The changing face of therapy. Y Sethi

There is no doubt that we are living in dynamic times, where new therapies are constantly evolving from the integration of earlier innovations, ideas and techniques into new approaches. Unfortunately therapy itself, is taking longer than we might have hoped or expected, to lose any stigma that may be attached to it, from times, when it was generally considered shameful to have a mental illness, or have any genetic association with one. Therapy now often takes place under the more socially acceptable label of personal development or coaching and the more solution focused, brief therapies that are gaining ground in the therapeutic forum.

The bigger picture.

It seems that we are being pressured as the human race, to expand our consciousness on many levels right now, in many aspects of life. The issue of global warming, the environment and survival, are demanding that we come out of our insular positions and consider the bigger picture and come together collectively, to see what we can do to remedy the situation. We are all undeniably connected and affect each other significantly as shown by present environmental and political developments. There is a realization of a need to find a healthy place for ourselves within the environment, and consider the delicate balance of nature and reduce our foot print on the planet.

This similar theme seems to be taking place in the therapeutic world as well. We have been in a state of intense focus on personal fulfilment and empowerment in many avenues of life, almost to the exclusion of anything else over the last 10-15 years if you look at the growth of the personal development industry. To service this inner focus, a wide range of therapeutic modalities have evolved from extreme left brain, rational, scientific to extreme right brain, esoteric, imaginative and creative methodologies. However the focus is still an inner one, primarily of personal, individual, therapy. As therapists we continue to find our niche in a diverse society, according to Madelung. E (2004) we are presently being challenged by the rapidly changing world to broaden our view. There now appears to be a flow towards encompassing both the macro and the micro, the larger and smaller perspectives and the right and the


left brain in briefer therapeutic interventions. In line with this push to develop a wider perspective, there has been another theme developing, in the growth of meditation and mindfulness teachings as suggested by Wells. A. (2002), as an aid in therapy, personal and spiritual growth. Such development may help us to expand our horizons towards a more universal consciousness in these challenging times of human history. In line with this, perhaps there is also a bigger picture that we need to consider in the therapeutic process. According to Foust. J.&P. (2005) we are energetic beings, born into the energy of our family system. We impact it and it has a large impact on us. We are individuals within a larger energy system. We are alone and yet at another level we are all connected.

So what of the more traditional approaches?

Therapy has come a long way since Freud’s discovery of “talk therapy” and dream analysis as shown by Corey. G.(2005) as a way of resolving the repressed fears and anxieties of the subconscious mind. Corey (2005) shows the development of theories into more present times with Carl Jung’s more acetic approach for exploring inner conflicts using dreams, archetypes, the shadow and the theory of collective consciousness. Adler’s contribution to our growing knowledge, was his relatively brief and supposedly more practical approach, noting the importance of societal and family influences on the personality of the individual. With his work came the idea of a certain order in families and the name Family Constellations emerged. Since those early times, according to Corey. G. (2005) we have had the development of at least three very different camps in therapy. The collective knowledge from the pioneers of these early therapeutic approaches is constantly being used in developing more modern modalities.

Three camps

Firstly the science, evidence based approaches of CBT, which have attempted to bring therapy out of the unconscious, esoteric periods of Freud and Jung, into more measurable, scientific methodologies Corey. G. (2005).
Secondly, around the same period in history, after the second world war came the development of the Humanistic therapies such as, Existential


and Gestalt therapies. The Humanistic approaches according to Strasser & Strasser (1997) attempt to come to terms with the paradoxes of freedom and responsibility, existential givens, integration of emotions and ideas, our ability to find “meaning” and the interaction of “I and thou” in relationships.

Last but not least came the next wave of group and family therapies such as Primal therapy, Psychodrama, Milan, Systemic and Strategic Family Therapy. These grew out of both the Psychodynamic, CBT and the Humanistic approaches, each developing their own particular flavour. At the centre of all family therapies is the acknowledgement that the family of origin has a great influence on each of us. However, in traditional family therapies, it continues to be a challenge to have the whole family agree to a therapeutic process, when perhaps, “little Johnny” is having problems. Hence the availability of family therapy has declined in favour of individual therapy in recent times.

At the same time as the third camp was evolving, another school was developing in, the hypnotherapy sector, pioneered by the great hypnotist and psychiatrist Milton Erickson and later more recent developments of Neuro Linguistic Programming and EMDR have arisen out of this. Individually more inner focused therapies have continued to evolve and integrate, incorporating many basic elements of the traditional approaches and the more recent developments, such as Transpersonal, Art therapies, Narrative, EFT, NIG (Neuro Imagining Gestalts) developed by Maddelung. E.Innercken. B. (2004), Ego State therapy developed by Emmerson. G. (2003) and many other modalities that are too numerous to mention. However, until recently, there has continued to be a separation between, group, family and personal therapies.

The inner focus.

Up until now, the main focus is still very much on personal therapy and on the inner construction of the individual, with often little consideration of the person within their family or environment. There has been a notion that empowerment gained through the more inner focused therapeutic process will be sufficient for the individual to make the changes they want in their lives. However, there has been lots of evidence to suggest that this is not the full story. Systemic Family therapies according to


Frank. U. (2003) including Virginia Satir’s Family Sculpting and the current Systemic Family Constellations by Bert Hellinger as explained in Hellinger.B. (2006), indicate that we have both an inner and a collective experience, to be considered, for a more holistic picture. This is backed up by the early work of, Adler’s sibling “pecking order” and Carl Jung’s theory of the “collective consciousness” of family and cultural groups. Ulsamer.B. (2005) also draws attention to the fact that we are all “connected” and are very much influenced by the energy (or genetics) of our family group, whether we are aware of it or not.

Traditional aims of therapy.

Even though the methodology or philosophy may vary from one modality to the next, the aim of therapy or counselling remains the same. It ranges from an intention to facilitate a change of behaviour or thinking and to allow a client in finding “meaning” in their life and if possible, expand consciousness. Andreas.S. Faulkner.C.(1996) also believe that therapy includes helping clients resolve and integrate inner conflicts and become aware of their inner resources and move towards empowerment and independence. Another important intention may be to improve relationships, raise self esteem and facilitate a broadening of perception.

Different levels of help.
Madelung.E &.Innecken B,( 2004), draw attention to the fact that there are many different levels of conflict or dis-ease and also appropriate levels of healing or therapy that may provide relief or resolution. Many clients simply want to move from a more dysfunctional to a more functional state in their daily lives. While others are seeking to resolve inner conflict or painful emotions and others still will be looking for meaning, integration, more peace and wholeness in their lives. The public’s needs are diverse.
Cognitive behavioural approaches may be perfect for helping someone to become more functional again and “talk therapy” in itself, may help someone become more aware and to unravel their thoughts and feelings and allow their life to slot into place, with the existentially philosophy that Strasser & Strasser (1997) describe, that many clients already have the resources they need in order to make sense of their world, but just need a little help from time to time in exploring their perceptions and


ideas. Hadley.J. Staudacher.C.(1996) show the more imaginative approaches of exploring images, emotions and the working of the subconscious mind state, can be invaluable if the client is prepared to go into a more experimental and experiential form of therapy. The Jungian, Transpersonal, Existential and Gestalt therapies can be invaluable in assisting in changing deeply held patterns. In addition, hypnotherapy or NLP as Andreas &Faulkner (1996) show can be extremely effective in helping the client to change unconscious blocks and move on relatively quickly. Group work and psychodrama may also be very productive in mirroring ourselves and in acting or playing out, particular situations or possibilities, in order to release emotions and complete unfinished business and create new possibilities. However, Leibermaeister. S, (2006) suggests that if the root of the clients’ problem is systemic, coming from their family of origin, then these former modalities may not be helpful in allowing the client to find deep and long term resolutions to their issues. Madelung. E. Innecken. B.(2004) makes the point that a relatively new therapy, Systemic Family Constellations is a deeper level of therapy that is similar in depth to long term Jungian therapy. However, constellation work is generally much briefer in duration. According to Hellinger. B. (2006) the originator of Systemic Family Constellations, some issues are deep generational issues that originate in systemic or generational energetic disturbances that manifest in the present generation, usually because they could not be resolved in the past. It may have involved due to shame or guilt or extreme emotion or trauma. Because of the systemic nature of the issue a CBT approach or counselling methodology that seeks to resolve purely personal conflict in the here and now are not likely to help. Payne. J. (2006) makes the point that a briefer systemic Family Constellation approach may assist a person to release themselves from the entanglement.

How deep do we really want to go?

Of course, it very much depends on what the client requires.
For some, being able to function in a practical way is all that is required and many forms of counselling and CBT may be useful here. Others may be looking for more emotional stability and personal contentment in their lives through the more humanistic approaches. Others might find that the core of their is trans-generational.


What is Systemic Family Constellations?

Systemic Family Constellations is a relatively new modality which is dynamic and still evolving, that seeks to find and resolve unconscious entanglements with the family of origin that are holding an individual back, from freedom and choice. Hellinger. B. (2000) called the therapy he developed Soul therapy as he observed that this process appears to tap into the soul of a client and that of the family group, revealing the underlying unconscious dynamics at work. Leibermeister. S. (2006) explains that many people who have tried many other modalities previously find relief and resolution in Family Constellation work because their issue is not simply an individual one but of systemic origin, sometimes going back several generations.

Systemic Family Constellation Philosophy

This is a methodology that is experiential and phenomenological that Frank .U. (2003) explains is based on an archaic Primal Order that Bert Hellinger developed called the Orders of Love Hellinger. B. (1999). Hellinger’s philosophy takes the view that we are each born as a smaller soul into a larger family soul, which connects us, in the present, to past generations or the family soul in general. Leibermeister.S. (2006) explains that this system holds the belief that all members have a place and an equal right to belong. As long as each person has their rightful place and accepts full responsibility for themselves and the consequences of their actions, the family energy is healthy and strong and the primal love connections are felt by all, leaving each person free to live their own life, while still maintaining a healthy connection to their roots.

Developing Systemic Family Constellations in the 1990’s, Bert Hellinger a German Psychotherapist appears to have drawn from many of the earlier traditional modalities and also adds techniques and knowledge from a variety of traditional and modern approaches and also has a strong spiritual dimension. Ursula Franke in Frank.U. (2003) outlines the development of Hellinger’s approach from an integration and study of, psychotherapy, Transactional Analysis, Hypnosis, primal therapy, Frank Farelly’s provocative therapy, Psychodrama, Systemic and Strategic Family therapies. Bert Hellinger also bought with him his experience of


working with the Zulus as a priest for many years, prior to his psychotherapy career, where he observed ancient healthy generational patterns that seemed to maintain harmony and structure in families and community. Hellinger. B. (1999) developed a methodology that taps into the energy of the family system, which according to Jamie & Faust (2005) seek to untangle “where love, energy and life force has stopped” (p60). It highlights important truths for the person, often revealing information and helps the client from Bert Hellinger’s (1999) point of view, to “acknowledge what is” and hence come to a new perspective.

What goes wrong in Families?

Systemic entanglements and dysfunctions occur when tragedies, exclusions and denial take place in families. This has the effect of taking away energy from certain members and causing other members of the group, often their children or other relatives, to identify with or support them unconsciously, energetically or emotionally. In this way the dysfunction is maintained in the family system. According to Systemic Family Constellation philosophy and practice, this is how dysfunction is passed on through generations. Ursula Frank (2003) states that information relating to the origins of such conditions as schizophrenia can be traced through the family system, sometimes going back many generations. Kutschera. I.Brugger.C. (2006) give lots of examples of how illnesses physical and mental are passes down generations. Often one person in the present is identifying with the dysfunctional unresolved energy of an ancestor, even though they may not know the person or the history of the family. According to Hellinger. B. (1999) children are born with an innate, strong love for the family they are born into, which he has called Blind Love. This is an unconscious love that is responsible for becoming entangled in disturbed family energy, as it seeks to help others in the system by forming energetic alliances. According to Ulsamer. B.(2005) tragedies or dysfunction in families float around the family energy and is picked up for expression by someone in the present. This is possibly how babies may be born with an innate sense of sadness, depression or anger. Often they are carrying emotions or patterns for someone else in the family who did not, or could not express it. One of the main purposes of this therapeutic process, is to facilitate the client in transforming Blind Love or emotional baggage to a more mature and


healthy “enlightened love” and freedom. With “enlightened love,” Hellinger B. (2006) believes that a person can remain connected to the family, but can also stand alone with strength and independence. This might sound like personal responsibility is not an important part of this process. Not at all. However, it is important to uncover the hidden dynamics in which a person is caught in, as this is largely unconscious. Ursula Frank (2003) makes the point that in contrast to psychotherapy, no particular situations or behaviours are acted out in Family Constellations, the aim is to uncover unconscious entanglements so as to render them treatable. Once visible, the person involved can start to make some choices and take responsibility for themselves in a more conscious manner or receive help towards a resolution.

Working experientially and phenomenologically

Systemic Family Constellations comes from a phenomenological, experiential perspective, therefore very few details of an issue are required, as this may influence the facilitator and the representatives in a workshop and it may be difficult to put this aside to see or feel what is coming out of the constellation. So in this process we need to be as Faust J.&P (2005) explain, comfortable with not knowing the story or many details and trust that the constellation will take us to what is important for the well-being of the client. We have a view of our story which may or may not be accurate. Frank. U.(2002) along with many other therapists working phenomenologically, have the view that our story is just a perception. In doing constellation work we are working with unconscious energies or feelings that once bought up can be resolved or released. Frank U. (2002) and Family Constellation practitioners generally, believes that it is not necessary for the therapist to understand much, just few key facts. A constellation will often show us another perspective which can free the client to make new meaning. As humans it is the meaning that we give to events or situations that become central themes in our life Corey.G. (2005).If a client can find a new perspective, this can be the beginning of a new start. A new life script.

What is a constellation?

A constellation is a process where usually in a workshop situation a collection of people who usually do not know each other, take turns in


setting up their own constellation, with the help of a facilitator using each other to represent the people of their issue. In doing this the client comes forward with a brief outline of their issue. The facilitator asks a few factual questions about any significant events, tragedies or exclusions that may have taken place in the family or relationship and then invites the person to choose representatives from group for themselves and for the other people involved and set them up in the room in relation to each other. The client then often observes the process. Faust J.&P (2005) says that in setting down the “Family members” according to an inner image or a “gut feeling” about where they need to be placed, the representatives, after a few moments, develop sensations in their body as a Knowing field as described by Faust J &P (2005) forms around the group. From this point on, the facilitator, by asking the representatives what they are experiencing, may add more representatives, change their position, allow the representatives to voice their experiences, or provide suitable sentences for them to say which Hellinger. B. (2000) calls “healing sentences”. This may allow the energy in the system to come to a more comfortable state, for the whole group and especially for the client. The process may last anything from twenty minutes to two hours. In tapping into the family energy field, it is possible for the client to gain a new perspective and also gain information about the experience of the other members of the group and see themselves from a different perspective.

Working with the inner and outer worlds.

With the advent of Systemic Family Constellations in the 1990’s, a new approach has emerged looking at each person as continuing to be part of their family energy field and intrinsically linked to past generations and also independent and free. This is a theme that is presently being further developed by practitioners all over the world, in seeking to use the best of the older innovations of psychotherapy and some of the latest psychotherapeutic techniques. Madelung. E Innecken.B.( 2004), makes the point that in setting up a family constellation we are representing the effect that they have on us and poses the question, that in setting up our family in this way, are not also setting up or inner family or inner parts of ourselves? Madelung and Innecken suggest that there is a need to come to a place of peace, or at least acceptance, of our roots for a deeper self acceptance.


Ursula Frank (2003) makes the point of families
“accept them in you as they are, even if you choose to live differently and you will be fine. Funnily enough this is the only way to be free of them.” (P 23)

Benefits and Limitations of constellation work.

Some of the benefits of Family Constellations are that it is phenomenological, experiential, solution focused and also brief therapy. In addition there is no need to take the people of your issue with you. You may go alone to a workshop or private session. A session may be a brief stand alone intervention, or a compliment to more conventional therapy.
It can create a different perspective, discharge heavy or difficult emotions, expose the love connections and help a client to find a healthy place within their family system. If the issue is indeed systemic, then this new perspective may lead to change on many different levels. John Payne (2006) suggests, it is not unusual for health issues to clear or reduce, or the person with whom a client had an issue to contact them unexpectedly after a constellation or for any contact to be quite different to their normal interactions. For developing communication skills, or dealing with specific, concrete incidents or conflicts other modalities may be more effective. Also, if a client wanted to play out a particular incident or complete specific unfinished business then therapies such as Gestalt or psychodrama, Sandplay or Voice Dialogue might be very productive. In addition, Constellation work generally requires a certain level of maturity in the client and a willingness to look outside their own perspective,
which may be challenging to some, as many clients are attached to their story or perception of themselves or their situation. In fact, after systemic Constellation work, it may be helpful in some cases to include some inner work in terms of personal therapy, using a more inner focused therapy, to help with integration. Maddelung.E (2004) has a developed an interesting mode of therapy that incorporates constellation and NLP for personal therapy called (NIG) Neuro Imaging Gestalt. I offer follow up workshop constellation work with private sessions for some clients, where inner work using counselling, hypnotherapy, NLP or ego state therapy is very helpful with processing.

The Alliance in Brief Therapy


As with any therapeutic process, a trusting, respectful, therapeutic alliance is necessary and a belief that the client already has the resources they need to move on in life. Andreas.S.& Faulker.C.( 1996) takes the view that as therapists, we are facilitators only of our clients process. The skill and perceptiveness of the facilitator is crucial to the success of the process and their ability to hold the space energetically and intuitively according to Faust J&P (2005), as is the ability of the client to be open to new perspectives or possibilities and a readiness for change.
One important aspect of brief therapy from the therapists point of view is the necessity of being able to create rapport relatively quickly with a client. Andreas.S.& Faulker.C.(1996) feel that this is essential in any therapeutic process and becomes even more important in brief therapy, given the time restraints involved. This remains one of its challenges, hence the growth in the knowledge and skill of being able to read body language and developing the art of creating rapport relatively quickly.

Brief therapy

No longer does brief therapy mean solution focused shallow therapy. There appears to be a move if you look at the growth of the personal development and coaching industry to integrate life skills and growth into a Holistic approach that also deals with emotional and relationship issues as well. I would suggest that we as counsellors and psychotherapists are well equipped to come into this modern, progressive forum if we are open to looking at both the micro (inner construction) or the macro (systemic connections), which includes both the rational and imaginative brain preferences. With the valuable knowledge of the creators and innovators of psychology behind us and the latest psychotherapeutic techniques, Leibermeister. S. (2006) suggests that mindfulness and the awareness of energy have a value in the therapeutic process. Madelung.E. (2004) suggests that therapy is now poised to evolve at a faster rate. It now has the chance to be an even more holistic and attract a bigger proportion of the population including those with mental health, emotional or relationship issues and an interest in personal development.

NLP (Neuro Linguistic Programming) is a very good example of a relatively modern therapy or modality that is very much present and solution focused and which also includes elements of cognitive


behavioural therapies. It also works with the subconscious mind, imagination and visualisation for speedy change. Andreas. S. & Faulkner.C. (1996) believe that a good NLP practitioner will be able to assist with the integration of inner conflicts and the strengthening of inner resources for more personal power, wholeness and well being. NLP is also a dynamic process and is continually evolving and incorporating other modalities within its structure. It is very effective in assisting in terms of beliefs, expectations, emotions and goal setting, but has yet to fully accept the impact that supposedly external systemic entanglements may have on our inner world. Instead it appears to see the individual as almost defiantly independent of family of origin, rather than connected to it. However, innovation is a continuing process. Systemic Family Constellations due to the innovations or Frank.U.(2002) developed ways of working in personal private sessions using floor anchors, models and hypnosis, as well as workshops or seminars and NLP is evolving using meta states and much more.

With the continuing growth in the personal development and coaching worlds we are being challenged as counsellors and psychotherapists to become much more holistic and integrated in our approach to therapy, in a diverse world that insists on relatively fast and effective services and results. There is also a rise in the number of people who are looking for a more holistic and spiritual approach that can deal with many facets of their life, their business, work, relationship and emotional issues. It seems that our traditional methodologies are being reworked and integrated with spiritual and scientific knowledge, so that we as therapists can look forward to being on a steep learning curve as we grow and develop in these exciting and challenging times.


Reference List

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Corey. G. 2008.Theory and Practice of Counselling & Psychotherapy. Thomson Brooks/Cole Kingsport.
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Foust. J.&P. 2005. Messengers of Healing. Zeig. Tucker & Theisen Inc. Phoenix
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Kutschera.I. Brugger. C. 2006. Whats Out of Order Here. Carl-Auer- Systeme. Verlag. Heidelberg.
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Stark. H. 2005. Systemic Constellation Work is an Art. Essays 1999-2005. Strasser.F &A 1997 Time Limited Existential Therapy. Wiley NY Ulsamer. B. 2003. The Art and Practice of Family Constellations. Carl- Auer-Systeme. Verlag. Heidelberg

Ulsamer. B. 2005. The Healing Power of the Past. Uderwood Books. Nevada.
Wells.A. 2002 Meta-cognitions: An information Processing Analysis. Clinical Psychology. sciences & practice. 9.95-100.

Yildiz Sethi