I work in systems psychotherapy with people living with brain impairments: Who changes? Who leads the change? - depends on the direction of the system. Isn't it likely that one never does therapy with individuals? One does therapy best by gathering as much of the system as possible into the session, literally or metaphorically, discovering the direction of that system of folks, then deflecting it toward health using its own momentum. Rather like saving Earth from a mega space rock - don't break it up into smaller bombs, nudge its integrity into a near miss trajectory. Assigning homework to family members instead of to the designated client, has oft proven that these groups of desperate people act in concert. Sometimes the concert is bad, sometimes good, but these people certainly act as a system.
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