Transcript Foundation Concepts in Family Therapy

Foundation
Concepts in
Family
Therapy
Some of the Core concepts
covered in Chapters 1-4
EPSY 6393 with Dr.
Sparrow
Myths to be
shattered
• Health could be achieved only by leaving
home; the hero myth
• Freud: Effects of family were real, but
they were intrapsychic, and in the past
• Rogers: Self actualization could only be
pursued in isolation from the family’s
oppressive influence
Family therapy’s premises
• That the forces of change are located
external to us, in the family system
• That change in any member affects the
whole family – systems theory
Which approach is best?
• Individual therapy when the social
relationships are stable, and the person
is in distress
• Family therapy when the social
relationships are unstable, and the
person is in distress
Big concept: The Family is a
System
• The family system is more than a
collection of individuals
• It is an organic whole with its own
identity and dynamics
• Members function in the system
differently than they do in isolation
Circular Causality
• Based on the idea that we are in a constant
feedback loop with the persons in our lives. Also
referred to as “cybernetic loops,” or
“synchronous feedback.”
• Linear causal explanations try to find who is at
fault, or to blame.
• Circular causal explanations try to understand
what each person is doing that sustains the
problem, and what they can do differently to
change the situation.
Family Therapy is simpler
than you Think!
A Small Number of
systems dynamics
accounts for most family
distress,
so relax, you
can do it!
Dr. Sparrow says
Group Theory:
The Basis for Family Therapy
• Group theory provided a foundation for
understanding the family
• Lewin
• group is more than sum of parts
• interaction could be curative
• a focus on the here and now; ahistorical
• Groups are inherently tense as members vie
for freedom and services
• Process dimension became more important
than content: how, not what
How Groups differ from
Families
• Group members come to therapy to find a
sanctuary in which to discuss problems vs.
families bring their problems into the office
• Group members can be assured that what
they say in therapy won’t follow them home vs.
families have to live with the consequences of
their disclosures
• Groups are comprised of equals without a past
vs. families are comprised of unequal
members who have a past and future together
Early Misconceptions
• The mother-child bond was the source of
all problems, e.g. “schizophrenegenic”
mothers.
• Parents are always to blame, and
children have to be protected from them.
The First Family Therapists:
The Palo Alto Group
• Bateson’s work with communication in
schizophrenic families led to some of the
first important contributions the the field.
• rules
• Metacommunicaton (report and demand)
• double binds
• feedback, or cybernetics
• homeostasis (Jackson)
Negative and Positive Feedback
• When a family’s rules are challenged,
the family usually treats this challenge as
“negative feedback,” that is a reason to
reassert its rules
• Positive feedback is information that a
family perceives as a call to change its
rules.
Families Break down under
Stress
• Normal families need help when they
can’t adjust to stress
• Family rigidity, or a refusal to alter rules,
keeps a family from adjusting to change
• Life changes bring about
• developmental stressors
• environmental stressors
Big Concept:
Families resist change
• Homeostasis means that families resist
change
• Direct attempts to foster change will
evoke resistance
• Insight is unnecessary, and can even get
in the way.
• Therapist must take an indirect approach
in order to succeed
Relationships are Symmetrical or
Complementary
• Symmetrical relationships have a lot of
similarity and equality -- common
ground, comfortable
• Complementary relationships are based
on differences, opposite attraction -- not
much common group, very dynamic
• The pursuer-distancer dynamic grows
out of complementary roles
Triangles are a basic structure in
dysfunctional families
• Triangles form when a person seeks out
a substitute for relating to a person with
whom he has difficulties
• Cross-generational coalitions are a
triangle between two generations; that is
one parent joining with a child against
the other parent.
Palo Alto Brief Therapy
School
• Based on the idea that families resist
change
• Assumed that a direct approach would
only provoke resistance
• downplayed importance of insight; in
fact, considered insight to be an obstacle
at times
Milton Erickson’s influence
on Jay Haley
• Erickson mastered techniques for
circumventing resistance in hypnotic
subjects.
• Symptom prediction, symptom
prescription (paradoxical or strategic)
• Indirect methods
• Reframing
Bowen’s Systems Family
Therapy
• differentiation of self is central concept
• triangle is smallest stable unit of
relationship.
• cross generational transmission of
patterns; focused on the family of origin,
not the nuclear family
• genograms as a way of assessing
generational patterns
Whitaker and Satir: Experiential Family
therapy
• Existential-humanistic, person centered
• Believed that family members needed to
unlease their true feelings, and become
more honest with each other.
• Believed that humans were essentially
good, and just needed to be helped in
expressing the truth of who they are.
Minuchin’s Structural Family
Therapy
• boundaries; disengagement and
enmeshment
• hierarchies
• joining
• enactment
• restructuring
Origin of Family problems
• As already stated, families break down
when unable to adjust their rules to
accommodate new developments
• Family therapists are interested in what
was happening when the problem arose
• But more interested in what the family is
doing to perpetuate the problem
• The family’s “solution” is often the
problem -- the reassertion of old rules
Process is Everything
• As mentioned earlier, a therapist must
focus on what is going on between
members, not the specific problem
• If a therapist tries to solve the problem as
it’s defined, rather than looking at the way
the family sustains the problem through
their interaction, there will be no progress.
What you do depends on
Your style and theory
• Some therapists will openly point out the
problems in relating, in order to bring
about insight.
• Some therapists will actively manipulate
the family (move them around, get them
to interact, etc.) to bring about change in
the session, without worrying about
insight.
• Some will do both.
Major interventions
• Joining -- Minuchin
• Process Questions -- Bowen
• Genograms -- Bowen
• I position (to stop blaming) -- Bowen
• Reframing -- Haley, Minuchin
• Paradoxical interventions and
therapeutic double binds -- Haley
• Enactment and restructuring-- Minuchin
Session Objectives:
First session
• Joining: Making contact with each person.
Balance warmth and professionalism to
prevent induction.
• Assess problem from each person’s
perspective
• Explore specific problems and attempted
solutions: Use process questions to explore.
• Develop hypotheses about the interactions
that are sustaining the problem.
Early Phase Objectives
• Keep it simple. Focus on primary problems and the
dynamics perpetuating them.
• Formulate hypotheses around structure and
dynamics, not so much the personal or
intrapersonal aspects.
• Bring the problem into the office. Allow interaction
and support “enactments.”
• Reframe, challenge, and restructure the enacted
dynamics around new boundaries
• Assign homework that continues the new
relationship dynamics
Mid-Phase Objectives
• Foster responsibility; challenge the blame game
with process statements/questions, unbalancing,
and reframing
• Keep your efforts related to primary complaint, but
your interventions focused on interactive process.
• Use intensity to challenge members to
demonstrate their competencies
• Don’t splinter the family into subgroup work without
keeping the big picture in mind.
Termination
• A time for the family to evaluate its progress, and to
consolidate what they’ve learned.
• Do they get it?
• Are the benefits being seen elsewhere?
(generalization of therapeutic gains)
•
Are they satisfied?
•
Can they do it on their own? Are relapses merely part of the
growth process, or are there problems that you still need to
address?
• Immunization strategies: preparation for relapse
Exceptions and Ethics Issues
Pertaining to Marital and Family
Work
• Child abuse
• Domestic violence
• Confidentiality, triangulation, attraction
Chapter Four:
Deepening Our Knowledge of
Systems
• Cybernetics revisted: Sequences of family
dynamics; negative and positive feedback
• Closed systems and open systems; therapist
role; living systems are open, and exhibit:
• equifinality
• morphogenesis -- tendency to seek change
Chapter Four:
Deepening Our Knowledge of
Systems
• Systems dynamics explains several
relationship problems that tend to get worse
without outside intervention:
• Controller/rebel
• Approacher/distancer
• Overfunctioning/underfunctioning
Chapter Four:
Deepening Our Knowledge of
Systems
Systems dynamics are revealed through
spontaneous sequences of behaviors.
These sequences tend to erupt early in the
family therapy sessions. By allowing them
to occur, you can see the problem in
action, and (depending on your approach)
can intervene to get the family to correct it.
challenge to Early Family therapy:
Social constructionism
• Relates to the age-old notion that knowledge
of the world is filtered through beliefs,
experience, and language, and relationships
• Reframing is a constructionistic technique:
co-creating reality
• Moves therapy into the cognitive realm, away
from focus on behavior.
• Minimizes the importance of the therapist as
an expert
Constructionism challenges
Prevailing “Truths”
• Cultural and gender assumptions vary
over time, so roles are changeable.
• Social “truths” become enshrined within
prevailing approaches to therapy
• “Deconstruction” of the socially
constructed narrative is essential.
• Collaboration is essential within a social
constructionist approach
Attachment Theory
• Is a way that family therapy has reintroduced
psychodynamic concepts into relational
events.
• Assumes that the basic human impulse is to
form secure bonds, or to seek closeness in the
face of stress.
• When the formation of secure bonds are
disrupted, a child reacts in two different ways.
• Resistance/clinging
• avoidance
Summary
• Context is more important than content, so it is
important to meet with the family to establish
the context of a person’s distress.
• People are complementary, and will
compensate for their partners’ style by going
the other direction. This creates a number of
“workable” problems.
• Families and couples are constantll engaged
in circular exchanges. Solutions have to take
this into account.
Summary
• Triangles account for much of a couple’s or a
family’s dysfuntion. Direct communication or
“detriangling” is the solution.
• Process is always more important than
content.
• Family structure determines how people
relate. (Boundaries are the key)
• Enmeshment
• Disengagement
Summary
• Symptoms can benefit a family by helping
members avoid other issues.
• Families pass through a predictable life cycle,
and face predictable challenges related to
each stage of developoment.
• Resistance is normal and healthy. Don’t fight
it, but create a trusting relationship with the
family and an environment that is comfortable.
Summary
• Family stories or narratives can help the
therapist understand how to intervene.
• Gender roles and assumptions play a huge
role in family distress.
• Culture and ethnicity –It is important to be
respectful of these factors, but it’s also
important to confront counterproductive beliefs
and values regardless of their source.