Family Therapy

1. Family Therapy http://www.youtube.com/watch?v=9PU-hTdkzg8

2. Two 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.

3. Differentiation 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.

4. Triangles • 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!

5. Triangles • 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?v=nAvspf49UTE

6. The 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?v=4fC6x8paqpc

7. Emotional 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.

8. Emotional 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?v=0Bgshe4S3_s

9. The 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.

10. Family 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.

11. Family 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.

12. Family 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.

13. The 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.").

14. Sibling 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."

15. Emotional 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.

18. Normal 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

20. Family 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.

29. Goals 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..

31. Techniques 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 organisation’s child protection policies

32. Getting 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.

33. Reflective 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."

34. Asking 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 wouldn’t 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”.

35. Being 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 client’s 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.

36. How 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?v=AQ4Pktv4-Gc • http://www.youtube.com/watch?v=8-1L5WclNTg • http://www.youtube.com/watch?v=iB1ZZ6Bh4GM • http://www.youtube.com/watch?v=fF-11ulCPTE