The Need for a Systemic Approach to Treatment

In the book Healing Together, the author writes about the importance of healing together in a marriage when one person has PTSD. The author walks the reader through what to expect and offers strategies of how to not only cope but heal from the effects of PTSD together. This book comes from a systemic approach to treating PTSD rather than an individual deficit model.

Family System’s Theory was originally developed by Murray Bowen. His theory suggested that people present with symptoms that are the result of the system they come from and not the individual alone. As a result, treatment then needed to be focused on the system also and not just the individual. Needless to say, there is a lot more to Family System’s Theory, but I won’t go into that in this blog.

The theory was tested early on in inpatient hospital settings for clients that presented with alcoholism. What they found was if the patient was treated in the hospital and they established sobriety, they often would relapse when they got home because the family system was not treated also. The system itself attempted to go back to what seemed “normal”.

In my work with sexual addiction over the years, I would always see both the male and their partner both individually and as a couple. It didn’t make sense to me to just see the male who presented with the addiction, when their spouse was often traumatized also. The partner needed counseling and support also and so did marital relationship. If this didn’t happen, the risk was that the spouse would become stuck in their healing process and often times the couple would become stuck in a “trauma cycle” of interaction. If this trauma cycle isn’t addressed, the dynamics of the cycle often increase the risk of relapse. The dynamic of the couple system remind the addict of what it was like often times growing up in their own family, thus encouraging the return to a negative way of coping or survival.

Over the years, there have been many programs that have reached out women who have experienced an abortion and provided opportunities for healing through faith based Bible study programs and services through Crisis Pregnancy Centers etc. Many of these programs helped a lot of women, but were not systemic in their focus both in assessment and treatment. As a result, women could be at risk of experiencing further trauma if their marital or family system at home was able to support the working through of a possible trauma. In addition, many would go through the healing experience alone, which could further breed a feeling of detachment.

Attachment theory suggests that we are wounded in relationships and we should heal in relationships. It is my belief that an abortion wound is an attachment wound at many different levels. The abortion happen in the context of a relationship and it would make sense that the healing process should happen in the context of a relationship.

As therapists treating abortion related trauma, I believe it is critically important that from the intake process, to assessment and treatment planning, we need to integrate Family Systems Theory into everything we do. If we don’t, we risk causing further pain for our clients. Just like with any trauma issue, amazing healing can happen in the context of a securely attached relationship. If that is not present, then we as therapists need to be wise in the approach and timing of any work that we do regarding the abortion issue. Sometimes, our first goal might be the stabilization of the couple system first before any trauma work happens.  

As we develop evidenced based programs for the treatment of abortion related trauma in the future, Family Systems Theory will surely be part of the models that are developed.