Family Therapy I – Flashcards

family therapy grew out of the study of groups

group depends on boundaries for differentiation of function, and on customs/habits for predictability

Groups: field theory, quasi-stationary social equilibrium

a group is more than the sum of its parts, developed by Kurt Lewin in 1940s, drew on Gestalt school of perception

Kurt Lewin, changing group behavior requires "unfreezing", something to shake up a group's beliefs so that they are willing to change; unfreezing is harder with families than with individuals

groups engage in patterns of fight-flight, dependency, and pairing

roles in groups tend to be stereotyped-->characteristic behavior patterns. Satir described "the placator" and "the agreeable one." Roles in families tend to be complementary (i.e., pursuer-distancer). Reciprocity is resistant to change because roles reinforce each other.

Continuity, committment, history, shared distortions make family therapy different. In family therapy, stressful environment is brought into therapy rather than kept separate. Democratic equality isn't appropriate in families.

started by Alfred Adler, treating the child was the most effective way to prevent adult neuroses, also counseled families and teachers. Aimed to alleviate feelings of inferiority, so they could achieve confidence and success through social usefulness. After WWII, child guidance clinics proliferated. Workers concluded that tensions in family were source of children's symptoms. Tended to blame parents, esp. mother.

David Levy - maternal overprotectiveness was chief cause of children's problems Frieda Fromm-Reichman - schizophrenogenic mother: domineering, agressive, rejecting women married passive men and produced schizophrenia in their children. This was a misdirection in the field, but by focusing on relationship between parents and children helped pave the way for family therapy.

Tavistock Clinic, 1949. Began doing conjoint sessions as a useful catalyst/supplement to individual psychotherapy.

Family therapy as primary treatment.

Studied nature of communication and schizophrenic communication in early 1950s.

Bateson, Haley, Weakland, Jackson hypothesized that family stability is achieved by feedback that regulates members' behavior. What a family system is disturbed, it endeavors to maintain stability. Symptomatic behavior can serve cybernetic function of preserving equilibrium.

Bateson, Haley, Weakland, Jackson Schizophrenics were an extension of disturbed family environment: double bind is a contradictory message

jumped to incorrect conclusion, families were blamed

input-output

All communication has overt content level (report) and metacommunication in the command (the covert message)

refuted notion that maternal rejection was key in schizophrenic families, focused instead on marital deficits: role reciprocity (balance is important to be an effective pair)

marital schism: husbands and wives undermine each other and compete openly for their children's affection, combative marital skew: involves serious character flaws in one partner who dominates the other. Thus one parent becomes passive and dependent while the other appears to be a strong parent figure, but is in fact a pathological bully.

studied schizophrenic families in the 1950s

Facade if harmony; so much togetherness that there's no room for separate identities, undermines intimacy, masks deeper conflict, distorts communication and impairs rationality (Wynne) rubber fence, communication deviance - thought disorder: disordered communication is a distinguishing characteristic of families with young adult schizophrenics

Acrimonious but superficial split that stifles autonomy; undermines intimacy, masks deeper conflict, distorts communication and impairs rationality (Wynne)

Invisible barrier that stretches only so far to permit limited extra familial contact, isolation protects rigid family structure; those who most need outside influence are not allowed it-->schizophrenic family maintains its own sick society (Wynne)

Disordered communication distinguishes families with young adult schizophrenics, communication as observable vehicle for transmitting thought disorder (Wynne studied over 600 schizophrenic families by the late '70s)

expanded thinking about families beyond communication into social roles within families Spiegel: individuals are not cogs in a machine, system in therapy includes therapist (second-order cybernetics). Distinction between interactions (participants do not change) and transactions (participants do change. R. D. Laing: helped popularize the family's role in psychopathology, borrowed Karl Marx's concept of mystification (class exploitation) and applied it to the "politics of families." Mystification means distorting someone's experience by denying or relabeling it. An example of this is a parent telling a child who's feeling sad, "You must be tired" (go to bed and leave me alone). Mystification distorts feelings and reality, this produces a lack of authenticity, but when the real self/false self split is carried to extremes, the result is madness (Laing, 1960).

first ones established in 1930s in LA, NYC, Philadelphia

in the 1930s, some psychoanalysts broke with tradition and conjointly counseled couples. Bela Mittleman in NY (1940w and 50s) suggested that husbands and wives could be treated by the same analyst and that by seeing both it was possible to reexamine their irrational perceptions of each other. This was a revolutionary notion: that the reality of object relationships might be at least as important as their intrapsychic representations. Described complementary marital patterns, including aggressive/submissive and detached/demanding, courting couples see each other's personalities through the eyes of their illusions: She sees his detachment as strength; he sees her dependency as adoration.

object relations were the central concern of psychoanalysts, Henry Dicks and Michael and Enid Balint did marital counseling

1950s: Don Jackson and Jay Haley were exploring marital therapy within the framework of communications analysis. field of marital therapy was absorbed into the larger family therapy movement.

many of the influential approaches to couples therapy came before their family therapy counterparts: cognitive-behavioral marital therapy, object relations marital therapy, and emotionally focused couples therapy.

began seeing families early, 1951, based on group therapy (family group therapy), treatment in three phases: child-centered, parent-centered, family-centered.

multiple family group therapy (Pete Laqueur) still occasionally used in hospital settings multiple impact therapy (Robert MacGregor in Texas) network therapy (Speck and Attneave) assembles entire social network

Don Jackson (Palo Alto) developed idea based on analysis of communication. Families as units that resist change became the defining metaphor of family therapy's early years. Overestimated the conservative properties of families. Recognition that families resist change was enormously productive for under-standing what keeps patients from improving. Illustrated with examples of schizophrenics.

Complementary relationships (first articulated by Bateson) are those in which partners are different in ways that fit together, like pieces of a jigsaw puzzle: If one is logical, the other is emotional; if one is weak, the other is strong. Symmetrical relationships are based on simi-larity. Marriages between two people who both have careers and share housekeeping chores are symmetrical. Jackson's (1965) family rules hypothesis was based on the observation that within any committed unit (dyad, triad, or larger group), there are redundant behavior patterns. Rules can describe regularity, rather than regulation. A corollary of the rules hypothesis was that family members use only a fraction of the full range of behavior available to them. Jackson's therapeutic strategies were based on the premise that psychiatric problems resulted from the way people behave with each other. In order to distinguish functional interactions from those that were problem maintaining, he observed when problems occurred and in what context, who was present, and how people responded to the prob- lem. Jackson would wonder out loud how a family might be worse off if the problem got solved. An individual might want to get better, but the family may need someone to play the sick role. Even positive change can be a threat to the defensive order of things. some family therapists jumped from the observation that symptoms may serve a purpose to the assumption that some families need a sick member, which, in turn, led to a view of parents victimizing scapegoated children.

every message is qualified by a different message on another level

covert messages are used in the struggle for control that characterizes many relationships. Symptoms represent an incongruence between levels of communication. The symptomatic person does something, such as touching a doorknob six times before turning it, while at the same time denying that he's really doing it. Since symptomatic behavior wasn't reasonable, Haley didn't reason with patients to help them. therapy became a strategic game of cat and mouse. Haley (1963) defined his therapy as a directive form of treatment. In what he called brief therapy, Haley zeroed in on the context and possible function of a patient's symp- toms. His first moves were designed to gain control of the therapeutic relationship. The decisive technique in brief therapy was the use of directives.

role theory: saw troubled family members as trapped in narrow roles, such as victim, placator, defiant one, or rescuer, that constrained relationships and sapped self-esteem. her major focus was always on the individual. Thus, Satir was a humanizing force in the early days of family therapy, when others were so enamored of the systems metaphor that they neglected the emotional life of families.

Menninger Clinic in 1940s, where he studied mothers and their schizophrenic children. mother-child symbiosis led to his concept of differentiation of self (autonomy and levelheadedness). From Menninger, Bowen moved to NIMH, where he developed a program to hospitalize whole families with schizophrenic members. This project expanded the focus on mother-child symbiosis to include the role of fathers and led to the concept of triangles (diverting conflict between two people by involving a third). Beginning in 1955, when Bowen started bringing family members together to discuss their problems, he was struck by their emotional reactivity. Feelings overwhelmed reason. Bowen felt families' tendency to pull him into the center of this undifferentiated family ego mass, and he had to make a concerted effort to remain objective. The ability to remain neutral and attentive to the process, rather than the content, of family discussions is what distinguishes a therapist from a participant in a family's drama. He found that it was easier for family members to avoid becoming reactive when they spoke to the therapist instead of to each other. Whenever two people are struggling with conflict they can't resolve, there is an automatic tendency to involve a third party. a triangle is the smallest stable unit of relationship. differentiation of self is best accomplished by developing personal relationships with as many members of the family as possible. Differentiating one's self from the family is completed when these relationships are maintained without becoming emotionally reactive or taking part in triangles.

focus on psychodynamic conflict, keen sense of the overall organization of families. Families are split into competing factions. similar to the psychoanalytic model of individuals Menninger Clinic and Child Guidance Clinic Unlike Bowlby, Ackerman did more than use these conjoint sessions as a temporary expedient; instead, he began to see the family as the basic unit of treatment. Ackerman was as concerned with what goes on inside people as with what goes on between them. He never lost sight of feelings, hopes, and desires. instead of conscious and unconscious issues, Ackerman talked about how families confront some issues while avoiding others, particularly those involving sex and aggression. He saw his job as bringing family secrets into the open. To encourage families to relax their emotional restraint, Ackerman himself was unrestrained, blunt, honest, believed neutrality was impossible

Ackerman organized at a meeting of the American Orthopsychiatric Association. Jackson, Bowen, Wynne, and Ackerman learned about each other's work and joined in a sense of common purpose.

psychologically troubled people are alienated from feeling and frozen into devitalized routines (Whitaker ; Malone, 1953). Whitaker turned up the heat. His "Psychotherapy of the Absurd" (Whitaker, 1975) was a blend of warm support and emotional goading, designed to loosen people up and help them get in touch with their experience in a deeper, more personal way. one of the first to experiment with family treatment. Tennessee, began to include spouses and children in treatment. Whitaker also pioneered the use of cotherapy, in the belief that a supportive partner helped free therapists to react without fear of countertransference. All of his interventions promoted flexibility. He didn't so much push families to change in a particular direction as he challenged them to open up—to become more fully themselves and more fully together. Emory University, where he continued to experiment with family treatment with a special interest in schizophrenics and their families. Organized a series of forums that led to the first major convention of the family therapy movement. Beginning in 1946 Whitaker and his colleagues began twice-yearly conferences In private practice, developed an experiential form of psychotherapy, using a number of provocative techniques

In 1957 he founded the Eastern Pennsylvania Psychiatric Institute in Philadelphia, where he attracted a James Framo and Geraldine Spark dedicated to openness and accountability. One of his most important contributions was to add ethical accountability to the usual therapeutic goals and techniques. neither pleasure nor expediency is a sufficient guide to human behavior. family members have to base their relationships on trust and loyalty

structural model early 1960s, discovered two patterns common to troubled families: Some are enmeshed— chaotic and tightly interconnected; others are disengaged—isolated and seemingly unrelated. Both lack clear lines of authority. Enmeshed parents are too entangled with their children to exercise leadership; disengaged parents are too distant to provide effective support. Family problems are tenacious and resistant to change because they're embedded in powerful but unseen structures. Once a social system such as a family becomes structured, attempts to change the rules constitute what family therapists call first-order change—change within a system that itself remains invariant. What's needed is second-order change—a change in the system itself. director of the Philadelphia Child Guidance Clinic in 1965. Minuchin brought Braulio Montalvo and Bernice Rosman with him, and they were joined in 1967 by Jay Haley. one of the great centers of the family therapy movement. In 1981 Minuchin moved to New York and established the Minuchin Center for the Family, where he pursued his dedication to teaching family therapists and writing influential books

Pragmatics of Human Communication, Palo Alto group, seminal text that introduced systemic family therapy

Minuchin, Philadelphia Child Guidance Clinic, structural, Families and Family Therapy

constructivism (Watslawick), importance of cognition in family life, reframing strategic therapy: Milton Erickson Change by Watzlawick, Weakland, and Fischl Problem-Solving Therapy by Jay Haley Paradox and Counterparadox by Mara Selvini Palazzoli and her Milan associates. pragmatic. Making use of the cybernetic metaphor, how family systems were regulated by negative feedback. They achieved results simply by disrupting the interactions that maintained symptoms. manipulative.

experiential, psychoanalytic, behavioral, and Bowenian