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What is the Intersystem Approach to Therapy?

October 30, 2018

Dr. Rita DeMaria is a staff therapist, office director, and director of Healthy Relationships and Wellness Programs at Council for Relationships. 

The Intersystem Approach is an integrative and dialectical meta-framework, which explores how individuals, couples, family systems and communities are functioning in their relationships with self and others. These four domains constitute a comprehensive approach for understanding how individuals are both impacted by and directly influence relationships, which are the primary elements of human experience. When we work with our clients, communities, students, and post graduates we focus systemically on the interplay of the individual’s biological and psychological experiences (the self) with the three other domains (the ‘systems’) – the couple, the intergenerational, and the contextual. The interactional aspects of the clinical work that we provide also includes biological, psychological and social dynamics.

The Intersystem Approach includes two central constructs: (1) the attachment theory construct, and (2) the interactional construct. Both constructs provide theoretical and conceptual tools to understand the relational underpinnings of how the four domains are always interconnected.

Gerald Weeks was the first to propose The Intersystem Approach in 1984 when he came to Philadelphia and continued his focus on the approach. There are several Systemic Sex Therapy texts and the Clinical Handbooks as well as the 2nd edition of Focused Genograms – Intergenerational Assessment of Individuals, Couples and Families (FG2) that provides a guide to constructing focused genograms through the lens of attachment theory. A genogram is a graphic representation of an intergenerational family tree that displays the interactions of families through the multiple generations of family history. Within each genogram, clinicians can develop maps and timelines for each of the four domains.

The Attachment Theory construct is an important inclusion within the Intersystem Approach and Focused Genograms. Attachment theory is one of the most significant theoretical and clinical advancements within the fields of psychology, couple and family therapy, trauma treatment, and other forms of community services. There are four domains that explain the unique attachment bonds that are formed in childhood, adulthood, family systems, and community/geographic locales.

The conceptual amalgamation of the Intersystem Approach and Focused Genograms provides a powerful guide for treatment depending on the nature of the problems. The Individual domain maps the childhood attachment patterns. The Couple domain introduces the updated Couple Interaction Map that provides a guide for mapping adult attachment style interaction patterns. The Family Connections Map provides a guide for exploring Family of Origin attachment focused family dynamics. The Contextual Eco-Map provides a guide for exploring social bonds within and among all the domains.

One of the most important contributions to the Intersystem Approach is using the Attachment Theory construct, to emphasize the therapeutic alliance (an evidence based aspect for therapeutic change) that is comprised of three facets: goals, tasks, and bond. Focused Genograms describes the development an attachment-focused therapeutic bond in detail. The addition of the Focused Genogram tools integrates attachment-focused assessments that help the therapist develop a therapeutic alliance that is exquisitely attuned to the attachment level of the individual or the relational unit(s).

The therapeutic bond has been termed therapeutic posture, which is defined as an attachment focused therapeutic bond within the therapeutic alliance. Clinical research has established that clients with insecure attachment at intake have poorer outcomes than those with secure attachments at intake. Therapeutic posture, within the therapeutic alliance, is formulated based on the assessment of each client’s internal working models of attachment, which are then depicted using the Internal Models Map (IMM). The clinician’s therapeutic posture vis a vis the client(s) is determined by “where the client is” at the start of treatment. Consequently, the clinician must learn how to assess and foster a congruent therapeutic posture in order to establish a sense of safety, security, and stability for the client.

The Intersystem Approach’s meta-framework produces a broad therapeutic focus, which provides a schema that facilitates greater therapeutic effectiveness. Specifically, the clinical applications of attachment theory within each domain, as well as the interactional construct, are guides to providing focused attachment focused, systemic interventions. Consequently, we propose that this methodology will lead to more positive outcomes in treatment for clients who present with insecure attachment.