Definitions of marriage, family types and counseling goals

Definitions of basic concepts
Meaning of Marriage & Family
What is marriage? Legal union between a man &
woman, united sexually, cooperate economically, and
may have children
• Bond between a man & woman
• Commitment
• Intimacy and sexually unite (a defining reason why
many marriages stay together)
• Cooperate economically
• May give birth or adopt
• Benefits: Live longer, healthier, fewer accidents.
• Legally recognized union

Introduction (cont.)
Culture defines of marriage
• Monogamy: one man, one woman. All 1st world countries are
monogamous.
• Polygamy - more than one wife or husband. Example: Islam &
Fundamental Mormons
• Bigamy – Marrying another person while still married to someone
else. It is against the law.
• Serial Monogamy or Modified Polygamy – Succession of marriages
over time. Typical of US marriages.
The Family as a System
 The family can be viewed as a system composed of various
subsystems, such as the marital subsystem, parent-child
subsystems, and sibling subsystem.
 Nuclear family: Mom, Dad, Kids
 Traditional family: Father bread winner, Mom is homemaker

Family cont,ed
None of us live utterly alone.
 Family is the primary unit where individuals find their self-identity
and desire to live.
A rigid definition of family involves persons united by ties of
marriage, blood, or adoption.
The members of a family have a common habitat, share same roof
and constitute a single house hold.
They interact and communicate with each other in the performance
of roles, as spouse, mother and father, son, daughter, etc.
The family maintains a common culture, but may operationalize it
differently.
A rather loose definition of family connotes a group of individuals
who live together during important phase of their lifetime and are
bound to each other by biological or social or psychological
relationship.

FUNCTIONS OF MARRIAGES AND FAMILIES
(cont.)
• First it provides a source of intimate relationships.
• Second, it acts as a unit of economic cooperation and
consumption.
• Third, it may produce and socialize children.
• Fourth, it assigns social roles and status to individuals.
• Intimate Relationships
• Intimacy is a primary human need.
• In our families we generally find our strongest bonds.
• Economic Cooperation
• The family is also a unit of economic cooperation that
traditionally divides its lines between male and female
roles.

FUNCTIONS OF MARRIAGES AND FA (cont.)
• Reproduction and Socialization
• Teaching the child how to fit into his or her particular
culture is one of the family’s most important tasks.
• The socialization function, however, is dramatically
shifting away from the family.
• Assignment of Social Role Status
• The family of orientation or origin is the family in which
we grow up, the family that orients us to the world.
• The family of procreation is the family we form through
marriage and childbearing.
• The family of cohabitation refers to the form through
living or cohabitation, whether married or unmarried.

Family Types
Advantages and
Disadvantages

Family Types
 Family- individuals related to each
other biologically or legally.
 Nuclear family- made up of a father,
mother and one or more biological
children.
 Extended family- Includes relatives in
a family: grandparents, aunts, uncles,
and cousins.

Family Types
 Single-parent family- one parent and at least
1 child.
 The blended family: is a family unit in which
one or both of the spouses have been previously
married and bring a child or children to the
relationship
 Adoptive family- Parents and one or more
children that are permanently and legally placed
in the home.
 Foster family- serves as a temporary family for
a child.

Nuclear Families
ADVANTAGES
 An intact family is the basic social unit.
 A mother and father support one
another in raising children.
 Children benefit from learning how
adult males and females interact in a
happy marriage.
 Can be more financially stable.

Nuclear Families
DISADVANTAGES
 Parents may disagree on how to raise
the children

Extended Families
Advantages
 More opportunities to gain knowledge
from elders.
 More possibilities for assistance with
child care.
 Extra help with household, discipline,
and other parental responsibilities

Extended Families
Disadvantages
 Many authority figures
 More people to share the space
 Added responsibilities of elderly
individuals

Single Parent
Advantages
 Only one authority figure for the
children to answer to.
 Less parental conflict in the family.

Single Parenting
Disdvantages
 Total financial responsibility
 Child care for young children can be a
challenge
 Limited time to spend with each child due
to balancing job and family.
 Lack of same sex role model for children.
 Stress due to total responsibility for family

Blended Families
Advantages
 An “instant family” has formed.
 Opportunity to have brothers and
sisters.
 Someone to share responsibilities for
child care, finances, and parenting.

Blended Families
Disadvantages
 Challenge adjusting to presence and
needs of new people in the family.
 Difficulty sharing parents and family
resources.
 Difficulty with accepting the new
authority figure.

Adoptive Families
Advantages
 Solution for people who can’t have
children.
 Adults provide a stable, loving
environment for a child in need of a
family.

Adoptive Families
Disadvantages
 Children may feel rejected by biological
parents.
 There may be a short transition period
to parenthood.
 Period of adjustment and acceptance is
needed for older children.

Foster Families
Advantages
 Supply temporary care for children in
need.
 Provide emotional support to the child
in trying times.
 Provide a family environment.

Foster Families
Disadvantages
 Children may have emotional and legal
issues from their birth parents.
 Frequent adjustments due to instability
in family placement.
 Competition with biological and other
foster children in the families.

Extended Family
Challenges
 Grandmother has retired and has
moved into your house. What issues
may come up that will need to be
handled in the family?
 Do multiple authority figures in a family
cause problems? How should they be
handled?

Single-Parent
Challenges
 How does the lack of a male or female
role model affect the children?
 How does the lack of a second income
affect the family?
 How are children affected by not
spending as much time with their
parent due to work obligations?

Blended Family
Challenges
 Are there ever times when the original
family will need to be alone, without the
inclusion of the new members?
 How will the decision about how to spend
holidays be made? What traditions will be
maintained and what new ones will be
adopted? Who will decide?
 Should a blended family live in the original
home of one of the families or should they
find a new residence? Could staying in the
old home cause problems?

Blended Family
Challenges
 The new parent has brought two new children into the
family of three existing children. How should physical
space be divided?
 How should the discipline be handled? Who will
discipline the children? Will both parents be
responsible for disciplining all the children?
 Who will decide upon issues such as household chores
and responsibilities? How is the work divided?
 What name will each new parent be called?

Adoptive Family
Challenges
 Should adoptive families tell their
children they are adopted?
 Should adopted children find their
biological parents?
 If you adopted a child how would you
handle these 2 issues?

Foster Family
Challenges
 When a child is placed in Foster Care
does it have an affect on the family?
 Should Foster children be treated
differently than biological children in a
family?
 Are Foster Care families a good thing?

1. 2. Classifications of family, marriage and family &
marriage counselling
• Marriage: a legal relationship between two people
living together as sexual partners.
• Marriage counseling: is intended to help couples
talk constructively about problems in their
relationship.
• This approach focuses on the need of each partner to
understand the point of view and feelings of the other,
and to identify positive aspects of the relationship as
well as those that may be causing conflicts.
• Family is a group of two people or more related by
birth, marriage, or adoption and residing together

Classifications of family, marriage and family &
marriage counselling (cont.)
• Family therapy: a form of intervention in which
members of a family are assisted to identify and
change problematic, maladaptive, self-defeating,
repetitive relationship patterns.
• Marriage and family counseling/ therapy: is focuses
on the well-being of primary relationships and
systems.

1.3. Goals of Marriage and Family Counseling
• The central aim of family therapy is to facilitate the resolution of
presenting problems and to promote healthy family development
by focusing primarily on the relationships between the person with
the problem and signiﬁcant members of his or her family and social
network.
• Family therapy is a broad psychotherapeutic movement that
contains many constituent schools and traditions.
• These many schools and traditions may be classiﬁed in terms of
their emphasis on:
– (1) problem-maintaining behaviour patterns;
– (2) Problematic and constraining belief systems and narratives; and
– (3) Historical and contextual predisposing factors.

Generally Goals of Marriage and Family Counseling
1. Exploring the interactional dynamics of the family and its
relationship to psychopathology
2. Mobilizing the family’s internal strength and functional resources
3. Restructuring the maladaptive interactional family styles
4. Strengthening the family’s problem-solving behavior
5. To provide a safe and acceptable environment for the family to
discuss their problems
6. To help the family members express their feelings of shame, guilt,
fear and hurt
7. To help them grow out of their dysfunctional coping behavior
8. To help the family to clarify their problems and set realistic goals

How Does Marriage and Family Therapy Differ
from Individual or Group Psychotherapy?
• Marriage and family therapy differs from individual or
group psychotherapy in focus and process.
• It focuses primarily on couple or family relation ships and
systems, and only secondarily on individuals.
• In contrast, traditional individual or group psychotherapy
focuses primarily on individual mental health, and
secondarily on family relationships.
• The process of marriage and family therapy tends to
involve facilitation of communication between family
members.
• In contrast, the process of traditional psychotherapy tends
to involve more inter action between client and therapist.

Infidelity
 Infidelity
– “the breaking of trust”
“Infidelity occurs when one partner in a
relationship continues to believe that the
agreement to be faithful is still in force,
while the other partner is secretly violating
it.”

Infidelity
Testing for Emotional Bonds
1. Do you confide more to your friend than your
mate/partner?
2. Do you discuss negative feelings or intimate details
about your marriage/relationship?
3. Are you open with your mate/partner about the
extent of your involvement with your friend?
4. Would you feel comfortable if your mate/partner
heard your conversations with your friend?

Infidelity
Testing for Emotional Bonds (continued)
5. Would you feel comfortable if your mate/partner saw
a videotape of your meetings?
6. Are you aware of sexual tensions in this friendship?
7. Do you and your friend touch differently when your’re
alone than in front of others?
8. Are you in love with your friend?
(Glass, 1988)

Infidelity
 Factors contributing to affairs:
– not understanding what relational love is
– inability to communicate feelings or needs
– not having the verbal skills to solve problems
together
– not being able to accommodate to one another’s
needs or interests
– not really knowing the person (your partner)
– not being able to cope with cultural or ethnic
differences

Infidelity
 Factors (continued)
– unrealistic expectations about the nature of a
committed relationship
– disappointment that your mate has not grown in
the same ways you have
– sexual curiosity
– emotional need (feeling lonely in the relationship
and looking elsewhere)
– sexual addiction

Infidelity
 Factors (continued)
– boredom
– losing the sense of fun and excitement you once
had as a couple
– getting so caught up in life’s daily obligations that
you lose sight of one another

Types of Infidelity:
Emotional vs. Sexual
• Emotional infidelity = when an individual who is in
a committed relationship feels romantic love
toward a person other than their mate
• Sexual infidelity = when one partner engages in
sexual activity with a person other than their
mate

Guilt
• Guilt has been defined as “an interpersonal
phenomenon that is functionally and causally
linked to communal relationships of people…
It is a mechanism for alleviated imbalances or
inequities in emotional distress within the
relationship”
(Baumeister, Stillwell, and Heatherton, 1994, p.243).
• Guilt is a primary consequence of infidelity
• Guilt is influenced by intent

The Study
• Men are predicted to experience more guilt from an
imagined performance of emotional infidelity
• Women will experience more guilt from an imagined
performance of sexual infidelity
• Women will expect their partner to have more
difficulty forgiving sexual infidelity
• Men will expect partner to have more difficulty
forgiving emotional infidelity

The Findings:
Sex differences in feelings of guilt
• Women feel guiltier following emotional infidelity
• Men feel guiltier following sexual infidelity
– Men reported experiencing less guilt than women
following both sexual and emotional infidelity
• Both men and women believe their
partners would have a harder time
forgiving sexual infidelity

Sex Differences in Feelings of Guilt:
Cross-Sex Mind Reading
• Results suggest an absence of cross-sex mind reading
which may lead to false inferences
Perception
• Women perceive their affairs to be more emotional,
while men perceive their affairs as sexual
Intra-Sexual Competition
• Men may experience more guilt related to sexual
infidelity because they know other men experience
feelings of jealousy over sexual infidelity

1.4. Individual & Family Development
• The 'life course' refers to different time dimensions
such as individual time (the time from birth to death),
social time (important social events such as marriage,
parenthood, and retirement), and historical time (the
era and culture in which one lives).
• The term 'life cycle' is used to describe the continuous
development of people over time. Individuals and
families experience predictable events and
developmental crises (changes) which are often
sequential.
• Life cycle stages require some level of success at each
stage before proceeding to the next stage.

Stages of Family Development
Stage 1. The Single Young Adult
 Goal: Accepting separation from
parents and responsibility for self
 Tasks
– Forming an identity separate
from that of parents
– Establishing intimate peer relationships
– Advancing toward financial independence
 Problems arise when either the young adult or
the
parents have difficulty separating from the
previous
interdependent relationship.

Stages of Family Development (cont.)
Stage 2. The Newly Married Couple
 Goal: Commitment to the new system
 Tasks
– Establishing a new identity
as a couple
– Realigning relationships with members of the
extended family
– Making decisions about having children
 Problems arise when either partner has difficulty
separating from family of origin or when the couple cut
themselves off completely from extended family.

Stage 3. The Family with Young Children
 Goal: Accepting a new generation
of members into the system
 Tasks
– Adjusting the marital relationship
to accommodate parental
responsibilities while preserving
the integrity of the couple relationship
– Sharing equally in the tasks of child-rearing
– Integrating the roles of extended family members
into the family
 Problems arise when the parents’ lack of knowledge about
normal childhood development interferes with satisfactory
child-rearing.

Stage 4. The Family with Adolescents
 Goal: Increasing the flexibility of
family boundaries to include
children’s independence and
grandparents’ increasing
dependence
 Tasks
– Shifting of parent-child relationships to permit
adolescents to move in and out of the system
– Refocusing on midlife marital and career
issues
– Beginning a shift toward concern for the older
generation
 Problems arise when parents are unable to
relinquish control and allow the adolescent
increasing autonomy or when the parents cannot
agree and support each other in this effort.

Stage 5. The Family Launching Grown Children
 Goal: Accepting a multitude
of exits from and entries into the
family system
 Tasks
– Renegotiation of marital system as a dyad
– Development of adult-to-adult relationships
between grown children and parents
– Realignment of relationships to include in-laws
and grandchildren
– Dealing with disabilities and death of parents
(grandparents)
 Problems arise when parents are unable to accept the
departure of their children from the home and their status
as adults, or
the death of their own parents,
or when the marital bond has
deteriorated.

Stage 6. The Family in Later Life
 Goal: Accepting the shifting of
generational roles
 Tasks
– Maintaining own and/or couple functioning and
interests in face of physiological decline
– Exploration of new familial and social role options
– Support for a more central role
for the middle generation
– Dealing with loss of spouse,
siblings, and other peers, and preparation for own
death; life review and integration
 Problems arise when older adults have failed to
fulfill the tasks of earlier stages and are
dissatisfied with the way their lives have gone.

Major Variations
Divorce
 Currently in the United States,
about half of all first marriages
end in divorce.
 There is some indication that this trend may be declining.
 Stages in the family life cycle of divorce
– Deciding to divorce
– Planning the breakup of the system
– Separation
– Divorce
 Tasks
– Accepting one’s own part in
the failure of the marriage
– Working cooperatively on
problems related to custody
and visitation of children and finances
– Realigning relationships with extended family
– Mourning the loss of the marriage relationship and the
intact family

Major Variations (cont.)
Remarriage
 About three-fourths of those who divorce eventually remarry. The
rate of redivorce for remarried couples is even higher than the
divorce rate after first marriages.
 Stages in the remarried family life cycle
– Entering the new relationship
– Planning the new marriage and family
– Remarriage and reestablishment of family
 Tasks
– Making a firm commitment to confront the complexities
of combining two families
– Maintaining open communication
– Facing fears
– Realigning relationships with extended family to include
new spouse and children
– Encouraging healthy relationships with biological
(noncustodial) parents and grandparents
 Problems arise when there is a blurring of boundaries
between custodial and noncustodial families.

Major Variations (cont.)
Cultural Variations
 Caution must be taken in generalizing about variations
in family life cycle development according to culture.
 Marriage
– Attitudes toward marriage are strongly influenced by Roman
Catholicism in many Italian American and Latino American
families.
– In Asian American families, although marriages are no longer
arranged, strong family influence on mate selection still exists.
– Jewish American families are as diverse as the mainstream
culture.
– In many ethnic subcultures, the father is considered the
authority figure and head of the household, and the mother
assumes the role of homemaker and caretaker.

Cultural Variations (cont.)
 Children
– Roman Catholicism promotes marital relations for
procreation, and large numbers of children are
encouraged.
– In the traditional Jewish community, having
children is seen as a scriptural and social
obligation.
– In traditional Asian American cultures, sons are
more highly valued than daughters, and the most
important child is the oldest son.
 Extended family
– Older family members are valued for their wisdom in
Asian, Latino, Italian, and Iranian subcultures.
– Several generations within these subcultures may live
together and share tasks of child-rearing.

Cultural Variations (cont.)
 Divorce
– In the Jewish community, divorce is often seen as
a violation of family togetherness.
– Because of the opposition to divorce by Roman
Catholicism, a low rate of divorce has existed
among those cultures that are largely Catholic.

Some Outcomes
of Separation
Not all separations end in divorce.
Sometimes people reconcile and try
and give their marriage a second try.
Research is sketchy on reconciliation,
but approximately 10% of couples
who have separated do reconcile.

Separation without Divorce
About 6% of couples never make the
divorce final. Even though they go
through the process and do the
necessary paperwork, they don’t get
the final decision from the judge.
They may in fact think they are
divorced when they are not.

Separation and Divorce
Divorce has been around as long as marriage
has been around.
– Trends in Divorce
• Over a lifetime between 43 to 46% of
marriages end in divorce.
• Divorce rates have actually been
decreasing throughout the 20th
century.
• Divorce rates are lower today than
they were between 1975 and 1990.

The Process of Divorce
Few divorces are spontaneous acts. It
is usually spread over a long period of
time during which couples gradually
redefine their relationships and their
expectations of each other.

Emotional Divorce
The emotional divorce begins long
before any legal steps are taken. One
or both partners may feel disillusioned
or unhappy in the marriage.
The couple may share the house and
the rearing of the children but may not
be emotionally sharing a life.

Legal Divorce
The legal divorce is the formal
dissolution of a marriage. During this
stage, couples reach agreements on
issues like custody of children and an
economic dissolution of assets. Some
issues may include alimony and child
support.

Economic Divorce
During the economic divorce the
couple may argue about what bills
each will be responsible for.
Coparental divorce involves
agreements about legal responsibility
for financial support of the children
and of school or day care
responsibilities.

Community Divorce
Partners go through community
divorce when they inform family and
friends, teachers, and others that they
are no longer together.
Some people actually send out formal
cards announcing their divorce; others
do it more informally.

Psychic Divorce
The psychic divorce is the final stage, in
which the couple separate from each
other emotionally and establish separate
lives.
One or both spouses may undergo a
period of mourning. Some never
complete this stage because they cannot
let go of the pain, anger, and resentment
toward the spouse.

Why Do People Divorce?
People divorce for three interrelated
reasons:
1. macro-level or social reasons
2. demographic variables
3. micro-level or interpersonal reasons

Military service—increases marital
quality due to access to higher
education and better job opportunities,
thus puts less stress on a marriage.
However, the wars in Iraq and
Afghanistan have been seen as
increasing the divorce rate as couples
spend less time together.

– Cultural values—Americans’ acceptance
of divorce has grown.
– Social integration —social bonds have
decreased.
– Technology—has made divorce more
accessible and affordable.

Demographic Variables
and Divorce
– Parental divorce—if the parents of one or both
of the couple were divorced when the couple
were young children there is more of a chance
that the couple themselves will divorce.
– Age at marriage —a number of studies have
found that early age at marriage, especially
younger than 18, increases the chance of
divorce.
– Premarital pregnancy and childbearing—
women who conceive or give birth to a child
before marriage have higher divorce rates than
those who don’t.

and Divorce
– Premarital cohabitation—couples who live
together before marriage have a higher divorce
rate than those who don’t. Studies have shown
that cohabitators have a more lenient attitude
toward divorce and less commitment.
– Presence of children—the presence of
especially young children in the home seems to
deter divorce, perhaps because it would be
more costly.
– Gender—women are twice as likely as men to
initiate a divorce.

and Divorce
– Race and ethnicity—divorce rates vary by
race and ethnicity. In 2007, 12% of blacks in
the U.S. were divorced, compared with 11%
of whites, 8% of Latinos, and 4% of Asians.
Across all ethic groups, African American
women have the lowest marriage rates but
higher divorce rates than Latinas or Asian
women.
– Social class—low educational attainment,
high unemployment rates, and poverty
increase the likelihood of separation and
divorce.

and Divorce
– Religion—according to some studies, about
21% of spouses have different religious
backgrounds. Married couples who are
religious report being happier with their
marriages than those who are not religious.
– Similarity between spouses—spouses who are
similar to each other on demographic
characteristics such as age, religion, race,
ethnicity, and education are less likely to
divorce.

Micro-Level/Interpersonal
Reasons for Divorce
– Unrealistic expectations—people now have
fewer children and more time to focus on their
relationship as a couple. One result is that the
couple can become disillusioned.
– Conflict and abuse—arguments and conflicts
are major reasons for divorce for both sexes.
42% of women but only 9% of men said that
domestic violence was a major reason for
divorce.
– Infidelity—cheating is a major reason for
divorce, especially for women.

Micro-Level/Interpersonal
Reasons for Divorce
– Communication—communication problems
derail many marriages. Couples who stay
together listen to each other respectfully even
when they disagree.
– Other important reasons for divorce include:
many couples try to stay together for the
children, but find they are dissatisfied when
the children are gone; wives grow disillusioned
with their husbands who can’t keep a job;
underemployed men who have trouble finding
work say that their wife’s nagging about the
bills makes them feel worse.

How Divorce Affects Children
– Nearly 1 million American children
undergo a parental breakup before
reaching adulthood.
– It is always stressful for adults, but for
children it is often a defining event in
their lives. Children are often hurt in
every way by their parent’s divorce.

What Helps Children
After a Divorce?
The children who experience the least
negative effects are those who receive
support from friends, neighbors, and
schools.
– Parents can reassure the children that
they are loved and supported by both
parents.
– Parents should talk about their feelings
because doing so sets the stage for open
communication.

What Helps Children
After a Divorce?
– They should emphasize that the children
are not responsible for the problems.
– They should reassure the children that
they will continue to see extended family.
– They should maintain an ongoing
relationship with the children.
– They should encourage children to talk
about their feelings and experiences
freely.

Positive Outcomes
There can be positive outcomes of
divorce. Less parental fighting can
cause less stress for children.
Earlier parental separation is better for
children in the long run than in
growing up in an intact family where
there is continuous conflict.

Counseling and Divorce
Mediation
Counseling and divorce mediation are
alternatives to the traditional
adversarial approach that is typical of
legal processes. Mediated divorces
tend to be less bitter and less
expensive and offer each partner
more say in child custody
arrangements.

Healthy Families
 Healthy families are not perfect; they may have yelling, bickering,
misunderstanding, tension, hurt, and anger - but not all the time
 In healthy families emotional expression is allowed and accepted. Family
members can freely ask for and give attention.
 Rules tend to be made explicit and remain consistent, but with some flexibility to
adapt to individual needs and particular situations.
 Healthy families allow for individuality; each member is encouraged to pursue his
or her own interests, and boundaries between individuals are honored.
 Children are consistently treated with respect, and do not fear emotional, verbal,
physical, or sexual abuse.
 Parents can be counted on to provide care for their children. Children are given
responsibilities appropriate to their age and are not expected to take on parental
responsibilities.
 Finally, in healthy families everyone makes mistakes; mistakes are allowed.
Perfection is unattainable, unrealistic, and potentially dull and sterile.

Family Functioning
 Boyer and Jeffrey describe six elements on
which families are assessed to be either
functional or dysfunctional.
1. Communication
 Family members are encouraged to express honest
feelings and opinions, and all members participate in
decisions that affect the family system.
 Behaviors that interfere with functional communication
include
– Making assumptions
– Belittling feelings
– Failing to listen
– Communicating indirectly
– Presenting double–bind messages

Family Functioning (cont.)
2. Self-concept Reinforcement
 Functional families strive to reinforce and strengthen each
member’s self-concept, with the positive result being that
family members feel loved and valued.
 Behaviors that interfere with self-concept reinforcement
include
– Expressing denigrating remarks
– Withholding supportive messages
– Taking over
3. Family Members’ Expectations
 In functional families, expectations are realistic, flexible,
and individualized.
 Behaviors that interfere with adaptive functioning in terms
of member expectations include
– Ignoring individuality
– Demanding proof of love

4. Handling Differences
 Functional families understand that it is acceptable to disagree
and deal with differences in an open, non-attacking manner.
 Behaviors that interfere with successful family negotiations
include
– Attacking
– Avoiding
– Surrendering
5. Family Interactional Patterns
 Family interactional patterns are functional when they are
workable and constructive and promote the needs of all family
members.
 They are dysfunctional when they become contradictory, self-
defeating, and destructive. Examples are patterns that
– Cause emotional discomfort
– Perpetuate or intensify problems rather than solve them
– Are in conflict with each other

6. Family Climate
 A positive family climate is founded on trust and is
reflected
in openness, appropriate humor and laughter, expressions
of caring, mutual respect, a valuing of the quality of each
individual, and a general feeling of well-being.
 A dysfunctional family climate is evidenced by tension,
pain, physical disabilities, frustration, guilt, persistent
anger, and feelings of hopelessness.

Family (review)
Ideal Family –
Has the skills needed for loving responsible
relationships
Dysfunctional Family –
Lacks skills to be successful and functional in
healthy ways
Family Continuum –
All families fall somewhere between ideal and
dysfunctional on the family continuum

Causes of Dysfunctional Families
 Addictions –
Chemical Dependence (drugs or alcohol addiction) –
 Compelling need to take a drug even though it harms the body,
mind or relationship
Other Addictions –
 Eating disorders, workaholic, exercise, gambling, nicotine,
relationships, shopping, TV, thrill seeking
What else can you be addicted to??
 Perfectionism –
Need to be accurate, parents overly critical of
themselves and their children
 begin to feel inadequate & insecure

Causes con’t
Violence – Physical force to injure,
damage or destroy oneself, others, or
property
Domestic Violence - occurs within family
Physical Abuse – Harmful treatment that results
in physical injury to the victim
Sexual Abuse – Sexual contact that is forced on
a person
Emotional Abuse – Putting down another
person and making that person feel worthless

Causes con’t
Neglect –
Failure to provide proper care and guidance
Abandonment –
Removes oneself from those whose care is
one’s responsibility
parents who abandon their children are not
available for them
Mental Disorders –
Mental or emotional condition that makes it
difficult for a person to live in a normal way

History of Family Therapy
• Prior to the development of marriage and family therapy as
profession, older family members assisted younger members and
adult family members cared for the very young and the very old
• Before 1940
• Focus on the individual Society utilized clergy, lawyers, and
doctors for advice and counsel
• Prevailing individual theories were psychoanalysis and
behaviorism
• •Catalysts for the growth of family therapy
• Courses in family life education became popular
• Establishment of marriage and family training programs (e.g.,
Marriage Council of Philadelphia in 1932)
• founding of the National Council on Family Relations in 1938 and
the journal Marriage and Family Living in 1939

History of Family Therapy (cont.)
• Family therapy: 1940 to 1949
 Establishment of the American Association of Marriage
Counselors in 1942
 First account of concurrent marital counseling published in
1948
 Research on families with a schizophrenic member
 National Mental Health Act of 1946 funded research on
prevention, diagnosis, and treatment of mental health disorders
 Individual leaders dominated the profession
 Nathan Ackerman used a psychoanalytical approach to
understand and treat families
 Gregory Bateson studied communication patterns in families
with a schizophrenic member and developed the double bind
theory

 Double bind theory ‐ two seemingly contradictory messages
may exist simultaneously and lead to confusion
 Brief therapy developed at MRI as one of the first new
approaches to family therapy
 Carl Whitaker pushed the conventional envelope by seeing
spouses and children in therapy
 set up the first family therapy conference at Sea Island, GA
 Murray Bowen studied families with schizophrenic members
 Held therapy sessions with all family members present
 pioneered theoretical thinking on the influence of previous
generations on the mental health of families
 Ivan Boszormenyi‐Nagy developed contextual therapy
focusing on the healing of human relationships through trust
and commitment

 An era of rapid growth in family therapy
 Increase in training centers and academic programs in family
therapy
 Jay Haley, expanding on the work of Milton Erikson, developed
strategic family therapy
 Emphasis on the therapist gaining and maintaining power during
treatment
 Strategic therapy uses directives to assist clients to go beyond
gaining insight
 Systems theory developed by Ludwig Von Bertalanffy in 1968
 Rapid growth in AAMFT based partly on recognition as
an accrediting body for marriage and family training
programs
 The American Association of Marriage and Family
Counselors (AAMFC) changed its name to the American
Association for Marriage and Family Therapy (AAMFT)

 marked by the retirement or death of many family therapy
founders and leaders and the emergence of new leaders
 Increase numbers of women leaders who created new theories
which challenged older ones
 Women's Project in Family Therapy in 1988 focused on
gender free approaches to family therapy
 increased numbers of individuals and associations devoted to
family therapy, including the International Association for
Marriage and Family Counseling
 increased levels of research in family therapy to provide
evidence of the effectiveness of family therapy
 increased numbers of publication in the family therapy field,
including the
 Family Therapy Networker
 Recognition of family therapy as one of four core mental
health providers eligible for federal training grants

Family therapy: 1990 to 1999
 Family therapy became a more global phenomenon, with
associations, research, and training institutes established
across the globe
 New theories were developed or refined
 Feminist family therapy examined gender sensitive issues in
therapy rather than masculine or feminine issues, per se
• The reflecting team approach of Tom Anderson used clinical
observers to discuss their impressions with the therapist and the
family,

Family therapy: 2000 to present
 Family therapy has spread to Europe, Asia, Africa, Australia
and South America
 International Family Therapy Association founded in 1987
 Professional associations continue to grow, providing services,
educational opportunities, and publications
 Marriage and family therapists recognized as one of five core
mental health providers (along with psychiatrists,
psychologists, social workers, and psychiatric nurses)
– Accreditation of family therapists
 Two associations accredit marriage and family training programs
 Commission on Accreditation for Marriage and Family Therapy
Education (COAMFTE)
 Council for Accreditation of Counseling and Related
Educational Programs (CACREP)
– Developing culturally effective family‐based research
 Increased research on the effectiveness of family therapy with
different cultural groups.

CHAPTER THREE
Processes in family therapy
3.1. THE STAGES OF FAMILY THERAPY
STAGE 1 - PLANNING
• The main tasks are to plan who to invite to the first session, or series of sessions,
and what to ask them.
• If there is confusion about who to invite a network analysis may be conducted.
1. Planning Who to Invite: Network Analysis
• To make a plan about who to invite to the sessions, the therapist must find out
from the referral letter or through telephone contact with the referrer who is
involved with the problem and tentatively establish what roles they play with
respect to it.
2. Planning What to Ask: Agenda Setting
• Planning what questions to ask in a first session will depend on
– the problem posed in the referring letter,
– the preliminary hypothesis that the therapist or
– therapy team have about the case and the routine interviewing procedures
typically used for such cases.

STAGE 2 - ASSESSMENT
• In the second stage of the therapeutic process there are three main tasks:
1. engagement and establishing a contract for assessment
2. completing the assessment and formulation
3. Building a therapeutic alliance.
Contracting for Assessment
• Contracting for assessment involves the therapist and clients clarifying expectations
and reaching an agreement to work together.
• The way in which the interviews will be conducted, their duration, and the roles of
the team (if a team is involved) should be explained.
Managing Engagement Challenges
• The process of contracting for assessment does not always run smoothly.
• Engagement challenges are to be expected.
• The issue of partial family attendance has been mentioned already.
• Refusal to participate in assessment, non-attendance and receiving grossly inaccurate
referral information are some of the more important obstacles to engagement and
establishing a contract for assessment.
• The contracting for assessment is complete when family members have been
adequately informed about the process and have agreed to complete the assessment.

Completing the Assessment: Enquiring about the Presenting Problem
• Once a contract for assessment has been established, each person may be
invited to give their view of the presenting problem.
• This typically involves questions about the nature, frequency and intensity of the
problems; previous successful and unsuccessful solutions to these problems; and
family members' views on the causes of these problems and possible solutions
that they suspect may be fruitful to explore in future.
• Completing the Assessment: Constructing a Genogram
• The genogram is a family tree that contains clinical information about the people
in a family and their pattern of organization.
• The process of genogram construction may be routinely incorporated into initial
family assessment sessions.

• When constructing a genogram, there are three common pitfalls.
• The first is to ask too many questions about negative or trivial details.
• The second is to miss the opportunity to use genogram construction as a chance
to label family members' strengths.
• The third is not to ask enough questions about significant family patterns.
• If family members cannot remember ages, dates, occupations or details about
other problems, unless you have reason to believe that these omissions have a
particular significance that is relevant to the presenting problem and their way of
coping with it, ignore the omissions.
Alliance Building
• In addition to providing information, the process of assessment also serves as a
way for the therapist and members of the family to build a working alliance.
• Building a strong working alliance is essential for valid assessment and effective
therapy.
• All other features of the consultation process should be subordinate to the
working alliance, since without it clients drop out of assessment and therapy or
fail to make progress.

Formulation and Feedback
• The assessment is complete when the presenting problem is clarified and the
context within which it occurs has been understood; a formulation of the main
problem and family strengths has been constructed.
STAGE 3 - TREATMENT
• Once a formulation has been constructed, the family may be invited to agree a
contract for treatment, or it may be clear that treatment is unnecessary.
• In some cases, the process of assessment and formulation leads to problem
resolution.
Setting Goals and Contracting for Therapy
• The contracting process involves establishing clearly defined and realistic goals
and outlining a plan to work towards those goals in light of the formulation
presented at the end of the assessment stage.
• Clear, realistic, visualized goals that are fully accepted by all family members and
that are perceived to be moderately challenging are crucial for effective therapy.
• Asking clients to visualize in concrete detail precisely how they would go about
their day-to-day activities if the problem were solved is a particularly effective
way of helping clients to articulate therapeutic goals.

Participating in Treatment
• When therapeutic goals have been set, and a contract to work towards them has
been established, it is appropriate to start treatment.
• Treatment may involve interventions that aim to alter problem-maintaining
behavior patterns; interventions that focus on the development of new narra-
tives and belief-systems that open up possibilities for problem resolution; and
interventions that focus on historical, contextual or constitutional predisposing
factors.
Troubleshooting Resistance
• Some clients often do not follow therapeutic advice that would help them solve
their problems. This type of behavior has traditionally been referred to as
resistance.
• Accepting the inevitability of resistance as part of the therapist client relationship
and developing skills for managing it, can contribute to the effective practice of
family therapy.
• Client transference and therapist countertransference may also contribute to
resistance.
• clients have difficulty cooperating with therapy because they transfer, onto the
therapist, relationship expectations that they had as infants of parents whom
they experienced as either extremely nurturing or extremely neglectful.

STAGE 4 - DISENGAGING OR RECONTRACTING
• In the final stage of therapy the main tasks are to fade out the frequency of
sessions; help the family understand the change process; facilitate the
development of relapse management plans; and frame the process of
disengagement as the conclusion of an episode in an ongoing relationship rather
than the end of the relationship.
1. Fading out Sessions
• The process of disengagement begins once improvement is noticed.
• The interval between sessions is increased at this point.
• This sends clients the message that you are developing confidence in their ability
to manage their difficulties without sustained professional help.
2. Discussing Permanence and the Change Process
• The degree to which goals have been met is reviewed when the session contract
is complete or before this, if improvement is obvious.
• Then the therapist helps the family construct an understanding of the change
process by reviewing with them the problem, the formulation, their progress
through the treatment programme and the concurrent improvement in the
problem.

3. Relapse Management
• In relapse management planning, family members are helped to forecast the
types of stressful situations in which relapses may occur; their probable negative
reactions to relapses; and the ways in which they can use the lessons learned in
therapy to cope with these relapses in a productive way.
4. Framing Disengagement as an Episode in a Relationship
• Disengagement is constructed as an episodic event rather than as the end of a
relationship.
• This is particularly important when working with families where members have
chronic problems.
• Three strategies may be used to achieve this.
• First, a distant follow-up appointment may be scheduled.
• Second, families may be told that they have a session in the bank, which they can
make use of whenever they need it without having to take their turn on the wait-
ing list again.
• Third, telephone back-up may be offered to help the family manage relapses.
• In all three instances, families may disengage from the regular process of
consultations, while at the same time remaining connected to the therapeutic
system.

5. Reconstructing
• In some instances, the end of one therapeutic contract will lead imme-
diately to the beginning of a further contract.
• For example, following an episode of treatment for child-focused
problems, a subsequent contract may focus on marital difficulties or
individual work for the adults in the family.
6. Failure Analysis
• If goals are not reached, it is in the clients' best interests to avoid doing
more of the same.
• Rather, therapeutic failures should be analyzed in a systematic way.
• The understanding that emerges from this is useful both for the clients
and for the therapist.
• From the clients' perspective, they avoid becoming trapped in a
consultation process that maintains rather than resolves the problem.
• From the therapists' viewpoint, it provides a mechanism for coping with
burn-out that occurs when multiple therapeutic failures occur.

3.2. FORMULATING PROBLEMS AND EXCEPTIONS
• For any problem, an initial hypothesis and later formulation may be
constructed using ideas from many schools of family therapy in
which the pattern of family interaction that maintains the problem
is specified;
• the constraining beliefs and narratives that underpin each family
member's role in this pattern are outlined; and
• the historical, contextual and constitutional factors that underpin
these belief systems and narratives are specified.
• In light of formulations of a family's problem and strengths, a range
of interventions that address interaction patterns, belief systems,
broader contextual factors or constitutional vulnerabilities may be
considered and those which fit best for the family and make best
use of their strengths may be selected.

3.3. THE THREE-COLUMN PROBLEM FORMULATION MODEL
1. Problem-maintaining Behaviour Patterns
• The problem-maintaining behavior pattern includes a description of what
happened before, during and after the problem in a typical episode.
• Commonly, the pattern will also include positive and negative feelings.
Problem-maintaining Behaviour Patterns are includes:
– Confused communication
– Symmetrical interaction patterns
– The pathological triangle is characterized by a cross-generational coalition
between a parent and a child to which the other parent is hierarchically
subordinate.
– Triangulation in which the triangulated individual (usually a child) is required to
take sides with one of two other family members (usually the parents).
– Lack of intimacy or a significant imbalance of power may maintain.
– A lack of coordination among involved professionals likes teachers, social
service professional and mental health
– Over-involved relationships and also by distant, disengaged relationships.
– Rigid repetitive interactions or chaotic unpredictable interactions.

2. Problem-maintaining Belief Systems
• A belief system characterized by cognitive distortions, such as maximizing
negatives and minimizing positives, may sub serve problem- maintaining
interaction patterns. There are many beliefs about marital, parental and other
family relationships that can maintain problem behavior and these beliefs often
take the form:
• Where family members attribute negative characteristics or intentions to each
other. Such attributions include defining a family member as bad, sad, sick or
mad, although often more sophisticated labels than these are used.
• Certain problematic defense mechanisms may be central to belief systems that
maintain problematic behavior patterns.
– Problematic defense mechanisms include denial and also, passive aggression,
rationalization, reaction formation, displacement, splitting and projection.
– With passive aggression, rather than openly talking about a conflict of
interests within the family, one member passively avoids cooperating with
others.
• With rationalization, family members construct rational arguments to justify
destructive behavior.

3. Problem-maintaining Contextual Factors
• Problem-maintaining behavior patterns and the belief systems and narratives that
sub serve these may arise from predisposing factors.
• These predisposing factors may be rooted in historical family-of-origin experiences of
parents or spouses; the current broader context within which the family finds itself;
or constitutional vulnerabilities of individual family members.
Problem-maintaining Contextual Factors include:
– Bereavement, particularly death of a parent;
– separations from parents in childhood through illness or parental divorce; physical,
emotional or sexual child abuse or neglect;
– social disadvantage and poverty; and
– Insecure attachment and authoritarian, permissive, neglectful or inconsistent
parenting.
– Parental psychological problems, such as depression; parental drug or alcohol
abuse; parental criminality; marital discord or violence; and general family
disorganization.
– Cultural norms and values, such as extreme patriarchy or a commitment to the use
of domestic violence or corporal punishment to solve family problems.
– Lifecycle transitions, home-work role strain and a lack of social support may activate
belief systems that sub serve problem-maintaining behavior patterns.

3.4. THE THREE-COLUMN EXCEPTION FORMULATION MODEL
1. Exceptional Behavior Patterns
• Commonly, includes positive and possibly negative feelings.
• Exceptions that involve effective problem-solving are often embedded in
behavior patterns characterized by
– Clear communication and emotionally supportive relationships where there is
flexibility about family rules, roles and routines.
– Parent-child interactions tend to be characterized by authoritative, consistent and
cooperative parenting.
– Couples' relationships, when exceptions to problems occur, tend to involve intimacy
and greater balance in the distribution of power (within the cultural constraints of
the family's ethnic reference group).
– Good inter professional coordination and cooperation between families and
professionals.
2. Exceptional Belief Systems
• Exceptional non-problematic behavior patterns may be sub served by a wide
variety of belief systems and narratives.
• The occurrence of exceptions may be associated with the development of the
belief that the advantages of resolving the problem outweigh the costs of change

2. Exceptional behavior patterns may occur
• When family members accept rather than deny the existence of the problem and
accept responsibility for their role in contributing to its resolution.
• When family members become, for a time, committed to the resolution of the
problem and experience themselves as competent to resolve their difficulties.
• When family members hold useful and empowering beliefs about the nature of
the problem and its resolution, exceptions may also occur.
• When family members construct positive and empowering beliefs and narratives
about family relationships, about parenting, about marriage and about their roles
in the family.
• When family members develop benign beliefs and narratives about the
intentions and characteristics of other family members, and come to view them
as good people who are doing their best in a tough situation, rather than
vindictive people who are out to persecute them.
3. Contextual Factors Associated with Resilience
• Exceptional behavior patterns and the productive belief systems and narratives
that sub serve these arise from factors which foster resilience.
• These protective factors may be rooted in the historical family-of-origin
experiences of parents or spouses; the current broader context within which the
family finds itself; or the characteristics of individual family members.

Contextual Factors Associated with Resilience includes:
• Good parent-child relationships characterized by secure attachment,
authoritative parenting and clear communication in the family of origin
foster later resilience in the face of adversity and empower people to
manage problems well in their families of procreation.
• Successful experiences of coping with problems in the family of origin,
flexible organization in the family of origin, good parental adjustment and
a positive relationship between parents in the family of origin may also
engender later resilience.
• A good social support network including friends and members of the
extended family and low extra familial stress enhance.
• High socioeconomic status and empowering cultural norms and values
also contribute to family resilience in the face of adversity.
• Important personal characteristics that contribute to family resilience are
physical health, high intelligence and easy temperament.

3.5. INTERVENTIONS FOR BEHAVIOUR, BELIEFS AND CONTEXTS
• Interventions may be classified in terms of the particular domain
they target within the three-column formulation models.
• Some interventions aim to directly disrupt problem-maintaining
behavior patterns or replace these with exceptional non-
problematic behavior patterns.
• Others aim to transform the belief systems and narratives that sub
serve these behavior patterns so that clients develop more
empowering narratives about themselves and their competence to
manage problems.
• Finally, some interventions aim to modify the impact of historical,
contextual and constitutional predisposing factors or mobilize
protective factors or family strengths within these domains.

CRITERIA FOR SELECTING INTERVENTIONS
• A number of criteria may be used in selecting interventions for particular
cases.
• Select interventions that fit with the three-column formulations of the
family's problem and exceptional circumstances in which the problem does
not occur.
• Select interventions that are compatible with the family's readiness to
change.
• Where clients are ambivalent or uncommitted, then these issues rather than
action planning should be the focus of treatment.
• Interventions that are compatible with the family's rules, roles, routines,
belief systems and culture are probable preferable to those are incompatible.
• Interventions that make best use of family strengths are probably better than
those that do not fully exploit the family's own problem-solving and self-
healing resources to the full.
• It is also preferable to select interventions that make best use of the
therapist's or team's skills in helping the helping clients solve their problems.

BEHAVIOUR-FOCUSED INTERVENTIONS
• Interventions that aim to directly disrupt or replace problem-maintaining
behavior patterns include the following:
Creating a Therapeutic Context:
• In every session the process of creating a context for therapeutic work is an
intervention which disrupts, initially only temporarily, problem-maintaining
behavior patterns.
Changing Behavior Patterns within Sessions:
• Within sessions, families may be invited to try to solve their problem or some
aspect of it in their usual way.
• Once the invitation is offered, the therapist stops talking and leaves time and
space for the family to enact their usual routine for trying to solve the problem.
• By observing these enactments, the therapist may see first-hand an example of
part or the entire behavior pattern that maintains the problem, since often
problems are maintained by ineffective attempts at their resolution.
Tasks between Sessions:
• Families may be invited to complete tasks between sessions that aim to disrupt
or replace problem-maintaining behavior patterns.

Among the more widely used are the following:
– symptom monitoring
– encouraging restraint
– practicing symptoms
– Graded challenges
Skills Training:
• Clients may have difficulties communicating clearly and solving problems because they
lack the skills or because intoxication, negative mood states or other factors interfere with
the use of well-developed skills.
• Where such factors are present, therapy should focus on removing these obstacles to
effective communication and problem solving.
Changing Behavioral Consequences:
• When families' main difficulties are child-focused behavioral or emotional problems, using
reward systems and behavior control routines are particularly useful interventions.
• They provide families with alternative routines to the problem-maintaining behavior
patterns in which they have become embroiled, insofar as they alter the typical
consequences of the child's behavior.
• Changing Behavioral Consequences may use the following mechanisms:
– Reward Systems
– Behavioral Control Skills
– Invitations to Complete Tasks

3.6. INTERVENTIONS FOCUSING ON BELIEF SYSTEMS
Addressing Ambivalence:
• resistance occurs because family members are ambivalent about the process of
change.
• When this occurs, the central task in family therapy is to suspend all attempts at
empowering clients to achieve their stated therapeutic goals and focus all
therapeutic effort on addressing this ambivalence, no matter how long this takes.
Highlighting Strengths:
• When clients have difficult or chronic problems, they become demoralized and
develop beliefs that they are powerless to change their situation.
• Highlighting strengths reduces demoralization and helps clients construct
personal and family narratives about their ability to solve their own problems.
Reframing Problems:
• When a family therapist reframes a problem, the problem is framed in
interactional terms rather than individual terms; solvable terms rather than
uncontrollable or fixed terms; and family members' reasons for engaging in
problem- maintaining behavior are framed as arising from positive rather than
negative intentions.

Presenting Multiple Perspectives:
• In such instances, especially when trying to solve complex problems, it is
often very helpful for families to have access to multiple perspectives on
their difficulties and multiple potential options for the resolution of these;
within a frame that challenges either-or, black-and-white thinking.
Externalizing Problems and Building on Exceptions:
• With externalizing problems and building on exceptions the overall aim is
to help clients first separate out the problem from the person; identify
the effects of the problem on the person; identify and amplify situations
in which the person was able to modify or avoid the problem including
recent pre-therapy changes; develop a self-narrative that centralizes
these competencies; empower the person who has overcome the
problem to let other network members know about these competencies
and support their development; and develop a personal narrative that
links the current life exceptions to clients' past and future.

3.7. INTERVENTIONS THAT FOCUS ON HISTORICAL, CONTEXTUAL AND
CONSTITUTIONAL FACTORS
• Interventions that aim to modify the impact of historical, contextual and
constitutional predisposing factors or mobilize protective factors
Addressing Family-of-origin Issues:
• Where parents or spouses have difficulty making progress in marital or family
therapy by altering problem-maintaining behavior patterns or the belief systems
that directly underpin may be the case that unresolved family-of-origin issues are
preventing them from making progress. These issues may include the following:
Major family-of-origin stresses
– bereavements
– separations
– child abuse
– social disadvantage
– Institutional upbringing.

• Family-of-origin parents-child problems
• insecure attachment
• authoritarian parenting
• permissive parenting
• neglectful parenting
• inconsistent parental discipline
• lack of stimulation
• scapegoating
• Triangulation.
• Family-of-origin parental problems
– parental psychological problems
– parental drug or alcohol abuse
– parental criminality
– marital discord or violence
– Family disorganization

Addressing Contextual Issues:
• Where families have difficulty making progress in therapy by altering problem
maintaining behavior patterns or the belief systems that directly underpin these in
response to that may be the case that factors in the family's wider social context are
preventing them from making progress.
• These factors include issues requiring role change such as lifecycle transitions and
homework role strain; lack of social support; recent loss experiences, such as
bereavement, parental separation, illness or injury, unemployment, moving house or
moving schools; recent bullying; recent child abuse; poverty; or ongoing secret
romantic affairs.
• A range of interventions may be considered for managing these various contextual
predisposing factors. These include:
– changing roles
– building support
– managing stresses
– mourning losses
– home-school liaison meetings
– network meetings
– child protection
– advocacy
– Exploring secrets.

Addressing Constitutional Factors:
• When families have a member who has a constitutional vulnerability, they are
unlikely to benefit from therapy that relies exclusively on the aim only to alter
problem-maintaining behavior patterns or the belief systems that directly
underpin these, without directly addressing the constitutional vulnerability.
• Such constitutional vulnerabilities may be genetic or they may involve
debilitating somatic states, squeal of early illness or injury, learning difficulties, or
difficult temperament.
• Families with members who have constitutional vulnerabilities require psycho-
education about the condition or vulnerability; help with ensuring the vulnerable
family member adheres to the medication regime where this is appropriate;
referral for medical consultation where appropriate; and support in securing an
appropriate educational placement if this is required, especially in the case of
individuals with learning difficulties.
Psycho-education:
• In psycho education, families are given both general information about the
problem and a specific formulation of the vulnerable family member's specific.
– Think complex - talk simple.
– Create hope - name strengths.
– Adherence to Medical Regimes

Family Systems Therapy
THEORY
 First developed by Alfred Adler in Vienna in
the 1920’s
 Took root in America in the 40’s – 60’s
 Many approaches to therapy (adlerian,
multigenerational, structural, experiential)
 States that individuals are best understood
within the context of relationships and
through assessing the various interactions
within an entire family

 Symptoms are viewed as an
expression of a dysfunction within a
family and are often passed across
generations
 Therefore, the clients problematic
behavior may serve a function or
purpose for the family
 May be a function of the family’s
inability to operate productively

 Can be a symptom of dysfunctional patterns
handed down across generations
 Change by the client reverberates
throughout the other parts of the family
 Because a family is an interactional unit, it is
best to treat the whole family
 Best to assess an individual by observing
the interactions with and mutual influences
of other family members

 Therapists believe that to focus on the
internal dynamics of an individual
without adequately considering
interpersonal dynamics as well yields
an incomplete picture
 The family provides a primary context
for understanding how individuals
function in relationship to others
outside the family

 Parents and children become locked in
repetitive and negative interactions
 Thought the problems of one family
are common to all others in the
community

KEY CONCEPTS:
FAMILY ATMOSPHERE
 Defined as the climate of relationships that
exist between people
 Each member exerts an influence on every
other member
 A ‘climate’ or ‘atmosphere’ develops that is
said to characterize how the family relates
to one another

FAMILY CONSTELLATION
• Constellation consists of parents, children, and
extended family
• Birth order
• Constellation can give therapist a written
description of how a person finds a place within
the system
• Therapists can ask parents to describe each
child
• Genogram (3 generational family map)

MISTAKEN GOALS
• Goals of children’s misbehavior
• Attention getting, power struggle, revenge
• Therapist looks at parents actions and
reactions to these behaviors

GOALS OF THERAPY
• Establish and support parents as effective
leaders of the family
• Replace automatic, often unconscious,
negative interactions with a conscious
understanding of the family process
• Encourage functional family interaction

THERAPISTS ROLE AND FUNCTION
• Therapists are collaborators who work to
join the family from a position of mutual
respect
• Therapists investigate the family
constellation, the motivations behind
problematic interactions, the family
process throughout the typical day

• Develop interventions and
recommendations
• Correct faulty goals; look at the
motivation behind the goals
• Provide parents with parenting skills

TECHNIQUES
• Problem description and goal identification
• Typical day: ask the family describe a typical day; this
assesses family atmosphere and interaction
• Parent interviews: yield tentative hypotheses regarding
children’s misbehavior
• Child interviews: find out what goals of misbehavior are
• Encouragement: used with both parents and children

STRENGTHS
• Comprehensive process in assisting families
• Looks at many aspects of the family (i.e.,
atmosphere, constellation, goals)
• Respect is given to both children and adults
• Interventions are suggested to children and
adults

WEAKNESSES
• How much insight can children provide
• Parents feigning or embellishing
• Provides much insight into behavior,
interactions, and motivation, but not
many explicit interventions

Bowen Family Systems Therapy
• Introduction
• Bowen was one of the few early pioneers
who paid attention to the larger network of
family relationships.
• “Bowen family systems therapy has by far
the most comprehensive view of human
behavior and human problems of any
approach to family treatment” (p. 137).

Sketches of Leading Figures
• Bowen family systems therapy evolved
from psychoanalytic principles and practice.
• Bowen was innovative and developed
comprehensive ideas.
• Bowen was the oldest child from a large
family in rural Tennessee.
• Many prominent MFTs trained with Bowen,
including many feminist therapists such as
Betty Carter and Monica McGoldrick.

Theoretical Formulations
Differentiation of Self
• This is both an intrapsychic and interpersonal
concept.
• Intrapsychic aspect: ability to separate feeling
from thinking. “The differentiated person isn’t a
cold fish who only thinks and never feels … he
or she is capable of strong emotion and
spontaneity, but also capable of the objectivity
that comes with the ability to resist the pull of
emotional impulses” (p. 140).

Differentiation of Self (cont.)
• Interpersonal aspect:
– Undifferentiated people react emotionally –
positively or negatively – to others.
– Undifferentiated people have limited
autonomous identity.
– Differentiated people are able to take
principled stands.
– Differentiated people are able to develop
intimacy without become reflexively shaped by
others.
– The process of differentiation promotes
personal responsibility.

Triangles
• All emotionally significant relationships are
shadowed by third parties (including relatives,
friends, objects, work, memories).
• Relationships are dynamic; there are cycles of
closeness of distance. Triangles are likely to
develop during times of distance.
• In relationships, the partner who experiences the
most distress will often connect with someone
else as a way to gain an ally.
• Sometimes, significant others offer support when
they sense anxiety or conflict.

Triangles (cont.)
• Triangulation lets off steam, but it freezes conflict
in place: “Unburdening yourself to a friend will
make you feel better. It will also lessen the
likelihood that you’ll engage the problem at its
source” (p. 141).
• Interlocking triangles are present in systems of
more than three.
• Rules that govern emotional processes:
– One person cannot change the relationship between
two others or between another person and her or his
habit.
– The more you try to change the relationship of
another, the more likely it is that you will reinforce the
aspects of the relationship that you want to change.

Nuclear Family Emotional Processes
Dr. Ronald Werner-Wilson
• Undifferentiated people experience
difficulty managing anxiety and stress.
• Lack of Differentiation X Anxiety = Fusion
Between Spouses.
• Emotional fusion is unstable. It tends to
produce:
– overt marital conflict;
– reactive emotional distance;
– physical or emotional symptoms (usually the
more accommodating partner);
– projection of problems on to children.

Family Projection Process
• Definition: “the process by which parents
project part of their immaturity to one or
more children” (Bowen, 1978, p. 477).
• The child who is the most emotionally
attached to parents is likely to be the object
of parental projection and, as a result, have
lower levels of differentiation (Bowen,
1978).

Multigenerational Transmission
Process
• This refers to the transmission of a family
projection process.
• The nature and degree of intensity of
emotional responses are passed down from
generation to generation (Friedman, 1991).
• Levels of differentiation are affected
through generations based on levels of
differentiation of partners as they marry.

Sibling Position
• Belief that personality characteristics are
influenced by sibling position. He also
believed that family functioning and other
variables influenced roles.
• Sibling conflict may often be the result of
triangular relationships (e.g., coalitions
with parents can foster sibling antagonism).

Emotional Cutoff
• All people have some degree of unresolved
emotional attachment to their parents.
• Level of cutoff is influenced by degree of
differentiation: there is an attempt to
distance by avoiding contact.

Societal Emotional Process
• Emotional processes in families influence
emotional processes in families.
• Social forces (including sexism, racism,
poverty) fundamentally influence how
families interact with each other.

Normal Family Development
• Bowen believed that families varied on a
continuum from emotional fusion to
differentiation.
• Optimal Family Development: thought to take
place when
– family members are relatively differentiated;
– anxiety is low;
– parents are in good emotional contact with their own
families of origin.
• Emotional attachment between spouses often is
similar to those from families of origin.
• Family development is a process of expansion,
contraction, and realignment that supports entry,
exit, and development of family members.

Characteristics of Well-adjusted
Families (Fogarty, 1976a):
• They are balanced and can adapt to change.
• Emotional problems are seen as existing in the
whole group.
• They are connected across generations to all
family members.
• Minimum use of fusion or distance to solve
problems.
• Each dyad is capable of dealing with conflict
within it.
• Differences are tolerated.
• There is an awareness of what each person
receives from others.

Characteristics of Well-adjusted
Families (cont.)
• Each person is allowed her/his own
emptiness.
• Preserving a positive emotional climate is
more important than doing what is popular
or socially appropriate.
• Each member thinks the family is a pretty
good place to live.
• Members use each other as sources for
feedback and learning, not as emotional
crutches.

Development of Behavior Disorders
• Symptoms develop from stress that
exceeds a person’s ability to handle it.
• Symptoms are a product of emotional
reactivity, acute or chronic.
• The ability to deal with stress is influenced
by level of differentiation.
– Remember, differentiation is not a synonym for
maturity.
– It reflects both an intrapsychic and
interpersonal process. As a result, symptoms
also develop when stress exceeds a systems
ability to bind or neutralize it.

Goals of Therapy
• Trace Family Patterns
– Pay attention to processes: patterns of
emotional reactivity.
– Pay attention to structure: patterns of
interlocking triangles.
• Goal of therapy: decrease anxiety and
increase differentiation of self.
• Goals become less specific over time.

Goals of Therapy (cont.)
• Guerin’s approach:
– Place the presenting problems in multigenerational
context by completing a thorough and accurate
genogram.
– Connect with key family members: work to calm
their anxiety and level of emotional arousal so that
anxiety throughout the system can be lowered.
– Define parameters of the central symptomatic
triangle
• Feminist approach: address inequality in
relationships.

Conditions of Behavior Change
• Therapists must be able to tolerate anxiety.
• Therapists must practice differentiation and avoid
triangulation.
• Therapists ask questions to foster self-reflection and
direct them to individuals one-at-a-time.
• Individuals are encouraged to look for their own role in
processes.
• Therapy requires an awareness about the entire family
(even though it does not need to include the presence
of the entire family).
• Differentiation requires cultivating a personal
relationship with everyone in the extended family.

Techniques
• Genogram: family diagram to collect and organize
information about the family.
• The therapy triangle: therapist should try to
remain free of emotional entanglements in order
to avoid feel stuck or stalemated.
• Relationship experiments: ask clients to try new
behaviors and pay attention to the processes.
• Coaching: ask process questions designed to help
clients cultivate responses.
• The “I-Position”: take a personal stance and say
what you feel.

Techniques (cont.)
• Multiple family therapy: work with multiple
couples at once. Observing other couples
can be helpful.
• Displacement stories: tell stories (or
recommend movies) that minimize
defensiveness.

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