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Family Constellations – Framework and Brief Literature Review

Family constellations (hereinafter CF) are a systemic phenomenological approach that positions itself as an autonomous and distinct practice.

Its creator, Bert Hellinger, in addition to training in philosophy, studied and integrated many therapeutic currents, being also a psychotherapist. Of these currents, Levi Moreno’s Psychodrama stands out; Eric Berne’s Transactional Analysis; Artur Janov’s Primal Therapy; Gestalt Therapy by Fritz Perls and Paul Goodman; the Family Sculptures by Vírgina Satir, among many others.

FC have been making their way since the 1970s and currently have hundreds of thousands of people around the world using this practice with real and lasting results in their lives as a complement to other therapeutic self-help approaches.

Thus, FC are based on a vast theoretical field based also on the most recent sciences such as epigenetics and quantum physics. It should be noted that the studies carried out on the subject were highly recommended by the British biologist Rupert Sheldrake, who developed the Theory of Morphogenetic Fields. Much of the work that is done in the constellations is anchored in the phenomenological model.

In fact, it seems that the theoretical and investigative body of FC has already recognized its beginning and a path that has been increasingly solidified from the various publications in scientific journals with great methodological rigor (with peer review – peer review).

We have identified some quality publications featured on EBSCO:

• Fidyk, A. (2016). Unconscious ties that bind – attending to complexes in the classroom: part 2. International Journal of Jungian Studies, 8 (3), 195-210.
• Hunger, C., Bornhäuser, A., Link, L., Schweitzer, J., & Weinhold, J. (2014). Improving experience in personal social systems through family constellation seminars: Results of a randomized controlled trial. Family Process, 5 (2), 288-306. doi: 10.1111 / famp.12051
• Hunger, C., Weinhold, J., Bornhaauser, A., Link, L., & Schweitzer, J. (2015). Mid-and long-term effects of family constellation seminars in a general population sample: 8- and 12-month follow-up. Family Process 54, 344–358.
• Mayer, C-H., & Viviers, A. (2015). Constellation work principles, resonance phenomena, and shamanism in South Africa. South African Journal of Psychology, 46, 130-145. doi: 10.1177 / 0081246315591339
• McQuillin, J., & Welford, E. (2013). How Many people are gathered here? Group work and family constellation theory. Transactional Analysis Journal, 43 (4), 352-365.
• Pritzker, S., & Duncan, W. (2019). Technologies of the Social: Family Constellation Therapy and the remodeling of relational selfhood in China and Mexico. Culture, Medicine & Psychiatry, 43 (3), 468-495. doi: 10.1007 / s11013-019-09632-x
• Sethi, Y. (2008). Coming full circle to systemic family constellations in personal therapy. The Australian journal of clinical hypnotherapy and hypnosis, 29, 2, 5-11.

It is also possible to find, in this database, reviews published in newspapers, of books about FC:

• Gilbert, A. (2010). Working with systemic constellations. Therapy Today, 21, 6, 45-46.
• Grimwae, Jo. (2005). To the heart of the matter: Brief therapies. Australian & New Zealand Journal of Family Therapy, 26 (3), 173.
• Ingram, C. (2007). Peace begins in the soul. Australian & New Zealand Journal of Family Therapy, 28, 58-59.

In consultation with the Redalyc database, the following scientific articles on FC were published:

• Alonso, Y. (2005). Bert Hellinger’s family constellations: a psychotherapeutic procedure in search of identity. International Journal of Psychology and Psychological Therapy, 5, 1, 83-94.
• Hellinger, B. (2009). The collective unconscious and Family Constellations. Cuadernos de Información y Comunicación, 14, 83-88.
• Peñarieta Acosta, M.F. (2005). Free theme in psychotherapy family constellations: heal from the familiar soul. Ciencia Médica Scientific Journal, 8, 1,48-49.

A brief survey was also carried out with the marker “FC” on the B-on portal: a scientific information research tool, which has institutions of scientific prestige as members (eg, University of Porto; University of Minho; University of Coimbra), it was possible to identify the following scientific articles:

• Birkenkrahe, M. (2009). System constellations as a tool supporting organizational learning and change processes. International Journal of Learning and Change, 3 (2), 125-144.
• Cohen, D. B. (2006). “Family constellations”: An innovative systemic phenomenological group process from Germany. Family Journal, 14 (3), 226-233. doi: 10.1177 / 1066480706287279
• Crawford, J. (2013). Sister of the Heart and Mind: Healing and Teaching with Family System Constellations. Women & Therapy, 36 (1-2), 100-109.
• Franke, U. (2017). In my mind’s eye: Family constellations in individual therapy and counseling. Carl-Auer Verlag.
• Hogeland, A. (2010). Family constellation therapy. Homeopathic Links, 23, 24-26.
• Hunger, C., Bornhaauser, A., Link, L., Giegges, J, Voss, A., Weinhold, J., & Schweitzer, J. (2017). The Experience in Personal Social Systems Questionnaire (EXISpers): Development and Psychometric Properties. Family Process, 56, 154–170.
• Klimecki, O. M., Leiberg, S., Lamm, C., & Singer, T. (2012). Functional neural plasticity and associated changes in positive affect after compassion training. Cerebral Cortex, 23 (7), 1552-1561.
• Ramos, S., & Ramos, J. A. (2019). Process of change and effectiveness of family constellations: A mixed methods single case study on depression. The Family Journal, 27 (4), 418–428. doi: 10.1177 / 1066480719868706
• Rothbaum, F., Rosen, K., Ujiie, T., & Uchida, N. (2002). Family systems theory, attachment theory, and culture. Family Process, 41 (3), 328-350.
• Salters, D. (2013). Sandplay and family constellation. Transactional Analysis Journal, 43, 3, 224-239. doi: 10.1177 / 0362153713509955.
• Stiefel, I., Harris, P., & Zollmann, A. (2013). Family constellation – A therapy beyond words. Australian and New Zealand Journal of Family Therapy, 23, 38-44. doi: 10.1002 / j.1467-8438.2002.tb00484.x
• Talarczyk, M. (2011). Family constellation method of Bert Hellinger in the context of the Code of Ethics for Psychotherapists. Archives of Psychiatry and Psychotherapy, 13 (3), 65-74.
• Weinhold, J., Hunger, C., Bornhäuser, A., Link, L., Rochon, J., Wild, B., & Schweitzer, J. (2013). Family constellation seminars improve psychological functioning in a general population sample: Results of a randomized controlled trial. Journal of Counseling Psychology, 60 (4), 601-609. doi: 10.1037 / a0033539
• Welford, E. (2014). Giving the dead their rightful place: Grief work with the family. Transactional Analysis Journal, 44, 320-333. doi: 10.1177 / 0362153714559920

In order to assess the evidence of the effectiveness of Family Constellation Therapy (FCT), Hurley, Koenning and Bray (cf. https://pacja.org.au/?p=4441) presented a literature review in 2017, recommended in reputable databases – Academic Search Premier, The Allied and Complementary Medicine Database, CINAHL Plus with Full Text, Education Research Complete, ERIC, Humanities International Complete, MEDLINE with Full Text, Psychology and Behavioral Sciences Collection and PsycINFO – having identified 141 abstracts ( abstracts), 124 of which were excluded due to the fact that it referred to Alder’s systemic family therapy, with the result that 15. Of these, 4 were excluded because it was a chapter in a book; 2 doctoral studies and 1 book, with 11 articles with peer review, between 2002 and 2016. The authors organized these articles into three groups:

 

• In the first, there are those who outlined and critically described FCT (Cohen, 2006; Crawford, 2013; Sethi, 2008; Stiefel et al., 2002);
• In the second, there are the articles that sought to integrate FCT with other psychotherapeutic approaches (Fidyk, 2016; McQuillin & Welford, 2013; Welford, 2014);
• In the third and last group are found studies that offered research results exclusively on FCT (Hunger et al., 2014; Hunger et al., 2017; and Weinhold et al., 2013).
• The empirical evidence of the benefits of using FC is numerous, whether in the field of justice, education, clinic, or organizations. And, empirically, the results look promising, encouraging the integration of FC in various academic curricula in the psychological sciences, in several foreign universities.
• As far as the family problem is concerned, FCs incorporate, from the outset, two crucial aspects. The first refers to the systemic approach and the use of techniques common to psychodrama, which ends up reinforcing its effectiveness. The second, and probably due to this incorporation, and other elements (eg, during the therapeutic process, the patient is encouraged to express himself with compassion and truth about what the family system needs), it is possible to observe a stimulation of neural pathway activity in brain regions associated with social interactions and positive affects, such as the medial orbitofrontal cortex (Klimecki, Leiberg, Lamm, & Singer, 2012). Thus, practical results, demonstrated through scientific and accredited studies, cannot (and should not) be overlooked.
• It is precisely in this context that it is important to underline that the current scenario of FC and, more precisely since 2013, is not the same as that registered for a long time, despite the fact that there were more or less scattered reports on the effectiveness of the technique, there were, in scientific terms, and in general, elements to support such effectiveness. In this line, it was in 2013 that a group of researchers from the University of Heidelberg, in Germany, sponsored by independent entities, carried out a quasi-experimental and controlled study on the effectiveness of FCT with submission to “Family Constellation Seminars”, carried out in accordance with the method proposed by Bert Hellinger. This initial study ended up being developed and currently the detailed results of these investigations are consultable, which globally allow concluding the improvement of physical and psychological health, self-esteem and self-acceptance, persistent 4 months after participation in FCT; a greater emotional connection and relational autonomy was found, persisting 4 weeks and 4 months after the intervention. The follow-up study showed improvement indicators at 8 and 12 months after treatment.

In order to systematize these results a little, which seem to be relevant and reinforce the effectiveness of FC, three of these studies are briefly presented below:

1. Hunger, C., Bornhäuser, A., Link, L., Schweitzer, J., & Weinhold, J. (2014). Improving experience in personal social systems through family constellation seminars: Results of a randomized controlled trial. Family Process, 5 (2), 288-306. doi: 10.1111 / famp.12051 (https://www.ncbi.nlm.nih.gov/pubmed/24251855)

This study sought to analyze the effectiveness of Family Constellations Seminars in the experience of belonging, autonomy, agreement and trust. A randomized, blinded, stratified and balanced clinical trial was conducted. 208 adults participated, with a mean age of 48 years (SD = 10), mostly (79%) women, who were part of the intervention group. The change was measured in the short term, between 2 weeks to 4 months of follow up, using the personal domain of the Experience In Social Systems Questionnaire (EXIS. pers), as well as the Outcome Questionnaire, OQ-45 and Tool for the Evaluation of the Psychotherapeutic Progress, FEP. The average obtained in these instruments showed improvements in 2 weeks and 4 months in the intervention group, when compared to individuals in the control group. No adverse events were reported. This study provides the first evidence that Family Constellations Seminars tend to positively influence the experience of individuals in their social systems.

2. Hunger, C., Weinhold, J., Bornhaauser, A., Link, L., & Schweitzer, J. (2015). Mid-and long-term effects of family constellation seminars in a general population sample: 8- and 12-month follow-up. Family Process 54, 344–358 (https://www.ncbi.nlm.nih.gov/pubmed/25264190)

The authors report that in a previously randomized study, the effectiveness of short-term FC seminars in the general population was demonstrated. In this article, the authors analyze the stability of these effects, namely in the medium and long term. 104 adults participated, with a mean age of 47 years (SD = 9), and mostly (84%) females who were part of the intervention group. It was assumed that the FC seminars would increase the participants’ psychological functioning (administered the Outcome Questionnaire 45.2) in 8 and 12 months after the intervention. The effects of the FC seminars were also assessed on the psychological distress, motivational incongruity, the experience of individuals in their personal social system and general achievement of goals. The results showed improvements in the indicators considered. No adverse events were reported. This study provides the first proof of the medium and long term effectiveness of Family Constellation Seminars in a population without clinical pathology.

3. Weinhold, J., Hunger, C., Bornhäuser, A., Link, L., Rochon, J., Wild, B., & Schweitzer, J. (2013). Family constellation seminars improve psychological functioning in a general population sample: Results of a randomized controlled trial. Journal of Counseling Psychology, 60 (4), 601-609. doi: 10.1037 / a0033539 (https://www.ncbi.nlm.nih.gov/pubmed/23957767)

This randomized, monocentric, blind, stratified and balanced controlled study analyzes the effectiveness of family constellation seminars on psychological health. The 208 participants chose their role as active participants (AP) or observers (OP), the majority (79%) being women, with an average age of 48 years (SD = 10) and placed in the intervention group. It was assumed that the FC seminars would increase the participants’ psychological functioning (administered the Outcome Questionnaire 45.2) in 2 weeks and 4 months after the intervention (follow up). The effects of the FC seminars were assessed on psychological distress and motivational incongruity, the results of which showed improvement in 2 weeks of follow up and 4 months later. No adverse events were reported. This study provides evidence of the effectiveness of FC in a population without clinical pathology.

A recent study was found, within this typology, with 200 participants, which is expected to be completed in 2020, so its main results are not yet available (https://clinicaltrials.gov/ct2/show/NCT03233958).

The suitability of these studies and their suitability to demonstrate the announced results has not been called into question and, to this extent, they have been recognized and cited in relevant academic circles (eg, https://www.aft.org.uk/SpringboardWebApp/userfiles /aft/file/Research/Final%20evidence%20base.pdfe https://pacja.org.au/?p=4441).

From the above, it is clear that Family Constellations are currently in a phase of scientific legitimation, so it is expected to increase scientific interest in this area and, consequently, studies may grow exponentially in the coming years, as any knowledge that evolves.

Maria Gorjão Henriques

 

[1] e.g.: https://www.aft.org.uk/SpringboardWebApp/userfiles/aft/file/Research/Final%20evidence%20base.pdfe https://pacja.org.au/?p=4441