Title: Family Therapy
1Family Therapy
- http//www.youtube.com/watch?v9PU-hTdkzg8
2Two Focuses
- The first is togetherness and the second is
individuality. - Too much togetherness creates fusion and prevents
individuality, or developing one's own sense of
self. - Too much individuality results in a distant and
estranged family.
3Differentiation of Self
- The first concept is Differentiation of Self, or
the ability to separate feelings and thoughts.
Undifferentiated people can not separate feelings
and thoughts when asked to think, they are
flooded with feelings, and have difficulty
thinking logically and basing their responses on
that. Further, they have difficulty separating
their own from other's feelings they look to
family to define how they think about issues,
feel about people, and interpret their
experiences.Differentiation is the process of
freeing yourself from your family's processes to
define yourself. This means being able to have
different opinions and values than your family
members, but being able to stay emotionally
connected to them. It means being able to calmly
reflect on a conflicted interaction afterward,
realizing your own role in it, and then choosing
a different response for the future.
4Triangles
- Triangles are the basic units of systems. Dyads
are inherently unstable, as two people will
vacillate between closeness and distance. When
distressed or feeling intense emotions, they will
seek a third person to triangulate. - Think about a couple who has an argument, and
afterward, one of the partners calls their parent
or best friend to talk about the fight. The third
person helps them reduce their anxiety and take
action, or calm their strong emotions and
reflect, or bolster their beliefs and make a
decision. - This is a healthy triangulation!
5Triangles
- People who are more undifferentiated are likely
to triangulate others and be triangulated. People
who are differentiated cope well with life and
relationship stress, and thus are less likely to
triangulate others or be triangulated. - Think of the person who can listen to the best
friend's relationship problems without telling
the friend what to do or only validating the
friend's view. Instead, the differentiated person
can tell the best friend "You know, you can be
intimidating at those times..." or "I agree with
you but you won't change your partner you either
have to learn to accept this about them, or have
to call this relationship quits... - http//www.youtube.com/watch?vnAvspf49UTE
6The Nuclear Family Emotional Processes
- These are the emotional patterns in a family that
continue over the generations. - Think about a mother who lived through The Great
Depression, and taught her daughter to always
prepare for the worst case scenario and be happy
simply if things are not that bad. The daughter
thinks her mother is wise, and so adopts this way
of thinking. She grows up, has a son, and without
realizing it, models this way of thinking. He may
follow or reject it, and whether he has a happy
or distressed relationship may depend on the kind
of partner he finds. - http//www.youtube.com/watch?v4fC6x8paqpc
7Emotional Process
- Likewise, think of a daughter who goes to work
for her father, who built his own father's small
struggling business into a thriving company. He
is seen in the family as a great business person
as he did this by taking risks in a time of great
economic opportunity. He teaches his daughter to
take risks, "spend money to make money," and
assume a great idea will always be profitable.
His daughter may follow or reject her father's
advice, and her success will depend on whether
she faces an economic boom or recession.
8Emotional Process
- In both cases, the parent passes on an emotional
view of the world (the emotional process), which
is taught each generation from parent to child,
the smallest possible "unit" of family (the
nuclear unit). Reactions to this process can
range from open conflict, to physical or
emotional problems in one family member, to
reactive distancing (see below). Problems with
family members may include things like substance
abuse, irresponsibility, depression.... - http//www.youtube.com/watch?v0Bgshe4S3_s
9The Family Projection Process
- This is an extension of The Nuclear Family
Emotional Process in many ways. - The family member who "has" the "problem" is
triangulated and serves to stabilize a dyad in
the family.
10Family Projection Process
- Thus, the son who rejects his mother's
pessimistic view may find his mother and sister
become closer, as they agree that he is immature
and irresponsible. The more they share this view
with him, the more it makes him feel excluded and
shapes how he sees himself. He may act in accord
with this view and behave more and more
irresponsibly. He may reject it, constantly
trying to "prove" himself to be mature and
responsible, but failing to gain his family's
approval because they do not attribute his
successes to his own abilities ("He was so lucky
that his company had a job opening when he
applied..." or "It's a good thing the loan
officer felt sorry for him because he couldn't
have managed it without that loan..."). He might
turn to substance abuse as he becomes more and
more irresponsible, or as he struggles with never
meeting his family's expectations.
11Family Projection Process
- Similarly, the daughter who faces harsh economic
times and is more fiscally conservative than her
father is seen by the parents as too rigid and
dull. They join together to worry that she'll
never be happily married. She might accept this
role and become a workaholic who has only
superficial relationships, or reject it and take
wild risks that fail. In the end, she may become
depressed as she works more and more, or as she
fails to live up to her father's reputation as a
creative and successful business person.
12Family Projection Process
- The family member who serves as the "screen" upon
which the family "projects" this story will have
great trouble differentiating. It will be hard
for the son or daughter above to hold their own
opinions and values, maintain their emotional
strength, and make their own choices freely
despite the family's view of them.
13The Multigenerational Transmission Process
- This process entails the way family emotional
processes are transferred and maintained over the
generations. This captures how the whole family
joins in The Family Projection Process, for
example, by reinforcing the beliefs of the
family. As the family continues this pattern over
generations, they also refer back to previous
generations ("He's just like his Uncle Albert -
he was always irresponsible too" or "She's just
like your cousin Jenny - she was divorced four
times.").
14Sibling Position
- sibling order, believing that each child had a
place in the family hierarchy, and thus was more
or less likely to fit some projections. The
oldest sibling was more likely to be seen as
overly responsible and mature, and the youngest
as overly irresponsible and immature for example.
- Think of the oldest sibling who grows up and
partners with a person who was also an oldest
sibling. They may be drawn to each other because
both believe the other is mature and responsible. - Alternately, an oldest sibling might have a
relationship with someone who was a youngest
sibling. When one partner behaves a certain way,
the other might think "This is exactly how my
older/younger sibling used to act."
15Emotional Cutoff
- This refers to an extreme response to The Family
Projection Process. This entails a complete or
almost-complete separation from the family. The
person will have little, if any, contact, and may
look and feel completely independent from the
family. However, people who cut off their family
are more likely to repeat the emotional and
behavioral patterns they were taught.
16- In some cases, they model the same values and
coping patterns in their adult family that they
were taught in their childhood family without
realizing it. They do not have another internal
model for how families live, and so it is very
hard to "do something different." Thus, some
parents from emotionally constrained families may
resent how they were raised, but they do not know
how to be "emotionally free" and raise a family
as they believe other families would.
17- In other cases, they consciously attempt to be
very different as parents and partners however,
they fail to realize the adaptive characteristics
of their family and role models, as well as the
compensatory roles played in a complex family.
Thus, some parents from emotionally constrained
childhood families might discover ways to be
"emotionally unrestrained" in their adult
families, but may not recognize some of the
problems associated with being so emotionally
unrestrained, or the benefits of being
emotionally constrained in some cases. Because of
this, Bowen believed that people tend to seek out
partners who are at about the same level of
individuation.
18Normal Family Development
- optimal family development occurs when family
members are differentiated, feel little anxiety
regarding the family, and maintain a rewarding
and healthy emotional contact with each other.
19- are balanced in terms of their togetherness and
separateness, and can adapt to changes in the
environment - view emotional problems as coming largely from
the greater system but as having some components
in the individual member - are connected across generations to extended
family - have little emotional fusion and distance
- have dyads that can deal with problems between
them without pulling others into their
difficulties - tolerate and support members who have different
values and feelings, and thus can support
differentiation - are aware of influences from outside the family
(such as Societal Emotional Processes) as well as
from within the family - allow each member to have their own emptiness and
periods of pain, without rushing to resolve or
protect them from the pain and thus prohibit
growth - preserve a positive emotional climate, and thus
have members who believe the family is a good one
- have members who use each other for feedback and
support rather than for emotional crutches
20Family Disorders
- family problems result from emotional fusion, or
from an increase in the level of anxiety in the
family. Typically, the member with "the symptom"
is the least differentiated member of the family,
and thus the one who has the least ability to
resist the pull to become fused with another
member, or who has the least ability to separate
their own thoughts and feelings from those of the
larger family. The member "absorbs" the anxiety
and worries of the whole family and becomes the
most debilitated by these feelings. Families face
two kinds of problems.
21- Vertical problems are "passed down" from parent
to child. Thus, adults who had cold and distant
relationships with their parents do not know how
to have warm and close relationships with their
children, and so pass down their own problems to
their children. - Horizontal problems are caused by environmental
stressors or transition points in the family
development. This may result from traumas such as
a chronic illness, the loss of the family home,
or the death of a family member. However,
horizontal stress may also result from Social
Emotional Processes, such as when a minority
family moves from a like-minority neighborhood to
a very different neighborhood, or when a family
with traditional gender roles immigrates to a
culture with very different views, and must raise
their children there. The worst case for the
family is when vertical and horizontal problems
happen at once.
22- The basic roles which I list below apply to
American culture specifically, and Western
Civilization generally - but with a few changes
in details could be made to fit most any culture.
- There are four basic roles that children adopt in
order to survive growing up in emotionally
dishonest, shame-based, dysfunctional family
systems. Some children maintain one role into
adulthood while others switch from one role to
another as the family dynamic changes (i.e. when
the oldest leaves home, etc.) An only child may
play all of the roles at one time or another.
23"Responsible Child" - "Family Hero"
- This is the child who is "9 going on 40." This
child takes over the parent role at a very young
age, becoming very responsible and
self-sufficient. They give the family self-worth
because they look good on the outside. They are
the good students, the sports stars, the prom
queens. The parents look to this child to prove
that they are good parents and good people. As an
adult the Family Hero is rigid, controlling, and
extremely judgmental (although perhaps very
subtle about it) - of others and secretly of
themselves. They achieve "success" on the
outside and get lots of positive attention but
are cut off from their inner emotional life, from
their True Self. They are compulsive and driven
as adults because deep inside they feel
inadequate and insecure. - The family hero, because of their "success" in
conforming to dysfunctional cultural definitions
of what constitutes doing life "right", is often
the child in the family who as an adult has the
hardest time even admitting that there is
anything within themselves that needs to be
healed.
24"Acting out child" - "Scapegoat"
- This is the child that the family feels ashamed
of - and the most emotionally honest child in the
family. He/she acts out the tension and anger
the family ignores. This child provides
distraction from the real issues in the family.
The scapegoat usually has trouble in school
because they get attention the only way they know
how - which is negatively. They often become
pregnant or addicted as teenagers. These children
are usually the most sensitive and caring which
is why they feel such tremendous hurt. They are
romantics who become very cynical and
distrustful. They have a lot of self-hatred and
can be very self-destructive. This often results
in this child becoming the first person in the
family to get into some kind of recovery.
25"Placater" - "Mascot" - "Caretaker"
- This child takes responsibility for the emotional
well-being of the family. They become the
families 'social director' and/or clown,
diverting the family's attention from the pain
and anger. This child becomes an adult who is
valued for their kind heart, generosity, and
ability to listen to others. Their whole
self-definition is centered on others and they
don't know how to get their own needs met. They
become adults who cannot receive love, only give
it. They often have case loads rather than
friendships - and get involved in abusive
relationships in an attempt to "save" the other
person. They go into the helping professions and
become nurses, and social workers, and
therapists. They have very low self-worth and
feel a lot of guilt that they work very hard to
overcome by being really "nice" (i.e. people
pleasing, classically codependent) people.
26"Adjuster" - "Lost Child"
- This child escapes by attempting to be
invisible. They daydream, fantasize, read a lot
of books or watch a lot of TV. They deal with
reality by withdrawing from it. They deny that
they have any feelings and "don't bother getting
upset." These children grow up to be adults who
find themselves unable to feel and suffer very
low self-esteem. They are terrified of intimacy
and often have relationship phobia. They are
very withdrawn and shy and become socially
isolated because that is the only way they know
to be safe from being hurt. A lot of actors and
writers are 'lost children' who have found a way
to express emotions while hiding behind their
characters.
27- It is important to note that we adapt the roles
that are best suited to our personalities. We
are, of course, born with a certain personality.
What happens with the roles we adapt in our
family dynamic is that we get a twisted,
distorted view of who we are as a result of our
personality melding with the roles. This is
dysfunctional because it causes us to not be able
to see ourselves clearly. As long as we are
still reacting to our childhood wounding and old
tapes then we cannot get in touch clearly with
who we really are.
28- The false self that we develop to survive is
never totally false - there is always some Truth
in it. For example, people who go into the
helping professions do truly care and are not
doing what they do simply out of Codependence.
Nothing is black and white - everything in life
involves various shades of gray. Recovery is
about getting honest with ourselves and finding
some balance in our life. Recovery is about
seeing ourselves more clearly and honestly so
that we can start being True to who we really are
instead of to who our parents wanted us to be.
(Reacting to the other extreme by rebelling
against who they wanted us to be is still living
life in reaction to our childhoods. It is still
giving power over how we live our life to the
past instead of seeing clearly so that we can own
our choices today.) The clearer we can see our
self the easier it becomes to find some balance
in our life - to find some happiness,
fulfillment, and serenity.
29Goals of Therapy
- reframing the presenting problem as a
multigenerational problem that is caused by
factors beyond the individual - lowering anxiety and the "emotional turmoil" that
floods the family so they can reflect and act
more calmly - increasing differentiation (individuality),
especially of the co-dependent, so as to increase
their ability to manage their own anxiety,
transition more effectively into a healthy
relationship with the addict, and thus fortify
(strengthen) the entire family unit's emotional
wellbeing - using the therapist as part of a "healthy
triangle" where the therapist teaches the family
to manage their own anxiety, create distance and
closeness in healthy ways - focusing away from "the problem" and including
the overall health and happiness of the family.
Thus creating positive habits and interests - evaluating the progress of the family in terms of
how they function now compared to when they
started, as well as how adaptive they can be to
future changes - addressing the power differential in families
such as economic power and gender role
socialization.
30- In general, the therapist accomplishes this by
giving less attention to specific problem they
present with, and more attention to family
patterns of emotions and relationships, as well
as family structures of dyads and triangles. - tries to lower anxiety to promote understanding,
which is the critical factor in change open
conflict is prohibited as it raises the family
members' anxiety during future sessions - remains neutral and detriangulated, and in effect
models for the parents some of what they must do
for the family - promotes separation of members, as often a single
member can cause changes in the larger family
using "I" statements is one way to help family
members separate their own emotions and thoughts
from those of the rest of the family - develops a personal relationships with each
member of the family and encourages family
members to form stronger relationships too - encourages cut off members to return to the
family - may use descriptive labels like "pursuer
(co-dependent)-distancer (addict)," and help
members see the dynamics occurring following
distancers only causes them to run further away,
while working with the pursuer to create a safe
place in the relationship invites the distancer
back. - coaches and consults with the family, interrupts
arguments, and models skills..
31Techniques Getting the environment right
- Counseling techniques
- create a space to talk which is private and quiet
and where you know you will be free from
interruptions (always seek the advice of a
colleague about the safety and appropriateness of
this action). Where possible, make sure the
seating is comfortable and make sure that there
is appropriate heating and ventilation. - Get the message across that you have time to
attend to the issue that you want to address.
Get the message across that the conversation is
private and that you will not be passing on what
the family says to any third party. - You have to also make it clear that if the
family gives you information that suggests that
they or others are in danger (for example a
disclosure of abuse or threat of self-harm) you
cannot keep this confidential. Make sure that
you are fully aware of your organisations child
protection policies
32Getting the listening right
- One way of encouraging a person/persons to talk
is to make sure that they know you are listening.
- You can do this by just being attentive and by
showing with your body language that you are
listening. - Sometimes this will be by facing the person and
making good eye contact. - Sometimes sitting side by side will be less
threatening. Try not to interrupt when the
person is talking. - By occasionally nodding or quietly saying "yes"
or "aha" the person should be encouraged to open
up. - Reporting back to the person/family a short
summary of what they have just said and asking
them if you have got it right is another way of
doing this. - Make sure you look and sound calm, unhurried and
caring.
33Reflective Listening
- S "I'm very depressed today, Doctor."D "You're
very depressed, Mr. Smith."S "Yes. I haven't
been this depressed in a long time."D "You
haven't been this depressed in a long time."S
"I'm so depressed that I'm thinking about killing
myself."D "You're thinking about killing
yourself."S "I'd like to kill myself right
now."D "You'd like to kill yourself right
now."S "Yes, I'm so desperate that I think I'll
open this window and jump out."D "You're
thinking of jumping out that window."S "I'm
gonna do it. See? I'm opening the window.... and
I'm gonna jump."D "You're going to jump out the
window."S "Bye, doc. Here I go........
aaaaaaaaaaaaaaaaaaaaah" (splat)D
"Aaaaaaaaaaaaaaaaaaaaaah, splat."
34Asking the right questions
- Try to ask more open questions than closed
questions. - An open question is one which cannot be answered
with yes or no and which encourages a more
detailed answer, for example - What are your feelings about this?
- What are the advantages of doing things the way
you have suggested? - What are the disadvantages?
- Avoid closed questions such as
- Are you sad?
- Are you looking forward to the holidays?
- Another disadvantage of closed questioning is
that the desired answer might be implied within
the question and you might inadvertently steer
the person to give an answer that they wouldnt
otherwise have given. An example of this would
be - Are you going to stop obsessing about your
addicted family member because it is upsetting
you so much? - The implied expected answer here is quite clearly
yes.
35Being affirming
- To encourage the flow of conversation it is
important that you show respect by taking an
accepting attitude. - The message you are trying to get across is "I
have respect for your opinions and your view of
the world at this present time". - This is not the same as saying that you agree
with the clients opinions or actions and it is
okay for you to make it clear that your opinions
and moral view are different, as long as this is
done in a respectful way.
36How to make it work
- Do not turn your conversation into an
interrogation. - However good you are at counseling some people
will not be ready to talk to you or want to talk
to you. - This does not mean that you have failed. It
might be that they will talk later or that they
will talk to a colleague of yours who they know
better or a colleague of the opposite sex.
37- http//www.youtube.com/watch?vAQ4Pktv4-Gc
- http//www.youtube.com/watch?v8-1L5WclNTg
- http//www.youtube.com/watch?viB1ZZ6Bh4GM
- http//www.youtube.com/watch?vfF-11ulCPTE