Attending to the Whole System: Eco-Informed Family Therapy

Whenever we (TAL and MLCT) write and speak about ecological issues and family therapy (FT; see Blumer, Hertlein, & Fife, 2012; Hertlein & Blumer, 2012; Laszloffy, 2009; Laszloffy & Davis, 2019; Laszloffy & Twist, 2019), we always start by referring to Bateson because he played a foundational role in the birth of systemic FT. His application of cybernetics to human systems laid the groundwork for what became our field. Bateson, thought-trained as an anthropologist, was very much an ecologist at heart, and he spoke at length about the vital need for humans to recognize that we are embedded in the ecological system and what we do to it, we do to ourselves. He warned about the dangers of chopping up the ecology (literally and metaphorically) through our widespread abuse of the environment and our refusal to accept that humans are a part of the ecosystem, not separate from it, and if we are to be well, we need to treat our ecological system well. Strangely, while the pioneers newly forming the field of FT did an excellent job of applying systemic principles by locating individual behavior within the family context, they were remiss in taking the logical next step by locating individual and family behavior within the broader social and ecological systems.

While there is now a much greater acceptance of the need to consider the sociocultural context, nearly 70 years since the field’s inception, our field is only now finally starting to face that family therapists (FTs) need to be attuned to the impact of the ecological context on the lives of our clinical participants and ourselves.

Devastating effects of climate change

With a deadly deep freeze that ravaged much of the central United States in February of 2021, hitting Texas the hardest, with wildfires incinerating regions across the globe, from California, to Australia, to the Amazon, and even in the Arctic, and with a record-breaking number of brutally forceful hurricanes, tornados, typhoons and cyclones flooding towns and ripping apart communities from the southwest US to Indonesia to India, nature’s call can no longer be ignored. Humanity is being forced to finally wake up and see the impact of our abuse of the environment. Indeed, the devastating effects of climate change have created a new class of people known as “environmental migrants” or “climate refugees.” These people have been forced to flee in response to either sudden or gradual changes in the natural environment resulting from any number of significant climate changes like rising sea-levels, extreme weather events, or drought and water scarcity (Biermann & Boas, 2008). With the growing number of individuals and families who have lost their homes and communities, and have suffered injury, illness, or the death of loved ones due to climate change, increasingly therapists are being called upon to treat the effects of environmentally-based trauma (Laszloffy, 2019). At the same time, there is an ever-intensifying need for therapists to understand and be prepared to address the mental and relational health impact resulting from environmental toxicity and from our disconnected relationship with nature (e.g., nature-deficit disorder).

Environmental toxicity

On a daily basis, humankind engages in actions that assault the environment. Agribusiness¹  is responsible for wide-scale deforestation and desertification from the rangelands of the western US to the Amazon basin, and factory farms are responsible for polluting the land, air, and water with the runoff from industrial waste including millions of tons of untreated manure. Industrial pollution injects a slew of toxins into our land, air, and water, and our consumer culture is responsible for a deluge of plastics that end up in landfills (where they do not biodegrade), or in the oceans where they eventually form “islands” of accumulated garbage—some the size of Texas. Plastics also are broken-down over time by exposure to the elements until they become microplastics.² Scientists report that the invasion of microplastics into the environment is so pervasive they estimate that most, if not all marine life, have ingested it, hence, other animals, including humans, who eat fish, also have ingested microplastics. Indeed, researchers have found that we humans are ingesting on average about five grams of microplastic per week, which is roughly the equivalent of a credit card worth of plastic a week (de Wit & Bigaud, 2019).

While all life on the planet is affected by environmental pollution and toxicity, we are not all affected equally. Those who are privileged on the basis of race, social class, immigration status, economics, and/or nationality have access to resources that allow them to minimize direct exposure to the more overt effects of pollution and environmental toxicity, while those who are oppressed often are in the direct line of fire. For example, the health and viability of indigenous/First Nations communities are often ravaged by mining and fossil fuel infrastructures like pipelines, and many poor and/or working-class communities, especially those of color, are often powerless to fend off the proximal placement of industrial and agribusiness operations that directly pollute their air and water supplies, and developing nations often endure the initial impact of industrial and electronic waste that western nations generate and export. Yet, while the privileged can run, no one can hide, because the Earth is a system, and what effects a part, eventually affects the whole.

Those who are privileged on the basis of race, social class, immigration status, economics, and/or nationality have access to resources that allow them to minimize direct exposure to the more overt effects of pollution and environmental toxicity, while those who are oppressed often are in the direct line of fire.

In addition to macro-level sources of pollution and toxicity, we must consider the toxins we are exposed to at the individual level through dietary selections and our daily interactions with the consumer goods and products that we ingest, inhale, and absorb through our skin. As single units, the toxins contained in the foods we consume and in our household cleaning supplies, beauty products, apparel, mattresses, upholstery, furniture, petroleum-based plastic water bottles, non-stick cookware, dry cleaning chemicals and so forth, is low, but in combination, they add up. Indeed, it is estimated that most humans today are carrying measurable levels of at least 700 contaminants in our bodies (Onstot, Ayling, & Stanley, 1987). These human-made often toxic chemicals, as well as other naturally occurring chemicals, make up our “body burden,” which refers to the total concentration of chemicals in our bodies at any given time. Through biomonitoring of chemicals in human tissues and fluids, researchers have found that all humans on the planet today carry at least some degree of body burden of synthetic chemicals (Gennings, Ellis, & Ritter 2012).

In preparing to explore such questions with clinical participants, FTs will need to become more knowledgeable about environmental health and sustainable viability within relevant local communities, including practicing greater awareness of the role local industries play as potential sources of contamination and pollution (Laszloffy, 2019). We may also need to collaborate and consult with professionals and providers who specialize in assessing and treating conditions related to environmental toxicity and its effects on mental, physical, and emotional wellbeing (e.g., functional medicine physicians, complementary medical providers, alternative medicine professionals), so we can more holistically assist people who may present with environmentally-rooted trauma (Laszloffy, 2019).

FTs can also use eco-friendly genograms or green-o-grams (Blumer et al., 2012; Hertlein, Fife, Blumer, Smith, & Card, 2010) during this assessment process. These are like other kinds of focused genograms, which are tools that enable FTs to reflect with their clinical participants on patterns occurring across generations in a focused manner. They help said relational systems develop a heightened awareness about the effect of such patterns on their individual behavior and systemic dynamics (DeMaria, Weeks, & Twist, 2017). Eco-friendly genograms can be used to assess and explore an individual’s and relational system’s legacy related to the environment, conservation, toxicity, etc. (Blumer et al., 2012).

Environmental toxicity assessment questions:

(Laszloffy, 2019)

• How much attention do you pay to the chemicals that you have in your house (e.g., products used for household cleaning, laundry cleaning, personal hygiene, beauty/cosmetics, paint/paint removers, auto maintenance, and insect control)?
  Are you aware of the potential for home furnishings (e.g., carpets, mattresses, furniture made from particle board, textiles, and curtains) and building materials (e.g., insulation and treated wood) to contain toxic chemicals (e.g., flame retardants)? How much awareness do you have of the composition of the furnishings and materials that comprise your residence?
  In what ways could you reduce your contact with products, foods, and spaces that may be potentially harmful in terms of their toxicity?
  What foods do you primarily consume? What is the source of these foods you eat?
  What toxic chemicals may be present in your work environment?
  What environmental hazards may have occurred and/or be present in your neighborhood and local community, and how might you possibly be exposed to toxicity as a result (e.g., are the toxins present in and therefore absorbed through contact with air, water, or land?)?
  For any questions asked above that you did not know the answers for, or had limited knowledge about, what steps could you take to deepen your knowledge?

Disconnection from nature

Richard Louve (2005) coined the term “Nature-Deficit Disorder” (NDD) to describe the emotional and behavioral effects children suffer when they lack sufficient exposure to and contact with nature. Although not a medical diagnosis, the term speaks to the dysfunction that stems from the reality that many children, and adults, spend the preponderance of their days inside with minimal time spent outdoors. While many of our ancestors spent their lives interacting on a daily basis with the land around them and with non-human animals, modern humans spend most of their time inside hooked up to devices that draw them into a virtual vortex. One report issued by the Environmental Protection Agency (EPA) cited that the average US resident spends 87% of their life indoors, then another 6% of their life in automobiles, with only 7% spent outdoors (Klepeis et al., 2001). That comes to one half of one day per week outdoors.

Exposure to and engagement with nature is essential for overall physical, mental, and relational health and wellbeing. There is a growing body of scholarship demonstrating that there is a correlation between depression, anxiety, stress, lethargy, difficulty concentrating, poor sleep, restlessness, and/or a sense of meaninglessness and a lack of contact with nature (Greenleaf, Bryant, & Pollock, 2014; Hechter & Fife, 2019; Hertlein & Hechter, 2019). At the same time, myriad researchers are increasingly demonstrating that exposure to an engagement with nature is not only correlated with improving these symptoms, but also tends to speed up the recovery process from illness or injury (Moxham, Liersch-Sumskis, Taylor, Patterson, & Brighton, 2015).

Research indicates that exposure to nature has beneficial effects, even just the hint of nature. For example, having a window with a view of trees in a hospital room is correlated with quicker rates of recovery (Ulrich, 1984) and the viewing of technology-based nature scenes by patients is correlated with reduced levels of stress and more regulated heartbeats (Brown, Barton, & Gladwell, 2013). Especially for children, study after study confirms that access to green spaces is linked to increased prosocial behavior in children who help, cooperate, comfort and share more, just as the loss of access to this greenery has the opposite effect (McCormick, 2017). Unfortunately, many children today spend very little time outdoors and instead spend much of their time indoors, often on any number of modern technological devices.

Thus, for FTs, it is necessary to be attuned to how much time clinical participants, especially children, spend indoors versus outdoors, and what kinds of activities they are doing in each of these environments. In some cases, the presenting issues may be directly tied to nature deficiency, while in other cases, they may be tied to out-of-control-digital(digi)-behaviors (OCDB)³  (Twist & McArthur, 2020). FTs can assess OCDB and other technology-related behavioral patterns in individuals and relational systems through the use of a technological genogram, technology-focused genogram, or technogram (Blumer & Hertlein, 2015; Hertlein & Blumer, 2013). In other cases, such factors are not the basis for the problems that are presented with in therapy, but nevertheless, incorporating nature-based interventions into the treatment process has many positive effects on emotional wellness, interpersonal functioning, and physical health (Flaskerud, 2014; Miller, 2014). Examples of nature-based interventions include, but are not limited to, assigning outdoor time, using nature-metaphors, nature-based art therapy techniques, and techniques from wilderness and adventure therapies (Hechter & Fife, 2019).

We propose the following series of questions to assist FTs in exploring how much or how little contact clinical participants have with nature. However, before considering these questions with clinical participants, in the spirit of attending to one’s own ecological self-of-the-therapist (or self-of-the-eco-therapist; Laszloffy & Davis, 2019; Twist, Leon, Korbar, & Yuen, 2019), we suggest FTs begin by contemplating these questions for themselves.

How we got here and what needs to happen next

How is it possible that our species has been on such a massively self-destructive course of action with so little awareness of the harm we have been inflicting? The answer to this question is rooted in the dualism that is an inherent feature of western thought. Dualism splits the world up into opposites such as mind/body, this/that, good/bad, have/ have-nots, rich/poor, male/female, cisgender/transgender, self/other, and of course, human/animal and culture/nature. Not only is reality constructed around such dualities, but also these dualities are arranged hierarchically so that one set is viewed as being superior to or better than the other. With respect to the human/animal and culture/nature splitting, this has resulted in a perception that humans are not also animals, and also, that humans exist outside and separate from and are superior to nature (Hernandez-Wolfe, 2018; 2019). Not only are these perceptions inaccurate, they are dangerous, because as long as humans view ourselves as separate and superior, we are prone to objectifying and therefore mistreating other animals and the environment.

Nature-deficit assessment questions

(Laszloffy, 2019)

• Within the course of a given week, how much time do you spend outdoors?
• When you are outdoors, with which activities are you typically engaged?
• Do you enjoy spending time outdoors? If so, what do you enjoy about your outdoor time? If not, why do you not enjoy time spent outdoors?
• When you were growing up, to what extent, and in what ways did you spend time outdoors and interact with nature?
• When you were growing up, what messages did you get about nature and the outdoors from your family?
• In what ways is nature a source of comfort, vitality, pleasure, positive challenge, and/or relaxation in your life?
• In what ways is nature a source of fear, mistrust, and/or negativity?
  

In our minds, nature is something that exists separate from and outside of ourselves; nature is “the other” and viewing something as an “other” is part of the process of objectification that leads to violence and a lack of empathy, guilt, and/or remorse. This mentality underpins all forms of oppression and in this way, our abuse of the environment and our exploitation of other animals stems from the same process that underpins racism, sexism, classism, heterosexism, cisgenderism, ageism, etc. Our maltreatment of the land and other animals is tied to these other forms of oppression and if we are going to become a society based on equity and fairness, we must see all of these issues as connected. For instance, we cannot be advocates for racial justice while we minimize or ignore the needs of folx of lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, polyamorous/pansexual, and/or additional queer (LGBTQIAP+) identities, backgrounds, and experiences, and relatedly queer justice. Similarly, we cannot advocate for queer justice while ignoring or minimizing the rights of non-human animals.

We have to recognize that all forms of oppression stem from the same ideology of domination and it is this ideology that must be disrupted. We have to be committed to justice for all, meaning all life on the planet. Unless and until we can see that all beings are interconnected and that what we do to other people, including other animals and the environment, we do to ourselves. We are inextricably intertwined and before any significant change can occur, we have to start by seeing and behaving in ways that acknowledge our interconnectedness. FTs can take a leading role in advocating for a systems approach to justice with the understanding that none of us can be free as long as any of us remain oppressed (Hernandez-Wolfe, 2018; 2019). This is a role we need to be taking not only in our clinical practice, but also in our teaching and training of the next generation of FTs (Twist et al., 2019).

In conclusion, FTs are ideally positioned to play a crucial role in addressing mental and relational health in terms of environmental trauma and toxicity and in terms of exposure to and engagement with nature. But also, as healers, agents of positive change, and as members of a profession rooted in systemic principles, we have a responsibility to understand and challenge the false divisions that lead us to feel separate from and therefore justified in exploiting other humans, non-human animals, and the Earth that is our home. We can ill afford to wait any longer to act. Now is the time!