Setting the Stage for Family Counseling/Therapy

1. Setting the Stage for Family Counseling/Therapy • Psychoanalysis: Freud’s acknowledged the role of family relationships in personality development (after World War II) • General Systems Theory: Biologist Bertalanffy and his study of components of a self-regulating total system in continuous change seeking a steady state. (1940s) • Schizophrenic Studies: Bateson’s work on double bind interactions (1950s) • Child Guidance Centers: brought parents into treatment (began in 1930’s); Nathan Ackerman--grandfather of family therapy • Group Therapy: used small group processes for therapy (after World War II) • Family therapists emerged in the 1950s and 60s

2. Bowen’s Strategy of Family Counseling • Differentiation of Self • Triangles • Nuclear family emotional system • Family projection process • Emotional cut off • Multigenerational transmission process • Sibling position • Societal regression

3. Bowen’s Theory provides a framework for understanding how emotional ties within families of origin influence the lives of individuals in ways they often fail to appreciate.Family Emotional Systems Theory (Murray Bowen’s Theory)

4. Bowen’s theory and approach is generally appropriate when the focus will be on the quality of nuclear or extended family interpersonal processes and on the desire for one or more family members to become more differentiated. Level III families often need help with issues related to boundaries, enmenshment, and emotional distance.

5. Differentiation of Self • Extent to which a person is able to distinguish between the intellectual process and the feeling process • Striving for balance, achieving self-definition but not losing spontaneous emotional expression • Fusion is when there is no balance between thoughts and feelings

6. Emotion Reason

7. Triangles • Basic building block in a family’s emotional system • When a moderate anxiety level is reached between two family members, one of the family members may bring in a vulnerable third person. • Triangles dilute anxiety

8. Nuclear Family Emotional System • Four relationship patterns that foster problem development. System anxiety can be passed to other generations. • Marital conflict • Problematic emotional functioning • Functional impairment • Emotional fusion

9. Family Projection Process • Projection is when one person attributes to someone else his or her unacceptable thoughts and feelings. • Parental projection is a major source of transmitted family anxiety.

10. Emotional Cutoff • A person’s attempt to emotionally distance him or herself from certain members of the family or from the entire family. Emotional cutoff is the result of a person’s inability to directly resolve issues of fusion, which in turn prevents him or her from forming a unique identity or satisfying relationships with others.

11. Multigenerational Transmission Process • Severe dysfunction in a family is the result of the operation of the family’s emotional system over several generations. • Genogram: major tool for assessment of families. Visual representation of a family’s composition, structure, member characteristics, and relationships. • Family Mapping: depicts structures and patterns of family systems

12. Bowen’s Family Intervention Techniques • Reduction of anxiety and relief from symptoms • An increase in each participant’s level of differentiation in order to improve adaptiveness. • Meeting with two adults (I.e., parents) is of utmost importance. • Calm questioning and focusing on one’s role in the family problems is critical. • Counselor takes on role of “coach.” She/he asks questions and makes suggestions that the family members discuss and enact with each other. • Counselor may ask family members to talk to him/her to minimize interpersonal tensions. • Genogram is used to gain insight. • Detriangulation • Increase insight

13. Structural Family Interventions • Salvador Minuchin presented the structural approach to working with inner city, poor families (with troubled youth). • Interest in how the components of the system interact, how balance or homeostasis is achieved, how family feedback mechanisms operate, how dysfuntional communication patterns develop, and family transactional patterns. • Most effective with families with level 1 and 2 needs, single mothers, families overwhelmed by life’s circumstances.

14. Structural Therapists Look For…. • Boundaries: What defines who is in or out of a family relationship or the focal issue? • Alignment: Who is with or against the other in the transactions generating the problem? • Power: What is the relative influence of the participants in the interactions that create the problem?

15. Structural Interventions/Techniques • Joining: the process of “coupling” that occurs between the counselor and the family, leading to the development of the therapeutic system. This is done by tracking (counselor following the content of the family facts), mimesis (counselor becomes like the family in the manner or content of communications), confirmation (using a feeling word to reflect an expressed or unexpressed feeling of a family member), and accommodation (counselor makes personal adjustments in order to achieve a therapeutic alliance).

16. Structural Interventions/Techniques (cont.) • Reframing: changing a perception by explaining a situation from a different context. The meaning of a situation changes not the facts. • Enactment: families bringing problematic behavioral sequences into the counseling session • Working with spontaneous interaction: counselors point out the dynamics and sequencing of behaviors observed in session. Focus is on process not content. • Restructuring: changing the structure of the family. Example: if a father dominates to the point of children feeling intimidated, the counselor may ask the rest of the family to uniformly refuse what the father requests, (the family behaving differently).

17. Human Validation Process Approach (Virginia Satir) • “Grandmother” of family counseling • Offered the first training program in family therapy in 1955 at the Illinois State Psychiatric Institute • Coined the term “conjoint family therapy” to describe her type of family therapy. • Satir’s approach is mainly concerned with the family as a balanced system. To Satir, the rules that govern a family system are related to how the parent/s go about achieving and maintaining their own self-esteem; these rules, in turn, shape the context within which the children grow and develop their own sense of self-esteem.

18. Satir’s Communication Styles • Satir contended that the way the family communicates reflects the feelings of self-worth of its members. Dysfunctional communication (indirect, inappropriate, unclarified, inaccurate) characterizes a dysfunctional family system. • Placater: acts weak, tentative, self-effacing, always agrees, apologizes, tries to please. • Blamer: dominates, invariably finds fault with others, and self-righteously accuses • Super-Reasonable: rigid stance, remains detached, calm, cool, maintaining intellectual control while not becoming emotionally involved • Irrelevant: distracts others and seems unable to relate to anything going on • Congruent: real, genuinely expressive, responsible for sending straight (not double binding) messages.

19. Famous Inspirational Quotes by Virginia Satir • “Feelings of worth can flourish only in an atmosphere where individual differences are appreciated, mistakes are tolerated, communication is open, and rules are flexible--the kind of atmosphere that is found in a nurturing family.”

20. Strategic Family Counseling • Jay Haley coined the term “strategic therapy” to describe the work of Milton Erickson. • Strategic family counseling is short term treatment, about 10 sessions. Sometimes strategic family counseling is called brief family counseling. • Erickson believed in the following: • Accepting and emphasizing the positive • Using indirect and ambiguously worded directives • Encouraging or directing routine behaviors so that resistance is shown through change and through normal and continuous actions.

21. Strategic Family Counseling Dimensions • Family rules: the overt and covert rules families use to govern themselves, such as “you must only speak when spoken to.” • Family homeostasis: the tendency of the family to remain in its same pattern of functioning unless challenged to do otherwise. • Quid pro quo: the responsiveness of family members to treat others in the same way they are treated, that is, something for something • Redundancy principle: the fact that a family interacts within a limited range of repetitive behavioral sequences • Punctuation: the idea that people in a transaction believe that what they say is caused by what others say • Symmetrical relationships and complementary relationships: the fact that relationships within a family are both among equals (symmetrical) and unequals (complementary) • Circular Causality: events in a family are interconnected

22. Strategic Interventions/Techniques • Reframing: different interpretation is given to a family situation or behavior • Directive: instruction from a family counselor for a family to behave differently. This is the basic tool of the approach. Directives may include nonverbal messages (e.g., silence, voice tone, posture), direct and indirect suggestions (e.g., “go fast”, “you may want to talk slowly”) and assigned behaviors (e.g., when you think you won’t sleep, force yourself to stay up all night.). • Paradox: Gives permission to family to do something they are already doing and is intended to lower or eliminate resistance to change. • Restraining: counselor tells family that they are incapable of doing anything other than what they are doing. • Prescribing: family members are instructed to enact a troublesome behavior in front of the therapist. • Redefining: attributing positive connotations to symptomatic or troublesome actions.

23. Multicultural Issues in Family Work • Seven major factors that distinguish ethnic minorities from mainstream middle class white American families • Ethnic minority experiences with racism and oppression • The impact of external systems on minority cultures • Biculturalism • Ethnic differences in minority status • Ethnicity and language • Ethnicity and social class • Ethnicity as a narrative identity