Transcript Trauma Bonds Re-enactment

Family-System Therapy
Theories and Practices
An Introduction
Copyright © 1997-2002 Melvin W. Wong, Ph.D. All Rights Reserved
Melvin W. Wong, Ph.D.
黃偉康博士
Licensed Clinical Psychologist
ChristianMentalHealth.com
220 Montgomery St., Suite 1098, San Francisco, CA 94104
1357 Mowry Avenue, Fremont, CA 94538
Tel (510) 794-8898
Fax (510) 475-1473
Course Requirements
Class Attendance & Finish the Reader
Each student is expected to complete
one paper assignments
A written report (about 10 pages) to be
submitted to the office, entitled:
“If I were a master Family
Systems Theorist”
“If I were a master Family
Systems Theorist”
When you become a master family systems theorist,
how would you describe your system theory?
 Include your use of common terms: enmeshment,
triangulation, etc.
 Include any new terms that you have invented?
 What about the relationship between husband & wife?
 What are your constructs?
 How do you do assessments?
 What are your therapy goals?
 How do you do interventions?
“If I were a master Family
Systems Theorist”
How would your theory be different from the four
theories we have discussed in class?
In what way is your theory similar to the four theories
we have discussed in class?
What makes your theory relevant for Hong Kong
Chinese families?
What makes your theory relevant for Christians?
How would you implement your theory in prevention
efforts at church?
 How would you prevent divorces?
 What ministry can you provide for children of divorce?
Term Paper Due
Friday, July 26, 2002
Handed in at Kay Wong’s office
If you need your grade to graduate,
Please say so on the front page of your paper!
(If you need more time to finish your work,
please make an application for extension at
the registrar’s office or through Kay Wong)
Class Time
09:00 to 10:30 AM
10:30 to 10:45 AM
10:45 to 12:00 PM
12:00 to 01:00 PM
01:00 to 02:30 PM
02:30 to 02:45 PM
02:45 to 05:00 PM
05:00 to 05:30 PM
Instruction session 1
Break 1
Instruction session 2
Lunch
Instruction 3 (or film)
Break 2
Instruction session 4
Q/A Individual Time
Course Description and Outline
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This graduate marriage and family studies course
provides fundamental introduction to the study of
common marriage and family systems theories.
Theories and techniques of family therapy will be
reviewed and practical application discussed.
The structural family therapy approach is studied
in depth.
Theoretical perspectives are presented through
readings, lectures, and videotapes by the masters;
classroom PowerPoint presentations and student
demonstrations.
Course Objectives and Outcomes
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Upon completion of this course, students will be able
to understand and use the four predominant theories:
The Structural Model, the Bowenian Model, the Satir
model and the Strategic School.
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Students will be shown how to assess their counseling
cases from a system's perspective using the theoretical
framework from the above approaches, and to apply, to
some extent, some of the intervention techniques covered.
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Cultural and theological and other relevant issues will
also be addressed to assist students in this course to
enhance their ability to minister through the local
church.
Course Objectives and Outcomes
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Students will establish a working knowledge of
the historical developments central to Marriage
and Family Therapy standards as well as marital
and family counseling in general.
They will have a working understanding of
general systems theory, as well as a working
knowledge of the major models of family therapy;
they will understand family assessment, treatment
planning and intervention techniques, from the
perspectives of the various models discussed.
Assessment Criteria or Course Requirements
Students are expected to attend class
minimum of 100%.
 There are assigned reading for the course
based on the required textbook below.
 There will be either an examination at the
end of the course or a term paper due.
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Students are expected to participate in classroom
discussion as well as a short presentation of their
papers if one is assigned.
Textbook
Nichols, M.; Schwartz, R.,
Family Therapy: Concepts and Methods.
Boston: Allyn & Bacon, 2001
(fifth edition).
Reference Books
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Goldenberg, I, & Goldenberg, H. (2000). Family
Therapy: An overview. Needham Heights, MA:
Allyn & Bacon, 5th ed.
Haley, J. (1977). Problem-solving Therapy. San
Francisco, CA: Jossey-Bass.
Minuchin, S. (1974). Families and Family
Therapy. Cambridge, MA: Harvard University
Press.
Satir, V. (1993). Conjoint Family Therapy. Palo
Alto, CA: Science Behavior Books.
Acknowledgments & Credits
Michael P. Nichols, The Essentials of Family Therapy
Curricula (English) References From:
C. R. Barké, Ph.D.; Tamara L. Kaiser, Ph.D.; Michael I. Vickers, Ph.D.
Curricula (Chinese) References From:
關何少芳 (香港家庭治療協進會主席)
黃張淑英 (香港家庭治療協進會學術秘書)
楊陳素端 (1990)
Videos by the Masters
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Key videos will be shown as direct
illustrations from the masters of a particular
theory.
– “Marriage: Just a Piece of Paper?”
– “Minuchin Interview”
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Other videos will be included on a timepermitting basis.
– "Unfolding the laundry," Salvador Minuchin
The family is the context of most
human problems
The whole is greater than the sum of its parts
Like all human groups, the family has
emergent properties -fall into two
categories
1. Structure and
2. Process
Family Therapy is New
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Psychiatry: Medical Model
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Schizophrenia was not believed to be biological
Family is not included in hospital treatment
Family is believed to be the cause of illness
Psychiatrists are not trained to treat families
Change the Family to change the Person
– Change the Person and change the Family
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Theorists were smart researchers
– Studied different parts to improve the whole
Triangle-Triangles-Triangulation
A Three-Person system; according to Bowen, the
smallest stable unit of human relationship.
“Diverting conflict between two people by
involving a third.”
“The unhappy mother uses her last born son to
triangulate against his father”
She is unhappy with her marriage and to find
stability and significance in her identity as a
woman, she chose her youngest son to be a
husband replacement: He is young and compliant
System (Family System)
Mary Richmond, 1917
Families are not isolated wholes (closed systems),
but exist in a particular social context, which
interactively influences and is influenced by their
functioning (they are open).
Her approach to practice was to consider the
potential effect of all interventions on every
systemic level, and to understand and to use the
reciprocal interaction of the systemic hierarchy for
therapeutic purposes.
Boundary
Emotional and physical barriers that
protect and enhance the integrity of
individuals, subsystems, and families
The family is the context of most
human problems
1.
2.
The structure of families includes
triangles, subsystems, and boundaries.
The processes that describe family
interactions-emotional reactivity,
dysfunctional communication, etc.-the
most central is circularity.
Rather than worrying about who started what, family
therapists understand and treat human problems
as a series of moves and countermoves, in
repeating cycles.
Family Systems Secret
What is the Family Systems Secret?
Fix the Marriage
Then
The Family is Fixed
Bad Marriage is the Context of
Most of Human Problems
Family is Bad: Father & Mother are Bad
Like all human groups, the family has
emergent properties – Parental Happiness
determines family happiness
1. How to be Happily Married?
and
2. How to keep Children Happy?
Marriage: Just a Piece of Paper?
Discussion
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Cohabitation: No Marriage = No divorce
– No commitment, no security (Maturity issue)
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Consumerism in Marriage Relationships:
– “If I don’t like it, I move on” (Fear-reduction based)
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Divorce’s victims: Children (No advocate, no defense)
– Abandonment fear: “If mom & dad can split up, they can
leave me too!” (limited cognitive abilities as children)
– Daughters of divorce: “Boy crazy, need a dad” (Intimacy)
– Sons of divorce: “What is the role of man in a family, none?”
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Covenant Marriage vs. Contract Marriage
– Premarital Counseling & Prove Fault before divorce
Important Resource
Marriage Clinic
John Gottman
(available at the Baptist Seminary library)
616.89156
G686m c.2
The Four Models of Family Therapy
Structural Model
(Salvador Minuchin)
Intergenerational Model
(Murray Bowen, Boszormonyi-Nagy, James Framo)
Humanistic-Experiential Model
(Virginia Satir, Carl Whitaker)
Strategic (Communication) Model
(Jay Haley)
Complementary Relationship
Relationship based on differences that fit
together in which qualities of one make
up for lacks in the other
Therefore, in marriages, there will always
be differences because each spouse is
different: This is the perpetual tension
that exists in a marriage
Family Homeostasis
Tendency of families to resist change
in order to maintain a steady state
Group Dynamics
Interactions among group members
that emerge as a result of
properties of the group rather than
merely of their individual qualities
Identified Patient (IP)
The symptom-bearer or official
patient as identified by the family
Videos by the Masters
Salvador Minuchin
Interview
Masters Series Videos
Salvador Minuchin
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First-born son from an Argentinean-Jewish family
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Complex, closed-extended family community: Gossips
Defended Jewish identity & Argentinean freedom
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– Imprisoned for political struggle against dictatorship: Peron
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Studied to be a pediatrician to be a child psychologist
Worked with delinquent youths multi-culturally
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Dated & married “Pat”: “Capitalist” Spent 3 months: 1st date
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Visited other family therapy research groups ’70’s
“Not a good team psychiatrist” “Not sexist” “Convinced”
Empirical observations of families: Psychosomatic families
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Subsystems & Boundaries
Families are structured in Subsystems as determined
by
Generation, gender, common interests and function
which are demarcated by interpersonal
Boundaries
The invisible barriers that regulate the amount of
contact with others
Boundaries safeguard the separateness and autonomy
of the family and its subsystem
Structural Family Therapy (Minuchin)
Constructs
Structure
 The invisible set of functional demands
(rules, roles, etc.) that organize the ways in
which family members interact.
 These form repeated transactions or patterns
of how, when, and who to interact with,
which underpin the system and its
functioning.
Structural Family Therapy (Minuchin)
Subsystems
 The family system differentiates and carries
out its functions through subsystems, which
include each individual as a subsystem, and
other combinations, including generational,
gender, interest, or function/role subsystems.
 Families typically include a marital
subsystem, a parental subsystem, and a
sibling subsystem.
Structural Family Therapy (Minuchin)
Boundaries
 To ensure proper family functioning, the
boundaries of subsystems must be clear.
 A boundary is described as the rules that
define who participates and how.
 It functions to protect the differentiation and
separateness of subsystems and facilitate
transactions among subsystems.
Structural Family Therapy (Minuchin)
Boundaries are described on a continuum
 From
Diffuse 混雜邊界 (Enmeshment)
– Forming an enmeshed style of
transactions in the system, to
 Rigid 分離邊界 (Disengaged Boundary)
– Forming a disengaged style of
transactions in the system
Structural Family Therapy (Minuchin)
Healthy Family Functioning
 In healthy families, there is a clear hierarchy,
 with parents functioning as executive
subsystem with effective power,
 children in a sibling subsystem, less power,
though this changes developmentally over
time.
Structural Family Therapy (Minuchin)
Boundaries are clear, flexible and
permeable among all members, and
between subsystems, meaning members can
communicate with one another, can access
others' time, attention and energy.
 Parents are aligned and function jointly,
marital relationship is open internally, but
clearly separate from children.
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Structural Family Therapy (Minuchin)
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Rules and roles are clearly and explicitly
defined, yet with some flexibility across
circumstances, and changing over time as
children develop.
Structural Family Therapy (Minuchin)
Unhealthy Family Functioning
 In unhealthy families, any or all of these are
missing or distorted.
 There may be overly rigid or diffuse
boundaries between persons or subsystems,
 reversed hierarchy with children having too
much power influence,
Structural Family Therapy (Minuchin)
coalitions across subsystems,
 conflict within subsystems,
 cross-subsystem alignments,
 rules and roles are ambiguous or conflicting,
 or remain fixed as children grow older,
 system may be disengaged or enmeshed.
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Structural Family Therapy (Minuchin)
Therapy Goals
Structural family therapy goals focus on
restructuring, altering any or all of the
structural components, thereby promoting
changes in symptoms and symptommaintaining behaviors of members.
Structural Family Therapy (Minuchin)
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Examples of restructuring goals would be
establishing an effective hierarchy,
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making boundaries more flexible or less diffuse,
deconstructing coalitions,
 establishing healthy alignments,
 improving within subsystem
communication,
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Structural Family Therapy (Minuchin)
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clarifying or establishing clear rules and
roles, changing these to reflect
developmental processes.
Structural Family Therapy (Minuchin)
Assessment
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Assessment is accomplished through a
combination of inquiry, using circular questions
as a tracking method, joining, with the therapist
interacting with the family members, and
observation using enactments in which the
family interacts around a topic or issue.
Family maps may be constructed by the therapist
and/or members, depicting structural
components.
Structural Family Therapy (Minuchin)
Interventions
 The therapy employs brief, direct, active
restructuring interventions.
 The sequence of these may include joining,
enactments, diagnosing, highlighting and
modifying interactions, boundary making,
unbalancing and challenging family
assumptions (rules and roles).
Structural Family Therapy (Minuchin)
Others include shaping competence,
 emphasizing positive and effective
behaviors;
 and reframing behaviors from negative to
positive.
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Virginia Satir
Humanistic-Experiential Model
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“If people are left alone, they tend to flourish!” (Carl Rogers)
“Self-actualization” (Abraham Maslow)
“Family myths” Mystification: Control to achieve peace
and quiet
Counter-Transference: Emotional reactivity on the part of
the therapist
Family Sculpting: Nonverbal experiential technique;
family members position themselves in settings that reveal
significant aspects of perceptions and feelings
Role playing: Acting out the parts of important characters
to dramatize feelings to practice new ways of relating
Virginia Satir
Humanistic-Experiential Model
HUMANISTIC FAMILY THERAPY
Constructs
Open/Closed Family systems
 Satir views families as either
 open (functional) or
 closed (dysfunctional).
Virginia Satir
Humanistic-Experiential Model
In closed families every individual must be
very cautious about what he or she says;
 everyone is supposed to have the same
feelings, thoughts, beliefs, and desires.
 Honest self-expression is impossible;
differences are dangerous;
 members must become "dead to
themselves."
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Virginia Satir
Humanistic-Experiential Model
An open system permits honest selfexpression,
 differences are viewed as natural,
 members can say what they feel or think
and can
 negotiate for personal growth and reality
without threatening the system.
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Virginia Satir
Humanistic-Experiential Model
Family Roles
Satir identified four family roles, which represent
patterned ways that individuals may behave.
1.
2.
3.
4.
blamer,
placator,
irrelevant distracter,
super-reasonable computer.
Virginia Satir
Humanistic-Experiential Model
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As roles, each of these restricts or
constrains open communication, though in
different ways, and thereby limit growth
and functioning of the system.
Virginia Satir
Humanistic-Experiential Model
Family Functioning
 Satir's approach is considered a "growth"
model of functioning and therapy.
 In healthy families, the system nurtures its
members, facilitating their growth and
natural development, members listen and
are considerate, value one another, and are
open about themselves ("Anything can be
talked about").
Virginia Satir
Humanistic-Experiential Model
This promotes both the healthy selfactualization of individuals and the
accomplishment of family goals and tasks.
 In unhealthy families, there are rules, roles
and communication patterns which limit or
prevent open, honest and expressive
interactions among members.
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Virginia Satir
Humanistic-Experiential Model
Therapy Goals
 Satir's family therapy goals focus on the
identification and habilitation of "process,"
rather than on symptom or problem
reduction.
 The symptom is a signal of dysfunction in
the family, and "the illness goes away when
the individual is either removed from the
maladaptive system,
Virginia Satir
Humanistic-Experiential Model
or the system is changed to permit healthy
response and communication" (Satir, 1967).
 Process is more a matter of "how" than
"what,"
 and she will focus on process rather than
content.
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Virginia Satir
Humanistic-Experiential Model
Assessment
 Assessment is accomplished by Satir
through the use of a "family life
chronology,"
 which is an interview process, that may
span several sessions, or be interspersed
across session.
Virginia Satir
Humanistic-Experiential Model
It begins with the meeting of the couple,
moves to their families of origin, returns to
the planning of children, and then focuses
on the routine facts of a typical day.
 Each member is involved in the process,
and discuss feelings, hopes and
disappointments as well as facts.
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Virginia Satir
Humanistic-Experiential Model
Diagnostically, Satir uses several tools,
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an analysis of the family's handling of
differences;
role function analysis;
model analysis;
communication analysis; and
rule analysis.
Virginia Satir
Humanistic-Experiential Model
Interventions
 Satir's interventions are a combination of
her own responses and directives in session
(encouraging the use of "I" statements,
reframing), in session exercises, such as
role-playing and sculpting, and games
(rescue game, lethal game, communication
game), and homework assignments.
Strategic Family Therapy
(Haley, Madanes)
Constructs
 More interested in changing behaviors and
patterns than in understanding them, more
focus on technique than theory.
 Behavior in families is patterned and rule
governed, often by the labels or
interpretations placed on behavior.
 In families, hierarchy is crucial, and needs
to be top-down and functional.
Strategic Family Therapy
(Haley, Madanes)
Family Functioning
 Decline to identify "normal" functioning in
any absolute sense – if it is working for the
family it is healthy, if not, it is dysfunctional
("Non-normative").
 Generally, though, in healthy families, there
are functional rules that govern behavior, but
also flexibility to attempt different solutions
to problems that the rules do not work for.
Strategic Family Therapy
(Haley, Madanes)
Families make misguided attempts to solve
difficulties, when these fail they are termed
"problems" and they repeat unsuccessful
solutions, which makes the problem seem
worse, an develops into a vicious circle.
 "Symptoms" are unsuccessful solutions. In
unhealthy families,
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Strategic Family Therapy
(Haley, Madanes)
Therapy Goals
 Strategic family therapy goals focus on the
presenting problem, or symptom.
 The goals are to eliminate the symptomatic
behaviors or patterns of interaction which
are experienced as distressing or prevent
successful completion of individual or
family tasks and development.
Strategic Family Therapy
(Haley, Madanes)
Also to develop alternative behaviors or
solutions which facilitate accomplishment.
 Let go of utopian, broad sweeping goals.
 Once presenting problem is eliminated,
therapy is concluded.
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Strategic Family Therapy
(Haley, Madanes)
Assessment
 Assessment is accomplished through
observation and inquiry about actual
behaviors between and among members of
the family, and of the ways behaviors are
defined, labeled and interpreted.
Strategic Family Therapy
(Haley, Madanes)
Three common types of unsuccessful
solutions (symptoms)
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Solution is to deny that there is a problem;
action is needed but not taken;
Solution is an effort to solve something that is
not really a problem; action is not needed but is
taken;
Solution is an effort to solve problem within a
framework that makes it impossible for it to
work; action is taken but at the wrong level.
Strategic Family Therapy
(Haley, Madanes)
Interventions
 Approach to problems is to first identify the
feedback loops that are maintaining the
behaviors,
 then identify the frames (rules) that support
these interactions, then change the rules.
Strategic Family Therapy
(Haley, Madanes)
Interventions are strategies that are planned
and implemented by the therapist, using
directives, which may be straightforward or
indirect or paradoxical.
 Process is one of interrupting, even
reversing, unsuccessful feedback loops.
 Specific interventions include prescribing
the symptom, restraining, prescribing
ordeals, pretending, and rituals.
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