Trauma and the Family: A Systems-oriented Approach

Abstract

Since at least the middle of the 19th century clinicians have been interested in the symptoms expressed by individuals following exposure to situations inducing severe and chronic stress (trauma). The symptom cluster has been labelled differently over the years. The current diagnosis of post-traumatic stress disorder (PTSD) refers to these symptoms. Although not formally noted in the diagnostic categories, the literature has included much discussion of complex of PTSD (C-PTSD), also often referred to as disorders extreme stress not otherwise specific (DESNOS). The linking of PTSD and C-PTSD to early developmental environments represents an important step in understanding the individual's susceptibility to subsequent stress. The focus of clinical assistance has generally settled on the symptomatic individual. Various treatment approaches and techniques have been applied with varying results. The notion that the individual symptoms might be addressed with therapeutic processes applied beyond the individual to the relationship systems, particularly the family, in which the symptomatic individual lives and functions, has received less attention. The idea of chronic anxiety, included in Bowen's discussion of the relationship between anxiety and family relational activity (Bowen,), provides a conceptual framework from which specific therapeutic processes directed to the relationship system itself can be hypothesised and implemented.