Family therapy -  counselling techniques
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Family therapy - counselling techniques



In this manual you will find a brief history and description of the main visions and schools of FAMILY THERAPY.....

In this manual you will find a brief history and description of the main visions and schools of FAMILY THERAPY..
More important however is the included survey of techniques used in family counselling and the concrete examples of therapy structure.



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Family therapy -  counselling techniques Family therapy - counselling techniques Document Transcript

  • AN INTRODUCTION TOFAMILY THERAPYTags: Family Therapy - Practical Guide – Manual – Theory – Summary - Course – counselling – counsellor
  • PrefaceAll information in this manual was collected for personal use from freely accessible sites on the internet, alot of it was found in the free encyclopaedia Wikipedia.The same applies to all pictures used, which I downloaded from public domain sites.Since I feel many people will benefit and appreciate being allowed to get easy access to this kind ofinformation ordered in short, easily accessible chapters, I decided to make it available for free toeverybody.Should any of the authors of the borrowed texts feel that the present manual is not compatible with theway in which they planned to make their work available to the public, then I hereby invite them to contactme at and let me know which part of the manual should be replaced byinformation from other sources.Please check on or for a printed version of this manual.2
  • FAMILY THERAPY CONTENTSFamily Therapy – Wikipedia 5 • 1 History and theoretical frameworks 6 • 2 Techniques 9 • 3 Publications • 4 Licensing and degrees 10 o 4.1 Values and ethics in family therapy • 5 Founders and key influences 11 • 6 Summary of Family Therapy Theories & Techniques • 7 Academic resources • 8 Professional Organizations • 9 See also • 10 References 19 • 11 External linksBrief Strategic Family Therapy 21Strategic Family Therapy – Kimberly Gail 23Solution Focused Brief Therapy – Wikipedia 24 • 1 Basic Principles • 2 Questions • 3 Resources • 4 History of Solution Focused Brief Therapy • 5 Solution-Focused counselling • 6 Solution-Focused consulting • 7 ReferencesBrief (psycho-) Family Therapy – Wikipedia 29Extended Family Therapy or Bowenian Family Systems Therapy I - Wikipedia 31 • Introduction 31 • Differentiation of Self 33 • Triangles 36 • The Nuclear Family Emotional Processes 38 • The Family Projection Process 41 • The Multigenerational Transmission Process 45 • Sibling Position 48 • Emotional Cutoff 50 • Societal Emotional Processes 52 • Normal Family Development 54 • Family Disorders 54 • Goals of Therapy 55 • Techniques • Family Therapy with One Person 3
  • Bowen’s Family Systems Therapy II 56 • More about triangles 62Salvador Munichin’s Structural Family Therapy - I 66Salvador Munichin’s Structural Family Therapy - I 68Virginia Satir’s Humanistic Family Therapy 70Behavourial & Conjoint Family Therapy 72Milan Systemic Family Therapy or “Long Brief Therapy” 75Response Based Therapy – Wikipedia 76Narrative Family Therapy I - Wikipedia 78Narrative Family Therapy II 83Definitions 84Basic Family Therapy Techniques 86 • Techniques for Information Gathering 87 • Joining 88 • Diagnosing 89 • Family System Strategies 89 • Intervention Techniques 90 • Communication Skill Building Techniques 95Structure of a Family Therapy Session 96Stages and steps of Problem Centred Systems Therapy - Can.Fam.Physician 97A guideline for family assessment 97Structure of Family Therapy 100Systemic Family Therapy Manual 103Basic Family Therapy Techniques in alphabetical order 153Summary of Family Therapy Theories and Techniques 164Family Therapy Survey 1674
  • FAMILY THERAPYFrom Wikipedia, the free encyclopediaFamily therapy, also referred to as couple and family therapy and family systems therapy, is a branch ofpsychotherapy that works with families and couples in intimate relationships to nurture change and development. Ittends to view change in terms of the systems of interaction between family members. It emphasizes familyrelationships as an important factor in psychological health.What the different schools of family therapy have in common is a belief that, regardless of the origin of theproblem, and regardless of whether the clients consider it an "individual" or "family" issue, involving families insolutions is often beneficial. This involvement of families is commonly accomplished by their direct participation inthe therapy session. The skills of the family therapist thus include the ability to influence conversations in a waythat catalyzes the strengths, wisdom, and support of the wider system.In the fields early years, many clinicians defined the family in a narrow, traditional manner usually includingparents and children. As the field has evolved, the concept of the family is more commonly defined in terms ofstrongly supportive, long-term roles and relationships between people who may or may not be related by blood ormarriage.Family therapy has been used effectively in the full range of human dilemmas; there is no category of relationshipor psychological problem that has not been addressed with this approach. The conceptual frameworks developed byfamily therapists, especially those of family systems theorists, have been applied to a wide range of humanbehaviour, including organizational dynamics and the study of greatness.Contents • 1 History and theoretical frameworks • 2 Techniques • 3 Publications • 4 Licensing and degrees o 4.1 Values and ethics in family therapy • 5 Founders and key influences • 6 Summary of Family Therapy Theories & Techniques • 7 Academic resources • 8 Professional Organizations • 9 See also • 10 References • 11 External links 5
  • History of Marital TherapyGurman, A. S. & Fraenkel, P. (2002). The history of couple therapy: A millennial review. Family Process, 41, 199-260.G&F point out that couples therapy (formerly marital therapy) has been largely neglected, even though family therapists do 1.5-2 times as much couple work as multigenerational family work. They also note this is not such a bad ratio, as 40% of peoplecoming to therapy attribute their problems to relationship issues. G&F define Four Phases in the History Couples Therapy:Phase I - 1930 to 1963Atheoretical • 1929 to 1932 - Three marital clinics opened; they were service and education oriented, and saw mostly individuals • The closest thing to theory was what was borrowed from psychoanalytic - interlocking neurosis • 1931 the first marital therapy paper was published • Theory was marginalized due to a lack of brilliant theorists, and a lack of distinction from individual analysisPhase II - 1931 to 1966Psychoanalytic Experimentation • Therapists are seen as telling truth from distortion, rather than creating a truth • Mostly individual sessions, but some conjoint; still treated like seeing two individual clients in the same room though • Some started to downplay the role of the therapist • Family was outshining couples work, and the couple techniques werent innovative or particularly effectivePhase III - 1963 to 1985Family Therapy Incorporates • Family therapy overpowers couples, even though a number of big name people really mostly saw couples o Jackson Coined concepts like quid pro quo, homeostasis, and double bind for conjoint therapy o Satir Coined naming roles members played, fostered self-esteem and actualization, and saw the therapist as a nurturing teacher o Bowen Multigenerational theory approach, with differentiation, triangulation, and projection processes, with the therapist as an anxiety-lowering coach - societal projection process was the forerunner of our modern awareness of cultural differences Copied from the web. o Haley Power and control (or love and connection) were key. Avoided insight, emotional catharsis, conscious power plays. Saw system as more, and more important, than the sum of the partsPhase IV - 1986 to nowRefining and Integrating • 1986 was the publication of G&K book • New Theories were tried and refined, like Behavioral Marital Therapy, Emotionally Focused Marital Therapy, and Insight-Oriented Marital Therapy. All four have received good empirical support. Couples therapy was used to treat depression, anxiety, and alcoholism. • Efforts were focused on preventing couples problems with programs like PREP • Feminism, Multiculturalism, and Post-Modernism impacted the field • Eclectic integration, brief therapy, and sex therapy ideas were incorporated into our work Copied from the web. •
  • History and theoretical frameworksFormal interventions with families to help individuals and families experiencing various kinds of problems havebeen a part of many cultures, probably throughout history. These interventions have sometimes involved formalprocedures or rituals, and often included the extended family as well as non-kin members of the community (see forexample Hooponopono). Following the emergence of specialization in various societies, these interventions wereoften conducted by particular members of a community – for example, a chief, priest, physician, and so on - usuallyas an ancillary function.[1]Family therapy as a distinct professional practice within Western cultures can be argued to have had its origins inthe social work movements of the 19th century in England and the United States.[1] As a branch of psychotherapy,its roots can be traced somewhat later to the early 20th century with the emergence of the child guidance movementand marriage counselling.[2] The formal development of family therapy dates to the 1940s and early 1950s with thefounding in 1942 of the American Association of Marriage Counsellors (the precursor of the AAMFT), and throughthe work of various independent clinicians and groups - in England (John Bowlby at the Tavistock Clinic), the US(John Bell, Nathan Ackerman, Christian Midelfort, Theodore Lidz, Lyman Wynne, Murray Bowen, Carl Whitaker,Virginia Satir), and Hungary (D.L.P. Liebermann) - who began seeing family members together for observation ortherapy sessions.[1][3] There was initially a strong influence from psychoanalysis (most of the early founders of thefield had psychoanalytic backgrounds) and social psychiatry, and later from learning theory and behaviour therapy -and significantly, these clinicians began to articulate various theories about the nature and functioning of the familyas an entity that was more than a mere aggregation of individuals.[2]The movement received an important boost in the mid-1950s through the work of anthropologist Gregory Batesonand colleagues – Jay Haley, Donald D. Jackson, John Weakland, William Fry, and later, Virginia Satir, PaulWatzlawick and others – at Palo Alto in the US, who introduced ideas from cybernetics and general systems theoryinto social psychology and psychotherapy, focusing in particular on the role of communication (see BatesonProject). This approach eschewed the traditional focus on individual psychology and historical factors – that involveso-called linear causation and content – and emphasized instead feedback and homeostatic mechanisms and “rules”in here-and-now interactions – so-called circular causation and process – that were thought to maintain orexacerbate problems, whatever the original cause(s).[4][5] (See also systems psychology and systemic therapy.) Thisgroup was also influenced significantly by the work of US psychiatrist, hypnotherapist, and brief therapist, MiltonH. Erickson - especially his innovative use of strategies for change, such as paradoxical directives (see also Reversepsychology). The members of the Bateson Project (like the founders of a number of other schools of family therapy,including Carl Whitaker, Murray Bowen, and Ivan Böszörményi-Nagy) had a particular interest in the possiblepsychosocial causes and treatment of schizophrenia, especially in terms of the putative "meaning" and "function" ofsigns and symptoms within the family system. The research of psychiatrists and psychoanalysts Lyman Wynne andTheodore Lidz on communication deviance and roles (e.g., pseudo-mutuality, pseudo-hostility, schism and skew) infamilies of schizophrenics also became influential with systems-communications-oriented theorists andtherapists.[2][6] A related theme, applying to dysfunction and psychopathology more generally, was that of the"identified patient" or "presenting problem" as a manifestation of or surrogate for the familys, or even societys,problems. (See also double bind; family nexus.)By the mid-1960s a number of distinct schools of family therapy had emerged. From those groups that were moststrongly influenced by cybernetics and systems theory, there came MRI Brief Therapy, and slightly later, strategictherapy, Salvador Minuchins Structural Family Therapy and the Milan systems model. Partly in reaction to someaspects of these systemic models, came the experiential approaches of Virginia Satir and Carl Whitaker, whichdownplayed theoretical constructs, and emphasized subjective experience and unexpressed feelings (including thesubconscious), authentic communication, spontaneity, creativity, total therapist engagement, and often included theextended family. Concurrently and somewhat independently, there emerged the various intergenerational therapiesof Murray Bowen, Ivan Böszörményi-Nagy, James Framo, and Norman Paul, which present different theories aboutthe intergenerational transmission of health and dysfunction, but which all deal usually with at least threegenerations of a family (in person or conceptually), either directly in therapy sessions, or via "homework", "journeyshome", etc. Psychodynamic family therapy - which, more than any other school of family therapy, deals directlywith individual psychology and the unconscious in the context of current relationships - continued to develop 7
  • through a number of groups that were influenced by the ideas and methods of Nathan Ackerman, and also by theBritish School of Object Relations and John Bowlby’s work on attachment. Multiple-family group therapy, aprecursor of psychoeducational family intervention, emerged, in part, as a pragmatic alternative form of intervention- especially as an adjunct to the treatment of serious mental disorders with a significant biological basis, such asschizophrenia - and represented something of a conceptual challenge to some of the "systemic" (and thus potentially"family-blaming") paradigms of pathogenesis that were implicit in many of the dominant models of family therapy.The late-1960s and early-1970s saw the development of network therapy (which bears some resemblance totraditional practices such as Hooponopono) by Ross Speck and Carolyn Attneave, and the emergence ofbehavioural marital therapy (renamed behavioural couples therapy in the 1990s; see also relationship counselling)and behavioural family therapy as models in their own right.[2]By the late-1970s the weight of clinical experience - especially in relation to the treatment of serious mentaldisorders - had led to some revision of a number of the original models and a moderation of some of the earlierstridency and theoretical purism. There were the beginnings of a general softening of the strict demarcationsbetween schools, with moves toward rapprochement, integration, and eclecticism – although there was,nevertheless, some hardening of positions within some schools. These trends were reflected in and influenced bylively debates within the field and critiques from various sources, including feminism and post-modernism, thatreflected in part the cultural and political tenor of the times, and which foreshadowed the emergence (in the 1980sand 1990s) of the various "post-systems" constructivist and social constructionist approaches. While there was stilldebate within the field about whether, or to what degree, the systemic-constructivist and medical-biologicalparadigms were necessarily antithetical to each other (see also Anti-psychiatry; Biopsychosocial model), there was agrowing willingness and tendency on the part of family therapists to work in multi-modal clinical partnerships withother members of the helping and medical professions.[2][6][7]From the mid-1980s to the present the field has been marked by a diversity of approaches that partly reflect theoriginal schools, but which also draw on other theories and methods from individual psychotherapy and elsewhere –these approaches and sources include: brief therapy, structural therapy, constructivist approaches (e.g., Milansystems, post-Milan/collaborative/conversational, reflective), solution-focused therapy, narrative therapy, a rangeof cognitive and behavioural approaches, psychodynamic and object relations approaches, attachment andEmotionally Focused Therapy, intergenerational approaches, network therapy, and multisystemic therapy(MST).[8][9][10][11][12][13][14][15] Multicultural, intercultural, and integrative approaches are beingdeveloped.[16][17][18][19][20][21] Many practitioners claim to be "eclectic," using techniques from several areas,depending upon their own inclinations and/or the needs of the client(s), and there is a growing movement toward asingle “generic” family therapy that seeks to incorporate the best of the accumulated knowledge in the field andwhich can be adapted to many different contexts;[22] however, there are still a significant number of therapists whoadhere more or less strictly to a particular, or limited number of, approach(es).[23]Ideas and methods from family therapy have been influential in psychotherapy generally: a survey of over 2,500 UStherapists in 2006 revealed that of the ten most influential therapists of the previous quarter-century, three wereprominent family therapists, and the marital and family systems model was the second most utilized model aftercognitive behavioural therapy.[24]As we move through the 21st century, the internet is fostering the growth of online programs that make courses andprograms in family therapy more widely accessible. Using mass media techniques to increase public understandingof issues in family therapy has added a new frontier for amplification in the future.8
  • TechniquesFamily therapy uses a range of counselling and other techniques including: • communication theory • media and communications psychology • psychoeducation • psychotherapy • relationship education • systemic coaching • systems theory • reality therapyThe number of sessions depends on the situation, but the average is 5-20 sessions.A family therapist usually meets several members of the family at the same time. This has the advantage of makingdifferences between the ways family members perceive mutual relations as well as interaction patterns in thesession apparent both for the therapist and the family.These patterns frequently mirror habitual interaction patterns at home, even though the therapist is now incorporatedinto the family system.Therapy interventions usually focus on relationship patterns rather than on analyzing impulses of the unconsciousmind or early childhood trauma of individuals as a Freudian therapist would do - although some schools of familytherapy, for example psychodynamic and intergenerational, do consider such individual and historical factors (thusembracing both linear and circular causation) and they may use instruments such as the genogram to help toelucidate the patterns of relationship across generations.The distinctive feature of family therapy is its perspective and analytical framework rather than the number ofpeople present at a therapy session. Specifically, family therapists are relational therapists: They are generally moreinterested in what goes on between individuals rather than within one or more individuals, although some familytherapists—in particular those who identify as psychodynamic, object relations, intergenerational, EFT, orexperiential family therapists—tend to be as interested in individuals as in the systems those individuals and theirrelationships constitute.Depending on the conflicts at issue and the progress of therapy to date, a therapist may focus on analyzing specificprevious instances of conflict, as by reviewing a past incident and suggesting alternative ways family membersmight have responded to one another during it, or instead proceed directly to addressing the sources of conflict at amore abstract level, as by pointing out patterns of interaction that the family might have not noticed.Family therapists tend to be more interested in the maintenance and/or solving of problems rather than in trying toidentify a single cause. Some families may perceive cause-effect analyses as attempts to allocate blame to one ormore individuals, with the effect that for many families a focus on causation is of little or no clinical utility.PublicationsFamily therapy journals include: Journal of Marital and Family Therapy, Family Process, Journal of FamilyTherapy, Journal of Systemic Therapies, The Australian & New Zealand Journal of Family Therapy, ThePsychotherapy Networker, The Journal of Sex and Marital Therapy, The Australian Journal of Family Therapy, TheInternational Journal of Narrative Therapy and Community Work, Journal for the Study of Human Interaction andFamily Therapy, 9
  • Licensing and degreesFamily therapy practitioners come from a range of professional backgrounds, and some are specifically qualified orlicensed/registered in family therapy (licensing is not required in some jurisdictions and requirements vary fromplace to place). In the United Kingdom, family therapists are usually psychologists, nurses, psychotherapists, socialworkers, or counsellors who have done further training in family therapy, either a diploma or an M.Sc.. However, inthe United States there is a specific degree and license as a Marriage and Family therapist.Prior to 1999 in California, counsellors who specialized in this area were called Marriage, Family and ChildCounsellors. Today, they are known as Marriage and Family Therapists (MFT), and work variously in privatepractice, in clinical settings such as hospitals, institutions, or counselling organizations.A masters degree is required to work as an MFT in some American states. Most commonly, MFTs will first earn aM.S. or M.A. degree in marriage and family therapy, psychology, family studies, or social work. After graduation,prospective MFTs work as interns under the supervision of a licensed professional and are referred to as anMFTi.[25]Marriage and family therapists in the United States and Canada often seek degrees from accredited Masters orDoctoral programs recognized by the Commission on Accreditation for Marriage and Family TherapyEducation(COAMFTE), a division of the American Association of Marriage and Family Therapy. For accreditedprograms, click here.Requirements vary, but in most states about 3000 hours of supervised work as an intern are needed to sit for alicensing exam. MFTs must be licensed by the state to practice. Only after completing their education and internshipand passing the state licensing exam can a person call themselves a Marital and Family Therapist and workunsupervised.License restrictions can vary considerably from state to state. Contact information about licensing boards in theUnited States are provided by the Association of Marital and Family Regulatory Boards.There have been concerns raised within the profession about the fact that specialist training in couples therapy – asdistinct from family therapy in general - is not required to gain a license as an MFT or membership of the mainprofessional body, the AAMFT.[26]Values and ethics in family therapySince issues of interpersonal conflict, power, control, values, and ethics are often more pronounced in relationshiptherapy than in individual therapy, there has been debate within the profession about the different values that areimplicit in the various theoretical models of therapy and the role of the therapist’s own values in the therapeuticprocess, and how prospective clients should best go about finding a therapist whose values and objectives are mostconsistent with their own.[27][28][29] Specific issues that have emerged have included an increasing questioning of thelongstanding notion of therapeutic neutrality,[30][31][32] a concern with questions of justice and self-determination,[33]connectedness and independence,[34] "functioning" versus "authenticity",[7] and questions about the degree of thetherapist’s "pro-marriage/family" versus "pro-individual" commitment.[35]10
  • Founders and key influencesSome key developers of family therapy are: • Alfred Adler (phenomenology) • Nathan Ackerman (psychoanalytic) • Tom Andersen (Reflecting practices and dialogues about dialogues) • Harlene Anderson (Postmodern Collaborative Therapy and Collaborative Language Systems) • Harry J Aponte (Person-of-the-Therapist) • Gregory Bateson (1904–1980) (cybernetics, systems theory) • Ivan Böszörményi-Nagy (Contextual therapy, intergenerational, relational ethics) • Murray Bowen (Systems theory, intergenerational) • Steve de Shazer (solution focused therapy) • James Dobson (Christian psychologist) Focus on the Family • Milton H. Erickson (hypnotherapy, strategic therapy, brief therapy) • Richard Fisch (brief therapy, strategic therapy) • James Framo (object relations theory, intergenerational) • Edwin Friedman (Family process in religious congregations) • Harry Goolishian (Postmodern Collaborative Therapy and Collaborative Language Systems) • John Gottman (marriage) • Robert-Jay Green (LGBT, cross-cultural issues) • Jay Haley (strategic therapy, communications) • Lynn Hoffman (strategic, post-systems, collaborative) • Don D. Jackson (systems theory) • Sue Johnson (Emotionally focused therapy, attachment theory) • Bradford Keeney (cybernetics, resource focused therapy) • Walter Kempler (Gestalt psychology) • Bernard Luskin (media psychology, Public understanding of issues through media) • Cloe Madanes (strategic therapy) • Salvador Minuchin (structural) • Braulio Montalvo (structural)[citation needed] • Virginia Satir (communications, experiential, conjoint and co-therapy) • Mara Selvini Palazzoli (Milan systems) • Ross Speck (network therapy) • Robin Skynner (Group Analysis) • Paul Watzlawick (Brief therapy, systems theory) • John Weakland (Brief therapy, strategic therapy, systems theory) • Carl Whitaker (Family systems, experiential, co-therapy) • Michael White (narrative therapy) • Lyman Wynne (Schizophrenia, pseudomutuality)Principal Leaders in the Field: • Salvador Minuchin • John Elderkin Bell • Jay Haley • Philip Guerin • Murray Bowen • Don Jackson • Nathan Ackerman • Carl Whitaker • Virginia Satir • Betty Carter • Ivan Boszmormenyi-Nagy • Michael White 11
  • Salvador MinuchinBorn and raised in Argentina, Salvador Minuchin began his career as a family therapist in the early 1960s when hediscovered two patterns common to troubled families: some are "enmeshed," chaotic and tightly interconnected, whileothers are "disengaged," isolated and seemingly unrelated. When Minuchin first burst onto the scene, his immediateimpact was due to his dazzling clinical artistry. This compelling man with the elegant Latin accent would provoke,seduce, bully, or bewilder families into changing -- as the situation required -- setting a standard against which othertherapists still judge their best work. But even Minuchins legendary dramatic flair didnt have the same galvanizingimpact as his structural theory of families.In his classic text, Families and Family Therapy (Minuchin, 1974) Minuchin taught family therapists to see what theywere looking at. Through the lens of structural family theory, previously puzzling interactions suddenly swam into focus.Where others saw only chaos and cruelty, Minuchin helped us understand that families are structured in "subsystems"with "boundaries," their members shadowing to steps they do not see.In 1962 Minuchin formed a productive professional relationship with Jay Haley, who was then in Palo Alto. In 1965Munuchin became the director of the Philadelphia Child Guidance Clinic, which eventually became the worlds leadingcenter for family therapy and training. At the Philadelphia Clinic, Haley and Minuchin developed a training program formembers of the local black community as paraprofessional family therapists in an effort to more effectively related to theurban blacks and Latinos in the surrounding community.In 1969, Minuchin, Haley, Braulio Montalvo, and Bernice Rosman developed a highly successful family therapy trainingprogram that emphasized hands-on experience, on-line supervision, and the use of videotapes to learn and apply thetechniques of structural family therapy. Minuchin stepped down as director of the Phildelphia Clinic in 1975 to pursue hisinterest in treating families with psychosomatic illnesses and to continue writing some of the most influential books in thefield of family therapy. In 1981, Minuchin established Family Studies, Inc., in New York, a center committed to teachingfamily therapists. Minuchin retired in 1996 and currently lives with his wife Patricia in Boston.Jay HaleyA brilliant strategist and devastating critic, Jay Haley was a dominating figure in developing the Palo Alto Groupscommuncations model and stategic family therapy, which became popular in the 1970s. He studied under three of themost influential pioneers in the evolution of family therapy - Gregory Bateson, Milton Erickson, and Salvador Minuchin,and combined ideas from each of these innovative thinkers to form his own unique brand of family therapy.In 1953 Haley was studying for a masters degree in communication at Stanford University when Gregory Batesoninvited him to work on the schizophrenia project. Haley met with patients and their families to observe thecommunicative style of schizophrenics in a natural environment. This work had an enormous impact in shaping thedevelopment of family therapy.Haley developed his therapeutic skills under the supervision of master hypnotist Milton Erickson from 1954 to 1960.Haley developed a brief therapy model which focused on the context and possible function of the patients symptoms andused directives to instruct patients to act in ways that were counterproductive to their maladaptive behavior. Haleybelieved that it was far more important to get patients to actively do something about their problems rather than help themto understand why they had these problems.Haley was instumental in bridging the gap between strategic and structural approaches to family therapy by lookingbyond simple dyadic relationships and exploring his interest in trangular, intergenerationsl relationships, or "perversetriangles." Haley believed that a patients symptoms arose out of an incongruence between manifest and covert levels ofcommunication with others and served to give the patient a sense of control in their interpersonal relationships.Accordingly, Haley thought that the healing aspect of the patient-therapist relationship involved getting patients to takeresponsibility for their actions and to take a stand in the therapeutic relationship, a process he called "therapeuticparadox."Haley conducted research at the Mental Research Institute in Palo Alto until he joined Salvador Minuchin at thePhiladelphia Child Guidance Clinic in 1967. At the Philadelphia Clinic, Haley pursued his interests in training andsupervision in family therapy and was the director of family therapy research for ten years. He was also an active clinicalmember of the University of Pennsylvanias Department of Psychiatry. In 1976, Haley moved to Washington D.C. andfounded the Family Therapy Institute with Cloe Madanes, which has become one of the major training institutes in thecountry. Haley retired in 1995 and currently lives in La Jolla, California.12
  • Murray BowenAmong the pioneers of family therapy, Murray Bowens emphasis on theory and insight as opposed to action andtechnique distinguish his work from the more behaviorally oriented family therapists (Nichols & Schwartz, 1998. FamilyTherapy: Concepts and Methods. 4th ed. Allyn & Bacon). Bowens therapy is an outgrowth of psychoanalytic theory andoffers the most comprehensive view of human behavior and problems of any approach to family therapy. The core goalunderlying the Bowenian model is differentiation of self, namely, the ability to remain oneself in the face of groupinfluences, especially the intense influence of family life. The Bowenian model also considers the thoughts and feelingsof each family member as well as the larger contextual network of family relationships that shapes the lie of the family.Bowen grew up in Waverly, Tennessee, the oldest child of a large cohesive family. After graduating from medical schooland serving five years in the military, Bowen pursued a career in psychiatry. He began studying schizophrenia and hisstrong background in psychoanalytic training led him to expand his studies from individual patients to the relationshippatterns between mother and child. From 1946 to 1954, Bowen studied the symbiotic relationships of mothers and theirschizophrenic children at the Menninger Clinic in Topeka, Kansas. Here he developed the concepts of anxious andfunctional attachment to describe interactional patterns in the mother-child relationship.In 1954, Bowen became the first director of the Family Division at the National Institute of Mental Health (NIMH). Hefurther broadened his attachment research to include fathers and developed the concept o triangulation as the centralbuilding block o relationship systems (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn& Bacon). In his first year at NIMH, Bowen provided separate therapists for each individual member of a family, butsoon discovered that this approach fractionated families instead of bringing them together. As a result, Bowen decided totreat the entire family as a unit, and became one of the founders of family therapy.In 1959, Bowen began a thirty-one year career at Georgetown Universitys Department of Psychiatry where he refined hismodel of family therapy and trained numerous students, including Phil Guerin, Michael Kerr, Betty Carter, and MonicaMcGoldrick, and gained international recognition for his leadership in the field of family therapy. He died in October1990 following a lengthy illness.Nathan AckermanNathan Ackermans astute ability to understand the overall organization of families enabled him to look beyond thebehavioral interactions of families and into the hearts and minds of each family member. He used his strong will andprovocative style of intervening to uncover the familys defenses and allow their feelings, hopes, and desires to surface.Ackermans training in the psychoanalytic model is evident in his contributions and theoretical approach to familytherapy. Ackerman proposed that underneath the apparent unity of families there existed a wealth of intrapsychic conflictthat divided family members into factions (Nichols & Schwartz, Family Therapy: Concepts and Methods. 4th ed. Allyn &Bacon 1998). Ackerman joined the Menninger Clinic in Topeka, Kansas, and became the chief psychiatrist of the ChildGuidance Clinic in 1937.Initially, Ackerman followed the child guidance clinic model of having a psychiatrist treat the child and a social workersee the mother (Nichols & Schwartz, Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon 1998). However,within his first year of work at the clinic, Ackerman became a strong advocate of including the entire family whentreating a disturbance in one of its members, and suggested that family therapy be used as the primary form of treatmentin child guidance clinics (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon).Ackerman was committed to sharing his ideas and theoretical approach with other professionals in the field. In 1938Ackerman published The Unity of the Family and Family Diagnosis: An Approach to the Preschool Child, both of whichinspired the family therapy movement. Together with Don Jackson, Ackerman founded the first family therapy journal,Family Process, which is still the leading journal of ideas in the field today. In 1955 Ackerman organized the firstdiscussion on family diagnosis at a meeting of the American Orthopsychiatric Association to facilitate communication inthe developing field of family therapy.In 1957 Ackerman established the Family Mental Health Clinic in New York City and began teaching at ColumbiaUniversity. He opened the Family Institute in 1960, which was later renamed the Ackerman Institute after his death in1971. 13
  • Virginia SatirVirginia Satir is one of the key figures in the development of family therapy. She believed that a healthy family lifeinvolved an open and reciprocal sharing of affection, feelings, and love. Satir made enormous contributions to familytherapy in her clinical practice and training. She began treating families in 1951 and established a training program forpsychiatric residents at the Illinois State Psychiatric Institute in 1955.Satir served as the director of training at the Mental Research Institute in Palo Alto from 1959-66 and at the EsalenInstitute in Big Sur beginning in 1966. In addition, Satir gave lectures and led workshops in experiential family therapyacross the country. She was well-known for describing family roles, such as "the rescuer" or "the placator," that functionto constrain relationships and interactions in families (Nichols & Schwartz, 1998. Family Therapy: Concepts andMethods. 4th ed. Allyn & Bacon).Satirs genuine warmth and caring was evident in her natural inclination to incorporate feelings and compassion in thetherapeutic relationship. She believed that caring and acceptance were key elements in helping people face their fears andopen up their hearts to others (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn &Bacon). Above all other therapists, Satirs was the most powerful voice to wholeheartedly support the importance of loveand nurturance as being the most important healing aspects of therapy. Unfortunately, Satirs beliefs went against themore scientific approach to family therapy accepted at that time, and she shifted her efforts away from the field to traveland lecture. Satir died in 1988 after suffering from pancreatic cancer.Ivan Boszmormenyi-NagyIvan Boszmormenyi-Nagys emphasis on loyalty, trust, and relational ethics -- both within the family and between thefamily and society -- made major contributions to the field of family therapy since its inception in the 1950s (Nichols &Schwartz, Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon 1998). A student of Virginia Satir and anaccomplished scholar and clinician, Nagy was trained as a psychoanalyst and his work has encouraged many familytherapists to incorporate psychoanalytic ideas with family therapy.Nagy is perhaps best known for developing the contextual approach to family therapy, which emphasizes the ethicaldimension of family development. Based on the psychodynamic model, contextual therapy accentuates the need forethical principles to be an integral part of the therapeutic process. Nagy believes that trust, loyalty, and mutual support arethe key elements that underlie family relationships and hold families together, and that symptoms develop when a lack ofcaring and liability result in a breakdown of trust in relationships (Nichols & Schwartz, Family Therapy: Concepts andMethods. 4th ed. Allyn & Bacon 1998). The therapists role is to help the family work through avoided emotionalconflicts and to develop a sense of fairness among family members.In 1957, Nagy established the Eastern Pennsylvania Psychiatric Institute (EPPI) and served as codirector and cotherapistalong with social worker Geraldine Spark. Nagy was also an active researcher of schizophrenia and family therapy andcoauthored Invisible loyalties: Reciprocity in intergenerational family therapy (Boszormenyi-Nagy & Spark, 1973). Sincethe closing of EPPI, Nagy has continued to develop his contextual approach to family therapy and remains associatedwith Hahnemann University in Pennsylvania.John Elderkin BellPerhaps one of the first family therapists was John Elderkin Bell, who began treating families in the early 1950s. Bellsingenious approach to family therapy involved developing a step-by-step, easy-to-follow plan of attack to treat familyproblems in stages. Bells treatment approach was an outgrowth of group therapy and was aptly named family grouptherapy. In 1951 Bell discovered that John Bowlby, a well-respected clinician, was applying group psychotherapytechniques to treat individual families. Bell decided to follow Bowlbys approach, and did not discover until many yearslater that Bowlby had only used this treatment approach with one family.Bell believed that the treatment of families should follow a series of three stages designed to encourage communicationamong family members and to solve family problems. In the first stage, the child-centered phase, Bell encouragedchildrens involvement by facilitating the expression of their thoughts and feelings. In the parent-centered stage, parentsresponded to their childrens concerns and often related difficulties they experienced with their childrens behavior. Thefamily-centered stage was the final phase of treatment, and Bell continued to stimulate communication among familymembers and to help solve family problems.Unfortunately, Bells pioneering efforts in the field of family therapy are less well-known as compared to other familytherapists. Bell did not publish his ideas until the 1960s, and he did not establish family therapy clinics or trainingcenters.14
  • Philip GuerinA student of Murray Bowen, Philip Guerins own innovative ideas led to his developing a sophisticated clinical approachto treating problems of children and adolescents, couples, and individual adults (Nichols & Schwartz, 1998. FamilyTherapy: Concepts and Methods. 4th ed. Allyn & Bacon). Guerins highly articulated model outlines several therapeuticgoals, which emphasize the multigenerational context of families, working to calm the emotional level of familymembers, and defining specific patterns of relationships within families. Guerins family systems approach is designed tomeasure the severity of conflict and to identify specific areas in need of improvement.In 1970 Guerin became the Director of Training of the Family Studies Section at Albert Einstein College of Medicine andBronx State Hospital, a family therapy training center originally organized by Israel Zwerling and Marilyn Mendelsohn.Guerins pioneering efforts and exceptional leadership resulted in his establishing an extramural training program inWestchester in 1972 and founding the Center for Family Learning in New Rochelle, New York, one of the mostexceptional family therapy programs for training and practice in the nation (Nichols & Schwartz, 1998. Family Therapy:Concepts and Methods. 4th ed. Allyn & Bacon).In addition to being a distinguished clinician, Guerin has authored some of the most influential and valuable books andarticles in the field of family therapy. Two of his best are: The Evaluation and treatment of marital conflict: A four-stageapproach (Guerin, 1987) and Working with relationship triangles: The one-two-three of psychotherapy (Guerin, Fogarty,Fay & Kautto, 1996).Don JacksonThe vibrant and creative talent of Don Jackson contributred to his success as a writer, researcher, and cofounder of theleading journal in the field of family therapy, Family Process. A 1943 graduate of Stanford University School ofMedicine, Jackson strongly rejected the psychoanalytic concepts that formed the basis of his early training. Instead, hefocused his interest on Batesons analysis of communication and behavior, which shaped his most important contributionsto the developing field of family therapy.By 1954, Jackson had developed a rudimentary family interactional therapy out of his pioneering work with the Palo Altogroup and research on schizophrenia (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn& Bacon). Jackson observed the mutual impact of schizophrenic patients and their families in the home environment, andquickly recognized the importance of treating the family unit instead of removing patients for individual treatment. Hisearly work centered on the effects of patients therapy on the entire family, and he developed the concept of familyhomeostasis to describe how families resist change and seek to maintain redundant patterns of behavior. Jackson alsosuggested that family members react to schizophrenic members symptoms in ways that serve to stabilize the familysstatus quo and often result in inflexible ways of thinking and maintain the symptomatic behavior (Nichols & Schwartz,1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon).In 1958, Jackson established the Mental Research Institute and worked with Virginia Satir, Jules Riskin, Jay Haley, JohnWeakland, Paul Watzlawick and Bateson. By 1963, Jacksons model of the family involved several types of rules thatdefined the communication patterns and interactions among family members. Jackson believed that family dysfunctionwas a result of a familys lack of rules for change, and that the therapists role was to make the rules explicit and toreconstruct rigid which maintained family problems. In 1968, tragically Jackson died by his own hand at the age of 48.Carl WhitakerCarl Whitakers creative and spontaneous thinking formed the basis of a bold and inventive approach to family therapy.He believed that active and forceful personal involvement and caring of the therapist was the best way to bring aboutchanges in families and promote flexibility among family members. He relied on his own personality and wisdom, ratherthan any fixed techniques, to stir things up in families and to help family members open up and be more fully themselves(Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Whitakers confrontiveapproach earned him the reputation as the most irreverent among family therapys iconoclasts.Whitaker viewed the family as an integrated whole, not as a collection of discrete individuals, and felt that a lack ofemotional closeness and sharing among family members resulted in the symptoms and interpersonal problems that ledfamilies to seek treatment. He equated familial togetherness and cohesion with personal growth, and emphasized theimportance of including extended family members, especially the expressive and playful spontaneity of children, intreatment. A big, comfortable, lantern-jawed man, Whitaker liked a crowd in the room when he did therapy. Whitakeralso pioneered the use of cotherapists as a means of maintaining objectivity while using his highly provocative techniques 15
  • to turn up the emotional temperature of families (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4thed. Allyn & Bacon).Beginning in 1946, Whitaker served as Chairman of the Department of Psychiatry at Emory University, where he focusedon treating schizophrenics and their families. He also helped to develop some of the first major professional meetings offamily therapists with colleagues such as John Warkentin, Thomas Malone, John Rosen, Bateson, and Jackson. In 1955,Whitaker left Emory to enter into private practice, and became a professor of Psychiatry at the University of Wisconsin in1965 until his retirement in 1982. Whitaker died in April 1995, leaving a heartfelt void in the field of family therapy.Betty CarterAn ardent and articulate feminist, Betty Carter was instrumental in enriching and popularizing the concept of the familylife cycle and its value in assessing families. Carter entered the field of family therapy after being trained as a socialworker, and emphasized the importance of historical antecedents of family problems and the multigenerational aspects ofthe life cycle that extended beyond the nuclear family. Carter further expanded on the family life cycle concept byconsidering the stages of divorce and remarriage (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods.4th ed. Allyn & Bacon).Carters interest in family therapy was stimulated by taking part in a family therapy field placement at the AckermanInstitute as part of her M.S.W. requirements at Hunter College. She quickly became an avid student of the Bowenianmodel, and served on the staff of the Family Studies Section at Albert Einstein College of Medicine and Bronx StateHospital with Phil Guerin and Monica McGoldrick. Carter left the Center for Family Learning to become the foundingdirector of the Family Institute of Westchester in 1977. Carter served as Codirector of the Womens Project in FamilyTherapy with Peggy Papp, Olga Silverstein, and Marianne Walters, and has been an outspoken leader about the genderand ethnic inequalities that serve to keep women in inflexible family roles.Currently, Carter is an active clinician and specializes in marital therapy and therapy with remarried couples (Nichols &Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Her work with couples focuses onhelping her clients to understand their situation and to address unresolved family issues. Carter incorporates tasks, such asletter writing, which serve to intensify and speed up the communication process and help couples move out of rigidpatterns of behavior.Michael WhiteMichael White, the guiding genius of narrative family theapy, began his professional life as a mechanical draftsman. Buthe soon realized that he preferred people to machines and went into social work where he gravitated to family therapy.Following an initial attraction to the cybernetic thinking of Gregory Bateson, White became more interested in the wayspeople construct meaning in their lives than just with the ways they behaved.In developing the notion that peoples lives are organized by their life narratives, White came to believe that stories dontmirror life, they shape it. Thats why people have the interesting habit of becoming the stories they tell about theirexperience.Narrative therapists break the grip of unhelpful stories by externalizing problmes. By challenging fixed and pessimisticversions of events, therapists make room for fliexibility and which new and more optimistic stories can be envisioned.Finally, clients are encouraged to create audiences of support to witness and promote their progress in restoring their livesalong preferred lines.Whites innovative thinking helped shape the basic tenets of narrative therapy, which considers the broader historical,cultural and political framework of the family. In the narrative approach, therapists try to understand how clientspersonal beliefs and perceptions, or narratives, shape their self-concept and personal relationships. Individual clients offamilies are then encouraged to reconstruct their narratives to facilitate more adaptive views of themselves and moreeffective interpersonal interactions. Whites leadership of the narrative movement in family therapy is based not only onhis imaginative ideas but also on his inspriational persistence in seeing the best in people even when theyve lost faith inthemselves. White is well-known for his persistence in challenging clients negative self-beliefs and for his relentlessoptimism in helping people to develop healthier interpretations of their life experiences. Whites tenaciously positiveattitude has undoubtably contributed to his enormous success as a therapist.Currently, White lives in Adelaide, South Australia. Together with his wife, Cheryl, White works at the Dulwich Centre,a training and clinical facility that also publishes the Dulwich Newsletter, which White uses to explore his ideas with thefield.16
  • MODELS AND SCHOOLSFamily therapists and counselors use a range of methods and over the years a number of models or schools offamily therapy have developed.A well-known classification of these approaches is described by Gurman and Kniskern (1991): 1. Behavioural Family Therapy 2. Bowen theory 3. Brief Therapy: MRI 4. Contextual Therapy 5. Eriscksonian Family Therapy 6. Focal Family Therapy 7. Milan Systemic Therapy 8. Family Psychoeducational Therapy 9. Strategic Therapy 10. Structural Therapy 11. Symbolic-Experiential TherapySome contemporary family therapies:Structural Family Therapy (Minuchin, 1974, Colapinto, 1991)In this type of therapy, the structural therapist believes that change of behaviour is most important. Therapy beginswith the therapist “joining” with the family. He or she has the purpose to enhance the feeling of worth of individualfamily members. The therapist must attune himself or herself to the families value systems and existing hierarchies.After “joining”, the therapist challenges “how things are done“ and begins restructuring the family by offeringalternative, more functional ways of behaving.Conjoint Family Therapy (Satir, 1967)Conjoint family therapy works with personal experiences and helps experiencing the value of the individual withinthe family system. Therapists use all levels of communication to express the relational qualities present in thefamily to achieve change in family system. This approach uses many feeling and communication exercises andgames, for example family sculpture.Contextual Therapy (Boszormenyi-Nagy, 1991)In the contextual approach the word “context“ indicates the dynamic connectedness of a person with her or hissignificant relationships, the long-term relational involvement as well as the person’s relatedness to his or hermultigenerational roots. The therapist encourages family members to explore their own multilaterality.Strategic Therapy (Madanes, 1981)In this approach, the therapist considers the therapy in terms of step-by-step change in the way from one type ofabnormal organisation to another type before a more normal organisation is finally achieved. For a strategictherapist two questions are basic: How is the symptom “helping” the family to maintain a balance or overcome acrisis? How can the symptom be replaced by a more effective solution of the problem? 17
  • Brief TherapyThis name refers not only to the duration of the therapy, but it represents comprehensively a way of orientation intherapeutic practice. Problem formation and maintenance is seen as parts if vicious-circle process, in whichmaladaptive “solutions“ behaviours maintain the problem. Alteration of these behaviours /or beliefs/ shouldinterrupt the cycle and initiate the resolution of the problem.Milan Systemic Therapy (Boscolo et al, 1987)Basic assumption of Milan Systemic Therapy is that mind is social. The symptomatic behaviour is conceived as apart of the transactional patterns of the system. Significance of any particular behaviour or event may be derivedfrom its social context. The therapists consider that the way to eliminate the symptom which is present in the familyis to change the rules and beliefs. Change is achieved in clarifying the ambiguity in relationships.Narrative Therapy (Freedman, Combs, 1996)The followers of the narrative approach consider that experience rooted in the life events is elaborated in the form ofa story, which gives to these events a meaning reflecting the systems of belief. In the therapy process, the “lifestory” of a family is connected with the internal and external culture of the family. Change is enabled by retellingthe story, in the course of which meanings attributed to the events can change or alternate. resources • Family Process • Journal of Child and Family Studies, ISSN: 1062-1024 (Print) 1573-2843 (Online), Springer • Journal of Marital and Family Therapy • Journal of Family Psychology • Family Relations • Contemporary Family Therapy • Australian & New Zealand Journal of Family Therapy • Family Matters, Australian Institute of Family Studies • Journal of Comparative Family Studies, ASIN: B00007M2W5, Univ of Calgary/Dept Sociology • Journal of Family Studies, ISSN: 1322-9400, eContent Management Pty Ltd • [1] Journal of Family Therapy, AFT (Association for family Therapy & Systemic Practice in the UK) • [2] Context Magazine, AFT, UK • [3] Karnac Systemic Thinking and Practice SeriesProfessional Organizations • American Association for Marriage and Family Therapy • American Family Therapy Academy • European Family Therapy Association (EFTA) • International Association of Marriage and Family Counsellors • National Council on Family Relations • The Ackerman Institute for the Family18
  • See also • Alternative dispute resolution • Internal Family Systems Model • CAMFT • Interpersonal psychotherapy • Child abuse • Interpersonal relationship • Conflict resolution • Mediation • Deinstitutionalisation • Multisystemic Therapy (MST) • Domestic violence • Positive psychology • Dysfunctional family • Relationships Australia • Family Life Education • Strategic Family Therapy • Family Life SpaceReferences 1. ^ a b c Broderick, C.B. & Schrader, S.S. (1991). The History of Professional Marriage and Family Therapy. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of Family Therapy. Vol. 2. NY: Brunner/Mazel 2. ^ a b c d e Sholevar, G.P. (2003). Family Theory and Therapy. In Sholevar, G.P. & Schwoeri, L.D. Textbook of Family and Couples Therapy: Clinical Applications. Washington, DC: American Psychiatric Publishing Inc. 3. ^ Silverman, M. & Silverman, M. Psychiatry Inside the Family Circle. Saturday Evening Post, 46-51. 28 July 1962. 4. ^ Guttman, H.A. (1991). Systems Theory, Cybernetics, and Epistemology. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of Family Therapy. Vol. 2. NY: Brunner/Mazel 5. ^ Becvar, D.S., & Becvar, R.J. (2008). Family therapy: A systemic integration. 7th ed. Boston: Allyn & Bacon. 6. ^ a b Barker, P. (2007). Basic family therapy; 5th edition. Wiley-Blackwell. 7. ^ a b Nichols, M.P. & Schwartz, R.C. (2006). Family therapy: concepts and methods. 7th ed. Boston: Pearson/Allyn & Bacon. 8. ^ Sprenkle, D.H., & Bischof, G.P. (1994). Contemporary family therapy in the United States. Journal of Family Therapy, 16(1): 5-23(19) 9. ^ Dattilio, F.R. (Ed.) (1998). Case Studies in Couple and Family Therapy: Systemic and Cognitive Perspectives. Guildford Press: New York. 10. ^ Gurman, A.S. & Fraenkel, P. (2002). The history of couple therapy: a millennial review. Family Process, 41(2): 199-260(62) 11. ^ Couple therapy Harvard Mental Health Letter 03/01/2007. 12. ^ Attachment and Family Systems. Family Process. Special Issue: Fall 2002 41(3) 13. ^ Denborough, D. (2001). Family Therapy: Exploring the Fields Past, Present and Possible Futures. Adelaide, South Australia: Dulwich Centre Publications. 14. ^ Crago, H. (2006). Couple, Family and Group Work: First Steps in Interpersonal Intervention. Maidenhead, Berkshire; New York: Open University Press. 15. ^ Van Buren, J. Multisystemic therapy. Encyclopedia of Mental Disorders. retrieved 29 Oct. 2009 16. ^ McGoldrick, M. (Ed.) (1998). Re-Visioning Family Therapy: Race, Culture, and Gender in Clinical Practice. Guilford Press: New York. 17. ^ Dean, R.G. (2001). The Myth of Cross-Cultural Competence. Families in Society: The Journal of Contemporary Human Services. 82(6): 623-30. 18. ^ Krause, I-B. (2002). Culture and System in Family Therapy. London; New York: Karnac. 19. ^ Ng, K.S. (2003). Global Perspectives in Family Therapy: Development, Practice, and Trends. New York: Brunner- Routledge. 20. ^ McGoldrick, M., Giordano, J. & Garcia-Preto, N. (2005). Ethnicity & Family Therapy, 3rd Ed.: Guilford Press. 21. ^ Nichols, M.P. & Schwartz, R.C. (2006). Recent Developments in Family Therapy: Integrative Models; in Family therapy: concepts and methods. 7th ed. Boston: Pearson/Allyn & Bacon. 22. ^ Lebow, J. (2005). Handbook of clinical family therapy. Hoboken, NJ: John Wiley and Sons. 23. ^ Booth, T.J. & Cottone, R.R. (2000). Measurement, Classification, and Prediction of Paradigm Adherence of Marriage and Family Therapists. American Journal of Family Therapy. 28(4): 329-346. 24. ^ The Top 10: The Most Influential Therapists of the Past Quarter-Century. Psychotherapy Networker.: 2007, March/April (retrieved 7 Oct 2010) 19
  • 25. ^ "Therapy Center:Credentials". Psychology Today. Retrieved 2008-08-13. 26. ^ Doherty W (2002). "Bad Couples Therapy and How to Avoid It: Getting past the myth of therapist neutrality". Psychotherapy Networker 26 (Nov-Dec): 26–33. 27. ^ Doherty, W., & Boss, P. (1991). Values and ethics in family therapy. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of Family Therapy. Vol. 2. NY: Brunner/Mazel 28. ^ Dueck A (1991). "Metaphors, models, paradigms and stories in family therapy". In Vande Kemp H. Family therapy: Christian perspectives. Grand Rapids, MI: Baker Book House. pp. 175–207. ISBN 0-8010-9313-9. 29. ^ Wall J, Needham T, Browning DS, James S (Apr 1999). "The Ethics of Relationality: The Moral Views of Therapists Engaged in Marital and Family Therapy". Family Relations (National Council on Family Relations) 48 (2): 139–49. doi:10.2307/585077. JSTOR 585077. 30. ^ Grosser GH, Paul NL (Oct 1964). "Ethical issues in family group therapy". Am J Orthopsychiatry 34 (5): 875–84. doi:10.1111/j.1939-0025.1964.tb02243.x. PMID 14220517. 31. ^ Hare-Mustin RT (Jun 1978). "A feminist approach to family therapy". Fam Process 17 (2): 181–94. doi:10.1111/j.1545-5300.1978.00181.x?journalCode=famp. PMID 678351. 32. ^ Gottlieb, M.C. (1995). Developing Your Ethical Position in Family Therapy: Special Issues. Paper presented at the Annual Meeting of the American Psychological Association (103rd, New York, NY, August 11–15, 1995). 33. ^ Melito, R. (2003). Values in the role of the family therapist: Self determination and justice. Journal of Marital and Family Therapy. 29(1):3-11. 34. ^ Fowers BJ, Richardson FC (1996). "Individualism, Family Ideology and Family Therapy". Theory & Psychology 6 (1): 121–51. doi:10.1177/0959354396061009. 35. ^ USA Today 6/21/2005 Hearts divide over marital therapy. 36. ^ Gehart, D. R., & Tuttle, A. R. (2003). Theory-based treatment planning for marriage and family therapists: Integrating theory and practice. Pacific Grove, CA: Brooks/Cole/Thomson. 37. ^ Goldenberg, I., & Goldenberg, H. (2008). Family therapy: An overview. Belmont, CA: Thomson Brooks/Cole. 38. ^ Gurman, A. S. (2008). Clinical handbook of couple therapy. New York: Guilford Press. 39. ^ a b Sexton, T. L., Weeks, G. R., & Robbins, M. S. (2003). Handbook of family therapy: The science and practice of working with families and couples. New York: Brunner-Routledge.External linksIncluded in this list are the main professional associations in the US and internationally; they reflect to some degreethe different theoretical, ideological, and cross-cultural views of family therapy theory and practice. • American Association for Marriage and Family Therapy: main professional association in US • American Family Therapy Academy: main research-oriented professional association in US • Association for Family Therapy and Systemic Practice in the UK • Australian and New Zealand Journal of Family Therapy: the de facto professional association for Australia and NZ • Bowen Theory from the Bowen Center for the Study of the Family. • California Association of Marriage and Family Therapists • European Family Therapy Association • International Family Therapy Association • Historical overview of the field; Therapist profiles; Timeline from Allyn and Bacon/Longman publishing. • Family Support Partnership - An Overview of Family Therapy and Mediation • Dulwich Centre: Gateway to Narrative Therapy & Community Work • [4] • "Mind For Therapy" group devoted to creative origins of Family Therapy • Glossary of Family Systems and intergenerational concepts • MFT at Notre Dame de Namur University, Belmont CA• Social Construction Therapies Network20
  • Brief Strategic Family TherapyThe family is defined by an organizational structure that is characterized by degrees of cohesiveness, love, loyalty,and purpose as well as high levels of shared values, interests, activities, and attention to the needs of its members.Families may be considered a system, organized wholes or units made up of several interdependent and interactingparts. Each member has a significant influence on all other members. For positive change in an identified client,therefore, family members have to change the way they interact. Family therapists work with the presentrelationships rather than the past. They are interested in the balance families maintain between bipolar extremes thatcharacterize dysfunctional families.Strategic refers to the development of a specific strategy, planned in advance by the therapist, to resolve thepresenting problem as quickly and efficiently as possible.DESCRIPTIONBrief Strategic Family Therapy (BSFT) is a short-term, problem-focused therapeutic intervention, targeting childrenand adolescents 6 to 17 years old, that improves youth behaviour by eliminating or reducing drug use and itsassociated behaviour problems and that changes the family members’ behaviours that are linked to both risk andprotective factors related to substance abuse. The therapeutic process uses techniques of:Joining—forming a therapeutic alliance with all family membersDiagnosis—identifying interactional patterns that allow or encourage problematic youth behaviourRestructuring—the process of changing the family interactions that are directly related to problem behavioursPROGRAM BACKGROUNDBSFT was developed at the Spanish Family Guidance Center in the Center for Family Studies, University of Miami.BSFT has been conducted at these centers since 1975. The Center for Family Studies is the Nation’s oldest andmost prominent center for development and testing of minority family therapy interventions for prevention andtreatment of adolescent substance abuse and related behaviour problems. It is also the Nation’s leading trainer ofresearch-proven, family therapy for Hispanic/Latino families.INDICATEDThis program was developed for an indicated audience. It targets children with conduct problems, substance use,problematic family relations, and association with antisocial peers.CONTENT FOCUSALCOHOL, ANTISOCIAL/AGGRESSIVE BEHAVIOUR, ILLEGAL DRUGS, SOCIAL ANDEMOTIONAL COMPETENCE, TOBACCOThis program addresses family risk and protective factors to problem behaviour, including substance useamong adolescents.Parents as a primary target population:The program involves family systems therapy, involving all family members. It seeks to change the way familymembers act toward each other so that they will promote each other’s mastery over behaviours that are required forthe family to achieve competence and to impede undesired behaviours.INTERVENTIONS BY DOMAININDIVIDUAL: Life and social skills trainingFAMILY : Home visits, Parent education/family therapy, Parent education/parenting skills trainingTask-oriented family education sessions combining social skills training to improve family interaction (e.g.,communication skills)PEER : Peer-resistance education 21
  • KEY PROGRAM APPROACHESPARENT-CHILD INTERACTIONS : All of the key strategies are focused on improving the interactions betweenparents and child.PARENT TRAINING : A key change strategy is to empower parents by increasing their mastery of parenting skills.SKILL DEVELOPMENT : The program fosters conflict resolution skills, parenting skills, and communicationskills.TECHNIQUES USED• Joining—forming a therapeutic alliance with all family members• Diagnosis—identifying interactional patterns that allow or encourage problematic youth behaviour• Restructuring—the process of changing the family interactions that are directly related to problem behavioursTHERAPYThe program involves creating a counsellor-family work team that develops a therapeutic alliance with each familymember and with the family as a whole; diagnosing family strengths and problematic interactions; developingchange strategies to capitalize on strengths and correct problematic family interactions; and implementing changestrategies and reinforcing family behaviours that sustain new levels of family competence. Strategies includereframing, changing alliances, building conflict resolution skills, and parental empowerment.HOW IT WORKSBSFT can be implemented in a variety of settings, including community social services agencies, mental healthclinics, health agencies, and family clinics. BSFT is delivered in 8 to 12 weekly 1- to 1.5-hour sessions. The familyand BSFT counsellor meet either in the program office or the family’s home. Sessions may occur more frequentlyaround crises because these are opportunities for change. There are four important BSFT steps:Step 1:Organize a counsellor-family work team. Development of a therapeutic alliance with each family member andwith the family as a whole is essential for BSFT. This requires counsellors to accept and demonstrate respect foreach individual family member and the family as a whole.Step 2:Diagnose family strengths and problem relations. Emphasis is on family relations that are supportive and problemrelations that affect youths’ behaviours or interfere with parental figures’ ability to correct those behaviours.Step 3:Develop a change strategy to capitalize on strengths and correct problematic family relations, therebyincreasing family competence. In BSFT, the counsellor is plan- and problem-focused, direction-oriented (i.e., moving from problematic to competent interactions), and practical.Step 4:Implement change strategies and reinforce family behaviours that sustain new levels of family competence.Important change strategies include reframing to change the meaning of interactions; changing alliances andshifting interpersonal boundaries; building conflict resolution skills; and providing parenting guidance andcoaching.BARRIERS AND PROBLEMSProblem: The most common problem is engaging and retaining whole families in treatment.Solution: Specialized engagement strategies have been developed to deal with the problem.Problem: A common problem in implementing a whole-family intervention involves limited availability of familymembers.Solution: Sessions often must occur during evening hours and on weekends.22
  • Strategic Family TherapyStrategic family therapy is a family-oriented therapy that involves a patients daily family environment as a majorpart of treatment. Pressure from family, society and peers can create rifts in even the strongest families creatingdysfunction. The goal is to fix the problem creating disruption and preserving the family unit no matter what.Strategic Family Therapy (Madanes and Haley) designs a strategy for each specific problem. Clear goals set,symptoms deprived of their relationship-controlling function. Therapist controls the therapy.Every interaction is a struggle for control of the relationships definition. Symmetrical (similar, often competitive)vs. complementary (different, often counterresponding) interactions. Metacommunication and repetitive interactionsexamined. Prescriptive and descriptive paradoxical assignments.Madanes: "pretend techniques." Circular questioning. Positive connotation (as reframe of symptomatic behaviour).Haley ModelJay Haley and Salvador Minuchin are considered the pioneers of strategic family therapy. In the 1950s and 1960s,Haley and other therapists began experimenting with alternative models of working with families that relied onsolution-focused techniques. The solution-focused approach was favored over traditional psychoanalysis.The therapy is based on the idea that people dont develop problems in isolation. Strategic therapy implementstechniques that meet the specific need of a family and their interaction.Behavior ProblemsChildren between the ages eight and 17 are vulnerable to developing behavior problems. When this happens it canthrow family dynamics into a state of chaos. Strategic family therapy is a solution-oriented approach. They focus ongetting to the root of the problem rather than what caused it. The therapist works on helping their clients turn theirlives around by creating a carefully planned strategy, execution and monitoring progress. The therapy is based onfive stages: identify problems that can be solved, establish goals, create interventions that meet these objectives,analyze the responses, and examine the results. The therapy emphasis is on the social situation not the individual.Solving problems, meeting family goals and help change a persons dysfunctional behavior.Family InteractionStrategic family therapy considers the family unit as a system. Families function just like any other system. Theynaturally establish rules and interactions that affect every member. When the affected family members problems arerecognized and addressed, the entire family becomes part of the solution process. The idea behind this method isthat the family has the most influence on a persons life.TherapyAll the family members participate within a safe, therapeutic setting. The therapist attempts to recreate typicalfamily interactions and conversation through provocative questioning techniques so that the problems can bepresented and addressed accordingly. It also give family members a chance to see how their interactions andresponses can contribute to a dysfunctional situation. The therapy works on helping families discover their uniqueability to solve their problems using internal resources they werent aware they had.Who Does it Help?All families face challenges. ADD/ADHD, depression and substance abuse are a few of examples of issues that canaffect a family unit. If a child were dealing with any of the previous issues and had become estranged from thefamily, the therapist would bring everyone together in a clinical setting to watch how they interact. Then he couldwork closely with everyone in the family to implement and execute solutions to help correct the dysfunctionalbehavior. 23
  • Solution focused brief therapyFrom Wikipedia, the free encyclopediaSolution focused brief therapy (SFBT), often referred to as simply solution focused therapy or brief therapy, is atype of talking therapy that is based upon social constructionist philosophy. It focuses on what clients want toachieve through therapy rather than on the problem(s) that made them to seek help. The approach does not focus onthe past, but instead, focuses on the present and future. The therapist/counsellor uses respectful curiosity to invitethe client to envision their preferred future and then therapist and client start attending to any moves towards itwhether these are small increments or large changes. To support this, questions are asked about the client’s story,strengths and resources, and about exceptions to the problem.Solution focused therapists believe that change is constant. By helping people identify the things that they wish tohave changed in their life and also to attend to those things that are currently happening that they wish to continue tohave happen, SFBT therapists help their clients to construct a concrete vision of a preferred future for themselves.The SFBT therapist then helps the client to identify times in their current life that are closer to this future, andexamines what is different on these occasions. By bringing these small successes to their awareness, and helpingthem to repeat these successful things they do when the problem is not there or less severe, the therapists helps theclient move towards the preferred future they have identified.Solution focused work can be seen as a way of working that focuses exclusively or predominantly at two things. 1)Supporting people to explore their preferred futures. 2) Exploring when, where, with whom and how pieces of thatpreferred future are already happening. While this is often done using a social constructionist perspective theapproach is practical and can be achieved with no specific theoretical framework beyond the intention to keep asclose as possible to these two things.Contents • 1 Basic Principles • 2 Questions • 3 Resources • 4 History of Solution Focused Brief Therapy • 5 Solution-Focused counselling • 6 Solution-Focused consulting • 7 ReferencesBasic Principles:Clients have resources and strengths to resolve complaints — It is therapist’s task to access these abilities and helpclients put them to use.Change is constant — Therapists can do a great deal to influence client’s perceptions regarding the inevitability ofchange and what is supposed to happen during the therapy session.24
  • The therapist’s job is to identify and amplify change — He/She accomplishes this through choice of questions,topics focused on or ignored. “Focus on what seems to be working however small, to label it as worthwhile, and towork toward amplifying it.” If [the change] is in a crucial area, it can change the whole system.It is usually unnecessary to know a great deal about the complaint in order to resolve it — What is significant iswhat the clients are doing that is working. Learn from clients’ identifying when the problem is not troublesome.Clients can learn to function that way again to solve the problem.It is not necessary to know the cause or function of a complaint to resolve it — Even the most creative hypothesesabout the possible function of a symptom will not offer therapists a clue about how people can change. It simplysuggests how people’s lives have become static. Ask those who want to know why they have a symptom: “Would itbe enough if the problem were to disappear and you never understood why had it?”A small change is all that is necessary: A change in one part of the system can affect change in another part of thesystem — “We have the sense that positive changes will at least continue and may expand and have beneficialeffects in other areas of the person’s life.Clients define the goal — Do not assume that therapists are better equipped to decide how their clients should livetheir lives; ask people to establish their own goals for treatment.Rapid change or resolution of problems is possible — “We believe that, as a result of our interaction during the firstsession, our clients will gain a more productive and optimistic view of their situations.” Therapists expect them togo home and do what is necessary to make their lives more satisfying (p. 45). Average length of treatment is lessthan 10 sessions, usually 4 to 5, occasionally only 1.There is no one “right” way to view things; Different views may be just as valid and may fit the facts just as well —Views that keep people stuck are simply not useful. Sometimes all that is necessary to initiate significant change is ashift in the person’s perception of the situation.”Focus on what is possible and changeable rather than what is impossible and intractable — Focus on aspects of aperson’s situation that seem most changeable. This imparts a sense of hope and powerQuestionsThe miracle question The miracle question is a method of questioning that a coach, therapist, or counsellor uses toaid the client to envision how the future will be different when the problem is no longer present. Also, this may helpto establish goals.A traditional version of the miracle question would go like this: "Suppose our meeting is over, you go home, do whatever you planned to do for the rest of the day. And then, some time in the evening, you get tired and go to sleep. And in the middle of the night, when you are fast asleep, a miracle happens and all the problems that brought you here today are solved just like that. But since the miracle happened overnight nobody is telling you that the miracle happened. When you wake up the next morning, how are you going to start discovering that the miracle happened? ... What else are you going to notice? What else?"Whilst relatively easy to state the miracle question requires considerable skill to ask well. The question must beasked slowly with close attention to the persons non-verbal communication to ensure that the pace matches thepersons ability to follow the question. Initial responses frequently include a sense of "I dont know." To ask thequestion well this should be met with respectful silence to give the person time to fully absorb the question. 25
  • Once the miracle day has been thoroughly explored the worker can follow this with scales, on a scale where 0 =worst things have ever been and 10 = the miracle day where are you now? Where would it need to be for you toknow that you didnt need to see me any more? What will be the first things that will let you know you are 1 pointhigher. In this way the miracle question is not so much a question as a series of questions.There are many different versions of the miracle question depending on the context and the client.In a specific situation, the counsellor may ask, "If you woke up tomorrow, and a miracle happened so that you no longer easily lost your temper, what would you see differently?" What would the first signs be that the miracle occurred?"The client (a child) may respond by saying, "I would not get upset when somebody calls me names."The counsellor wants the client to develop positive goals, or what they will do, rather than what they will not do--tobetter ensure success. So, the counsellor may ask the client, "What will you be doing instead when someone callsyou names?"Scaling Questions Scaling questions are tools that are used to identify useful differences for the client and may helpto establish goals as well. The poles of a scale can be defined in a bespoke way each time the question is asked, buttypically range from "the worst the problem has ever been" (zero or one) to "the best things could ever possibly be"(ten). The client is asked to rate their current position on the scale, and questions are then used to help the clientidentify resources (e.g. "whats stopping you from slipping one point lower down the scale?"), exceptions (e.g. "on aday when you are one point higher on the scale, what would tell you that it was a one point higher day?") and todescribe a preferred future (e.g. "where on the scale would be good enough? What would a day at that point on thescale look like?")Exception Seeking Questions Proponents of SFBT insist that there are always times when the problem is lesssevere or absent for the client. The counsellor seeks to encourage the client to describe what different circumstancesexist in that case, or what the client did differently. The goal is for the client to repeat what has worked in the past,and to help them gain confidence in making improvements for the future.Coping questions Coping questions are designed to elicit information about client resources that will have goneunnoticed by them. Even the most hopeless story has within it examples of coping that can be drawn out: "I can seethat things have been really difficult for you, yet I am struck by the fact that, even so, you manage to get up eachmorning and do everything necessary to get the kids off to school. How do you do that?" Genuine curiosity andadmiration can help to highlight strengths without appearing to contradict the clients view of reality. The initialsummary "I can see that things have been really difficult for you" is for them true and validates their story. Thesecond part "you manage to get up each morning etc.", is also a truism, but one that counters the problem focusednarrative. Undeniably, they cope and coping questions start to gently and supportively challenge the problem-focused narrative.Problem-free talk In solution-focused therapy, problem-free talk can be a useful technique for identifyingresources to help the person relax, or be more assertive, for example. Solution focused therapists will talk aboutseemingly irrelevant life experiences such as leisure activities, meeting with friends, relaxing and managingconflict. The therapist can also gather information on the clients values and beliefs and their strengths. From thisdiscussion the therapist can use these strengths and resources to move the therapy forward. For example; if a clientwants to be more assertive it may be that under certain life situations they are assertive. This strength from one partof their life can then be transferred to the area with the current problem. Or if a client is struggling with their childbecause the child gets aggressive and calls the parent names and the parent continually retaliates and also getsangry, then perhaps they have an area of their life where they remain calm even under pressure; or maybe they have26
  • trained a dog successfully that now behaves and can identify that it was the way they spoke to the dog that made thedifference and if they put boundaries in place using the same firm tonality the child might listen.Dan Jones, in his Becoming a Brief Therapist book is in the problem free areas you find most of the resources to help the client. It also relaxes them and helps buildrapport, and it can give you ideas to use for treatment...Everybody has natural resources that can be utilised. Thesemight be events...or talk about friends or family...The idea behind accessing resources is that it gives you somethingto work with that you can use to help the client to achieve their goal...Even negative beliefs and opinions can beutilised as resources [1]ResourcesA key task in SFBT is to help clients identify and attend to their skills, abilities, and external resources (e.g. socialnetworks). This process not only helps to construct a narrative of the client as a competent individual, but also aimsto help the client identify new ways of bringing these resources to bear upon the problem. Resources can beidentified by the client and the worker will achieve this by empowering the client to identify their own resourcesthrough use of scaling questions, problem-free talk, or during exception-seeking.Resources can be Internal: the clients skills, strengths, qualities, beliefs that are useful to them and their capacities.Or, External: Supportive relationships such as, partners, family, friends, faith or religious groups and also supportgroups.History of Solution Focused Brief TherapySolution Focused Brief Therapy is one of a family of approaches, known as systems therapies, that have beendeveloped over the past 50 years or so, first in the USA, and eventually evolving around the world, includingEurope. The title SFBT, and the specific steps involved in its practice, are attributed to husband and wife Steve deShazer and Insoo Kim Berg and their team at the Brief Family Therapy Center in Milwaukee, USA. Core membersof this team were Eve Lipchik, Wallace Gingerich, Elam Nunnally, Alex Molnar, and Michele Weiner-Davis. Theirwork in the early 1980s built on that of a number of other innovators, among them Milton Erickson, and the groupat the Mental Research Institute at Palo Alto – Gregory Bateson, Donald deAvila Jackson, Paul Watzlawick, JohnWeakland, Virginia Satir, Jay Haley, Richard Fisch, Janet Beavin Bavelas and others.The concept of brief therapy was independently discovered by several therapists in their own practices over severaldecades (notably Milton Erickson), was described by authors such as Haley in the 1950s, and became popularized inthe 1960s and 1970s. Richard Bandler, John Grinder and Stephen R Lankton have also been credited, at least inpart, with the inspiration for and popularization of brief therapy, particularly through their work with MiltonErickson.[2] While Jay Hayley and the team at the Mental Research Institute at Palo Alto aimed to uncover theprinciples that underpinned Ericksons approach to brief therapy, John Grinder and Richard Bandler providedpractical guidelines for the application of some of the hypnotic techniques of Erickson.[3][4]Solution Focused Brief Therapy has branched out in numerous spectrums - indeed, the approach is now known inother fields as simply Solution Focus or Solutions Focus. Most notably, the field of Addiction Counselling hasbegun to utilize SFBT as an effective means to treat problem drinking. The Center for Solutions in Cando, ND hasimplemented SFBT as part of their program, wherein they utilize this therapy as part of a partial hospitalization andresidential treatment facility for both adolescents and adults. 27
  • Solution-Focused counsellingSolution-Focused counselling is a solution focused brief therapy model. Various similar, yet distinct, models havebeen referred to as solution-focused counselling. For example, Jeffrey Guterman developed a solution-focusedapproach to counselling in the 1990s. This model is an integration of solution-focused principles and techniques,postmodern theories, and a strategic approach to eclecticism.Solution-Focused consultingSolution-Focused consulting is an approach to organizational change management that is built upon the principlesand practices of Solution-Focused therapy. While therapy is for individuals and families, Solution-Focusedconsulting is being used as a change process for organizational groups of every size, from small teams to largebusiness units.References• ^ Jones, Dan Becoming a Brief Therapist: Special Edition The Complete Works,, 2008, page 451, ISBN 1-409- 23031-7• ^ See page 671 in Steenbarger (2002) "Single-session therapy: Theoretical underpinnings" In Elsevier Encyclopedia of Psychotherapy• ^ (Shazer 1982 p.22)• ^ Shazer, SD. (1982) Patterns of brief family therapy: an ecosystemic approach. Guilford Press.• I.K.Berg and S.deShazer: Making numbers talk: Language in therapy. In S. Friedman (Ed.), "The new language of change:• Constructive collaboration in psychotherapy." New York:Guilford, 1993.• I.K.Berg, "Family based services: A solution-focused approach." New York:Norton. 1994.• I.K.Berg; "Solution-Focused Therapy: An Interview with Insoo Kim Berg.", 2003.• B.Cade and W.H. O’Hanlon: A Brief Guide to Brief Therapy. W.W. Norton & Co 1993.• D. Denborough; Family Therapy: Exploring the Fields Past, Present and Possible Futures. Adelaide, South Australia: Dulwich Centre Publications, 2001.• Shazer: Clues; Investigating Solutions in Brief Therapy. W.W. Norton & Co 1988• E.George, C.Iveson, H. Ratner; Problem to solution; brief therapy with individuals and families. BT Press, 1990.• M.A. Hubble, B.L. Duncan, S.D. Miller; The Heart and Soul of Change; what works in therapy. American Psychological Association, 1999.• S.D. Miller, M.A. Hubble, B.L. Duncan; Handbook of Solution-focused brief therapy. Jossey-Bass Publishers, 1996.• B.O’Connell; Solution Focused Therapy. Sage, 1998.• B.O’Hanlon and S. Beadle; A Field Guide to PossibilityLand: possibility therapy methods. BT Press 1996.• B. OHanlon and M. Weiner-Davis: "In Search of Solutions: A New Direction in Psychotherapy." WW Norton & CO. New York 1989• J.T. Guterman; Mastering the Art of Solution-Focused Counselling. American Counselling Association 2006.• M.Talmon; Single Session Therapy; maximizing the effect of the first (and often only) therapeutic encounter. Jossey-Bass• Publishers, 1990.• Peter De Jong, Insoo Kim Berg Interviewing for Solutions Brooks Cole Publishers, 2nd edition 2002• P.Ziegler and T. Hiller: Recreating Partnership: A Solution-Oriented, Collaborative Approach to Couples Therapy. W.W.• Norton 2001.• Guterman, J.T. (2006). Mastering the Art of Solution-Focused Counselling. Alexandria, VA: American Counselling• Association. ISBN 1-55620-267-9• Guterman, J.T., Mecias, A., Ainbinder, D.L. (2005). Solution-focused treatment of migraine headache. The Family28
  • Brief (psycho-) therapyFrom Wikipedia, the free encyclopediaBrief psychotherapy or Brief therapy is an umbrella term for a variety of approaches to psychotherapy. It differsfrom other schools of therapy in that it emphasises (1) a focus on a specific problem and (2) direct intervention. Inbrief therapy, the therapist takes responsibility for working more pro-actively with the client in order to treat clinicaland subjective conditions faster. It also emphasizes precise observation, utilization of natural resources, andtemporary suspension of disbelief to consider new perspectives and multiple viewpoints.Rather than the formal analysis of historical causes of distress, the primary approach of brief therapy is to help theclient to view the present from a wider context and to utilize more functional understandings (not necessarily at aconscious level). By becoming aware of these new understandings, successful clients will de facto undergospontaneous and generative change.Brief therapy is often highly strategic, exploratory, and solution-based rather than problem-oriented. It is lessconcerned with how a problem arose than with the current factors sustaining it and preventing change. Brieftherapists do not adhere to one "correct" approach, but rather accept that there being many paths, any of which mayor may not in combination turn out to be ultimately beneficial.Founding proponents of brief therapyMilton Erickson was a master of brief therapy, using clinical hypnosis as his primary tool. To a great extent hedeveloped this himself. His approach was popularized by Jay Haley, in the book "Uncommon therapy: Thepsychiatric techniques of Milton Erickson M.D.""The analogy Erickson uses is that of a person who wants to change the course of a river. if he opposes the river bytrying to block it, the river will merely go over and around him. But if he accepts the force of the river and diverts itin a new direction, the force of the river will cut a new channel." (Haley, "Uncommon therapy", p.24, emphasis inoriginal)Richard Bandler, the co-founder of neuro-linguistic programming, is another firm proponent of brief therapy. Aftermany years of studying Ericksons therapeutic work, he wrote:"Its easier to cure a phobia in ten minutes than in five years... I didnt realize that the speed with which you dothings makes them last... I taught people the phobia cure. Theyd do part of it one week, part of it the next, and partof it the week after. Then theyd come to me and say "It doesnt work!" If, however, you do it in five minutes, andrepeat it till it happens very fast, the brain understands. Thats part of how the brain learns... I discovered that thehuman mind does not learn slowly. It learns quickly. I didnt know that." (Time for a change, 1993, p.20) 29
  • Short-term counselling with lasting resultsAn Overview of Brief Therapy Brief Therapy is a model of therapy that focuses strongly on your present and future, as opposed to your past. Traditional psychotherapy tends to focus on the past and looks for the cause of problems. In contrast, Brief Therapy focuses on the solution to problems, which is why it is often called solution-oriented therapy. Some Brief Therapy experts would go so far as to say they dont even need to know what the past problems were to help the client. Although this is an extreme view, it does illustrate that Brief Therapy is firmly rooted in the present with an eye toward changing the future. The brief therapy solution-focused approach can be summed up in three stages, according to Peller and Walter (1992): 1. Find out what you (the client) want 2. Determine what is currently working for you and do more of that 3. Do something different. The simplicity of these stages belies their effectiveness. Consider, for example, the seemingly simple task of finding out what you want to achieve in therapy. Most people go into therapy knowing all too well what they dont want, what has been troubling them, or how frustrated they are by their problems. In the solution-focused model, our goal is to help you find out what you do want. Identifying your goal (or goals) is perhaps the single most important thing you will do in your Brief Therapy sessions. In effect, the goals that you articulate will guide you through the rest of your sessions, and they will be the mark against which you will measure your success. In the next stage, the emphasis is on finding out what parts of your life are working just fine. Brief Therapists are strong adherents to the "if it aint broke dont fix it" philosophy. When we find out what parts of your life youre happy with, we can use them as a strong foundation upon which you can build an improved lifestyle. In traditional therapy, by contrast, the focus is on diagnosing what is wrong with you or what is not working for you. In Brief Therapy you will present your problems, but you will solve them by using the strengths that you already have. The last stage (Do something different) will help you when if you realize that one approach is not working effectively. Because everyone has an almost infinite capacity for creative solutions (even if you dont realize it now) we wont waste time on any approach thats not working for you. Since our time frame is measured in weeks and months (as opposed to years) we want to find a solution that works in the shortest time possible. Brief Therapy emphasizes the client as the expert. You will be in charge of your own therapy and you will decide when you have attained your goals. Your therapist will listen to what you have to say, and together you will develop goals and work collaboratively to find solutions. Perhaps the most important thing to remember is that Brief Therapy is effective because people are capable of change in a short amount of time.30
  • Bowen’s Strategic Family Therapy - IContents • Introduction • Differentiation of Self • Triangles • The Nuclear Family Emotional Processes • The Family Projection Process • The Multigenerational Transmission Process • Sibling Position • Emotional Cutoff • Societal Emotional Processes • Normal Family Development • Family Disorders • Goals of Therapy • Techniques • Family Therapy with One PersonIntroduction Family Systems TheoryIntroductionThe pioneers of family therapy recognized that current social and cultural forces shape our values about ourselvesand our families, our thoughts about what is "normal" and "healthy," and our expectations about how the worldworks. However, Bowen was the first to realize that the history of our family creates a template which shapes thevalues, thoughts, and experiences of each generation, as well as how that generation passes down these things to thenext generation.Bowen was a medical doctor and the oldest child in a large cohesive family from Tennessee. He studiedschizophrenia, thinking the cause for it began in mother-child symbiosis, which created an anxious and unhealthyattachment. He moved from studying dyads (two way relationships like parent-child and parent-parent) to triads(three way relationships like parent-parent-child and grandparent-parent-child) afterward. At a conference organizedby Framo, one of his students, he explained his theory of how families develop and function, and presented as a casestudy his own family.Bowens theory focuses on the balance of two forces. The first is togetherness and the second is individuality. Toomuch togetherness creates fusion and prevents individuality, or developing ones own sense of self. Too muchindividuality results in a distant and estranged family.Bowen introduced eight interlocking concepts to explain family development and functioning, each of which isdescribed below.The family systems theory is a theory introduced by Dr. Murray Bowen that suggests that individuals cannot beunderstood in isolation from one another, but rather as a part of their family, as the family is an emotional unit.Families are systems of interconnected and interdependent individuals, none of whom can be understood inisolation from the system. 31
  • The family systemAccording to Bowen, a family is a system in which each member has a role to play and rules to respect. Members ofthe system are expected to respond to each other in a certain way according to their role, which is determined byrelationship agreements.Within the boundaries of the system, patterns develop as certain family members behaviour is caused by and causesother family members behaviours in predictable ways.Maintaining the same pattern of behaviours within a system may lead to balance in the family system, but also todysfunction.For example, if a husband is depressive and cannot pull himself together, the wife may need to take up moreresponsibilities to pick up the slack. The change in roles may maintain the stability in the relationship, but it mayalso push the family towards a different equilibrium. This new equilibrium may lead to dysfunction as the wife maynot be able to maintain this overachieving role over a long period of time.There are eight interlocking concepts in Dr. Bowens theory:1) Differentiation of self: The variance in individuals in their susceptibility to depend on others for acceptance and approval.2) Triangles: The smallest stable relationship system. Triangles usually have one side in conflict and two sides in harmony, contributing to the development of clinical problems.3) Nuclear family emotional system: The four relationship patterns that define where problems may develop in a family. - Marital conflict - Dysfunction in one spouse - Impairment of one or more children - Emotional distance4) Family projection process: The transmission of emotional problems from a parent to a child.5) Multigenerational transmission process: The transmission of small differences in the levels of differentiation between parents and their children.6) Emotional cut-off: The act of reducing or cutting off emotional contact with family as a way of managing unresolved emotional issues.7) Sibling position: The impact of sibling position on development and behaviour.8) Societal emotional process: The emotional system governs behaviour on a societal level, promoting both progressive and regressive periods in a society.32
  • 1. Differentiation of SelfThe first concept is Differentiation of Self, or the ability to separate feelings and thoughts. Undifferentiated peoplecan not separate feelings and thoughts; when asked to think, they are flooded with feelings, and have difficultythinking logically and basing their responses on that. Further, they have difficulty separating their own from othersfeelings; they look to family to define how they think about issues, feel about people, and interpret theirexperiences.Differentiation is the process of freeing yourself from your familys processes to define yourself. This means beingable to have different opinions and values than your family members, but being able to stay emotionally connectedto them. It means being able to calmly reflect on a conflicted interaction afterward, realizing your own role in it, andthen choosing a different response for the future.Differentiation of SelfFamilies and other social groups tremendously affect how people think, feel, and act, but individuals vary in theirsusceptibility to a "group think" and groups vary in the amount of pressure they exert for conformity. Thesedifferences between individuals and between groups reflect differences in peoples levels of differentiation of self.The less developed a persons "self," the more impact others have on his functioning and the more he tries tocontrol, actively or passively, the functioning of others. The basic building blocks of a "self" are inborn, but anindividuals family relationships during childhood and adolescence primarily determine how much "self" hedevelops. Once established, the level of "self" rarely changes unless a person makes a structured and long-termeffort to change it.People with a poorly differentiated "self" depend so heavily on the acceptance and approval of others that eitherthey quickly adjust what they think, say, and do to please others or they dogmatically proclaim what others shouldbe like and pressure them to conform. Bullies depend on approval and acceptance as much as chameleons, butbullies push others to agree with them rather than their agreeing with others. Disagreement threatens a bully asmuch as it threatens a chameleon. An extreme rebel is a poorly differentiated person too, but he pretends to be a"self" by routinely opposing the positions of others.A person with a well-differentiated "self" recognizes his realistic dependence on others, but he can stay calm andclear headed enough in the face of conflict, criticism, and rejection to distinguish thinking rooted in a carefulassessment of the facts from thinking clouded by emotionality. Thoughtfully acquired principles help guidedecision-making about important family and social issues, making him less at the mercy of the feelings of themoment. What he decides and what he says matches what he does. He can act selflessly, but his acting in the bestinterests of the group is a thoughtful choice, not a response to relationship pressures. Confident in his thinking, hecan either support anothers view without being a disciple or reject another view without polarizing the differences.He defines himself without being pushy and deals with pressure to yield without being wishy-washy.Every human society has its well-differentiated people, poorly differentiated people, and people at many gradationsbetween these extremes. Consequently, the families and other groups that make up a society differ in the intensity oftheir emotional interdependence depending on the differentiation levels of their members. The more intense theinterdependence, the less the groups capacity to adapt to potentially stressful events without a marked escalation ofchronic anxiety. Everyone is subject to problems in his work and personal life, but less differentiated people andfamilies are vulnerable to periods of heightened chronic anxiety which contributes to their having a disproportionateshare of societys most serious problems. 33
  • Example:The example of the Michael, Martha, Amy triangle reflects how a lack of differentiation of self plays out in a familyunit; in their case, a moderately differentiated unit. (Triangles example ) The description that follows is of how thistriangle would play out if Michael, Martha, and Amy were more differentiated people.Michael and Martha were quite happy during the first two years of their marriage. He liked making the majordecisions, but did not assume he knew "best." He always told Martha what he was thinking and he listened carefullyto her ideas. Their exchanges were usually thoughtful and led to decisions that respected the vital interests of bothpeople. Martha had always been attracted to Michaels sense of responsibility and willingness to make decisions, butshe also lived by a principle that she was responsible for thinking things through for herself and telling Michaelwhat she thought. She did not assume Michael usually knew "best."[Analysis: Because the level of stress on a marriage is often less during the early years, particularly before the birthsof children and the addition of other responsibilities, the less adaptive moderately differentiated marriage and themore adaptive well-differentiated marriage can look similar because the tension level is low. Stress is necessary toexpose the limits of a familys adaptive capacity.]Martha conceived during the third year of the marriage and had a fairly smooth pregnancy. She had a few physicalproblems, but dealt with them with equanimity. She was somewhat anxious about being an adequate mother but feltshe could manage these fears.When she talked to Michael about her fears, she did not expect that he would solve them for her, but she thoughtmore clearly about her fears when she talked them out with him. He listened but was not patronizing. He recognizedhis own fears about the coming changes in their lives and acknowledged them to Martha.[Analysis: The stresses associated with the real and anticipated changes of the pregnancy trigger some anxiety inboth Michael and Martha, but their interaction does not escalate the anxiety and make it chronic. Martha hadsomewhat heightened needs and expectations of Michael, but she takes responsibility for managing her anxiety andhas realistic expectations about what he can do for her. Michael does not get particularly reactive to Marthasexpectations and recognizes he is anxious too. Each remains a resource to the other.]A female infant was born after a fairly smooth labor. They named her Amy. Martha weathered the delivery fairlywell and was ready to go home when her doctor discharged her. The infant care over the next few months wasphysically exhausting for Martha, but she was not heavily burdened by anxieties about the baby or about heradequacy as a mother. She continued to talk to Michael about her thoughts and feelings and still did not feel he wassupposed to do something to make her feel better. Although Michael had increasing work pressures he remainedemotionally available to her, even if only by phone at times. He worried about work issues, but did not ruminateabout them to Martha. When she asked how it was going, he responded fairly factually and appreciated her interest.He occasionally wished Martha would not get anxious about things, but realized she could manage. He was notcompelled to "fix" things for her.[Analysis: Sure of herself as a person, Martha is able to relate to Amy without feeling overwhelmed byresponsibilities and demands and without unfounded fears about the childs well-being. Sure of himself, Michaelcan meet the reality demands of his job without feeling guilty that he is neglecting Martha. Each spouse recognizesthe pressure the other is under and neither makes a "federal case" about being neglected. Each is sufficientlyconfident in the others loyalty and commitment that neither needs much reassurance about it. By the parentsrelating comfortably to each other, Amy is not triangled into marital tensions. She does not have a void to fill in hermothers life related to distance between her parents.]34
  • After a few months, Michael and Martha were able to find time to do some things by themselves. Martha found thather anxieties about being a mother toned down and she did not worry much about Amy. As Amy grew, Martha didnot perceive her as an insecure child that needed special attention. She was positive about Amy, but not constantlypraising her in the name of reinforcing Amys self-image. Michael and Martha discussed their thoughts and feelingsabout Amy, but they were not preoccupied with her. They were pleased to have her and took pleasure in watchingher develop. Amy grew to be a responsible young child. She sensed the limits of what was realistic for her parentsto do for her and respected those limits. There were few demands and no tantrums. Michael did not feel critical ofAmy very often and Martha did not defend Amy to him when he was critical. Martha figured Michael and Amycould manage their relationship. Amy seemed equally comfortable with both of her parents and relished exploringher environment.[Analysis: Michael and Martha can see Amy as a separate and distinct person. The beginning differentiationbetween Amy and her parents is evident when Amy is a young child. They have adapted quite successfully to theanxieties they each experienced associated with the addition of a child and the increased demands in Michaels worklife. Their high levels of differentiation allow the three of them to be in close contact with little triangling.] 35
  • 2. TrianglesTriangles are the basic units of systems. Dyads are inherently unstable, as two people will vacillate betweencloseness 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.People who are more undifferentiated are likely to triangulate others and be triangulated. People who aredifferentiated cope well with life and relationship stress, and thus are less likely to triangulate others or betriangulated. • Think of the person who can listen to the best friends relationship problems without telling the friend what to do or only validating the friends 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 wont change your partner; you either have to learn to accept this about them, or have to call this relationship quits..."TrianglesA triangle is a three-person relationship system. It is considered the building block or "molecule" of largeremotional systems because a triangle is the smallest stable relationship system. A two-person system (dyad) isunstable because it tolerates little tension before involving a third person. A triangle can contain much more tensionwithout involving another person because the tension can shift around three relationships. If the tension is too highfor one triangle to contain, it spreads to a series of "interlocking" triangles.Spreading the tension can stabilize a system, but nothing gets resolved. Peoples actions in a triangle reflect theirefforts to ensure their emotional attachments to important others, their reactions to too much intensity in theattachments, and their taking sides in the conflicts of others.Paradoxically, a triangle is more stable than a dyad, but a triangle creates an "odd man out," which is a very difficultposition for individuals to tolerate. Anxiety generated by anticipating or being the odd one out is a potent force intriangles. The patterns in a triangle change with increasing tension. In calm periods, two people are comfortablyclose "insiders" and the third person is an uncomfortable "outsider." The insiders actively exclude the outsider andthe outsider works to get closer to one of them.Someone is always uncomfortable in a triangle and pushing for change. The insiders solidify their bond by choosingeach other in preference to the less desirable outsider. Someone choosing another person over oneself arousesparticularly intense feelings of rejection. If mild to moderate tension develops between the insiders, the mostuncomfortable one will move closer to the outsider. One of the original insiders now becomes the new outsider andthe original outsider is now an insider. The new outsider will make predictable moves to restore closeness with oneof the insiders.At moderate levels of tension, triangles usually have one side in conflict and two sides in harmony. The conflict isnot inherent in the relationship in which it exists but reflects the overall functioning of the triangle. At a high levelof tension, the outside position becomes the most desirable. If severe conflict erupts between the insiders, oneinsider opts for the outside position by getting the current outsider fighting with the other insider. If themaneuvering insider is successful, he gains the more comfortable position of watching the other two people fight.When the tension and conflict subside, the outsider will try to regain an inside position.Triangles contribute significantly to the development of clinical problems. Getting pushed from an inside to anoutside position can trigger a depression or perhaps even a physical illness. Two parents intensely focusing on whatis wrong with a child can trigger serious rebellion in the child.36
  • Example:Michael and Martha were extremely happy during the first two years of their marriage. Michael liked making majordecisions and Martha felt comforted by Michaels "strength." After some difficulty getting pregnant, Marthaconceived during the third year of the marriage, but it was a difficult pregnancy. She was quite nauseous during thefirst trimester and developed blood pressure and weight gain problems as the pregnancy progressed. She talkedfrequently to Michael of her insecurities about being a mother. Michael was patient and reassuring, but also beganto feel critical of Martha for being "childlike."[Analysis: The pregnancy places more pressure on Martha and on the marital relationship. Michael is outwardlysupportive of Martha but is reactive to hearing about her anxieties. He views her as having a problem.]A female infant was born after a long labor. They named her Amy. Martha was exhausted and not ready to leave thehospital when her doctor discharged her. Over the next few months, she felt increasingly overwhelmed andextremely anxious about the well-being of the young baby. She looked to Michael for support, but he was gettinghome from the office later and Martha felt that he was critical of her problems coping and that he dismissed herworries about the child. There was much less time together for just Michael and Martha and, when there was time,Michael ruminated about work problems. Martha became increasingly preoccupied with making sure her growingchild did not develop the insecurities she had. She tried to do this by being as attentive as she could to Amy andconsistently reinforcing her accomplishments. It was easier for Martha to focus on Amy than it was for her to talk toMichael. She reacted intensely to his real and imagined criticisms of her. Michael and Martha spent more and moreof their time together discussing Amy rather than talking about their marriage.[Analysis: Martha is the most uncomfortable with the increased tension in the marriage. The growing emotionaldistance in the marriage is balanced by Martha getting overly involved with Amy and Michael getting overlyinvolved with his work. Michael is in the outside position in the parental triangle and Martha and Amy are in theinside positions.]As Amy grew, she made increasing demands on her mothers time. Martha felt she could not give Amy enoughtime, that Amy would never be satisfied. Michael agreed with Martha that Amy was too selfish and resented Amystemper tantrums when she did not get her way. However, if Michael got too critical of Amy, Martha would defendAmy, telling Michael he was exaggerating. Yet, whenever tensions developed between Martha and Amy, Marthawould press Michael to spend more time with Amy to reassure her that she was loved. He gave into Marthas pleas,but inwardly felt that they were following a policy of appeasement that was making Amy more demanding. Michaelfelt that if Martha had his maturity, Amy would be less of a problem, but, despite this attitude, Michael usuallyfollowed Marthas lead in relationship to Amy.[Analysis: When tension builds between Martha and Amy, Michael sides with Martha by agreeing that Amy is theproblem. The conflictual side of the triangle then shifts from between Martha and Amy to between Michael andAmy. If the conflict gets too intense between Michael and Amy, Martha sides with Amy, the conflict shifts into themarriage, and Amy gains the more comfortable outside position.] 37
  • 3. The Nuclear Family Emotional ProcessesThese 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. • Likewise, think of a daughter who goes to work for her father, who built his own fathers small struggling business into a thriving company. He is seen in the family as a great businessperson 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 fathers advice, and her success will depend on whether she faces an economic boom or recession.In both cases, the parent passes on an emotional view of the world (the emotional process), which is taught eachgeneration from parent to child, the smallest possible "unit" of family (the nuclear unit). Reactions to this processcan range from open conflict, to physical or emotional problems in one family member, to reactive distancing (seebelow). Problems with family members may include things like substance abuse, irresponsibility, depression....Nuclear Family Emotional SystemThe concept of the nuclear family emotional system describes four basic relationship patterns that govern whereproblems develop in a family. Peoples attitudes and beliefs about relationships play a role in the patterns, but theforces primarily driving them are part of the emotional system. The patterns operate in intact, single-parent, step-parent, and other nuclear family configurations.Clinical problems or symptoms usually develop during periods of heightened and prolonged family tension. Thelevel of tension depends on the stress a family encounters, how a family adapts to the stress, and on a familysconnection with extended family and social networks. Tension increases the activity of one or more of the fourrelationship patterns. Where symptoms develop depends on which patterns are most active. The higher the tension,the more chance that symptoms will be severe and that several people will be symptomatic.The four basic relationship patterns are:Marital conflict- As family tension increases and the spouses get more anxious, each spouse externalizes his or heranxiety into the marital relationship. Each focuses on what is wrong with the other, each tries to control the other,and each resists the others efforts at control.Dysfunction in one spouse- One spouse pressures the other to think and act in certain ways and the other yields tothe pressure. Both spouses accommodate to preserve harmony, but one does more of it. The interaction iscomfortable for both people up to a point, but if family tension rises further, the subordinate spouse may yield somuch self-control that his or her anxiety increases significantly. The anxiety fuels, if other necessary factors arepresent, the development of a psychiatric, medical, or social dysfunction.Impairment of one or more children- The spouses focus their anxieties on one or more of their children. Theyworry excessively and usually have an idealized or negative view of the child. The more the parents focus on thechild the more the child focuses on them. He is more reactive than his siblings to the attitudes, needs, andexpectations of the parents. The process undercuts the childs differentiation from the family and38
  • makes him vulnerable to act out or internalize family tensions. The childs anxiety can impair his schoolperformance, social relationships, and even his health.Emotional distance- This pattern is consistently associated with the others. People distance from each other toreduce the intensity of the relationship, but risk becoming too isolated.The basic relationship patterns result in family tensions coming to rest in certain parts of the family. The moreanxiety one person or one relationship absorbs, the less other people must absorb. This means that some familymembers maintain their functioning at the expense of others. People do not want to hurt each other, but whenanxiety chronically dictates behaviour, someone usually suffers for it.Example:The tensions generated by Michael and Marthas interactions lead to emotional distance between them and to ananxious focus on Amy. Amy reacts to her parents emotional over involvement with her by making immaturedemands on them, particularly on her mother.[Analysis: A parents emotional over involvement with a child programs the child to be as emotionally focused onthe parent as the parent is on the child and to react intensely to real or imagined signs of withdrawal by the parent.]When Amy was four years old, Martha got pregnant again. She wanted another child, but soon began to worryabout whether she could meet the emotional needs of two children. Would Amy be harmed by feeling left out?Martha worried about telling Amy that she would soon have a little brother or sister, wanting to put off dealing withher anticipated reaction as long as possible. Michael thought it was silly but went along with Martha. He wasoutwardly supportive about the pregnancy, he too wanted another child, but he worried about Marthas ability tocope.[Analysis: Martha externalizes her anxiety onto Amy rather than onto her husband or rather than internalizing it.Michael avoids conflict with Martha by supporting the focus on Amy and avoids dealing with his own anxieties byfocusing on Marthas coping abilities.]Apart from her fairly intense anxieties about Amy, Marthas second pregnancy was easier than the first. A daughter,Marie, was born without complications. This time Michael took more time away from work to help at home, feelingand seeing that Martha seemed "on the edge." He took over many household duties and was even more directive ofMartha.Martha was obsessed with Amy feeling displaced by Marie and gave in even more to Amys demands for attention.Martha and Amy began to get into struggles over how available Martha could be to her. When Michael would gethome at night, he would take Amy off her mothers hands and entertain her. He also began feeling neglected himselfand quite disappointed in Marthas lack of coping ability..Martha had done some drinking before she married Michael and after Amy was born, but stopped completelyduring the pregnancy with Marie. When Marie was a few months old, however, Martha began drinking again,mostly wine during the evenings, and much more than in the past. She somewhat tried to cover up the amount ofdrinking she did, feeling Michael would be critical of it. He was. He accused her of not trying, not caring, and beingselfish. Martha felt he was right. She felt less and less able to make decisions and more and more dependent onMichael. She felt he deserved better, but also resented his criticism and patronizing. She drank more, even duringthe day. Michael began calling her an alcoholic.[Analysis: The pattern of sickness in a spouse has emerged, with Martha as the one making the most adjustments inher functioning to preserve harmony in the marriage. It is easier for Martha to be the problem than to stand up toMichaels diagnosing her and, besides, she feels she really is the problem. 39
  • As the pattern unfolds, Michael increasingly over functions and Martha increasingly under functions. Michael is asallergic to conflict as Martha is, opting to function for her rather than risk the disharmony he would trigger byexpecting her to function more responsibly.]By the time Amy and Marie were both in school, Martha reached a serious low point. She felt worthless and out ofcontrol. She felt Michael did everything, but that she could not talk to him. Her doctor was concerned about herphysical health. Finally, Martha confided in him about the extent of her drinking. Michael had been pushing her toget help, but Martha had reached a point of resisting almost all of Michaels directives. However, her doctor scaredher and she decided to go to Alcoholics Anonymous. Martha felt completely accepted by the A.A. group and greatlyrelieved to tell her story. She stopped drinking almost immediately and developed a very close connection to hersponsor, an older woman. She felt she could be herself with the people at A.A. in a way she could not be withMichael. She began to function much better at home, began a part-time job, but also attended A.A. meetingsfrequently. Michael had complained bitterly about her drinking, but now he complained about her preoccupationwith her new found A.A. friends. Martha gained a certain strength from her new friends and was encouraged bythem "to stand up" to Michael. She did. They began fighting frequently. Martha felt more like herself again.Michael was bitter.[Analysis: Marthas involvement with A.A. helped her stop drinking, but it did not solve the family problem. Thelevel of family tension has not changed and the emotional distance in the marriage has not changed. Because of"borrowing strength" from her A.A. group, Martha is more inclined to fight with Michael than to go along andinternalize the anxiety. This means the marital pattern has shifted somewhat from dysfunction in a spouse to maritalconflict, but the family has not changed in a basic way. In other words, Marthas level of differentiation of self hasnot changed through her A.A. involvement, but her functioning has improved.]40
  • 4. The Family Projection ProcessThis 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. • Thus, the son who rejects his mothers 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 familys 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 "Its a good thing the loan officer felt sorry for him because he couldnt 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 familys expectations. • 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 shell 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 fathers reputation as a creative and successful business person.The family member who serves as the "screen" upon which the family "projects" this story will have great troubledifferentiating. It will be hard for the son or daughter above to hold their own opinions and values, maintain theiremotional strength, and make their own choices freely despite the familys view of them.Family Projection ProcessThe family projection process describes the primary way parents transmit their emotional problems to a child. Theprojection process can impair the functioning of one or more children and increase their vulnerability to clinicalsymptoms. Children inherit many types of problems (as well as strengths) through the relationships with theirparents, but the problems they inherit that most affect their lives are relationship sensitivities such as heightenedneeds for attention and approval, difficulty dealing with expectations, the tendency to blame oneself or others,feeling responsible for the happiness of others or that others are responsible for ones own happiness, and actingimpulsively to relieve the anxiety of the moment rather than tolerating anxiety and acting thoughtfully. If theprojection process is fairly intense, the child develops stronger relationship sensitivities than his parents. Thesensitivities increase a persons vulnerability to symptoms by fostering behaviours that escalate chronic anxiety in arelationship system.The projection process follows three steps:(1) the parent focuses on a child out of fear that something is wrong with the child;(2) the parent interprets the childs behaviour as confirming the fear; and(3) the parent treats the child as if something is really wrong with the child.These steps of scanning, diagnosing, and treating begin early in the childs life and continue. The parents fears andperceptions so shape the childs development and behaviour that he grows to embody their fears and perceptions.One reason the projection process is a self-fulfilling prophecy is that parents try to "fix" the problem they havediagnosed in the child; for example, parents perceive their child to have low self-esteem, they repeatedly try toaffirm the child, and the childs self-esteem grows dependent on their affirmation. 41
  • Parents often feel they have not given enough love, attention, or support to a child manifesting problems, but theyhave invested more time, energy, and worry in this child than in his siblings. The siblings less involved in the familyprojection process have a more mature and reality-based relationship with their parents that fosters the siblingsdeveloping into less needy, less reactive, and more goal-directed people. Both parents participate equally in thefamily projection process, but in different ways. The mother is usually the primary caretaker and more prone thanthe father to excessive emotional involvement with one or more of the children. The father typically occupies theoutside position in the parental triangle, except during periods of heightened tension in the mother-childrelationship. Both parents are unsure of themselves in relationship to the child, but commonly one parent acts sureof himself or herself and the other parent goes along. The intensity of the projection process is unrelated to theamount of time parents spend with a child.Example:The case of Michael, Martha, and Amy illustrates the family projection process. Marthas anxiety about Amy beganbefore Amy was born. Martha feared she would transfer inadequacies she had felt as a child, and still felt, to herown child. This was one reason Martha had mixed feelings about being a mother. Like many parents, Martha felt amothers most important task was to make a child feel loved. In the name of showing love, she was acutelyresponsive to Amys desires for attention. If Amy seemed bored and out of sorts, Martha was there with an idea orplan. She believed a childs road to confidence and independence was in the child feeling secure about herself.Martha did not recognize how sensitive she was to any sign in Amy that she might be upset or troubled and howquickly she would move in to fix the problem.Martha loved Amy deeply. She and Amy often seemed like one person in the way they were attuned to each other.As a very small toddler, Amy was as sensitive to her mothers moods and wants as Martha was to Amys moods andwants.[Analysis: Marthas excessive involvement programs Amy to want much of her mothers attention and to be highlysensitive to her mothers emotional state. Both mother and child act to reinforce the intense connection betweenthem.]At some point in the unfolding of their relationship, Martha began to feel irritated at times by what Martha regardedas Amys "insatiable need" for attention. Martha would try to distance from Amys neediness, but not verysuccessfully because Amy had ways to involve her mother with her. Martha flip-flopped between pleading with andcajoling Amy one minute and being angry at and directive of her the next. It seemed to lock them together evenmore tightly. Martha looked to Michael to take over at such times. Despite calling Amys need for attentioninsatiable, Martha felt Amy really needed more of her time and she faulted herself for not being able to giveenough. She wanted Michael to help with the task. It bothered Martha if Amy seemed upset with her. Amys upsetstriggered guilt in Martha and a fear that they were no longer close companions. She wanted to soothe Amy and feelclose to her.[Analysis: Martha blames Amy for the demands she makes on her, but at the same time feels she is failing Amy.Martha tries to "fix" Amys problem by doing more of what she has already been doing and solicits Michaels helpin it. Martha is meeting many of her own needs for emotional closeness and companionship through Amy, thus getsvery distressed if Amy seems unhappy with her. The marital distance accentuates Marthas need for Amy.]Marthas second pregnancy changed a reasonably manageable situation into an unmanageable one. The dilemma ofmeeting the needs of both children seemed impossible to Martha. She felt Amy was already showing signs of"inheriting" her insecurities. How had she failed her?42
  • When it was time for Amy to start school, Martha sought long conferences with the kindergarten teacher to plan thetransition. If Amy balked at going to school, Martha became frightened, angry, exasperated, and guilty. Thekindergarten teacher felt she understood children like Amy and took great interest in her. Amy was bright, thrivedon the teachers attention, and performed very well in school. Martha had none of these fears when Marie startedschool and, not surprisingly, none of the school transition problems occurred with her. Marie did not seem to requireso much of the teachers attention; she just pursued her interests.As Amy progressed through grade school, her adjustment to school seemed to depend heavily on the teacher shehad in a particular year. If the teacher seemed to take an unusual interest in her, she performed very well, but if theteacher treated her as one of the group, she would lose interest in her work. Martha focused on making sure Amygot the "right" teacher whenever possible. Maries performance did not depend on a particular teacher.[Analysis: Marthas difficulty being a "self" with her children is reflected in her feeling inordinately responsible forthe happiness of both children. This makes it extremely difficult for her to interact comfortably with two children.Amy transfers the relationship intensity she has with her mother to her teachers. When a teacher makes her special,Amy performs very well, but without that type of relationship, Amy performs less well. Marie is less involved withher mother and, consequently, her performance is less dependent on the relationship environment at school and athome.]If Amy complained about the ways other kids treated her in school, Martha and Michael would talk to her about notbeing so sensitive, telling her she should not care so much about what other people think. If Amy had a specialfriend, she was extremely sensitive to that friend paying attention to another little girl. Martha lectured Amy aboutbeing less sensitive but also planned outings and parties designed to help Amy with her friendships. Michaelcriticized Martha for this, saying Amy should work out these problems for herself, but he basically went along withall of Marthas efforts.[Analysis: The parents words do not match their actions. They lecture Amy about being less sensitive, but thefrequent lectures belie their own anxieties about such issues and their doubts about Amys ability to cope. Amyssensitivity to being in the outside position in a triangle with her playmates reflects her programming for suchrelationship sensitivities in the parental triangle.]Martha and Amy had turmoil in their relationship during Amys elementary school years, but things got worse inmiddle school. Amy began having academic problems and complained about feeling lost in the larger school. Sheseemed unhappy to Martha. Martha talked to Michael and to the pediatrician about getting therapy for Amy. Theyhired tutors for Amy in two of her subjects, even though they knew that part of the problem was Amy not workinghard in those subjects. When Amys grades did not improve, Michael criticized her for not taking advantage of thehelp they were giving and not appreciating them as parents. Martha scolded Michael for being too hard on Amy, butinwardly she felt even more critical of her than Michael did. She had worked hard to prevent these very problems inAmy. How could Amy disappoint her so much? In the summers when there were no academic pressures, Marthaand Amy got along much better.[Analysis: Commonly parents get critical of a child with whom they have been excessively involved if the childsperformance drops. They push for the child to have therapy or tutors rather than think about the changes theythemselves need to make. Medicine, psychiatry, and the larger society usually reinforce the child focus by definingthe problem as being in the child and by often implying that the parents are not attentive and caring enough.] 43
  • The big changes occurred when Amy started high school. Martha felt Amy was telling her less of what washappening in her life and that she was more sullen and withdrawn. Amy also had a new group of girlfriends thatseemed less desirable to Martha. Amy had also found boys. Martha and Amy got into more frequent conflicts. Amyfelt controlled by her parents, not given the freedom to make her own decisions, pick her own friends. She resentedher mothers obvious intrusions into her room when she was out. She began lying to her mother in an effort to evadeher rules. Martha was no longer drinking herself at this point, but worried that Amy was using drugs and alcohol.She challenged Amy about it, but her challenges were met with denials.When Martha felt particularly overwhelmed by the situation, Michael would step in and try to lay down the law toAmy. He accused Amy of not appreciating all they had done for her and of deliberately trying to hurt them. Hewanted to know "why" she disobeyed them. Amy would lash back at her father in these discussions, at which pointMartha would intervene. Amy stayed away from the house more, told her parents less and less, and got in with afairly wild crowd. She acted out some of her parents worst fears, but did not feel particularly good about herself andabout what she was doing. Amy felt alienated from her parents. The parents focus on her deteriorating gradesincluded lectures and groundings, but Amy easily evaded these efforts to control and change her.[Analysis: The more intense the family projection process has been, the more intense the adolescent rebellion.Parents typically blame the rebellion on adolescence, but the parents reactivity to the child fuels the rebellion asmuch as the childs reactivity. When the parents demand to know "why" Amy acts as she does, they place theproblem in Amy. Similarly, parents often blame the influence of the peer group, which also places the problemoutside themselves. Peers are an important influence, but a childs vulnerability to peer pressure is related to theintensity of the family process. The intense family process closes down communication and isolates Amy from thefamily. This is why a child who is very intensely connected to her parents can feel distant from them. The siblingswho are less involved in the family problem navigate adolescence more smoothly.]Michael and Martha became increasingly critical of Amy, but also latched onto any signs she might be doing a littlebetter. They gave her her own phone, bought the clothes she "just had to have," and gave her a car for her sixteenthbirthday. Many of these things were done in the name of making Amy feel special and important, hoping that wouldmotivate her to do better. Throughout all the turmoil surrounding Amy, Marie presented few problems.[Analysis: The parents permissiveness is just as important in perpetuating the problems in Amy as the critical focuson her. As a teenager, Amy is just as critical of her parents as they are of her. Marie is a more mature person thanAmy, but she is not free of the family problem; for example, she sides with her parents in blaming Amy for thefamily turmoil.]44
  • 5. The Multigenerational Transmission ProcessThis process entails the way family emotional processes are transferred and maintained over the generations. Thiscaptures how the whole family joins in The Family Projection Process, for example, by reinforcing the beliefs of thefamily. As the family continues this pattern over generations, the also refer back to previous generations ("Hes justlike his Uncle Albert - he was always irresponsible too" or "Shes just like your cousin Jenny - she was divorcedfour times.").Multigenerational Transmission ProcessThe concept of the multigenerational transmission process describes how small differences in the levels ofdifferentiation between parents and their offspring lead over many generations to marked differences indifferentiation among the members of a multigenerational family. The information creating these differences istransmitted across generations through relationships. The transmission occurs on several interconnected levelsranging from the conscious teaching and learning of information to the automatic and unconscious programming ofemotional reactions and behaviours. Relationally and genetically transmitted information interact to shape anindividuals "self."The combination of parents actively shaping the development of their offspring, offspring innately responding totheir parents moods, attitudes, and actions, and the long dependency period of human offspring results in peopledeveloping levels of differentiation of self similar to their parents levels. However, the relationship patterns ofnuclear family emotional systems often result in at least one member of a sibling group developing a little more"self" and another member developing a little less "self" than the parents.The next step in the multigenerational transmission process is people predictably selecting mates with levels ofdifferentiation of self that match their own. Therefore, if one siblings level of "self" is higher and another siblingslevel of "self" is lower than the parents, one siblings marriage is more differentiated and the other siblings marriageis less differentiated than the parents marriage. If each sibling then has a child who is more differentiated and achild who is less differentiated than himself, one three generational line becomes progressively more differentiated(the most differentiated child of the most differentiated sibling) and one line becomes progressively lessdifferentiated (the least differentiated child of the least differentiated sibling). As these processes repeat overmultiple generations, the differences between family lines grow increasingly marked.Level of differentiation of self can affect longevity, marital stability, reproduction, health, educationalaccomplishments, and occupational success. This impact of differentiation on overall life functioning explains themarked variation that typically exists in the lives of the members of a multigenerational family. The highly differentiated people have unusually stable nuclear families and contribute much to society; the poorlydifferentiated people have chaotic personal lives and depend heavily on others to sustain them. A key implication ofthe multigenerational concept is that the roots of the most severe human problems as well as of the highest levels ofhuman adaptation are generations deep. The multigenerational transmission process not only programs the levels of"self" people develop, but it also programs how people interact with others. Both types of programming affect theselection of a spouse. For example, if a family programs someone to attach intensely to others and to function in ahelpless and indecisive way, he will likely select a mate who not only attaches to him with equal intensity, but onewho directs others and make decisions for them.Example:The multigenerational transmission process helps explain the particular patterns that have played out in the nuclearfamily of Michael, Martha, Amy, and Marie. Martha is the youngest of three daughters from an intact Midwesternfamily. From her teen years on, Martha did not feel especially close to either of her parents, but especially to her 45
  • mother. She experienced her mother as competent and caring but often intrusive and critical. Martha felt she couldnot please her mother.Her sisters seemed to feel more secure and competent than Martha. She asked herself how she could grow up in aseemingly "normal" family and have so many problems, and answered herself that there must be something wrongwith her. When she faced important dilemmas in her life and had decisions to make, her mother got involved andstrongly influenced Marthas choices. Her mother said Martha should make her own decisions, but her mothersactions did not match her words. One of her mothers biggest fears was that Martha would make the wrong decision.In time, Marthas sisters came to view her much like their mother did and treated her as the baby of the family, asone needing special guidance. Marthas father was sympathetic with her one-down position in the family, but hedistanced from family tensions.Martha detested herself for needing the acceptance and approval of others to function effectively and for feeling shecould not act more independently. She worried about making the wrong decision and turned frequently to hermother for help.[Analysis: The primary relationship pattern in Marthas family of origin was impairment of one or more children,and the projection process focused primarily on Martha. The mothers overfunctioning promoted Marthasunderfunctioning, but Martha largely blamed herself for her difficulties making decisions and functioningindependently. Marthas intense need for approval and acceptance reflected the high level of involvement with hermother. She managed the intensity with her mother with emotional distance. These basic patterns were laterreplicated in her marriage and with Amy.]Marthas mother is the oldest child in her family and functioned as a second parent to her three younger siblings.Marthas mothers mother became a chronic invalid after her last child was born. As a child, Marthas motherfunctioned as a second mother in her family and, with the encouragement of her father, did much of the caretakingof her invalid mother. Marthas mother basked in the approval she gained from both of her parents, especially fromher father. Her father was often critical of his wife, insisting she could do more for herself if she would try. Marthasgrandmother responded to the criticism by taking to bed, often for days at a time. Marthas mother learned to thriveon taking care of others and being needed.[Analysis: Marthas mother probably had almost as intense an involvement with her parents as she subsequently hadwith Martha, but the styles of the involvements were different. Two relationship patterns dominated Marthasmothers nuclear family: dysfunction in one spouse and overinvolvement with a child. Marthas mother wasintensely involved in the triangles with her parents and younger siblings and in the position of overfunctioning forothers. In other words, she learned to meet her strongly programmed needs for emotional closeness by taking careof others, a pattern that played out with Martha.]Michael grew up as an only child in an intact family from the Pacific Northwest. He met Martha when he attendedcollege in the Midwest. Michaels mother began having frequent bouts of serious depression about the time hestarted grade school. She was twice hospitalized psychiatrically, once after an overdose of tranquilizers. Michaelfelt "allergic" to his mothers many problems and kept his distance from her, especially during his adolescence. Hecared about her and felt she would help him in any way she could, but viewed her as helpless and incompetent. Heresented her "not trying harder." He had a reasonably comfortable relationship with his father, but felt his fathermade the family situation worse by opting for "peace at any price." It was easier for his father to give in to his wifessometimes childish demands than to draw a line with her.Michael related to his mother almost exactly like his father did. His mother expressed resentment about herhusbands passivity. She accused him of not really caring about her, only doing things for her because she demandedit. Michaels mother worshiped Michael and was jealous of interests and people that took him away from her.46
  • [Analysis: Interestingly, Michaels parental triangle was similar to Marthas mothers parental triangle. His motherwas intensely involved with him and it programmed Michael both to need this level of emotional support from theimportant female in his life, but also to react critically to the females neediness. Michaels parental triangle alsofostered a belief that he knew best.]Michaels mother had been a "star" in her family when she was growing up. She was an excellent student andathlete. She had a very conflictual relationship with her mother and an idealized view of her father. She metMichaels father when they were both in college. He was two years older than she and when he graduated, she quitschool to marry him. Her parents were very upset about the decision. Michaels fatherhad been at loose ends when he met his future wife, but she was what he needed. He built a very successful businesscareer with her emotional support. He functioned higher in his work life than in his family life.[Analysis: Michaels father functioned on a higher level in his business life than in his family life, a discrepancy thatis commonly present in people with mid-range levels of differentiation of self.] 47
  • 6. Sibling PositionBowen stressed sibling order, believing that each child had a place in the family hierarchy, and thus was more orless 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."Sibling PositionBowen theory incorporates the research of psychologist Walter Toman as a foundation for its concept of siblingposition. Bowen observed the impact of sibling position on development and behaviour in his family research.However, he found Tomans work so thorough and consistent with his ideas that he incorporated it into his theory.The basic idea is that people who grow up in the same sibling position predictably have important commoncharacteristics. For example, oldest children tend to gravitate to leadership positions and youngest children oftenprefer to be followers. The characteristics of one position are not "better" than those of another position, but arecomplementary. For example, a boss who is an oldest child may work unusually well with a first assistant who is ayoungest child. Youngest children may like to be in charge, but their leadership style typically differs from anoldests style.Tomans research showed that spouses sibling positions affect the chance of their divorcing. For example, if anolder brother of a younger sister marries a younger sister of an older brother, less chance of a divorce exists than ifan older brother of a brother marries an older sister of a sister. The sibling or rank positions are complementary inthe first case and each spouse is familiar with living with someone of the opposite sex. In the second case, however,the rank positions are not complementary and neither spouse grew up with a member of the opposite sex. An olderbrother of a brother and an older sister of a sister are prone to battle over who is in charge; two youngest childrenare prone to struggle over who gets to lean on whom.People in the same sibling position, of course, exhibit marked differences in functioning. The concept ofdifferentiation can explain some of the differences. For example, rather than being comfortable with responsibilityand leadership, an oldest child who is anxiously focused on may grow up to be markedly indecisive and highlyreactive to expectations. Consequently, his younger brother may become a "functional oldest," filling a void in thefamily system. He is the chronologically younger child, but develops more characteristics of an oldest child than hisolder brother. A youngest child who is anxiously focused on may become an unusually helpless and demandingperson. In contrast, two mature youngest children may cooperate extremely effectively in a marriage and be at verylow risk for a divorce.Middle children exhibit the functional characteristics of two sibling positions. For example, if a girl has an olderbrother and a younger sister, she usually has some of the characteristics of both a younger sister of a brother and anolder sister of a sister. The sibling positions of a persons parents are also important to consider. An oldest childwhose parents are both youngests encounters a different set of parental expectations than an oldest child whoseparents are both oldests.48
  • Example:Knowledge of Michael and MarthaMichael is an only child who, like Marthas mother, was raised in a family with a mother who had many problems.Michaels father is the younger brother of a sister and his mother is the older sister of a brother. Michaels motherwas the more focused on child when she was growing up, a focus that took the form of high performanceexpectations coupled with considerable family anxiety about her ability to meet those expectations. In many ways,Michaels Marthas sibling positions and those of their parents adds to the understanding of how things played out intheir lives. Martha is the youngest of three girls and was the most intensely focused on child in her family.Furthermore, Marthas mother is the oldest of four siblings and was raised in a family with a mother who was achronic invalid. Marthas mother was a not very well differentiated oldest daughter. Her life energy focused ontaking care of and directing others to the point that she unwittingly undermined the functioning of her youngestdaughter. Martha played out the opposite side of the problem by becoming an indecisive, helpless, and mostly self-blaming person. Marthas father was the youngest brother in a family of five children.[Analysis: Martha, by virtue of her mothers focus on her, has the moderately exaggerated traits of a youngest child.Furthermore, her father being a youngest and her mother an oldest favored her mothers functioning setting the tonein the family. In other words, her mother was quicker to act than her father in face of problems.] father was quitedependent on his wife for affirmation and direction, even when she was depressed and overwhelmed. As an onlychild, the pattern of functioning of the triangle with his parents was the major influence on Michaels development.His emotional programming in that triangle made him a perfect fit with Martha.[Analysis: Michaels only child position makes him a somewhat reluctant leader in his nuclear family. He wantsMartha to function better and to take more responsibility. He is unhappy feeling the pressure himself. Despite beingin the one-up position in the marriage, he is as dependent on Martha as his father was dependent on his wife.] 49
  • 7. Emotional CutoffThis refers to an extreme response to The Family Projection Process. This entails a complete or almost-completeseparation from the family. The person will have little, if any, contact, and may look and feel completelyindependent from the family. However, people who cut off their family are more likely to repeat the emotional andbehavioural patterns they were taught. • 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. • 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.Emotional CutoffThe concept of emotional cutoff describes people managing their unresolved emotional issues with parents, siblings,and other family members by reducing or totally cutting off emotional contact with them. Emotional contact can bereduced by people moving away from their families and rarely going home, or it can be reduced by people stayingin physical contact with their families but avoiding sensitive issues. Relationships may look "better" if people cutoffto manage them, but the problems are dormant and not resolved.People reduce the tensions of family interactions by cutting off, but risk making their new relationships tooimportant. For example, the more a man cuts off from his family of origin, the more he looks to his spouse,children, and friends to meet his needs. This makes him vulnerable to pressuring them to be certain ways for him oraccommodating too much to their expectations of him out of fear of jeopardizing the relationship. New relationshipsare typically smooth in the beginning, but the patterns people are trying to escape eventually emerge and generatetensions. People who are cut off may try to stabilize their intimate relationships by creating substitute "families"with social and work relationships.Everyone has some degree of unresolved attachment to his or her original family, but well-differentiated peoplehave much more resolution than less differentiated people. An unresolved attachment can take many forms. Forexample, (1) a person feels more like a child when he is home and looks to his parents to make decisions for himthat he can make for himself, or (2) a person feels guilty when he is in more contact with his parents and that hemust solve their conflicts or distresses, or (3) a person feels enraged that his parents do not seem to understand orapprove of him. An unresolved attachment relates to the immaturity of both the parents and the adult child, butpeople typically blame themselves or others for the problems.People often look forward to going home, hoping things will be different this time, but the old interactions usuallysurface within hours. It may take the form of surface harmony with powerful emotional undercurrents or it maydeteriorate into shouting matches and hysterics. Both the person and his family may feel exhausted even after a briefvisit. It may be easier for the parents if an adult child keeps his distance. The family gets so anxious and reactivewhen he is home that they are relieved when he leaves. The siblings of a highly cutoff member often get furious athim when he is home and blame him for upsetting the parents. People do not want it to be this way, but thesensitivities of all parties preclude comfortable contact.50
  • Example:Neither Michael nor Martha wanted to live near their families. When Michael got a good job offer on the East coast,both of them were eager to move east. They told their families they were moving away because of Michaels greatjob offer, but they welcomed the physical distance from their families. Michael felt guilty about living far awayfrom his parents and his parents were upset about it, especially Michaels mother. Michael called home everyweekend and managed to combine business trips with brief stays with his parents. He did not look forward to thephone calls and usually felt depressed after them. He felt as if his mother deliberately put him on "guilt trips" byemphasizing how poorly she was doing and how much she missed seeing him. She never failed to ask if hiscompany could transfer him closer to home. It was much less depressing for Michael to talk to his father, but theytalked mostly about Michaels job and what his Dad was doing in retirement.[Analysis: Michael blamed his mother for the problems in their relationship and, despite his guilt, felt justifieddistancing from her. People commonly have a "stickier" unresolved emotional attachment with their mothers thanwith their fathers because the way a parental triangle usually operates is that the mother is too involved with thechild and the father is in the outside position.] In the early years, Martha wouldsometimes participate in Michaels phone calls home but, as her problems mounted, she usually left the calls toMichael. Michael did not say much to his parents about Marthas drinking or about the tensions in their marriage.He would report on how the kids were doing. Michael, Martha, and the kids usually made one visit to Michaelsparents each year. They did not look forward to the four days they would spend there, but Michaels mother thrivedon having them. Martha never said anything to Michaels parents about her drinking or the marital tensions, but shetalked at length about Amy to Michaels mother. Amy often developed middle ear infections during or soon afterthese trips.[Analysis: Frequently one or more family members get sick leading up to, during, or soon after trips home. Amywas more vulnerable because of the anxious focus on her.] Martha followed a pattern similar to Michaels in dealingwith her family. One difference was that her parents came east fairly often. When they came, Marthas motherwould get more worried about Martha and critical of both her drinking and of how she was raising Amy. Marthadreaded these exchanges with her mother and complained to Michael for days after her parents returned home. Deepdown, however, Martha felt her mother was right about her deficiencies. Marthas mother pumped Michael forinformation about Martha when Martha was reluctant to talk. Michael was all too willing to discuss Marthasperceived shortcomings with her mother.[Analysis: Given the striking parallels between the unresolved issues in Michaels relationship with his family,Marthas relationship with her family, and the issues in their marriage, emotional cutoff clearly did not solve anyproblems. It simply shifted the problems to their marital relationship and to Amy.] 51
  • 8. Societal Emotional ProcessesThese processes are social expectations about racial and class groups, the behaviours for each gender, the nature ofsexual orientation... and their effect on the family. In many ways, this is like The Family Projection Process scaledup to the level of a society as a whole. Families that deal with prejudice, discrimination, and persecution must passon to their children the ways they learned to survive these factors. The coping practices of the parents and extendedfamily may lead to more or less adaptive emotional health for the family and its members.Societal Emotional ProcessEach concept in Bowen theory applies to nonfamily groups, such as work and social organizations. The concept ofsocietal emotional process describes how the emotional system governs behaviour on a societal level, promotingboth progressive and regressive periods in a society. Cultural forces are important in how a society functions but areinsufficient for explaining the ebb and flow in how well societies adapt to the challenges that face them. Bowensfirst clue about parallels between familial and societal emotional functioning came from treating families withjuvenile delinquents. The parents in such families give the message, "We love you no matter what you do." Despiteimpassioned lectures about responsibility and sometimes harsh punishments, the parents give in to the child morethan they hold the line. The child rebels against the parents and is adept at sensing the uncertainty of their positions.The child feels controlled and lies to get around the parents. He is indifferent to their punishments. The parents tryto control the child but are largely ineffectual.Bowen discovered that during the 1960s the courts became more like the parents of delinquents. Many in thejuvenile court system considered the delinquent as a victim of bad parents. They tried to understand him and oftenreduced the consequences of his actions in the hope of effecting a change in his behaviour. If the delinquent becamea frequent offender, the legal system, much like the parents, expressed its disappointment and imposed harshpenalties. This recognition of a change in one societal institution ledBowen to notice that similar changes were occurring in other institutions, such as in schools and governments. Thedownward spiral in families dealing with delinquency is an anxiety-driven regression infunctioning. In a regression, people act to relieve the anxiety of the moment rather than act on principle and a long-term view. A regressive pattern began unfolding in society after World War II. It worsened some during the 1950sand rapidly intensified during the 1960s. The "symptoms" of societal regression include a growth of crime andviolence, an increasing divorce rate, a more litigious attitude, a greater polarization between racial groups, lessprincipled decision-making by leaders, the drug abuse epidemic, an increase in bankruptcy, and a focus on rightsover responsibilities.Human societies undergo periods of regression and progression in their history. The current regression seemsrelated to factors such as the population explosion, a sense of diminishing frontiers, and the depletion of naturalresources. Bowen predicted that the current regression would, like a family in a regression, continue until therepercussions stemming from taking the easy way out on tough issues exceeded the pain associated with acting on along-term view. He predicted that will occur before the middle of the twenty-first century and should result inhuman beings living in more harmony with nature.Example:It is more difficult for families to raise children in a period of societal regression than in a calmer period. Aloosening of standards in society makes it more difficult for less differentiated parents like Michael and Martha tohold a line with their children. The grade inflation in many school systems makes it easier for students to passgrades with less work. In the litigious climate, if schools try to hold the line on what they can realistically do fortheir students, they often face lawsuits from irate parents.52
  • The prevalence of drug and alcohol abuse gives parents more things to worry about with their adolescents. Thecurrent societal regression is characterized by an increased child focus in the culture. Much anxiety exists about thefuture generation. Parents are criticized for being too busy with their own pursuits to be adequately available to theirchildren, both to support them and to monitor their activities. When children like Amy report that they feel distantfrom their parents and alienated from their values, the parents critics fail to appreciate the emotional intensity thatgenerates such alienation. The critics prod the parents to do more of what they have already been doing.People who advocate more focus on the children cite the many problems young people are having as justificationfor their position. Using the childs problems as justification for increasing the focus on them is precisely what thechild focused parents have been doing all along. An increase in the problems young people are having is part of anemotional process in society as a whole. A more constructive direction would be for people to examine their owncontributions to societal regression and to work on themselves rather than focus on improving the future generation. 53
  • Normal Family DevelopmentTo Bowen, all families lie along a continuum. While you might try to classify families as falling into discreetgroups, there really are no "types" of families, and most families of one type could become a family of another typeif their circumstances changed. In many ways, Bowen was among the first of the culturally sensitive familytherapists.Bowen believed that optimal family development occurs when family members are differentiated, feel little anxietyregarding the family, and maintain a rewarding and healthy emotional contact with each other. Fogarty offers thatadjusted families • 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 crutchesFamily DisordersBowen believed that family problems result from emotional fusion, or from an increase in the level of anxiety in thefamily. Typically, the member with "the symptom" is the least differentiated member of the family, and thus the onewho has the least ability to resist the pull to become fused with another member, or who has the least ability toseparate their own thoughts and feelings from those of the larger family. The member "absorbs" the anxiety andworries of the whole family and becomes the most debilitated by these feelings. Families face two kinds ofproblems. Vertical problems are "passed down" from parent to child. Thus, adults who had cold and distantrelationships with their parents do not know how to have warm and close relationships with their children, and sopass down their own problems to their children. Horizontal problems are caused by environmental stressors ortransition points in the family development. This may result from traumas such as a chronic illness, the loss of thefamily home, or the death of a family member. However, horizontal stress may also result from Social EmotionalProcesses, such as when a minority family moves from a like-minority neighborhood to a very differentneighborhood, or when a family with traditional gender roles immigrates to a culture with very different views, andmust raise their children there. The worst case for the family is when vertical and horizontal problems happen atonce.Family Therapy with One PersonFamily therapy can be done with one person. Such therapy typically focuses on differentiation of theperson from the family. The therapist helps the individual stop seeing family members in terms of theroles (parent, sibling, caretaker...) they played, and start seeing them as people with their own needs,strengths, and flaws. The individual learns to recognize triangulation, and take some ownership inallowing or halting it when it happens. The individual client should have good insight into the family(genograms may be especially helpful in this), and be very motivated to make changes either in his or herown life, or in the family.54
  • Goals of TherapyTreatment entails • 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, especially of the adult couple, so as to increase their ability to manage their own anxiety, transition more effectively to parenthood, and thus fortify the entire family units emotional wellbeing • using the therapist as part of a "healthy triangle" where the therapist teaches the couple to manage their own anxiety, distance, and closeness in healthy ways • forming relationships with the family member with "the problem" to help them separate from the family and resist unhealthy triangulation and emotional fusion • opening closed ties with cut off members • focusing on more than "the problem" and including the overall health and happiness of the family • evaluating progress of the family in terms of how they function now, as well as how adaptive they can be to future changes • addressing the power differential in heterosexual couple based on differences, for example, in economic power and gender role socialization (this is a contribution of those who have reconsidered Bowens theory through a feminist lens)In general, the therapist accomplishes this by giving less attention to specific problem they present with, and moreattention to family patterns of emotions and relationships, as well as family structures of dyads and triangles. Morespecifically, the therapist • tries to lower anxiety (which breeds emotional fusion) 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 differentiation of members, as often a single member can spur 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-distancer," and help members see the dynamic 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...TechniquesBowen did not believe in a "therapeutic bag of tricks." Questioning the family and constructing afamily genogram are the closest things to basic techniques all Bowenian therapists would use.Carter has assigned tasks to the adult couple to help them realize more about their family history,and encourages letter writing to distant members, visiting mother-in-laws... to speed things up.Guerin accepts the familys opinion of who "has the problem" and works from there with a variety oftechniques to help all family members own some responsibility for helping that sick member getbetter. He will also use stories or films to present another real or imaginary family with the sameproblem as the family in therapy, and highlight how the family in the story or film overcame theirdifficulties. 55
  • Bowen’s Strategic Family Therapy - IIMurray Bowen’s approach operates on the premise that a family can best be understood when it is analyzed from atleast a three-generation perspective, because a predictable pattern of interpersonal relationships connects thefunctioning of family members across generations.According to Bowen, the cause of an individuals problems can be understood only by viewing the role of the familyas an emotional unit. A basic assumption in Bowen family therapy is that unresolved emotional fusion (orattachment) to ones family must be addressed if one hopes to achieve a mature and unique personality.Bowen (1966, 1976) identifies eight key concepts as being central to his theory that can be grouped into four areasof assessment:1) Spousal relationships2) de-triangulation (triangulation)3) differentiation (differentiation of the self, sibling position, emotional cutoff).4) emotional systems (the nuclear family emotional system, societal regression, the family projection process and the multigenerational transmission process, sibling position),Of these, the major contributions of Bowens theory are the core concepts of differentiation of the self andtriangulation.He focused on helping families develop individual identities for each member while maintaining a sense ofcloseness and togetherness with their families.1) Bowen paid attention to the spousal relationship and the definition and clarification of the couples relationship.Interrelations emphasized more than components;systemwide ripples ("these cause each other") emphasized more than linearity (this causes that).Whatever its components, unresolved stress between parents reverberates down through all family inter-relationsand normally results in coalitions, emotional parent-child alignments against the other parent and perhaps otherchildren.Example: Mom is a rageaholic, so when she explodes, Dad and Brother console one another and perhaps agree thatshes nuts.A linear approach would emphasize Moms upbringing and lack of anger management skills and thereby ignorethe coalition process itself and reinforce its tendency to scapegoat,whereas a systems approach would focus on the present-time context of Moms explosions, looking at theinteractions leading up to it and encouraging Dad and Mom to work out new, nonescalating ways to talk andnegotiate--perhaps in couples therapy--rather than blaming her or him or failing to confront and defuse alliancesforming elsewhere in the family.56
  • 2) Triangulation – A situation in which two family members involve a third family member in a conflictual scenario. Bowen considers de-triangulation of self from the family emotional system.Triangulation and Nuclear Family Emotional System. Bowen (1976) notes that anxiety can easily developwithin intimate relationships.Under stressful situations, two people may recruit a third person into the relationship to reduce the anxiety and gainstability. This is called triangulation. When tension arises between two people and a third is engaged to relieve the tension it is called triangulation . When tension is greater than what the three person system can handle, a series of interlocking triangles is created. For example, three people create one triangle, four people create four interlocking triangles and five people create nine interlocking triangles etc. Each triangle has two positive sides and one negative side. Bowen (1978) identifies two variables important in determining why triangles occur in relationships. The first is the level of differentiation . This refers to the degree to which individuality is maintained in a system. The second variable is the level of anxiety . This refers to the amount of emotional tension in a system. A low level of differentiation, or a higher level of anxiety produce more triangling. Anticipating and diffusing triangulating maneuvers forces the parties to focus on the problem. Other successful strategies in remaining de-triangled are seriousness and humor.Although triangulation may lessen the emotional tension between the two people, the underlying conflict is notaddressed, and in the long run the situation worsens: What started as a conflict in the couple evolves into a conflictwithin the nuclear family emotional system.Family Projection Process and Multigenerational Transmission. The most common form of triangulationoccurs when two parents with poor differentiation fuse, leading to conflict, anxiety and ultimately the involvementof a child in an attempt to regain stability. When a parent lacks differentiation and confidence in her or his rolewith the child, the child also becomes fused and emotionally reactive.The child is now declared to “have a problem,” and the other parent is often in the position of calming andsupporting the distraught parent. Such a triangle produces a kind of pseudo stability for a while: the emotionalinstability in the couple seems to be diminished, but it has only been projected onto the child.This family projection process makes the level of differentiation worse with each subsequent generation (Papero,2000). When a child leaves the family of origin with unresolved emotional attachments, whether they are expressedin emotional fusion or emotional cutoff, they will tend to couple and create a family in which these unresolvedissues can be re-enacted. The family projection process has now become the foundation for multigenerationaltransmission.E.g.: when parents have unresolved and intense conflicts, they may focus on their offspring. Thus one or morechildren may become problematic as a result of being triangulated into their parents’ relationship. Instead offighting with each other, the parents are temporarily distracted by riveting their attention on their child(ren).Similarly, the conflict between the parents also may involve the triangulation of the child(ren) as interpreters of oneto the other.Thomas Fogarty introduced to Bowen theory a distinction between triangles and triangulation. For him, the formerwas a structure that existed in all families while the latter was an emotional process.His focus on couples led him to believe that there was directional movement within family triangles that almostalways included a pursuer and a distancer. 57
  • These were complementary relational positions whereby - the pursuer is someone who wants lots of relational contact, especially during times of stress; - the distancer is less expressive of thoughts and feelings, and often finds comfort in necessary tasks rather than relationship.3) Differentiation Of The Self and Emotional Cutoff.The cornerstone of Bowens theory is differentiation of the self, which involves both the psychological separation ofintellect and emotion and independence of the self from others.Differentiated individuals are able to choose to be guided by their thoughts rather than their feelings.Undifferentiated people have difficulty in separating themselves from others and tend to fuse with dominantemotional patterns in the family. - These people have a low degree of autonomy, - they are emotionally reactive, and - they are unable to take a clear position on issues: - they have a pseudo-self.Self-differentiation was Bowen’s principal goal of family therapy.Bowen would model differentiation to his clients by using "I" statements and taking ownership of his ownthoughts, feelings, and behaviours. Differentiation – The ability of an individual to separate rational and emotionalselves.Functional families are characterized by each members success in finding the healthy balance between belonging toa family and maintaining a separate identity.One way to find the balance between family and individual identity is to define and clarify the boundaries thatexist between the subsystems. A family may have several subsystems such as a spouse, sibling, and parent-childsubsystem. Each subsystem contains its own subject matter that is private and should remain within that subsystem.Boundaries between subsystems range from rigid to diffuse. One of the most common family problems is a weakboundary between subsystemsDiffuse boundaries can lead to over-enmeshment. Enmeshment: inappropriate, boundary-violating closeness in which family members are emotionally overreactive to one anotherRigid boundaries allow too little interaction between family members, which may result in disengagement.(Disengagement: too much emotional distance between family members.)Overall, human systems tend to work best when subsystem boundaries are clear (neither too open nor tooclosed), interactions are clear and nonrepetitive, lines of authority are visible, rules are overt and flexible,changing alignments replace rigid coalitions, and stressors are confronted instead of pushed onto scapegoatsFamilies who understand and respect differences between healthy and unhealthy subsystem boundaries and rulesfunction successfully. Families who do not understand and respect these differences find themselves in adysfunctional state of conflict.People who are fused to their families of origin tend to marry others to whom they can become fused;that is, people at similar levels of differentiation tend to seek out and find each other when coupling.One pseudo-self relies on another pseudo-self for emotional stability.58
  • Unproductive family dynamics of the previous generation are transmitted from one generation to the next throughsuch a marriage (Becvar & Becvar, 2003).In family systems theory, the key to being a healthy person encompasses both a sense of belonging to ones familyand a sense of separateness and individuality.Differentiation from the family of origin allows one to accept personal responsibility for one’s thoughts,feelings, perceptions, and actions.Simply leaving one’s family of origin physically or emotionally, however, does not imply that one hasdifferentiated. Indeed, Bowen’s phrase for estrangement or disengagement is emotional cutoff, a strong indicationof an undifferentiated self.Individuation, or psychological maturity, is a lifelong developmental process that is achieved relative to the familyof origin through reexamination and resolution of conflicts within the individual and relational contexts.The distinction between emotional reactivity and rational thinking can be difficult to discern at times.Those who are not emotionally reactive experience themselves as having a choice of possible responses; theirreactions are not automatic but involve a reasoned and balanced assessment of self and others.Emotional reactivity, in contrast, is easily seen in clients who present themselves as paranoid, intensely anxious,panic stricken, or even “head over heels in love.” In these cases, feelings have overwhelmed thinking and reason,and people experience themselves as being unable to choose a different reaction.Emotional reactivity in therapists almost always relates to unresolved issues with family-of-origin members. Forexample, the sound of a male’s voice in a family session reminds the therapist of his father and immediately triggersold feelings of anger and anxiety as well as an urgency to express them. Clarity of response in Bowen’s theory ismarked by a broad perspective, a focus on facts and knowledge, an appreciation of complexity, and a recognition offeelings, rather than being dominated by them: Such people achieve what Bowen sometimes referred to as a solidself (Becvar & Becvar, 2003).4) Understanding family emotional systems and how they work is central to Bowens theory.The nuclear emotional process refers to how the family system operates in a crisis.The family projection process refers to how parents pass good and bad things on to their children.The multigenerational transmission process refers to how a family passes its good and baggage betweengenerationsBowen focused on how family members could maintain a healthy balance between- being enmeshed (overly involved in each other’s lives)- and being disengaged (too much detachment from each other).Although all family therapists are interested in resolving problems presented by a family and decreasingsymptoms, Bowen therapists are mainly interested in changing the individuals within the context of the system.They contend that problems that are manifest in ones current family will not significantly change until relationshippatterns in ones family of origin are understood and addressed. Emotional problems will be transmitted fromone generation to the next until unresolved emotional attachments are dealt with effectively. Change mustoccur with other family members and cannot be done by an individual in a counseling room.Living systems and all the other system-related processes--move forward through key "horizontal"transitional stages (brought about by time and change).Symptoms occur when vertical stressors (old issues, past mistakes, emotional legacies) impinge on the systemduring a transition. 59
  • Families are likeliest to be conflicted and symptomatic when key horizontal transitions like marriage, the birth ofchildren, children going to school, children moving away from home, changes of jobs, etc. coincide with aresurfacing of vertical stressors like old emotional baggage.Example: a workaholic husband driven to succeed by high internalized standards that equate esteem with production(vertical stressor) puts in even more overtime to stuff the loneliness he feels when his eldest son leaves for college(horizontal stressor).In this case, part of the therapeutic agenda would include giving the family tools for negotiating the "empty nestsyndrome" while helping the husband get in touch with his mourning, examine his expectations of himself, andreconnect with his family.Calibration: setting of a present-oriented, systemwide range limit around a comfortable emotional "bias."A typical situation: an unintense family with a cool emotional atmosphere unconsciously selects a member to turnup the heat; brother and sister start fighting. This turns into an argument between the parents, the drama escalates,and then, before it gets too hot, a child who plays the role of family ambassador calms everybody down.In that family the bias, the emotional level setting, is too low; a good dose of constructive intensity might recalibratethe bias and make explosions unnecessary.Self-regulating via feedback loops--negative (toward stability) and positive (toward change)--that maintainthe bias.Every seasoned drug and alcohol counsellor knows that when one member of the family stops drinking or using, thefamily will subtly try to push him back into his old vices--not because they want him sick, but because families,like other organisms, naturally resist changes that might further destabilize the system.So one day the husband says to his abstaining wife, "Why not skip your AA meeting tonight so we can catch amovie?" Or the mother of a teen whos quit using congratulates him on finding a job--in a head shop.Introducing positive (= system-changing) feedback loops into these families might include warning them aboutenabling, relapses and resistance to change and examining what family members gain from having a malfunctioningmember (control? A scapegoat? Distraction from other conflicts? Someone to rescue?).Sibling Position. Bowen adopted Toman’s (1993) conceptualization of family constellation and sibling (or birth)position.Toman believed that position determined power relationships, and gender experience determined one’s ability to getalong with the other sex.In addition to noting the unique positions of only children and twins, Toman focused on ten power/sex positions:1. the oldest brother of brothers;2. the youngest brother of brothers;3. the oldest brother of sisters;4. the youngest brother of sisters;5. the male only child;6 – 10 and the same five configurations for females in relation to sisters and brothers.Under this conceptualization, the best possible marriage, for example, is hypothesized to be the oldest brother ofsisters marrying the youngest sister of brothers; in this arrangement, both parties would enter the marriage withsimilar expectations about power and gender relationships. Conversely, the worst marriage would occur betweenthe oldest brother of brothers and the oldest sister of sisters. In this case, both parties would seek and want power60
  • positions, and neither would have had enough childhood experience with the other sex to have adequate genderrelationships.Toman supported his hypothesis by noting that the divorce rate among couples comprised of two oldest childrenwas higher than any other set of birth positions. The absence of divorce, however, is not the same as a happymarriage. When we consider the critical traits in a happy marriage, his predictions based on birth order start to losecredibility. Happiness in coupling or marriage is demonstrably more related to attitudinal and behaviouralinteractions within the spousal system—especially during periods of family stress—than to birth order(Gottman, 1994, Walsh, 2003).Guerin (2002) discussed the importance of what he called the “sibling cohesion factor” (p. 135), especially whenthere were more than two children in the sibling subsystem, allowing for triangles to form. The sibling cohesionfactor is the capacity of the children within the sibling subsystem to meet without their parents and discussimportant family issues, including their evaluation of their parents. Healthier families tend to have this factor aspart of the family process; the lack of it suggests to Guerin that there is intense triangulation between the parentsand children.The practice of Bowen family therapy is governed by the following two goals:(1) lessening of anxiety and symptom relief and(2) an increase in each family members level of differentiation of the self (Kerr & Bowen, 1988).To bring about significant change in a family system, it is necessary to open closed family ties and to engageactively in a detriangulation process (Guerin, Fogarty, Fay, & Kautto, 1996). Although problems are seen asresiding in the system rather than in the individual, the route to changing oneself is through changing in relationshipto others in the family of origin.Bowen encouraged his clients to come to know others in their family as they are.He helped individuals or couples gather information, and he coached or guided them into new behaviours bydemonstrating ways in which individuals might change their relationships with their parents, siblings, and extendedfamily members.He instructed them how to be better observers and also taught them how to move from emotional reactivity toincreased objectivity.He did not tell clients what to do, but rather asked a series of questions that were designed to help them figure outtheir own role in their family emotional process.Other concepts:Emotional divorce (like when a sick child holds the parents together); theory is important; no one ever really leavesthe family system; mother-child symbiosis when unresolved predisposes to schizophrenia; solid self vs. pseudoself;over- underadequate reciprocity.Two natural forces: growth of individual and emotional connection. Emphasized the first.Fusion breeds anxiety and increases emotional reactivity. Three outcomes of fusion: physical or mental dysfunctionin a spouse; in a child; chronic marital conflict.Dysfunctional reciprocal relationships: include overadequate/underadequate, decisive/indecisive,dominant/submissive, hysterical/obsessive, schizoid/conflict, or cutoff between spouses. 61
  • MORE ABOUT TRIANGLES1. Cross-generational coalitions (i.e. mother-father-child triangles) are associated with child behaviourproblems.In studies of adolescent antisocial behaviour, differences in dyadic interaction between families with a child withbehaviour problems and families with a well adjusted child have been evaluated.Empirical studies show that on average:• Children with behaviour problems are more aligned with their mothers and more disengaged from their fathers than are the well-adjusted adolescents.• Parents of children with behaviour problems have more discordant relations than the parents of well-adjusted adolescents.• Within families of well-adjusted adolescents, the parents are more supportive of each other than the adolescent.This suggests that strengthening the parental dyad through the resolution of marital problems, and promoting morepositive father-adolescent relations will weaken the cross-generational coalition and ameliorate the symptomaticbehaviour.In another study , the family triangle was defined as a family systems construct used to describe familycommunication patterns in which a dyad cannot cope with demands for intimacy or conflict resolution. As such,triangles occur to reduce tension between two people, but are problematic because they do not provide solutions.2. The authors reviewed three family triangles:• Triangulation: occurs when a parent demands that a child side with her or him against the other parent.• Detouring: occurs when spouses ignore the issues in their own relationship and focus on the childs issues.• Cross-generational coalition: exists when one parent sides with a child against another parent. This differs from triangulation because it is the parent who initiates the coalition and the attachment between the parent and the child exceeds that between the parents.All three family triangles are considered to have negative developmental effects on the child.• They create a false sense of attachment and security and do not give the child the opportunity to develop a healthy separate identity. For this reason the study considers the "impact of cross-generational coalitions on interpersonal intimacy and view intimacy as a developmental task relevant to young adults"• Children with a cross-generational attachment have larger intellectual-intimacy, emotional-intimacy and sexual-intimacy discrepancy scores.• Cross-generational coalitions also affect the ability to successfully negotiate psycho-social developmental tasks. Tests reveal that, even while away from home, children are still affected by the family triangle.• "Detriangulating" can contribute considerably in resolving intimacy issues. Detriangulating involves: a) not talking with one parent about the other parent, b) teaching the client about triangulation patterns, c) the client becoming more objective and less emotional with his or her parents.62
  • Because the family is not a static entity, a change in one part of the system affects the actions of all othersinvolved. Bowen sometimes worked with one member of a conflictual dyad (or couple). He did not require thatevery family member be involved in the therapy sessions.Bowen tended to work from the inside out: Starting with the spousal relationship, he helped the two adults establishtheir own differentiation.As a therapist, he attempted to maintain a stance of neutrality. If the therapist becomes emotionally entangled withany one family member, the therapist loses effectiveness and becomes part of a triangulated relationship.Bowen maintains that, to be effective, family therapists have to have a very high level of differentiation. Iftherapists still have unresolved family issues and are emotionally reactive, they are likely to revisit those difficultiesin every family they see.3. Vogel, E.F. and Bell, N.W. (1968). The Emotionally Disturbed Child as the Family Scapegoat.The purpose of this study was to learn more about how "the emotionally disturbed child used as a scapegoat for theconflicts between parents and what the functions and dysfunctions of this scapegoating are for the family." (p. 412)When parents experience crises for which they have no adequate coping mechanisms, they look for ways todischarge some of the tension. One of the most common methods is to involve a third person. When the third personis their child, parents often project their problems on to the child. They focus their attentions on the problems ofthe child so they can avoid the pain of admitting their own problems. This is what Vogel and Bell call"scapegoating".There were many reasons why the child was selected as the scapegoat.• First, the child was relatively powerless to leave the family nor to counter the parents triangulation. The childs personality is very flexible and adopts quickly to the assigned role of scapegoat.• The child has few task which are vital in the maintenance of the family. "The cost in dysfunction of the child is low relative to the functional gains for the whole family."• Often, the chosen child would best symbolize the parental conflicts. For example, if the conflict was over achievement, the child who stood out most (for either over- or under-achieving) would be targeted.• Children were also picked because they possessed the same undesirable traits (either physically, behaviourally or emotionally) as the parent.• The study also found that the scapegoated child had a (considerably) lower IQ than the other children. Many had physical abnormalities. All of the parents reported having had tensions since early in the marriage.Once the child is selected she or he must carry out the role of the problem child. The authors found that the problembehaviour was reinforced through inconsistent parenting.The dysfunction would be both supported and criticized. In some cases, parents would encourage opposing types ofbehaviour. In other instances parents promoted different norms. This set up a self-perpetuating cycle which"normalized" the childs problems. The dysfunction became part of the family.The families used rationalizations to maintain the equilibrium attained when the child took on the parents problems.• One rationalization was that the parents, rather than the children, were the victims.• Another was to emphasize how fortunate the child was, because their life was better than the parents. The parents felt justified in depriving the children of things they wanted and then used the complaints to reinforce the scapegoating. 63
  • • Another common belief was that the child could behave if she or he wanted to. This rationalized sever punishment.The authors point out that there are both functions and dysfunctions of scapegoating.• For the parents, scapegoating serves to stabilize their relationship. They were also better able to live up to the societal expectations of a happy marriage. Scapegoating permits the family to maintain its solidarity. At the same time, communities can scapegoat the family with the dysfunctional child.• One of the dysfunctions is that scapegoating creates "realistic problems and extra tasks" for the family. Another is that the child often becomes very adept at fighting back and usually directs their aggression towards the ever- present mother.4. Marks, S. (1989). Towards a systems theory of marital quality.Marks (1989) suggests that relationships can be understood in terms of two intersecting triangles. He has borrowedMargaret Meads concept of "I" and "me" in describing the nature of the triangle. The "I" is the presentation of theself at that moment or in that situation. This contrasts with the "me" which is an organization of tendencies. Thesituation brings the "I" out of the "me". The triangle is three points and those can be understood as three tendencies,or three "me" corners. At any given moment one corner will be the focus of energy. That corner will then be the "I",the present manifestation of the tendencies. In therapy, the placement of the"I" structures the future.Each triangle has three corners.1) The first corner is the Inner-self (I-corner), the driving force.2) The second is the Partnership (P-corner) corner. This coordinates the self with a primary partner.3) The third corner is any area where the self concentrates energy that is different from the first two corners, eg job, children, religion, friends etc.Marks conception differs from Bowens view of triangles in marriage. Bowen sees the couple as two corners of thetriangle. The couple uses the third corner as a buffer against their tension. The third corner provides a distractionand relieves the marital pressure. In a marital therapy situation, the therapist can act as the third corner.The "Three Corners" model is a systems theory of the self in marriage. A traditional concept in marriage therapy is"marital quality". Marks states "Quality of marriage is a consequence of the way married selves are systematicallyorganized. A person whose "I" maintains some regular motion around and between all three corners has ahigh quality marriage."The article introduces seven different manifestations of the dual triangle construct.The first three are low quality relationships. These are characterized by a concentration of energy on one cornerwithout a flow of energy to all parts.1) The first triangle is the "Romantic Fusion", wherein all the energy is focused on the P . This is the traditional beginnings of a relationship. This becomes unhealthy after a while because other areas of the self are neglected.2) The second is the "Dependency-Distancing" relationship. This is a traditional unhealthy female-male situation where the woman places energy on the partner and the partner (the man) places energy on the 3rd corner, usually work.3) The third is the "Separated" relationship where both people focus their energy on their 3rd corner. Marks says that while this can be very healthy and stable, as a marriage is concerned it is low quality.64
  • The last four triangles represent high quality marriages.There is a radical shift in the conception of the triangle. Because there is a constant flow of energy, the three pointsare connected by rounded lines, making a circle. This represents uninterrupted energy flow between the "mes". In ahigh quality marriage there is a multiplicity of healthy connections which are as dynamic and fluid as the energy.4) The fourth is the "Balanced Connection" which has an equal concentration of energy.5) The fifth is "Couple Centered". The energy is focused on the P , but differs from the second triangle in that the other "mes" receive energy.6) The sixth is "Family Centered". Both people focus their energy on the family, which would be a joint 3rd interest.7) The seventh is "Loose". The energy is focused on the 3rd , without detriment to the stability of the couple because, again, there is a steady flow of energy to the other corners.Marks (1989) concept of the self as a triangle is very useful and deserves more attention. A useful applicationwould be in Slaters (1994) article on triangles in committed lesbian relationships. In his article, Marks does notdiscuss the possibility of energy revolving around the "I". This might reflect an assumption that there is a sufficientconcentration on the "I" naturally, that the inner-self is the base of all the external interactions. This assumes adegree of differentiation that, developmentally, is traditionally more male than female. Slater points out that theaffected partner needs consolidate her sense of identity and perceive it as originating within herself. This wouldresult in the "I" in Marks model to be the focus of energy. Without this option, the therapist would concentrate theaffected partner on the "P" and miss the opportunity for individual growth.Criticisms on the triangle theoryAs exciting and varied as triangle theory is, there are valid criticisms. One is that the majority of the studies focusedon dependence as being the dominant catalyst for problems. A good example is West (1986) who states : “In thisenmeshed situation the child seems to experience a distorted sense of attachment, involvement, or belonging withthe family and fails to experience a secure sense of separateness, individuality or autonomy. “This implies that independence is more important than attachment, and given what we know about gender roles, thatmale characteristics are more important than female characteristics. The possible gender bias could be addressed bya study on the role of an overly-detached family member on the creation of triangles. This would look at the rolethat stereotypical male behaviour has on the other two members. 65
  • Salvador Minuchin’s Structural family therapy IFrom Wikipedia, the free encyclopediaStructural Family Therapy (SFT) is a method of psychotherapy developed by Salvador Minuchin which addressesproblems in functioning within a family. Structural Family Therapists strive to enter, or "join", the family system intherapy in order to understand the invisible rules which govern its functioning, map the relationships betweenfamily members or between subsets of the family, and ultimately disrupt dysfunctional relationships within thefamily, causing it to stabilize into healthier patterns.[1] Minuchin contends that pathology rests not in the individual,but within the family system.SFT utilizes, not only a unique systems terminology, but also a means of depicting key family parametersdiagrammatically. Its focus is on the structure of the family, including its various substructures. In this regard,Minuchin is a follower of systems and communication theory, since his structures are defined by transactionsamong interrelated systems within the family. He subscribes to the systems notions of wholeness and equifinality,both of which are critical to his notion of change. An essential trait of SFT is that the therapist actually enters, or"joins", with the family system as a catalyst for positive change. Joining with a family is a goal of the therapist earlyon in his or her therapeutic relationship with the family.Contents • 1 Family Rules • 2 Therapeutic Goals and Techniques • 3 See also • 4 ReferencesFamily RulesIn SFT, family rules are defined as an invisible set of functional demands that persistently organizes the interactionof the family. Important rules for a therapist to study include coalitions, boundaries, and power hierarchies betweensubsystems.[1]According to Minuchin, a family is functional or dysfunctional based upon its ability to adapt to various stressors[2](extra-familial, idiosyncratic, developmental), which, in turn, rests upon the clarity and appropriateness of itssubsystem boundaries. Boundaries are characterized along a continuum from enmeshment through semi-diffusepermeability to rigidity. Additionally, family subsystems are characterized by a hierarchy of power, typically withthe parental subsystem "on top" vis-à-vis the offspring subsystem.In healthy families, parent-children boundaries are both clear and semi-diffuse, allowing the parents to interacttogether with some degree of authority in negotiating between themselves the methods and goals of parenting. Fromthe children’s side, the parents are not enmeshed with the children, allowing for the degree of autonomous siblingand peer interactions that produce socialization, yet not so disengaged, rigid, or aloof, ignoring childhood needs forsupport, nurturance, and guidance. Dysfunctional families exhibit mixed subsystems (i.e., coalitions) and improperpower hierarchies, as in the example of an older child being brought in to the parental subsystem to replace aphysically or emotionally absent spouse.66
  • Therapeutic Goals and TechniquesMinuchin’s goal is to promote a restructuring of the family system along more healthy lines, which he does byentering the various family subsystems, "continually causing upheavals by intervening in ways that will produceunstable situations which require change and the restructuring of family organization... Therapeutic change cannotoccur unless some pre-existing frames of reference are modified, flexibility introduced and new ways of functioningdeveloped."[citation needed] To accelerate such change, Minuchin manipulates the format of the therapy sessions,structuring desired subsystems by isolating them from the remainder of the family, either by the use of space andpositioning (seating) within the room, or by having non-members of the desired substructure leave the room (butstay involved by viewing from behind a one-way mirror). The aim of such interventions is often to cause theunbalancing of the family system, in order to help them to see the dysfunctional patterns and remain open torestructuring. He believes that change must be gradual and taken in digestible steps for it to be useful and lasting.Because structures tend to self-perpetuate, especially when there is positive feedback, Minuchin asserts thattherapeutic change is likely to be maintained beyond the limits of the therapy session.One variant or extension of his methodology can be said to move from manipulation of experience toward fosteringunderstanding. When working with families who are not introspective and are oriented toward concrete thinking,Minuchin will use the subsystem isolation—one-way mirror technique to teach those family members on theviewing side of the mirror to move from being an enmeshed participant to being an evaluation observer. He doesthis by joining them in the viewing room and pointing out the patterns of transaction occurring on the other side ofthe mirror. While Minuchin doesn’t formally integrate this extension into his view of therapeutic change, it seemsthat he is requiring a minimal level of insight or understanding for his subsystem restructuring efforts to "take" andto allow for the resultant positive feedback among the subsystems to induce stability and resistance to change.Change, then, occurs in the subsystem level and is the result of manipulations by the therapist of the existingsubsystems, and is maintained by its greater functionality and resulting changed frames of reference and positivefeedback.See also • Family systems therapy • Salvador Minuchin • Systems theoryReferences 1. ^ a b Minuchin, S. (1974). Families and Family Therapy. Harvard University Press. 2. ^ Seligman, Linda (2004). Diagnosis and Treatment Planning in Counseling. New York: Kluwer Academic. ISBN 0306485141., p. 246 • Minuchin, S. & Fishman, H. C. (2004). Family Therapy Techniques. Harvard University Press. • Piercy, Fred (1986). Family Therapy Sourcebook. New York: Guilford Press. ISBN 0898629136. • Will, David (1985). Integrated Family Therapy. London: Tavistock. ISBN 042279760X. 67
  • Salvador Minuchin’s Structural Family Therapy IIA directive therapy, change-oriented through changing the family structure (transaction-governing rules of afamily). A symptom services and is rooted in dysfunctional transactions, structure (boundaries). • Salvador Minuchin’s style was to get the family to talk briefly until he identified a central theme of concern and the leading and supporting roles in the theme. • Next he examined boundaries or family rules that define the participants, the areas of responsibility, the decision making and privacy rules. • The idea is to change the immediate context of the family situation and thereby change the family members’ positions. • His approach was both active and directive. He would shift the family focus from the identified client to the therapist to allow the identified client to rejoin the family. • When treatment is complete, the therapist moves outside the family structure and leaves the family intact and connected without the loss of individual family member identities.The Structural Family Therapy is a type of family therapy, based on the assumption that family member behaviouris ongoing and repetitive and can be understood only in the family context.This therapy may be characterized by the highly active therapist who gives specific directives for behaviour changethat are carried out as homework assignments.Paradoxical interventions are often used to harness the strong resistance clients have to change and to takingdirectives.Clients may be asked to intensify the problem as one way of using paradox.Another way is for the therapists to take a "one-down" position, encouraging the client not to do too much too soon.Counselors must differentiate between first-order and second-order changes.First-order changes are those that help the system stay at its current level of functioning. They occur when thesymptom is temporarily removed, only to reappear later because the family system has not been changed.Second-order changes restructure the system to bring it to a different level. They occur when symptom andsystem are repaired and the need for the symptom does not reappear.E.g.: Teaching family members how to use "I" statements and listen empathically demonstrate first-order changesthat enhance the familys current functioning. Coaching a widow through the loss of her husband, helping a couplelet go of the last child to leave the nest, and restructuring an alcoholic family to eliminate drinking are second-orderchanges that alter the family fundamentally, bringing it to an entirely new structure and psychological place.Key concepts:Enmeshment: encourages somatization, and disengagement, acting out. High resonance.Ecological context: the familys church, schools, work, extended family members.Sick child: family conflict defuser.Common boundary problem: parents confuse spouse functions with parent functions.Rules: generic and idiosyncratic rules that regulate transactions govern structure.Boundaries: can be diffuse (enmeshed), rigid (disengaged), or clear.Power: determined by authority and responsibility for acting on it.Coalitions: can be stable or detouring.Transitional anxieties: Families are constantly in transition, and transitional anxieties and lack of differentiation are sometimes mislabeled pathological.68
  • Reaction to therapist probes: A family will either dismiss the therapists probes, assimilate to previous transaction patterns, or respond as to a novel situation, in which case stress increases and the probe is restructuring.Rigid triad: where parents habitually use a child to lightningrod conflict. Rigid boundary around the triad; common when the children have severe psychosomatic problems.Dysfunctional families: A dysfunctional family is one that responds to inner or outer demands for change by stereotyping its functioning.Three reasons that make clients move:They are challenged in their perception of their reality, given alternative possibilities that make sense, or self-reinforcing new relationships appear once theyve tried out new alternatives. People need some support within afamily to move into the unknown.Four sources of family stress:One member with extrafamilial forces, whole family with extrafamilial forces, transition points in the familysevolution, idiosyncratic problems.Sets: repeated family reactions to stress. Spontaneous sets: interpreted like enactments.Goals:clear boundaries as gatekeepers,clear lines of authority,systems and subsystems (the parental one is where pathology begins),increase flexibility to alternative transactions,help negotiate family life cycle transitions.Family mapping via diagram of current structure.Interventions:Joining and accomodating (same process: joining emphasizes therapists outer adjustment to family, accomodatingtherapists inner adjustment; adopting familys affective style;joining from a distant position = teaching, advice),mimesis (imitation, or joining from a close position),tracking (of family communications and behaviour, or joining from a median position),enactments that simulate transactions to be changed,detriangulation of IP by forming a coalition with him against a parent,maintenance (of the familys current structure),marking boundaries (when they are strengthened, the subsystems functioning will increase),mimic IP to show that hes like the powerful therapist rather than deviant, make the IP a cotherapist to theoverfunctioner,reframing in terms of structure or interaction,unbalancing by escalating stress,general restructuring techniques (e.g., rearranging how they sit, blocking certain transactions, working as a familyinsider).. 69
  • Virginia Satir’s Humanistic family therapyOne of the founders of the MRI communications school. Emphasized the importance of giving families hope andbuilding self-esteem in family members. **** Also read: Behavioural and Conjoint Family Therapy ****Key concepts: • Turn roles into relationships, rules into guidelines. • Our similarities unite us, and our differences make us grow. • A symptom may be distorting self-growth by trying to alleviate family pain; symptoms are a light on the dashboard or a ticket into therapy. Broken families follow broken rules. Pathology is a deficit in growth. What growth price does each part of the system pay to keep the overall balanced? "Rupture point": where coping skills fail and family needs to change. • Primary triad (mother, father, child) is source of self-identity. • Mind, soul, body triad: a current basis of self-identity. • Self, the core, has eight levels: physical, intellectual, emotional, sensual, interactional, contextual, nutritional, and spiritual. A good therapist works on all levels. • Three parts to every communication: Me, you, context. Dysfunctional communications leave one of these out of account. • Games: rescue games, coalition games, lethal games, growth games. • The five freedoms: To see and hear what is here instead of what should be, was, or will be; To say what one feels and thinks, instead of what one should; To feel what one feels, instead of what one ought; To ask for what one wants, instead of always waiting for permission; To take risks in ones own behalf, instead of choosing to be only "secure" and not rocking the boat. • Maturation: development of a clear identity and power of choice; self-relatedness; ability to communicate with others. Coping skills increase with self-esteem. • "Threat and Reward" (rule-makers/followers; rigid roles) vs. "Seed" (innate growth potential) worldviews. • Five components of self-esteem: Security, belonging, competence, direction, selfhood. • In a dysfunctional family, symptomatic behaviour makes sense. It is also covertly rewarded.70
  • Interventions:Reduce individual and family pain.Family life chronology (three generations).Communication work and esteem building. Growth.Identification of family roles, and turning these into relationships.Family reconstruction: an exercise in which roles in significant family historical events are directed by the Explorer,who is led by the Guide.Look at implicit premises that guide perceptions and interactions.Analysis of how family members handle differentness.Cut games, straighten transactions.Self-manifestation (congruence) analysis.Model analysis of which models have impacted early on.Expand experiencing and choice-making.Parts party: awareness and exercise of mind and body.Sculpting (group posture) technique.Labeling assets.Use of drama, metaphor, art, stories, self.Criteria for termination:when family members can complete transactions, check, ask; can interpret hostility; can see howothers see them; can see how they see themselves; can tell each other how he manifests himself;can tell other member what he hopes, fears, expects from the other; can disagree; can makechoices; can learn through practice; can free selves from harmful effects of past models; can givea clear message, be congruent. 71
  • Behavioural & Conjoint Family TherapyFamily therapists following a communications approach to family therapy hold the view that accuratecommunication is the key to solving family problems. (Conjoint family therapy = The involvement of two or moremembers of a family in therapy at the same time.)An open and honest manner of communicating rather than using phony or manipulative roles characterizes goodproblem-solving families.Gottman built his approach on matching intent and impact of communication.He used a behavioural interviewing method to teach people about what they are doing that is not working and tohelp them correct the situation by learning how to get the impact they want from their communication.His stages include1) exploration,2) identification of goals,3) perceptions of issues,4) selection of one issue for discussion,5) an analysis of interactions,6) negotiation of a contract.Virginia Satir considered herself a detective who helps children figure out their parents. She thought 90% of whathappens in a family is hidden. The familys needs, motives, and communication patterns are included in this 90%.She believed that whatever people are doing represents the best they are aware of and the best they can do.She considered people geared to surviving, growing, and developing close relationships with others.Self-esteem plays a prominent role in Satirs system.She viewed mature people as being in touch with their feelings, communicating clearly and effectively, andaccepting differences in others as a chance to learn.She believed the four components in a family situation that are subject to change are 1) the members feelings of self-worth, 2) the familys communication abilities, 3) the system, 4) and the rules of the family.The three keys to Satir’s system are 1) to increase the self-esteem of all family members, 2) help family members better understand their encounters 3) and use experiential learning to improve interactions.Communication is the most important factor in Satirs system and determines the kinds of relationships people havewith one another and how people adjust. She discussed response patterns to which people resort as a reaction toanxiety.72
  • These universal response roles or communication stances are:Five roles: placater, blamer, super-reasonable, irrelevant, and congruent (or leveling) communicator.The first four are mostly poses covering lack of self-worth. 1) the placater : an individual who avoids conflict at the cost of his/her integrity 2) the blamer : a person who places blame on others and does not take responsibility for what is happening. 3) the computer : the super reasonable individual who denies his emotions 4) the distractor : takes irrelevant stances 5) the leveler : Communicates in a congruent way in which genuine expression’s of one’s feelings are made in an appropriate context.Leveling helps people develop healthy personalities; all the others hide real feelings for fear of rejection.Satir divided families into two types: nurturing and troubled. Each type had varying degrees.Her main objective for her clients was recognition of their type and then change from type or degree.The counseling method of conjoint family therapy involves 1) communication, 2) interaction, 3) and general information for the entire family.She used several techniques to reach her goals of establishing proper environments and assisting family members inclarifying what they want or hope for themselves and for the family. Her method is designed to help familymembers discover what patterns of communication do not work and how to understand and express their feelings inan open, level manner.Simulated family games, systems games, and communication games are some of the methods she developed to dealwith family behaviour.Some of Satir’s games are :• Growth model – assumes that an individual’s behaviour changes due to interactions with other people.• Medical model – purports that the cause of the problem is an illness of the individual.• Sick model – proposes that the individual’s thinking and attitudes are wrong and must be changed.• Filial therapy is a play therapy method based on the principles of child-centered therapy. The goals of filial therapy are to reduce the child’s problem behaviours, to help parents gain the skills of child-centered therapist to use as the parents relate to their children and to improve the parent-child relationship.• Strategic family play therapy is a form of counseling in which all family members and the counsellor play.• Theraplay is a treatment method modeled after the healthy parent-child interaction in which parents are involved first as observers and then as co-therapists.The counsellors role in this model is of a facilitator who gives total commitment and attention to the process andthe interactions. The counsellor intervenes to assist leveling and taking responsibility for ones own actions andfeelings.Play therapy with families has the advantage of helping children communicate their story to the therapist.Dynamic family play therapy engages family members in creative activity by using natural play.The counsellor’s goal is to help the family develop and increase spontaneity. 73
  • KEY CONCEPTS1. The individual is considered as part of a family and the interactions and relationships within the family are the focus of therapy.2. The systems approach to family therapy is focused on how family members can maintain a healthy balance between being enmeshed and being disengaged.3. Structural family therapy is based on the idea that the family is an evolving, hierarchical organization made up of several subsystems with rules and behaviour patterns for interacting across and within those subsystems.4. According to structural theorists, defining and clarifying boundaries that exist between subsystems is imperative.5. Minuchins approach is directed toward changing the family structure or organization as a way of modifying family members behaviour.6. Strategic family therapy is based on the assumption that the familys ineffective problem solving develops and maintains symptoms.7. Conjoint family therapy is based on honest communication, members’ feelings of self-worth, and the rules of the family.8. Some of the family play therapy approaches include dynamic family play therapy, filial therapy, strategic family play therapy and theraplay.74
  • Milan Systemic family therapy or “Long Brief Therapy”:Led by Mara Selvini-Palazzoli.Sessions held about once a month to let things incubate; families wanting more are trying to control thetherapy.Neutral, nonreactive therapist who asks family to generate its own solutions.key concepts:Emphasis on information, paradox, circular feedback loops.Repetitive interactions: games by which members try to control one another. Change the interactions and thebehaviour will too.Dysfunctional families make an "epistemological error" that can be corrected.Therapy:one or two therapists see the family while a team watches from behind a mirror.Sessions broken by an intersession during which the therapist talks to the team away from the family.Interventions:Counterparadox.Pre-session hypothesizing.Circular and triadic questioning.Positive connotation of a behaviours intent.Assignment of rituals.Invariant prescription to loosen parent-child collusion. 75
  • Response-based Family TherapyFrom Wikipedia, the free encyclopediaResponse-based therapy is a relatively new psychotherapeutic approach to treating psychological trauma resultingfrom violence, based on the theory that whenever people are treated badly, they resist.[1] Incorporating elements ofSolution focused brief therapy, Narrative therapy, and discourse analysis, it was first proposed by a Canadian familytherapist and researcher, Dr. Allan Wade, in his 1997 article "Small Acts of Living: Everyday Resistance toViolence and Other Forms of Oppression." [2].Therapeutic methods of response-based therapy are based on two theoretical foundations: (1) That alongsideaccounts of violence in history, there exists an often-unrecognized parallel history of "determined, prudent, andcreative resistance," and (2) language is frequently used in a manner that (a) conceals violence, (b) obscures andmitigates perpetrator responsibility, (c) conceals victims resistance, and (d) blames or pathologizes victims. Thissecond principle employs "discourse analysis" and is referred to in response based therapy as the "four discursiveoperations."[3]This presupposition of resistance as a natural response to violence is used to engage clients in in-depthconversations about how they responded to specific acts of violence. In response-based literature, resistance isdefined and examples given:“Any mental or behavioural act through which a person attempts to expose, withstand, repel, stop, prevent, abstainfrom, strive against, impede, refuse to comply with, or oppose any form of violence or oppression (including anytype of disrespect), or the conditions that make such acts possible, may be understood a a form of resistance.”(Wade, 1997, p. 25)“Whenever people are abused, they do many things to oppose the abuse and to keep their dignity and their self-respect. This is called resistance. The resistance might include not doing what the perpetrator wants them to do,standing up against, and trying to stop or prevent violence, disrespect, or oppression. Imagining a better life mayalso be a way that victims resist abuse.” (Calgary Women’s Emergency Shelter, 2007, p. 5).Therapy consists of using language to (1) expose violence, (2) clarify perpetrators responsibility, (3) elucidate andhonor victims resistance, and (4) contest victim blaming [4].In response-based therapy, the client is viewed as an "agent" who has the capability to respond to an act, rather thana passive "object" that is "acted upon." Example: the response-based therapist would not ask a victim "How did thatmake you feel?", but instead would ask "When [act of violence] was done to you, how did you respond? What didyou do?"References 1. ^ Wade, 1997, p. 23 2. ^ Wade, A. (1997). Small acts of living: Everyday resistance to violence and other forms of oppression. Contemporary Family Therapy, 19(1), 23-39 3. ^ Coates, L., & Wade, A. (2004). Telling It Like It Isn’t: Obscuring Perpetrator Responsibility for Violent Crime. Discourse and Society, 15(5), 3-30. 4. ^ Todd, N. & Wade, A. (2003) Coming to Terms with Violence and Resistance: From a Language of Effects to a Language of Responses, in T. Strong & D. Pare (eds), Furthering Talk: Advances in the Discursive Therapies, New York: Kluwer Academic Plenum. p. 152.76
  • Related reading • Calgary Womens Emergency Shelter. (2007). Honouring Resistance: How Women Resist Abuse in Intimate Relationships (formerly Resistance to Violence and Abuse in Intimate Relationships: A Response-Based Perspective) Available from Calgary Womens Emergency Shelter, P.O. Box 52051 Edmonton Trail N., Calgary, Alberta T2E 8K9. • Coates, L. & Wade, A. (2004). Telling It Like It Isn’t: Obscuring Perpetrator Responsibility for Violent Crime. Discourse and Society, 15(5), 3-30. • Coates, L. & Wade, A. (2007). Language and Violence: Analysis of Four Discursive Operations. Journal of Family Violence, 22(7), 511-522. • Maddeaux-Young, H. N. (2006). Therapeutic Responses To Violence: A Detailed Analysis Of Therapy Transcripts. Master of Arts Thesis, University of Lethbridge, Department of Sociology.[1]. • Renoux, M. & Wade, A. (2008, June). Resistance to Violence: A Key Symptom of Chronic Mental Wellness. Context, 98, 2-4. • Todd, N. and Wade, A. (2001). The Language of Responses Versus the Language of Effects: Turning Victims into Perpetrators and Perpetrators into Victims, unpublished manuscript, Duncan, British Columbia, Canada. • Todd, N. & Wade, A. (2003). Coming to Terms with Violence and Resistance: From a Language of Effects to a Language of Responses, in T. Strong & D. Pare (eds), Furthering Talk: Advances in the Discursive Therapies, New York: Kluwer Academic Plenum. • Wade, A. (1997). Small Acts of Living: Everyday Resistance to Violence and Other Forms of Oppression, Journal of Contemporary Family Therapy, 19, 23–40. • Wade, A. (1999). Resistance to Interpersonal Violence: Implications for the practice of therapy. University of Victoria, Ph.D. Dissertation, Department of Psychology. • Wade, A. (2007a). Despair, resistance, hope: Response-based therapy with victims of violence. In C. Flaskas, I. McCarthy, and J. Sheehan (Eds.), Hope and despair in narrative and family therapy: Adversity, forgiveness and reconciliation (pp. 63–74). New York , NY : Routledge/Taylor & Francis Group. HF • Wade, A. (2007b). Coming to Terms with Violence: A Response-Based Approach to Therapy, Research and Community Action. Yaletown Family Therapy: Therapeutic Conversations. [2] • Weaver, J., Samantaraya, L., & Todd. N. (2005). The Response-Based Approach in Working with Perpetrators Of Violence: An Investigation. Calgary Womens Emergency Shelter [3] 77
  • Narrative Family Therapy - IFrom Wikipedia, the free encyclopediaNarrative Therapy is a form of psychotherapy using narrative. It was initially developed during the 1970s and1980s, largely by Australian Michael White and his friend and colleague, David Epston, of New Zealand.Their approach became prevalent in North America with the 1990 publication of their book, Narrative Means toTherapeutic Ends,[1] followed by numerous books and articles about previously unmanageable cases of anorexianervosa, ADHD, schizophrenia, and many other problems. In 2007 White published Maps of Narrative Practice,[2] apresentation of six kinds of key conversations.Contents • 1 Overview • 2 Narrative therapy topics o 2.1 Concept o 2.2 Narrative approaches o 2.3 Common elements o 2.4 Method o 2.5 Outsider Witnesses • 3 Criticisms of Narrative Therapy • 4 See also • 5 References • 6 External linksOverviewThe term "narrative therapy" has a specific meaning and is not the same as narrative psychology, or any othertherapy that uses stories. Narrative therapy refers to the ideas and practices of Michael White, David Epston, andother practitioners who have built upon this work. The narrative therapist focuses upon narrative and situatedconcepts in the therapy. The narrative therapist is a collaborator with the client in the process of discovering richer(or "thicker") narratives that emerge from disparate descriptions of experience, thus destabilizing the hold ofnegative ("thin") narratives upon the client.By conceptualizing a non-essentialized identity, narrative practices separate persons from qualities or attributes thatare taken-for-granted essentialisms within modernist and structuralist paradigms. This process of externalization[1]allows people to consider their relationships with problems, thus the narrative motto: “The person is not theproblem, the problem is the problem.” So-called strengths or positive attributes are also externalized, allowingpeople to engage in the construction and performance of preferred identities.Operationally, narrative therapy involves a process of deconstruction and "meaning making" which are achievedthrough questioning and collaboration with the client. While narrative work is typically located within the field offamily therapy, many authors and practitioners report using these ideas and practices in community work,[3] schools[4][5] and higher education [6]Although narrative therapists may work somewhat differently (for example, Epston uses letters and other documentswith his clients, though this particular practice is not essential to narrative therapy), there are several commonelements that might lead one to decide that a therapist is working "narratively" with clients.78
  • Narrative therapy topicsConceptNarrative therapy holds that our identities are shaped by the accounts of our lives found in our stories or narratives.A narrative therapist is interested in helping others fully describe their rich stories and trajectories, modes of living,and possibilities associated with them. At the same time, this therapist is interested in co-investigating a problemsmany influences, including on the person himself and on their chief relationships.By focusing on problems effects on peoples lives rather than on problems as inside or part of people, distance iscreated. This externalization or objectification of a problem makes it easier to investigate and evaluate the problemsinfluences.Another sort of externalization is likewise possible when people reflect upon and connect with their intentions,values, hopes, and commitments. Once values and hopes have been located in specific life events, they help to “re-author” or “re-story” a persons experience and clearly stand as acts of resistance to problems.The term “narrative” reflects the multi-storied nature of our identities and related meanings. In particular, re-authoring conversations about values and re-membering conversations about key influential people are powerfulways for people to reclaim their lives from problems. In the end, narrative conversations help people clarify forthemselves an alternate direction in life to that of the problem, one that comprises a persons values, hopes, and lifecommitments.Narrative approachesBriefly, narrative approaches hold that identity is chiefly shaped by narratives or stories, whether uniquely personalor culturally general. Identity conclusions and performances that are problematic for individuals or groups signifythe dominance of a problem-saturated story.Problem-saturated stories gain their dominance at the expense of preferred, alternative stories that often are locatedin marginalized discourses. These marginalized knowledges and identity performances are disqualified orinvisibilized by discourses that have gained hegemonic prominence through their acceptance as guiding culturalnarratives. Examples of these subjugating narratives include capitalism; psychiatry/psychology; patriarchy;heterosexism; and Eurocentricity.Furthermore, binaries such as healthy/unhealthy; normal/abnormal; and functional/dysfunctional ignore both thecomplexities of peoples’ lived experiences as well as the personal and cultural meanings that may be ascribed totheir experiences in context.Common elementsCommon elements in narrative therapy are:• The assumption that narratives or stories shape a persons identity, as when a person assesses a problem in their life for its effects and influences as a "dominant story";• An appreciation for the creation and use of documents, as when a person and a counsellor co-author "A Graduation from the Blues Certificate";• An "externalizing" emphasis, such as by naming a problem so that a person can assess its effects in her life, come to know how it operates or works in her life, relate its earliest history, evaluate it to take a definite position on its presence, and in the end choose their relationship to it.• A focus on "unique outcomes" (a term of Erving Goffman) or exceptions to the problem that wouldnt be predicted by the problems narrative or story itself.• A strong awareness of the impact of power relations in therapeutic conversations, with a commitment to checking back with the client about the effects of therapeutic styles in order to mitigate the possible negative effect of invisible assumptions or beliefs held by the therapist.• Responding to personal failure conversations [7] 79
  • MethodIn Narrative therapy a persons beliefs, skills, principles, and knowledge in the end help them regain their life from aproblem. In practice a narrative therapist helps clients examine, evaluate, and change their relationship to a problemby acting as an “investigative reporter” who is not at the centre of the investigation but is nonetheless influential;that is, this therapist poses questions that help people externalize a problem and then thoroughly investigate it.Intertwined with this problem investigation is the uncovering of unique outcomes or exceptions to its influences,exceptions that lead to rich accounts of key values and hopes—in short, a platform of values and principles thatprovide support during problem influences and later an alternate direction in life.The narrative therapist, as an investigative reporter, has many options for questions and conversations during apersons effort to regain their life from a problem. These questions might examine how exactly the problem hasmanaged to influence that persons life, including its voice and techniques to make itself stronger.On the other hand, these questions might help restore exceptions to the problems influences that lead to naming analternate direction in life. Here the narrative therapist relies on the premise that, though a problem may be prevalentand even severe, it has not yet completely destroyed the person. So, there always remains some space for questionsabout a persons resilient values and related, nearly forgotten events. To help retrieve these events, the narrativetherapist may begin a related re-membering conversation about the people who have contributed new knowledges orskills and the difference that has made to someone and vice-versa for the remembered, influential person.Outsider WitnessesIn this particular narrative practice or conversation, outsider witnesses are invited listeners to a consultation. Oftenthey are friends of the consulting person or past clients of the therapist who have their own knowledge andexperience of the problem at hand. During the first interview, between therapist and consulting person, the outsiderlistens without comment.Then the therapist interviews them with the instructions not to critique or evaluate or make a proclamation aboutwhat they have just heard, but instead to simply say what phrase or image stood out for them, followed by anyresonances between their life struggles and those just witnessed. Lastly, the outsider is asked in what ways they mayfeel a shift in how they experience themselves from when they first entered the room[8]Next, in similar fashion, the therapist turns to the consulting person, who has been listening all the while, andinterviews them about what images or phrases stood out in the conversation just heard and what resonances havestruck a chord within them.In the end, an outsider witness conversation is often rewarding for witnesses. But for the consulting person theoutcomes are remarkable: they learn they are not the only one with this problem, and they acquire new images andknowledge about it and their chosen alternate direction in life. The main aim of the narrative therapy is to engage inpeoples problems by providing the alternative best solution.80
  • Criticisms of Narrative TherapyTo date, there have been several formal criticisms of Narrative Therapy over what are viewed as its theoretical andmethodological inconsistencies, among various other concerns.[9][10][11] • Narrative therapy has been criticised as holding to a social constructionist belief that there are no absolute truths, but only socially sanctioned points of view, and that Narrative therapists therefore privilege their clients concerns over and above "dominating" cultural narratives.[10][12] • Several critics have posed concerns that Narrative Therapy has made gurus of its leaders, particularly in the light that its leading proponents tend to be overly harsh about most other kinds of therapy.[10][12] Others have criticized Narrative Therapy for failing to acknowledge that the individual Narrative therapist may bring personal opinions and biases into the therapy session.[10] • Narrative therapy is also criticized for the lack of clinical and empirical studies to validate its many claims.[13] Etchison & Kleist (2000) state that Narrative Therapys focus on qualitative outcomes is not congruent with larger quantitative research and findings which the majority of respected empirical studies employ today. This has led to a lack of research material which can support its claims of efficacy.[13]See alsoTheoretical foundations • Constructivist epistemology • Feminism • Hermeneutics • Postmodernism • PoststructuralismRelated types of therapy • Brief therapy • Family therapy • Response based therapy • Solution focused brief therapyOther related concepts • Dialogical self • Lucid dream • Questioning 81
  • References 1. ^ a b White, M. & Epston, D. (1990). Narrative means to therapeutic ends. New York: WW Norton. 2. ^ White, M. (2007). Maps of narrative practice. NY: W.W. Norton. 3. ^ Dulwich Centre, 1997, 2000 4. ^ Winslade, John & Monk, Gerald. (2000) Narrative Mediation: A New Approach to Conflict Resolution. San Francisco: Jossey-Bass. ISBN 0-7879-4192-1 5. ^ (Lewis & Chesire, 1998) 6. ^ (Nylund and Tilsen, 2006). 7. ^ Narrative Means to Therapeutic Ends; Maps of Narrative Practice; White, M. (2000). Reflections on Narrative Practice Adelaide, South Australia: Dulwich Centre Publications 8. ^ White, M. (2005). Narrative practice and exotic lives: Resurrecting diversity in everyday life. Adelaide: Dulwich Centre Publications. pp 15. 9. ^ Fish, V., Post Structuralism in Family Therapy: Interrogating the Narrative/Conversational Mode. Journal of Family Therapy 19(3) 221-232 (1993) 10. ^ a b c d Minuchin, S., Where is the Family in Narrative Family Therapy? Journal of Marital and Family Therapy, 24(4), 397-403 (1998) 11. ^ Madigan, S., The Politics of Identity: Considering Community Discourse In The Externalizing of Internalized Problem Conversations, Journal of Systemic Therapies, 15(1), 47-62 (1996) 12. ^ a b Doan, R.E., The King is Dead: Long Live the King: Narrative Therapy and Practicing What We Preach, Family Process 37(3), 379-385 (1998) 13. ^ a b Etchison, M., & Kleist, D.M, Review of Narrative Therapy: Research and Review, Family Journal 8(1) 61-67 (2000) 82
  • Narrative Family Therapy - IIWe do not tell stories only: we are stories.Storytelling is now emerging as a critical component of Scottsdale family therapy. There are now quite anumber of Scottsdale therapists who have gained positive results in their sessions with individuals facingvaried family issues. It is essential that we spend some time and understand some important principles thatcome into play when storytelling is adopted as a major element of the family therapy approach.Storytelling as a major element of family therapy relays ideas and messages holistically. As a result to this,the listeners are able to receive the message in a simple, logical manner and in one single flow.Storytelling is considered as an age-old form of expressing ideas and emotions. This type of communicationis the native language which can be used with persons as young as two years of age. On the other hand, theabstract form of communication becomes effective only to individuals who are at least 8 years old.This method of communication allows the family therapist to communicate in a way that allows him to sortout the elements in logical sequence out from a chaotic setting. This approach connects the individual totime and space, and the direction of the sequence of events becomes clearer enabling the therapist to delivera more sensible idea or message. Family therapists are able to deliver holistic realities once they adoptstorytelling as an integral part of the therapy sessions as opposed to abstract method of communicationwhich normally breaks down the message into fragments.Abstract type of communication forces on our perceived time and space and sets its own framework andapplies such mental framework to another individual. What happens to such type of therapy is that theperson is limited to just two options- accepting or rejecting the idea relayed by the family therapist. With theabstract communication approach, one ends up with a yes-no, all or nothing type of confrontation. Bycontrast, storytelling comes out as a collaborative encounter which encourages the listener to participate inan arm-in-arm activity with the family therapist. This narrative element of family therapy is more of arhythmic dance rather than a communication struggle.What makes this narrative approach a truly effective adjunct of the entire family therapy procedure is that itallows the listener create a parallel event in his own consciousness. This increases the possibility ofacceptance more than the rejection that we normally experience in the abstract type of communication.Another critical aspect of storytelling has something to do with tacit knowledge. We know more things thanwe actually believe we have and it is important to acknowledge the importance of tacit knowledge in theoverall scheme of things.Finally, abstract type of communication is in general described as dry and dull because individuals struggleto relate it to reality. As living creatures with unique characteristics we are easily attached to things that areanimate and reject inert and inanimate things like abstracted concepts. Individuals always consider theexperience of storytelling as lively and entertaining. It is one great way we can accept ideas as it ispresented explicitly by a competent family therapist.White, Michael: peoples lives are organized by their life narratives. We become the stories we tell aboutour own experience. Replace unhelpful stories with helpful ones.Article Source: 83
  • DEFINITIONSThe identified patientThe identified patient (IP) is the family member with the symptom that has brought the family intotreatment. Children and adolescents are frequently the IP in family therapy. The concept of the IP is used byfamily therapists to keep the family from scapegoating the IP or using him or her as a way of avoidingproblems in the rest of the system.Homeostasis (Balance)Homeostasis means that the family system seeks to maintain its customary organization and functioningover time, and it tends to resist change. The family therapist can use the concept of homeostasis to explainwhy a certain family symptom has surfaced at a given time, why a specific member has become the IP, andwhat is likely to happen when the family begins to change.The extended family field.The extended family field includes the immediate family and the network of grandparents and otherrelatives of the family. This concept is used to explain the intergenerational transmission of attitudes,problems, behaviours, and other issues. Children and adolescents often benefit from family therapy thatincludes the extended family.DifferentiationDifferentiation refers to the ability of each family member to maintain his or her own sense of self, whileremaining emotionally connected to the family. One mark of a healthy family is its capacity to allowmembers to differentiate, while family members still feel that they are members in good standing of thefamily.Triangular relationshipsFamily systems theory maintains that emotional relationships in families are usually triangular. Whenevertwo members in the family system have problems with each other, they will "triangle in" a third member asa way of stabilizing their own relationship. The triangles in a family system usually interlock in a way thatmaintains family homeostasis. Common family triangles include a child and his or her parents; two childrenand one parent; a parent, a child, and a grandparent; three siblings; or, husband, wife, and an in-law.Multisystemic TherapyIn the early 2000s, a new systems theory, multisystemic therapy (MST), has been applied to family therapyand is practiced most often in a home-based setting for families of children and adolescents with seriousemotional disturbances. MST is frequently referred to as a "family-ecological systems approach" because itviews the familys ecology, consisting of the various systems with which the family and child interact (forexample, home, school, and community). Several clinical studies have shown that MST has improvedfamily relations, decreased adolescent psychiatric symptoms and substance use, increased schoolattendance, and decreased re-arrest rates for adolescents in trouble with the law. In addition, MST canreduce out-of-home placement of disturbed adolescents.Calibration:Setting of a range limit (bias) in a system, like a thermostat in a room. The limit of how much change afamily will tolerate. (Bias: a familys emotional thermostat. The therapist needs to look into who has thepower to reset it.)Family Life Cycle:Just like an individual, a family has developmental tasks and key (second-order) transitions like leavinghome, joining of families through marriage, families with young children (the key milestone, and one thatinitiates vertical realignment), families with adolescents, launching children and moving on, families in laterlife. Key question: "How well did the family do on its last assignment?" Horizontal stressors are thoseinvolving these transitional assignments; vertical stressors are transmitted mainly via multigenerationaltriangling. Symptoms tend to occur when horizontal and vertical stressors intersect. Divorce adds extradevelopmental steps for all involved families. 84
  • Centrifugal/centripetal:Tendency of family members to move toward or away from a family.Circular (mutual, reciprocal) causality:When things cause each other rather than just one causing the other (linear causality). Emphasizes present,process over past, content.Open/Closed systems:Open: Those that embrace new information and display negentropy (growth).Closed: Those unfriendly to new information; they tend to have a lot of entropy.Cybernetics:Norbert Weiner (1948) used this term to describe systems that self-regulate via feedback loops.Feedback loops: information pathways that help the system balance and correct itself. Can be negative(maintains the current bias and level of functioning) or positive (changes the bias/level of functioning).Double bind(Bateson, Jackson, Haley, Weakland): when the content and process of a message dont line up and yourenot allowed to comment on that.No-talk rule: an unwritten family rule against members commenting on certain uncomfortable issues.Three kinds of therapeutic double-binds or paradoxes: prescribing, restraining ("dont change") , andpositioning (exaggerate negative interpretations of the situation).Equifinality / Equipotentiality:Equifinality: things with dissimilar origins can wind up in similar places (e.g., an abuse survivor andsomeone from a healthy family can both grow up to be good parents).Equipotentiality: things with a common origin can go in very different directions of development (e.g., oftwo abuse survivors, one heals and the other becomes a criminal).First-order / Second-order change:First-order change: change that helps the system accommodate to its current level of functioning.Second-order change: a change that fundamentally impacts the system, thereby taking it to a new level offunctioning.Pseudomutuality:Wynne, Lyman: noticed that many families exhibit pseudomutuality (fake togetherness).Punctuation:“The selective description of a transaction in accordance with a therapist’s goals”. Therefore, it isverbalizing appropriate behaviour when it happens.Rules:Expectations that govern the system on many levels. Can be covert or overt. Good rules maintain stabilitywhile allowing some adaptive changes; rigid ones block even modest attempts to adapt. A therapeutic task isto make the covert rules overt. 85
  • Basic Techniques in Family Counselling and TherapyThe area of marriage and family counselling/therapy has exploded over the past decade. Counsellors at alllevels are expected to work effectively with couples and families experiencing a wide variety of issues andproblems. Structural, strategic, and transgenerational family therapists at times may seem to be operatingalike, using similar interventions with a family. Differences might become clear when the therapist explainsa certain technique or intervention. Most of todays practicing family therapists go far beyond the limitednumber of techniques usually associated with a single theory.Bowen therapists believe that understanding how a family system operates is far more important than usinga particular technique. They tend to use interventions such as process questions, tracking sequences,teaching, coaching, and directives with a family. They value information about past relationships as asignificant context from which they design interventions in the present.The following select techniques have been used in working with couples and families to stimulate change orgain greater information about the family system. Each technique should be judiciously applied and viewedas not a cure, but rather a method to help mobilize the family. The when, where, and how of eachintervention always rests with the therapists professional judgment and personal skills.OBSERVATIONFamily units establish equilibriums to protect the family unit, but that equilibrium can cause an imbalancefor individual parts of the family. A clinical psychologist is trained to observed the family dynamic andmonitor both verbal and non-verbal cues. During the assessment phase and initial interviews, the familysystems psychologist will monitor how the parents interact with each other and how their children react tothem. He or she will compare his or her observations with testing data offered in both subjective andobjective forms. The subjective test data is gathered during the interview while the objective test data isgathered via clinical tests that family members are requested to fill out and return to the psychologist.Observation is an effective family therapy technique because it offers the psychologist the first real windowinto the family dynamic. Family therapy may be recommended for any number of causes, but for thepsychologist to make a fair and accurate assessment, he or she must get a base measurement of the familysinteractions, emotional balance and initial dysfunction. During observation, for example, it may be revealedthat a mothers depression and need for anti-anxiety medication is due in part to her husbandsunemployment and the economic pressure she is overcompensating to fulfill. To create an effectivetreatment plan for the family, the therapist needs as much data as possible.IDENTIFICATIONFamily therapy techniques are used with individuals and families to address the issues that effect the healthof the family system. The techniques used will depend on what issues are causing the most problems for afamily and on how well the family has learned to handle these issues.Strategic techniques are designed for specific purposes within the treatment process. Backgroundinformation, family structuring and communication patterns are some of the areas addressed through thesemethods. 86
  • I/ INFORMATION-GATHERING TECHNIQUESAt the start of therapy, information regarding the familys background and relationship dynamics is neededto identify potential issues and problems.GETTING INFORMATION THROUGH USING OPEN-ENDED QUESTIONS.An open-ended question cannot be answered with a simple "yes" or "no", or with a specific piece ofinformation, and gives the person answering the question scope to give the information that seems to themto be appropriate. Open-ended questions are sometimes phrased as a statement which requires a response.Examples of open-ended questions: • Tell me about your relationship with your husband. • How do you see your future? • Tell me about the children in this photograph. • What is the purpose of this rule? • Why did you choose that answer?THE GENOGRAMIs an information gathering technique used to create a family history, or geneology. Both the family andtherapist work to create this diagram.Bowen assumes that multigenerational patterns and influences are central in understanding present nuclearfamily functioning. A family genogram consists of a pictorial layout of each partners three-generationalextended family. It is a tool for both the therapist and family members to understand critical turning pointsin the familys emotional processes and to note dates of births, deaths, marriages, and divorces. Thegenogram also includes additional information about essential characteristics of a family: cultural and ethnicorigins, religious affiliation, socioeconomic status, type of contact among family members, and proximity offamily members. Names, dates of marriage, divorce, death, and other relevant facts are also included.Siblings are presented in genograms horizontally, oldest to youngest, each with more of a relationship to the parents than to one another. Bowen also integrates data related to birth order and family constellation. By providing an evolutionary picture of the nuclear family, a genogram becomes a tool for assessing each partners degree of fusion to extended families and to each other. The genogram, a technique often used early in family therapy, provides a graphic picture of the family history. The genogram reveals the familys basic structure and demographics. As an informational and diagnostic tool, the genogram is developed by the therapist in conjunction with the family. 87
  • THE FAMILY FLOORPLANBy having family members draw up floor plans of their home, they provide information on territorial issues,rules, and comfort zones between different members.The family floor plan technique has several variations. Parents might be asked to draw the family floor planfor the family of origin. Information across generations is therefore gathered in a nonthreatening manner.Points of discussion bring out meaningful issues related to ones past.Another adaptation of this technique is to have members draw the floor plan for their nuclear family. Theimportance of space and territory is often inferred as a result of the family floor plan. Levels of comfortbetween family members, space accommodations, and rules are often revealed. Indications ofdifferentiation, operating family triangles, and subsystems often become evident. Used early in therapy, thistechnique can serve as an excellent diagnostic tool (Coppersmith, 1980).FAMILY PHOTOSIs an information gathering technique which has the potential to provide a wealth of information about pastand present functioning and about how each member perceives the others.One use of family photos is to go through the family album together. Verbal and nonverbal responses topictures and events are often quite revealing. Adaptations of this method include asking members to bring insignificant family photos and discuss reasons for bringing them, and locating pictures that represent pastgenerations. Through discussion of photos, the therapist often more clearly sees family relationships, rituals,structure, roles, and communication patterns.II/ JOININGThis is the process of coupling that occurs between the therapist and the family, leading to the developmentof therapeutic system. In this process the therapist allies with family members by expressing interest inunderstanding them as individuals and working with and for them. Joining is considered one of the mostimportant prerequisites to restructuring. It is a contextual process that is continuous. There are four ways ofjoining in structural family therapy: tracking, mimesis, confirmation of a family member and accomodation.1) TRACKING:The tracking technique is a recording process where the therapist keeps notes on how situations developwithin the family system. Interventions used to address family problems can be designed based on thepatterns uncovered by this technique. In tracking, the therapist follows the content of the family that is thefacts. Tracking is best exemplified when the therapist gives a family feedback on what he or she hasobserved or heard.Most family therapists use tracking. Structural family therapists (Minuchin & Fishman, 1981) see trackingas an essential part of the therapists joining process with the family. During the tracking process thetherapist listens intently to family stories and carefully records events and their sequence. Through tracking,the family therapist is able to identify the sequence of events operating in a system to keep it the way it is.What happens between point A and point B or C to create D can be helpful when designing interventions.2) MIMESIS:The therapist becomes like the family in the manner or content of their communications.3) CONFIRMATION OF A FAMILY MEMBER:Using an affective word to reflect an expressed or unexpressed feeling of that family member.4) ACCOMMODATION:The therapist adapts to a familys communication style. He makes personal adjustments in order to achieve atherapeutic alliance. 88
  • III/ DIAGNOSINGDiagnosing is done early in the therapeutic process. The goal is to describe the systematic interrelationshipsof all family members to see what needs to be changed or modified for the family to improve. Bydiagnosing interactions, therapists become proactive, instead of reactive.IV/ FAMILY SYSTEM STRATEGIESA family operates like a system in that each members role contributes to the patterns of behaviour thatmake the system what it is. Certain therapy techniques are designed to reveal the patterns that make a familyfunction the way it does.ASKING PROCESS QUESTIONS.The most common Bowen technique consists of asking process questions that are designed to get clients tothink about the role they play in relating with members of their family. Bowens style tended to becontrolled, somewhat detached, and cerebral. In working with a couple, for example, he expected eachpartner to talk to him rather than to talk directly to each other in the session. His calm style of questioningwas aimed at helping each partner think about particular issues that are problematic with their family oforigin. One goal is to resolve the fusion that may exist between the partners and to maximize eachpersons self-differentiation both from the family of origin and the nuclear family system.A Bowen therapist is more concerned with managing his or her own neutrality than with having the "right"question at the right time. Still, questions that emphasize personal choice are very important. They calmemotional response and invite a rational consideration of alternatives. A therapist attempting to help awoman who has been divorced by her husband may ask:• "Do you want to continue to react to him in ways that keep the conflict going, or would you rather feel more in charge of your life?"• "What other ways could you consider responding if the present way isnt very satisfying to you and is not changing him?"• "Given what has happened recently, how do you want to react when youre with your children and the subject of their father comes up?"Notice that these process questions are asked of the person as part of a relational unit. This type ofquestioning is called circular, or is said to have circularity, because the focus of change is in relation toothers who are recognized as having an effect on the persons functioning.FAMILY SCULPTINGFamily sculpting is a technique thats used to realign relationship patterns within the group. Members areasked to physically arrange where they want each member to be in relation to the others. This techniqueprovides insight into relationship conflicts within the family. Family sculpting provides for recreation of thefamily system, representing family members relationships to one another at a specific period of time. Thefamily therapist can use sculpting at any time in therapy by asking family members to physically arrange thefamily. Adolescents often make good family sculptors as they are provided with a chance to nonverballycommunicate thoughts and feelings about the family. Family sculpting is a sound diagnostic tool andprovides the opportunity for future therapeutic interventions.FAMILY CHOREOGRAPHYIn family choreography, arrangements go beyond initial sculpting; family members are asked to positionthemselves as to how they see the family and then to show how they would like the family situation to be.Family members may be asked to reenact a family scene and possibly resculpt it to a preferred scenario.This technique can help a stuck family and create a lively situation. 89
  • V/ Intervention TechniquesIntervention techniques are directives given by the therapist to guide a familys interactions towards moreproductive outcomes. Reframing is a method used to recast a particular conflict or situation in a lessthreatening light. A father who constantly pressures his son regarding his grades may be seen as athreatening figure by the son. Reframing this conflict would involve focusing on the fathers concern for hissons future and helping the son to "hear" his fathers concern instead of constant demands for improvement.Another technique has the therapist placing a particular conflict or situation under the familys control. Whatthis means is, instead of a problem controlling how the family acts, the family controls how the problem ishandled. This requires the therapist to give specific directives as to how long members are to discuss theproblem, who they discuss it with, and how long these discussions should last. As members carry out thesedirectives, they begin to develop a sense of control over the problem, which helps them to better deal with iteffectively.RELATIONSHIP EXPERIMENTS.“Relationship experiments are behavioural tasks assigned to family members by the therapist to first exposeand then alter the dysfunctional relationship process in the family system” (Guerin, 2002, p. 140). Mostoften, these experiments are assigned as homework, and they are commonly designed to reverse pursuer-distancer relationships and/or address the issues related to triangulation.Detriangulation. Relationship experiments are incorporated within Guerin’s five-step process forneutralization of symptomatic triangles in which he(1) identifies the triangle,(2) delineates the triangle’s structure and movement,(3) reverses the direction of the movement,(4) exposes the emotional process, and(5) addresses the emotional process to augment family functionality.COACHING.Bowen used coaching with well-motivated family members who had achieved a reasonable degree of self-differentiation. To coach is to help people identify triggers to emotional reactivity, look for alternativeresponses, and anticipate desired outcomes. Coaching is supportive, but is not a rubber-stamp: It seeks tobuild individual independence, encouraging confidence, courage, and emotional skill in the person.I-POSITIONS.I-positions are clear and concise statements of personal opinion and belief that are offered withoutemotional reactivity. When stress, tension, and emotional reactions increase, I-positions help individualfamily members to step-back from the experience and communicate from a more centred, rational, andstabilized position. Bowen therapists model I-positions within sessions when family members becomeemotionally reactive, and as family members are able to take charge of their emotions, Bowen therapistsalso coach them in the use of I-statements.DISPLACEMENT STORIES.Displacement stories are usually implemented through the use of film or videotape, although storytellingand fantasized solutions have also been used. The function of a displacement story is to provide a family orfamily members with an external stimulus (film, video, book or story) that relates to the emotional processand triangulation present in the family, but allows them to be considered in a less defensive or reactivemanner. Films, like “I Never Sang For My Father,” “Ordinary People,” or “Avalon” have all been used byBowen therapists to highlight family interactions and consequences and to suggest resolutions of a morefunctional nature. 90
  • TAKING SIDE & MEDIATING.In contrast to Bowens belief in the importance of neutrality, another influential family therapist, Zuk (1981)discusses practical applications of working with triangles in family therapy. Zuk terms his triadic-basedtechnique go-between process because it relies on the therapists "taking and trading roles... of the mediatorand side-taker". The mediator is one person mediating between at least two others. The side-taker joins oneperson in coalition against another.Zuk (1981) outlines three steps involved in the go-between process (p. 38).• In step 1, the therapist works on initiating conflict.• In step 2, the therapists moves into the role of the go-between.• In step 3, the therapist assumes the role of side-taker.In all three steps it is important to keep the interactions focused on the present. Past events preclude thetherapists involvement in mediating or side-taking.Because triangles constantly move around, the current permutation might be different from the past. Thegoal of the therapist is to change the pathogenic relating around into a more productive way of relating.THE EMPTY CHAIRThe empty chair technique, most often utilized by Gestalt therapists (Perls, Hefferline, & Goodman, 1985),has been adapted to family therapy. In one scenario, a partner may express his or her feelings to a spouse(empty chair), then play the role of the spouse and carry on a dialogue. Expressions to absent family,parents, and children can be arranged through utilizing this technique.FAMILY COUNCIL MEETINGSFamily council meetings are organized to provide specific times for the family to meet and share with oneanother. The therapist might prescribe council meetings as homework, in which case a time is set and rulesare outlined. The council should encompass the entire family, and any absent members would have to abideby decisions. The agenda may include any concerns of the family. Attacking others during this time is notacceptable. Family council meetings help provide structure for the family, encourage full familyparticipation, and facilitate communication.STRATEGIC ALLIANCESThis technique, often used by strategic family therapists, involves meeting with one member of the familyas a supportive means of helping that person change. Individual change is expected to affect the entirefamily system. The individual is often asked to behave or respond in a different manner. This techniqueattempts to disrupt a circular system or behaviour pattern.PRESCRIBING INDECISIONThe stress level of couples and families often is exacerbated by a faulty decision-making process. Decisionsnot made in these cases become problematic in themselves. When straightforward interventions fail,paradoxical interventions often can produce change or relieve symptoms of stress. Such is the case withprescribing indecision. The indecisive behaviour is reframed as an example of caring or taking appropriatetime on important matters affecting the family. A directive is given to not rush into anything or make hastydecisions. The couple is to follow this directive to the letter.PUTTING THE CLIENT IN CONTROL OF THE SYMPTOMThis technique, widely used by strategic family therapists, attempts to place control in the hands of theindividual or system. The therapist may recommend, for example, the continuation of a symptom such asanxiety or worry. Specific directives are given as to when, where, and with whom, and for what amount oftime one should do these things. As the client follows this paradoxical directive, a sense of control over thesymptom often develops, resulting in subsequent change. 91
  • SPECIAL DAYS, MINI-VACATIONS, SPECIAL OUTINGSCouples and families that are stuck frequently exhibit predictable behaviour cycles. Boredom is present, andfamily members take little time with each other. In such cases, family members feel unappreciated andtaken for granted. "Caring Days" can be set aside when couples are asked to show caring for each other.Specific times for caring can be arranged with certain actions in mind (Stuart, 1980).PROBLEM SOLVINGProblem solving is an effective therapy technique not because it teaches the family how to resolve the issuethat brought them to see the family systems psychologist, but it teaches them how to identify, develop plansand create resolutions for future problems. Problem solving may seem like a common sense resolution, butit requires a willingness on the parts of all parties to contribute to the solution.Problem solving is a family therapy technique that requires effective communication and often comes laterin therapy sessions as the therapist challenges family members to role-play situations previously deemedirresolvable. Family members may also be required to play the part of other family members, parentsplaying the part of the children or dad taking on the role of mom to a childs dad and a moms child. Byactively role playing other members of the family, each member is required to see that persons point ofview. This leads to learning how to disagree in positive and respectful manner and to not allow thosedisagreements to impede problem solving efforts.FAMILY CONTRACTSThe family contract is a therapeutic tool that allows families to negotiate terms and come to an agreementon how they want to handle future family problems and to commit to positive change. A family contract, forexample, may detail that a child who copes with an eating disorder commits to talking about her feelings onweight, eating and social perception. Her parents will then commit to listening and not dismissing herfeelings. All parties commit to working together to build self-esteem and a healthy lifestyle.Family contracts are a positive tool in the arsenal of a family systems psychologist because they arefacilitated agreement that a family makes to avoid future dysfunction. The family contract also helps familymembers recognize when problems are occurring, particularly if elements of the contract are not beingupheld. Effective family therapy techniques treat the entire family as an emotional unit of which each familymember is a part of and acknowledges that what affects one member of the family affects the whole family.By treating the whole family as a unit, the family also becomes a part of the solution.REFRAMINGTechnique used to create a different perception of reality. Reframing is a process in which a perception ischanged by explaining a situation in terms of a different context. For example, the therapist can reframe adisruptive behaviour as being naughty instead of incorrigible allowing family members to modify theirattitudes toward the individual and even help him or her makes changes.Most family therapists use reframing as a method to both join with the family and offer a differentperspective on presenting problems. Specifically, reframing involves taking something out of its logicalclass and placing it in another category (Sherman & Fredman, 1986). For example, a mothers repeatedquestioning of her daughters behaviour after a date can be seen as genuine caring and concern rather thanthat of a nontrusting parent. Through reframing, a negative often can be reframed into a positive.Reframing is altering the meaning or value of something, by altering its context or descriptionReframing is a powerful change stratagem. It changes our perceptions, and this may then affect our actions.But does changing our symbolic representation of the real world actually change anything in the real worlditself?Kolb describes the four basic creative dimensions as Meaning, Value, Relevance and Fact. This issummarized in the diagram above. In these terms, reframing is altering Meaning, Value, Relevance or Factby altering context or perspective. 92
  • Bandler & Grinder (NLP) identify two forms of reframing: meaning and context. Context reframing takesan undesired attribute and finds a different situation where it would be valuable. In meaning reframing,you take an undesired attribute and find a description where the attribute takes on a positive value.Reframing - Virginia SatirA classic example of a reframe by Virginia Satir concerns a father who complains at the stubbornness of hisdaughter. This results in a double reframe, in which Satir points out two things to the father:1. There are situations where she will need stubbornness, to protect herself or achieve something.Reframing switches to a context that makes the stubbornness relevant.2. It is from the father himself that she has learned to be stubborn. By forcing the father to equate hisown stubbornness with hers, this creates a context in which he either has to recognize the value of herstubbornness, or deny the value of his own.Reframing - Milton EriksonOne of the common challenges of family therapy is to help the parents to let their children go. Independenceis of course a negative goal. The parents have to gradually stop supporting their children, and the childrenhave to gradually stop relying on their parents.Milton Erikson often used the approach of creating an alternative goal for the parents: of preparingthemselves to be grandparents. In a typical case, a young woman consulted him; her parents had used theirlife savings to build an extension to their house, where she was to live, when she got married (At this time,she was away at college, and had no steady boyfriend.) Erikson met the parents, and congratulated them fortheir willingness to participate so actively in the rearing of their (hypothetical) grandchildren, having babiescrying through the night, toddlers crawling through the living rooms, toys strewn across the house,babysitting. He thus created a powerful positive image of the joys of grandparenthood; yet for some reason,the couple decided to rent the extra rooms out to mature lodgers instead, and save the money to support theirgrandchildren’s education. When the daughter subsequently got married, she lived in a city some distanceaway with husband and baby, and the grandparents visited frequently, but not too frequently. used to create a different perception of reality. Punctuation is “the selective description of atransaction in accordance with a therapist’s goals”. Therefore it is verbalizing appropriate behaviour whenit happens.UNBALANCINGTechnique used to create a different perception of reality. This is a procedure wherein the therapist supportsan individual or subsystem against the rest of the family. When this technique is used to support anunderdog in the family system, a chance for change within the total hierarchical relationship is fostered. 93
  • RESTRUCTURINGTechnique used to create a different sequence of events. The procedure of restructuring is at the heart of thestructural approach. The goal is to make the family more functional by altering the existing hierarchy andinteraction patterns so that problems are not maintained. It is accomplished through the use of enactment,unbalancing, and boundary formation.ENACTMENTTechnique used to create a different sequence of events. The process of enactment consists of familiesbringing problematic behavioural sequences into treatment by showing them to the therapist a demonstrativetransaction. This method is to help family members to gain control over behaviours they insist are beyondtheir control. The result is that family members experience their own transactions with heightenedawareness. In examining their roles, members often adapt new, more functional ways of acting.BOUNDARY FORMATIONTechnique used to create a different sequence of events. Part of the therapeutic task is to help the familydefine, or change the boundaries within the family. The therapist also helps the family to either strengthenor loosen boundaries, depending upon the family’s situation.WORKING WITH SPONTANEOUS INTERACTIONIn addition to enactment, structural family therapists concentrate on spontaneous behaviours in sessions. Itoccurs whenever families display behaviours in sessions that are disruptive or dysfunctional, such asmembers yelling at one another or parents withdrawing from their children. The focus is on process notcontent. It is important that therapists help families recognize patterns of interaction and what changes theymight make to bring about modification.INTENSITYIntensity is the structural method of changing maladaptive transactions by using strong affect, repeatedintervention, or prolonged pressure. Intensity works best if done in a direct, unapologetic manner that is goalspecific.SHAPING COMPETENCEThe family therapists help families and individuals in becoming more functional by highlighting positivebehaviours.ADDING COGNITIVE CONSTRUCTIONSAdvice & Information are derived from experience and knowledge of the family in therapy. They are usedto calm down anxious members of families or reassure these individuals and families about certain actions.Pragmatic fictions are formal expressions of opinion to help families and their members change.Paradox is an apparently sound argument leading to a contradiction. It is used to motivate family membersto search or alternatives. Family members may defy the therapists and become better or they may explorereasons why their behaviours are as they are and make changes in the ways members interact.Also used to tell the family what to do with the expectation of noncompliance. 94
  • VI/ COMMUNICATION SKILL BUILDING TECHNIQUESMore often than not, its a familys communication patterns and styles that lead to conflict and division.Communication techniques are used to build skills that allow for effective communication between familymembers.Some of these methods include reflecting, repeating, fair fighting and nonjudgmental brainstorming.REFLECTINGReflecting is a listening technique which involves having a member express her feelings and concerns, thenhaving another member repeat back what he heard that person say.REPEATINGRepeating is also a listening technique. It involves having a member state how he feels, while anothermember repeats back what was said. Repeating and reflecting techniques allow members to betterunderstand where the other is coming from and why she feels as she does.FAIR FIGHTINGFair fighting techniques focus on attentive listening and expressing feelings and concerns in anonthreatening manner.TAKING TURNS EXPRESSING FEELINGStaking turns expressing feelingsNONJUDGMENTAL BRAINSTORMINGnonjudgmental brainstormingIf each member of the family is interdependent on other members of the family it stands to reason thatdysfunction with one will affect the whole. Effective communication is an important lesson that familysystems psychologist incorporate into group and individual family therapy sessions. To create an effectivesolution to any dysfunction or problem in the group dynamic requires effective communication so that allmembers of the group or family are in touch with each other.For example, the mother who commits to more and more tasks in order to compensate for her familysoverextending commitments may stretch herself to the limits because she lacks the ability to communicatehow stretched thin she is. Instead, she promises to do more and more, exerting increasing emotional andmental stress upon herself when she cannot meet all the commitments she is making. This leads todisappointment and disagreement in the family. When other members of the family express theirdisappointment, this impacts her already damaged sense of self-worth leading to a vicious cycle that mayresult in depression, generalized anxiety disorder, substance abuse and more. In every way, however, thefamily is not happy.Therapists teach effective communication skills and the importance for mom to let the family know she isoverextended and that she either needs help or they need to rearrange priorities in order to break out of thecircular causality of this familys problems.Effective communication allows a family to dialogue on their problems, concerns and feelings withoutlashing out or feeling obligated to resolve the problems being shared. A large portion of effectivecommunication resides in active listening, a skill that must be learned.Communication patterns and processes are often major factors in preventing healthy family functioning.Faulty communication methods and systems are readily observed within one or two family sessions. Thefamily therapist constantly looks for faulty communication patterns that can disrupt the system. 95
  • Structure of a Family Therapy SessionBy an eHow ContributorFamily communication is an evolving and complicated issue for most families. Sometimes a familytherapy session is the only place where each family member can have a voice. As children growand marriages evolve, the lack of communication within a family may cause issues, anger andsadness in some family members.Family therapy sessions help with issues like divorce, financial problems, grief, depression, stressand substance abuse. As a counselor, you will need to have all voices heard to find out what issuesor problems each of the family members bring to the family dynamic.Instructions1. Research and Backgroundo 1 Ask the family member who initiated the family session why he feels the family needs the therapy.This will give you his perspective on the situation and on what is happening to the family.o 2 Find out which family members are involved, and invite them to the sessions. Let each family member know that the therapy will not be effective if anyone misses a session. It is best to reschedule if one family member cannot make it to a session.o 3 Conduct an individual and private session with each family member before commencing the family session.o 4 Ask all family members why they think they need a family session. Inquire if they have any issues with the family or any individual members of the family.o 5 Take notes on each session. Make sure you write down each family members thoughts and concerns for future reference.o 6 Recommend individual counseling for those members who have problems stemming from trauma or childhood problems. They will continue to bring their issues to the family dynamic, so it is critical to resolve their issues to help the family unite. 96
  • 2. Family Sessiono 1 Review your notes from each session you had with individual family members. This will refresh your memory and let you understand more background information before you conduct your family session.o 2 Set rules for the family therapy session. Ask members to contribute to how the session will be conducted. Some members may insist on having one person at a time speak, or perhaps there may be a time limit set for each person. Let each person contribute.o 3 Begin by asking each member what kind of family dynamic they prefer. You can ask them if they prefer a family that is close, laughs a great deal and takes fun-filled family vacations without drama.o 4 Ensure that each member is allowed to speak without interruption. You will be acting as a mediator on how the session is conducted. You will also be enforcing the rules the family has set in advance.o 5 Start to resolve each individual issue that the family has brought up. Give each family member an opportunity to provide a solution.o 6 Apply values and standards to the solutions to the family issue that fit within that familys value system. Devise a followup to find how the solutions are working, and invite individual family members to contact you to ask questions.o 7 Meet with individual family members to see if the resolution is what they expected. Inquire if they feel problems are resolving. Some issues may be based from family disputes; others may stem from trauma or childhood problems.Read more: How to Conduct a Family Therapy Session | eHow.com 97
  • Stages and Steps of Problem-Centred Systems TherapyAssessment Contracting Treatment ClosureOrientation Orientation Orientation OrientationData gathering Outlining options Clarifying priorities Summary ofProblem Negotiating Setting tasks treatmentdescriptions expectations Task evaluation Longterm goalsClarification and Contract signing Follow up (optional)agreement on aproblem listA Guideline for Family AssessmentAreas Covered1. Orientation 2. Data 3. Problem List 4. ProblemTheir expectations Gathering Familys list ClarificationOur expectations a. Presenting Doctor adds his Obtain agreementRationale for Problem (for each on list from aboveseeing the family problem) Nature and history of problem Affective/emotion al components Precipitating events Who is involved and how b. General Family Functioning: McMaster model dimensions Problem solving Roles Communication Affective involvement Affective responsiveness Behavior control c. Other Investigationsbiop sychosocial: medical d. Any other problems? 98
  • Summary of Dimension ConceptsProblem-solving Affective InvolvementTwo types of problems B. Affective Six styles identifiedinstrumental and affective 1. Nurturance and Support 1. Absence of involvement 2. Adult Sexual Gratification 2. Involvement devoid ofSeven stages to the process feelings C. Mixed 3. Narcissistic involvement1. Identification of the 1. Life Skills Development 4. Empathic involvementproblem 2. Systems Maintenance 5. Over-involvement2. Communication of the and management 6. Symbiotic involvementproblem to the appropriateperson(s) Other family functions:3. Development of action -adaptive and maladaptive Postulatedalternatives4. Decision of one alternative Most effective: empathic Role functioning is assessed involvement. - Least effective:5. Action by considering how the family -symbiotic and absence of6. Monitoring the action allocates responsibilities and involvement7. Evaluation of success handles accountability for them.PostulatedMost effective when all seven Postulatedstages are carried out. - Most effective when allLeast effective when cannot necessary family functionsidentify problem (stop before Behavior Control have clear allocation to Applies to three situationsstep 1) reasonable individuals(s), and 1. Dangerous situations accountability built in. - 2. Meeting and expressing Least effective when necess- psychobiological needs and ary family functions are not drives (eating, drinking,Communication addressed and/or allocation sleeping, eliminating, sex and and accountability not aggression)Instrumental and affective maintained. 3. Interpersonal socializingareas behaviour inside and outsideTwo independent dimensions the family1. Clear and Direct2. Clear and Indirect Standard and latitude of3. Masked and Direct acceptable behavior4. Masked and Indirect Affective determined by four styles Responsiveness 1. RigidPostulated Two groupings 2. FlexibleMost effective: clear and -welfare emotions and 3. Laissez-fairedirect. - Least effective: emergency emotions 4. Chaoticmasked and indirect Postulated To maintain the style, various Most effective when full range techniques are used and of responses are appropriate in implemented under role amount and quality to stimu- functions (systems main-Roles lus. - Least effective when tenance and management)Two family function types very narrow range (one or two-necessary and other affects only) and/or amount Postulated and quality is distorted, given Most effective: flexibleTwo areas of family functions the context behavior control. --instrumental and affective Least effective: chaotic behaviour controlNecessary family functiongroupingsA. Instrumental 1. Provision of Resources 99
  • Structure of Family Therapy —Outline by Patty SalehpurA. Assumptions 1. Family are individuals who effect each other in powerful but unpredicatable ways 2. The consistent repetitive organized and predictable patterns of family behavior are important 3. The emotional boundaries and coalitions are importantB. Salvador Minuchin 1. Always concerned with social issues 2. Developed a theory of family structure and guidelines to organize therapeutic techniques 3. 1970 headed Philadelphia Child Guidance Clinic where family therapists have been trained in structural family therapy ever since 4. Born in Argentina , served in the Israel army as a physician, in the USA trained in child psychiatry and psychoanalysis with Nathan Ackerman, worked in Israel with displaced children, also worked in the USA with Don Jackson with middle class families. 5. Fist generation of family structural therapists: Braulio Montalvo, Jay Haley, Bernie Rosman, Harry Aponte, Carter Umbarger, Marianne Fishman, Cloe Madanes, and Stephen Greenstein.C. Theoretical formulations - three essential constructs 1. Structure — the organized pattern in which family members interact, predictable sequences of family interaction, patterns of interaction. Structure involves a series of covert rules. There are universal and idiosyncratic constraints. Families may not be able to tell you the family structure, but they will show it to you in their interactions. 2. Subsystems — Families are differentiated into subsystems of members who join together to perform various functions. Each person is a member of one or more subsystems in the family. Some groupings are obvious and based on such factors as generation, gender, age or common interests. Other coalitions may be subtle. Every member may play many roles in various subgroups. 3. Boundaries are invisible barriers that regulate the amount and nature of contact with members. They range from rigid to diffuse, clear to unclear, disengaged to enmeshedD. Normal family development 1. Marriage begins with accommodation and boundary making 2. Couples are influenced by the structure of their families of origin 3. Couples also form boundaries with their families of origin 4. The advent of children requires that the structure of the family change 100
  • E. The development of behavior disorders 1. Family dysfunction results from stress and failure to realign the structure to cope with it. 2. Disengaged families have rigid boundaries and excessive emotional distance. They fail to mobilize to deal with the stress. 3. Enmeshed families have diffuse boundaries and family members overreact emotionally and become intrusively involved with one another. These actions hinder mature actions to resolve stress. 4. Subsystems in the family may be disengaged or enmeshed. 5. Power hierarchies may develop which may be weak and ineffective or rigid and arbitrary. 6. Conflict avoidance prevents effective problem solving. 7. Generational coalitions may also prevent effective problem solving. 8. Family structure may fail to adjust to family developmental processes. 9. A major change in family composition demands structural adaptation. 10. Symptoms in one family member may reflect dysfunctional structural relationships or simply individual problems.F. Goals of therapy 1. Changing family structure - altering boundaries and realigning subsystems 2. Symptomatic change - growth of the individual while preserving the mutual support of the family 3. Short-range goals may be developed to alleviate symptoms especially in life threatening disorders such as anorexia nervosa, but for long-lasting effective functioning the structure must change. Behavioral techniques fit into these short-term strategies.G. Techniques — join, map, transform structure 1. Joining and accommodating, then taking a position of leadership a. Listen to "I" statements 2. Enactment for understanding and change 3. Working with interaction and mapping the underlying structure a. Looking at the power hierarchies b. Using enactment to understand and clarify c. Looking at the boundary structures 4. Diagnosing a. individual vs. subgroup b. structural diagnosis 101
  • 5. Highlighting and modifying interpersonal interactions is essential a. Control intensity by the regulation of affect, repetition and duration b. Don’t dilute the intensity through overqualifying, apologizing or rambling c. Shape competence, e.g. "It’s too noisy in here. Would you quiet the kids."6. Boundary making and boundary strengthening a. Seating b. Seeing subgroups or individuals to foster boundaries and indivduation c. Clarify circular causation7. Unbalancing may be necessary a. Taking sides b. Challenging c. Directives8. Challenging the family’s assumptions may be necessary a. Teaching may be necessary b. Pragmatic fictions c. Paradoxes d. Therapist sometimes must challenge the way family members perceive reality, changing the way family member relate to each other offers alternative views of reality.9. Therapists must create techniques to fit each unique family 102
  • Systemic Family Therapy Manual Ms. Helen Pote Dr. Peter Stratton Prof. David Cottrell Ms. Paula BostonProf. David ShapiroMs Helga Hanks Leeds Family Therapy & Research Centre School of Psychology University of Leeds Leeds, LS2 9JT This manual was developed through an MRC Small Project Grant, Number G9700249 No part of this document should be reprinted without the permission of the authors. 103
  • Table of Contents1. Introduction 6 1.1 Origins of the Manual 6 1.2 Aims and applicability of the manual 6 1.3 Notes on use of manual 7 1.4 Ethical and Culturally Sensitive Practice 8 1.5 Clinical Examples 82. Guiding Principles 9 2.1 Systems Focus 9 2.2 Circularity 9 2.3 Connections and Patterns 9 2.4 Narratives and Language 10 2.5 Constructivism 10 2.6 Social Constructionism 10 2.7 Cultural Context 10 2.8 Power 10 2.9 Co-constructed therapy 11 2.10 Self-Reflexivity 11 2.11 Strengths and Solutions 113. Outline of Therapeutic Change 12 3.1 Models of Therapeutic Change 12 3.2 Overview of Specific Goals 134. Outline of Therapist Interventions 14 4.1 Linear Questioning 14 4.2 Circular Questions 14 4.3 Statements 15 4.4 Reflecting Teams 16 4.5 Child Centred Interventions 18 104
  • 5. Therapeutic Setting 19 5.1 Convening Sessions 19 5.2 Team 19 5.3 Video 20 5.4 Pre-therapy Preparation 20 5.5 Pre and Post Session Preparation 21 5.6 Correspondence 22 5.7 Case Notes 22 5.8 Session Notes 226. Initial sessions 23 6.1 Outline Therapy Boundaries & Structure 23 6.2 Engage and Involve all family members 24 6.3 Gather and Clarify Information 25 6.4 Establish Goals and Objectives of Therapy 25 4 Initial Session Checklist for Therapists 267. Middle sessions 27 7.1 Develop engagement 27 7.2 Gather Information and Focus Discussion 27 7.3 Identify & Explore Beliefs 28 7.4 Work towards change at the level of behaviours 30 and beliefs 7.5 Return to Objectives and Goals of Therapy 37 4 Middle Sessions Checklist for Therapists 388. End sessions 39 8.1 Gather Information and Focus Discussion 39 8.2 Continue to work towards change at the level of 40 behaviours and beliefs 8.3 Develop family understanding about behaviours and beliefs 41 8.4 Collaborative ending decisions 41 8.5 Review the process of therapy 42 4 End Session Checklist for Therapists 42 105
  • 9. Indirect Work 43 9.1 Child Protection 43 9.2 Clarifying therapy with referrer present 43 9.3 Identifying network and clarifying relationships 43 9.4 Assessing risk 44 9.5 Correspondence 4410. Proscribed Practices 45 10.1 Advice 45 10.2 Interpretation 45 10.3 Un-transparent/Closed Practice 45 10.4 Therapist monologues 45 10.5 Consistently siding with one person 45 10.6 Working in the transference 46 10.7 Inattention to use of language 46 10.8 Reflections 46 10.9 Polarised position 46 10.10 Sticking in one time frame 46 10.11 Agreeing / not challenging ideas 46 10.12 Ignoring information that contradicts hypothesis 46 10.13 Dismissing ideas 47 10.14 Inappropriate affect 47 10.15 Ignoring family affect 47 10.16 Ignoring difference 47 106
  • AppendicesAppendix 1: Sample Appointment Letter 48Appendix II: Sample Video Consent Form 49Appendix III: Sample Referrer letter 50Appendix IV: Post-assessment letter to referrer 51Appendix V: Closing letter to referrer 52 FiguresFigure 1: Models of Therapeutic Change 12 TablesTable 1: Perceptions that are helpful in achieving change 13 107
  • 1. Introduction1.1 Origins of the ManualThe manual was developed through a research project funded by the Medical Research Council.The team developing the manual comprised of a group of experienced family therapists working atLeeds Family Therapy & Research Centre (LFTRC). LFTRC is a centre working systemically withindividuals, couples and families across the age span, as well as with professional systems.The therapists contributing to this manual have historically been influenced by Milan Systemicfamily therapy models, and would now describe their practice as being influenced by Post-Milanand Narrative Models.1.2 Aims and applicability of the manualThe manual is principally designed as a research tool for outcome studies in which theeffectiveness of systemic therapy can be assessed. It therefore aims to offer a framework andguidelines for the implementation of systemic family therapy, so that therapists can offer a unifiedversion of therapy, with some flexibility to express their own creativity.For this purpose the manual should be used in conjunction with the accompanying adherenceprotocol. This is designed to assess the degree to which therapists are able to adhere to the methodsoutlined throughout the manual.For research purposes the manual is designed for use by trained family therapists or other trainedtherapists with experience in family therapy. The manual’s function is to guide therapeutic workwith families in a clinic setting. Therapists using the manual will be expected to be working as partof a systemic family therapy team. Details on the composition of therapy teams are outlined later. υSection 5.2The manual can also be used less formally as a framework for training and supervision, indeveloping skills for trainee family therapists.1.3 Notes on use of manualAs with any interpersonally focused therapy, systemic family therapy does not follow a rigidlyprescribed treatment sequence (Lambert & Ogles 1988). In using the manual therapists shouldconsider the following guidelines:• Therapists should first become familiar with the guiding principles which will influence all aspects of the therapy that they carry out using this manual. They should consider the guiding principles which are influencing them currently and the connections they make between these principles. υ Section 2.• They should then consider the section concerning models of change, and consider the model of change that is influencing their own therapeutic practice. υ Section 3.• After these more theoretical aspects have been addressed, the therapist should begin to consider the general interventions used, thinking carefully about the descriptions of these interventions, and how they may translate into their own practice. υSection 4.• The manual then turns to guidelines for convening sessions, and setting up the therapy itself. 108
  • Therapists should therefore begin to follow the guidelines of the manual from the moment they take referrals, in order to consider systemic issues in convening therapy. υ Section 5.• Therapists should then use the manual to more specifically guide therapy sessions, reading the practical guidelines outlined for the beginning middle and end of therapy, and following the goals defined for each of these stages. Therapists’ checklists are provided at the end of each of these sections to help therapists consider whether they have covered all aspects of the guidelines. υ Sections 6, 7, & 8.• Therapists should go on to consider the aspects of indirect work that support the family therapy which should still be managed following the systemic guiding principles. υ Section 9.• Finally, therapists should consider the proscribed practices which should not form a significant proportion of their work, and refer back to these during the course of therapy to ensure proscribed practices do not emerge during the course of therapy. υ Section 10.This manual has an accompanying questionnaire for therapists and an adherence protocol to assessthe degree to which therapist practice reflects that of the manual. This may be used as a personalcheck for therapists or trainers using the manual, or more formally by an independent researcher toassess adherence when the manual is being used as a research tool.1.4 Ethical & Culturally Sensitive PracticeIn using this manual therapists should pay keen attention to ensuring their practice is both ethicaland culturally sensitive. Their practice should comply with the Association for Family Therapy andSystemic Practice (AFT): Code of Conduct and Ethical Guidelines. Therapists should remaincurious and open minded in working with families, and this may be especially important where theindividuals/families are of a different gender, cultural or societal background to that of thetherapist. Care should be taken in the assumptions and agendas therapists develop during therapyin this regard.1.5 Clinical ExamplesAll of the clinical material used in this manual has been adapted from extracts of therapyundertaken at Leeds Family Therapy & Research Centre. Identifying details have been removedfrom the material, and the dialogue modified to protect confidentiality. We would like to thank allof the families and therapists who have given permission for the therapy they undertook to be usedfor research. Without this permission the research project to develop this manual would not havebeen possible. 109
  • 2. Guiding PrinciplesThese principles are based at the level of theory, and should be used to guide therapists’ practicewhilst using this manual in work with families. Therapists should be familiar with all of theprinciples though they may privilege different principles according to their current interests and theneeds of the family with which they are working. The therapist should consider the principlesflexibly and decide which might best fit with the issues with which the family are struggling andthe therapists own current constructions. The principle of self-reflexivity may be particular helpfulin enabling the therapist to reach this. υSection 2.10In devising this manual therapists considered their own constructions of how these principles mightconnect. Therapists should consider for themselves the connections they are currently makingbetween these principles and the effect this may have on their work with families.2.1 Systems FocusIn working systemically the central focus should be upon the system rather than the individual,particularly in relation to the difficulties and issues that the family system brings to therapy. Thesystem may be A consistent view is that these difficulties do not arise within individuals but in therelationships, interactions and language that develop between individuals.2.2 CircularityPatterns of behaviour develop within systems, which are repetitive and circular in nature and alsoconstantly evolving. Behaviour and beliefs that are perceived as difficulties will also thereforedevelop in a circular fashion, being affected by and affecting all members of the system.2.3 Connections and PatternsIn understanding relationships and difficulties within systems it will be important for the therapistto consider the connections between circular patterns of behaviour, and the connections betweenthe beliefs and behaviours within systems. The process of therapy should enable family membersto consider these connections from new and/or different perspectives.2.4 Narratives and LanguageBehaviours and beliefs form the basis of stories or narratives, which are constructed by, around,and between individuals and the system itself. The language that is used to describe thesenarratives and the interactions between individuals constructs the reality of their everyday lives.The stories that people live often match the stories that are told about individuals, but at timeswhen stories lived and stories told are incongruous change may occur, at the levels of livedbehaviours and/or the construction of new narratives.2.5 ConstructivismThis is the idea that people form autonomous meaning systems and will interpret and make senseof information from this frame of reference. In social interactions understanding is constrained andaffected by this meaning system, and people cannot make assumptions about what meaning will beattributed to the information they offer/contribute to others. Thus there is only the possibility ofperturbing other people’s meaning systems. 110
  • 2.6 Social ConstructionismIn working with systems in the process of change at the level of behaviour or narratives, it will beimportant to consider ideas of social constructionism. Relevant is the idea that meaning is createdin the social interactions that take place between people and is thus context dependent andconstantly changing, this takes precedence over the concept of a single external reality.2.7 Cultural ContextThe therapist should consider the importance of context, in relation to the cultural meanings andnarratives within which people live their lives, including issues of race, gender, disability and classetc. The relationship between these narratives, the therapeutic relationship and its context, as wellas the wider context for the therapeutic team and the family should be an important considerationat the point of referral and throughout the therapy.2.8 PowerThe therapist should take a reflexive stance in relation to the power differentials that exist withinthe therapeutic relationship, and within the family relationships.2.9 Co-constructed therapyIn therapeutic interactions reality is co-constructed between the therapist (and team) and the peoplewith whom they meet. They form part of the same system, and share responsibility for change andthe process of therapy. Particular attention should thus be paid to the contributions that allmembers of the therapeutic system make in the process of change.2.10 Self-ReflexivityThe therapist should aim to apply systemic thinking to themselves and thus reject any thinkingabout families and their processes that does not also apply to therapists and therapy. Self-reflexivity focuses especially on the effect of the therapy process on the therapist and the way thatthis is a source of (resource for) change in the family. In order to use self-reflexivity it will benecessary for the therapist to be alert to their own constructions, functioning and prejudices so thatthey can use their self effectively with the family.2.11 Strengths and SolutionsThe therapist should take a non-pathologising, positive view of the family system, and the currentdifficulties they are struggling with. A family system that enters the therapeutic system should beconsidered as a system that owns a wealth of strengths and solutions in the face of difficultsituations. It is important for the therapist to recognise that there is a multi-versa of possibilitiesavailable for each family in the process of change, and the family themselves will be in the bestposition to generate suitable solutions. The therapist can facilitate this process by attending to thestrengths and solutions in the stories that the family system brings to therapy. 111
  • 3. Outline of Therapeutic Change3.1 Models of Therapeutic ChangeIn systemic work many different models of change have been hypothesised. In using this manualtherapists should consider the model of change outlined in Figure 1.Figure 1. Model of Therapeutic Change Cybernetics Narratives Redundant patterns / beliefs Meaning through Langauge Understand patterns / beliefs / stories Develop different patterns / beliefs / stories Amplify changeTherapists are working with families to understand the patterns of behaviour, beliefs or stories thathave developed in family systems, and the wider context in which they live. Through the processof understanding these behaviour patterns, beliefs or stories, therapists will begin to introduce newor different information. Therapists may also use active strategies to introduce this newinformation. The information will affect the development of behavioural patterns, beliefs andstories and the influence they have on the family. It therefore helps the family to develop newperceptions or actions that they can use to tackle the difficulties with which they are struggling.New perceptions that are often helpful to families in achieving change, are outlined in Table 1.Once change is beginning to occur, therapists highlight this process to families, enabling them todevelop further changes and develop their understanding of how change was possible. This willdevelop the family’s resources in coping with future struggles.It will be important for therapists to consider the model of change with which they are currentlyworking and consider what aspects of this model of change they are currently privileging. What istheir overall aim during the process of therapy? 112
  • Table 1: Perceptions that are helpful in achieving changeInitial Perception of Struggles Developing Perception of StrugglesLocated in the individual Arising from the systemUncontrollable/Unchangeable TemporaryIntrinsic AccidentalBlameworthy RedundantSinister Well meaning but mistakenLinear CircularPartisan Neutral3.2 Overview of Specific GoalsWithin each stage of therapy there are also specific goals that the therapist should be considering.The goals are listed here and elaborated within sections 6, 7 & 8. Goals during initial session1. Outline Therapy Boundaries & Structure2. Engage and Involve all family members3. Gather and Clarify Information4. Establish Goals and Objectives of Therapy Goals during middle sessions1. Develop and Monitor Engagement2. Gather Information and Focus Discussion3. Identify & Explore Beliefs4. Work towards change at the level of beliefs and behaviours5. Return to Objectives and Goals of Therapy Goals during ending sessions1. Gather Information and Focus Discussion2. Continue to work towards change at the level of behaviours and beliefs3. Develop family understanding about behaviours and beliefs4. Secure Collaborative Decision re: Ending5. Review the process of therapy 113
  • 4. Outline of Therapist InterventionsTherapists have a range of interventions open to them in working with the family to co-createchange. The 4 interventions listed below are those which are most commonly used in systemicfamily therapy and should be used in therapist’s practice throughout the course of therapy. Thedegree to which each of these interventions will be used will vary throughout the course of therapy,and therapists’ should follow the guidelines below regarding this. Additional interventions that areused less frequently are highlighted in the appropriate stage of therapy. ⇒ Sections 6, 7, & 8.4.1 Linear QuestioningDirect linear questions can often be useful in gathering information from the system and clarifyinginformation given, especially at the beginning of therapy. Linear questions can be built up in acircular manner around the family by asking different family members the same/similar linearquestions. Linear Questions Examples• How old are you?• Where do you go to school?• What do you do if you are upset?• What do you do after that?4.2 Circular QuestionsCircular questions are aimed at looking at difference and therefore are a way of introducing newinformation into the system. They are effective at illuminating the interconnectedness of the familysub-systems and ideas. A variety of circular questions may be used by the therapist as outlined inTable 2. These may be more or less appropriate as therapy progresses.The use of particular types of circular questioning at different stages of the therapy will behighlighted throughout the manual. The time scale of circular questions often changes fluidlybetween the past, present, future. Circular Question ExamplesType of Circular Question ExamplesAbout another’s state / behaviour / What do you think John is feeling?beliefs What do you think John is feeling when he shouts at you? What ideas do you think John might have about that?Offering alternative perspectives What does John think of your school performance? 114
  • If I asked a teacher what would they say about it?About relationships - direct Do the girls really dislike each other? - indirect How do the children react when they see you arguing?Circular Definitions When you and John raise your voices and Jill starts crying what does John do then?About possible futures What will you think in 5 years time? Miracle question: Imagine you woke up tomorrow morning and all the difficulties you were experiencing currently had disappeared, how would things be different? What effect would that have upon your relationship with x?Ranking Who is most likely to get upset when father is away, and who next is most upset? On a scale of one to ten, how close do you think James and Sue feel when they argue?Though many family members will be able to answer circular questions, and think aboutinformation in a circular manner, younger children or those with developmental difficulties, mayfind it cognitively impossible to view events from another person’s perspective.υ Section 4.54.3 StatementsStatements are used by the therapist for 3 main functions:• To clarify and acknowledge a communication from the family• To comment on the position or emotional state of a member of the family• To introduce therapist/team ideas, directly or in the form of a reflecting team. υSection 4.4In using statements therapists should ensure that they are not of long duration, and do not becometherapist monologues. Statements should also be delivered in such a manner that they are open toquestion or comment from the family and not viewed as conclusive statements. Statements aresometimes used as a way of organising information before a question is formulated to the family. Statement Examples• So let me make sure I have understood this, you feel if you didn’t go out at all, your mum and dad would feel reassured that you would be safe. Have I got that right?• I can see this is very upsetting, and remains an area of great distress for you. Who would be most likely to comfort you when you are feeling like this?• You were talking a lot about trust, and about how sometimes you had struggled with developing trust as a child, and later as an adult. How much do you feel trust is around now in your relationship with John?4.4 Reflecting Teams 115
  • Reflecting teams aim to introduce the therapy team’s ideas into the therapy in a reflexive manner.There are many different models for reflecting teams, and in turn these are often adapted to suit thewishes and needs of the family in therapy. A general model for introducing and implementingreflecting teams is outlined below.1. Reflecting teams can be introduced during the therapy session or at the end of the session.2. The format of the reflecting team should be negotiated with the family.3. The reflecting team may consist of some or all of the therapy team as seems appropriate relative to the size of the team and wishes of the family.4. The family should be offered a range of formats including: • Reflecting team joining family and therapist in room. • Family and therapist observing reflecting team through the one way screen.5. In offering their reflections to the family, team members should ensure they: • are respectful of family, therapist and team members, • hold a tentative and curious stance, • stay connected to the ideas of the previous contributor, • stay connected with the language used by the family, • use age appropriate language, • do not overwhelm the family with too many ideas, • keep the duration of the reflecting team to no more than 10 minutes.6. The therapist should take responsibility for monitoring the effect of the reflecting team on the family.7. The family should always be given the opportunity to offer their comments on the therapy team’s reflections and ideas.8. Feedback should be gained from the family about how comfortable and useful they found the process of the reflecting team, and the ideas the reflecting team shared. Reflecting Team ExampleA reflecting team is used at the end of a session with a father, stepmother, and their two teenagechildren. Much of the session has been focused on the difficulties the parents are experiencing insetting consistent boundaries for the children, especially as they have different parenting styles.They have touched on the transition to becoming a stepfamily.RT1: I suppose what struck me in listening to the discussion today was how much Jean and Johnseem to have been thinking about pulling together as parents to help give Jack and Jodie clearboundaries of what they can and can’t do in this family, without wanting too come down too hardon their freedom.RT2: I was wondering how this pulling together process is affected by the fact that John had to doa lot of the decision making and parenting on his own for a number of years. Does it feel like a 116
  • welcome relief to share things with Jean, or does the extra negotiating make it harder?RT3: I suppose that would depend on what are the family’s ideas about sharing out roles. I mean Iwas wondering whether they see the role of a stepparent as being any different from that of aparent in their family.RT1: Yes sometimes the roles can be quite different, each one having its pros and cons.Sometimes a stepparent can bring a fresh perspective on things, take a step back and look at thingsin a different way, like Jean felt she often did. A parent might enjoy a special relationship ofunderstanding because they have been closer to the child for longer. It may be that thesedifferences could be used to complement each other.RT3: I was thinking these things might be influenced a lot by gender, because Jean was saying sheand Jodie have developed a closer relationship, partly because they were both women, and therewere different expectations of the things Jean might be able to do as a step-mum.RT2: It feels like these things take time to negotiate though, and I wonder if this period ofnegotiation is what the family are still struggling with, because it might take longer when thechildren are teenagers, and have plenty of ideas themselves about how things should be.RT1: I wondered what ideas the family had of how to take this negotiation further, if it issomething they feel might be worthwhile pursuing. Is it something they would like to discuss here,with us, or do they feel the negotiation will just evolve naturally?Th: Perhaps we can leave it there then, and I will take your ideas up with the family.4.5 Child Centred InterventionsIt will be important for therapists to bear in mind the needs of children within therapy session.Interventions will need to be tailored to fit their development level, both cognitively andemotionally. Particularly:• The process and implicit rules of therapy may be particularly confusing and anxiety provoking for children. Engagement should therefore focus on aspects of the world which the child is familiar or is likely to enjoy. Therapists should use a friendly manner, and try not to raise issues which are likely to provoke anxiety. It may also be necessary for therapists to clearly and explicitly explain parts of the therapeutic process which children may find confusing.• Questions will need to be adapted so that children can understand the meaning of questions and the form of answers that are required. This may require therapist’s to give concrete examples or use names of individuals to whom they are referring. This is particularly relevant for circular questions which require respondents to take another’s perspective. υ Section 4.2• Children are likely to use multiple channels for communication. It is important for therapists not to rely solely on verbal channels in communicating with children. Drawings, play, and puppetry may all be helpful in enabling children to communicate their ideas, and therapists should be comfortable in using these methods with children. 117
  • 5. Therapeutic Setting5.1 Convening SessionsIn setting up the initial therapy session, therapists should begin by discussing the referralinformation within the therapy team. In deciding whom to invite to the first session attentionshould be paid to the following factors:• Who is living in the household?• Who else is mentioned as important members of the family system?• Recent family life events, that may affect attendance e.g. childbirth / separation.• Is further information required from referrers before therapy can commence?• What professional systems are involved with the family? In relation to: i. The presenting issues. ii. Other issues, such as child protection.• Would it be helpful to initiate a professional / network meeting prior to the therapy commencing?Therapists should first write to the family, using the letter template provided. υ Appendix I.A follow up phone call should then be made one week before the initial session to discuss thetherapy. As it is likely that the therapist will only speak to one member of the family during thisphonecall, therapists should ask whoever they speak to, to convey the message to the rest of thefamily. The topics to be covered in the phone call are:• Team working• Attendance issues, who will be coming, how to get there, and ambivalence about attending.• Therapist’s interest in hearing everyone’s ideas• Video recording• Confidentiality5.2 TeamThe team within which you are working should comply with the following guidelines:• Include at least two qualified family therapists (eligible for UKCP registration)• One of the qualified therapists should meet with the family whilst the other forms part of the observing team.• Team members should have read and incorporated the guiding principles into their thinking. υ Section 2• Teams should include therapist and family activities in their observations.• Teams should have at least one method for observing the therapist, e.g. one way mirror, in room observation• Teams should have at least one method of communication between team and therapist, e.g. telephone, earbug, interruptions. 118
  • 5.3 VideoThere should be capacity to video therapy sessions and permission to video therapeutic workshould be sought from the family in a manner which clearly discusses the video permission theyare granting. υ Section 6.1 - Permission should be confirmed by using the form provided. υAppendix II.5.4 Pre-therapy preparationIn preparing for the first session the therapist and the team should meet for at least 15 minutesbefore the session begins and address the following issues:• Construct a genogram from referral information υ Genogram example• Summarise the main themes from the referral• Consider the recent life events of the family• Consider difficulties which may arise around engagement and how to address these• Consider broader system issues, and define who is in the network• Brainstorm themes/hypotheses/formulations which may be relevant to the family GenogramsGenograms are a means to visually conceptualise the family and wider system, in terms of itsmembers and relationships. They should include the following information:• All members of the family system, including adopted/fostered members• Delineation of the household• All members of the wider system• Dates of birth• Deaths, with dates• Partnerships and marriages, with dates• Separations and divorces, with dates• Pregnancies, miscarriages, and terminations, with dates• Occupations / SchoolingAny information that is missing from the referral information should be noted and enquired aboutduring the initial session of therapy. T obias Ma r cia P au l m : 1952 71 66 dob: 12.4.27 died : 1967 dob: 20.5.32 h ea r t a ttack m : 1977 d: 1988 54 44 43 38 28 31 26 L eona r d C ar m el L eon B r ia n dob: ? dob: 3.6.54 dob: 30.7.55 dob: 13.8.60 J ean J oa n C har les dob: ? dob: ? dob: ? P ain ter n u r se n u r se du e : F eb 1999 18 16 14 14 T obias J acob R ach elle Monica dob: 10.5.80 dob: 19.1.82 dob: 12.2.84 ban k w or k er S t J am es G r a m m er S ch ool 119
  • 5.5 Pre & Post Session PreparationThe therapist and therapy team should allow 15 minutes before and after each session toprepare for their meeting with the family and review the progress of therapy. Issues to beaddressed in these discussions should include:Pre-Session• Summary of the main themes from previous session• Information which requires clarification from previous session• Between session contact the therapist has had with the family/wider system• The current formulation/themes/hypothesis of the issues with which the family are bringing• Ways forward for the current session which are being considered• Any team – therapist issues which need to be addressed• Any family – family/team issues which need to be addressedPost-session• Review of main interventions and family’s response• Ideas for future sessions, themes/issues to follow up, E.g. narrative prompts, unexplored areas, facts to check• Feedback to therapist of team observations• Therapist’s reflections on issues evoked for them by the session• Review of important information shared, e.g. life events, elements of genogram5.6 CorrespondenceLetters should be used throughout therapy to maintain contact with the family system and thewider network, as illustrated in this manual. υAppendices I, III, IV, V. Throughout this contact,the team’s writing of the letters should always consider the guiding principles outlined in Section2. Particularly important are issues of connecting with the whole system and not locating pathologywithin individuals. Particular attention to the language used will be important so thatcorrespondence can be both easily understood, and reflect the contributions of the family totherapy.5.7 Case notesAll written records should be non-pejorative, legible, dated, signed, with no abbreviations.Alterations and Corrections should be clearly marked and signed.Case notes should include: • Family information sheet • Genogram • Referral information/letter • All other written communications to and from the centre • Record of attendance • Sessions notes • Notes on telephone contacts to and from the centre 120
  • 5.8 Session notesThe therapy team should make session notes for each meeting between the therapist andfamily/wider system. In this way case notes form an observational record of the process of therapy.Session notes should include : • Date and number of session • Who attended therapy • Therapist/Team member names • Main themes of the session – including key language used by family • Team observations – clearly labelled as impressions • Record of interventions • Key points/ideas/decisions to follow up in later sessionsTeam members should record session notes on the record form provided. ⇒Appendix VI 121
  • 6. Initial sessionsInitial sessions of therapy consist of the first and second session of therapy. If a family seems wellengaged, and if all of the goals for initial sessions have been covered during the first session,therapists may proceed to the goals for middle session. υ Section 7. If this is not the casetherapists’ should continue to focus on the goals for initial session for a second session. Goals during initial session1. Outline Therapy Boundaries & Structure2. Engage and Involve all family members3. Gather and Clarify Information4. Establish Goals and Objectives of Therapy6.1. Outline Therapy Boundaries & StructureDuring the initial stages of therapy it is important for the therapist to set the boundaries of therapyby sharing some information with the family / professional system which informs them about theprocess of therapy, and orientates them to the first meeting. This information is most easily sharedby simple statements made by the therapist, these should include:• IntroductionsThe therapist should introduce himself or herself as a team member and explain the role andcontext within which they work (the team and the centre).• Team workingThe therapist should explain that they work as part of a team, and that the team’s role is to generateideas and help the therapist understand the family / system. The therapist should explain how manyteam members there are, and the professional background of the team members. The technicalequipment used should be explained including the use of the one way screen / phone / earbug.• VideoThe therapist should explain that family sessions are usually videod, but that the cameras are NOTyet switched on. The purpose of the filming (research / review) should be explicitly stated, asshould the storage of videotapes, and who has access to the tapes.The choice of whether to proceed with video should then be given, and the forms completed at theend of the meeting, giving the family a chance to decide then that the video can be erased.υAppendix II• ConfidentialityThe confidentiality of the videotapes and any information discussed in the session should beoutlined. Specific statements about the boundaries of confidentiality should be made in relation toother systems, and with regard to child protection issues.• Structure of the session 122
  • Information should be given on the length of the meeting, the breaks, and the use of team feedbackthrough messages or reflecting teams. Explain that during the break, videoing will stop and thescreen will be covered.• Structure of therapyExplain that if the family/team decide to meet again, that the meetings will be approximately every4 weeks, on the same day, and the same place. Explain that the length of therapy will be decidedtogether by the family / team in accordance with their needs and wishes.• QuestionsTime should then be spent giving the family an opportunity to ask questions and meet the team.Agreement to proceed with videoing should be confirmed, and the family informed that the videowill now be switched on.6.2 Engage and Involve all family members• Supportive environment: Initially it is very important for the therapist to provide a warm, supportive and empathic environment, to increase trust and rapport and to build the therapeutic relationship. The therapist must work to help the family feel understood, accepted, comfortable and less anxious. This may include making the room comfortable and safe for younger children, and making it clear they are free to play/draw during the session.• Hear from everyone: Therapists should try to hear from all members of the system/family, initially connecting with them all at an individual level, and assessing the level of contribution they feel they are able to make to the discussion, from either verbal or non-verbal cues. The therapist should try to make sure that everyone in the system is able to contribute to the discussion if they wish.• Neutrality: The therapist is trying not only to hear everyone’s views but also to establish their interest in different perspectives that may be held within the system. At this point unless serious concerns arise regarding safety/confidentiality the therapist should remain neutral to the difficulties and issues that the family are presenting and their views about them.6.3 Gather and Clarify InformationInformation should be gathered by the therapist to orientate them to the system and enable them tohear more about the issues the family is bringing to therapy. Information should be obtained on thefollowing topics:• The Context of therapy: decision to come to therapy, relationship with referrer, previous experiences of therapy, concerns or dilemmas, and their expectations of what would be a successful therapy outcome.• The System: Gathering information about the system and its relationship to other systems will be important in beginning to develop a broader picture of the family composition, relationships, history, and family patterns. Information should therefore not only be factual, in relation to who is in the system, how old are they etc., but also the relationships and roles they have developed within the system. Information concerning the system should be collated and added to the genogram generated in pre-therapy preparation. υSection 5.4• The Presenting difficulties or issues: If the family are introducing information about the 123
  • difficulties it will be important to follow this up, and open up a wider dialogue about the difficulties, hearing everyone’s perspective. Attention should be paid at this early stage to tracking the behaviour patterns that are defined as difficult, though some exploration of explanations and beliefs that have developed around the difficulties may be appropriate.• Solutions and Successes to date: It is important to gain some awareness of the actions the family has taken to try and address the difficulties, and their evaluation of the effectiveness of these measures. If the family are finding it difficult to generate concrete examples of things they have tried, hypothetical ideas for future solutions may bring ideas forward for discussion.Attention should be paid to collecting information in a circular manner. Although it will beappropriate to ask linear questions in collecting information, especially at this early stage oftherapy, circularity can be maintained by linking multiple linear questions between familymembers in a circular way.6.4 Establish Goals and Objectives of TherapyThe therapist should consider with the system what are their goals and objectives for therapy. Whatare the family hoping to get from the meeting today and the therapy in broader terms, and what aretheir different views about this and how might this impact on the therapy?The establishment of goals should be achieved in a way which expresses the Possibility ofChange, and should convey the expectation that change is possible, and likely to occur, that thetherapy team may be able to work with the family towards this. This intention is to build thefamily’s confidence in their ability to make changes. Initial Session Checklist for TherapistsNow you have finished the initial session/s of therapy:4 Do you know who is in the family?4 Have you outlined the way you work and the setting?4 Have you introduced the therapy team to the family?4 Have you discussed issues of confidentiality?4 Have you given the family a chance to ask questions about the therapeutic process?4 Have you begun to engage all members of the family?4 Do you know the important people in the wider system/network?4 Do you have a clear idea of the difficulties/issues with which the family are struggling?4 Have you heard views of the difficulties from each family member?4 Do you have an idea of the solutions and strategies that the family have tried so far?4 Do you have an idea about the family’s strengths?4 Do you have an idea about what the family would like to change or be different?4 Have you remembered to obtain written video permission?4 Have you written to the referrer to inform them of the appointment? υ Appendix III 124
  • 7. Middle Sessions Goals during middle sessions1. Develop and Monitor Engagement2. Gather Information and Focus Discussion3. Identify & Explore Beliefs4. Work towards change at the level of beliefs and behaviours5. Return to Objectives and Goals of Therapy7.1 Develop engagementThe therapist should pay particular attention to developing a co-constructed therapeuticrelationship. In addition to attending to the three aspects of engagement from the initial meeting(supportive environment/hearing from everyone/neutrality), attention should be paid to:• Creating and offering choices about the process of therapy• Resolving issues in the family-therapist-team system as they arise. This will require therapists to allow sufficient time for team discussions pre and post sessions (υSection 5.5), and time within sessions to discuss the process of therapy with families and any concerns or questions they have in relation to this.7.2 Gather Information & Focus DiscussionInformation is still gathered by the therapist, but more of an emphasis should be paid to focusingthis discussion, so that issues and areas for discussion from the initial broad discussions may belooked at in greater detail or from different perspectives. The therapist plays a role in developingthis discussion to develop themes and keep the discussion focused. Information may often focus onthe following topics:• The presenting difficulties or issues: The therapist will still be gathering information about the difficulties and issues presented. They will look more closely at the consequences/effects of behaviours. They should be tracking behavioural patterns, and giving feedback to the family about the behavioural or emotional interactions and sequences which are discussed or observed. Therapists’ should be collecting this information in a manner that enables circular descriptions of behaviour to develop.• The family and wider system: The therapist will still gather information about the family and wider system as is necessary to understand the information and stories being presented by the family. The gathering of information about the family should have reduced considerably from the initial sessions. As the therapist becomes more familiar with who is in the family and their roles, the focus of information should turn more to relationships.• Solutions & Successes: The focus on the successes and solutions available to the family should be steadily increasing throughout therapy. 125
  • 7.3 Identify & Explore BeliefsThe therapist should identify and explore the family’s thoughts, beliefs, myths or attitudes, whichmay be contributing to their dilemmas and difficulties.The therapist should be beginning to develop a picture of the ideas and beliefs that inform andinfluence behaviour, as they are gathering a circular description of the difficulties with which thefamily are struggling. Circular questions which build up circular descriptions of behaviour can alsobe used to explore the beliefs and assumptions which lie behind those behaviours.Example:Father and stepmother in the family are talking about their parents’ beliefs about childcare, inrelation to being offered numerous solutions from grandparents and friends about how to managethe teenage years. The therapist is trying to explore ideas about childcare, where these havedeveloped from, and how they might develop in the future.Fa: Well my mother would have a lot to say about that. I mean if we were ever like that there wasa firm hand. We would have never have got away with it.Th: And where do you think your ideas and values about how to manage the children come from,your own parents?Fa: Well, not really so much from my parents, I mean I would disagree with a lot of their ideasabout how to do things. I think really I have got more of my guides from the church, that’s whathas really shaped me.Th: And when was it you started to take on the ideas of the church.Fa: Well I suppose in my late teens, early twenties really, but I have always been interested. Jane(stepmother) has been going since a child and I would say your family were more stronglyChristian than mine were, wouldn’t you?Mo: Yes, I have always gone to church.Th: What are the values from the church that have influenced you as parents?Mo: Well really a sense of sharing, we feel it’s important for us both to take some interest in thechildren, and show them we care, not just one or other of us. But, I don’t know whether we alwaysmanage it.Th: (to the teenage children) When you two are parents where do you think your values will comefrom?Son: Well neither of them, well… I suppose I am a bit like dad, maybe I’d be a bit like him.Th: (To son) And if you were a parent, in their situation as parents now, what might you advisethem to do? The exploration of family beliefs should be used by the therapist to look at a range of family activities, and not just the presenting difficulties. Therapists should explore the family’s beliefs in relation to:• The presenting difficulties. E.g. What ideas has your wife come up with to explain the behaviour John is showing? How do you understand the idea that James is less concerned about the behaviour than Jill? 126
  • • Relationships within the family and with the wider system. E.g. Who feels it is most important to keep liasing with the school over this issue? What would your church say about how families cope with loss and bereavement?• Solutions that have been tried or hypothesised. E.g. What gave you the confidence to keep going with this new idea? What gave you the idea to try and tackle things in this manner?• Successes in all areas of family life and relationships to the wider system. E.g. Would that be judged as a success in your family? If John’s grandparents were here would they see that as a success, or would they have different ideas about success?• Therapy process, beliefs about therapy E.g. What led to your decision not to bring the children to today’s meeting? In what ways do you think Jill was disappointed with the therapy she went to last year?• Family behaviour during therapy. E.g. Jill is looking distressed, what do you think was so upsetting for her in talking about the difficulties you are experiencing? How do you understand John’s anger with the way that things have gone in today’s meeting?7.4 Work towards change at the level of beliefs and behaviours• Challenge existing patterns and assumptions: To move with the family to a position where they are able to query their own beliefs, perceptions and feelings. The therapist should actively query the family’s existing beliefs, assumptions or behaviours. The use of circular questioning, alternative perspective and possible futures questioning may be particularly helpful in achieving this.Example:A 12-year-old child (John) is discussing how he feels to blame when things in the family go wrong,or there are arguments between he and his mother. The therapist begins by clarifying what are thechild’s assumptions, then begins to challenge some of the linear aspects of them.John: Well I know it must be me, cause I am the one who always gets shouted at.Th: So do you sometimes feel you are to blame for things that happen at home?John: Well mainly.Th: Who would be able to convince you otherwise?John: Well sometimes Nan says things are not my fault, and that me and mum should listen moreto each other, but, I figure it must be me or mum who is at fault.Th: Does it have to be either your mum to blame or you to blame?John: Well I don’t know, we are all right together sometimes.Th: How would your Nan explain the times when you and your mum do get on well together?John: Well she says we are alright when we stop and listen, sometimes we can just bite off eachother’s heads you see, over nothing, when no-one has really done anything wrong. 127
  • • Provide distance between the family and the problem: Providing distance to try and free the family from the pressure of the difficulties, so that they are more able to consider and reflect upon them. Alternative perspective circular questions and those aimed at looking at possible futures can often be helpful in achieving this.Example:The therapist is talking alone to a mother who has been attending therapy with her children. Sincethe separation from her partner she has been finding coping with the demands of the childcareincreasingly arduous, and at times has felt very low about her ability to carry on and cope. Thetherapist is trying to work towards creating some distance between the mother and the situation inwhich she finds herself, to allow a space for reflection on the position she is in.Mary: Sometimes I feel so inadequate as a mother, I find myself constantly doubting my ownjudgement.Th: If we met with a group of single parents, do you think that would be a concern for most ofthem? Would they say making parental decisions alone is very demanding because they may nothave immediate confirmation from another adult?Mary: Well maybe, but it is so hard because though there is not another adult there, the childrenare quick enough to say, other mums don’t do that, or so and so’s mum would let them do this orthat.Th: When your children grow up, do you think they will more fully appreciate the job you do, andyour determination to do your best by them?Mary: Well I hope so, I think sometimes they know now how hard things are for me on my own,how much more running around I have to do, and sometimes how exhausted I am.Th: When they become parents of their own children, do you think they will see how hard youhave been trying to be both mum and dad at times?• Externalise One specific way of providing distance between the family and the difficulties, which is particularly useful if the difficulties are seen to reside within one family member is to externalise the problem. That is to give the problem an external, objective reality outside of the person. This can be useful in mobilising the family’s resources to unite in working towards solutions and new ways of thinking which challenge the difficulties.Example:The therapist is talking to a 10-year-old boy (Max) during the course of a family meeting. Max hasbeen describing how bad tempered he can be, especially at school. Family members have beenagreeing that Max is bad tempered. The therapist is working to externalise the temper from Max, inorder that he and his family find ways they can have an influence on the tempers.Th: Can we give this bad temper a name?Max: Well, it’s a sort of me at my angriest, a mad max I suppose.Th: When mad max is around, what effect does he have on your friendships at school?Max: Well, that when it can be at its worst, mad max can get me to be very argumentative, myfriends stay well away from me.Th: So when mad max is around they stay away. What happens when mad max isn’t there?Max: Well I tend to play football with my mates. 128
  • • Reframe: Reframe some of the constraining ideas presented by the family. Relabelling in a positive way, ideas and descriptions given by family members, in a manner which is consistent with their realities. Circular questions are often most helpful in opening up reframes with the family.ExampleA father is defining himself and his parenting behaviour as the ‘problem’ in relation to hischildren’s teenage struggles. The therapist works towards redefining the descriptions of behaviouras less problematic and offering some positives for the family.Cl: I think I’m basically just too inconsistent, it depends what mood I am in, or how busy I am, asto what answer the kids will get from me.Th: I am just wondering, this inconsistency, who is it a problem for?Cl: Well them, I think. They don’t know where they stand half the time.Th: Does it leave people not knowing where they stand or does it leave people having to make uptheir own minds?Cl: Well both, I’ve never really thought about it like that, but I feel like I don’t always think beforeI react.Th: Tell me Jane, what are some of the helpful things about your dad just reacting sometimes?• Open up new stories/explanations: Either by facilitating the family’s evolution of new ideas and narratives, or by the introduction of these ideas by the therapist. All family members will have stories about their lives, the lives of other family members, and the life of the family. They will prioritise certain information from the world around them to build these stories and neglect other aspects. Exploration of neglected information may open up the development of stories which are more helpful to the family in coping with their concerns. Information which is neglected often concerns: • Successes • Solutions • Exceptions • Alternative views from the network • Other strengthsThe therapist should pay particular attention to enquiring about this information as therapyprogresses, using circular questions so that the information is provided in a non-threateningmanner. Often circular questions, which are aimed at offering alternative perspectives, can behelpful to this aim. As information is likely to remain neglected by the family even if introducedinto the therapeutic conversation, it can often be helpful to emphasise neglected information bytherapist statements and reflecting team messages.Example:Mother: Cindy has always wanted to be a nurse. She entered nurse training but as usual she madea mess of it. She always does things the hard way. She continued to dream of going away tocollege, and get on in some way even after she had failed her exams. She is now doing volunteerauxiliary nursing.Th: She has continued to work as an auxiliary nurse, she really sounds determined. It seemsimpressive that she has found another way to fulfil her ambition, and not let herself getdiscouraged. Where does she get that determination from? 129
  • • Elicit Solutions: It will be helpful to gather information from the family about solutions for the difficulties that they have tried or would consider useful. Ideas generated by them are usually most helpful and linear questions are often used to develop an overview of solutions that the family have tried or thought of. If the family are finding it difficult to generate successes circular future orientated questions – such as the miracle question - can be helpful. However at times it may be useful for the therapist or therapy team to offer ideas to begin a process whereby the family can generate solutions. If this is necessary ideas should be tentative and flexible enough to allow the family to disregard them or build upon them.Example:The therapist is talking to a mother and her three children. They are having difficulties gettingalong together, which is intensified by the cramped living accommodation, and their feelings thatthey don’t have space for themselves.Th: So it seems important for you to be able to keep things private, to have space that is your veryown. What ideas have you come up with to achieve this?Mo: Well we tried letting the children lock their rooms, so that they wouldn’t be in and out of eachother’s rooms, arguing about stuff. But it’s just seemed to cause more arguments, they would juststand outside each other’s doors screaming to be let in.Th: So what else did you try then?Mo: Well we have tried just about everything, you name it we have tried it.Th: Jane, what does your mum mean? Tell me a bit more about all the things your family havetried.Jane: Well when the keys got taken off us, I said Jack and Jodie had to knock on my door, but theynever did, especially him. So mum said we would have to play down stairs all the time, whichdidn’t last long, because when I had a friend round I wanted to go upstairs.Th: So Jack, your sister says you have all being trying hard with ideas about this, can you tell meany other things that have been tried?Jack: Nothing else.Th: Well can you think of other things you think might help which you haven’t tried yet?Jack: No, nothing seems to work.Th: Imagine in a month’s time Jane and Jodie had stopped coming into your room, what wouldhave had to happened to make that possible?Jack: Well mum might have really told them off when they did it, and said no TV and stuff likethat.Th: Jodie do you think that would stop Jack coming into your room if your mum said that to him?Jodie: No, he would do it anyway.Th: What do you think might help Jack to stop coming in?Jodie: No computer.• Amplify change: In order to maximise the change or potential change that is occurring throughout the course of therapy it will be important for the therapist to focus on statements the family present about progress. Initially these aspects may be minimal, or presented in a manner by the family which denies the magnitude of the effort or progress they have made. The therapist should focus on descriptions of actions where the family could be seen to have initiated or implemented change, in a manner which is positive but sensitive to the family’s level of confidence that change has occurred. 130
  • Example:A 10-year old boy (Jake) is talking about a time when he and he had been pleased about hisbehaviour, against a context of difficulties in relationships and communication with his father, aswell as difficulties at school. The therapist explores the event in more detail to emphasise thesuccess and implications of this for their relationship.Jake: Well last Thursday we went to the park, and I went on a school trip, and we got to go on afair ride, and the teacher said I had been really good.Th: That sounds like a really nice time, does your mum know about this?Jake: Yeah, I told her what the teacher had said.Th: How did your mum react to the good news?Jake: She was pleased I think.Th: How did you know? How could you tell your mum was pleased?Jake: She looked quite happy, and she said we could go to McDonalds on the way home.Th: (to mother) So you were able to show Jake how pleased you were, how did you feel heresponded to that?Fa: I was quite surprised actually, we went to McDonalds and he didn’t play up at all, and he toldme about the day, which is a bit of a first for him.Th: So you noticed you were able to talk more together, what made that possible?Fa: Well I don’t know, really.Th: Did you notice you were more relaxed at all?Fa: Well I suppose that did help, we had a bit of time together because we were out just the two ofus, and I wasn’t wound up so much, cause I was really pleased that he had behaved himself allday?Th: What would make it possible for you to both find other times in the week when you couldhave a bit more time just the two of you, to feel more relaxed and talk.• Enhance mastery: To encourage the family to gain a sense of mastery or control over their situation, their thoughts, feelings and behaviours. This should enable the family members to take responsibility for their own roles and actions, and for the process of change. In addition should enable family members to gain an awareness of the actions and motivations of other people in their family in achieving change.Example:A mother and her two children aged 5 and 7 years are attending a late middle session of therapy.The parents separated 3 years ago, and the mother has been finding managing the children’sbehaviour difficult since this time. The therapist and family have been working together throughthe therapy to identify the things that the mother is doing well in relation to managing thechildren’s behaviour and managing her own low feelings. The therapist is commenting on thisprocess and highlighting the mother’s own stories of competence which are often lost.Mo: Well I feel like things have been going quite well with the kids, they have been behavingreally well most times, but I don’t know sometimes I still feel low, I wonder whether I am doingok. What do you think?Th: We would predict many of the things you have been telling me about today, about things beingup and down at this stage. I hesitate to advise a family who have come up with such good ideas andsolutions on their own. Especially when most of them seem to be having the desired effect. Whathave you been thinking of trying most recently? 131
  • Mo: Well I’m not sure sometimes I feel it’s right to take a sympathetic approach to the kids, thenother times I come down on them hard, you know, if they are playing up.Th: If Josie (mother’s friend) were looking in on how you were managing them now, would shesay you are combining these two approaches, or are you sticking with one or the other?Mo: Well she’d see a mix of the both I think, I mean I try and judge each situation as it comes.Th: So do you feel you are becoming more confident in trusting your judgement about what isright for the kids and when?Mo: Well a bit yes, I mean they don’t pull the wool over my eyes, I know when they are justplaying up or when they are really upset.Th: So when did you decide to be a bit more flexible about how you dealt with the situations athome?• Introduce therapist/team ideas: May include the therapist sharing their ideas and hypothesis about the family, individual, or difficulties, for a variety of reasons. Including: • Normalise difficulties • Move the family to new ideas • Connect family’s ideas • Suggest ways to organise the discussion, e.g. Enactments.Example:A mother, her social worker and the therapist are having a session. The mother begins to discussher experiences of violence from her ex-partner when she was first married, in her early twenties.As the mother is taking a rather critical stance towards her own actions at that time, the therapistnormalises her reactions to the violence, to try to begin to open up less critical stories and reframethe mother’s actions at the time as understandable rather then ‘weak’.Mo: I suppose I should have been stronger, and not let him trample all over me. My mum used tosay just get out, leave him, and I did for a while, I did try, but then I weakened and let him backeven though I thought why I am I doing this? What about the kids? I really should have tried to bestronger.Th: Was your mum the only person with whom you shared this?Mo: Well I tried to talk to my friend but I felt a bit bad, because all the same stuff had happened toher, and I just told her to leave and lost patience with her, and then I ended up being just as weak asshe was.Th: From talking to other women who have lived with violence like you have, I often hear asimilar story that they feel they should leave, but it is easier said than done when you are livingwith that fear on a day to day basis.Mo: That was it really, the fear, it kept me weak, and I loved him.Th: Women tell me they hold onto a hope that if only they did a bit better, were a bit stronger, theirpartner will change, so they keep trying over and over again. Did that happen for you?Mo: Yes, I took him back more than once you see, lots, but then I thought no more, not with thekids seeing things and all that.Th: What gave you the strength to put the kids first, and keep sticking to it? 132
  • 7.5 Return to Objectives and Goals of TherapyThe therapist should return to the issues of goals for therapy as therapy progresses:i. If goals seemed unclear during the initial stages of therapy, it may take some time and thought with the family for them to consider the areas they want to change in therapy, or to find priorities for change.ii. If goals are achieved, so that goals can be renegotiated, perhaps for change at a wider system level, or a decision to move towards the end of therapy is madeiii. If goals change due to changing circumstances for the family.Example:Things are beginning to improve for a family whose initial concerns were the suicide attempt madeby their daughter. She is no longer suicidal and seems to be getting happier at home and at school.The therapist discusses with the family whether they are happy with this progress, and whetherthey are left with other issues they would like to bring to therapy.Fa: I mean I think we are all lot more relaxed about Janice now, she was in her room for hours atthe weekend, and I realised at the end of the day that I hadn’t gone and checked on her once, and Ifigured that was because I was beginning to trust her again, I mean I didn’t have to watch her every5 minutes, or worry what she was up to.Th: So it seems like all of you are feeling that your concerns that Janice will harm herself are lessnow, and Janice you said you felt a bit happier at school. Now these changes are taking place, hasit left you with different ideas about what it could be helpful for us to discuss here?Janice: Nothing much else to say.Th: John do you think there are things which Janice might appreciate us talking about here?John: Well I know she doesn’t like talking about it, and I think that’s half the trouble, but I thinkmaybe we need to think about how to help Janice cope with all the stuff that goes on at school, allthe bullying.Th: Janice, is that one of the most difficult things for you to talk about?Janice: Yes.Th: Would it be helpful to think with you and your family how we could make talking about iteasier?Janice: I’m not sure, there is nothing they can do anyway.Fa: Me and your mum think if you could talk a bit though, you would like have a shoulder to cryon and not feel alone.Th: Do you feel you mum and dad might be able to help support you Janice?Janice: Yes I suppose so, I did talk to mum once and I felt better.Th: Would that be something we could try to develop here.Janice: Well I will give it a go. 133
  • Middle Sessions Checklist for TherapistsNow you are nearing the end of the middle sessions of therapy:4 Have you continued to engage the family in the work together?4 Have you addressed problems in working together as they have arisen?4 Have you developed a circular description of the interactions and difficulties with which the family are struggling?4 Are you developing a clear idea about the strengths and resources the family are drawing upon?4 Are you working with the family to generate new solutions for the issues they are bringing?4 Have you begun to explore the family’s beliefs and ideas about the interactions and relationships in their family?4 Has there begun to be a shift in the interactions in which the family are engaged?4 Have you challenged the family’s beliefs about the issues that they are discussing?4 Have you worked with the family to open up new stories/explanations about the difficulties they are experiencing?4 Have you worked to reframe the difficulties or struggles that the family are experiencing?4 Have you introduced distance between the family and the difficulties or tried to externalise the difficulties?4 Have you tried to amplify the successes and change that the family achieved?4 Are you working with the family to try and increase the sense of mastery and control they feel they have over the difficulties?4 Have you reconsidered with the family if they are achieving change in the way they had hoped?4 Have you written to the referrer to inform them of the progress of therapy? υ Appendix IV. 134
  • 8. End sessions Goals during ending sessions1. Gather Information and Focus Discussion2. Continue to work towards change at the level of behaviours and beliefs3. Develop family understanding about behaviours and beliefs4. Secure Collaborative Decision re: Ending5. Review the process of therapy8.1 Gather Information & Focus DiscussionInformation gathering and focusing the information brought by the family to sessions is stillimportant towards the end of therapy, though the focus of the information is likely to beconsiderably different.• The Presenting difficulties or issues: There will still be a lot of information shared about the difficulties with which the family are struggling, though the focus will be on changes that have arisen concerning these issues over the course of therapy.• Solutions and Successes to date: There should be a considerable amount of discussion about the solutions that the family are now implementing in relation to the difficulties, as well as the successes they feel they have achieved so far, and those they are looking forward to in the future. If the family are slipping into focusing on the difficulties, it will be important to enquire further about the successes about which the therapist has heard over the course of therapy, which the family are currently neglecting.• The System / Wider system: There should be a considerable decrease in the amount of information shared about the system and wider system. Of the information that is shared it is likely to be in relation to how the difficulties are showing/decreasing in other contexts. Also supports in the wider network which may be drawn upon once therapy has concluded are often explored. 135
  • 8.2 Continue to work towards change at the level of behaviours and beliefsAs in middle sessions the therapist and family are continuing to work towards change at the levelsof belief and behaviour. The methods they use can incorporate any of those highlighted in themiddle session. See section 7.4. However it is more common in end sessions for the focus to be onthe following methods:• Amplifying change: In order to maximise the change or potential change that is occurring throughout the course of therapy it will be important for the therapist to focus on statements the family present about progress. Initially these aspects may be minimal, or presented in a manner by the family which denies the magnitude of the effort or progress they have made. The therapist should focus on descriptions of actions where the family could be seen to have initiated or implemented change, in a manner, which is positive, but sensitive to the family’s level of confidence that change has occurred.• Enhancing mastery: To encourage the family to gain a sense of mastery or control over their situation, their thoughts, feelings and behaviours. This is to enable the family members to take responsibility for their own roles and actions, and for the process of change. In addition should enable family members to gain an awareness of the actions and motivations of other people in their family in achieving change.• Challenging existing patterns and assumptions: To move with the family to a position where they are able to query their own beliefs, perceptions and feelings. The therapist should actively query the family’s existing beliefs, assumptions or behaviours. The use of circular questioning, alternative perspective, and possible futures questioning may be particularly helpful in achieving this.• Reframing: Reframe some of the constraining ideas presented by the family. Relabelling in a positive way, ideas and descriptions given by family members, in a manner which is consistent with their realities. Circular questions are often most helpful in opening up reframes with the family.• Developing new stories and explanations: Either by facilitating the family’s generation of new ideas and narratives, or the introduction of these ideas by the therapist. All family members will have stories about their lives, the lives of other family members, and the life of the family. They will prioritise certain information from the world around them to build these stories and neglect other aspects. Exploration of neglected information may open up the development of stories to become stories that are more helpful to the family in coping with their concerns. Information which is often neglected often concerns: • Successes & Solutions • Strengths • Exceptions • Alternative views from the network8.3 Develop family understanding about behaviours and beliefsAs therapy ends it will be important for the therapist to work with the family to develop andencourage their understanding of the process of the development of difficulties. This may behelpful in equipping the family with the ability to recognise the development of such processes inthe future. Particular attention should be paid to:• Underlying family interactional patterns.• Motivations for assumptions, behaviours and feelings.• Understanding of a family member’s reactions to other’s behaviours. 136
  • 8.4 Collaborative ending decisionThe timing of ending is not always obvious and in aiming to make the ending process acollaborative process the therapist and therapy team should be alert to a number of signals insessions which may indicate that therapy may soon draw to a close. These include:• Positive feedback from the family: the family situation or the issues they presented are reported as improved or improving. The family report having made changes in other areas of their lives.• Negative feedback from the therapy: The family report dissatisfaction about the therapy, or the progress they are making. This is often done through expressing the views of a family member absent from therapy.• Therapist notices changes: Missed sessions by the family. Changes in the level of engagement in therapy. Therapist notices positive changes in the way the family are interacting during sessions, for example they are beginning to use new narratives, or are beginning to comment in a different way on their relationships and the issues with which they are struggling. The relationship to therapy may change, with the family becoming more confident in their own abilities, resources and solutions, and attributing change to this.If it seems that ending therapy is indicated it is important for the therapist to hear from everyonetheir thoughts and feelings about ending therapy and make this a collaborative decision. To do thisthe therapist and therapy team must share their thoughts about ending with each other and thefamily. The team should consider the following issues and then gather the family’s views on these.• Whether the family might feel it was appropriate to end therapy, do they feel they have achieved what they set out to achieve?• How might the family prefer to end therapy, would they like a follow up appointment or would they like to re-contact the team if necessary?• Might the family feel it would be important to engineer systems of support, before therapy ends?• With whom should the team share information about the therapy and what has been achieved, e.g. referrer, school.• A useful and engaging way of saying goodbye to the family.Once this information has been shared decisions should be reached about:• When therapy will end.• What follow up arrangements will be made.• What the family might do if difficulties should arise again.• Who will be contacted post therapy.8.5 Review the process of therapyIt will be helpful for the therapist to invite the family to review the process of therapy. This may beuseful for the team and family in relation to prevention of future difficulties, and to empower thefamily in any future contact with therapeutic services.Issues that should be considered include:• What has been gained/lost for the family through therapy?• Any misunderstandings not addressed during therapy should be clarified and addressed.• Reasons for therapist’s behaviours and procedures used.• What might the family do differently if future difficulties arise? End Sessions Checklist for Therapists 137
  • Before you end therapy check:4 Do the family have an understanding of the issues which they are happy with?4 Are the family happy with the ways of interacting that they are currently developing?4 Have you continued to amplify change, enhance mastery, challenge existing patterns and assumptions, reframe concerns and difficulties, and develop new stories and explanations of difficulties?4 Have you discussed ending therapy with the family, and listened to their wishes about ending?4 Have you reviewed with the family the goals outlined in the initial and middle stages of therapy?4 Have you considered contingency plans for the family when future difficulties arise?4 Have you reviewed with the family what was useful and not useful about therapy?4 Have you discussed how to re-engage with therapy if required?4 Have you written a closing summary of the work to the referrer? υ Appendix V 138
  • 9. Indirect WorkThere are many areas of systemic work, which although they do not directly involve the presenceof the family, are essential in supporting the ongoing work with the family. Directions forconducting this non-direct work are therefore outlined below. Therapists are reminded that theguiding principles outlined at the beginning of this manual will also be applicable to the non-directwork outlined in this section.9.1 Child ProtectionTherapists should abide by the local child protection procedures outlined by their area. Whereverpossible the local procedures should be carried out using the systemic principles described insection 2. It may be necessary to move from the domain of therapy to the domain of protection butthe manner in which this is achieved should retain a systemic focus, and not preclude thepossibility of moving back into the domain of therapy at a later stage. Therapists should inform thefamily that they are now not talking with them in their therapeutic role as they have seriousconcerns about the safety of a family member. Particular attention should be paid to bearing theneeds of the system in mind whilst still prioritising the needs of the child for protection, thelanguage and narratives about abuse and protection, and the co-construction of the relationship. Ifat all possible, without placing the child at further risk, therapists should discuss the childprotection issues with the family, and keep them informed of any protective procedures that thetherapist is to instigate.9.2 Clarifying therapy with referrer presentIn situations where referrals are vague, complex, or involve a network of professionals, it may benecessary to clarify the nature and boundaries of the referral over the telephone, or in person. Thisideally should be done with the referrer and family at a pre-therapy meeting, where the multipleviews about therapy, its utility and limits, can be shared between all members of the system.However in referrals where there may be tensions in the referring relationship, or issues ofadvocacy may limit the family’s ability to communicate their ideas and wishes, separate contactsshould be used to clarify therapy, before therapy commences.9.3 Identifying the network and clarifying relationshipsIt is important for the therapy team to identify the components of the family’s network from thereferral information given and during the assessment process. This includes professional andextended family contact, as well as other relationships, friendships and occupational aspects of thefamily’s life. This should be done for current relationships as well as important contacts in thefamily’s history. Important life events such as illnesses, hospitalisations, and periods of separationcan be built into this picture. This information should be used in relation to the therapeutic goalsand in relation to contact with the wider system that the therapy team and family participates induring therapy.If the family are participating in any other therapeutic activity during the time they are attendingfamily therapy, for example individual or couple therapy, the boundaries of the work should beclarified in relation to the current goals for family therapy.In addition, in identifying the network and clarifying relationships, the boundaries ofconfidentiality and the family’s wishes concerning this should be discussed and clearly stated to allmembers of the network.9.4 Assessing riskAt times during therapy it will be necessary to consider the risk which one or more member of thefamily poses in relation to their own well being or the well being of a family member. The risk 139
  • may be in relation to a number of issues, for example, child protection, domestic violence, orsuicide attempts. Therapists should bring their concerns into the discussion with the family to heartheir own views of the risks. It is important that the therapist’s and family’s concerns are identified,in a manner which opens up communication and leads to the establishment of contingency plans tomonitor or prevent further risks. In relation to suicidal ideation it may be necessary for the therapistto move outside the domain of therapy and complete a full psychiatric risk assessment, or refer tosomeone able to complete this. Again this should be a process in which the family are activelyinvolved and therapists should inform the family that they are now not talking with them in theirtherapeutic role as they have serious concerns about the risks to a family member. 140
  • 10. Proscribed PracticesThe proscribed practices described below are things that would not be included in a routine therapysession. It may be that on one or two occasions it is appropriate to use one of these approaches,however they must be used within a systemic framework, that is, using the guiding principlesoutlined at the start of this manual.Team members should monitor sessions for proscribed interventions, and record these, togetherwith any justification, in session notes? ⇒ Section 5.810.1 AdviceAs a systemic therapist you would not usually offer direct advice to the family about theirinteractions or the difficulties they are experiencing. If the family ask for advice about a particularissue with which they are struggling or the therapist feels advice may be appropriate in helping thefamily work towards their goals, advice may be offered in a non-directive or reflexive manner.Options should be presented as choices about which the family can make their own decisions.10.2 InterpretationPsychodynamic interpretations about the meaning of symptoms or interactions in relation toindividual or trauma would not be usual for systemic therapists. Rather, meanings are explored inrelational and interactional terms between members of the system.10.3 Un-transparent/Closed PracticeTherapists should not remain closed about their working practices, ways of thinking andunderstanding the difficulties with which the family are struggling. They should try to remaintransparent by explaining their practices at the beginning of therapy, and during therapy asappropriate.10.4 Therapist monologuesIn the co-created process of therapy therapists should not find themselves lecturing or using longmonologues in their interactions with the family. The process should be more like a sharing ofideas between therapist and family, and between family members.10.5 Consistently siding with one personIn taking a neutral stance therapists should not find themselves consistently siding with one personin the family. It may be necessary at times, for ethical or therapeutic reasons, to align oneself witha member of the family, but if therapy is to continue, this should not be a constant state.10.6 Working in the transferenceTherapists should be paying attention to the relational and engagement issues between themselvesand the family with which they are working but they should not use the relational aspects betweenthemselves and the family as the tool of therapy, that is work within the transference.10.7 Inattention to use of languageTherapists should not be inattentive to the use of language used by the family. They should payattention to the both the words and phrases used, and the meanings attributed to these.10.8 ReflectionsTherapist’s simple reflections of the points or phrases that are used by the family should be kept toa minimum. Reflections may be used to enhance engagement and to develop the family’s sense of 141
  • being listened to and understood, but when used, reflections should be followed by questions, andincreased curiosity about the issues presented.10.9 Polarised positionTherapists should avoid taking a position which is polarised from that of the family, or a positionwhich is likely to escalate to a polarised position. Therapists should be thinking about how to takea position which connects to the ideas of the family, whilst still questioning those ideas, andallowing them to remain curious. The therapeutic team can enable the therapist to achieve this bypresenting the multiple perspectives from which the family situation can be understood.10.11 Sticking in one time frameTherapists should not stick in one time frame, but move the focus of their questions and discussionbetween the past, present and future.10.12 Agreeing / not challenging ideasTherapists should not be in a continual state of agreement with the family’s ideas. They shouldremain curious and challenging about the nature and content of these ideas, in order to introducenew unexplored possibilities and ideas.10.13 Ignoring information that contradicts hypothesisTherapists should not ignore, or minimise information presented by the family which contradictstheir own ideas and hypotheses, rather they should take this information seriously and use it tomodify and expand their working ideas.10.14 Dismissing ideasThe ideas presented by the family about the difficulties with which they are struggling, or theprocess of therapy itself should not be dismissed by the therapist.10.15 Inappropriate affectThe therapist’s affect should match that of the family, and would be considered inappropriate if itremained dissimilar from family for an extended period of time. One example might be if thefamily were feeling optimistic about change and the progress they were making, and the therapistremained pessimistic. There may be times, when a mismatch of affect is used transiently, in orderfor the therapists to take a position in relation to the family as a way of questioning or challengingtheir ideas.10.16 Ignoring family affectTherapists should pay attention to the affect that the family is showing in the session, and notignore strong expressions of affect during the sessions. This may be particularly relevant when amember of the family shows distress during the meeting, either by sad or angry behaviour.10.17 Ignoring differenceTherapists should not ignore issues of difference between themselves and the family or within thefamily. These may be differences in views, beliefs, gender, abilities, class or race, and should beraised by the therapist in a sensitive and open manner for further exploration. 142
  • Appendix 1: Sample Appointment LetterAppointment letters should include:• Referral source and name of referrer• Invitation to the whole family• Reasons why all the household should attend• Date, time and place• Confirmation request• Brief explanation of teamwork• Main therapists nameDear Mr & Mrs Smith & Jodie and Jonathan,We have heard from your GP, Dr. Jones, that it might be worthwhile exploring whether familytherapy could be of help to you all. We would therefore like to offer you an appointment to comealong and meet us at our Family Therapy and Research Centre on Wednesday 13th July at 4.30pm.This first session would be to discuss the issues that concern you and to decide whether family therapymight be useful. We find it helpful to meet all members of the family or household so that we canlearn how things are from everyones point of view. We hope to see as many of you as possible forthis first appointment.We work as a team in order to generate more ideas which we hope to share with you.There are about 5 people in the team, but the person who will be talking with you most directly is Dr.Peter Stratton.Enclosed is a map giving directions to the clinic, which is situated in the Department of Psychology atLeeds University.Please let us know whether or not you can attend, as soon as possible by telephoning our secretary onthe above number. It is important that you give us this information as we have a waiting list forappointments.Yours sincerely,Dr Peter StrattonFamily TherapistOn behalf of Leeds Family Therapy Team 143
  • Appendix II: Sample Video Consent Form Consent Form for the Use of Video TapeWe give consent for the use of these video recordings for the following purposes:1. To help the team deliver a more effective service to our family. For the purposes of supervision and in order to plan future therapy sessions. Confidentiality will always be maintained. Viewing will be confined to the regular members of your family therapy team.2. For teaching & research, in order to develop our service through training other therapists, and improving the service for families through research. Such tapes are only shown to audiences of professional clinicians and researchers who are warned about the importance of confidentiality.Please delete as appropriate.Signed: …………………………………………………………………………………………………………………………………………………………….Dated: ………………………………………………………………………….You are entitled to change your mind about the consent given above at any time.All video material is stored in locked cabinets and every effort will be made to ensureconfidentiality. No video material will be identified using your family’s name.Signed: …………………………………………………………………………………………………………………………………………………………….All Family MembersDated: ………………………………………………………………………….Member of Family Therapy Team 144
  • Appendix III: Sample Referrer letterThis letter is to be sent to the referrers when first appointment sent out. It should include:• Referral date• Referral reason• Family name & address• Date of appointment• Proposed future contact• Contact personDear Dr. JonesRe: Smith Family 11 James Avenue, Leeds, LS2Further to your referral of the Smith family, for help concerning bereavement issues, in March 1998,we have offered them an appointment at the Leeds Family Therapy and Research Centre onWednesday 13th July at 4.30pm.We will keep you informed of their progress should they go ahead with family therapy.If in the meantime you have any further issues regarding this family please contact Dr. Peter Stratton.Yours sincerelyDr Peter StrattonFamily TherapistOn behalf of Leeds Family Therapy Team 145
  • Appendix IV: Post-assessment letter to referrerA letter should be sent to the referrer once an assessment is completed or when the initial goals oftherapy are clarified with the family. This letter should include:• Number of assessment sessions attended• Who attended• Brief family composition• Referrers concerns• Family’s concerns• Systemic Formulation/Understanding of Difficulties• Agreed Goals for Therapy• Agreed liaison with other systems 146
  • Dear Dr. JonesRe: Smith Family - 11 James Avenue, Leeds, LS2I have now seen the Smith family on 2 occasions following your referral for help with bereavement issuesfollowing the death of the eldest child in the family, Julie. Mr & Mrs Smith attended alone for the firstmeeting, as they were concerned to give us a picture of the difficulties without upsetting the children. Thiswas followed up with a meeting with the whole family.As you know the family consist of Mr & Mrs Smith, and their 2 children Jodie (6 years) & John (9 years),both of whom are attending Jacob School. The eldest child of the family, Julie, died in a car crash inSeptember 1997.Mr & Mrs Smith outlined to us their concerns that their children were expressing no grief relating to thedeath of their elder sister Julie. They were concerned about how the loss was affecting them in both theirachievement and behaviour at school, and expressed a wish that they were more able to talk about theissue as a family. The children were quite cautious about discussing this issue initially, and expressed adesire not to upset their parents further by talking about Julie’s death.It seemed that although this was a topic all the family felt would be helpful to discuss more openly, no onedared to begin the conversation, as they were concerned not to bring further distress to members of theirfamily. The children had carried this silence to school, and would not talk to any of Julie’s old friendsabout her, yet consistently showed distress through their behaviour and lack of concentration.It was therefore decided to try and begin to talk about Julie’s death and the impact this had had on thewhole family in our meetings. The children very much wanted this to be at their pace, and we have beenthinking with them about ways to help the process of talking easier.We also plan to make links with Jacob school, to discuss how the children might show their distress indifferent ways at school.I will contact you again once therapy has ended to discuss the utility of these interventions for the family.Yours sincerely,Dr Peter StrattonFamily TherapistOn behalf of The Leeds Family Therapy Team
  • Appendix V: Closing letter to referrerA letter should be sent to the referrer after therapy has ended and should include:• Reasons and date of original referral.• Number of meetings held• Who attended the meetings• The family’s concerns• Systemic Formulation/Understanding of Difficulties• Themes covered in meetings• Utility of therapy for the family• Evaluation of current state• Future plans• Copies to other agencies involved, with family’s permissionDear Dr JonesRe: Smith family - 11 James Avenue, Leeds, LS2.You will remember you referred the Smith family for family therapy in March 1998, for help with bereavementissues.The family attended for 5 appointments. We saw them last in November 1998 and a further appointment forDecember was cancelled. All members of the family attended meetings following an initial meeting with Mr & MrsSmith alone.The parents outlined to us their concerns that their 2 children Jodie (6years) & John (9years), were expressing nogrief relating to the death of their elder sister Julie, who died in a car crash in September 1997. Mr & Mrs Smithwere concerned about how the loss was affecting them in both their achievement and behaviour at school, andexpressed a wish that they were more able to talk about the issue as a family.Our 5 meetings were spent looking at the effect Julie’s death had had on both the parents and the children, and thestories they had developed for understanding what had happened. At the family’s request we also invited theHeadmistress of the children’s school, Mrs Small, to look at ways the children could express their grief about Julie’sdeath within the school setting. In addition we thought about ways they might be supported to develop theirconcentration, when distracted or upset at school.The family used all of the meetings to their fullest, and communication concerning the bereavement improved veryrapidly. The children also reported feeling happier at school.We had planned to continue, but the family phoned and left a message to say they felt things had improved at homeand at school and they would contact us again if the need arose. We left it with them that we would be very happyto see them again if requested.Yours sincerelyDr Peter StrattonFamily TherapistOn behalf of The Leeds Family Therapy Teamc.c. Mrs Small, Headmistress, Jacob school 148
  • Appendix VI : Session Notes Record Form SYSTEMIC FAMILY THERPY MANUAL SESSION NOTES Record SheetDate of Session Session NumberWho attended therapy?Therapist nameTeam member namesMain themes of the session Include key language used by familyMain themes continuedTeam observations Clearly labelled as impressions 149
  • InterventionsInterventions continuedKey points/ideas/decisions to follow up in later sessions1.2.3.Proscribed Practices included in session Justification1.2.3. 150
  • BASIC FAMILY THERAPY TECHNIQUESIN ALPHABETICAL ORDERBasic Techniques in Family Counselling and Therapy 151
  • BASIC FAMILY THERAPY TECHNIQUESIN ALPHABETICAL ORDERBasic Techniques in Family Counselling and Therapy• ACCOMMODATIONThe therapist makes personal adjustments in order to achieve a therapeutic alliance.Accommodating is: adapting to a familys communication style.• ADVICE & INFORMATIONThese are derived from experience and knowledge of the family in therapy. They are used to calm down anxiousmembers of families or reassure these individuals and families about certain actions.• AFFECTIVE CONFRONTATIONAffective Confrontation of Rigid Patterns and Roles is used to interrupt rigid pattrns.The goals may bea/ to raise clients awareness when they do not know how they are contributing to the problem.b/ to raise a taboo subject that the client and others have been avoiding, orc/ to increase motivation to make changes when there is cognitivie awareness but no change in action.Examples:"When did you divorce your husband and marry your son?""You are aware that you have abandoned the family to advance your career?""What do you think would be more detrimental for your daughter: missing dance practice once a week for a fewmonths or having her parents divorce? Do you want to ask your child what her preference is?"• ASKING PERMISSIONNarrative therapists use permission questions to emphasize the democratic nature of the therapeutic relationship andto encourage clients to maintain a clear, strong sense of agency when talking with the therapist.Asking permission to ask a question goes against the prevailing assumption that therapists can ask any question theywant tot gather information they purportedly need to help the client. Many clients feel compelled to answer thesequestions, even if they are not comfortable doings so.Narrative therapists show their sensitivity by asking permission before asking questions that are generally taboo orconcern difficult objects.Example: "Would it be okay if I ask you some questions about your sex life?"In addition, throughout the interview, the therapist may ask for client input and permission to continue with aparticular topic or line of questioning. 152
  • • BEGINNER’S MIND"In the beginners mind there are many possibilities, in the experts mind there are few"Position of curiosity. Viewing experiences as though for the first time.A beginners mind is very open, very alert. It is not filled with ideas and notions, truths and dogmas. It is receptive.• BOUNDARY FORMATIONPart of the therapeutic task is to help the family define, or change the boundaries within the family. The therapistalso helps the family to either strengthen or loosen boundaries, depending upon the family’s situation.• ADDING COGNITIVE CONSTRUCTIONSAdvice & Information are derived from experience and knowledge of the family in therapy. They are used tocalm down anxious members of families or reassure these individuals and families about certain actions.Pragmatic fictions are formal expressions of opinion to help families and their members change.Paradox is an apparently sound argument leading to a contradiction. It is used to motivate family members tosearch or alternatives. Family members may defy the therapists and become better or they may explore reasons whytheir behaviours are as they are and make changes in the ways members interact.• COMMUNICATION TECHNIQUESMATCHING THE CLIENT’S LANGUAGEExample: Use the exact words the client uses to describe the problem in asking questions about what they havedone before, when it is not so serious a problem, etc.Also, attend to client’s metaphors and utilize them also to extend observations, learn about their interests or hobbiesto use metaphors that involve them.MATCHING SENSORY MODALITIESUse words pertaining to “seeing” or “hearing” how things are and use words in the same vein.CHANNELING THE CLIENT’S LANGUAGEChannel away from jargon into action descriptions used in every day language. This has the effect ofdepathologizing or normalizing clients’ situations. Gradually change your terminology to less serious, morepositive words. (Example: Use the words “transitional period” as this give the client the opportunity to take solacein hearing that a problem is temporary, helps shape their expectations for the future).USE OF VERB FORMSCreate a reality where the problem is in the past and possibilities exist for the present and in the future. “When youhad this problem before, you used to . . you were having difficulty . . how did the old you . . .”Help clients make distinctions that are helpful (feeling like or thinking about . . . rather than doing it). 153
  • GIVE CLOSE EXAMINATION TO THEIR LANGUAGE AND YOURS. A. Vague statements B. Unspecified verbs : “He ruined the relationship” (how, what way?). “I am scared” (of what) C. Specify comparison: “He is lazy” (compared to whom) D. Empty nouns: respect, love, anger, depression E. Generalization: all, none, always, never F. Cannot/will not vs. doesn’t /did not G. Characterizations lazy, aggressive H. Challenge claims: “How do you know you feel depressed”• COMMUNICATION SKILL-BUILDING TECHNIQUESMore often than not, its a familys communication patterns and styles that lead to conflict and division.Communication patterns and processes are often major factors in preventing healthy family functioning. Faultycommunication methods and systems are readily observed within one or two family sessions. A variety oftechniques can be implemented to focus directly on communication skill building between a couple or betweenfamily members.Communication techniques are used to build skills that allow for effective communication between familymembers.Listening techniques including restatement of content, reflection of feelings, taking turns expressingfeelings, and nonjudgmental brainstorming are some of the methods utilized in communication skill building.REFLECTING involves having a member express her feelings and concerns, then having another member repeatback what he heard that person say.REPEATING techniques involves having a member state how he feels, while another member repeats back whatwas said. Repeating and reflecting techniques allow members to better understand where the other is coming fromand why she feels as she does.FAIR FIGHTING TECHNIQUES focus on attentive listening and expressing feelings and concerns in anonthreatening manner.• CONCLUSIONThe techniques suggested here are examples from those that family therapists practice. Counsellors will customizethem according to presenting problems. With the focus on healthy family functioning, therapists cannot allowthemselves to be limited to a prescribed operational procedure, a rigid set of techniques or set of hypotheses.Therefore, creative judgment and personalization of application are encouraged. 154
  • • CONFIRMATION OF A FAMILY MEMBER:Using an affective word to reflect an expressed or unexpressed feeling of that family member.The therapist can join families from different positions of proximity.In the close position of proximity, he can affiliate with family members, perhaps even entering into coalition withsome members against others.Probably the most useful tool of affiliation is confirmation.The therapist validates the reality of the family member(s) he joins. He searches out positives and makes a point ofrecognizing and awarding hem.• DETRIANGULATIONThe process by which an individual removes himself or herself from the motional field of two others.(triangulation is: Detouring conflict between two people by involving a third person, stabilizing the relationshipbetween the original pair.)• DIAGNOSINGDiagnosing is done early in the therapeutic process. The goal is to describe the systematic interrelationships of allfamily members to see what needs to be changed or modified for the family to improve. By diagnosing interactions,therapists become proactive, instead of reactive.• DIFFERENTIATION OF SELFPsychological separation of intellect and emotions and independence of self from others; opposite of fusion.(Fusion is a blurring of psychological boundaries between self and others and a contamination of emotional andintellectual functioning; opposite of differentiation.)• DISEQUILIBRIUM TECHNIQUESThe following techniques are used to create a different perception of reality.REFRAMING: The technique of reframing is a process in which a perception is changed by explaining a situationin terms of a different context. For example, the therapist can reframe a disruptive behaviour as being naughtyinstead of incorrigible allowing family members to modify their attitudes toward the individual and even help himor her makes changes.PUNCTUATION: Punctuation is “the selective description of a transaction in accordance with a therapist’s goals”.Therefore it is verbalizing appropriate behaviour when it happens.UNBALANCING: This is a procedure wherein the therapist supports an individual or subsystem against the rest ofthe family. When this technique is used to support an underdog in the family system, a chance for change withinthe total hierarchical relationship is fostered. 155
  • • EMOTIONAL CUT-OFFBowens term for flight from an unresolved emotional attachment• THE EMPTY CHAIRThe empty chair technique, most often utilized by Gestalt therapists (Perls, Hefferline, & Goodman, 1985), has beenadapted to family therapy. In one scenario, a partner may express his or her feelings to a spouse (empty chair), thenplay the role of the spouse and carry on a dialogue. Expressions to absent family, parents, and children can bearranged through utilizing this technique.• ENACTMENTThe process of enactment consists of families bringing problematic behavioural sequences into treatment byshowing them to the therapist a demonstrative transaction. This method is to help family members to gain controlover behaviours they insist are beyond their control. The result is that family members experience their owntransactions with heightened awareness. In examining their roles, members often adapt new, more functional waysof acting.• FAMILY CHOREOGRAPHYIn family choreography, arrangements go beyond initial sculpting; family members are asked to position themselvesas to how they see the family and then to show how they would like the family situation to be. Family members maybe asked to reenact a family scene and possibly resculpt it to a preferred scenario. This technique can help a stuckfamily and create a lively situation• FAMILY COUNCIL MEETINGSFamily council meetings are organized to provide specific times for the family to meet and share with one another.The therapist might prescribe council meetings as homework, in which case a time is set and rules are outlined. Thecouncil should encompass the entire family, and any absent members would have to abide by decisions. The agendamay include any concerns of the family. Attacking others during this time is not acceptable. Family councilmeetings help provide structure for the family, encourage full family participation, and facilitate communication.• FAMILY FLOOR PLANThe family floor plan technique has several variations. Parents might be asked to draw the family floor plan for thefamily of origin. Information across generations is therefore gathered in a nonthreatening manner. Points ofdiscussion bring out meaningful issues related to ones past.Another adaptation of this technique is to have members draw the floor plan for their nuclear family. Theimportance of space and territory is often inferred as a result of the family floor plan. Levels of comfort betweenfamily members, space accommodations, and rules are often revealed. Indications of differentiation, operatingfamily triangles, and subsystems often become evident. Used early in therapy, this technique can serve as anexcellent diagnostic tool (Coppersmith, 1980). 156
  • • FAMILY LIFE CYCLEStages of family life from separation from ones parents to marriage, laving children, growing older, retirement, and,finally, death.Jjust like an individual, a family has developmental tasks and key (second-order) transitions like leaving home,joining of families through marriage, families with young children (the key milestone, and one that initiates verticalrealignment), families with adolescents, launching children and moving on, families in later life. Key question:"How well did the family do on its last assignment?" Horizontal stressors are those involving these transitionalassignments; vertical stressors are transmitted mainly via multigenerational triangling. Symptoms tend to occurwhen horizontal and vertical stressors intersect. Divorce adds extra developmental steps for all involved families.Carter and mcgoldrick elaborated the family life cyclea. Leaving homeb. Joining of families through marriagec. Families with young childrend. Adolescencee. Launching children and moving onf. Families in later life• FAMILY PHOTOSThe family photos technique has the potential to provide a wealth of information about past and present functioning.One use of family photos is to go through the family album together. Verbal and nonverbal responses to picturesand events are often quite revealing. Adaptations of this method include asking members to bring in significantfamily photos and discuss reasons for bringing them, and locating pictures that represent past generations. Throughdiscussion of photos, the therapist often more clearly sees family relationships, rituals, structure, roles, andcommunication patterns.• FAMILY SCULPTINGDeveloped by Duhl, Kantor, and Duhl (1973), family sculpting provides for recreation of the family system,representing family members relationships to one another at a specific period of time. The family therapist can usesculpting at any time in therapy by asking family members to physically arrange the family. Adolescents often makegood family sculptors as they are provided with a chance to nonverbally communicate thoughts and feelings aboutthe family. Family sculpting is a sound diagnostic tool and provides the opportunity for future therapeuticinterventions.An activity in which family members place themselves in postures symbolic of the family dynamics.Satir placed people in position herself to activate right-brain experiencing.• FAMILY SYSTEM STRATEGIESA family operates like a system in that each members role contributes to the patterns of behaviour that make thesystem what it is. Certain therapy techniques are designed to reveal the patterns that make a family function the wayit does. The tracking technique is a recording process where the therapist keeps notes on how situations developwithin the family system. Interventions used to address family problems can be designed based on the patternsuncovered by this technique. Family sculpting is another technique thats used to realign relationship patterns withinthe group. Members are asked to physically arrange where they want each member to be in relation to the others.This technique provides insight into relationship conflicts within the family. 157
  • • FRAMING QUESTIONSQuestions asked can elicit information about strengths, abilities, and resources. Perceptions of problems thenchange significantly in this context. 1. THE MIRACLE QUESTION: Suppose that one night, while you were asleep, there was a miracle and thisproblem was solved. How would you know? What would be different?This type of question seems to make a problem-free future more real and therefore more likely to occur.The therapist gives guidelines and information to help the client go directly to a more satisfactory future.2. FAST-FORWARDING QUESTIONS can be used when clients can’t identify exceptions or past solutions.Clients are asked to envision a future without the problem and describe what that looks like. (The miracle questionor a magic wand question). => “What will not would be different?”3. THE EXCEPTION QUESTION: Asks the client to focus on times when problem does not occur or has notoccurred when they expected it would. They may discover solutions they had forgotten or not noticed. Thetherapist might find clues on which to build future solutions.Example: “What is different about those times when things are working?”• THE GENOGRAMOne of the best ways to begin therapy and to gain understanding of how the emotional system operates in yourfamily system is to put together your family genogram. Studying your own patterns of behaviour, and how theyrelate to those of your multigenerational family, reveals new and more effective options for solving problems andfor changing your response to the automatic role you are expected to play.The genogram, a technique often used early in family therapy, provides a graphic picture of the family history. Thegenogram reveals the familys basic structure and demographics. (McGoldrick & Gerson, 1985). Through symbols,it offers a picture of three generations. Names, dates of marriage, divorce, death, and other relevant facts areincluded in the genogram. It provides an enormous amount of data and insight for the therapist and family membersearly in therapy. As an informational and diagnostic tool, the genogram is developed by the therapist in conjunctionwith the family.• GOAL SETTINGStart small — “What will be the first sign that things are moving in the right direction?” Goals must be concrete.• IDENTIFICATIONFamily therapy techniques are used with individuals and families to address the issues that effect the health of thefamily system. The techniques used will depend on what issues are causing the most problems for a family and onhow well the family has learned to handle these issues. Strategic techniques are designed for specific purposeswithin the treatment process. Background information, family structuring and communication patterns are some ofthe areas addressed through these methods. 158
  • • INFORMATION-GATHERING TECHNIQUES At the start of therapy, information regarding the familys background and relationship dynamics is needed to identify potential issues and problems. • The genogram is a technique used to create a family history, or geneology. Both the family and therapist work to create this diagram. • Having family members bring in meaningful family photos is also a technique used to gather information as to how each member perceives the others. • One other technique involves having family members draw up floor plans of their home. This exercise provides information on territorial issues, rules, and comfort zones between different members.• INTENSITYIntensity is the structural method of changing maladaptive transactions by using strong affect, repeated intervention,or prolonged pressure. Intensity works best if done in a direct, unapologetic manner that is goal specific.• INTERVENTION TECHNIQUESIntervention techniques are directives given by the therapist to guide a familys interactions towards moreproductive outcomes. Reframing is a method used to recast a particular conflict or situation in a less threateninglight. A father who constantly pressures his son regarding his grades may be seen as a threatening figure by the son.Reframing this conflict would involve focusing on the fathers concern for his sons future and helping the son to"hear" his fathers concern instead of constant demands for improvement. Another technique has the therapistplacing a particular conflict or situation under the familys control. What this means is, instead of a problemcontrolling how the family acts, the family controls how the problem is handled. This requires the therapist to givespecific directives as to how long members are to discuss the problem, who they discuss it with, and how long thesediscussions should last. As members carry out these directives, they begin to develop a sense of control over theproblem, which helps them to better deal with it effectively.• JOININGThis is the process of coupling that occurs between the therapist and the family, leading to the development oftherapeutic system. In this process the therapist allies with family members by expressing interest in understandingthem as individuals and working with and for them. Joining is considered one of the most important prerequisites torestructuring. It is a contextual process that is continuous. There are four ways of joining in structural familytherapy. • Tracking: In tracking, the therapist follows the content of the family that is the facts. Getting information through using open-ended questions. Tracking is best exemplified when the therapist gives a family feedback on what he or she has observed or heard. • Mimesis: The therapist becomes like the family in the manner or content of their communications. • Confirmation of a family member: Using an affective word to reflect an expressed or unexpressed feeling of that family member. • Accommodation: The therapist makes personal adjustments in order to achieve a therapeutic alliance. 159
  • • PARADOXICAL INJUNCTIONSA paradox is an apparently sound argument which leads to a contradiction. It is used to motivate family members tosearch or alternatives. Family members may defy the therapists and become better or they may explore reasons whytheir behaviours are as they are and make changes in the ways members interact.• PRAGMATIC FICTIONSFormal expressions of opinion to help families and their members change.• PRESCRIBING INDECISIONThe stress level of couples and families often is exacerbated by a faulty decision-making process. Decisions notmade in these cases become problematic in themselves. When straightforward interventions fail, paradoxicalinterventions often can produce change or relieve symptoms of stress. Such is the case with prescribing indecision.The indecisive behaviour is reframed as an example of caring or taking appropriate time on important mattersaffecting the family. A directive is given to not rush into anything or make hasty decisions. The couple is to followthis directive to the letter.• PROBLEM SOLVING TECHNIQUES1. Dissolve the idea that there is a problem: Help people see their situations in new ways.2. Negotiate a solvable problem: Reduce the size of the problem in the client’s eyes. (Get specific about the problem; focus on when it is not so serious a problem).3. Frame towards the idea that clients have all the abilities and resources to solve the problem: Create an atmosphere that facilitates the realization of strengths and abilities.• PUNCTUATIONPunctuation is “the selective description of a transaction in accordance with a therapist’s goals”. Therefore it isverbalizing appropriate behaviour when it happens.Punctuation: thinking that you cause what I say.• PUTTING CLIENT IN CONTROL OF THE SYMPTOMThis technique, widely used by strategic family therapists, attempts to place control in the hands of the individual orsystem. The therapist may recommend, for example, the continuation of a symptom such as anxiety or worry.Specific directives are given as to when, where, and with whom, and for what amount of time one should do thesethings. As the client follows this paradoxical directive, a sense of control over the symptom often develops,resulting in subsequent change. 160
  • • REFRAMINGMost family therapists use reframing as a method to both join with the family and offer a different perspective onpresenting problems. Specifically, reframing involves taking something out of its logical class and placing it inanother category (Sherman & Fredman, 1986). For example, a mothers repeated questioning of her daughtersbehaviour after a date can be seen as genuine caring and concern rather than that of a nontrusting parent. Throughreframing, a negative often can be reframed into a positive.The technique of reframing is a process in which a perception is changed by explaining a situation in terms of adifferent context. For example, the therapist can reframe a disruptive behaviour as being naughty instead ofincorrigible allowing family members to modify their attitudes toward the individual and even help him or hermakes changes.• REFRAMING PROBLEM DEFINITIONSSolution Oriented therapists offer new, more workable problem definitions that are within the power of the clientand therapist to solve. They usually help the client reframe the problem definition to a more positive one or listenfor a hint of something in the client’s complaint that can be solved. This co-creates the experience that the problemis solvable and the client has some ability to solve it.• RESTRUCTURINGThe procedure of restructuring is at the heart of the structural approach. The goal is to make the family morefunctional by altering the existing hierarchy and interaction patterns so that problems are not maintained. It isaccomplished through the use of enactment, unbalancing, and boundary formation.• SHAPING COMPETENCEThe family therapists help families and individuals in becoming more functional by highlighting positivebehaviours.• SPECIAL DAYS, MINI-VACATIONS, SPECIAL OUTINGSCouples and families that are stuck frequently exhibit predictable behaviour cycles. Boredom is present, and familymembers take little time with each other. In such cases, family members feel unappreciated and taken for granted."Caring Days" can be set aside when couples are asked to show caring for each other. Specific times for caring canbe arranged with certain actions in mind (Stuart, 1980).• STRATEGIC ALLIANCESThis technique, often used by strategic family therapists, involves meeting with one member of the family as asupportive means of helping that person change. Individual change is expected to affect the entire family system.The individual is often asked to behave or respond in a different manner. This technique attempts to disrupt acircular system or behaviour pattern. 161
  • • TRACKINGThe tracking technique is a recording process where the therapist keeps notes on how situations develop within thefamily system. Interventions used to address family problems can be designed based on the patterns uncovered bythis techniqueMost family therapists use tracking. Structural family therapists (Minuchin & Fishman, 1981) see tracking as anessential part of the therapists joining process with the family. During the tracking process the therapist listensintently to family stories and carefully records events and their sequence. Through tracking, the family therapist isable to identify the sequence of events operating in a system to keep it the way it is. What happens between point Aand point B or C to create D can be helpful when designing interventions.In tracking, the therapist follows the content of the family that is the facts. Getting information through using open-ended questions. Tracking is best exemplified when the therapist gives a family feedback on what he or she hasobserved or heard.• UNBALANCINGThis is a procedure wherein the therapist supports an individual or subsystem against the rest of the family. Whenthis technique is used to support an underdog in the family system, a chance for change within the total hierarchicalrelationship is fostered.• INTRODUCING UNCERTAINTYThe therapist can introduce some uncertainty into the problem definition by asking “What gives you theimpression that things seem difficult to handle?” Or he/she can imply that there are days when theproblem is nonexistent by asking “What is different about the days when things seem manageable?”• WORKING WITH SPONTANEOUS INTERACTIONIn addition to enactment, structural family therapists concentrate on spontaneous behaviours in sessions. It occurswhenever families display behaviours in sessions that are disruptive or dysfunctional, such as members yelling atone another or parents withdrawing from their children. The focus is on process not content. It is important thattherapists help families recognize patterns of interaction and what changes they might make to bring aboutmodification. 162
  • Summary of Family Therapy Theories & Techniques Theoretical Theorists Summary Techniques Model Also known as "Individual Psychology". Sees the person as a whole. Ideas include compensation for feelings of inferiority leading to striving for Psychoanalysis, TypicalAdlerian Family Alfred Adler significance toward a fictional final goal with a Day, Reorienting, Re-Therapy private logic. Birth order and mistaken goals are educating explored to examine mistaken motivations of children and adults in the family constellation. Individuals are shaped by their experiences with caregivers in the first three years of life. Used as a foundation for Object Relations Theory. TheAttachment John Bowlby, Mary Psychoanalysis, Play Strange Situation experiment with infants involvesTheory Ainsworth Therapy a systematic process of leaving a child alone in a room in order to assess the quality of their parental bond. Also known as “Intergenerational Family Therapy” (although there are also other schools of Murray Bowen, Betty intergenerational family therapy). Family members Carter, Philip Guerin, are driven to achieve a balance of internal and Michael Kerr, Thomas Detriangulation,Bowenian Family external differentiation, causing anxiety, Fogarty, Monica Nonanxious Presence,Systems triangulation, and emotional cutoff. Families are McGoldrick, Edwin Genograms, Coaching affected by nuclear family emotional processes, Friedman, Daniel sibling positions and multigenerational Papero transmission patterns resulting in an undifferentiated family ego mass. Problems are the result of operant conditioning Therapeutic Contracts, that reinforces negative behaviours within the Modeling, SystematicCognitive family’s interpersonal social exchanges that John Gottman, Albert Desensitization,Behavioural extinguish desired behaviour and promote Ellis, Albert Bandura Shaping, Charting,Family Therapy incentives toward unwanted behaviours. This can Examining Irrational lead to irrational beliefs and a faulty family Beliefs schema. Individuals form meanings about their experiences within the context of social relationship on a personal and organizational level. Collaborative therapists help families reorganize and dis-solve Harry Goolishian, Dialogical Conversation, their perceived problems through a transparentCollaborative Harlene Anderson, Tom Not Knowing, Curiosity, dialogue about inner thoughts with a “not-Language Systems Andersen, Lynn Being Public, Reflecting knowing” stance intended to illicit new meaning Hoffman, Peggy Penn Teams through conversation. Collaborative therapy is an approach that avoids a particular theoretical perspective in favor of a client-centered philosophical process.Communications Virginia Satir, John All people are born into a primary survival triad Equality, Modeling 163
  • Approaches Banmen, Jane Gerber, between themselves and their parents where they Communication, Family Maria Gomori adopt survival stances to protect their self-worth Life Chronology, Family from threats communicated by words and Sculpting, Metaphors, behaviours of their family members. Experiential Family Reconstruction therapists are interested in altering the overt and covert messages between family members that affect their body, mind and feelings in order to promote congruence and to validate each person’s inherent self-worth. Families are built upon an unconscious network of implicit loyalties between parents and children that Rebalancing, FamilyContextual Ivan Böszörményi- can be damaged when these “relational ethics” of Negotiations, Validation,Therapy Nagy fairness, trust, entitlement, mutuality and merit are Filial Debt Repayment breached. Couples and families can develop rigid patterns of interaction based on powerful emotional Reflecting, Validation,Emotion-Focused Sue Johnson, Les experiences that hinder emotional engagement and Heightening, Reframing,Therapy Greenberg trust. Treatment aims to enhance empathic Restructuring capabilities of family members by exploring deep- seated habits and modifying emotional cues. Stemming from Gestalt foundations, change and Carl Whitaker, David growth occurs through an existential encounter Battling, Constructive Kieth, Laura Roberto, with a therapist who is intentionally “real” and Anxiety, RedefiningExperiential Walter Kempler, John authentic with clients without pretense, often in a Symptoms, AffectiveFamily Therapy Warkentin, Thomas playful and sometimes absurd way as a means to Confrontation, Co- Malone, August Napier foster flexibility in the family and promote Therapy, Humor individuation. Complications from social and political disparity between genders are identified as underlying causes of conflict within a family system. Demystifying, Modeling,Feminist Family Therapists are encouraged to be aware of these Sandra Bern, Equality, PersonalTherapy influences in order to avoid perpetuating hidden Accountability oppression, biases and cultural stereotypes and to model an egalitarian perspective of healthy family relationships. A practical attempt by the “Milan Group” to establish therapeutic techniques based on Gregory Luigi Boscolo, Bateson’s cybernetics that disrupts unseen Hypothesizing, CircularMilan Systemic Gianfranco Cecchin, systemic patterns of control and games between Questioning, Neutrality,Family Therapy Mara Selvini Palazzoli, family members by challenging erroneous family Counterparadox Giuliana Prata beliefs and reworking the family’s linguistic assumptions. Families facing the challenges of major illness Goerge Engel, Susan experience a unique set of biological, Grief Work, FamilyMedical Family McDaniel, Jeri psychological and social difficulties that require a Meetings, Consultations,Therapy[39] Hepworth & William specialized skills of a therapist who understands Collaborative Doherty the complexities of the medical system, as well as Approaches the full spectrum of mental health theories and 164
  • techniques. Established by the Mental Research Institute (MRI) as a synthesis of ideas from multiple Reframing, Prescribing Gregory Bateson, theorists in order to interrupt misguided attempts the Symptom,MRI Brief Milton Erickson, Heinz by families to create first and second order change Relabeling, RestrainingTherapy von Foerster by persisting with “more of the same,” mixed (Going Slow), Bellac signals from unclear metacommunication and Ploy paradoxical double-bind messages. People use stories to make sense of their experience and to establish their identity as a social and political constructs based on local Deconstruction, Michael White, David knowledge. Narrative therapists avoid Externalizing Problems,Narrative Therapy Epston marginalizing their clients by positioning Mapping, Asking themselves as a co-editor of their reality with the Permission idea that “the person is not the problem, but the problem is the problem.” Individuals choose relationships that attempt to Detriangulation, Co- Hazan & Shaver, DavidObject Relations heal insecure attachments from childhood. Therapy, Scharff & Jill Scharff,Therapy Negative patterns established by their parents Psychoanalysis, Holding James Framo, (object) are projected onto their partners. Environment By applying the strategies of Freudian psychoanalysis to the family system therapists can Psychoanalysis,Psychoanalytic Nathan Ackerman gain insight into the interlocking Authenticity, Joining,Family Therapy psychopathologies of the family members and seek Confrontation to improve complementarity Kim Insoo Berg, Steve The inevitable onset of constant change leads to de Shazer, William negative interpretations of the past and language Future Focus, Beginner’sSolution Focused OHanlon, Michelle that shapes the meaning of an individual’s Mind, Miracle Question,Therapy Weiner-Davis, Paul situation, diminishing their hope and causing them Goal Setting, Scaling Watzlawick to overlook their own strengths and resources. Directives, Paradoxical Symptoms of dysfunction are purposeful in Injunctions, Positioning, Jay Haley, Cloe maintaining homeostasis in the family hierarchy asStrategic Therapy Metaphoric Tasks, Madanes it transitions through various stages in the family Restraining (Going life cycle. Slow) Joining, Family Salvador Minuchin, Family problems arise from maladaptive Mapping, Harry Aponte, Charles boundaries and subsystems that are created withinStructural Therapy Hypothesizing, Fishman, Braulio the overall family system of rules and rituals that Reenactments, Montalvo governs their interactions. Reframing, Unbalancing 165
  • Family Therapy Survey Nichols and Schwartz (1998)I. The Foundations of Family Therapy - Outline by David PeersA. The myth of the hero 1. The individual is unique and autonomous 2. Breaking free from childhood 3. The myth of rising above the human condition and individuation 4. Individuals are sustained by interpersonal relationships 5. Families are both withholding and uplifting - sometimes at the same timeB. Psychotherapeutic sanctuary 1. Therapy in isolation or in groups? 2. Freud and Rogers emphasized private patient/therapist relations 3. Freud: real family who needs it? The use of transference - the therapist as parent 4. Rogers: exploration of self and self - actualization. The need for approval 5. Rogers: support, unconditional positive regard, and the art of listeningC. Family vs. Individual therapy 1. Both are approaches to treatment and understandings of human behavior 2. Individual therapy a. Concentrated focus b. Internalization of personal dynamics 3. Family therapy a. External focus b. Changing organizations - change on the entire family, systemic 4. Are we separate entities or embedded in a network of relationships?D. Psychology and social context 1. Family therapy flourishes because of success and recognition of interconnectedness 2. Is psychotherapy intrapsychic or interpersonal? Perhaps both or neither? 3. Family therapy as an orientation rather than a technique 4. Uncovering family influences 5. Individuals within a system 166
  • E. The power of family therapy 1. Evolution from 1950’s to today 2.1975 - 1985 as golden age - shared optimism and common purpose 3. Problems may originate from interaction so change focuses on interactions 4. Questions: a. Constructivist notions? b. Narrative therapy? c. Integrative techniques? d. Social issues?F. Contemporary cultural influences 1. Managed health care a. Crisis intervention versus ongoing personal exploration? b. Confidentiality?. Prejudicial employers? 2. Postmodern skepticism a. Integrated schools of thought b. Approaches to clients or clients to approaches?G. Thinking in lines vs. Thinking in circles 1. Cause and effect perspectives - unilateral influence 2. Circles of thought as empowering 3. Transforming interactions 4. Major advantage of family therapy: works directly on unhappy relationships 5. The difficulty of change 6. Personal participation in problems 7. Circular problems - the cause is the result and the result the cause 8. Learning life’s painful lessons and understanding the family’s story 167
  • II. The Evolution Of Family Therapy - Outline by Lori RiceA. The undeclared war 1. 1950’s - - change in one person changes the system 2. Brown research with schizophrenic patients returning home (1959) 3. Current psychiatric hospital therapy and possible family segregationB. Small group dynamics 1. William Mcdougall - group mind 2. Lewin - group is more than the sum of its parts - - group discussions superior to individual instruction for changing ideas/behavior 3. Bion (1948) fight - flight, dependency, and pairing 4. Process/content in group dynamics 5. Role theories 6. Similarities between group and family therapiesC. Child guidance movement 1. Scholars publishing more than clinicians 2. Movement assumption: Emotional problems begin in childhood, therefore treat the child 3. Shift to include families in treatment, but typically blame parents for child’s problems Fromm - Reichmann’s schizophrenogenic motherD. The influence of social work 1. Family casework - families must be considered as units 2. Social workers among most influential in family therapyE. Research on family dynamics and the etiology of schizophrenia 1. Gregory Bateson a. Researched communication among animals b. Functions of communication: report and command, metacommunication c. Bateson joined by others to investigate conflicts between messages and qualifying messages d. Double bind 2. Theodore Lidz 3. Lyman Wynne - rubber fences, pseudomutuality, and pseudohostility 4. Role theorists marriage counseling 168
  • III. Early Models And Basic Techniques:Group Process And Communications AnalysisOutline by Sarah Sifers.A. Family therapy has a history of being condescendingB. Sketches of leading figures 1. Group family therapy (group) - Bell, Dreikurs, Midelfort, Foulkes, Skynner 2. Communications family therapy (communication) - Jackson, Haley, Bateson, SatirC. Theoretical formulations - group 1. Group/family leaders 2. Family defense mechanisms 3. Subgroups 4. Field theory (Lewin) - conflict is an ‘inevitable part of group life 5.Role theory - every group has roles that have "rules" for conduct (intra - and inter - role conflict, fit between personality and role)D. Theoretical formulations - communications 1. Black box - disregards individual complexity to focus on input and output (communication) 2. Circular causal (disregard past) 3. Syntax - - ways words are put together to make sentences 4. Semantics - clarity, private or shared communication systems, concordance versus confusion 5. Pragmatics - behavioral effects of communication 6. People are always communicating 7. Re ort - (content) conveys information 8. Command - statement about the definition of the relationship 9. Family rules - description of regular interactions 10. Family homeostasis - acceptable behavioral balance within the family 11. Complementary relationships - based on differences that fit together 12. Symmetrical relationships - based on equality and mirroring of behavior 13. Communication punctuation - organizes behavioral events and reflects observer bias 14. Negative feedback loop - perpetuates problems by maintaining status quo 15. Positive feedback loop - alters the system to accommodate novel input 169
  • E. Normal family development 1. Group a. Instrumental and expressive leaders b. Three phases of group development: inclusion, control, affection c. Cohesiveness d. Need compatibility 2. Communications a. Feedback loops b. Normal families become unbalanced during transitions in family life cycleF. Development of behavior disorders 1. Group - symptoms as products of disturbed and disturbing group processes - if needs continue to go unmet, symptoms may be perpetuated into a role and group organizes around a "sick" member 2. Communications - "identified patient" as a role with counterroles and complimentary roles that maintain the system - - - caused by pathological communication such as paradoxical injunctions/ double bindsG. Goals of therapy 1. Group - individuation of group members, personal growth, and improved relationships 2. Communications - change/prevent maladaptive interactions viii.H. Conditions for behavior chang 1. Group - help family members talk to each other, concentrating more on process than content, then explore those feelings 2. Communications - making covert messages behind symptoms overt. Therapist may manipulate the family be prescribing the symptom or therapeutic double binds, introducing positive feedback loopsI. Techniques of group family therapy 1. Therapist as process leader 2. Stages - child - centered, parent - centered, family - centered 3. Types of therapy - multiple group therapy, multiple impact therapy, network therapy 4. Resistance - anything that interfered with balanced self - expressionJ. Techniques of communications family therapy 1. Structured family interview (5 tasks) 2. Teaching rules of clear communication - (using "I", stating facts, talking to - not about) 3. Used family’s moment to circumvent resistance 4. Therapist as referee and reframer, making implicit rules explicit and using therapeutic paradox 170
  • K. Lessons from early models 1. Group - group dynamics, roles, process/content distinction, free and open discussion, reflective interpretations, connective interpretations, reconstructive interpretations, normative interpretations, networking, confronting, caveat - families aren’t egalitarian 2. Communications - double bind, metacommunication, homeostasis, rules, feedback loops, cybernetics, altering patterns of communication, paradoxical directives, symptoms - focused, focus on marital pairL. System’s anxiety 1. Therapists viewed family as being to blame for a "victim’s" illness and were, therefore, the enemy 2. Cybernetics and general systems theory helped clinicians understand families, but tend to dismiss selfhood as an illusionM. Stages of family therapy (checklists in text) 1. Initial call - keep it short 2. First interview - build alliance and hypothesize 3. Early phase of treatment - refining hypothesis and beginning to work on problems 4. Middle phase of treatment - family begins to take more active role 5. Termination - review and consolidateN. Family assessment 1. Presenting problem 2. Understanding referral route 3. Identifying systemic context (interpersonal context of presenting concern) 4. Stages of life cycle 5. Family structure 6. Communication 7. Drug and alcohol abuse 8. Domestic violence and sexual abuse 9. Extramarital involvement (not just sexual affairs) 10. Gender (roles, expectations, and society) 11. Cultural factors (including mainstream) 12. Ethical dimension (therapist and family’s ethics)O. Working with managed care - it’s necessary, so cooperate 171
  • IV. The Fundamental Concepts Of Family TherapyOutline by Anabella PavonA. Conceptual influences on the evolution of family therapy 1. Opening thoughts a. Systems theory i. Consensus among family therapists about systems theory - most influential in development ii. Consensus among family therapists about systems theory - don’t really know how to explain it iii. Systems theory - abstract concept; way of thinking rather than established doctrine b. Many influences on family therapy i. Biology v. Community mental health ii. Physiology vi. Anthropology iii. Cybernetics vii. Social work iv. Psychosomatic medicine 2. Functionalism a. Reaction to evolutionary method of removing from context b. Anthropology - Malinowski and Brown - need to study in context c. Functionalist premise - "...the adaptive value of any activity can be found if the behavior is viewed in the context of the environment" (pg. 110) d. Evolutionary theory and psychoanalysis e. Bateson f. Functionalist influence on family therapy i. Deviant behaviors may be functional - (scapegoats) ii. Brass tacks - families are organisms adapting to environment in context - problems with family show problems with adjustment to environment iii. Problem - "us against them" 3. General systems theory - Bertalanffy - a misinterpretation a. All systems are subsystems b. What did family therapy forget? Larger systems c. Is it important for family therapists to consider values? 4. Cybernetics of families a. Weiner’s idea of self - correcting systems b. Feedback loop i. Negative feedback loop - reduces deviation or change ii. Positive feedback loop - amplifies deviation or change c. Cybernetics applications to families: family rules, neg. Feedback, sequences of interactions, positive feedback loops when neg. Feedback loops don’t work d. Metacommunicating - communicating about communicating e. Bateson - introduced concept to family therapy - movement from linear circular causality f. Split - Haley control and power vs. Bateson 172
  • 5. From cybernetics to structure a. Haley - coalitions b. Structural concept of families - subsystems with boundaries c. Basic premise - chance structural context, change individual d. Minuchin - cartographer of family structure 6. Satir’s humanizing effect - look at nurturance instead of control 7. Bowen and differentiation of self a. Undifferentiated family ego mass b. Differentiation of self c. Multigenerational transmission process 8. Family life cycleB. Enduring concepts and methods 1. Interconnectedness 2. Sequences of interaction a. Triangles b. Circular sequences c. Indirect communication 3. Family structure 4. Function of the symptom 5. Circumventing resistance 6. The nonpathological view of people 7. Family of origin 8. Focussing on solutions 9. Changing a family’s narrative 10. The influence of culture 173
  • V. Bowen Family Systems TherapyOutline by Jared WarrenA. Sketches of leading figures 1. Murray Bowen 2. Philip Guerin 3. Thomas Fogarty 4. Betty Carter 5. Monica McGoldrick 6 Edwin Friedman 7. Michael Kerr 8. James FramoB. Theoretical formulations 1. Differentiation of self 2. Triangles 3. Nuclear family emotional process 4. Family projection process 5. Multigenerational transmission process 6. Sibling position 7. Emotional cutoff 8. Societal emotional processC. Normal family development 1. All families lie on continuum from emotional fusion to differentiation 2. Optimal family development: good differentiation, low anxiety, parents in good emotional contact with families of origin 3. Fogarty elaborates 12 characteristics of well - adjusted families in "systems concepts and the dimensions of self’ (1976) 4. Hallmark of well adjusted person is rational objectivity and individuality 5. Carter and mcgoldrick elaborated the family life cycle a. Leaving home b. Joining of families through marriage c. Families with young children d. Adolescence e. Launching children and moving on f. Families in later life 6. First - order change vs. Second - order change 174
  • D. Development of behaviour disorders 1. Symptoms develop when level of anxiety exceeds system’s ability to cope 2. Most vulnerable individual is most likely to develop symptoms 3. Bowen’s primary approach: calm down the parents and coach them to deal more effectively with the problem 4. Guerin and fogarty put more emphasis on relationship with symptomatic child and nuclear family triangles 5. According to bowen, behavior disorders result from emotional fusion transmitted from one generation to the nextE. Goals of therapy 1. Keys to therapy: process and structure 2. Primary goals: decrease anxiety and increase differentiation of self 3. Creation of new triangle in therapy between husband, wife, and emotionally neutral therapist 4. Goals for extended family: developing one - to - one relationships and avoiding triangles 5. Approaches of Guerin and McGoldrickF. Conditions for behavior change 1. Therapists must avoid taking sides and promoting triangulation, and avoid being reactive to inevitable emotionality in families 2. Change requires awareness of entire family 3. Development of personal relationship with everyone in familyG. Techniques 1. Bowenian therapy with couples a. Use of displacement b. Therapist concentrates on process of couple’s interactions c. Use of the "i - position" d. Didactic teaching 2. Bowenian therapy with one person a. Goal of differentiation b. Genograms c. Identifying triangles, reentry into family of originH. Evaluating therapy theory and results 1. Major shortcoming: can neglect importance of working directly with nuclear family 2. Evaluation has relied more on clinical reports than empirical dataI. Summary - Seven prominent techniques 1. Genogram 2. The therapy triangle 3. Relationship experiments 4. Coaching 5. The "I-position" 6. Multiple family therapy 7. Displacement stories 175
  • VI. Experiential Family Therapy Outline by Sarah SifersA. Leading figures and background 1. Emerged in the 1960s from humanistic psychology and drew heavily from gestalt therapy and encounter groups (it is not very popular today) 2. Carl Whitaker 3. Virginia Satir (yes, the same one from communications family therapy) 4. Walter Kempler 5. Bunny and Fred Duhl 6. David Kantor 7. Current figures: Leslie Greenberg and Susan JohnsonB. Theoretical formulations 1. Commitment to freedom, individuality, personal awareness, individuals’ goals and values, self - expression, and personal fulfillment, but largely atheoretical 2. There is a wide variety of perspectives that a rather loosely connected under the heading of experiential family therapyC. Normal family development a. Continuous growth and change and flexibility b. Nurtures and supports individualgrowth and experience (which leads to increased growth in the family) open (say anything) and constructiveproblem solving c. Natural and spontaneous; freedom, privacy, and togethernessD. Development of behavior disorders 1. Family and societal pressures prevent naturally occurring self - actualization 2. Denial of impulses and suppression of feelings (emotional deadness) 3. Seeking security and stability (rigid) rather than satisfaction 4. Loyalty to family stressed over loyalty to self 5. Mystification - smothering emotion and desire 6. Marriages consist of two people trying to work out conflicts that arise from each trying to reconstruct his or her family of origin and their differences frighten them causing them to cling closer together 7. Includes "normal" difficulties such as infidelity or "quiet desperation"and "invisible" (culturally accepted) symptoms such as overwork and smoking 8. Intrapsychic defenses that lead to interpersonal problems 9. Getting stuck during a life transition or change 10. Lack of warmth >>> avoidance >>> preoccupation with outside activities 11. "wrong" communication: blaming, placating, being irrelevant, and being super reasonable 176
  • E. Goals of therapy 1. Find fulfilling roles for self that don’t override concern for the needs of the family as a whole (personal growth and family integration) 2. Increased self - awareness and expression that facilitates open family communication (you can’t communicate what you’re not aware of) 3. Growth, personal integrity, freedom of choice, less dependence, "expanded experience," increased sense of competence, self - esteem, and well - being 4. Openly acknowledge support, and make use of individual differences 5. Being spontaneous, "crazy"F. Conditions for behavior change 1. Evocative measures (resulting in anger, anxiety, etc.) To create therapeutic change by opening people up or discover hidden emotions 2. Therapist must be warm and supportive, become a family member, be a "real person" 3. Therapist teaches by example how to be open, honest, and spontaneous 4. Including as many family members as possible (3 generations and kids) 5. Therapist needs to be mature, experienced, and have a satisfying family lifeG. techniques 1. Clarifying communication (often through directives) 2. Focus on solutions rather than past grievances and point out positives 3. Support all family members’ self - esteem 4. Asking questions about emotions that are not expressed clearly (ind. Nonverbal cues) 5. Use of touch 6. Use of co - therapists to manage counter - transference 7. Very little formal assessment or history taking 8. Specific techniques (see book for description): family sculpture, family puppet interviews, family art therapy, conjoint family drawings, gestalt therapy techniques, symbolic drawing of family life space, role playing, there - and then techniques, "psychotherapy of the absurd" 9. Interrupting family dialogues to work with individualsH. Evaluation 1. No empirical studies, but some anecdotal support 2. Family therapists would benefit from being more honest and open with clients 3. Shifting the focus to an individual is a way to stop family bickering 177
  • VII. Psychoanalytic Family Therapy Outline by Anabella PavonA. Introduction 1. Many early family therapists have their roots in psychoanalytic training 2. Several psychodynamic therapists completely turned away from looking at the individual 3. 80s - family therapists looked at the individual again 4. Paradox: psychoanalysis is for the individual, family therapy the family. How can there be Psychoanalytic family therapy?B. Sketches of leading figures 1. Four groups of contributors to psychoanalytic family therapy - forerunners, psychoanalytically trained pioneers, psychoanalytic ideas and thoughts when the field turned from psychoanalytic ideas, and contemporary psychoanalytic family therapists 2. Adelaide Johnson - superego lacunae - gaps in personal morality passes on by parents 3. Erik Erikson - sociology and ego psychology 4. Wait ... There’s more - Erich Fromm predecessor of Bowen, Sullivan, Wynne, Lidz, Acherman - strongest tie to psychoanalytic theory 5. Nathan Acherman - the psychodynamics of family life (1958) - first book dealing strictly with diagnosis and treatment of families 6. Ivan Boszormenyi - Nagy - center of family therapy at the eastern Pennsylvania Psychiatric Institute. 7. Dicks - worked with couples in England 8. John BowlbyC. Theoretical formulations 1. "Practical essence of psychoanalytic theory is being able to recognized and interpret Unconscious impulses and defenses against them .... 2. Freudian drive psychology - sexual and aggression 3. Self psychology - people want to be appreciated 4. Object relations theory - bridge between psychoanalysis and family therapy - relate to people in the present partially based on expectations we develop in early relationshipsD. Normal family development 1. Healthy psychological development based on good early environment - parents - good object relations 2. Lots of talk about the mother and early mother/child attachment 3. Separation/individuation - provision of reliable support from mother is necessary 4. Parents need to be empathetic and model idealization 5. Ivan Boszormenyi - Nagy - contextual therapy - concerned with the ethics of families "loyalty and trust provide the glue that holds families together" 178
  • E. Development of behavior disorders 1. Where non - psychoanalytic family therapist look at problems in interactions between people while psychoanalytic therapists look at problems in the actual people in the family 2. Symptoms come from attempting to cope with unconscious conflicts and the Anxiety that signals the emergence of repressed impulses" 3. Some problems can occur with parents not accepting children’s separation 4. Kohut - mirroring and idealization - when these needs aren’t met from parents, go on to be showy and seek admiration 5. Fixation and regression in families - after marriage, people can go back to behaviors seen when they were younger 6. Nnagy - symptoms occur when trust breaks down in relationships - individuals feel the effects 7. Kernberg - blurred boundaries occur when connections are formed with family membersF. Goals of therapy 1. " . . . Free family members of unconscious restrictions so that they’ll be able to interact with one another as whole, healthy persons on the basis of current realities rather than Unconscious images of the past." 2. Therapy focuses on supporting defenses and helping communication instead of analysis of defenses and finding repressed needs and impulsesG. Conditions for behavior change 1. Insight is necessary - in family therapy expand that insight knowing that psychological life goes beyond conscious experiences. Want family members to understand and accept repressed parts of personalities. Need to work through those things. 2. Important for the therapist to establish a sense of securityH. Techniques 1. Four basic techniques - listening, empathy, interpretation, and keep analytic neutrality 2. Don’t focus on reassuring or advise or confronting, silence is important. If they do intervene it’s to provide empathic understanding to help member of the family open up. Analysts also clarify things that appear to be hidden or need clarification 3. Mostly used with couples. 4. Therapists focus on the feelings associated with problems, not the causality to begin questioning about what’s at the root of the problem 5. Explore in four areas with couples: internal experience, history of the experience, how partner can trigger the experience, and how the context of session and therapist’s input might contribute to the situation 6. "Family dynamics are more than the additive sum of individual dynamics" (p. 228) 7. Therapist has to have a hypothesis 179
  • VIII. Structure Family Therapy — Outline by Patty SalehpurA. Assumptions 1. Family are individuals who effect each other in powerful but unpredicatable ways 2. The consistent repetitive organized and predictable patterns of family behavior are important 3. The emotional boundaries and coalitions are importantB. Salvador Minuchin 1. Always concerned with social issues 2. Developed a theory of family structure and guidelines to organize therapeutic techniques 3. 1970 headed Philadelphia Child Guidance Clinic where family therapists have been trained in structural family therapy ever since 4. Born in Argentina , served in the Israel army as a physician, in the USA trained in child psychiatry and psychoanalysis with Nathan Ackerman, worked in Israel with displaced children, also worked in the USA with Don Jackson with middle class families. 5. Fist generation of family structural therapists: Braulio Montalvo, Jay Haley, Bernie Rosman, Harry Aponte, Carter Umbarger, Marianne Fishman, Cloe Madanes, and Stephen Greenstein.C. Theoretical formulations - three essential constructs 1. Structure — the organized pattern in which family members interact, predictable sequences of family interaction, patterns of interaction. Structure involves a series of covert rules. There are universal and idiosyncratic constraints. Families may not be able to tell you the family structure, but they will show it to you in their interactions. 2. Subsystems — Families are differentiated into subsystems of members who join together to perform various functions. Each person is a member of one or more subsystems in the family. Some groupings are obvious and based on such factors as generation, gender, age or common interests. Other coalitions may be subtle. Every member may play many roles in various subgroups. 3. Boundaries are invisible barriers that regulate the amount and nature of contact with members. They range from rigid to diffuse, clear to unclear, disengaged to enmeshedD. Normal family development1. Marriage begins with accommodation and boundary making2. Couples are influenced by the structure of their families of origin3. Couples also form boundaries with their families of origin4. The advent of children requires that the structure of the family changeE. The development of behavior disorders1. Family dysfunction results from stress and failure to realign the structure to cope with it.2. Disengaged families have rigid boundaries and excessive emotional distance. They fail to mobilize to deal withthe stress.3. Enmeshed families have diffuse boundaries and family members overreact emotionally and become intrusivelyinvolved with one another. These actions hinder mature actions to resolve stress.4. Subsystems in the family may be disengaged or enmeshed.5. Power hierarchies may develop which may be weak and ineffective or rigid and arbitrary.6. Conflict avoidance prevents effective problem solving. 180
  • 7. Generational coalitions may also prevent effective problem solving.8. Family structure may fail to adjust to family developmental processes.9. A major change in family composition demands structural adaptation.10. Symptoms in one family member may reflect dysfunctional structural relationships or simply individualproblems.F. Goals of therapy 1. Changing family structure - altering boundaries and realigning subsystems 2. Symptomatic change - growth of the individual while preserving the mutual support of the family 3. Short-range goals may be developed to alleviate symptoms especially in life threatening disorders such as anorexia nervosa, but for long-lasting effective functioning the structure must change. Behavioral techniques fit into these short-term strategies.G. Techniques — join, map, transform structure 1. Joining and accommodating, then taking a position of leadership a. Listen to "I" statements 2. Enactment for understanding and change 3. Working with interaction and mapping the underlying structure a. Looking at the power hierarchies b. Using enactment to understand and clarify c. Looking at the boundary structures 4. Diagnosing a. individual vs. subgroup b. structural diagnosis 5. Highlighting and modifying interpersonal interactions is essential a. Control intensity by the regulation of affect, repetition and duration b. Don’t dilute the intensity through overqualifying, apologizing or rambling c. Shape competence, e.g. "It’s too noisy in here. Would you quiet the kids." 6. Boundary making and boundary strengthening a. Seating b. Seeing subgroups or individuals to foster boundaries and indivduation c. Clarify circular causation 7. Unbalancing may be necessary a. Taking sides b. Challenging c. Directives 8. Challenging the family’s assumptions may be necessary a. Teaching may be necessary b. Pragmatic fictions c. Paradoxes d. Therapist sometimes must challenge the way family members perceive reality, changing the way family member relate to each other offers alternative views of reality. 9. Therapists must create techniques to fit each unique family 181
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