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Intergenerational Therapy

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Murray Bowen founded this field Useful for interpersonal relationships Used genograms often

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The Sexual Crucible Model

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Part of Bowen intergen therapy Integrates sex therapy and couples therapy

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Differentiation:

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Based on balance btwn need for togetherness and autonomy separate intrapersonal and interpersonal distress

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Intergen Therapy Process

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Observation is the form of intervention therapists: Emotional triangles Chronic anxiety Multigenerational patterns Sibling position (hierarchies)

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Goals of intergen therapy (Bowen)

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Increase each person's level of differentiation ( in specific contexts) Define for each client specifically which context differentiation is increasing Decrease emotional reactivity to chronic anxiety in the system As differentiation increases, anxiety decreases

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Overview of Experiential Therapy

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• Individual and family focus • Warmth, empathy, and therapist use of self • Problems caused by underlying emotional suppression • Emphasis on experiential activities in therapy room as a method of growth • Most systemic therapies assert that treating the system will create individual level change • An explicitly individual-level focus is counter to traditional systemic frameworks • Focuses on the emotional level of interactions more than the behavioral level

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Symbolic Experiential Therapy

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• Exemplifies authentic self through honest, uninhibited sharing of thoughts and emotions • Creates change through real, in-the-moment, authentic interactions with clients • Use of co-therapists • "Therapy of the Absurd", use of uncommon methods to challenge and perturb the system • Wanted to separate personal and interpersonal distress

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Who were the pioneers of experiential therapy?

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Satir (1st woman of MRI) and Whitaker

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Experiential therapy interventions

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• Therapeutic interventions include: sculpting, use of touch, parts party, family reconstruction, enacting, family life chronology, family roles, survival stances, etc

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Communication Stances

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• Created by Virginia Satir • Categories to explain the ways that people relate to the world and themselves • Has implications for relationship patterns and therapy techniques that work better for certain stances Placator

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Communication Stance: placador

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People pleasing tendencies, minimize reality of self and emphasize others and context

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Communication Stance: blamer

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Minimize others, and increases awareness of self and context, direct confrontation often strengthens the therapeutic relationship

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Communication Stance: supperreasonable

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Minimize the self and other, and emphasize context The goal when working with this stance is to help clients value the internal subjective realities of themselves and others

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Communication Stance: Irrelevant

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Minimize self, context, and other Progress is typically slower with this type of client

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Communication Stance: Congruent

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Respectfully balance the needs of self and others while appropriately acknowledging the context This is the goal of therapy

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Structural Therapy

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Salvador Munichin and Jay Haley

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Structural Boundaries

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Rules for managing physical and emotional distance

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Enmeshment and Diffuse Boundaries

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Overly involved Small fence, ankle height, easily movable

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Disengagement and Rigid Boundaries

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Overly distant Think about a brick wall, with only one door opening

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Enactments

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Occurs in three phases: Observation of spontaneous interactions Eliciting transactions between members Redirecting alternative transactions

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Benefits of Enactments include:

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* in the moment practice and experience w new interactions * therapist able to provide feedback in the moment * family aware problem doesn't belong to a single person * family becomes competent by successfully engaging in new preferred behaviors

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Three main phases of structural therapy

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join, map, and intervene

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Join (main phase in structural therapy)

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Accommodate to family style (build an alliance)

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Map (main phase in structural therapy)

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Assess the family structure, boundaries and hierarchy. Evaluate and assess what is working and what is not.

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Intervene (main phase in structural therapy)

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To transform the structure to diminish symptoms (address problems you identified in the assessment)

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1st session of structural therapy

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Begin therapy with the entire family to assess the system. After assessment, therapist may meet with specific subsystems (couple, child, individual, etc.) This is to set boundaries, build alliances and reinforce hierarchies

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Satir growth model (experiential therapy)

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• Intentional focus on self-esteem • Exemplifies authentic self through genuine expression of caring and concern for the client • Creates change through structured use of experiential exercises and modeling • Therapeutic interventions include: sculpting, use of touch, parts party, family reconstruction, enacting, family life chronology, family roles, survival stances, etc.

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Assessment/ observation of structural therapy

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Role of the "symptom" in the family Subsystems Cross-generational coalitions Boundaries Hierarchy Family life cycle development Strengths

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goals of structural therapy

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Clear boundaries between all subsystems allowing connectedness & differentiation within cultural contexts Clear distinction between the couple subsystem & parental subsystem Effective parental hierarchy Family structure promotes development and growth

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Structural interventions

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Enactments & modifying interactions (providing feedback in the moment) Boundary making Intensity and crisis induction Unbalancing Expanding family truths & realities Compliments & shaping competence

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PMTO model

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Based on Social Learning Theory (behavior not only biological but socially learned) Influences: Behaviorism, cognitive theory and structuralism

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PMTO process

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Parents identify problem behaviors Identify the opposite (positive) behaviors Shape behavior through feedback: Change the responses that maintain problem behavior (usually negative reinforcement) Create new responses that reinforce positive behaviors (positive feedback, incentives, and clear consequences) Build Realistic Expectations Reinforce parents as authority, create structure, and clear boundaries

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PMTO Limitations

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Does not usually address origins of behaviors Does not address attachment injuries between kids & parents Therapist maneuverability limited Some kids don't respond to behaviorism (not one-size-fits-all) Culturally biased Not well adapted for adolescents Not adapted for higher level of functioning Extrinsic motivation v. intrinsic

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PMTO Benefits

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Simple and straightforward Focus is positive, so it shifts relationship Results can be fast Families benefit from structure and consistent systems Model is kid-centered regarding trauma work

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Strategic Family Therapy

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Grew out of communications theory developed in the schizophrenia project (Bateson). Became 3 models

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3 models of strategic family therapy

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Evolved into three distinct models: MRI's brief therapy model Haley & Madanes strategic model Milan systemic model

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Theories of Strategic therapy

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Family rules: Not decided on overtly, families are generally unaware of them. Family homeostasis: Homeostatic mechanisms bring families back to equilibrium in the face of any disruption. Feedback loops: Focus on the interactions that perpetuate problems instead of the underlying causes. Positive feedback loops: Central to the Strategic model. What interactions exacerbate the problem? First order change vs. second order change. Reframing: Sharing another interpretation of the behavior

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Strategic Approach to Problems

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) Identify the positive feedback loops. 2) Determine the rules that support the interactions. 3) Find a way to change the rules/interaction in order to interrupt the problematic behavior.

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Therapist Role in Strategic

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Avoid authoritarian position as it can engage the therapist and client(s) into a power struggle. Take the one-down stance often. "Go slow" "Don't change too fast" Prescription of relapse

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Structured family intvw strategic therapy model

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Formal assessment was not typical, but Watzlawick introduced this format in the 60's. The therapists role was to observe the patterns utilizing one of these prompts: 1. Decide their main problem 2. Plan a family outing 3. Have the parents discuss how they met 4. Discuss the meaning of a proverb 5. Identify "faults" and place blame on the "correct person"

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MRI goals strategic therapy

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MRI therapists focus on the problems that families come in with, versus the whole picture. "People who have problems are stuck rather than sick, [the therapist's] job is to simply help them get moving again." The model is mainly behavioral: The ultimate goal of therapy is to change the behavior associated with the problem. behavior.

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Strategic therapy Haley treatment steps

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It is not tailored to specific steps, though believed it had to begin well to end well. Focused the initial phase on interviewing the entire family. Social stage (joining)--therapist acts as host engaging the whole family Problem stage--Defining problem Interaction stage--therapist observes family discuss problem with little involvement Goal setting stage--solving specific problems Haley loves directives! homework

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MRI Treatment Steps

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Introductions Define the problem Understand the attempted solutions Set goals for therapy Behavioral interventions until problem is resolved Termination

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Solution-Focused Therapy-Three Major Rules of the Model

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If it isn't broken, don't fix it. If it works, do more of it. If it is not working, do something different.

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Solution focused theory

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Small steps can lead to big changes. The future is both created and negotiable. A solution is not necessarily related to the problem. Solution language is different from problem language. Change is inevitable, problems do not happen all the time.

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Myths of SF therapy (4)

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1 Therapists give advice Clients identifies solutions and they assist client 2 They never talk about the problem spend less time on problems exception questions 3 They never talk about past they do talk about past strngths what works/doesnt 4 Emotions are not discussed in therapy they dont view the expression emotions as curative emotions are clues for what works and where to go

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SF Client Motivation: Visitors, Complainants, and Customers

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Visitors: usually brought to therapy by an outside other such as partner, parents, courts, etc Complainants: identify a problem but expect therapy or some other person to be the primary source of change Customers: identify a problem and want to take action towards the problem

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Solution focused intervention

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Ask about pre-session change. Clear, concrete and specific goals. Miracle question. Scaling questions. Constructing and paying attention to solutions and exceptions.

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SF Formula First Session Task

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Over the next week, I want you to pay attention to what you don't want to change. What do you want to keep the same?

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The Miracle Question

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What difference would you (& others) notice? What are the first things you notice? Has any of this ever happened before? Would it help to recreate any of these miracles? What would need to happen to do this?

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Five Useful Questions

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The Miracle (Magic Wand) Question Has anything been better since the last appointment? What's changed? What's better? Can you think of a time in the past (month / year / ever) that you did not have this problem? What would have to happen for that to occur more often? Scaling Questions 1 - 10 With all of that going on, how do you manage to cope?

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Exception Questions

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Amplifying the exception How do you explain to yourself why these times are different? How do you achieve that? What do you do differently then? Who else is involved that notices the difference? What do they say or do? What else? What would you have to do or see for this to happen more often? What else?

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Summary of SFT:

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Builds on client resources, skills and abilities. Has a present and future orientation, building goal picture. Focus on previous or formulated solutions and exceptions to problems. Encourages clients to do more of what works. Simple but not easy, takes skill to become proficient.

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