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Community in the therapy room: Social networks in therapy

Posted By Deepu George and Kathryn Martin, Wednesday, July 18, 2012

Medhi was a 42-year-old male who sought therapy for "work-related” adjustment issues and to focus on his development within the company. I worked as an on-site psychologist in Bangalore, India where he worked for a Fortune 500 Company. In his 6th year of employment with the company, he felt unsatisfied with the work environment, displeased with his co-workers, and was increasingly frustrated when younger talents acquired higher positions in his department. He contended that, due to his seniority in age, he should be automatically promoted. He refused to interact with his colleagues, who were either in their mid-20’s or early 30’s. He resented them, due to his traditional beliefs that he should be promoted, simply for the time he put in with the company. His morale was further impaired when a younger member of the team was selected as the new team leader and he was expected to report to this individual. With increasing frustrations in his work environment and a negative attitude about his co-workers, he grew more depressed.

He reluctantly approached therapy to address "work dissatisfaction.” As a relational thinker, it was clear to me that Medhi’s relational ties among his colleagues were weak and that his growing dissatisfaction was only symptomatic of long-term patterns he developed before this situation.
Building Community
"We need to place a greater focus on the intersection of the relational, inter-actional, and systemic perspectives to create hybrid innovations in therapeutic healing and community building."

Focusing beyond the psychological process (depression, anxiety, cognitive distortion, etc.), it was easy to conceptualize Medhi’s dissatisfaction as a reflection of the social networks with which he was engaged or, in this case, those networks with which he was not engaged.

One benefit of our clients' social networks (or lack thereof) is that they translate new ideas and behavior from our therapeutic work with them to their real life situations. All clients are members of a larger community and are participating actors in one or more community networks. We can establish lists of these possible communities: from volunteering at food pantries to more formal roles like chairman of a trust or a little league coach. Some examples of such avenues are groups or circles that developed with the goal of bringing members together. The idea was conceived after 9/11 to facilitate communities to come together to promote better social relations.

Despite the nature of the presenting problem, assuming a broader systemic lens, to include not only family systems, but also the communities in which a client participates, connotes that psychological issues, like anxiety, are "a contract between people” (Haley, 1987). These issues then, are maintained in their immediate life contexts, like family, as we all know, and even community.

The concept of social organization and implications of social networks in creating life experience for its members is closely tied to how family therapy theories define relational issues. Jay Haley (1987) conceptualizes clinical problems as issues rooted in social units. In his words, "A symptom is a label for, a crystallization of, a sequence in a social organization” (p. 2). Therefore in Strategic Family Therapy, successful therapy essentially involved ‘changing the social situation.’ Haley (1987) tells us that the notion of diagnoses, insurance companies, professional colleagues, nurses, and psychiatrists are all part of a problem or the idiosyncratic social organization that maintains the problem.

Implicit in Haley’s definition are implications for – community -- both formal and informal networks. He "assumes a broader perspective” when he understands that the school system may be a part of the problem when a child refuses to return to school rather than it being caused just by a pathological relational system at home. Thus, Strategic Therapy points to social structures in framing the therapist-client relationship, and larger implications of the social organizational structure.

Employing a relational lens with Medhi, he and I explored his relational patterns at work, in his neighborhood, in his child’s school, at the office sports club, and in other associations. Medhi was a solo performer at work and a silent member of his local community. The main interpersonal contact he had was with his wife and his child, and even this was limited to the essentials of daily living. It seemed that he was but a lonely passenger, riding in the backseat of his life. Therapeutically, we looked at interactional patterns with his co-workers and how he behaved with shop owners, vendors, neighbors, etc., to understand a base behavioral pattern. Our work together focused more on social engagement as a treatment outcome rather than altering thoughts or shifting moods. He was also encouraged to maintain a map of relationships, which we developed to help him get more involved.

"Social support" is used as a blanket term in therapy. If we operationalize social support, it translates to meaningful social connections in your life context (family, community, workplace, church etc.,). Therapeutic objectives are rarely informed by this goal. However, if therapists can help a client map out their social connections, we can more clearly define the extent of social support offered to them. When we actually engage formal and informal networks outside the therapeutic system, as well, this support increases. Clinically, the therapist can focus on the web of relationships that the client is involved in to leverage the community context. A lack of a communal perspective isolates the individual stories within the four walls of our offices or clinics.

As Medhi became more engaged within his office, began to have more meaningful interactions with his neighbors and increased his presence as a member in other networks, his complaints about dissatisfaction at work reduced. While this did not immediately guarantee him a promotion, there was a different "sequence in social organization” (Haley, 1987) that mapped his interactions within the same system. In more theoretical terms, Medhi’s issues were seen as a larger issue closely tied to the social ethos of his work-place and his neighborhood. Therefore, understanding social networks is an important part of assuming a systems perspective.

Another pioneer in family therapy who was passionately committed to understanding relational patterns in context was Böszörményi-Nagy. Rightfully, he called his approach Contextual Family Therapy. He said that context is generated by interconnectivity, which is a process of the give and take that transpires between partners. Therefore, inter-connected issues generate the context for growth and development, which becomes a contextual issue. In essence, families or individuals enter a contextual contract with each other; either formal or informal. This contractual, relational agreement can occur between individuals as well as systems and vice versa.

Feminist therapists have been persistent in exposing the linkages between the personal and the communal (Doherty, 1995). Feminist Family Therapy and psychotherapy has accepted that social change is a critical outcome of the therapeutic exchange. While the clinical implications in feminist-oriented therapy do not define informal and formal networks per se, these structures can help us pursue pathways of achieving social change.

Therapists, especially those of us trained in systems thinking, positively affirm the inter-connectedness or inter-dependence in human life and interaction. Engaging the client or the family system with external forces broadens the understanding of inter-dependence. Real life interactions of our clients with their neighbors, colleagues, etc enhance and sustain therapeutic gains. Likewise, Medhi’s assignments to interact with others in his office and neighborhood validated his growth much more effectively than what I could have provided as a therapist.

To quote Mancini & Bowen (2009) "Human beings are innately social” (p. 245). Consequently, relationships with each other are cardinal for personal and community development. The ‘innately social’ tendencies manifest through informal contexts as individuals and families pace through lifecycle challenges. So, informal networks in the community are natural and more real to life than sanitized, controlled settings of the therapy room. Giving a life and voice to these "innately social” tendencies and providing pathways to achieve them in client’s lives awakens community in clinical practice. For example, the duration of therapy sessions usually varies from 50 minutes to 90 minutes, and occur usually once a week. Our clients spend more time in the informal sections of their life than in the therapy room, where life happens. Thus, informal networks are an influential entity in understanding the human condition.

We as family therapists, along with other healthcare professionals are agents of multiple formal networks due to professional identities, ethical guidelines, licensing systems, and sanctions we adhere to from some collective body. As a therapist, we must be aware of this unique position and use our credentials strategically. How can private practitioners better situate our practices within the context of community relations? Doherty and Beaton’s (2000) Levels of Involvement is a clear and concise rubric that I recommend to therapists to define this role precisely. Additionally, the levels represent developmental tasks for therapists as they grow with their practice. Once a therapist finds his or her optimum level of functioning, that professional can decide which level best addresses what type of presenting problems.

Social connections of the past, which mainly transpired through human interaction, have a new skin in the 21st century. With advances in communication technology and the advent of social networking media in every sphere of human life, the quality of informal social connections has become virtual and less intimate. Socially and therapeutically, I think that relationships – human interaction and intimate personal connections – cannot be substituted by virtual and electronic mediums. Psychotherapy is also part of this emerging trend with methods of on-line therapy, associations for the same, and development of ethics for online relationships (e.g. Online Therapy: A Therapists’ guide to Expanding Your Practice by Derring- Palumbo & Zeine.). However, in leveraging the community context in the therapy room, informal networks play a critical role in human transformation, and they mitigate the quality of life within a community. In making this conceptual leap of community in the therapy room, we must also understand that social support is not synonymous with social networks, and we must resist the temptation to assume that larger networks imply stronger social support (McDonald et. al 1998, as cited in Pickens 2003).

Social support is a byproduct of meaningful social connections individuals build with each other, which in sense provides a sense of community for the actors engaged in that relational setting. In today’s terms, a client with 900 facebook friends isn’t necessarily someone with a strong social support network.

In short, literature has identified several clinical areas where social networks play a key dimension in therapeutic endeavors. The most common examples are in the case of elderly, mental illness, domestic violence, violence prevention efforts, addiction treatments etc., (Sluzki, 2000; Todd & Armstrong, 1984; Pickens, 2003). All of these studies come with their specific caveats and strengths, and therefore are specific to the mentioned clinical issues. As the field of family therapy and social networks develops, we as clinicians need to place a greater focus on the intersection of the relational, inter-actional, and systemic perspectives to create hybrid innovations in therapeutic healing and community building. After all, each healthy individual and each healed relationship are signs for a better and stronger society.


Haley, J. (1987). Problem-solving Therapy (Second Edition.). San Francisco: Jossey Bass Publishers.

Doherty, W. J. (1995). Soul Searching: Why Psychotherapy Must Promote Moral Responsibility (1st ed.). Basic Books.

Mancini, J. A., & Bowen, G. L. (2009). Community resilience: A social organization theory of action and change. In J. A. Mancini, & K. A. Roberto, (Eds.) Pathways of Human Development: Explorations of Change.( 245-265). Lexington Books.

Doherty, W. J., & Beaton, J. M. (2000). Family therapists, community, and civic renewal. Family Process, 39(2), 149–161.

Pickens, J. M. (2003). Formal and informal social networks of women with serious mental illness. Issues in Mental Health Nursing, 24(2), 109–127.

Sluzki, C. (2000). Social networks and the elderly: Conceptual and clinical issues, and a family consultation. Family Process, 39(3), 271-284.

Todd, D. M., & Armstrong, D. (1984). Support systems of elders in rural communities. Contemporary Family Therapy, 6(2), 82–92.


Deepu George
Deepu George is a doctoral student in the Family Therapy program at the University of Georgia. He is interested in social determinants of health, medical family therapy, community development and capacity building. With a Master’s Degree in Holistic Psychological Counseling from Bangalore, India, his aim is to continue his passion for applying systems lens in health care, family therapy, conflict resolution & peace-building, and community capacity work.

Kathryn Martin
Kathryn Martin is a Marriage and Family Therapist Associate in private practice in Austin, Texas. With a Masters in Clinical Psychology from Pepperdine University, Kathryn uses a systemic perspective with her clients through multi-modal treatments including online therapy, movement, and relaxation.

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