The Power of Systems Thinking with Dr. Juan Turon, LMFT - Episode 1

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Speaker 1 0:00

Hello and welcome to Mind and Medicine, a Sentara podcast. I'm Tommy Bateman, your host, and today we will be meeting with Dr Juan Turon to talk about the power of systems thinking. But before we begin, some important CME announcements. This episode is accredited for AMA PRA Category 1 credits. For full accreditation, designation, and disclosure information, please refer to the show notes and now the show. All right, Juan, thank you for joining us today. Now, uh this is gonna be a very interesting episode because uh we're gonna be talking about two things at once and blending them all together. And I think the audience is really gonna have a good time listening to this one. But before we begin, uh give give us an overview of you.

Speaker 0:47

Okay, well, first of all, thank you for for having me. Um, this is the first podcast I ever do, so it's a new experience. Um, I am a family therapist by trade in education. I have uh my education is a bachelor's degree in in general psychology, experimental psychology. Um, I also went to England, to Cambridge, and I studied for a month um anthropology and then came back and had a different spin on things. And then I encountered this field of family therapy that you seem familiar with, marriage and family therapy. And I did my master's in that. Um, then I was blessed to meet Dr. Salvador Minucci and work with him under his supervision for seven years. Fantastic. Um, and then I embarked on my PhD journey in Florida and in Nova Southeastern University. I think this was this, I want to say the second generation for that program. This is the PhD in family therapy, it's relatively new. Yeah, it didn't exist a few decades ago. So I think I was the second cohort to participate in the PhD program in MERS and family therapy. So I got the PhD in immersion family therapy. I became licensed in Florida in 2013. I worked as a private practitioner for many years. And in 2018, I moved to Virginia Beach. Now I'm by the ocean front and join the beach. Absolutely. Uh and now I work in the capacity of a private owner of a practice, and I also uh supervise students, which I enjoy greatly.

Speaker 1 2:08

Very good. Thank you. Thank you for that overview. And I I I do find it interesting. I mentioned before we started recording that um I was trained initially by a Minution disciple, um, Dr. Green, and he went, he was out of Philadelphia uh as well. So I think that's really interesting. I did not know that beforehand that you too worked directly for Minuche. So this is this is fun. Um interesting, an interesting connection there. But uh let's let's start there with um systems and uh family systems therapy. Uh why don't you give us a brief overview of that and and how um how it works?

Speaker 2:43

You know, in the the brief conversation you and I had prior, um, I was saying to you that the difference between individual therapy and and system therapy is is no different in some ways when you do use a sports analogy to um to a golfer and then a football player. Right? The football player, everything he does is looking at everybody else in the field, not just his team, but the other person's team, um, and knowing that whatever he does will affect the team and whatever the team does will affect him. Um and that sometimes a lot of golfers play football in our field. A lot of individual therapists offer to do family therapy, which is rare because the family as a system is becoming extinct, unfortunately, particularly in the United States. Um family unity sitting at the table, having meals, all these things are becoming somewhat extinct. The the couch has become the table, right? But the systems thinking has to do with relationships. The idea of systems thinking is that the symptom does not reside within the individual. I don't know uh who the audience is here, but I imagine they're therapists.

Speaker 1 3:56

Yes, medical personnel, therapists, yeah.

Speaker 3:58

Wonderful. The idea of of system thinking is very anti-medical because the idea of system thinking is that the symptom does not reside within the individual, meaning system thinkers do not go too much by the DSM.

Speaker 2 4:16

Right.

Speaker 4:17

But the idea is that the symptom is within the system, and that goes beyond semantic importance, meaning it's not just semantics, it's a profound theory behind it. The idea of system thinking is that an individual does not have ADHD, but the family system as a whole has ADHD. The idea is that the individual does not have bipolarity, but that the system has bipolarity, the family as a system is very bipolar. That when that individual becomes stable, the family becomes more bipolar, for example. Yeah, yeah. And so these are complex notions because they have a lot of practical ramifications in the way in which practitioners practice the craft of therapy, right? And the final point, I think that in a very brief summary of what system thinking is, is that the therapist also is part of that system. When I was in England and I studied a few courses in anthropology, one thing I learned about anthropologists is that anthropologists go into a tribe and they become submersed in that tribe until the tribe sees them as another one of them. When the tribe no longer sees them as an outsider, they begin to take notes, but as insiders, fully knowing that they're affecting that which they're observing. And part of the system's training is increasing the awareness that we become a part of that system in the family and that we affect the family system as the family system affects us.

Speaker 1 6:02

You're you're this is this is fascinating. So let me flesh out a couple things too. Um that's why I was like, just keep doing your thing. It's great. One of the questions I had too, or uh or immediate thoughts I had was um, you know, when you said the family has the the diagnostic label, not just or the system has the label, not the individual. And I can imagine, I'm thinking of my own my own history. My child has a diagnosis, therefore I, you know, before that child, my family was very, very different. And before the symptoms emerged, my family was very, very different. Um, and so I can't say that the the the condition that my child is dealing with is isolated to my child. Is that something is that kind of what you're uh getting at when you said the system has the has a diagnosis?

Speaker 6:51

Yes, and no. Yes, in the sense that the family system changes as the in every individual in the family changes. And you know, it would be no different than if the father was experiencing financial difficulty through work, then as he changes his mood, the family system would change in agreement to that. The family is a living organism. So when someone in the organism changes, everything else changes. The premise of family therapy, um, which today is couples therapy, right? What used to be family therapy, the video that you used to watch of Minucci with a family while we were smoking a cigarette. Back in those days, you could, if you were a teacher, you could smoke in the classroom, and if you were a therapist, you could smoke in the therapy room. Thankfully, things have changed. Cigarettes are for one. Uh, but that idea has changed. Now it's couples. The new unit, systemic unit of treatment is couples, it's no longer families. It's impossible almost for a therapist to get the family to come to therapy as a family.

Speaker 2 7:50

Right.

Speaker 7:51

But the premise of family therapy is that the child manifests her symptoms or his symptoms because of the way in which the family functions. Meaning that the family is not the problem, but the family is certainly, when it comes to the unit of treatment, a part of the solution. The family therapists focus on family functioning, not in individual diagnosis. It's a difficult concept to grasp because we have become superbly individualistic as a society. We have become a system where family units operate individually. The husband is on the computer, the wife is in the bedroom on the iPad, and the child is in the room watching TV while having an Instagram conversation with kids their age while doing the homework. Because children nowadays can do their life, they can they can do five things at once, right? And and so we have become very good at living life separately as individuals.

Speaker 1 9:00

Yes.

Speaker 9:01

Very rarely do systems. If I ask people right now to ask themselves, people whoever listens to you, I imagine it's a lot of people using knives. When was the last time that you guys sat down at the table to have dinner and make eye contact and have an open forum to where your children can talk about how their day was? What time is dinner time at the table for you guys? The answer will be we don't know. We sit at the couches sometimes.

Speaker 2 9:26

Oof, oof, yeah.

Speaker 9:29

Um I work with a lot of couples. And when I ask couples, when is your night of the of the week to sit down and just play cards and talk? They look at me in awe. Those who have a pet, I ask them if they walk the dog and they say, We do. I say, How many times do you walk them? And usually on average, couples walk their dog three times a day, minimum. And they spend 10 to 15 minutes out there with the dog. When I ask them what is the night that they spend just playing cards and talking and having a glass of wine, perhaps they look at each other dumbfounded. And I let them know that they have successfully spent more time on a weekly basis picking up their dog poop than spending time with each other.

Speaker 1 10:25

That's a fact. Let that sit, people. Let's just let's have a moment of silence for picking up dog poop rather than playing with your children because I felt that one in my soul a little bit too.

Speaker 10:37

And then the same thing happens with the family, the family system. When I introduced myself, I gave you a curriculum vitae. But beneath that, as far as the person as a therapist, I grew up differently. I grew up in the United States in the 1940s, perhaps. Because I'm from Argentina originally.

Speaker 1 10:58

Right.

Speaker 10:58

We just lost the finals to Spain. I'm still grieving.

Speaker 1 11:02

Yeah, I understand. You have you have the greatest of all time and lost, and that that hurts.

Speaker 11:06

We he still is a great.

Speaker 1 11:08

He still is.

Speaker 11:09

In Argentina, um we are polemic by um upbringing because we are born watching parents complain about corrupt governments.

Speaker 2 11:21

Right.

Speaker 11:22

Uh we are raised in a situation where we're not poor enough to be a third-world country, but we're not wealthy enough to be a first-world country. So we bank on the resources we have, and the resources we can bank on are human interaction, connection, sitting under the table. Because we cannot buy food outside, we have to cook, so we cook for lunch, for dinner, and we sit at the table and we talk. When I moved to the States, I had to learn to sit down with my American mom and her daughter, and I will cook as a 15-year-old, and I will set the table and will have them sit down. And when I left to go to Florida, they they cried. Because they had gotten used to communicating, connecting. The point where the second year came around and idea didn't have to ask, and they used to sat at the table. Right? And there are a lot of deficiencies that come with this idea that that is increasing, especially with social media, where we're becoming increasingly autistic. And I don't mean that in the derogatory way, meaning towards ourselves. I hear a lot of people and all the audience here have had somebody in their families, in their lives, or even themselves, who pride themselves in saying, I'm not a people's person. Today it's a cool thing to say that. If you say as a social gathering, they are not a social person, you're cool. And it's really drawing us apart from others. So the systems theory is a very, very important theory that is becoming extinct. It's inadequate. When I tell people that their children's dysfunctions are part of a family dysfunction, it's very repellent because it requires assuming a sense of responsibility that is typical of somebody who accepts that they can be part of the solution. And as a family therapist, I challenge people to increase their competencies. Hymnotherapy does the same thing in a subconscious way. This the difference between psychoanalysis, broadly speaking, psychoanalysis and hypnotherapy, probably at the head of psychoanalysis, we will think of Sigmund Freud.

Speaker 2 13:40

Right.

Speaker 13:40

I always jokingly say our favorite cocaine user. You know, Floyd used cocaine, right? Um genius. And then at the head of psycho uh of um hypnotherapy in family systems, we will think of Milton Ericsson. Yeah. Okay. The wizard of the desert, they called him, right? And Ericsson was a character that if you're a therapist and you're interested, uh, please write down the book Uncommon Therapy by Jay Haley. Wonderful. Erickson himself didn't write anything, but we have Jeffrey Sage, who wrote a lot about Ericsson. And Jay Haley wrote the most masterful piece of work that talks about how his therapy was different through hypnosis. The difference between hypnosis and psychoanalysis broadly is that psychoanalysis sees the subconscious mind as a black box of repressed issues. Meaning you go to a psychoanalyst, meaning an Argentine therapist, Argentina psychoanalysis is here, right? And the therapist already assumes that you have a black box that you don't have access to of repressed trauma. And he begins weaving his thing of interpreting your dreams, free association techniques. And Sminucci once said, psychoanalysts have a series of interventions that go like this. Uh-huh. Oh wow. Right. Right. And they begin to tap into that box. So the idea is the subconscious mind is a black box of repressed trauma. Whereas hypnotherapists from Milton Erickson school, I think the most important one in my readings and my understanding is Douglas Flemonds. If you're lucky enough to get an interview with Douglas Flemonds, you will give the audience something wonderful. He's a genius. Um who will hate to hear me say that. But hypnotherapists believe that the subconscious mind is a black box of hidden resources. And that's a function that we family therapists stole from Erickson. That the goal of, if you read Milucci's books, you right here, they're all signed by him, by the way. You'll see that the that he mentions the role of a systems thinker, the family therapist, is to the family comes with an individual pathology within a member of the family saying help them, help her. And what they walk out of family therapy with is heightened functioning at a systemic level, as a family. It improves the functioning of the family as a whole. They force the diagnosis to wither away by doing things as a system. They take responsibility. This is very tribal. Tribes function that way. In any tribe in Africa, if you read a little bit about it from an anthropological lens, the problem of one person doesn't exist. There are tribes in the Amazon where when you don't have a house, they build your house as a village, and then you help build other people's houses. Right. These are revolutionary concepts today, because we're going in the opposite direction. So the long way about answer about systems theory is that it's a theory that is becoming extinct because we're changing a society, but the idea is beautiful, almost utopic, that your son is responsible for you as much as you are for him, as you are for your wife, as she is for you, and as a system, you're connected as a web of mutual support, and that you have untapped resources. Family therapists help you to function better as a system where everybody improves together. People change together. The other idea that we're used to now is that we bring our kid to an individual therapist because he will feel more comfortable talking to a stranger than to us, which is denouncing that we haven't worked as a system, right? As a system, as a family. By now, your child should feel more comfortable talking to you than anybody in the world. And I'm not saying this in general for the audience. And they do so in a variety of ways. But broadly speaking, there is a systemic map that all family therapists have in common. It's a four-piece map to navigate as a therapist, right? Navigate the waters of family therapy. If I had a goal, I'm gonna be, I think I'm gonna be giving a lecture in Terra in October. I've been told. And my goal there is to introduce this map to individual, to golf players, to individual practitioners so they can feel comfortable working with a family. So what I'm going to do on the 15th of October, ideally, is in I think I have 45 minutes, is that I will tell them that when a family is in front of them, they should do these four things in their own time with their own style and bring their own nuances, but know that there is a map that is different from individual therapy. Okay, I think that that's the answer I have.

Speaker 1 19:07

Yeah, yeah. So um, and I'm and I'm loving the answer, and it it's it's it's interesting because you say it's dying uh in in this community, or at least in, you know, I'm a white Anglo-Saxon Protestant from you know colonial Virginia, Virginia. In my, you know, I can know my own ethnic background. It used to be that we would work as a society or collaborate with one another, build each other's houses, farm each other's land, and help each other out. And it's still I'm in the middle of the country, so it's still very much that way in some with among some people. But definitely in my in my culture, it is definitely going away. However, my question then is is that is this a development away from nature or towards nature, or should I say, will we be drawn back towards systems thinking, whether we mean to or not, because individualistic or narcissistic individualistic thinking um is unsustainable?

Speaker 20:08

You know, I think the answer to that would be to speculate, you know, yeah, because um it will be to look into the future and kind of become a fortune teller. But um I know that is um it is a very much a very animalistic thing to unnatural thing to do what we're doing. It's very unnatural. Um, people are suffering stress, anxiety, depression more than ever before. Of course, before we didn't have the means to kind of estimate the numbers, right? But I believe that um this way of letting go of our of the system's hand and working on our own and insisting on that is is could could possibly be responsible for a lot of the mental malady that we experience today. Um but if you look at animal behavior, um you know, by the way, no, like human instinct, human instinct doesn't exist. We know that like human instinct does not exist. We we don't have instinct. Uh that's a purely non-human animal thing. But um but I do believe that there's a lot of animal behavior that we that we we we kind of um operate on the same basis. Uh most animals, um a lot of animals operate in in a way that is systemic, very systemic. In chimpanzees, we know that if a chimpanzee loses itself from the group, it's dead because another group will kill it. Yes. Right? Uh and so in chimpanzees, which is probably the closest to humans, um, not being part of a group is equal to equivalent to death. As we know. So when we feel alone, we feel that we don't belong to a group, we definitely experience a lot of a lot of things that are not pleasant, right? This feeling of the fear. A lot of people are afraid of being alone, for example. A lot of people don't know how to be alone, cannot be alone. And again, it has a primal thing that that goes beyond ourselves, which is it it's equivalent to danger of not surviving, being alone. Right. Do I think that that we're gonna go back to systems? I think that we're we're the the the very very very very young generations are kind of starting to um you know no no longer do people pursue the American dream. I think that the American dream is something of the past. I think that now um people are pursuing experiences. You see young people want to travel they want to have experiences that are not in such a rush to find their calling or find out who they want to be they kind of want to get out there and explore and have experiences. I think younger people are seeking out conversation way more than before. Right? But but I know that this I I do know that this um removal from the collective is very pathological and I I do vacillate between Argentina and the states sure um and I do see the difference right uh and it's very concerning for me when I see the difference when I experience the difference mainly because I love this country. I'm a big fan of the United States I came here people say why did you come to the United States I say because of the United States and so I always want to bring whatever is best for the country my books are in English you know and I'm working on manuscripts and they're in English because I wanted to stay here and improve things here right um I think that um the American society is very strong at finding eventually finding what's best for the fabric of the nation I think once they figure out what's going on they'll they'll they'll find ways very ingenious ways of bringing it back to the system and the family but um I I wouldn't want to speculate.

Speaker 1 23:46

Right. And and the reason we went down the speculative route is because of the nature of the discussion so oh so far. And I noticed when you talked about your background anthropology I see philosophy books in your in in your in your background um this is a very eclectic approach and you said it's not medical necessarily and that we're using the the methods of the scientific method to come to um a research conclusion even though there's plenty of uh evidence backing for systems and family system therapy um however you're bringing in other things cultural you know anthropological philosophical into this um practice of yours yeah you know systemic and the you know I mean if you go by my background I don't plan on it I do have a lot of therapy books but I also have I don't know I think I only finished I have Twilight yeah why not I have a daughter who's 17 so I have this kind of head thing that he likes um uh so please don't go by what you see my oh yeah I'm going by what we were what you were talking about definitely you were you were definitely saying some uh you were you were bringing in many disciplines into this one which I do think is uh uh um a a strong characteristic of systems thinking right I you know I was blessed I went to a program that that had just become uh a newborn program and if you had been part of the program at Nova Southeastern University you would have never known that it was new because it was run masterfully masterfully run wonderfully run from the faculty to the programs to everything to to the the facilities to be able to see patients behind the one-way mirror like Jay Haley I mean top of the cream amazing right anybody that that ever wants to go and visit Nova Southeastern the family therapy program per se is is an amazing place to be um clinically speaking um from the research and everything but you know psychology stemmed from from philosophy so so it's it's an offshoot of philosophy you I think you see it more pronounced now in um individual cognitive behavioral approaches where a lot of the stoicism movement right is diluted into diluted into techniques and ideas of separating emotion from logic but it's a that's all like diluted stoicism but over the course of the um the the the time and the last few decades maybe five six decades therapy has become watered down a lot of new approaches that seem very simple um have emerged and they're tricky because they're approaches that are easy to um quantify or qualify as efficient through research through the scientific method but it doesn't mean that they are um I think the difficulty is that psychological techniques and psychological models have evolved much faster than philosophy over the last few decades.

Speaker 26:44

And that means that the result are a lot of psychological models that have very little philosophical scaffolding a whim right and I think that the medical people who watch this probably understand that that that's wrong because in the medical field things need to really be validated studied saturated there's a process and and in psychology in the last few years not so much and I know that's a it's a wild statement that I'm making it's a criticism it's a personal observation from what I read that somebody sits and writes a book and from the book it's a matter of therapy right and there's very little philosophical um there are exceptions to that I think when you look at Michael White and narrative therapy and family therapy you know he's he spends a vast majority of of the book at the beginning talking about maps the book is called maps title maps yeah uh talking about um Bishop Foucault right the the French philosopher so you see that there's a philosophy out of which stems a model of therapy but I think that that a lot of models are are not doing that and then we can also talk about the the whole avenue of self-help right if you're Barnes and Nobles you have a lot of books and self-help that you can just say goodbye to philosophy altogether. Self-help books are basically grabbing one concept of psychology and blowing it up into a book with language that people can understand and it's you know it's great but it's sometimes not too useful. It's alleviating but it's technology it's not therapy. Oh yeah I think that when you see philosophy is because you know PhD essentially is a doctorate in philosophy. Ph philosophy D for doctor so a doctor in philosophy means that you have a responsibility to continue reading and reading at the ideally reading also philosophy and understanding what why why things happen the way they do. So any strong basis of philosophy cannot guarantee you have you're gonna have an interventionist who actually at least thinks right um before intervening meaning you have a carpenter that measures way more than the cat.

Speaker 1 28:56

You've been listening to Mind and Medicine a Sentera podcast as a reminder please check the show notes for details on how to claim your continuing education credits as well as any resources mentioned in the episode. That's it for now but keep an eye out for another episode and more evidence based education for healthcare providers on the go. You well