Foundation Concepts in Family Therapy

1. Foundation Concepts in Family Therapy Some of the Core concepts covered in Chapters 1-4 EPSY 6393 with Dr. Sparrow

2. Myths to be shattered • Health could be achieved only by leaving home; the hero myth • Freud: Effects of family were real, but they were intrapsychic, and in the past • Rogers: Self actualization could only be pursued in isolation from the family’s oppressive influence

3. Family therapy’s premises • That the forces of change are located external to us, in the family system • That change in any member affects the whole family – systems theory

4. Which approach is best? • Individual therapy when the social relationships are stable, and the person is in distress • Family therapy when the social relationships are unstable, and the person is in distress

5. Big concept: The Family is a System • The family system is more than a collection of individuals • It is an organic whole with its own identity and dynamics • Members function in the system differently than they do in isolation

6. Circular Causality • Based on the idea that we are in a constant feedback loop with the persons in our lives. Also referred to as “cybernetic loops,” or “synchronous feedback.” • Linear causal explanations try to find who is at fault, or to blame. • Circular causal explanations try to understand what each person is doing that sustains the problem, and what they can do differently to change the situation.

7. Family Therapy is simpler than you Think! A Small Number of systems dynamics accounts for most family distress, so relax, you can do it! Dr. Sparrow says

8. Group Theory:The Basis for Family Therapy • Group theory provided a foundation for understanding the family • Lewin • group is more than sum of parts • interaction could be curative • a focus on the here and now; ahistorical • Groups are inherently tense as members vie for freedom and services • Process dimension became more important than content: how, not what

9. How Groups differ from Families • Group members come to therapy to find a sanctuary in which to discuss problems vs. families bring their problems into the office • Group members can be assured that what they say in therapy won’t follow them home vs. families have to live with the consequences of their disclosures • Groups are comprised of equals without a past vs. families are comprised of unequal members who have a past and future together

10. Early Misconceptions • The mother-child bond was the source of all problems, e.g. “schizophrenegenic” mothers. • Parents are always to blame, and children have to be protected from them.

11. The First Family Therapists: The Palo Alto Group • Bateson’s work with communication in schizophrenic families led to some of the first important contributions the the field. • rules • Metacommunicaton (report and demand) • double binds • feedback, or cybernetics • homeostasis (Jackson)

12. Negative and Positive Feedback • When a family’s rules are challenged, the family usually treats this challenge as “negative feedback,” that is a reason to reassert its rules • Positive feedback is information that a family perceives as a call to change its rules.

13. Families Break down under Stress • Normal families need help when they can’t adjust to stress • Family rigidity, or a refusal to alter rules, keeps a family from adjusting to change • Life changes bring about • developmental stressors • environmental stressors

14. Big Concept:Families resist change • Homeostasis means that families resist change • Direct attempts to foster change will evoke resistance • Insight is unnecessary, and can even get in the way. • Therapist must take an indirect approach in order to succeed

15. Relationships are Symmetrical or Complementary • Symmetrical relationships have a lot of similarity and equality -- common ground, comfortable • Complementary relationships are based on differences, opposite attraction -- not much common group, very dynamic • The pursuer-distancer dynamic grows out of complementary roles

16. Triangles are a basic structure in dysfunctional families • Triangles form when a person seeks out a substitute for relating to a person with whom he has difficulties • Cross-generational coalitions are a triangle between two generations; that is one parent joining with a child against the other parent.

17. Palo Alto Brief Therapy School • Based on the idea that families resist change • Assumed that a direct approach would only provoke resistance • downplayed importance of insight; in fact, considered insight to be an obstacle at times

18. Milton Erickson’s influence on Jay Haley • Erickson mastered techniques for circumventing resistance in hypnotic subjects. • Symptom prediction, symptom prescription (paradoxical or strategic) • Indirect methods • Reframing

19. Bowen’s Systems Family Therapy • differentiation of self is central concept • triangle is smallest stable unit of relationship. • cross generational transmission of patterns; focused on the family of origin, not the nuclear family • genograms as a way of assessing generational patterns

20. Whitaker and Satir: Experiential Family therapy • Existential-humanistic, person centered • Believed that family members needed to unlease their true feelings, and become more honest with each other. • Believed that humans were essentially good, and just needed to be helped in expressing the truth of who they are.

21. Minuchin’s Structural Family Therapy • boundaries; disengagement and enmeshment • hierarchies • joining • enactment • restructuring

22. Origin of Family problems • As already stated, families break down when unable to adjust their rules to accommodate new developments • Family therapists are interested in what was happening when the problem arose • But more interested in what the family is doing to perpetuate the problem • The family’s “solution” is often the problem -- the reassertion of old rules

23. Process is Everything • As mentioned earlier, a therapist must focus on what is going on between members, not the specific problem • If a therapist tries to solve the problem as it’s defined, rather than looking at the way the family sustains the problem through their interaction, there will be no progress.

24. What you do depends on Your style and theory • Some therapists will openly point out the problems in relating, in order to bring about insight. • Some therapists will actively manipulate the family (move them around, get them to interact, etc.) to bring about change in the session, without worrying about insight. • Some will do both.

25. Major interventions • Joining -- Minuchin • Process Questions -- Bowen • Genograms -- Bowen • I position (to stop blaming) -- Bowen • Reframing -- Haley, Minuchin • Paradoxical interventions and therapeutic double binds -- Haley • Enactment and restructuring-- Minuchin

26. Session Objectives:First session • Joining: Making contact with each person. Balance warmth and professionalism to prevent induction. • Assess problem from each person’s perspective • Explore specific problems and attempted solutions: Use process questions to explore. • Develop hypotheses about the interactions that are sustaining the problem.

27. Early Phase Objectives • Keep it simple. Focus on primary problems and the dynamics perpetuating them. • Formulate hypotheses around structure and dynamics, not so much the personal or intrapersonal aspects. • Bring the problem into the office. Allow interaction and support “enactments.” • Reframe, challenge, and restructure the enacted dynamics around new boundaries • Assign homework that continues the new relationship dynamics

28. Mid-Phase Objectives • Foster responsibility; challenge the blame game with process statements/questions, unbalancing, and reframing • Keep your efforts related to primary complaint, but your interventions focused on interactive process. • Use intensity to challenge members to demonstrate their competencies • Don’t splinter the family into subgroup work without keeping the big picture in mind.

29. Termination • A time for the family to evaluate its progress, and to consolidate what they’ve learned. • Do they get it? • Are the benefits being seen elsewhere? (generalization of therapeutic gains) • Are they satisfied? • Can they do it on their own? Are relapses merely part of the growth process, or are there problems that you still need to address? • Immunization strategies: preparation for relapse

30. Exceptions and Ethics Issues Pertaining to Marital and Family Work • Child abuse • Domestic violence • Confidentiality, triangulation, attraction

31. Chapter Four:Deepening Our Knowledge of Systems • Cybernetics revisted: Sequences of family dynamics; negative and positive feedback • Closed systems and open systems; therapist role; living systems are open, and exhibit: • equifinality • morphogenesis -- tendency to seek change

32. Chapter Four:Deepening Our Knowledge of Systems • Systems dynamics explains several relationship problems that tend to get worse without outside intervention: • Controller/rebel • Approacher/distancer • Overfunctioning/underfunctioning

33. Chapter Four:Deepening Our Knowledge of Systems Systems dynamics are revealed through spontaneous sequences of behaviors. These sequences tend to erupt early in the family therapy sessions. By allowing them to occur, you can see the problem in action, and (depending on your approach) can intervene to get the family to correct it.

34. challenge to Early Family therapy:Social constructionism • Relates to the age-old notion that knowledge of the world is filtered through beliefs, experience, and language, and relationships • Reframing is a constructionistic technique: co-creating reality • Moves therapy into the cognitive realm, away from focus on behavior. • Minimizes the importance of the therapist as an expert

35. Constructionism challenges Prevailing “Truths” • Cultural and gender assumptions vary over time, so roles are changeable. • Social “truths” become enshrined within prevailing approaches to therapy • “Deconstruction” of the socially constructed narrative is essential. • Collaboration is essential within a social constructionist approach

36. Attachment Theory • Is a way that family therapy has reintroduced psychodynamic concepts into relational events. • Assumes that the basic human impulse is to form secure bonds, or to seek closeness in the face of stress. • When the formation of secure bonds are disrupted, a child reacts in two different ways. • Resistance/clinging • avoidance

37. Summary • Context is more important than content, so it is important to meet with the family to establish the context of a person’s distress. • People are complementary, and will compensate for their partners’ style by going the other direction. This creates a number of “workable” problems. • Families and couples are constantll engaged in circular exchanges. Solutions have to take this into account.

38. Summary • Triangles account for much of a couple’s or a family’s dysfuntion. Direct communication or “detriangling” is the solution. • Process is always more important than content. • Family structure determines how people relate. (Boundaries are the key) • Enmeshment • Disengagement

39. Summary • Symptoms can benefit a family by helping members avoid other issues. • Families pass through a predictable life cycle, and face predictable challenges related to each stage of developoment. • Resistance is normal and healthy. Don’t fight it, but create a trusting relationship with the family and an environment that is comfortable.

40. Summary • Family stories or narratives can help the therapist understand how to intervene. • Gender roles and assumptions play a huge role in family distress. • Culture and ethnicity –It is important to be respectful of these factors, but it’s also important to confront counterproductive beliefs and values regardless of their source.