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The Family

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"A family is a system in which members organize into a group, forming a whole that transcends the sum of its individual parts."

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Individual Therapist

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• Focus on obtaining an accurate diagnosis • Begin with client immediately • Focus on causes, purposes, and cognitive, emotional, and behavioral process involved with symptoms • Be concerned with client's individual concerns

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Systemic Therapist

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Explore the system for family process and rules, perhaps using a genogram • Invite client's mother, father and siblings • Focus on family relationships within which affect the symptoms • Be concerned with transgenerational meanings, rules, cultural, and gender perspectives within the system • Intervene in ways designed to help change Clients's context

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Basic Family Therapy Concepts

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•Family Structure •Family Processes - changes, adapts •Organization - around relationships •Wholeness - greater than parts •Cybernetic Epistemology

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Cybernetic Epistemology

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•Family therapists prefer circular causality vs. linear, interacting loops - never ending cycle •Focus on family homeostasis •Family receives both positive and negative feedback - promoting homeostasis or promoting change

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The Family Systems Perspective: Individuals

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are best understood through assessing the interactions within an entire family

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The Family Systems Perspective: Symptoms

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are viewed as an expression of a dysfunction within a family

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The Family Systems Perspective: Problematic Behaviors

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• Serve a purpose for the family • Are a function of the family's inability to operate productively • Are symptomatic patterns handed down across generations

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The Family Systems Perspective: Family

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is an interactional unit and a change in one member effects all members

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Open Systems

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• Allow new information in • Preferable to closed ones • Allows situations to be seen from different perspectives

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Closed Systems

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• Have varying degrees of inner circles • Those outside the system completely are viewed as having nothing to contribute (e.g. they wouldn't understand the "way we do things")

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Structure

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• Hierarchy • Structure and roles • Helps maintain homeostasis

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Transactional Communication

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• P-A-C • Type of communication effects structure and homeostasis

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Strategic

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Jay Haley

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Structural

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Salvador Minuchin

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Experiential

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Carl Whitaker

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Adlerian

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Alfred Adler

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Multigenerational

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Murray Brown

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Human Validation Model

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Virginal Satir

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Adlerian Family Therapy

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•Basic assumption is that both parents and children become locked in repetitive, negative interactions based on mistaken goals that motivate the members. •Adlerians use an educational model to counsel families •Emphasis is on family atmosphere and family constellation •Therapists function as collaborators who seek to join the family •Parent interviews yield hunches about the purposes underlying children's misbehavior

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Adlerian Family Therapy Treatment Goals

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•Unlock mistaken goals and interactional patterns • Interactional patterns • An example of mistaken goal ...what happens when you leave for college in terms of mistaken goals of you and your parents? •Engage parents in a learning experience and a collaborative assessment •Emphasis is on the family's motivational patterns •Main aim is to initiate a reorientation of the family

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Key questions of Adlerian - Teleological Lens The end results helps in understanding motivation

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• What purpose does this symptom, interaction or process serve? • How does the individual's behavior protect the self and the family system. • What are the social consequences of an action or interaction? • Do the goals of family members appear to be at cross-purposes, but still serve to maintain the system • Are the goals of the family at odds with the goals of therapy? • Example - a child acting out, becoming the scapegoat, to keep parent's together, or to distract from a more painful feature of the family

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Adlerian Theory: There are levels of sequences

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Father confronts daughter Daughter enacts hurt and helplessness Mother rescues daughter

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Multigenerational Family Therapy -Bowen

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Multigenerational Family Therapy -Bowen •One cannot manage present family dynamics without understanding the dynamics in the family of origin •The application of rational thinking to emotionally saturated systems •A well-articulated theory is considered to be essential •With the proper knowledge the individual can change •Change occurs only with other family members •Differentiation of the self •A psychological separation from others but maintain a relationship. Do others still "push your buttons"? •Triangulation •A third party is recruited to reduce anxiety and stabilize a couples'relationship, a two-against-one experience

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Triangulation

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•Occurs when a third person is brought into a dyadic relationship to de-intensify a dispute between two people (generally the parents) •Communication occurs through a third person •The third person often hears negative comments about the individuals involved in the dispute •When triangulation occurs, two people need to be communicating directly, but enmesh a third person so as to avoid any direct communication

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Multigenerational Family Therapy Treatment Goals

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To change the individuals within the context of the system •To end generation-to-generation transmission of problems by resolving emotional attachments, marginalization •To lessen anxiety and relieve symptoms •To increase the individual member's level of differentiation

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Human Validation Process Model - Satir

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•Enhancement and validation of self-esteem •Family rules •Congruence and openness in communications •Sculpting •Nurturing triads •Family mapping and chronologies

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Human Validation Process Model Therapy Goals

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• Open communications • Individuals are allowed to honestly report their perceptions. 4 communication strategies used to manage stress in the family system: • Blaming - shift responsibility to preserve self • Placating - agreeing just to decrease tension • Super reasonable - intellectual, non-emotional • Irrelevance - distracting • Deal with these by being emotionally congruent - openly talking about feelings, accepting responsibility when appropriate, speak for self, stay grounded • What does your family do under stress? • Enhancement of self-esteem • Family decisions are based on individual needs • Encouragement of growth • Differences are acknowledged and seen as opportunities for growth • Transform extreme rules into useful and functional rules • Families have many spoken and unspoken rules

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Experiential Family Therapy - Whitaker

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•A freewheeling, intuitive, sometimes outrageous approach aiming to: • Unmask pretense, create new meaning, and liberate family members to be themselves •Techniques are secondary to the therapeutic relationship •Pragmatic and atheoretical •Interventions create turmoil and intensify what is going on here and now in the family

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Experiential Family Therapy Treatment Goals

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•Facilitate individual autonomy and a sense of belonging in the family •Help individuals achieve more intimacy by increasing their awareness and their experiencing •Encourage members to be themselves by freely expressing what they are thinking and feeling •Support spontaneity, creativity, the ability to play, and the willingness to be "crazy" •Break out of structured roles that have been limiting, in doing so a certain degree of resistance will be demonstrated because of the disruption in homeostasis

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STRUCTURAL FAMILY THERAPY KEY CONCEPTS Family Structure

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• Invisible set of functional demands that organizes the ways in which family members interact • It operates through transactional patterns

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STRUCTURAL FAMILY THERAPY KEY CONCEPTS Transactional Patterns

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• Repeated transactions establish patterns of how, when and to whom to relate

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STRUCTURAL FAMILY THERAPY KEY CONCEPTS Boundaries

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• Rules defining in a system who participates, how and when • Determines the system's sub-systems (i.e. each family structure) • Continuum ranges from diffuse ('enmeshment') to rigid ('dis- engagement')

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STRUCTURAL FAMILY THERAPY KEY CONCEPTS Subsystem

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• Individuals belong to different subsystems, with different levels of power and skills • 3 - spousal, parental, and sibling

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STRUCTURAL FAMILY THERAPY KEY CONCEPTS Dysfunction

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• A deviation from the healthy or normal

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STRUCTURAL FAMILY THERAPY KEY CONCEPTS Dysfunction occurs when one of the following occurs

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• Rigid, diffuse or unclear boundaries Coalitions formed against third party • Coalitions cross generational boundaries • Denied or concealed coalition

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STRUCTURAL FAMILY THERAPY KEY CONCEPTS Adaptation

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Developmental changes within a family requiring alteration of boundaries • When adaptation does not occur it results in dysfunction

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Structural Family Therapy

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•Focus is on family interactions to understand the structure, or organization of the family •Symptoms are a by-product of structural failings •Structural changes must occur in a family before an individual's symptoms can be reduced •Techniques are active, directive, and well thought-out

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Structural Family Therapy Treatment Goals

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•Reduce symptoms of dysfunction •Bring about structural change by: • Modifying the family's transactional rules • Developing more appropriate boundaries • Creation of an effective hierarchical structure •It is assumed that faulty family structures have: • Boundaries that are rigid or diffuse • Subsystems that have inappropriate tasks and functions

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Strategic Family Therapy

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•Focuses on solving problems in the present •Presenting problems are accepted as "real"and not a symptom of system dysfunction •Therapy is brief, process-focused, and solution-oriented •The therapist designs strategies for change •Change results when the family follows the therapist's directions & change transactions

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Strategic Family Therapy Treatment Goals

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•Resolve presenting problems by focusing on behavioral sequences •Get people to behave differently •Shift the family organization so that the presenting problem is no longer functional •Move the family toward the appropriate stage of family development •Problems often arise during the transition from one developmental stage to the next

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Bateson Described the Double-bind relationship

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•Communication which leads to mixed messages •Repetitiveness leads to a unique learning experience in which the messages recipient cannot escape and cannot comment •Example? •We are always in a financial mess because you don't earn enough money •I need you home more because I need help with the children

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Mystification

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•Process that occurs when one or more family members fail to understand the meaning and or purpose of communication from another member, esp. a parent •The communication received is often deliberately vague •The vague communication places the mystified person in an inferior position and leads to powerlessness. •W - "Why are you angry?" •H - "I'm not angry. Where do you dream up these things"

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The Elephant in the Room

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•The problem that no one wants/dares to talk about •Problem is clearly visible to all involved •Fear of retaliation or negative consequences and shame often keep individuals from discussing the problem •Self blame is common •Enablers continue to allow the problem to exist and not be discussed (e.g. alcoholism, sexual abuse)

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Lack of Differentiation

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•Autonomy is important for all individuals •Autonomy represents the degree of independence that an individual needs to function apart from others in a system •Fusion is the absence of differentiation •Lack of differentiation leads to enmeshment with others

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Scapegoating

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•Families often scapegoat one individual for all of the family's problems •The person scapegoated may have difficulties but is unduly blamed •they may be displaying the symptoms of an unhealthy family environment or have a bona fide illness •Lesser forms of scapegoating occur when every failure or conflict is pinned to an individual •Scapegoating rarely takes into consideration any other factors

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Family Rules

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•A family is a rule-governed system in which the interactions of its members follow organized, established patterns. •Everyone has prescribed rules for boundaries of permissible behavior. •These rules serve to stabilize the system. •Dysfunction can be due to a family's lack of rules for accommodating to changing conditions.

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Lack of Boundaries

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•All individuals need boundaries •The absence of boundaries produces unclear limits in terms of what others may or may not say or do to a person •Without boundaries abuse can easily occur •Families often have no boundaries in some areas and overly rigid boundaries in others •Without boundaries humans are unable to emotionally relate to others or set reasonable limits on others

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Basic premise of psychotherapy process

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The goals of family therapy are to change maladaptive or dysfunctional family interactive patterns and/or to help clients construct alternative views about themselves that offer new options and possibilities.

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Mechanisms for Psychotherapy Structural Change - Minuchin

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• The family may not have modified its rules to effectively cope with the demands of the situation (i.e. a move) • Help them modify unworkable patterns creates opportunity to adopt new rules with more flexible boundaries. (enactment)

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Mechanisms for Psychotherapy Behavioral Change - Milan

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• Focus on the here and now behavior patterns and not the underlying causes • Paradoxical exercises to point out maladaptive behaviors, an outdated or rigid family rule. (double-bind)

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Mechanisms for Psychotherapy Experiential Change - Whitaker, Satir

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• The need to feel and experience what was previously "locked up." • Helping the client to give voice to the underlying emotions (fear of rejection) instead of the displayed defensive emotions (anger or blaming when afraid). (sculpting)

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Mechanisms for Psychotherapy Cognitive Change

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• Provide the family with insight and understanding. • Narrative Therapists have conversations about beliefs, values, and purpose so they can be more open to possibilities. (reframing, miracle question)

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STRUCTURAL FAMILY THERAPY (THERAPEUTIC TECHNIQUES)

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Goal is to restructure the family system to create clear and flexible boundaries

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STRUCTURAL FAMILY THERAPY (THERAPEUTIC TECHNIQUES) Joining

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Therapist utilizes family's language and styles of communication to form a partnership in a non-judgmental manner

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STRUCTURAL FAMILY THERAPY (THERAPEUTIC TECHNIQUES) Focusing

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Exploring specific areas

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STRUCTURAL FAMILY THERAPY THERAPEUTIC TECHNIQUES Enactment

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Therapist has family enact an interaction to enable the family to try different ways of interacting

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STRUCTURAL FAMILY THERAPY THERAPEUTIC TECHNIQUES Intensification

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Therapist increases emotional aspects of interactions by a variety of means

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STRUCTURAL FAMILY THERAPY THERAPEUTIC TECHNIQUES Unbalancing

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Conscious attempt to form coalition with one member against another or supporting one member at the expense of another to throw the family system off balance

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MILAN SYSTEMIC FAMILY THERAPY Key Concepts Neutrality

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Therapist is an observer and remains neutral

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MILAN SYSTEMIC FAMILY THERAPY Key Concepts Hypothesizing

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Therapist makes EDUCATED GUESSES about the patient's symptoms and context in which they occur

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MILAN SYSTEMIC FAMILY THERAPY Key Concepts Circular questioning designed to elicit differences

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• What is the symptom that the patient presents? What is it there for? What function might it serve? • What is the context of the symptom, i.e. what is happening when the symptom occurs? • Why now? Why this symptom?? Who can make it better, who makes it worse? • Who is affected by the symptom and in what way? How does the symptom affect the family and how does the family (and others) react?

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MILAN SYSTEMIC FAMILY THERAPY Stages of Treatment: Beginning

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• The entire family for first session • Subsequent ones, small children may be exempt due to behavior management. • Establish contact then obtain history..genogram • Negotiate what the problem is that they want to address...join the family in this process

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MILAN SYSTEMIC FAMILY THERAPY Stages of Treatment: Middle

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• Redefine the presenting problem • Help them to see that the identified patient is not the focus but rather a relationship problem to be viewed in the family context • The family is the patient

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MILAN SYSTEMIC FAMILY THERAPY Stages of Treatment: Final

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• They have learned more effective coping skills and better ways to ask for what they want from each other. • Disengagement is easier due to internal support system

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