SWK 674 Social Work And Families Lecture No Fifteen

1. SWK 674 Social Work And Families Lecture No Fifteen A Comparative View Of Family Theories And Therapies

3. Systems are complex Systems are complex, and each family member has specific needs that may conflict with those of fellow family members. By definition, members of a family are at different stages of life cycle development and may require different intervention procedures. Social Constructivists as well as advocates of gender-sensitive family therapy have been especially influential in drawing attention to the social and political climate in which today�s families function.

4. Units Of Study: Monads, Dyads and Triads Many of the early family therapy pioneers ( Bowen, Jackson, Wynne, Boszormenyi-Nagy) themselves largely schooled in psychoanalysis, did what most revolutionaries do-they rejected out of hand the then-mainstream theory of psychoanalysis. They especially rejected the psychoanalytic focus on interpersonal dynamics-the monadic view that problems reside within the individual.

5. Within families Within families there are dyadic ( two-person ) and triadic ( three-person) viewpoints. Thus, boundaries, emmeshments, disengagements, subsystems ( Minuchin) or triangles, symbiosis, fusion ( Bowen ), or relational ethics and family loyalty (Boszormenyi-Nagy ) all look beyond the individual to his or her recursive patterns or behavior within a system.

6. In general In general, modern psychoanalysis has morphed into object relations theory, and the new look is more relationship based. Object relations family therapists, still interested in intrapsychic conflict, now attempt to understand family relationships from the past that each partner brings into the marriage. The husband-wife dyad may contain examples of projective identification , as the partners project unwanted parts of themselves onto the other.

7. Bowen�s theory Bowen�s theory is clearly triadic, particularly in his concept of triangles and are the basic building block of the family�s emotional system. Similarly, Structuralists are triadic-boundary diffusion between two people inevitably involves reciprocal relationships (enmeshments, disengagements) with a third participant. Triadic explanations, such as coalitions and alliances, broaden the lens, providing a larger context for understanding behavior.

8. Solution-focused collaborative and narrative therapists Solution-focused collaborative and narrative therapists frequently direct attention to solving the individual�s problems, leading some critics to contend that the focus on the family is lost. On the other hand, Michael White, for example, and his narrative colleagues never loose sight of the family; indeed they try to change the direction of the family�s energy in order to help the family detach from a restraining story line.

9. Similarly Similarly, Michael De Shazer tries to help family members exchange their � problem � focus for a �solution � focus arrived at together, and Harlene Anderson attempts to help each member � dissolve � his or her version of the � problem. �Although they may not directly address the pattern of family conflict, all three persist in getting the family as a whole to abandon seemingly intractable, self-restricting stories about themselves in favor of new self-descriptions with more satisfying options.

10. Time Frame: Past, Present, Future Here again, early family therapy pioneers broke with the psychoanalytic search of the past for explanations of current difficulties, preferring to focus on the here-and-now family interactions. Without denying the influence of past experiences on family functioning, most looked to ongoing transactions, turning to past experiences only if necessary to enhance understanding of what is currently transpiring in the family system

11. Long-term classical psychodynamic therapy Long-term classical psychodynamic therapy does focus attention on conflicts developed in each client�s early formative years; but the length of treatment and high cost are out of favor today, particularly since the effectiveness of this type of therapy in symptom control has been challenged. In their contemporary form, such as in the object relations therapy, they do more than search for past trauma ( although they are interested in ferreting out introjects from the past ). They are briefer, and they aim more directly at helping clients discover how past unresolved conflicts and attachment loss help explain the current personal and interpersonal difficulties.

12. The transgenerational models The transgenerational models are most apt to attend to unfinished and recurring business from families of origin. Bowen is interested in the client�s degree of family fusion. Boszormenyi-Nagy in his or her sense of family loyalty and obligation. Both Bowen and Boszormenyi-Nagy helped families understand the impact of past generations on their values, their typical behavior patterns, attachments, ways of examining and resolving problems, power issues, and so forth. ( Framo and Whitaker also adopted a multigenerational outlook, the former by inviting clients to bring in families for family of origin sessions, the latter by bringing in grandparents as consultants to ongoing family sessions ). Bowen�s efforts to develop genograms with his client families helped explicate for them a transgenerational basis for their current behavior. Boszormenyi-Nagy insistence on family debts and obligations may be rooted in the past serves as a similar function.

13. Social-Constructivists Social-Constructivists, such as De Shazer, deal with problems in the present, looking from the start at future solutions. They do not look at the past for clues to the origin of the problem, not do they dwell in the present. Beginning with the initial contact with the family; they are looking for signs of change, working towards future solutions. If the past is questioned, it is likely to be in order to help the client recall when an earlier solution helped solve a problem and thus fight be employed again in the current situation.

14. Narrative therapists Narrative therapists also help clients search for unique outcomes-times when they overcame a problem-saturated story- in the serviced of �thickening � stories of success as an aid to overcoming future hurdles. For them, the past is a repository of successful resilient efforts at overcoming problems that can be applied to current difficulties.

15. Psycho educationally oriented therapists Psycho educationally oriented therapists , working with post-hospitalized schizophrenics and their families, offer practical hints for making day-to-day life together more harmonious and less stressful. They are not interested in how the symptoms emerged, who is to blame, and what in the past caused the present family difficulties. Rather, they would like to teach families how best to stop perpetuating the problem. Similarly, those offering short-term educational programs, teaching ways of coping with marital or parent-child conflict, emphasize the learning of skills and do not search for explanations of the possible origins of the presenting difficulties.

16. Functional And Dysfunctional Families All theories have at least an implicit-if in some cases, unstated-viewpoint regarding normal functioning. Bowen essentially bypasses the issue of normality by his concentration on optimal functioning and the related issues of differentiation and the separation of emotional and intellectual functioning.

17. According to Bowen According to Bowen, a well-differentiated person can become dysfunctional, but is likely to recover rapidly and with minimal impairment by calling upon a variety of coping mechanisms at his or her disposal; a poorly differentiated person gets caught up in family turmoil and recovers less well or quickly,. The ideal situation in a marriage, according to Bowen, is for two highly differentiated partners to achieve emotional and intellectual intimacy without a loss of autonomy.

18. Modern psychoanalytic theories Modern psychoanalytic theories, including object relations viewports, have a great deal to say about functional and/or dysfunctional families. They stress, for starters, the importance of the infant�s attachment to the mother or other caregiver as crucial to the development of a strong, cohesive self in an adult. Internalized images and introjects from the past shape future relationships, including marital choices.

19. Splitting, projective identification, and object hunger Splitting, projective identification, and object hunger all play a role in marriage, which is influenced by infantile experiences. In dysfunctional relationships, participants relate to one another as internalized objects, looking to reestablish missing or repudiated parts of themselves. To object relations theorists, dysfunctional family relationships result from unresolved infantile problems with parents, carried over from the individual�s parents and, if unresolved, passed along to future generations.

20. Experiential family therapists Experiential family therapists adopt a humanistic, egalitarian stance, and view functional families as naturally self-actualizing; they have free choice, free determination, and tend to operate as open systems. Individual development through the seeking of new experiences is encouraged and supported by the family. From the perspective of these models, dysfunction arises from societal pressures to deny and suppress natural impulses, consequently inhibiting spontaneity and growth.

21. Minuchin and the Structuralists Minuchin and the Structuralists see normal family life as ever changing and thus continuously in need of making accommodations to changing situations. What distinguishes such families from dysfunctional ones is the functional family�s flexibility in changing or modifying its structure to fit new situations such as changing life cycle stages or adjusting to new role changes or situational crises. The clarity of boundaries Between subsystems within the family, and an effectively functioning spousal subsystem, help ensure stability despite changing conditions.

22. Interactional family therapists Interactional family therapists at the Mental Research Institute believe dysfunction arises from persistent faulty solutions to common difficulties. They contend that mishandled, self-defeating, more-of-the �same solutions imposed by the family are not a symptom of some underlying problem, but rather that those flawed solutions represent the problem itself.

23. Behavioral/Cognitive family therapists Behavioral/Cognitive family therapists, supported by the most comprehensive research investigations into marital conflict, stress the importance of a positive communication exchange of rewarding behavior between partners in maintaining a happy relationship. Dysfunctional marriages, according to John Gottman, are filled with negativity-criticism, contempt, stonewalling and defensiveness.

24. Solution-focused therapists Solution-focused therapists downplay interest in formulating a theory of functionality and/or dysfunctionality, since they contend that whatever preconceived label we use to explain another�s behavior is in the eyes of the beholder and therefore an inadequate , arbitrary criterion of normality and abnormality. They add that ethnicity, rape, type of family organization, sexual orientation, and so forth, must be factored into any appraisal of the ways a family lives.

25. Collaborative and Narrative Therapists Collaborative therapists such as Harlene Anderson, also working from a social constructivist framework, are not interested in labels, but rather in �dissolving � problems and co-creating new stories in their place. Narrative therapists, departing from �the therapist as expert �position, honor each family�s unique heritage. And avoid pathologizing labels, which they are likely to view as thin descriptions unfairly imposed on families by doctors or others with definitional powers in society.

26. The Role Of The Therapist Object Relations therapists are interested in creating a safe, nurturing atmosphere in which to examine and attempt to resolve the family�s unconscious conflicts that interfere with current family relationships. To do so these therapists adopt a safe, holding environment; they are empathetic, attentive and interested in exploration; and they listen without rushing to advise or reassure. In providing clarification or insight into intrapsychic or interpersonal conflicts, they offer interpretations to each participant separately ( rather than focusing on the family system ), and then examine transference and counter transference reactions.

27. In contrast to such neutrality In contrast to such neutrality and keeping of therapeutic distance, experiential family therapists strive for active, spontaneous, honest and open encounters. Virginia Satir, with her warm and personal manner, tried to provide a role model for straight talk and clear communication, all directed at increasing client self-esteem. She often relied on touch to make contact-unlike Werner Kempler, whose confrontational verbal style, insistent and often uncomfortably open and direct, provoked clients into engaging in honest emotional exchanges with him and with each other.

28. Carl Whitaker Carl Whitaker, spontaneous, without a plan of engagement prior to a session with clients, and eschewing a neutral stance-shared his feelings and fantasies in order to allow his clients to feel free and safe enough to do the same.

29. Bowenians Bowenians are coaches, attempting to minimize their emotional impact on the family (and, in turn, avoiding being caught up in any family emotional conflict). Therapists using this approach attempt to be calm and low-key, behaving as experienced experts outside of the family who are questioning to help define and clarify the family�s emotional system. They try to regain in non-anxious emotional contact with family members, careful not to be triangulated into the family�s entangling conflicts and toning down family emotional expression, but at the same time directing efforts to help members gain greater self-differentiation ( take � I � positions ). Helping clients return to their families of origin after coaching them to continue their differentiating efforts is part of the therapist role.

30. Structuralists, Strategists, and Milan therapists Structuralists, Strategists, and Milan therapists all move in and out of therapeutic process at key points. Structuralists join the family system in a leadership role, accommodate to the family style, map out the structure the family has developed, and go about helping them change that structure to adapt to changing conditions. As active stage directors, they carefully plan how to adjust to each family, reframe messages, and help families create flexible boundaries and harmonious, integrated subsystems.

31. Strategists Strategists are also active and manipulative, issuing directives, relabeling behavior, sometimes prescribing symptom maintainence and employing after paradoxical techniques. Using a wide variety of techniques, they tailor interventions to specific symptoms and custom-design problem �solving strategies to eliminate the presenting problem.

32. The Milan group The Milan group employs many strategic techniques, but adds the unique contributions of positive connotations, rituals, and circular questioning ( an especially provocative and effective intervention that may allow the system to heal itself ). Milan therapists make frequent use of an active and intervening observing team behind the one-way mirror.

33. Solution-focused therapies Solution-focused therapies get right to work helping clients define the changes they are looking for; they do not spend time speculating on the origins of the presenting problems. Assuming clients know what it is they wish to change, these therapists collaboratively engage in therapeutic conversations ( �miracle questions �, �exceptions questions,� ), helping clients construct solutions.

34. Therapists Therapists who adopt the linguistic approach of Harlene Anderson and the late Harry Goolishan also use collaborative procedures, viewing clients as conversational partners; therapist and client engage in a joint search for altered or new meanings, attitudes and narratives.

35. Narrative therapists Narrative therapists, as co-authors, also help clients develop new meanings, using questioning to aid clients as they revisit and re-write old, self-defeating stories, replacing them with preferred empowering stories about actively directing their futures.

36. Feminist family therapists Feminist family therapists typically are active in helping both men and women overcome stereotypic thinking about gender roles, they, like the narrative therapists, help Help family members identify those damaging, culturally influenced, sexist practices that stifle individuality. Psycho educational family therapists are active teachers and coaches, interested in inculcating skills to aid in reducing family conflict.

37. Assessment Procedures All family therapists engage in some form of evaluation with families, beginning with the initial session and continuing through out treatment, as the therapist gathers data and formulates ( and reformulates ) hypotheses. As therapy proceeds, some of the original speculations may be confirmed and built upon, others negated by new information and rejected, still others changed as the therapist modifies his or her assumptions and shifts therapeutic strategies.

38. While some family therapists While some family therapists consider a formal assessment procedure to be central to their therapeutic planning, there are those who consider it peripheral to their therapeutic interventions, in some cases believing one should not sit in judgment of others (the client knows best what he or she needs ) even for therapeutic purposes.

39. Nevertheless Nevertheless, systemically or not, all therapists make some sort of appraisal of new client families, inevitably comparing them to other families worked with previously who presented similar complaints and who profited from a specific set of interventions.

40. Behavioral family therapists Behavioral family therapists are particularly interested in defining, and, if possible, measuring the extent of the maladaptive problem, using standardized interview procedures and formal test instruments. How frequently does the undesirable behavior occur? What events preceded the appearance of the behavior? What are its consequences? What reinforcements are operating to maintain the problem?

41. The most The most commonly encountered cognitive-behavioral therapists are likely to employ questionnaires and inventories for each family member, to get a sense of the different perspectives about the family problem. In particular, they want to assess not just the frequency but also the reciprocal patterns between members that perpetuate the problem, all in preparation for introducing a cognitive restructuring program.

42. Bowenians Bowenians begin by gathering historical data in the form of genograms, allowing the therapist and family members together to ferret out family problems over several generations. In the process the therapist and the family obtain an inside picture of unresolved issues and family patterns from the past, and the family also gains a perspective regarding issues that have hampered family functioning over generations.

43. Other family therapists Other family therapists interested in longitudinal history look for patterns from the past that impose themselves on current family functioning. Boszormenyi-Nagy might assess intergenerational indebtedness; object relations therapists focus on possible unconscious conflicts from the past, within each partner in a relationship, that have led to a stalemate in their attempt to develop intimacy.

44. In gender-sensitive approaches In gender-sensitive approaches, the feminist therapist working with a couple might review with them a history of exposure to sexist attitudes or current gender discrimination that negatively affects optimal marital functioning.

45. Another group of family therapists Another group of family therapists, interested in assessment, prefers a cross-sectional view of family functioning instead of adopting a longitudinal framework. What led the couple or family to see help now? A Mental Research Institute ( MRI ) strategic therapist might wonder aloud if the family has gotten stuck, trying the same Solution and meeting the same frustrating barriers again and again, this perpetuating the problem.

46. Structuralists Structuralists rely on observation of the family in action, mapping transactional patterns, provoking enactments to detect boundary problems such as enmeshment and disengagement. They might perceive that family as being at a transition point, needing a restructuring but unable to move beyond the impasse without the therapeutic intervention. Affiliating with the family, they are in no position to understand its organizational structure and ongoing transactional patterns, its subsystems and its hierarchical design. Experientialists, especially cross-sectional (�here-and-now� ), help families search for suppressed feelings and impulses that need to be unblocked in order to gain greater growth and fulfillment.

47. Beyond longitudinal and cross-sectional emphases in assessment Beyond longitudinal and cross-sectional emphases in assessment, there is a third viewpoint-minimal to no interest in the family�s history and current system of functioning. The social constructivists believe they are in no position to evaluate others, since their view is just one of many perceptions of the situation, and the client�s knowledge about themselves taking priority. Believing that they are not objective observers with a truthful interpretation of reality, social constructivists adopt the egalitarian viewpoint that they need to engage families in conversation, not evaluation. Such a collaboration results in the therapist and family members examining the family�s stories about themselves ( and especially the meaning families give to those stories ) that families can re-author for greater empowerment.

48. Solution-focused therapies Solution-focused therapies are a good example of unencumbered elegance, focusing from the start on simply finding the skeleton keys (general guides) to move clients towards solutions. In this brief approach, problems are not uncovered and assessed; rather, the thrust is towards solution development and client empowerment. The collaborative approach of Harlene Anderson also adopts a � not knowing � attitude by the therapist, meaning she does not determine or have set ideas about what is wrong with the family and what needs to change. That shared determination emerges from the conversation together.

49. Narrative therapists Narrative therapists, too, do not feel they have special privileges over their clients, nor are they interested in playing expert diagnostician of another person�s motives or personality characteristics. What they are interested in doing is liberating people from a sense of helplessness and despair; their persistent questioning is directed at exploring and expanding beliefs and visions about the future, not in gathering data for assessment or diagnostic purposes.

50. Insight and Action Modes The early family therapists, especially those with classical psychoanalytic training, believed insight produced understanding and clarification, perhaps helping clients better comprehend the underlying conflicts from the past that continued to undermine their current functioning. These therapists contended that by gaining greater self-awareness of such things as interlocking pathology or role complementarity or the function of a symptom in the family system, these families would then take action on their own behalf.

51. Nathan Ackerman Nathan Ackerman, for example, used psychodynamic techniques such as confrontation an interpretation to expose both intrapsychic and interpersonal conflict when working with troubled families. Bowen also helped clients gain insight into their role in family triangles and other interpersonal aspects of the nuclear family emotional system, encouraging them to use that understanding to attempt new relational patterns-new actions-based on these insights. Stressing the importance of action-they were often breaking away from the individual � talk � psychoanalysis-these therapists nevertheless saw insight as a necessary prerequisite for change through action.

52. Is insight Is insight into hidden and unresolved conflicts always necessary for behavioral change to occur? Strategists insist this is not the case. They argue that believing a family needs to gain insight into causes before change occurs is to erroneously believe in a linear, unidirectional causality from past to present. Behavioral/cognitive family therapists are also empathetically unconcerned with insight or inferred underlying motives, pragmatically focusing on observable behavior and what needs repair. For them, the search for underlying causes call for high levels of inference, and often ends up producing useless explanations at the cost of needed action.

53. Structuralists Structuralists provide a good example of combing action and insight- new actions lead to new experiences that in turn lead to new insights and understanding. Enactments, for example, may demonstrate successful actions that make insight possible and later can be added to the family repertoire. Restructuring helps families view the world differently and these new views inevitably lead to members flexibly trying out new roles and new experiences. Gestalt therapist Werner Kempler also tries for dramatic emotional breakthroughs in the session, believing these will later be carried forward in greater spontaneity and self-expression.

54. The Milan group The Milan group especially Cecchin and Boscolo, looking beyond insight-versus-action interventions, invites families to examine their meaning system and break through old games by building family consensus about reality, in an effort to discover new possibilities not previously considered. Their later formulations have led to the current cognitive emphasis prevalent in the social constructionist therapies. Cognitive change, as opposed to insight, opens avenues for fresh ways of thinking, not necessarily for gaining new insight.

55. Narrative therapy Narrative therapy bypasses any insight-action dichotomy, focuses instead on cognitive change ( finding new meanings ) ands the collaborative search for more optimistic, productive solutions that are within the client. Rather than offer insights-which would presume that they understand the client better than he or she does him or herself-narrative therapists provide a climate in which client and therapist can co-construct alternative stories in place of those that have left family members or kinship groups feeling defeated and hopeless. In this technique, narrative therapists are joined by advocates of reflecting teams and the linguistic, conversational techniques in giving priority to new meanings order action per se.

56. Key Methods Of Intervention Psychodynamic family therapists make use of interpretation in order to help clients understand the unconscious meaning of their thoughts, verbalizations and behavior. They may clarify or challenge client statements, or make comments that link one event with another (�You�re afraid to commit your relationship with Sally, here, because you suspect your mother was unfaithful to your father and covered it up. � ) These therapists rarely ask questions or take the lead in what gets discussed, sometimes deliberately becoming silent to provoke greater family exchange.

57. Experiential family therapists Experiential family therapists are often confrontational, in an effort to provoke self-discovery or self-examination (�you always seem to change the subject or make awoken whenever we discuss our sex life together. What�s making you so uncomfortable that you need to cover it up? ) They may introduce verbal or physical exercises ( sculpting, role play, reconstruction ) to encourage the expression of feelings , and often use self-disclosure to stimulate similar open behavior to clients.

58. Bowenians Bowenians question, coach, encourage individual efforts at self-determination by teaching clients to take �I positions �expressing how they feel. Contextual therapists appeal to fairness, promoting the balance of the family ledger. Structuralists work on clarifying boundary diffusion and often turn to enactments to introduce changes into the family structure. They join and accommodate to the family�s interactional style, and often use reframing to relabel a family�s perception of an event and make it more conductive to therapeutic change.

59. Strategists Strategists also utilize the reframing technique and addition use directives and paradoxical interventions to bring about change. Milan therapists use positive connotations and circular questioning to aid family members in learning about perceptions of other family members.

60. Behaviorists and cognitive behaviorists Behaviorists and cognitive behaviorists attend to the contingencies of reinforcement, first observing and analyzing how families reinforce undesirable or problematic behavior. After such a functional analysis, they rely on skills training and cognitive restructuring to teach families to alter or modify thoughts about the meaning of an event. Psycho educational family therapists make use of similar techniques to teach skills to specific populations.

61. Solution-focused therapists Solution-focused therapists address efforts to arrive at a successful solution by utilizing a variety of techniques-miracle questions, exception-finding questions, scaling. The narrative therapist�s trademark is externalization, by which the problem is recast as outside the symptom-bearer and the family is united to deal with the oppressive agent. By a series of persistent questions, clients are encouraged to adopt previously subjugated stories that replace negative and self-defeating dominant stories.

62. Crisis, Brief And Long-Term Family Therapy Brief family therapy is usually defined as less urgent and it has an agreed upon termination point. The duration of most family therapy has become shorter than in the past ( and frequently dramatically shorter than individual therapy ) particularly in the age of managed care and long waiting lists at clinics. Brief or time-limited therapy, say with a marital couple in distress, tends to be highly focused on the presenting problem.

63. In most cases its aims In most cases its aims are limited to achieving a specific goal, which may range from establishing more effective ways to resolve differences between spouses to decisions about divorce and child custody arrangements.

64. Strategic therapists Strategic therapists, particularly those at the Brief Therapy Project in Palo Alto,Ca Mental Research Institute, limit their sessions to ten sessions. They announce this policy to clients at the start as a motivator. Solution-focused therapists at the Milwaukee Brief Therapy Center offer still fewer sessions, but do not announce a time limit in advance. They immediately start to work with clients on solutions with the expectations of change and of utilizing client resources, and they often require a handful of sessions to reach the agreed-upon achievable goals. Haley performs strategies by stages, and the Milan group also sets limits on the number of sessions.

65. Social constructivists and narrative therapists Social constructivists and narrative therapists are also oriented to provide help that is brief and problem-driven, although the length of treatment is not their main concern. Unlike the strategists, who were influenced by Milton Erikson and Gregory Bateson, their focus is on language shaping a person�s experiences sand sense of reality. Correspondingly, they aim their interventions at cognitive changes as clients reconstruct their experiences through developing new stories.

66. While there are few While there are few long-term family therapies-psychoanalytic couples therapy efforts may be the exception.- some approaches contend that change takes time, and thus they require several weeks or even months before therapy termination. Experiential models with vague goals of �growth� or �self-fulfillment� tend to have arbitrary endpoints, letting the family members decide when they wish to stop.

67. Structuralists Structuralists wait to see how well the family has restructured its dysfunctional sets and how flexible it has become to accommodating change, before terminating the session. Bowenian therapy,-too- with goals of changing a large, extended family system- may be of considerable duration.

68. Families Families with severe and/or multiple problems require long-term help. , or help from time to time over the years for continued help. Long-lasting unresolved problems ( persistent bickering, gambling episodes, disputes with in-laws, bouts of alcoholism, violence, periodic infidelity, cycling in and out of serious depression ) may prolong treatment.

69. Goals of Treatment Some ( psychodynamic ) therapists do so by providing insight , some (experiential), by encouraging open communication and emotional expression, some ( behavioral cognitive ) by building skills and cognitive restructuring , some by expanding the family system through the use of reflecting teams or outside witness groups.

70. Object relations therapists Object relations therapists, for example, identify and help clients gain awareness of introjects from the past and negatively intrude on current ways of dealing with others. More focused in their aspirations, some (solution-focused or strategic) therapists help families solve the immediate problem they came to therapy to resolve; they are consistent with symptom reduction. Therapists using psycho educational approaches are satisfied if they can help a family cope with serious disorders and keep its diagnosed member from From returning to the hospital (or at least reducing the number of such returns). Narrative therapists cognitively focus on problem resolution, but to go beyond that, challenging the family to revise its relationship with the problem and encouraging members to re author their lives in more hopeful ways.

71. Different theorists Different theorists have different priorities regarding what requires change. Satir was insistent that family members learn to communicate with greater clarity, asking for what they want and expressing how they feel in a direct and undisguised manner. Whitaker wanted to make certain that what clients said was congruent with what they are experiencing internally, in an effort to increase authenticity. Both believed clients enhance their ability to live more fulfilled lives as individuals and as a family as they grow and work at self-discovery.

72. Bowen Bowen, in contrast, argued that individuation or self-differentiation was the key to starving off anxiety and avoiding being swept up in the family�s emotional system. Structuralists such as Minuchin very specifically set out to change those parts of the family system that call for reorganizing-its boundaries, its hierarchy, perhaps its parental subsystem.

73. Structuralists Structuralists, for example, join the family, accommodate to its style, and assess the family structure, and so forth, before making therapeutic moves directed at restructuring flawed parts of the system. Cognitively oriented family therapists also follow prescribed therapeutic formats. Some approaches (solution-focused ), however are less structured and pragmatic, aiming their interventions at finding new solutions to presenting complaints, and not particularly concerned about any underlying set of problems.