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Family Therapy

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  • 1. THE PRECURSORS Freud - symptomatic behavior in neurotic individuals. Adler – Family constellation Sullivan – interpersonal relations view for families with schizophrenia.- Ludwig von Bertalanffy (1968) – General systems theory and Circular causality John Bell (1961) – Family group therapy Bowen – Hospitalized families - family emotional systems. Wynn – pseudomutuality – false sense of closeness Nathan Ackerman – ‘The Psychodynamics of family life
  • 2. SCHIZOPHRENIA • Families were researched (1950) • Bateson's Palo Alto group. • Theodore Lidz • National Institute of Mental Health – Bowen, Wynn. • Branched out to a systems point of view. • Double bind communication messages – Mixed messages. • Marital skew – domination by one whilst the other accepts and children believe its normal. • Marital Schism – undermine spouse, threats of divorce, looks for loyalty and affection of child.
  • 3. CURRENT CONCEPTS Combined into 8 view points Object Relations Family Therapy • Psychodynamic view • Relationships with „objects‟ • Bring introjects into relationships • Disturbs the family relations • Gain insight
  • 4. EXPERIENTIAL FAMILY THERAPY Whitaker – Symbolic experiential family therapy Brings symbols and fantasies so we can grow Emotion focused couples therapy – change negative interactions focusing on emotional connection Transgenerational Family Therapy • Each family member is tied in some way. Individual problems arise and are maintained • Marries someone similar and the trend continues • Can result in schizophrenia
  • 5. STRUCTURAL FAMILY THERAPY • SALVADOR MINUCHIN • RULES, ROLES, ALIGNMENTS, COALITIONS, BOUNDARIES, SUB SYSTEMS. • CHANGE PATTERNS TO UNFREEZE. • STRATEGIC FAMILY THERAPY • JAY HALEY – PARADOXICAL INTERVENTIONS • SYSTEMIC FAMILY THERAPY – DIRTY GAMES AND POWER STRUGGLES • BOSCOLLO AND CECHING – CIRCULAR QUESTIONING
  • 6. C.B.T Cognitive Behavior Family Therapy Behavior – Reinforcement Cognitive – dysfunctional beliefs Learned schemas Social Constructionist Family Therapy Challenge systems thinking Limited lens Reality is mediated through language and are socially determined through our relationships offer new alternatives
  • 7. NARRATIVE THERAPY Narrative Therapy  Michael White – Reality is organized and maintained through our stories  Negative stories are overwhelming  Reduce power of problem stories  Reclaim successful stories  Life is multistoried  New alternatives  Externalization
  • 8. Continuity Predictable events Change Situational family crises  Transition points THEORY OF PERSONALITY
  • 9. FAMILY RULES Established expectations Persistent, repetiti ve behaviors Rules regulate and stabilize family system Redundancy principle: Family dysfunction
  • 10. FAMILY NARRATIVES AND ASSUMPTIONS Assumptions of self, family and the world Meanings given to events/situations Dominant stories/assumptions passed on from one generation to next
  • 11. Pseudomutuality Separateness vs. Togetherness Pseudohostility Arguments/Bickering between family members PSEUDOMUTUALITY AND PSEUDOHOSTILITY FRAGMENTED AND IRRATIONAL COMMUNICATION (TO AVOID DEALING WITH UNDERLYING ISSUES)
  • 12. MYSTIFICATION Masking the main problem To distort one‟s experience by denying what he/she believes is happening Contradicts one person‟s perception
  • 13. SCAPEGOATING Avoid dealing with main issue Blaming an identified individual for everything that goes wrong The identified person carries on the role.
  • 14. ANASTASIA
  • 15. WHO CAN WE HELP? WHO CAN WE HELP? INDIVIDUAL PROBLEMS INTERGENERATIONAL PROBLEMS MARITAL PROBLEMS
  • 16. INDIVIDUAL PROBLEMS WORKING WITH SINGLE INDIVIDUALS LOOK FOR CONTEXT OF BEHAVIOR WHEN PLANNING AND EXECUTING INTERVENTIONS
  • 17. WHAT ARE INDIVIDUAL PROBLEMS?
  • 18. INTERGENERATIONAL PROBLEMS PARENT & CHILD PARENT & ADOLESCENT CONFLICT WITH PARENT OR SOCIETY OUTDATED RULES AND BOUNDRIES INTERVENTION STREINGTHEN PARENTAL SUBSYSTEM DEFINE NEW BOUNDRIES & RULES
  • 19. WHAT ARE INTERGENERATIONAL PROBLEMS? DELEQUINCY AND AT RISK YOUTH CHILDREN TO FOREIGN BORN PARENTS
  • 20. MARITAL PROBLEMS SYMPTAMATIC BEHAVIOR TRACE TO EFFORTS BY THE FAMILY TO DEAL WITH CONFLICT LOOK FOR INTERPERSONAL DIFFICULTIES INTERVENTION THROUGH THERAPY
  • 21. WHAT ARE MARITAL PROBLEMS INEFFECTIVE COMMUNICATION PATTERNS SEXUAL INCOMPATABILITIES ANXIETY OVER MAKING/MAINTINIGN LONG TERM COMITMENT CONFLICTS OVER: • MONEY • IN-LAWS • CHILDREN • PHYSICAL ABUSE • POWER AND CONTROL
  • 22. WHAT CAN WE DO? LENGTH OF TREATMENT BRIEF OF EXTENDED RELETIVLY SHORT TERM (10-20) SESSIONS SETTINGS AND PRACTITIONERS OUTPATIENT OR INPATIENT SCHOOLS HOSPITALS PSYCHIATRISTS PSYCHOLOGISTS MFT’S SOCIAL WORKERS PASTORAL COUNCELORS STAGES OF TREATMENT BEGINNING – CONTACT, HISTORY AND RAPPORT MIDDLE – REDEFINE THE PRESENTING PROBLEM END – LEARN COPING SKILLS ANDPROBLEM SOLVING TECQNIQUES
  • 23. EVIDENCE INSURANCE COMPANIES NEED EVICENCE! INCREASED FUNDING FOR F.T. RESEARCH WHICH METHODS WORK?
  • 24. WHICH METHODS WORK?
  • 25. BACKGROUND: FRANK AND MICHELLE F R A N K Fathered two children: Ann (13) and Lance (12. Widower – Lost wife to cancer. Children spent a lot of time alone, Ann took over parenting role for her brother Lance. M I C H E L L E Mothered one daughter, Jessica (16). Divorced husband b/c of substance abuse, verbal abuse, and lack of employment. Michelle and Jessica developed a very close mother-daughter relationship for 12 years.
  • 26. GENOGRAM
  • 27. PROBLEM Frank: feeling guilt about not being an adequate provider for the family, troubled with little earnings and medical bills. Michelle: experiencing jealousy due to Frank‟s frequent business trips, feeling unattractive and fearful of abandonment by Frank. Ironically, her focus on Frank caused her to abandon Jessica for the first time. Jessica: losing closeness to her mother made her very resentful towards the entire family, sought comfort and belonging from a school gang and became a “tagger”. Ann: feels that Michelle is unable to fill the responsibility of mothering her and her brother. Shows no respect towards Michelle, very bossy. Lance: unable to properly grieve over the loss of his mother and stressed by familial conflict, he began wetting his bed. INCREASED TENSION BETWEEN THEIR CHILDREN MOSTLY INDIVIDUAL ISSUES THAT WERE TRIGGERED BY THE STRESS OF BECOMING A N “ I N S T A N T F A M I L Y ”
  • 28. TREATMENT Provide therapy sessions specific to each major subsystem. Good for strengthening bonds where closeness had been severed.  Frank and Michelle: child-rearing, romantic getaway, alternative income.  Jessica, Ann, and Lance: build sibling relationship, give privacy to parents.  Frank, Jessica, and Lance: grieving the loss of their mother.  Michelle and Jessica: rebuild mother-daughter relationship, discuss Jessica’s school issues.  Frank and Lance: develop father-son bond, help Lance eliminate bedwetting through behavioral program.  Ann: Make her feel special, discuss talents, hobbies, friendships and allow her to be the child. Discuss boundary issues with entire family.
  • 29. FOLLOW-UP S T R U C T U R A L C H A N G E Moving forward they were able to quickly recognize the dyad or triad that caused dysfunctional patterns and get themselves back on track. The family became more integrated and better functioning. Ann, Lance, Michelle and Jessica feel much closer to one another. B E H A V I O R A L C H A N G E Frank became proactive at work, received a promotion and bought the family a larger home. Lance stopped wetting his bed. Ann invested her interest in school clubs and allowed her self to “be a kid”. Jessica broke away from the school gang and began focusing on attending a local college.