Neimeyer,R and Neimeyer, G.(eds) A Casebook in Personal Construct Therapy Springer Publications, New York. Neimeyer, R. and Neimeyer G. (1985) Disturbed relationships: A personal c o n s t r u c t v i e w . In B u t t o n , E . ( e d ) Personal Construct Theory and Mental Health. Croon H e l m , Beckenham, Kent. Procter, H . G . (1978) Personal Construct Theory and the Family: A theoretical and methodological study. Unpubl. PhD thesis, University of Bristol. Procter,H.G. (1981) Family Construct Psychology: An approach to U n d e r s t a n d i n g and T r e a t i n g F a m i l i e s . In WalrondSkinner,S. ( e d ) Developments in Family Therapy. Routledge and Kegan Paul, London. Procter,H.G. (1985a) A Construct Approach to Family Therapy and S y s t e m s i n t e r v e n t i o n . I n B u t t o n , E . ( e d ) Personal Construct Theory and Mental Health. Croom H e l m , Beckenham, Kent. Procter,H.G. (1985b) Repertory Grid Techniques in Family T h e r a p y a n d R e s e a r c h . I n B e a i l , N ( e d ) Repertory Grid Technique: Application in Clinical and Educational Settings. Croom Helm, Beckenham, Kent. Procter,H.G. (1986) Change in the Family Construct System: The therapy of a mute and withdrawn schizophrenic patient. In Neimeyer,R and Neimeyer, G.(eds) A Casebook in Personal Construct Therapy Springer Publications, New York. Procter,H.G. and Parry,G. (1978) Constraint and Freedom: The Social Origin of Personal Constructs. In Fransella,F. (ed) Personal Construct Psychology 1977, Academic Press, London. Reiss, D. (1981) The Family's Contruction of Harvard University Press, London. Reality. Vetere, A. and Gale, A. (1987) Ecological Studies of Family Life. Wiley, Chichester. Acknowledgements Thanks to Joady Brennan for her suggestions in editing the manuscript and to Tracy Flannaghan for helping with the typing. 10