Family therapy notes pg 373 PDF

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Notes reviewing content on Family Therapy theories / Dr. Carter...

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Powerpoint notes: family therapy pp notes ν Family therapy is both a theory and a treatment method. ν The identified patient is the symptomatic family member considered to have a problem/be a problem for the family. ν The identified patient’s problems are a reflection of the family’s problematic interactions. ν Context has broadened to add in the surrounding cultural community. ν Reciprocal causality provides an opportunity to observe repetitive circular ways in which family members interact and to use such data to initiate therapeutic interventions. ν Family therapists direct their attention to the dysfunctional or impaired family unit rather than to a symptomatic person. Focus of Family Theory Approaches ν Present-oriented: ¥ Strategic ¥ Structural ¥ Social constructivist ¥ Cognitive behavioral ¥ Experiential ν Past-oriented: ¥ Object relations ¥ Multigenerational ¥ Narrative ν Open systems: ¥ Allow new information in. ¥ Preferable to closed ones. ¥ Allows situations to be seen from different perspectives. ν Closed systems: ¥ Have varying degrees of inner circles. ¥ Those outside the system completely are viewed as having nothing to contribute. ν Example: They wouldn't understand the "way we do things." Structural Family Therapy Key Concepts ν Family structure: ¥ Invisible set of functional demands that organizes ways in which family members interact. ¥ Operates through transactional patterns. ν Transactional patterns: ¥ Repeated transactions establish patterns of how, when and to whom to relate. ν Boundaries: ¥ Rules defining in a system who participates, how and when. ¥ Determines the system’s sub-systems (i.e. each family structure). ¥ Continuum ranges from diffuse (‘enmeshment’) to rigid (‘disengagement’). ν Sub-system

¥ ν ¥ ν ¥ ¥ ¥ ¥

Individuals belong to different subsystems, with different levels of power and skills. Dysfunction Deviation from the healthy or normal. Dysfunction occurs when one of the following occurs: Rigid, diffuse or unclear boundaries. Coalitions formed against third party. Coalitions cross generational boundaries. Denied or concealed coalition.

Basic Family Therapy Concepts ν Gender-sensitive outlook ¥ Stresses importance of not reinforcing stereotypical, sexist or patriarchal attitudes. ν Culturally-sensitive therapy ¥ Requires cultural competence. ¥ Therapist must remain aware of their own “cultural filters” and respect the “cultural filters” of the family being treated. Virginia Satir ν Described family roles that serve to stabilize expected characteristic behavior patterns in a family. ν Example: ¥ If one child is the “bad child," a sibling may take on the role of the "good child" to alleviate family stress. ν Role reciprocity underscores why family dynamics are resistant to change. Salvador Minuchin ν Founder of structural family therapy. ν Author of the classic Families and Family Therapy (1974). ν Concepts developed by Minuchin are used to train family therapists to this date. Family Systems ν Assumes an individual is understood best in the context of the family. ν Families have a structure (how it is organized) and function (how it meets member’s needs). ν Healthy families have a clear, flexible power structure. ν Most competent members have the most power. ν Dysfunctional families are often disengaged (isolated from one another) or enmeshed (overly involved with one another). ν Families that are cohesive and adaptable best serve the functions of members. ν Family systems attempt to achieve homeostasis. ν Example: If mom and dad are in conflict, a child may develop a problem to shift the focus. ν Multigenerational transmission of both strengths and problems are common. ν Example: Grandmother, mother, daughter all have been sexually abused.

Mystification ν Process that occurs when one or more family members fail to understand the meaning and/or purpose of communication from another member, especially a parent. ν Communication received is often deliberately vague. ν Vague communication places mystified person in an inferior position and leads to powerlessness. Triangulation ν Occurs when a third person is brought into a dyadic relationship to de-intensify a dispute between two people (generally the parents). ν Communication occurs through a third person. ν The third person often hears negative comments about the individuals involved in the dispute. Lack of Differentiation ν Autonomy is important for all individuals. ¥ Represents the degree of independence that an individual needs to function apart from others in a system. ν Fusion is the absence of differentiation. ν Lack of differentiation leads to enmeshment with others. Scapegoating ν Families often scapegoat one individual for all of the family’s problems. ν The person scapegoated may have difficulties, but is unduly blamed. ¥ They may be displaying the symptoms of an unhealthy family environment or have a bona fide illness. ν Lesser forms of scapegoating occur when every failure or conflict is pinned to an individual. ν Scapegoating rarely takes into consideration any other factors. Lack of Boundaries ν All individuals need boundaries. ν The absence of boundaries produces unclear limits in terms of what others may or may not say or do to a person. ν Without boundaries, abuse can easily occur. ν Families often have no boundaries in some areas and overly rigid boundaries in others. ν Without boundaries, humans are unable to emotionally relate to others or set reasonable limits on others. Structural Family Therapy Therapeutic Techniques ν Enactment: ¥ Therapist has family enact an interaction to enable the family to try different ways of interacting.

ν Intensification: ¥ Therapist increases emotional aspects of interactions by a variety of means. ν Unbalancing: ¥ Conscious attempt to form coalition with one member against another or supporting one member at the expense of another to throw the family system off balance. Milan System Family Therapy Key Concepts ν Neutrality ¥ Therapist is an observer and remains neutral. ν Hypothesizing ¥ Therapist makes EDUCATED GUESSES about the patient's symptoms and context in which they occur. ν Circular questioning designed to elicit differences: ¥ What is the symptom the patient presents? What is it there for? What function might it serve? ¥ What is the context of the symptom? What is happening when the symptom occurs? ¥ Why now? Why this symptom? Who can make it better? Who makes it worse? ¥ Who is affected by the symptom and in what way? How does the symptom affect the family and how does the family (and others) react? Family Therapy in a Multicultural World ν Family therapists stay aware of: ¥ Movements taking place in society and in specific cultural environments. ¥ Own personal strengths and most importantly, weaknesses, biases, and prejudices. ¥ When consultation is appropriate or when referral is necessary. ¥ Client’s internal/external frame of reference. ν Family therapy, because other family members are present, allows for differentiation between idiosyncratic behaviors and culturally-determined thinking or action. Multicultural family genograms offer a global perspective on issues of ethnicity, economics, religion and political factors influencing family dynamics.

Family therapy - theory and treatment method -identified patient: family member causes problems -improved functions of individuals as well as families Overview: Basic Concepts Paradigm shift - mid1950s bagan to look at family dynamic as it pertains to the identified patient Individual = why Family = what and how Reciprocal causality: provides an opportunity to observe repetitive way in which family members interact and to use such data to initiate therapeuitic interventions. The family as a system

Structure: how it arranges, organizes, and maintains itself at a particular cros section of time Processes: way it evolves , adapts, or changes over time / interactive patterns Ongoing living system Organization: Wholeness: units combined to create something greater (gregory Bateson) Cybernetic system: flow of information and the back and forth communication patterns that exist within families A Cybernetic Epistemology Locus of pathology changse from identified patient to the social contect and the interaction between individuals rather than the troubled person exclusively Linear causality: simple nonreciprical view that one event leads to another in stimulus-response fashion Circular causality: reciprocal actions occur within a relationship network by means of a nework of interacting loops Cybernetics: regulatory systems that operate by means of feedback loops (thermostat) Family homeostasis: by activating family learned mechanisms to decrease the stress and restore internal balance -information acts as a feedback mechanism, signaling that disequilibrium has been created and that some corrective steps are needed to help the relationship return to its previous balanced state (a lot of assuming previous balance - what if it never existed?) Negative feedback loop: attenuating effect, restoring equilbirum Positive feedback loop: leads to further change by accelerating the deviation Positive feedback may lead to change in function through insight and work more smoothly and a higher homeostatic level (shift) Systems, boundaries, and larger systems Family therapists view families as comprosing several coexisting subsystems in which members group together to carry out certain family functions or processes. -subsystems may be determined by generation, sex, or family function Three primary subsystems: spousal, parental, and sibling -spousal subsystem health provide security and teach children about the commitment by present positive model Boundaries: invisible lines that separate a system, a subsystem, or an individual from outside surroundings.-> protect systems integrity -range from rigid to diffuse -disengages families: members feel isolated from one anouther -enmeshed families: memebers are intertwined in one another’s lives -more flexible the boundaires the better the information flow -open system: open to new experiences, able to alter and discard unworkable or obsolete interactive patterns, -closed system: boundaries are not easliy crossed, the family is insular, not open to what is happeneing around it, suspicious of the outside world

-all exist along the continuum Cybernetics revisted and the postmodern challenge second-order cybernetics: later refinement; acknowledged the effect of the observer (family therapist) on his/her observation, influences goals and outcomes. -all family systems are influenced by one or more of society's larger systems -untangling dynamics can be difficult and present legal and ethical issues for the counselor. gender awareness and culture sensitivity men and women have different socialization experiences due to changes in society new male-female interactions and family adaptations gender-sensitive outlook: being careful not to reinforce stereotyped sexist, patriarchal attitudes or class differences. comprehensive picture requires cultural awareness and form of family organization culturally sensitive therapy: middle-class white values are not embraced by all therapists counseling is filtered through worldview spirituality and ritual can be beneficial for family systems, even if they are created by the family therapist must provide help in addressing the limitations imposed by the majority culture if the family is to overcome societal restrictions other systems object relations theory: emphasized search for satisfactory objects (persons) beginning in infancy introjects: imprints from the past that influence object relation orientation adlerian: emphasizes social context & embeddedness of the individual in his or her interpersonal relationships -both seek a holistic view of the person rogerian/person centered approach: applicable to helping families move in the direction of selfactualization existential: emphasizing awareness and the here and now of the client's existence. behaviorist: take more linear view than most family therapists -view destructive behavior as a form of communication or information exchange REBT: to individualistic for most family therapies evidence-based treatments identify specific groups and the cultural adaptations that are necessary History: Precursors: Freud, Adler, and Sullivan freud recognized family dynamics as essential to dysfunction but never involved family adler went further in emphasizing the family context for neurotic behavior stressing the importance of the family constellation on individual personality organization. harry stack sullivan: adopted interpersonal relations view / people were the product of their "relatively enduring patterns of recurrent interpersonal situations

general systems theory: ludwig von Bertalanffy -1940s: developing comprehensive theoretical model embracing all living systems -assumes interrelation between parts assume far greater significance -circular causality -symptoms in one family member signal family dysfunction rather than individual psychopathology group therapy: john bell / family group therapy involves entire families in the therapeutic process belief that kinship groups provide more real situations and provide a greater opportunity for powerful and longer-lasting system changes as a result of family-level intervention beginnings research on schizophrenia: began in the 1950s to zero in on schizophrenia as an area where family influences might be related to the development of psychotic symptoms -double-bind: communication pattern; exist when an individual, usually a child, habitually receives simultaneous contradictory message from the same important person, typically a parent, and concurrently is forbidden to comment on the contradiction. i.e. lying/non-verbal does not match verbal -schizophrenia reformulated as an interpersonal phenomenon and as a prototype of the consequences of failure in a family's communication system -two patterns of chronic marital discord that were common in schizophrenic families: 1. marital skew: extreme domination by one emotionally distrubed partner is accepted by the other, who implies to the children that the situation is normal 2. marital schism: parents undermine their spouses, threats of divorce are common, and each parent vies for the loyal and affaction of the child -family emotional system: viewpoint by Bowen that emphasized reciprocal functioniong pseudomutuality: false sense of family closeness in which the family gives the appearance of taking part in a mutual, open, and understanding relationship without really doing so. -individuals have poorly developed personal identities and doubt their ability to accurately derive meaning from personal experiences outside the family, preferring to remain within the safe and familiar family system with its enclosed boundaries. psychodynamics of family life: Nathan Ackerman -The Psychodynamics of Family Life, 1958 -demonstrated the applicability of family therapy to less disturbed patients -founded first journal in 1962 with don jacks called family process delinquent families: Salvador Minuchin -at residential setting for delinquent youngster s from urban slums -developed several brief, action-oriented therapeutic procedures aimed at helping reorganize unstable family structures

current status -eclecticism and integration of therapeutic approaches -2 main approaches: functional family therapy multisystemic therapy both evidence based therapies 8 theoretical viewpoints and corresponding approaches to family therapy can be identified object relations family therapy -introjects - memories of loss or unfulfillment from child moving into adulthood -people unconsciously relate to one another in the present largely on the basis of expectations formed during childhood -help families gain isnight into how they internalize objects from the past and ow these objects continue to intrude on current relationship is the central therapeutic effort -Virginia Satir experiential family therapy: -families require growth experience -by being real/authentic themselves and often self-disclosing, expereintial therapiests contend that thay can help family members learn to be more honest and expressive -symbolic-experiential family therapy: gave voice to his own impulses and fantasies and depathologized human experience as he helped family members probe their own covert world of symbolic meanings - freeing them to activate their innate growth processes emotion-focused couple therapy: experiental approach grounded in attachment theory intention is the change a couple's negative interactions while helping them cement their emotional connection to each other transgenerational family therapy Those with strongest affective connections (fusion) are most vulnerable to personal emotional reactions to family stress. The degree of differentiation of self from the family, the less like they will be overwhelmed by emotional reactivity in the family as well as personal personal dysfunction -bowen: child most vulnerable to dysfunction is the one most easily drawn into family conflict. -most attached child has lowest differentiation, will laos likely select a marital partner who has also poorly differentiated -spouses/partners match differentiations & that schizophrenia could result after several generation of increased fusion/vulnerability -Ivan Boszormenyi-Nagy: emphasizes the ethical dimensions in family generations Contextual therapists: patterns passed down from generation to generation, keys to understanding both the individual and family functioning Structural family therapy: Minuchin 1974 -focus on how families are organized and what rules govern their transactions.

-symptoms are viewed as conflict defusers -challenge rigid, repetitive transactions within a family, helping to “unfreeze” them to allow family reorganization Strategic family therapy: Jay Haley -designing novel strategies for eliminating undesired behavior -prefer assignment of tasks to get families to change habits -paradoxical intervention: -belief that families develop unworkable “solutions” to problems that become problems themselves -systemic family therapy: mara selvini-palozzoli (italy) -belief that behavioral symptoms in families represent “dirty games” in which parents and children engage in power struggles -Boscolo and Cecchin: -circular questioning: form of interviewing technique -based on second-order cybernetics, therapist viewed as part of the system Cognitive-Behavior Family Therapy -utilized cognitive restructuring for couples or parents to overcome dysfunctional beliefs, attitudes, or expectations and replace them with positive self perceptions -clients are taught how to better evaluate all beliefs Social constructionist family therapy -post-modern therapy -argue that each of our perceptions is not a duplicate of the world but a lens of our assumptions about people -culture and identity must be addressed to determine a family functioning level in context to worldview -family jointly ly construct new options that change past accounts of their lives and allow them to consider new alternatives that offer greater promise -see: solution-focused therapy and collaborative language systems approach Narrative therapy: Michael White 1995 -sense of reality is organized and maintained through the stories by which we circulate knowledge about ourselves and the outside world. -therapy helps reduce power of problem-saturated story and lets individual reclaim life by maintain a multistoried perspective -not concerned with how family patterns produced the problem but rather how the problem affected the family -therapist task: help liberate families from hopelesness by collaborating with them in exploring alternative stories, making new assumptions about themselves, and opening them up to new possibilities by re-authoring their stories. -externalization (seeing self from outside perspective) helps them notice alternative

choices and paves the way for alternative stories -White especially interested in helping clients reexamine the oppressive stories that formed the basis of how peeople lives their lives -deShazer helps clients view their problems differently, engaging them in dialogue directed at finding new and empowering soluti...