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Ch. 14 Family Therapy

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Nathan Ackerman
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The Initiator of family therapy. Trained in psychoanalysis. Aware of conscious as well as unconscious issues within the individual and the family. Facial expression, posture and seating arrangements were used as ways to assess family problems.
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Lynn Wynne
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Researcher. Found in families with children who have schizophrenia, there was often a conflict between the child’s need to develop a separate identity and to maintain intimate relationships with troubled or emotional family members. Thus, the interaction between individuals, not the person’s own psychological functioning, seem to have a role in the development of schizophrenia.
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General Systems Theory
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A family cannot be understood without knowing how the family functions as a whole unit. Each family is also part of a larger system, a neighborhood, and so on..If any part of the system changes the whole system reflects that change.
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Bowen’s Intergenerational approach
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Worked with parents of children with schizophrenia and their families. His approach emphasized the family’s emotional system and the history of this system as it may be traced through the family dynmaics of the parents’ families and even grand parents’ families. He was interested in how families projected their own emotionality onto a particular person.
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Theory of Family Systems
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Bowen’s theory is based on the individual’s ability to differentiate his own intellectual functioning from feelings. This concept is applied to family processes and the ways that individuals project their own stresses onto other family members. Families can pass this on over several generations.
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Differentiation of self
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Being able to differentiate ones’ intellectual processes from ones’s feeling processes represents a clear differentiation of self. A person who is highly differentiated is well aware of her opinions and has a sense of self, able to stand up for themselves, not dominated by emotions. Those who aren’t differentiated have thoughts and emotions that are fused
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Fusion/Pseudoself
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When thoughts and feelings are not distinct, fusion occurs. A person whose feelings and thoughts are fused may express a pseudoself rather than their true values or opinions.
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Triangulation
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When there is stress between two people in a family, they may bring another member in to dilute the anxiety or tension. Usually the least differentiated person is likely to be drawn in to the the conflict.
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Nuclear family emotional systems
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likely to be unstable if the members aren’t each well differentiated.
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Family Projection Process
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When there are relatively low levels of differentiation in the marriage, partners may project their stress onto one child. The child most emotionally attached to the parents may have the least differentiation between feelings and intellect.
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Emotional Cutoff
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When children receive too much stress because of over-involvement in the family, they may try to separate themselves from the family through emotional cutoff. example: child going to their room to get away from family conflict
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Multi-generational Transmission Process
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In his approach to work with families Bowen looked not just at the immediate family but also previous generations.
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Sibling Position
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Bowen believed that birth order had an impact on the functioning of children within the family. Relying on the work of Toman, eh believe that the sibling position of marriage partners would affect how they perform as parents. (less to do w/ birth order and more on how the child functions in the family – will influence the type of role they’ll assume as a parent.
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Societal Regression
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Bowen extended his model of family systems to societal functioning. Just as families can move toward undifferentiation or toward individuation, so can societies. (examples of stresses on societies that lead to undifferentiation: famine, civil uprisings, etc.
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Family Therapy Goals
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Bowen was interested in the impact of past generations on present family functioning. He set goals in working with families, he listened to the symptoms and dynamics sought to help families with stress levels and differentiation and meeting individual and family needs.
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Bowen’s Techniques of Family Therapy
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Evaluation Interview, followed by therapeutic intervention. In the evaluation: a family history is taken in to consideration, relationships within the family, sibling position. Genograms may be completed to get an accurate picture of family history.
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Genogram (Bowen)
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a method of diagramming families; includes significant information about families: sex, age, marriage dates, deaths and geographical locations. Can show patterns of differentiation.
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Detriangulation
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When possible Bowen tried to separate parts of a triangle directly. Goals to decrease anxiety and resolve symptoms, usually worked with the strongest most differentiated person in the family to help initiate change.
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Structural Family Therapy
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Salvador (Sal) Minuchin: How families operate as a system and their structure within the system are the focus of his work. Of particular interest: boundaries, organization and rules and guidelines that the family members use to make decisions.
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Family Subsystems
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For a family to function well, members must work together to carry out functions. Husband-wife subsystem is the meet the changing needs of the two partners. The parental subsystem is usually a father-mother team. The Sibling subsystem may develop coalitions to meet their own needs as well as deal with parents.
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Boundary Permeability
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Both systems and subsystems have rules as to who can participate in interactions and how they can participate. A highly permeable boundary would be found in emeshed families whereas nonpermeable or rigid boundaries would be found in disengaged families.
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Alignments and Coalitions
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Alignments deals with the ways family join or oppose each other in dealing with an activity or crisis. Coalitions refer to alliances between family members against other family members.
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Goals of Structural Family Therapy
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By making hypotheses about the structure of the family and the nature of the problem, structural family therapists can set goals for change. Therapists try to alter coalitions and alignments to bring about change and establish boundaries within the family that are neither too rigid or flexible. They help the family use power in a way that functions well.
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Techniques of Structural Therapy
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Join with the family in current and present happenings, sometimes use “maps” that describe boundaries and subsystems, as they have an impact on the family. Therapist can observe interactions and suggest power structure changes and boundaries. They bring about change by increasing the intensity of interventions and reframing the problems.
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Family Mapping in Structural Therapy (Minuchin)
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Minuchin uses diagrams to describe current ways that families relate. (example different dashed and solid lines representing types of boundaries.) Helps to see which subsystems contribute most actively to a problem. Maps of family interaction allow therapists to better understand repeated dysfunctional behavior so strategies of modification can be applied.
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Accommodating and joining
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Minuchin believes it is important to “join” the family system to enact change. The therefore tries to “fit in” and mimesis: refers to imitating the style and content of a family’s communications. (mimic body language, listen for vocabulary that defines the family relationships, “open book” example.)
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Enactment
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Therapist instructs family to act out an argument to observe how they deal with problems as they appear.
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Intensity
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Repeating a message, changing the length of time of a particular interaction or performing another action, change can be facilitated.
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Changing boundaries
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boundary marking to note boundaries in the family. To change boundaries, therapists may rearrange the seating of the family members and change the distance between them. They may unbalance the structure so power within a subsystem changes. (ex. powerless parents, therapist may side with them against the overly powerful child).
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Reframing
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The therapist may wish to give a different explanation so that constructive change can occur in a family situation. (example anorexia as stubbornness not illness…)
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Strategic Family Therapy Goals
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Clients are asked what they want to accomplish but the therapist ultimately decides the goal. The goals are concrete and specific with sufficient information to plan strategies and reach goals.
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Techniques in Strategic Family Therapy
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Tasks to alleviate presenting problem is central. Having family members complete tasks is important. Straight forward tasks: simple advice for ways members interact.
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Straightforward Tasks
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Easy to accomplish, clearly explained and fit the ability of the children and adults who will complete them. Sometimes metaphorical tasks are prescribed to bring meaning to larger more painful complex issues.
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Paradoxical Tasks
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Therapist is suggesting the family continue the behavior they are seeking help for, used if the family resists straightforward suggestions.
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Experiential Therapy of Carl Whitaker
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intuitive approach to therapy. interpersonal growth is the goal. His approach used countertransference (his own reactions to clients). For Intuitive approaches to family therapy, listened for impulses and symbols of unconscious behavior.
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Humanistic Family Therapy Approach (Satire)
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This type or Family Therapy focused on developing a sense of strength and self-worth and bringing flexibility into family situations to initiate change. Effective communication was key. Five styles of relating within the family: The placater, (weak an tenative, always agreeing), the blamer, finding fault with others, the superreasonable, detached, calm and unemotional, the irrelevant, distracting other and not relating, and the congruent communicator: geniuinely expressive, real and open.Based on Intuitive reactions and then interventions that lead to healthier family functioning.
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Integrative Approaches to Family Systems Therapy
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Most family therapists employ more than one theory of practice. There is a greater emphasis on concepts as opposed to theories.
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Psychoanalysis applied to Family Therapy
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Influenced by Nathan Ackerman’s work (ego and drive theory combined with an active approach to therapy). This type of family therapy theory, incorporates the use of Object-Relations to make observations about the nurturing or caring that family member provide for each other. Attend to attachment/separation from the parent. Past behavior explains resistance.
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Adlerian Therapy applied to Family Therapy
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This type of family therapy theory takes an educational point-of-view. Families are taught to resolve conflicts by developing mutual respect for each other. Practical approach.
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Existential Therapy applied to Family Therapy
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This type of Family Thearpy/Theory focuses not only on the relationship between individuals, but also on the awareness that individuals have of themselves and their own being in the world.
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Person-Centered Therapy applied to Family Therapy
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In this type of Family therapy empathy is central. Therapist tries to understand, at the deepest possible level, the conflict between the family members.
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Gestalt as applied to Family Therapy
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This theory of Family thearpy observes individuals in the family and how they cause boundary disturbances for each other. The focus is very much on the present. Therapists help the individuals in the family to become aware of patterns of interactions, their own needs and those of family member. Focus on sensations, listening, watching or touching to achieve awareness of boundaries so that appropriate separation and integration can be achieved.
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Behavior Therapy applied to Family Therapy
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This theory of Family thereapy focuses on behavior and experimental methods are used to change behavior. Baseline established of child’s behavior they wish to change. Then parents try behavioral techniques taught by the therapist.
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Relational Emotive Behavior Family Therapy (REBT)
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Goal of this therapy is to help family members see that they disturb themselves by their irrational beliefs. By learning about these beliefs, they can give them up. ABCDE Therapeutic approach is used. (Ellis) Each family member is responsible for his or her own actions and assume that responsibility.
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Cognitive Therapy applied to Family Therapy
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Education is central in this type of family therapy. Automatic thoughts and cognitive schemas of individuals are attended to so therapists can make interventions. Suggest distorted beliefs. ex. mind-reading.
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Reality Therapy applied to Family Therapy
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William Glasser’s approach to family therapy observed the choice systems of different family members and how they interact and connect with each other. Shared feelings, wants and values of each family member are considered. Suggestions are made to focus on doing things together to promote family harmony, but also on individual needs being met.
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Feminist Therapy applied to Family Therapy
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This type of family therapy helps take a look at political and social factors that provide insight into how family members react to each other. Focus is on how gender and power issues affect clients. Cultural and racial identity also considered.
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Brief Family Systems Therapy
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This theory of family therapy attempts to make interventions in a short period of time. The approach is practical, clear method and related to the presenting problem. Immediate and Lasting change is a goal in the family system, second order change.
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Mental Research Institute Brief Family Therapy (MRI)
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This type of family therapy was based on the work of Gregory Bateson, Don Jackson, Jay Haley, Milton Erickson and emphasizes resolving problems and relieving symptoms as well as working on the relationships within the family. Fewer than 10 sessions, structured approach to problem resolution. (doesn’t use Minuchin’s concepts of power and hierarchy) Use of complementary relationships and symmetrical relationships.
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Complementary relationships
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Term used in MRI Family Therapy to mean one person is superior whiel the other is inferior or submissive.
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Symmetrical Relationships
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Term used in MRI Family Therapy to mean that there is equality between partners.
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Long Brief Therapy of Milan Associates
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MRI Theorists devised this type of Family therapy theory, which is based on Haley’s strategic model. Solution-focused and narrative therapy techniques are used. About 10 sessions but meets monthly for a few hours with the family rather than weekly. ci
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Psychoeducational Approach to Family Therapy
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This approach to family therapy was created by Anderson, Reiss and Hogarty and takes what would appear to be a more traditional approach to support and educate the family to deal with a schizophrenic patient, by doing a one day workshop with the family. Programs that teach coping skills and communication skills have been developed to teach families how to communicate, solve problems or negotiate conflicts more effectively. Used in minority communities, increasingly.
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Professional Training & Organizations in the field of family therapy
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As the field of family therapy has grown, so has the need to set standards for training and practice. The AAMFT serves as a credentialing body for the field fo family therapy.
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Family Law
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Knowledge of the legal system as it relates to families can be extremely important for family therapists. Confidentiality, child abuse laws and dealing with dangerous clients make family therapists vulnerable to malpractice suits. Sometimes called to give expert testimony in divorce cases or visitation disputes.
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Medicine
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Increasing move to see the “root of the problem” as chemical imbalance. The trend for patients to be prescribed medicine for deviance has increased.