Systems of Family Therapy

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Systems of Family Therapy

• William R. Herkelrath, Ed.D.

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An Introduction to Family Therapy
Portions of the information contained in this
Power Point has been adopted fromFamily therapy
An overview(6th ed.) by Goldenberg Goldenberg,
Thomson Learning Australia.
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Two Different Worlds

• Individual Psychology vs.
• Systems Psychology

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Adopting a Family Relationship Framework

• A family is far more than a collection of
  individuals sharing a specific physical and
  psychological space. While families occur in a
  diversity of forms today and represent a
  diversity of cultural heritages, each may be
  considered a natural social system.
• In your small group compile a list of various
  forms that families take consider the great
  diversity of families today. Once you have your
  list go over each item and determine what defines
  that group as a family.

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Adopting a Family Relationship Framework

• A Paradigm Shift
• Cybernetics the science of communication
• Bateson deserves the major credit for seeing how
  cybernetic principles apply to human
  communication processes, including those
  associated with psychopathology.
• First-order a view from outside of the system
  of the feedback loops and homeostatic mechanisms
  that transpire within a system
• Second-order a view of an observing system in
  which the therapist, rather than attempting to
  describe the system by being an outside observer,
  is part of what is being observed and treated
• Content vs. Process

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Family Development Continuity and Change

• Generations within a family have an enduring,
  life-shaping impact on one another as they move
  through family life cycle states. In this
  multigenerational view, continuity and change
  characterize family life as the family system
  progresses through transitions over time.
• In your small group create a list of family life
  cycle development that is cognizant of the
  various forms of families from your previous
  list. Discuss the transitions that can be
  associated with these stages as well as the
  difficulty in progressing through these
  transitions for various family groups.

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Gender, Culture, and Ethnicity Factors in Family
Functioning

• In regard to gender, men and women are reared
  with different expectations, experiences,
  attitudes, goals, and opportunities, and these
  differences influence later culturally prescribed
  role patterns in family relationships.
• Cultural diversity is increasingly a part of
  American life, and family therapists have widened
  their focus from the family to include larger
  socio-cultural contexts that influence behavior.
• Ethnicity and social class considerations also
  influence family lifestyles.
• As a small group define gender, culture, and
  ethnicity and discuss how these concepts impact
  the family system.

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Psychodynamic Family Therapy

• Theoretical Viewpoints
• Unresolved conflicts from past continue to
  attach themselves to current objects and
  situations

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Psychodynamic Family Therapy

• Unit of Study Monadic
• Individual intra-psychic conflict brought to
  current family relations

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Psychodynamic Family Therapy

• Time Frame
• Past early internalized family conflicts lead
  to interpersonal conflicts within present-day
  family

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Psychodynamic Family Therapy

• Leading Figures
• Ackerman
• Scharff Scharff
• Framo
• Kohut

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Psychodynamic Family Therapy

• Major Concepts
• Interlocking pathology
• Scapegoating
• Role complementarity
• Introjects
• Attachments
• Projective identification
• Splitting
• Narcissism
• Selfobjects

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Psychodynamic Family Therapy

• Role of Therapist
• Neutral
• Blank screen upon whom each family member
  projects fantasies

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Psychodynamic Family Therapy

• Assessment Procedures
• Unstructured
• Ongoing effort to uncover hidden conflict within
  and between family members

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Psychodynamic Family Therapy

• Key Methods of Intervention
• Interpretations regarding the unconscious
  meaning of individual verbalizations and behavior
  and their impact on family functioning

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Psychodynamic Family Therapy

• Insight vs. Action
• Insight leas to understanding
• Conflict reduction
• Individual, intrapsychic and system change

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Psychodynamic Family Therapy

• Goals of Treatment
• Individual intrapsychic change
• Resolution of family pathogenic conflict
• Detriangulatuion
• Removal of projections
• Individuation

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Experiential/CommunicationsFamily Therapy

• Theoretical Viewpoint
• free choice
• self-determination
• growth of self
• maturity achieved by overcoming impasses in
  process of gaining personal fulfillment

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Experiential/CommunicationsFamily Therapy

• Unit of Study Dyadic
• problems arise from flawed interactions and
  communication lapses between family members
• husband and wife, etc.

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Experiential/CommunicationsFamily Therapy

• Time Frame - Present
• here-and-now
• immediate ongoing interaction

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Experiential/CommunicationsFamily Therapy

• Leading Figures
• Whitaker
• Kempler
• Satir
• Greenberg
• Johnson

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Experiential/CommunicationsFamily Therapy

• Major Concepts
• Symbolic factors represent familys internal
  world and determine meaning given external
  reality
• Self-awareness of the moment
• Self-esteem
• Clarity of communication
• Explore inner experiences and relationships

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Experiential/CommunicationsFamily Therapy

• Role of the Therapist
• Egalitarian active facilitator providing family
  with new experiences through the therapeutic
  encounter

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Experiential/CommunicationsFamily Therapy

• Assessment Procedures
• Unstructured search for suppressed feelings and
  impulses that block growth and fulfillment

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Experiential/CommunicationsFamily Therapy

• Key Methods of Intervention
• Confrontation to provoke self-discovery
• Self-disclosure by the therapist
• Exercises to uncover previously unexpressed
  inner conflicts

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Experiential/CommunicationsFamily Therapy

• Insight vs. Action
• Self-awareness of ones immediate existence leas
  to choice
• Responsibility
• Change

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Experiential/CommunicationsFamily Therapy

• Goals of Treatment
• Simultaneous sense of togetherness and healthy
  separation and autonomy
• Genuineness
• Learning to express ones sense of being
• Building self-esteem
• Relieving family pain
• Overcoming blockages to personal growth
• Overcoming negative interactive patterns

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Transgenerational Family Therapy

• Theoretical Viewpoint
• Emotional attachments to ones family of origin
  need to be resolved

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Transgenerational Family Therapy

• Unit of Study-Triadic
• Problems arise and are maintained by relational
  binds with others

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Transgenerational Family Therapy

• Time Frame-Past and Present
• Current marital relations assumed to result from
  partners fusions to their families of origin or
  to unpaid debts and obligations

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Transgenerational Family Therapy

• Leading figures
• Bowen
• Kerr
• Friedman
• Papero
• Boszormenyi-Nagy

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Transgenerational Family Therapy

• Major Concepts
• Differentiation of self vs. fusion
• Triangles
• Multigenerational transmission process
• Family ledger
• Ethics
• Family legacies
• Entitlements

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Transgenerational Family Therapy

• Role of Therapist
• Coach
• Direct but non-confrontational
• Detriangulated from family fusion
• Aids family in developing relational fairness

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Transgenerational Family Therapy

• Assessment Procedures
• Family evaluation interviews with any combination
  of family members
• Genograms
• Attention to intergenerational indebtedness

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Transgenerational Family Therapy

• Key Methods of Intervention
• Teaching differentiation
• Individuation
• Taking I stands
• Reopening cutoff relations with extended family
• Balancing family ledgers

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Transgenerational Family Therapy

• Insight vs. Action
• Rational processes used to gain insight into
  current relationships and intergenerational
  experiences
• Leads to action with family of origin

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Transgenerational Family Therapy

• Goals of Treatment
• Anxiety reduction, symptom relief, and increased
  self-differentiation of individuals leads to
  family system change
• Restoration of trust, fairness, ethical
  responsibility

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Structural Family Therapy

• Theoretical Viewpoint
• Symptoms in an individual are rooted in the
  context of family transaction patterns, and
  family restructuring must occur before symptoms
  are relieved.

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Structural Family Therapy

• Unit of Study-Triadic
• Family enmeshment and disengagement involve
  family subsystems and family systems as a whole

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Structural Family Therapy

• Time frame-present
• Ongoing interactions are maintained by unadaptive
  family organization
• Family is unable to deal with transitions in
  family life cycle

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Structural Family Therapy

• Leading figures
• Minuchin
• Montalvo
• Aponte
• Fishman

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Structural Family Therapy

• Major Concepts
• Boundaries
• Subsystems
• Coalitions
• Enmeshment
• Disengagement

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Structural Family Therapy

• Role of Therapist
• Active
• Stage director
• Manipulates family structure to change
  dysfunctional set

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Structural Family Therapy

• Assessment Procedures
• Observe family transactional patterns for clues
  to family structure
• Family mapping
• Enactments
• Tracking

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Structural Family Therapy

• Key Methods of Intervention
• Joining
• Accommodating
• Reframing
• Helping families create flexible boundaries and
  integrated subsystems

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Structural Family Therapy

• Insight vs. Action
• Action precedes understanding
• Change in transactional patterns leads to new
  experiences and corresponding insights

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Structural Family Therapy

• Goals of Treatment
• Restructured family organization
• Change in dysfunctional transactional patterns
• Symptom reduction in individual members

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Strategic Family Therapy

• Theoretical Viewpoint
• Redundant communication patterns offer clues to
  family rules and possible dysfunction
• A symptom represents a strategy for controlling a
  relationship while claiming it to be involuntary

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Strategic Family Therapy

• Unit of Study-Dyadic and Triadic
• Symptoms are interpersonal communications between
  at least two, and probably three participants in
  a reciprocal relationship

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Strategic Family Therapy

• Time Frame-Present
• Current problems or symptoms are maintained by
  ongoing, repetitive sequences between family
  members

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Strategic Family Therapy

• Leading Figures
• Haley
• Madanes
• Weakland
• Watzlawick
• Jackson
• Keim

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Strategic Family Therapy

• Major Concepts
• Symmetrical and complementary communication
  patterns
• Paradox
• Family hierarchy

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Strategic Family Therapy

• Role of Therapist
• Active
• Manipulative
• Problem-focused
• Prescriptive
• Paradoxical

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Strategic Family Therapy

• Assessment Procedure
• Unstructured
• Search for familys repetitive, destructive
  behavior patterns and flawed solutions that
  perpetuate the presenting problem

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Strategic Family Therapy

• Key Methods of Intervention
• Paradoxical interventions
• Prescribing the symptom
• Therapeutic double binds
• Directives
• Pretend techniques
• Relabeling

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Strategic Family Therapy

• Insight vs. Action
• Action-oriented
• Symptom reduction and behavior change brought
  about through directives rather than insight and
  understanding

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Strategic Family Therapy

• Goals of Treatment
• Symptom relief
• Resolution of presenting problem

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Milan Family Therapy

• Theoretical Viewpoint
• Dysfunctional families are caught up in
  destructive games and are guided by belief
  systems that do not fit the realities of their
  lives

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Milan Family Therapy

• Unit of Study-Triadic
• Problems express connecting relationship patterns
  between family members

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Milan Family Therapy

• Time Frame-Present
• Recognition of circular nature of current
  problems helps family abandon previous limited
  linear perspective

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Milan Family Therapy

• Leading figures
• Selvini-Palazzoli
• Boscolo
• Cecchin
• Prata
• Tomm

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Milan Family Therapy

• Major Concepts
• Paradox and counterparadox
• Invariant prescriptions
• Circular questioning
• Second-order cybernetics

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Milan Family Therapy

• Role of Therapist
• Neutral
• Active therapeutic partner
• Offers hypotheses as new information for family
  belief systems
• Use of reflecting team behind one-way mirror

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Milan Family Therapy

• Assessment Procedure
• Unstructured
• Non-manipulative
• Collaborates with family in developing systemic
  hypotheses regarding their problems

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Milan Family Therapy

• Key Methods of Intervention
• Positive connotations
• Circular questioning
• Reframing
• Paradox
• Invariant prescription
• Rituals

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Milan Family Therapy

• Insight vs. Action
• Emphasis on family gaining new meaning rather
  than insight or action based on therapist choice
  of therapeutic outcome

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Milan Family Therapy

• Goals of Treatment
• System change chosen by family because of new
  meaning given to their life patterns
• Interruption of destructive family games

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CBT Family Therapy

• Theoretical Viewpoint
• Personal functioning is determined by the
  reciprocal interaction of behavior and its
  controlling social conditions

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CBT Family Therapy

• Unit of Study-Monadic
• Symptomatic person is the problem
• Linear view of causality

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CBT Family Therapy

• Time Frame-Present
• Maladaptive behavior in an individual is
  maintained by current reinforcements from others

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CBT Family Therapy

• Leading Figures
• Patterson
• Stuart
• Liberman
• Alexander
• Falloon
• Ellis
• Beck
• Meichenbaum
• Gottman

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CBT Family Therapy

• Major Concepts
• Conditioning
• Reinforcement
• Shaping
• Modeling
• Schemas

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CBT Family Therapy

• Role of Therapist
• Teacher
• Trainer
• Model of desired behavior
• Contract negotiator

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CBT Family Therapy

• Assessment Procedures
• Structured
• Reliance on formal standardized tests and
  questionnaires
• Behavioral analysis before commencing treatment

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CBT Family Therapy

• Key Methods of Intervention
• Reinforcement of desired behaviors
• Skills training
• Contingency contracting
• Positive reciprocity between marital partners as
  well as parents and children
• Self-regulated modification of thought and
  activities

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CBT Family Therapy

• Insight vs. Action
• Actions taught to reward desired outcomes and
  ignore or punish undesired behavior
• Unconcerned with insight

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CBT Family Therapy

• Goals of Treatment
• Modification of behavioral consequences between
  persons in order to eliminate maladaptive
  behavior and/or alleviate presenting symptoms
• Cognitive restructuring