Foundation Concepts in Family Therapy

1
Foundation Concepts in Family Therapy

• Some of the Core concepts covered in Chapters 1-4
• EPSY 6393 with Dr. Sparrow

2
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 familys oppressive
  influence

3
Family therapys 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

4
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

5
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

6
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.

7
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
8
Group TheoryThe 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

9
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 wont 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

10
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.

11
The First Family Therapists The Palo Alto Group

• Batesons 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)

12
Negative and Positive Feedback

• When a familys 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.

13
Families Break down under Stress

• Normal families need help when they cant 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

14
Big ConceptFamilies 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

15
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

16
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.

17
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

18
Milton Ericksons influence on Jay Haley

• Erickson mastered techniques for circumventing
  resistance in hypnotic subjects.
• Symptom prediction, symptom prescription
  (paradoxical or strategic)
• Indirect methods
• Reframing

19
Bowens 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

20
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.

21
Minuchins Structural Family Therapy

• boundaries disengagement and enmeshment
• hierarchies
• joining
• enactment
• restructuring

22
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 familys solution is often the problem --
  the reassertion of old rules

23
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 its
  defined, rather than looking at the way the
  family sustains the problem through their
  interaction, there will be no progress.

24
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.

25
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

26
Session ObjectivesFirst session

• Joining Making contact with each person. Balance
  warmth and professionalism to prevent induction.
• Assess problem from each persons perspective
• Explore specific problems and attempted
  solutions Use process questions to explore.
• Develop hypotheses about the interactions that
  are sustaining the problem.

27
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

28
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
• Dont splinter the family into subgroup work
  without keeping the big picture in mind.

29
Termination

• A time for the family to evaluate its progress,
  and to consolidate what theyve 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

30
Exceptions and Ethics Issues Pertaining to
Marital and Family Work

• Child abuse
• Domestic violence
• Confidentiality, triangulation, attraction

31
Chapter FourDeepening 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

32
Chapter FourDeepening Our Knowledge of Systems

• Systems dynamics explains several relationship
  problems that tend to get worse without outside
  intervention
• Controller/rebel
• Approacher/distancer
• Overfunctioning/underfunctioning

33
Chapter FourDeepening 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.

34
challenge to Early Family therapySocial
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

35
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

36
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

37
Summary

• Context is more important than content, so it is
  important to meet with the family to establish
  the context of a persons 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.

38
Summary

• Triangles account for much of a couples or a
  familys 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

39
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. Dont fight it,
  but create a trusting relationship with the
  family and an environment that is comfortable.

40
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 its also
  important to confront counterproductive beliefs
  and values regardless of their source.